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Talaromycosis (penicilliosis) is an invasive mycosis that is endemic in tropical and subtropical Asia. Talaromycosis primarily affects individuals with advanced HIV disease and other immunosuppressive conditions, and the disease disproportionally affects people in low-income and middle-income countries, particularly agricultural workers in rural areas during their most economically productive years. Approximately 17 300 talaromycosis cases and 4900 associated deaths occur annually. Talaromycosis is highly associated with the tropical monsoon season, when flooding and cyclones can exacerbate the poverty-inducing potential of the disease. Talaromycosis can present as localised or disseminated disease, the latter causing cutaneous lesions that are disfiguring and stigmatising. Despite up to a third of diagnosed cases resulting in death, talaromycosis has received little attention and investment from regional and global funders, policy makers, researchers, and industry. Diagnostic and treatment modalities remain extremely insufficient, however control of talaromycosis is feasible with known public health strategies. This Viewpoint is a global call for talaromycosis to be recognised as a neglected tropical disease to alleviate its impact on susceptible populations., Competing Interests: Declaration of interests NPG reports grants from US National Institutes of Health, US Centers for Disease Control and Prevention, the CDC Foundation, the Bill & Melinda Gates Foundation, the UK Medical Research Council, and the South African National Health Laboratory Service Research Trust, outside the submitted work. JF-WC and K-YY have an issued patent on antibodies targeting T marneffei Mp1p proteins and their methods of use. JP reports grants from Merck, Astellas, Pfizer, Amplyx, and Minnetronix; and membership on advisory boards or consulting roles for Merck, Amplyx, Minnetronix, F2G, Scynexis, Ampili, and Matinas, outside the submitted work. TL reports research funding from Gilead Sciences, outside the submitted work. All other authors declare no competing interests., (Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Due to limited access to more powerful diagnostic tools, there are few data on the burden of fungal infections in Côte d'Ivoire, despite a high HIV and TB burden and many cutaneous diseases. Here we estimate the burden of serious fungal infections in this sub-Saharan country with a health profiling description. National demographics were used and PubMed searches to retrieve all published articles on fungal infections in Côte d'Ivoire and other bordering countries in West Africa. When no data existed, risk populations were used to estimate frequencies of fungal infections, using previously described methodology by LIFE (www.LIFE-Worldwide.org). The population of Côte d'Ivoire is around 25 million; 37% are children (≤14 years), and 9% are>65 years. Tinea capitis in children is common, measured at 13.9% in 2013. Considering the prevalence of HIV infection (2.6% of the population, a total of ∼500,000) and a hospital incidence of 12.7% of cryptococcosis, it is estimated that 4590 patients per year develop cryptococcosis. For pneumocystosis, it is suggested that 2640 new cases occur each year with the prevalence of 11% of newly diagnosed HIV adults, and 33% of children with HIV/AIDS. Disseminated histoplasmosis is estimated a 1.4% of advanced HIV disease - 513 cases. An estimated 6568 news cases of chronic pulmonary aspergillosis (CPA) occur after pulmonary tuberculosis (a 5-year prevalence of 6568 cases [26/100,000]). Allergic bronchopulmonary aspergillosis (ABPA) and severe asthma with fungal sensitisation (SAFS) were estimated in 104/100,000 and 151/100,000 respectively, in 1,152,178 adult asthmatics. Vulvovaginal candidiasis (VVC) is common and recurrent VVC affects ∼6% of women in their fertile years - 421,936 women. An unknown number develop candidaemia and invasive aspergillosis. The annual incidence of fungal keratitis is estimated at 3350. No cases of sporotrichosis, mucormycosis and chromoblastomycosis are described, although some cases of mycetoma and Conidiobolus infection have been reported. This study indicates that around to 7.25% (1.8 million) of the population is affected by a serious fungal infection, predominently tinea capitis in children and rVVC in women. These data should be used to inform epidemiological studies, diagnostic needs and therapeutic strategies in Côte d'Ivoire., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

