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Invasive fungal infections have gained importance recently. The opportunistic pathogens such as Candida, Aspergillus, Mucor, Cryptococcus, and Histoplasma are particularly known to infect the kidneys in predisposed individuals with serious complications. At the same time there is a high incidence of invasive fungal infections in patients with renal...
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Invasive fungal infections represent a major challenge in patients who underwent organ transplantation. Overall, the most common fungal infections in these patients are candidiasis, followed by aspergillosis and cryptococcosis, except in lung transplant recipients, where aspergillosis is most common. Several risk factors have been identified, which...
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Invasive fungal infections are a major cause of morbidity and mortality among solid organ transplant (SOT) and hematopoietic stem cell transplant (HSCT) recipients. Transplant patients are at risk for such invasive fungal infections. The most common invasive fungal infections are invasive candidiasis in the SOT and invasive aspergillosis in the HSC...
The COVID-19 pandemic has highlighted genetic vaccination as a powerful and cost-effective tool to counteract infectious diseases. Invasive fungal infections (IFI) remain a major challenge among immune compromised patients, particularly those undergoing allogeneic hematopoietic bone marrow transplantation (HSCT) or solid organ transplant (SOT) both...
Objectives:
To investigate the impact of COVID-19 on the burden of hospital-treated Aspergillus and Candida infections in England.
Design:
A retrospective study using Hospital Episodes Statistics data to estimate the burden of serious and invasive fungal infections (SIFIs) in all patients admitted in England during March 2018-February 2020 (pre-...
To study fungal infections such as Mucormycosis, Aspergillosis, Candidiasis, Cryptococcosis associated with Covid-19. A detailed study was done with the information gathered from the articles in specified databases, online sources, and online published materials to have current details of the situation of fungal infections in covid patients. Fungal...
Citations
... [24] However, our study shows data consistent with similar studies done in the tropics which show a peak incidence of fungal infections occurring after 6 months of transplant. [10,12,25] Mucor infections led to high mortality. Studies have reported variable mortality rates from Fungal Infections ranging from 20% to 100%. ...
Introduction: Multiple factors including infections affect graft and patient outcomes in Renal Allograft Recipients. Survival data from tropical countries is scarce, especially during the COVID 19 pandemic. Subjects and Methods: In this ambispective study, records of KTRs between 2011 to 2019 and prospective follow up of subsequent transplants up till 2021 was done. Infection rate, etiology, and patient and graft outcomes were studied with appropriate investigations. Univariate and multivariate analysis was done to assess the predictors of patient and graft outcomes. Results: A total of 249 patients were studied, of which 218 episodes of infection occurred in 129 patients (49.79%). Bacterial infections were the most common (40.50%), followed by viral (35.20%), mycobacterial (11%), and fungal (8.10%). Of all infections, 52.3% of cases occurred within the 1st 6 months. Infections led to patient mortality in 14.7% of cases. Infections were significantly associated with graft rejection and chronic graft dysfunction. Donor age, cytomegalovirus (CMV) infection, and graft rejection were independent predictors of chronic graft dysfunction. Recipient age and graft rejection were independent predictors of graft loss. Graft survival was 88.53%, 73.75%, and 44.90% at the end of 1, 3, and 5 years, respectively, with average 18% of total graft losses occurring during the pre‑COVID era as compared to 39% in COVID period. Conclusion: Invasive fungal infections and tuberculosis are more common in late transplant period. Recipient and donor age, graft rejection, CMV infection, and COVID pandemic period affected graft and patient outcomes. COVID pandemic period led to a disproportionately higher occurrence of graft loss.
... Solid-organ transplantation (SOT) is a risk factor in 2.6-11% of mucormycosis cases from India (Table 1), compared to 7-14% from global data [2,3]. The prevalence of mucormycosis in renal-transplant recipients in India varies from 0.05% to 2.7% [29][30][31][32][33][34], compared to global data of 0.04-0.05% [35]. ...
... A study from Western India (Gujarat) documented mucormycosis at 1.2% in renal-transplant recipients [30]. In North India, a group of authors conducted two retrospective studies on invasive fungal infections (IFIs) in renal-transplant recipients at different periods (1977-2000 and 2014-2017), and they documented the prevalence of mucormycosis at 2% and 2.7%, respectively [33,34]. These findings indicates that mucormycosis in renal-transplant recipients is more common in India than it is in developed countries. ...
