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Dimitrios P. Kontoyiannis - One of the best experts on this subject based on the ideXlab platform.
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comparative in vitro pharmacodynamic analysis of isavuconazole voriconazole and posaconazole against clinical isolates of aspergillosis mucormycosis Fusariosis and phaeohyphomycosis
Diagnostic Microbiology and Infectious Disease, 2019Co-Authors: Russell E. Lewis, Sebastian Wurster, Nathaniel D. Albert, Nicholas D Beyda, Dimitrios P. KontoyiannisAbstract:Abstract We compared the in vitro pharmacodynamics of isavuconazole, voriconazole, and posaconazole against 92 clinical isolates from documented cases of invasive aspergillosis, mucormycosis, Fusariosis, and phaeohyphomycosis. Whereas inhibitory and fungicidal concentrations of these triazoles were predictably similar with the exception of Mucorales, isavuconazole appeared to have improved pharmacodynamics against Fusarium solani.
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invasive Fusariosis in patients with hematologic malignancies at a cancer center 1998 2009
Journal of Infection, 2010Co-Authors: Marcela Campo, Russell E. Lewis, Dimitrios P. KontoyiannisAbstract:Summary Background Fusarium species cause severe infections in patients with hematologic malignancies. Few data are available concerning the outcome of Fusariosis in the era of the expanding antifungal armamentarium. Methods We retrospectively identified patients with hematologic malignancy and positive cultures for Fusarium species at the MDACC (1998–2009). The diagnosis of proven or probable Fusariosis was made according to modified EORTC/MSG criteria. Results Forty-four cases (75% proven) were identified over study period. Most (71%) patients had uncontrolled hematological malignancy and 21 patients (47%) received hematopoietic stem cell transplantation (85% allogeneic). Most patients (82%) were neutropenic at diagnosis (75% 3 ). Patients had overlapping clinical syndromes: sinus 27%, pulmonary 75%, skin 68%, fungemia 36% and disseminated infection 70%. Bacterial (54%), fungal (36%) and viral (27%) co-infections were common. Most patients (84%) received combination therapy (typically a lipid formulation of amphotericin B and a triazole) with a mean duration of 28 days. Mortality at 12 weeks was 66%; 50% of deaths were attributable to Fusarium . Factors associated with increased likelihood of death at 12 weeks, included albumin P Fusarium spp (OR 15.9; 1.1–231; P = 0.042) was the only risk factor independently associated with 12-week mortality with only 1/17 (6%) of patients still alive at 12 weeks. Conclusions Fusariosis, although uncommon, continues to have poor prognosis in neutropenic leukemic patients who present with fungemia.
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Invasive Fusariosis in patients with hematologic malignancies at a cancer center: 1998–2009
The Journal of infection, 2010Co-Authors: Marcela Campo, Russell E. Lewis, Dimitrios P. KontoyiannisAbstract:Summary Background Fusarium species cause severe infections in patients with hematologic malignancies. Few data are available concerning the outcome of Fusariosis in the era of the expanding antifungal armamentarium. Methods We retrospectively identified patients with hematologic malignancy and positive cultures for Fusarium species at the MDACC (1998–2009). The diagnosis of proven or probable Fusariosis was made according to modified EORTC/MSG criteria. Results Forty-four cases (75% proven) were identified over study period. Most (71%) patients had uncontrolled hematological malignancy and 21 patients (47%) received hematopoietic stem cell transplantation (85% allogeneic). Most patients (82%) were neutropenic at diagnosis (75% 3 ). Patients had overlapping clinical syndromes: sinus 27%, pulmonary 75%, skin 68%, fungemia 36% and disseminated infection 70%. Bacterial (54%), fungal (36%) and viral (27%) co-infections were common. Most patients (84%) received combination therapy (typically a lipid formulation of amphotericin B and a triazole) with a mean duration of 28 days. Mortality at 12 weeks was 66%; 50% of deaths were attributable to Fusarium . Factors associated with increased likelihood of death at 12 weeks, included albumin P Fusarium spp (OR 15.9; 1.1–231; P = 0.042) was the only risk factor independently associated with 12-week mortality with only 1/17 (6%) of patients still alive at 12 weeks. Conclusions Fusariosis, although uncommon, continues to have poor prognosis in neutropenic leukemic patients who present with fungemia.