We present Peryton (https://dianalab.e-ce.uth.gr/peryton/), a database of experimentally supported microbe-disease associations. Its first version constitutes a novel resource hosting more than 7900 entries linking 43 diseases with 1396 microorganisms. Peryton's content is exclusively sustained by manual curation of biomedical articles. Diseases and microorganisms are provided in a systematic, standardized manner using reference resources to create database dictionaries. Information about the experimental design, study cohorts and the applied high- or low-throughput techniques is meticulously annotated and catered to users. Several functionalities are provided to enhance user experience and enable ingenious use of Peryton. One or more microorganisms and/or diseases can be queried at the same time. Advanced filtering options and direct text-based filtering of results enable refinement of returned information and the conducting of tailored queries suitable to different research questions. Peryton also provides interactive visualizations to effectively capture different aspects of its content and results can be directly downloaded for local storage and downstream analyses. Peryton will serve as a valuable source, enabling scientists of microbe-related disease fields to form novel hypotheses but, equally importantly, to assist in cross-validation of findings., (© The Author(s) 2020. Published by Oxford University Press on behalf of Nucleic Acids Research.)

Acremonium-like fungi are emerging as important opportunistic pathogens in cutaneous, subcutaneous and serious invasive infections, especially in immunocompromised and debilitated individuals, and Acremonium infections are usually resistant to antifungal therapy. Several molecular studies have demonstrated that many species in the genus Acremonium are polyphyletic, and currently, the genus is restricted to the family Bionectriaceae (Hypocreales). Molecular identification and in vitro antifungal susceptibility tests of Acremonium-like fungi isolated from human clinical specimens in China were performed in this study. Three genetic loci: the large subunit ribosomal RNA gene (LSU), ribosomal internal transcribed spacer and elongation factor 1-α (EF1-α), were used to assess their taxonomic position for correct identification among various species. The multilocus study of twenty-eight strains showed that these strains were distributed in three main lineages: egyptiacum, Cordycipitaceae and Sarocladium; Acremonium egyptiacum and Sarocladium kiliense were the main species of these strains, and three isolates were too phylogenetically distant to be considered undescribed species. Relatively low minimum inhibitory concentrations (MICs) of 0.25-2 and 0.031-0.5 μg/mL were found for voriconazole and terbinafine for most species, respectively. Varied antifungal activities of ciclopirox olamine, amorolfine and posaconazole were found in our study. However, no antifungal effect of sertaconazole, itraconazole or fluconazole was observed against most strains. This is the first study on Acremonium-like species diversity by multilocus sequence analyses and antifungal susceptibility of clinically relevant isolates in China.

Opportunistic Infections (OIs) still remain a major cause of morbidity and death in children with either malignant or nonmalignant disease. OIs are defined as those infections occurring due to bacteria, fungi, viruses or commensal organisms that normally inhabit the human body and do not cause a disease in healthy people, but become pathogenic when the body's defense system is impaired. OIs can also be represented by unusually severe infections caused by common pathogens. An OI could present itself at the onset of a primary immunodeficiency syndrome as a life-threatening event. More often, OI is a therapyassociated complication in patients needing immunosuppressive treatment, among long-term hospitalised patients or in children who undergo bone marrow or solid organ transplantation. The aim of the present review is to provide a comprehensive and 'easy to read' text that briefly summarises the currently available knowledge about OIs in order to define when an infection should be considered as opportunistic in pediatrics as a result of an underlying congenital or acquired immune-deficit., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Objective: To evaluate the clinicopathological and mycological manifestations of fungal rhinosinusitis occurring in the Tengku Ampuan Rahimah Hospital, in Klang, Malaysia, which has a tropical climate., Methods: Records of patients treated from 2009 to 2016 were analysed retrospectively. Data from the records were indexed based on age, gender, clinical presentations, symptom duration, clinical signs and mycological growth., Results: Of 80 samples, 27 (33.75 per cent) had fungal growth. Sixteen patients were classified as having non-invasive fungal rhinosinusitis and 11 as having invasive fungal rhinosinusitis. The commonest clinical presentation was nasal polyposis in non-invasive fungal rhinosinusitis patients (p < 0.05) and ocular symptoms in invasive fungal rhinosinusitis patients (p < 0.05). The commonest organism was aspergillus sp. (p < 0.05) in non-invasive fungal rhinosinusitis and mucorales in invasive fungal rhinosinusitis., Conclusion: There is an almost equal distribution of both invasive and non-invasive fungal rhinosinusitis, as seen in some Asian countries. Invasive fungal rhinosinusitis, while slightly uncommon when compared to non-invasive fungal rhinosinusitis, is potentially life threatening, and may require early and extensive surgical debridement. The clinical presentation of nasal polyposis was often associated with non-invasive fungal rhinosinusitis, whereas ocular symptoms were more likely to be associated with invasive fungal rhinosinusitis.