Mucormycosis is an angioinvasive disease caused by saprophytic fungi of the order Mucorales. The exact incidence of mucormycosis in India is unknown due to the lack of population-based studies. The estimated prevalence of mucormycosis is around 70 times higher in India than that in global data. Diabetes mellitus is the most common risk factor, followed by haematological malignancy and solid-organ transplant. Patients with postpulmonary tuberculosis and chronic kidney disease are at additional risk of developing mucormycosis in this country. Trauma is a risk factor for cutaneous mucormycosis. Isolated renal mucormycosis in an immunocompetent host is a unique entity in India. Though Rhizopus arrhizus is the most common etiological agent of mucormycosis in this country, infections due to Rhizopus microsporus, Rhizopus homothallicus, and Apophysomyces variabilis are rising. Occasionally, Saksenaea erythrospora, Mucor irregularis, and Thamnostylum lucknowense are isolated. Though awareness of the disease has increased among treating physicians, disease-associated morbidity and mortality are still high, as patients seek medical attention late in the disease process and given the low affordability for therapy. In conclusion, the rise in the number of cases, the emergence of new risk factors and causative agents, and the challenges in managing the disease are important concerns with mucormycosis in India.
... In addition to this species, Mucormycosis and Aspergillosis are the other common agents for the development of fungal infections involving the kidney. There are also few reports introducing Cryptococcosis and Histoplasmosis as other pathogenic agents [5]. ...
... There are pathologic studies in the literature addressing abscess formation, emphysematous pyelonephritis, papillary necrosis, pyonephrosis, and vascular involvement leading to infarction or necrosis and development of fungal ball in the kidneys [5,17]. In this regard, Zhao Song et al. reported on the incidence of candidiasis in the kidney presenting as a mass lesion [18]. ...
... Clinically, this condition may present with fever, dysuria, flank pain or frank hematuria, and renal failure [5]. If the infection occurs by an ascending route, the presentations are more likely to be sloughing and debris or fungal ball formation in the pelvicalyceal system. ...
Background and purpose:
Fungal renal abscesses are rare entities associated with significant morbidity and mortality. Affected kidneys can have microabscess, pyelonephritis, pyonephrosis, or papillary necrosis.
Case report:
Herein, we reported an unusual case of a large renal abscess cause by Candida tropicalis in a diabetic patient. The entity presented as a lump in the abdomen and later was diagnosed to be an abscess on computed tomography scan. Candida tropicalis was confirmed on the culture of the aspirate. The abscess was successfully treated by percutaneous drainage and administration of amphotericin B deoxycholate.
Conclusion:
Candida tropicalis is now a global concern because of its rising prevalence and high virulence. The growing resistance of this Candida species to azoles, as in our case, calls for a more judicious usage of antifungal agents. Empirical therapy with either amphotericin or echinocandins is an option in case of high azole resistance. This case highlights the importance of timely diagnosis and implementation of aggressive management in cases suffering from fungal abscesses.
... Our case also highlights the importance of screening for the agents of viral hepatitis. The screening component of the National Viral Hepatitis Control Program can help to prevent the occurrence of such fatal infections in patients with HBV or HCV liver disease [8]. Figure 2D. ...
... Our patient had grade I renal parenchymal disease and also increased serum uric acid and serum creatinine. This might be another major risk factor in the above case for acquiring disseminated cryptococcosis [8,9]. ...
Background and purpose:
We report a case of disseminated cryptococcosis in a treatment-naïve patient, incidentally diagnosed with hepatitis C virus (HCV) infection and renal parenchymal disease. The patient succumbed to death given the very late diagnosis of the disease.