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Imaging of Pulmonary Fusariosis in Patients with Hematologic Malignancies
AJR. American journal of roentgenology, 2008Co-Authors: Edith M. Marom, Andrea Holmes, John F. Bruzzi, Mylene T. Truong, Paul O'sullivan, Dimitrios P. KontoyiannisAbstract:OBJECTIVE. The purpose of this study was to assess the radiographic features of pulmonary Fusariosis, an increasingly encountered cause of severe opportunistic mold pneumonia.CONCLUSION. Pulmonary Fusariosis has radiographic manifestations that are suggestive of an angioinvasive mold. Nodules or masses were the most common findings at CT, seen in 82% of patients compared with only 45% on chest radiography. The halo sign was not seen. Chest radiographs showed nonspecific findings in 30% of patients, and findings were normal at presentation in 25%. All of the patients had underlying hematologic malignancies. Thirteen of the 20 patients studied (65%) died within 1 month of diagnosis of pulmonary Fusariosis. Because early initiation of intense antifungal therapy offers the best chance for survival in pulmonary Fusariosis, early CT and appropriate microbiologic investigation should be obtained in severely immunocompromised patients.
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posaconazole as salvage treatment for invasive Fusariosis in patients with underlying hematologic malignancy and other conditions
Clinical Infectious Diseases, 2006Co-Authors: Issam I Raad, Ray Y Hachem, Raoul Herbrecht, John R. Graybill, Roberta S. Hare, Gavin Corcoran, Dimitrios P. KontoyiannisAbstract:Background. Conventional amphotericin B–based antifungal therapy for invasive Fusariosis in patients with a hematologic malignancy results in a 70% failure rate. Posaconazole is a broad-spectrum antifungal agent with in vitro and in vivo activity against Fusarium species. Methods. In this retrospective analysis of patients from 3 open-label clinical trials, we evaluated posaconazole for the treatment of invasive Fusariosis. Twenty-one patients with proven or probable invasive Fusariosis who had disease refractory to or who were intolerant of standard antifungal therapy received oral posaconazole suspension (800 mg per day in divided doses) as salvage therapy. Results. Successful outcome occurred in 10 (48%) of all 21 patients. Among patients with leukemia who received posaconazole therapy for 13 days, the overall success rate was 50%; for patients who recovered from myelosuppression, the success rate was 67%, compared with 20% for those with persistent neutropenia. Conclusion. These results suggest that posaconazole is useful for the treatment of invasive Fusariosis. After Aspergillus species, Fusarium species are among the leading fungal pathogens to cause invasive mold infection in patients with underlying hematologic malignancy and in those who have undergone hematopoietic stem cell transplantation (HSCT) [1–3]. Mortality rates associated with Fusariosis have equaled or exceeded 70% [2, 4], and progression in high-risk patients is often fulminant, leaving a narrow window of opportunity for therapeutic intervention. The primary antifungal therapy is amphotericin B or its lipid formulations [2, 5, 6]; however, this therapy is of limited efficacy because of its potential toxicity and poor activity against Fusarium organisms in vivo. Other treatment options include voriconazole, which is indicated for the treatment of Fusariosis in patients intolerant of or with disease refractory to other therapy.
Marcio Nucci - One of the best experts on this subject based on the ideXlab platform.
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Antimold Prophylaxis May Reduce the Risk of Invasive Fusariosis in Hematologic Patients with Superficial Skin Lesions with Positive Culture for Fusarium.