Opportunistic fungal infections continue to take an unacceptably heavy toll on the most disadvantaged living with HIV-AIDS, and are a major driver for HIV-related deaths. At the second EMBO Workshop on AIDS-Related Mycoses, clinicians and scientists from around the world reported current progress and key priorities for improving outcomes from HIV-related mycoses., (Copyright © 2017. Published by Elsevier Ltd.)

Purpose: The aim of this study was to determine the correlation between acute invasive fungal rhinosinusitis (AIFRS) and underlying diseases, micro-organisms, presenting symptoms, extent of disease, radiologic findings, and outcomes and propose a new classification system., Materials and Methods: The data of 19 AIFRS cases were analyzed retrospectively. Magnetic resonance imaging and computed tomography were performed in all patients preoperatively. All patients underwent at least 1 surgical debridement., Results: Hematologic diseases were the most common (52%) underlying diseases. Patients with type 2 diabetes and those with multiple etiologies causing immunosuppression had the lowest survival. Aspergillus and Mucoraceae species were isolated in 9 patients but were not associated with poor prognosis. Headache and nasal discharge or crusting were the most common presenting symptoms. Premaxillary involvement was significantly correlated with poor prognosis (P = .001). Unilateral involvement was correlated with poor prognosis, although this finding was not significant (P = .111). The overall mortality rate was 61.2%. Patients with neutropenia that was corrected had 80% survival (P = .014). Cessation of corticosteroids and regulating blood glucose levels in patients with immunosuppression from corticosteroid use resulted in 75% survival., Conclusion: There is no single curative treatment for AIFRS. For a favorable prognosis, underlying conditions must be treated in addition to surgical debridement and antifungals., (Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Fungal pathogens severely impact global food and fibre crop security. Fungal species that cause plant diseases have mostly been recognized based on their morphology. In general, morphological descriptions remain disconnected from crucially important knowledge such as mating types, host specificity, life cycle stages and population structures. The majority of current fungal species descriptions lack even the most basic genetic data that could address at least some of these issues. Such information is essential for accurate fungal identifications, to link critical metadata and to understand the real and potential impact of fungal pathogens on production and natural ecosystems. Because international trade in plant products and introduction of pathogens to new areas is likely to continue, the manner in which fungal pathogens are identified should urgently be reconsidered. The technologies that would provide appropriate information for biosecurity and quarantine already exist, yet the scientific community and the regulatory authorities are slow to embrace them. International agreements are urgently needed to enforce new guidelines for describing plant pathogenic fungi (including key DNA information), to ensure availability of relevant data and to modernize the phytosanitary systems that must deal with the risks relating to trade-associated plant pathogens.This article is part of the themed issue 'Tackling emerging fungal threats to animal health, food security and ecosystem resilience'., (© 2016 The Author(s).)

The incidence of life threatening invasive fungal infections in patients with hematological malignancies during intensive chemotherapy or after hematopoetic stem cell transplantation, patients after solid organ transplantation, ICU patients and premature infants is rising. Mortality rates of invasive fungal infections, caused by Aspergillus species or mucormycetes, may reach 100%, in spite of considerable progress in diagnosis, antifungal prophylaxis and therapy. Comprehensive, profound knowledge of specific diagnostic and current treatment algorithms is essential to improve the prognosis of patients suffering from systemic fungal infections; this article encompasses recent developments in the field of antifungal treatment., (© Georg Thieme Verlag KG Stuttgart · New York.)