Case report:
A 54-year-old male presented with the chief complaints of abdominal pain, chest pain, and phlegmy cough for a month. There was a past history of decreased urine output, lower limb swelling, and fever lasting for 15-20 days. After a general physical examination, the differential diagnosis of hepatitis C-related liver disease with hepatic encephalopathy, disseminated tuberculosis, and septic shock was made. Radiological examination revealed renal parenchymal disease on ultrasound abdomen and opacity with reticulonodular opacity in the bilateral lung zones. In laboratory investigations, serum reactive sample was tested for anti-HCV antibodies. In addition, Cryptococcus var grubii was identified in blood culture using the matrix-assisted laser desorption ionization-time of flight mass spectrometry (Bruker Daltonics, Germany). The patient succumbed to death before the initiation of any specific antifungal therapy.
Conclusion:
Cryptococcosis-HCV co-infection is a fatal condition with a fulminant course that might be difficult to treat.
... Ubiquitous in the environment, Aspergillus species most often cause pulmonary infection following inhalation of conidia. Renal involvement is most commonly encountered in the infrequent setting of hematogenous dissemination to multiple organs (5). Primary genitourinary aspergillosis is exceedingly rare. ...
... Many times the kidney lesions remain clinically inapparent and are discovered only at autopsy, especially if disease is confined to the renal cortex. In contrast, involvement of the renal pelvis, which occurs more commonly, features bezoar and cast A c c e p t e d M a n u s c r i p t 7 formation with subsequent obstructive symptoms (5,6,9). Aspergillus infection of the prostate typically presents with obstructive outflow symptoms that are difficult to distinguish from prostatic hypertrophy, and also can cause dysuria and pain similar to those noted with bacterial prostatitis (8). ...
Novel targeted pharmacotherapies have ushered in a new era in the management of chronic lymphocytic leukemia (CLL). Postmarketing surveillance indicates that some of these agents are associated with unexpected increases in opportunistic infections. In this report, we present a case of primary genitourinary invasive aspergillosis in a patient with CLL treated with venetoclax. We briefly review both genitourinary aspergillosis and infection risks associated with venetoclax treatment for CLL.
... 6 In another study from south India, the incidence of fungal infections in renal transplant recipients was found to be 6.6%. 8 In a study by Gupta et al, 10 the incidence of IFI in posttransplant patients was found to be 9.8%, with the most common infections being candidiasis (2.8%), aspergillosis (2.3%), mucormycosis (2%), and cryptococcosis (1.9%). They also showed that the incidence of angioinvasive fungi, such as Aspergillus and mucor was increasing. ...
Fungal infections are an important cause of morbidity and mortality in renal transplant recipients. These infections account for 5% of all infections in renal transplant recipients. The symptoms of systemic fungal infections are nonspecific, particularly in their early stages, and this can lead to delay in diagnosis. Retrospective analysis was conducted on all renal transplants that were performed at our center over a 20-year period from 1996-2016. Cases of invasive fungal infections (IFIs) that occurred among renal transplant recipients were identified to describe the epidmeiology of these infections. A total of 67 (9.2%) IFI cases were identified among 725 renal transplant recipients. Of the 67 patients (9.24%) with IFI, 31 (46.2%) cases were seen in deceased donor transplant recipients. Of 67 cases with IFI, 42 (62.7%) had received induction therapy. The incidence of fungal infections according to the induction agent used was, 14.3% with basiliximab, 12.3% each with daclizumab and rabbit antithymocyte globulin, and 6.3% among patients not given any induction. Invasive candidiasis was the most common IFI overall, followed by mucormycosis, invasive aspergillosis, and cryptococcosis. Median time to onset of IFI was 117.9 days. Majority of infections occurred within 180 days after transplantation. Late posttransplant (>180 days after transplantation) IFI's were predominantly caused by Candida, followed by Cryptococcus. The longest time to infection was a case of histoplasma, occurring seven years posttransplant. The overall 12-month cumulative incidence (CI) for any IFI was 9.1%. The 12-month CI of the first IFI increased from 7.3% between 1996 and 2001 to 10.5% between 2010 and 2016. The overall mortality rate was 38.8%. The use of newer and more-effective immunosuppressive agents in recent years are associated with increased rates of fungal infections in renal transplant recipients. Therefore, early detection of fungal infections and proper therapy are important in improving survival and reducing mortality.