Antimicrobial agents and chemotherapy, 2016Co-Authors: Andrea G. Varon, Simone A. Nouér, Gloria Barreiros, Beatriz Moritz Trope, Tiyomi Akiti, Marcio NucciAbstract:ABSTRACT Hematologic patients with superficial skin lesions on admission growing Fusarium spp. are at a high risk for developing invasive Fusariosis during neutropenia. We evaluated the impact of primary prophylaxis with a mold-active azole in preventing invasive Fusariosis in these patients. Between August 2008 and December 2014, patients with acute leukemia or aplastic anemia and recipients of hematopoietic cell transplants were screened on admission with dermatologic and direct exams and fungal cultures of superficial skin lesions. Until November 2009, no interventions were made. Beginning in December 2009, patients with baseline skin lesions and a direct exam and/or culture suggestive of the presence of Fusarium spp. received prophylaxis with voriconazole or posaconazole. Skin lesions in the extremities (mostly onychomycosis and interdigital intertrigo) were present on admission in 88 of 239 episodes (36.8%); 44 lesions had hyaline septate hyphae identified by direct exam, and cultures from 11 lesions grew Fusarium spp. Antimold prophylaxis was given for 20 episodes (voriconazole for 17 and posaconazole for 3). Invasive Fusariosis was diagnosed in 14 episodes (5.8%). Among patients with baseline skin lesions with positive cultures for Fusarium spp., 4 of 5 without antimold prophylaxis developed invasive Fusariosis versus 0 of 6 with antimold prophylaxis ( P = 0.01; 95% confidence interval for the difference between proportions, 22% to 96%). Primary antifungal prophylaxis with an antimold azole may prevent the occurrence of invasive Fusariosis in high-risk hematologic patients with superficial skin lesions on admission growing Fusarium spp.
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Earlier diagnosis of invasive Fusariosis with Aspergillus serum galactomannan testing
PLoS ONE, 2014Co-Authors: Marcio Nucci, Fabianne Carlesse, Paola Cappellano, Adriana Seber, Andrea G. Varon, Simone A. Nouér, Marcia Garnica, Arnaldo L. ColomboAbstract:Cross-reactivity of Fusarium species with serum galactomannan antigen (GMI) test has been observed. We sought to evaluate if GMI could help to early diagnose invasive Fusariosis and to monitor treatment response. We reviewed the records of all patients with invasive Fusariosis between 2008 and 2012 in three Brazilian hospitals. We selected patients who had at least 1 GMI test within 2 days before or after the date of the first clinical manifestation of Fusariosis, and analyzed the temporal relationship between the first positive GMI test and the date of the diagnosis of invasive Fusariosis, and the kinetics of GMI in relation to patients' response to treatment. We also selected 18 controls to determine the sensitivity and specificity of the test. Among 18 patients, 15 (83%) had at least one positive GMI (median 4, range 1-15). The sensitivity and specificity of was 83% and 67%, respectively. GMI was positive before the diagnosis of invasive Fusariosis in 11 of the 15 cases (73%), at a median of 10 days (range 3-39), and after the diagnosis in 4 cases. GMI became negative in 8 of the 15 patients; 3 of these 8 patients (37.5%) were alive 90 days after the diagnosis of Fusariosis compared with 2 of 7 (29%) who did not normalize GMI (p = 1.0). GMI is frequently positive in invasive Fusariosis, and becomes positive before diagnosis in most patients. These findings may have important implications for the choice of antifungal therapy in settings with high prevalence of invasive Fusariosis.
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Epidemiology of Fusariosis
Current Fungal Infection Reports, 2013Co-Authors: Marcia Garnica, Marcio NucciAbstract:Fusarium spp. are molds widely distributed in nature as soil saprophytes. Human infections by Fusarium spp. occur both in immunocompetent and immunocompromised hosts. The most common forms in immunocompetent individuals are onychomycosis and keratitis. By contrast, disseminated Fusariosis affects the immunocompromised host, especially hematopoietic cell transplant recipients and patients with acute leukemia. Severe neutropenia and T-cell immunodeficiency are the most important predisposing factors. Infection in compromised hosts is frequently fatal, and successful outcome is largely determined by the degree and persistence of immunosuppression and the extent of infection. The frequency of invasive Fusariosis is increasing in some regions, especially in South America.
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Superficial skin lesions positive for Fusarium are associated with subsequent development of invasive Fusariosis.