Posaconazole, a fluorinated triazole antifungal drug, is approved by the U.S. Food and Drug Administration (FDA) for (1) prophylaxis against Aspergillus and Candida infections in immunocompromised patients at high risk for these infections and (2) oropharyngeal candidiasis (OPC), including cases refractory to fluconazole and/or itraconazole. The European Medicines Agency (EMA) has approved posaconazole for (1) treatment of aspergillosis, fusariosis, chromoblastomycosis, and coccidioidomycosis in patients who are refractory to or intolerant of other azoles or amphotericin B; (2) first-line therapy for OPC for severe disease or in those unlikely to respond to topical therapy; and (3) prophylaxis of invasive fungal infections in high-risk hematologic patients and stem cell transplant recipients. In addition to approved indications, posaconazole has been used with success as salvage therapy for invasive mold infections and endemic mycoses in patients who are refractory to or intolerant of other antifungal agents, and as prophylaxis or salvage therapy in children, for whom indications are more limited owing to a paucity of data. Posaconazole has potent in vitro activity against a broad range of fungi and molds, including Aspergillus, Candida, Cryptococcus, filamentous fungi, and endemic mycoses including coccidioidomycosis, histoplasmosis, and blastomycosis. Importantly, posaconazole is much more active than other azoles against many Mucorales species and the combination of posaconazole with other antifungal agents may be synergistic. Hence, posaconazole is a potential candidate as a single or combination agent for difficult-to-treat fungal infections. Posaconazole has an excellent safety profile; to date, serious side effects are rare, even with prolonged use. However, newer posaconazole formulations achieve higher blood levels and it remains to be seen whether this may lead to an increase in the rate of adverse effects. Currently, posaconazole is used predominantly for prophylaxis and salvage therapy of fungal infections in adults. Indications for use as initial therapy of fungal infections and for broader use in children will depend on the accrual of additional clinical data., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

The incidence of severe fungal infections has increased worldwide and represents a serious threat, especially among immunocompromised and critically ill patients. Most common pulmonary fungal infections include aspergillosis, cryptococcosis, and Pneumocystis jiroveci pneumonia. Among nosocomial bloodstream infections, Candida spp. is the most common isolated fungus. Mortality rates up to 60% in critically ill patients with Candida infections and 90% in hematological patients with invasive aspergillosis are reported. Furthermore, fungal infections contribute to high morbidity and prolonged hospitalizations. Since standard cultural methods can show low sensitivity or provide delayed responses, new non-culture-dependent methods such as galactomannan β-D-glucan are now available. Novel antifungal compounds (e.g., amphotericin B lipid formulations, last-generation azoles, and echinocandins) have been introduced in the recent years. Nevertheless, despite new advances the appropriate use of diagnostic assays along with a thorough therapeutic management remain the key to ensure an early appropriate targeted treatment that represents the crucial factor to attain a successful approach to severe fungal infections., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Voriconazole is an important agent in the antifungal armamentarium. It is the treatment of choice for invasive aspergillosis, other hyaline molds, and many brown-black molds. It is also effective for infections caused by Candida species, including those that are fluconazole resistant, and for infections caused by the endemic mycoses, including those that occur in the central nervous system. It has the advantage of being available in both an intravenous and an oral formulation that is well absorbed. Drawbacks to the use of voriconazole are that it has unpredictable, nonlinear pharmacokinetics with extensive interpatient and intrapatient variation in serum levels. Some of the adverse effects seen with voriconazole are related to high serum concentrations, and, as a result, therapeutic drug monitoring is essential when using this agent. Drug-drug interactions are common, and possible interactions must be sought before voriconazole is prescribed. With prolonged use, newly described adverse effects, including periostitis, alopecia, and development of skin cancers, have been noted., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Dematiaceous fungi (black fungi) are a heterogeneous group of fungi present in diverse environments worldwide. Many species in this group are known to cause allergic reactions and potentially fatal diseases in humans and animals, especially in tropical and subtropical climates. This study represents the first survey of dematiaceous fungi in Malaysia and provides observations on their diversity as well as in vitro response to antifungal drugs. Seventy-five strains isolated from various clinical specimens were identified by morphology as well as an internal transcribed spacer (ITS)-based phylogenetic analysis. The combined molecular and conventional approach enabled the identification of three classes of the Ascomycota phylum and 16 genera, the most common being Cladosporium, Cochliobolus and Neoscytalidium. Several of the species identified have not been associated before with human infections. Among 8 antifungal agents tested, the azoles posaconazole (96%), voriconazole (90.7%), ketoconazole (86.7%) and itraconazole (85.3%) showed in vitro activity (MIC ≤ 1 µg/mL) to the largest number of strains, followed by anidulafungin (89.3%), caspofungin (74.7%) and amphotericin B (70.7%). Fluconazole appeared to be the least effective with only 10.7% of isolates showing in vitro susceptibility. Overall, almost half (45.3%) of the isolates showed reduced susceptibility (MIC >1 µg/mL) to at least one antifungal agent, and three strains (one Pyrenochaeta unguis-hominis and two Nigrospora oryzae) showed potential multidrug resistance.