... In a study by Gupta spanning 23 years (1977Gupta spanning 23 years ( -2000, of 850 patients undergoing renal transplant during that period, only 2 patients developed histoplasmosis. 3 Clinical manifestations are of 3 types: acute primary, chronic cavitary, and progressive disseminated. The disseminated form usually presents with fever of unknown origin, cytopenias, hepatosplenomegaly, and weight loss. ...
Histoplasmosis is a rare disease in nonendemic areas. We report a case of a 23-year-old male patient who presented with fever of unknown origin, cytopenias, organomegaly, and allograft dysfunction 4 months after renal transplant with father as donor. Bone marrow examination showed intracellular budding yeast cells, which was confirmed as histoplasmosis by culture of bone marrow biopsy sample. The patient was treated with intravenous liposomal amphotericin and responded well.
... At our center, previously (in an autopsy study), we found the incidence to be around 9.8%. [10] Other centers from India have reported a figure ranging from 2.5% to 19%. [11] The diagnosis of fungal infection was based on histopathological examination of the involved organ. ...
... This is consistent with a previous report (autopsy study) from our center in which these fungal infections accounted for 52% of all fungal infections. [10] In one recent study from India, invasive fungal infections were the most common pathogens, amounting to 55% of all infections. [6] The peak incidence of fungal infections was detected after 6 months following transplantation. ...
Introduction: Renal transplant recipients now have better graft survival rates, but continue to develop opportunistic infections. The present study was aimed at finding the incidence of opportunistic infections in the tropical environment in live-related transplant recipients. Materials and Methods: The study was carried out retrospectively with the help of medical records at a tertiary care hospital in North India from 2006 to 2010. The demographic and transplant details were noted, and data were analyzed for any possible risk factor. Results: A total of 1270 patients were studied, of which 231 infectious episodes were detected in 196 (15.4%) patients. Within 1 month, 11.7% of patients had infection, whereas 68.4% of patients had at least one infectious episode within the first 6 months of transplant. Bacterial infection (5.9%) followed by tuberculosis (4.9%), viral (3.8%), and fungal (2.1%) were the infections encountered. Aspergillosis (32.1%) was the most common fungal infection, followed by candidiasis and mucormycosis. The most common site of involvement was lung (26.4%), followed by urinary tract (13.0%). The overall patient survival was nearly 90%. Only 20% of patients had functional graft on follow-up in whom the graft was directly involved by a particular infection. Conclusions: Posttransplant infections continue to affect graft and patient survival. Higher rates are seen in the first 6 months posttransplant.
... Opportunistic infections are well known to occur in the renal transplant recipients (RTRs) [1]. Central nervous system (CNS) complications are a significant cause of morbidity and mortality. ...
Although rare, both Cladophialophora bantiana (C. bantiana) and Toxoplasma gondii have been known to be associated with brain abscess in renal transplant recipients (RTRs), however co-infection has never been reported till date. In the present case, 40 years old renal transplant recipient on curtailed immunosuppressive therapy presented with progressive headache and altered sensorium. The computed tomography of head showed multiple ring-enhancing discrete lesions in the left frontal lobe, with moderate perilesional oedema. Left frontal craniotomy and aspiration revealed thick yellowish brown pus, which on culture showed the growth of dematiaceous fungal hyphae “C. bantiana” and co-infection with “Toxoplasma” was confirmed by PCR as well as serology (both IgM and IgG – Toxoplasma) positivity. Stereotactic aspiration/open craniotomy and drainage is imperative to arrive at microbiological diagnosis and provide timely therapy to the patient.
... Sites of mucormycosis include rhinocerebral, pulmonary, cutaneous, generalized, renal and other solid organ systems that are affected in a descending order of presentation. Renal mucormycosis is characterized by extensive vascular involvement with thrombosis and necrosis of the renal parenchyma, both cortical and medullary, with clinical renal impairment [2], and high mortality rates (above 50-60% in all reported case series) [3]. ...
Mucormycosis is a rare fungal infection often seen in immunocompromised hosts. Isolated renal mucormycosis may however present in immunocompetent children as renal failure and has a uniformly poor prognosis if not detected and treated early into the course of illness. We present a 3-year-old boy with unrelenting pyelonephritis in whom serial urine cultures done were negative. A final diagnosis of isolated renal mucormycosis was made by magnetic resonance imaging and renal biopsy.