Journal of Infection, 2013Co-Authors: Andrea G. Varon, Simone A. Nouér, Gloria Barreiros, Beatriz Moritz Trope, Fabiana Magalhães, Tiyomi Akiti, Marcia Garnica, Marcio NucciAbstract:OBJECTIVES: To evaluate the frequency of skin colonization by Fusarium spp. in high-risk hematologic patients and its impact on the subsequent development of invasive Fusariosis. METHODS: We screened all high-risk hematologic patients from August 2008 to December 2009 with cultures of 6 pre-defined areas in the feet and hands on admission and at discharge. In addition, cultures of any skin lesion present on admission were performed. RESULTS: Among 61 patients screened, alterations in the skin and/or nails were present in 32 patients (52%) on admission, mostly represented by abnormal appearing nails and intertrigo. Four patients (7.2%) presented positive baseline cultures for Fusarium spp., all in existing lesions of onychomycosis, intertrigo or both. Invasive Fusariosis was diagnosed in six patients. The presence of a skin lesion at baseline that grew Fusarium spp. was associated with the subsequent development of invasive Fusariosis (p = 0.04). CONCLUSIONS: Our data suggest that: 1) baseline cultures in patients without alterations in the skin and/or nails seems not justifiable; 2) cultures of pre-existing lesions may help to identify a group of patients at higher risk to develop invasive Fusariosis. The use of anti-mould prophylaxis in this setting should be explored in future studies.
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Superficial skin lesions positive for Fusarium are associated with subsequent development of invasive Fusariosis.
The Journal of infection, 2013Co-Authors: Andrea G. Varon, Simone A. Nouér, Gloria Barreiros, Beatriz Moritz Trope, Fabiana Magalhães, Tiyomi Akiti, Marcia Garnica, Marcio NucciAbstract:To evaluate the frequency of skin colonization by Fusarium spp. in high-risk hematologic patients and its impact on the subsequent development of invasive Fusariosis. We screened all high-risk hematologic patients from August 2008 to December 2009 with cultures of 6 pre-defined areas in the feet and hands on admission and at discharge. In addition, cultures of any skin lesion present on admission were performed. Among 61 patients screened, alterations in the skin and/or nails were present in 32 patients (52%) on admission, mostly represented by abnormal appearing nails and intertrigo. Four patients (7.2%) presented positive baseline cultures for Fusarium spp., all in existing lesions of onychomycosis, intertrigo or both. Invasive Fusariosis was diagnosed in six patients. The presence of a skin lesion at baseline that grew Fusarium spp. was associated with the subsequent development of invasive Fusariosis (p = 0.04). Our data suggest that: 1) baseline cultures in patients without alterations in the skin and/or nails seems not justifiable; 2) cultures of pre-existing lesions may help to identify a group of patients at higher risk to develop invasive Fusariosis. The use of anti-mould prophylaxis in this setting should be explored in future studies. Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Andrea G. Varon - One of the best experts on this subject based on the ideXlab platform.
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Antimold Prophylaxis May Reduce the Risk of Invasive Fusariosis in Hematologic Patients with Superficial Skin Lesions with Positive Culture for Fusarium.
Antimicrobial agents and chemotherapy, 2016Co-Authors: Andrea G. Varon, Simone A. Nouér, Gloria Barreiros, Beatriz Moritz Trope, Tiyomi Akiti, Marcio NucciAbstract:ABSTRACT Hematologic patients with superficial skin lesions on admission growing Fusarium spp. are at a high risk for developing invasive Fusariosis during neutropenia. We evaluated the impact of primary prophylaxis with a mold-active azole in preventing invasive Fusariosis in these patients. Between August 2008 and December 2014, patients with acute leukemia or aplastic anemia and recipients of hematopoietic cell transplants were screened on admission with dermatologic and direct exams and fungal cultures of superficial skin lesions. Until November 2009, no interventions were made. Beginning in December 2009, patients with baseline skin lesions and a direct exam and/or culture suggestive of the presence of Fusarium spp. received prophylaxis with voriconazole or posaconazole. Skin lesions in the extremities (mostly onychomycosis and interdigital intertrigo) were present on admission in 88 of 239 episodes (36.8%); 44 lesions had hyaline septate hyphae identified by direct exam, and cultures from 11 lesions grew Fusarium spp. Antimold prophylaxis was given for 20 episodes (voriconazole for 17 and posaconazole for 3). Invasive Fusariosis was diagnosed in 14 episodes (5.8%). Among patients with baseline skin lesions with positive cultures for Fusarium spp., 4 of 5 without antimold prophylaxis developed invasive Fusariosis versus 0 of 6 with antimold prophylaxis ( P = 0.01; 95% confidence interval for the difference between proportions, 22% to 96%). Primary antifungal prophylaxis with an antimold azole may prevent the occurrence of invasive Fusariosis in high-risk hematologic patients with superficial skin lesions on admission growing Fusarium spp.