In recent years, the incidence of fungal infections of the skin, one of the most frequent forms of infection, has been steadily increasing in Europe. One of the main factors contributing to this increase is the gradual raise of migratory flows towards Europe. In the last decades Italy has witnessed an ever-increasing growth of the migrant population, and has become, to this day, one of the European countries with the highest number of immigrants. This phenomenon has had significant implications in clinical practice of dermatologic mycology as it is increasingly common to see unusual clinical isolate causal agents absent in our latitudes until a short time ago. This review provides an update on the epidemiology, classification, pathogenesis, clinical manifestations and treatment of the most important dermato-mycosis observed in the immigrant population, through the most typical cases, investigated by microscopic and cultural findings. These diseases continue to expand and are often difficult to detect. The special relationship between host-environment interaction-parasite plays a crucial role as, even more than in other categories, it is widely widespread among the immigrants.

Fungal infections are the most common opportunistic infections (OI) occurring during the course of HIV infection, though their incidence has decreased dramatically with the introduction of highly active antiretroviral therapy (cART). Most cases occur in untreated patients, noncompliant patients or patients whose multiple antiretroviral regimens have failed and they are a good marker of the severity of cellular immunodepression. Pneumocystis jiroveci pneumonia is the second most frequent OI in France and cryptococcosis remains a major problem in the Southern Hemisphere. With the increase in travel, imported endemic fungal infection can occur and may mimic other infections, notably tuberculosis. Fungal infections often have a pulmonary presentation but an exhaustive search for dissemination should be made in patients infected with HIV, at least those at an advanced stage of immune deficiency. Introduction of cART in combination with anti-fungal treatment depends on the risk of AIDS progression and on the risk of cumulative toxicity and the immune reconstitution inflammatory syndrome (IRIS) if introduced too early. Fungal infections in HIV infected patients remain a problem in the cART era. IRIS can complicate the management and requires an optimised treatment regime., (Copyright © 2013. Published by Elsevier Masson SAS.)

Objective: To evaluate the prevalence of fungal infections (both pre-cannulation and post-cannulation) while on extracorporeal membrane oxygenation support and the associated morbidity and mortality., Design: Retrospective cohort study., Patient and Methods: The Extracorporeal Life Support Organization database is an international voluntary registry of clinical data for patients placed on extracorporeal membrane oxygenation. The database was queried for all patients on extracorporeal membrane oxygenation from 1997 to 2009. Patient and extracorporeal membrane oxygenation data collected included age, support type, length of support, infection status and organism code, discharge status, complications, and component failures. Outcomes of interest were mortality, extracorporeal membrane oxygenation-related patient complications, and mechanical component failures., Results: From 1997 to 2009, there were 21,073 patients' extracorporeal membrane oxygenation runs analyzed of which 12,933 were in the neonatal group (0-30 days), 6,073 were in the pediatric group (31 days to <18 yrs old), and 2,067 were in the adult group (≥18 yrs). The prevalence of fungal infection during extracorporeal membrane oxygenation varied by age group and timing of infection and ranged from 0.04% to 5%. Fungal infections pre-extracorporeal membrane oxygenation and on-extracorporeal membrane oxygenation conferred a statistically significant higher relative risk of mortality for all age groups and varied by support type and timing of infection. Extracorporeal membrane oxygenation-related complications and component failures were not statistically significantly affected by infection status., Conclusions: Fungal infection before or during extracorporeal membrane oxygenation increases the odds of mortality and the magnitude of this effect is dependent upon age-group and timing of infection. This increased mortality was not the result of increased patient or mechanical complications during extracorporeal membrane oxygenation. For patients with fungal infections pre-extracorporeal membrane oxygenation, 82%-89% demonstrated presumed clearance during extracorporeal membrane oxygenation. Although the risk of mortality increased with fungal infections, it does not appear that fungal infection before or during extracorporeal membrane oxygenation is a contraindication to initiation or continuation of support.