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Earlier diagnosis of invasive Fusariosis with Aspergillus serum galactomannan testing
PLoS ONE, 2014Co-Authors: Marcio Nucci, Fabianne Carlesse, Paola Cappellano, Adriana Seber, Andrea G. Varon, Simone A. Nouér, Marcia Garnica, Arnaldo L. ColomboAbstract:Cross-reactivity of Fusarium species with serum galactomannan antigen (GMI) test has been observed. We sought to evaluate if GMI could help to early diagnose invasive Fusariosis and to monitor treatment response. We reviewed the records of all patients with invasive Fusariosis between 2008 and 2012 in three Brazilian hospitals. We selected patients who had at least 1 GMI test within 2 days before or after the date of the first clinical manifestation of Fusariosis, and analyzed the temporal relationship between the first positive GMI test and the date of the diagnosis of invasive Fusariosis, and the kinetics of GMI in relation to patients' response to treatment. We also selected 18 controls to determine the sensitivity and specificity of the test. Among 18 patients, 15 (83%) had at least one positive GMI (median 4, range 1-15). The sensitivity and specificity of was 83% and 67%, respectively. GMI was positive before the diagnosis of invasive Fusariosis in 11 of the 15 cases (73%), at a median of 10 days (range 3-39), and after the diagnosis in 4 cases. GMI became negative in 8 of the 15 patients; 3 of these 8 patients (37.5%) were alive 90 days after the diagnosis of Fusariosis compared with 2 of 7 (29%) who did not normalize GMI (p = 1.0). GMI is frequently positive in invasive Fusariosis, and becomes positive before diagnosis in most patients. These findings may have important implications for the choice of antifungal therapy in settings with high prevalence of invasive Fusariosis.
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Superficial skin lesions positive for Fusarium are associated with subsequent development of invasive Fusariosis.
Journal of Infection, 2013Co-Authors: Andrea G. Varon, Simone A. Nouér, Gloria Barreiros, Beatriz Moritz Trope, Fabiana Magalhães, Tiyomi Akiti, Marcia Garnica, Marcio NucciAbstract:OBJECTIVES: To evaluate the frequency of skin colonization by Fusarium spp. in high-risk hematologic patients and its impact on the subsequent development of invasive Fusariosis. METHODS: We screened all high-risk hematologic patients from August 2008 to December 2009 with cultures of 6 pre-defined areas in the feet and hands on admission and at discharge. In addition, cultures of any skin lesion present on admission were performed. RESULTS: Among 61 patients screened, alterations in the skin and/or nails were present in 32 patients (52%) on admission, mostly represented by abnormal appearing nails and intertrigo. Four patients (7.2%) presented positive baseline cultures for Fusarium spp., all in existing lesions of onychomycosis, intertrigo or both. Invasive Fusariosis was diagnosed in six patients. The presence of a skin lesion at baseline that grew Fusarium spp. was associated with the subsequent development of invasive Fusariosis (p = 0.04). CONCLUSIONS: Our data suggest that: 1) baseline cultures in patients without alterations in the skin and/or nails seems not justifiable; 2) cultures of pre-existing lesions may help to identify a group of patients at higher risk to develop invasive Fusariosis. The use of anti-mould prophylaxis in this setting should be explored in future studies.
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Superficial skin lesions positive for Fusarium are associated with subsequent development of invasive Fusariosis.
The Journal of infection, 2013Co-Authors: Andrea G. Varon, Simone A. Nouér, Gloria Barreiros, Beatriz Moritz Trope, Fabiana Magalhães, Tiyomi Akiti, Marcia Garnica, Marcio NucciAbstract:To evaluate the frequency of skin colonization by Fusarium spp. in high-risk hematologic patients and its impact on the subsequent development of invasive Fusariosis. We screened all high-risk hematologic patients from August 2008 to December 2009 with cultures of 6 pre-defined areas in the feet and hands on admission and at discharge. In addition, cultures of any skin lesion present on admission were performed. Among 61 patients screened, alterations in the skin and/or nails were present in 32 patients (52%) on admission, mostly represented by abnormal appearing nails and intertrigo. Four patients (7.2%) presented positive baseline cultures for Fusarium spp., all in existing lesions of onychomycosis, intertrigo or both. Invasive Fusariosis was diagnosed in six patients. The presence of a skin lesion at baseline that grew Fusarium spp. was associated with the subsequent development of invasive Fusariosis (p = 0.04). Our data suggest that: 1) baseline cultures in patients without alterations in the skin and/or nails seems not justifiable; 2) cultures of pre-existing lesions may help to identify a group of patients at higher risk to develop invasive Fusariosis. The use of anti-mould prophylaxis in this setting should be explored in future studies. Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Simone A. Nouér - One of the best experts on this subject based on the ideXlab platform.
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Antimold Prophylaxis May Reduce the Risk of Invasive Fusariosis in Hematologic Patients with Superficial Skin Lesions with Positive Culture for Fusarium.
Antimicrobial agents and chemotherapy, 2016Co-Authors: Andrea G. Varon, Simone A. Nouér, Gloria Barreiros, Beatriz Moritz Trope, Tiyomi Akiti, Marcio NucciAbstract:ABSTRACT Hematologic patients with superficial skin lesions on admission growing Fusarium spp. are at a high risk for developing invasive Fusariosis during neutropenia. We evaluated the impact of primary prophylaxis with a mold-active azole in preventing invasive Fusariosis in these patients. Between August 2008 and December 2014, patients with acute leukemia or aplastic anemia and recipients of hematopoietic cell transplants were screened on admission with dermatologic and direct exams and fungal cultures of superficial skin lesions. Until November 2009, no interventions were made. Beginning in December 2009, patients with baseline skin lesions and a direct exam and/or culture suggestive of the presence of Fusarium spp. received prophylaxis with voriconazole or posaconazole. Skin lesions in the extremities (mostly onychomycosis and interdigital intertrigo) were present on admission in 88 of 239 episodes (36.8%); 44 lesions had hyaline septate hyphae identified by direct exam, and cultures from 11 lesions grew Fusarium spp. Antimold prophylaxis was given for 20 episodes (voriconazole for 17 and posaconazole for 3). Invasive Fusariosis was diagnosed in 14 episodes (5.8%). Among patients with baseline skin lesions with positive cultures for Fusarium spp., 4 of 5 without antimold prophylaxis developed invasive Fusariosis versus 0 of 6 with antimold prophylaxis ( P = 0.01; 95% confidence interval for the difference between proportions, 22% to 96%). Primary antifungal prophylaxis with an antimold azole may prevent the occurrence of invasive Fusariosis in high-risk hematologic patients with superficial skin lesions on admission growing Fusarium spp.
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Earlier diagnosis of invasive Fusariosis with Aspergillus serum galactomannan testing
PLoS ONE, 2014Co-Authors: Marcio Nucci, Fabianne Carlesse, Paola Cappellano, Adriana Seber, Andrea G. Varon, Simone A. Nouér, Marcia Garnica, Arnaldo L. ColomboAbstract:Cross-reactivity of Fusarium species with serum galactomannan antigen (GMI) test has been observed. We sought to evaluate if GMI could help to early diagnose invasive Fusariosis and to monitor treatment response. We reviewed the records of all patients with invasive Fusariosis between 2008 and 2012 in three Brazilian hospitals. We selected patients who had at least 1 GMI test within 2 days before or after the date of the first clinical manifestation of Fusariosis, and analyzed the temporal relationship between the first positive GMI test and the date of the diagnosis of invasive Fusariosis, and the kinetics of GMI in relation to patients' response to treatment. We also selected 18 controls to determine the sensitivity and specificity of the test. Among 18 patients, 15 (83%) had at least one positive GMI (median 4, range 1-15). The sensitivity and specificity of was 83% and 67%, respectively. GMI was positive before the diagnosis of invasive Fusariosis in 11 of the 15 cases (73%), at a median of 10 days (range 3-39), and after the diagnosis in 4 cases. GMI became negative in 8 of the 15 patients; 3 of these 8 patients (37.5%) were alive 90 days after the diagnosis of Fusariosis compared with 2 of 7 (29%) who did not normalize GMI (p = 1.0). GMI is frequently positive in invasive Fusariosis, and becomes positive before diagnosis in most patients. These findings may have important implications for the choice of antifungal therapy in settings with high prevalence of invasive Fusariosis.