There is considerable controversy in the diagnosis and classification of the type of inflammation that is attributed to various forms of chronic rhinosinusitis (CRS). Specimens obtained during surgical treatment of CRS have been invaluable resources for identifying the underlying inflammatory process. The classification of sinus inflammation is based on histopathologic examination of these surgical specimens. Accurate identification of the pathology and standardized reporting are invaluable for postsurgical treatment options and our understanding of CRS. In a large multispecialty referral hospital where multiple surgeons and pathologists are involved in clinical practice, the lack of standardization in specimen collection, specimen processing, and reporting introduce several variables that make it extremely difficult for retrospective analysis. This report focuses on consecutive endoscopic sinus surgical procedures performed by 4 different sinus surgeons over a period of 4 years in a Central Texas multispecialty hospital. This is an analysis of the reality of clinical practice without intervention. At the core of this analysis are pathology reporting practices for fungal sinus disease and the undesirable variables introduced by nonstandardized reporting. A practical classification of CRS based on pathology is proposed., (Copyright © 2012 Elsevier Inc. All rights reserved.)

The classification of human fungal infections in medical reports is sometimes confusing. This occurs because some agents act as opportunistic organisms in immunosuppressed patients, whereas others affect the subcutaneous tissue and also cause disseminated or systemic disease. Finally, some clinically similar infections caused by aerobic actinomycetic bacteria and others caused by parasites (rhinosporidiosis) have been traditionally included in the descriptions of mycotic diseases. This contribution provides the clinician with a classification of subcutaneous, systemic, and opportunistic fungal infections., (Copyright © 2012 Elsevier Inc. All rights reserved.)

There are two main groups of biological agents regarded as occupational hazards: allergenic and/or toxic agents forming bioaerosols, and agents causing zoonoses and other infectious diseases. Bioaerosols occurring in the agricultural work environments comprise: bacteria, fungi, high molecular polymers produced by bacteria (endotoxin) or by fungi (β-glucans), low molecular secondary metabolites of fungi (mycotoxins, volatile organic compounds) and various particles of plant and animal origin. All these agents could be a cause of allergic and/or immunotoxic occupational diseases of respiratory organ (airways inflammation, rhinitis, toxic pneumonitis, hypersensitivity pneumonitis and asthma), conjunctivitis and dermatitis in exposed workers. Very important among zoonotic agents causing occupational diseases are those causing tick-borne diseases: Lyme borreliosis, anaplasmosis, babesiosis, bartonellosis. Agricultural workers in tropical zones are exposed to mosquito bites causing malaria, the most prevalent vector-borne disease in the world. The group of agents causing other, basically not vector-borne zoonoses, comprises those evoking emerging or re-emerging diseases of global concern, such as: hantaviral diseases, avian and swine influenza, Q fever, leptospiroses, staphylococcal diseases caused by the methicillin-resistant Staphylococcus aureus (MRSA) strains, and diseases caused by parasitic protozoa. Among other infectious, non-zoonotic agents, the greatest hazard for health care workers pose the blood-borne human hepatitis and immunodeficiency viruses (HBV, HCV, HIV). Of interest are also bacteria causing legionellosis in people occupationally exposed to droplet aerosols, mainly from warm water.

A survey of the incidence of clinically diagnosed cases of superficial mycosis was carried out using individual report cards in four Family Health units in Patos-PB, in 2007. We had a sample of 197 positive records with Pityriasis and Tinea as the most incident mycoses. There was a higher prevalence among female patients who were between 11 - 20 years of age. A high number of non-identified infections was found: 46,19%. The identification of the agents of such non-identified infections is not possible as they are not infections of compulsory notification.