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Superficial skin lesions positive for Fusarium are associated with subsequent development of invasive Fusariosis.
Journal of Infection, 2013Co-Authors: Andrea G. Varon, Simone A. Nouér, Gloria Barreiros, Beatriz Moritz Trope, Fabiana Magalhães, Tiyomi Akiti, Marcia Garnica, Marcio NucciAbstract:OBJECTIVES: To evaluate the frequency of skin colonization by Fusarium spp. in high-risk hematologic patients and its impact on the subsequent development of invasive Fusariosis. METHODS: We screened all high-risk hematologic patients from August 2008 to December 2009 with cultures of 6 pre-defined areas in the feet and hands on admission and at discharge. In addition, cultures of any skin lesion present on admission were performed. RESULTS: Among 61 patients screened, alterations in the skin and/or nails were present in 32 patients (52%) on admission, mostly represented by abnormal appearing nails and intertrigo. Four patients (7.2%) presented positive baseline cultures for Fusarium spp., all in existing lesions of onychomycosis, intertrigo or both. Invasive Fusariosis was diagnosed in six patients. The presence of a skin lesion at baseline that grew Fusarium spp. was associated with the subsequent development of invasive Fusariosis (p = 0.04). CONCLUSIONS: Our data suggest that: 1) baseline cultures in patients without alterations in the skin and/or nails seems not justifiable; 2) cultures of pre-existing lesions may help to identify a group of patients at higher risk to develop invasive Fusariosis. The use of anti-mould prophylaxis in this setting should be explored in future studies.
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Superficial skin lesions positive for Fusarium are associated with subsequent development of invasive Fusariosis.
The Journal of infection, 2013Co-Authors: Andrea G. Varon, Simone A. Nouér, Gloria Barreiros, Beatriz Moritz Trope, Fabiana Magalhães, Tiyomi Akiti, Marcia Garnica, Marcio NucciAbstract:To evaluate the frequency of skin colonization by Fusarium spp. in high-risk hematologic patients and its impact on the subsequent development of invasive Fusariosis. We screened all high-risk hematologic patients from August 2008 to December 2009 with cultures of 6 pre-defined areas in the feet and hands on admission and at discharge. In addition, cultures of any skin lesion present on admission were performed. Among 61 patients screened, alterations in the skin and/or nails were present in 32 patients (52%) on admission, mostly represented by abnormal appearing nails and intertrigo. Four patients (7.2%) presented positive baseline cultures for Fusarium spp., all in existing lesions of onychomycosis, intertrigo or both. Invasive Fusariosis was diagnosed in six patients. The presence of a skin lesion at baseline that grew Fusarium spp. was associated with the subsequent development of invasive Fusariosis (p = 0.04). Our data suggest that: 1) baseline cultures in patients without alterations in the skin and/or nails seems not justifiable; 2) cultures of pre-existing lesions may help to identify a group of patients at higher risk to develop invasive Fusariosis. The use of anti-mould prophylaxis in this setting should be explored in future studies. Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
Gloria Barreiros - One of the best experts on this subject based on the ideXlab platform.
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Antimold Prophylaxis May Reduce the Risk of Invasive Fusariosis in Hematologic Patients with Superficial Skin Lesions with Positive Culture for Fusarium.
Antimicrobial agents and chemotherapy, 2016Co-Authors: Andrea G. Varon, Simone A. Nouér, Gloria Barreiros, Beatriz Moritz Trope, Tiyomi Akiti, Marcio NucciAbstract:ABSTRACT Hematologic patients with superficial skin lesions on admission growing Fusarium spp. are at a high risk for developing invasive Fusariosis during neutropenia. We evaluated the impact of primary prophylaxis with a mold-active azole in preventing invasive Fusariosis in these patients. Between August 2008 and December 2014, patients with acute leukemia or aplastic anemia and recipients of hematopoietic cell transplants were screened on admission with dermatologic and direct exams and fungal cultures of superficial skin lesions. Until November 2009, no interventions were made. Beginning in December 2009, patients with baseline skin lesions and a direct exam and/or culture suggestive of the presence of Fusarium spp. received prophylaxis with voriconazole or posaconazole. Skin lesions in the extremities (mostly onychomycosis and interdigital intertrigo) were present on admission in 88 of 239 episodes (36.8%); 44 lesions had hyaline septate hyphae identified by direct exam, and cultures from 11 lesions grew Fusarium spp. Antimold prophylaxis was given for 20 episodes (voriconazole for 17 and posaconazole for 3). Invasive Fusariosis was diagnosed in 14 episodes (5.8%). Among patients with baseline skin lesions with positive cultures for Fusarium spp., 4 of 5 without antimold prophylaxis developed invasive Fusariosis versus 0 of 6 with antimold prophylaxis ( P = 0.01; 95% confidence interval for the difference between proportions, 22% to 96%). Primary antifungal prophylaxis with an antimold azole may prevent the occurrence of invasive Fusariosis in high-risk hematologic patients with superficial skin lesions on admission growing Fusarium spp.
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Superficial skin lesions positive for Fusarium are associated with subsequent development of invasive Fusariosis.
Journal of Infection, 2013Co-Authors: Andrea G. Varon, Simone A. Nouér, Gloria Barreiros, Beatriz Moritz Trope, Fabiana Magalhães, Tiyomi Akiti, Marcia Garnica, Marcio NucciAbstract:OBJECTIVES: To evaluate the frequency of skin colonization by Fusarium spp. in high-risk hematologic patients and its impact on the subsequent development of invasive Fusariosis. METHODS: We screened all high-risk hematologic patients from August 2008 to December 2009 with cultures of 6 pre-defined areas in the feet and hands on admission and at discharge. In addition, cultures of any skin lesion present on admission were performed. RESULTS: Among 61 patients screened, alterations in the skin and/or nails were present in 32 patients (52%) on admission, mostly represented by abnormal appearing nails and intertrigo. Four patients (7.2%) presented positive baseline cultures for Fusarium spp., all in existing lesions of onychomycosis, intertrigo or both. Invasive Fusariosis was diagnosed in six patients. The presence of a skin lesion at baseline that grew Fusarium spp. was associated with the subsequent development of invasive Fusariosis (p = 0.04). CONCLUSIONS: Our data suggest that: 1) baseline cultures in patients without alterations in the skin and/or nails seems not justifiable; 2) cultures of pre-existing lesions may help to identify a group of patients at higher risk to develop invasive Fusariosis. The use of anti-mould prophylaxis in this setting should be explored in future studies.
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Superficial skin lesions positive for Fusarium are associated with subsequent development of invasive Fusariosis.
The Journal of infection, 2013Co-Authors: Andrea G. Varon, Simone A. Nouér, Gloria Barreiros, Beatriz Moritz Trope, Fabiana Magalhães, Tiyomi Akiti, Marcia Garnica, Marcio NucciAbstract:To evaluate the frequency of skin colonization by Fusarium spp. in high-risk hematologic patients and its impact on the subsequent development of invasive Fusariosis. We screened all high-risk hematologic patients from August 2008 to December 2009 with cultures of 6 pre-defined areas in the feet and hands on admission and at discharge. In addition, cultures of any skin lesion present on admission were performed. Among 61 patients screened, alterations in the skin and/or nails were present in 32 patients (52%) on admission, mostly represented by abnormal appearing nails and intertrigo. Four patients (7.2%) presented positive baseline cultures for Fusarium spp., all in existing lesions of onychomycosis, intertrigo or both. Invasive Fusariosis was diagnosed in six patients. The presence of a skin lesion at baseline that grew Fusarium spp. was associated with the subsequent development of invasive Fusariosis (p = 0.04). Our data suggest that: 1) baseline cultures in patients without alterations in the skin and/or nails seems not justifiable; 2) cultures of pre-existing lesions may help to identify a group of patients at higher risk to develop invasive Fusariosis. The use of anti-mould prophylaxis in this setting should be explored in future studies. Copyright © 2013 The British Infection Association. Published by Elsevier Ltd. All rights reserved.