In principle, one has to differentiate between a mere colonization and an invasive fungal infection (IFI) with quite different clinical manifestations and consequences. If the term invasive were used in its proper sense (expressis verbis), all fungal infections could be called invasive, even a fungal keratitis or an infection of the hairs by dermatophytes. In general, however, the term IFI is used only to characterize systemic, generalized, deep-seated, visceral and severe, life-threatening fungal infections, in contrast to superficial, local, benign, self-limiting fungal diseases. The term IFI as used generally is thus misleading, confusing, and not at all helpful to correctly differentiate mild, moderate, and severe fungal infections., (Copyright 2009 International Society for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)

Unlabelled: Amphotericin B deoxycholate is associated with infusion-related toxicity and renal toxicity., Purpose: To evaluate medical indications of this compound in a tertiary care center, analyze adverse reactions, infusion protocols and outcome of treated patients., Patients and Methods: Retrospective analysis of 39 treatments indicated in 33 patients during 2007, exploring indications, infusion protocols and renal protective measures, infusion-related adverse reactions, nephrotoxicity, hypokalemia and outcomes., Results: On average, therapy lasted 12 days (2 to 39) and reached 600 mg of accumulated dose (100 to 1950) respectively. 24-hours infusions were applied in 63.2% of prescriptions and 35.9% received a 4-6 hour infusion schedule. In addition, 36.8% received daily a saline infusion before amphotericin. Adverse reactions were observed in 40% of treatments, predominating fever (25%). Nonetheless, nephrotoxicity was infrequent (9.4%), of low magnitude, only affecting patients without previous renal disease, and not requiring dialysis. Hypokalemia developed in 21.6% of treatments. More than half of medical indications were empirical (59%), for presumed infections by either filamentous fungi or yeasts. In the subgroup with microbiological information, main indications were invasive aspergillosis (15.4% of total), systemic candidiasis (12.8%) or meningeal cryptococcosis (10.3%). A favorable response was registered in 41%, and only 48.5% of patients survived. In a multivariate analysis, only age > 60 years remained as an independent factor for developing infusion-related adverse reactions. In the same manner, a SOFA score > 3 and corticosteroids administration at the same time than amphotericin B, were independently associated to a fatal outcome., Conclusion: infusion-related adverse reactions are frequent during amphotericin B deoxycholate therapy, but renal toxicity is occasionally observed. Amphotercin B was used mainly as empirical therapy in this study.

Background: Fungal (rhino-) sinusitis encompasses a wide spectrum of immune and pathological responses, including invasive, chronic, granulomatous, and allergic disease. However, consensus on terminology, pathogenesis, and optimal management is lacking. The International Society for Human and Animal Mycology convened a working group to attempt consensus on terminology and disease classification., Discussion: Key conclusions reached were: rhinosinusitis is preferred to sinusitis; acute invasive fungal rhinosinusitis is preferred to fulminant, or necrotizing and should refer to disease of <4 weeks duration in immunocompromised patients; both chronic invasive rhinosinusitis and granulomatous rhinosinusitis were useful terms encompassing locally invasive disease over at least 3 months duration, with differing pathology and clinical settings; fungal ball of the sinus is preferred to either mycetoma or aspergilloma of the sinuses; localized fungal colonization of nasal or paranasal mucosa should be introduced to refer to localized infection visualized endoscopically; eosinophilic mucin is preferred to allergic mucin; and allergic fungal rhinosinusitis (AFRS), eosinophilic fungal rhinosinusitis, and eosinophilic mucin rhinosinusitis (EMRS) are imprecise and require better definition. In particular, to implicate fungi (as in AFRS and EMRS), hyphae must be visualized in eosinophilic mucin, but this is often not processed or examined carefully enough by histologists, reducing the universality of the disease classification. A schema for subclassifying these entities, including aspirin-exacerbated rhinosinusitis, is proposed allowing an overlap in histopathological features, and with granulomatous, chronic invasive, and other forms of rhinosinusitis. Recommendations for future research avenues were also identified.

Purpose of Review: This review is timely and relevant because rhinosinusitis is a disease process that is heterogeneous in its clinical and pathologic manifestations. Therefore, no one causative factor has been identified that fully accounts for all rhinosinusitis. The purpose of this review is to provide a succinct update of rhinosinusitis classification, pathophysiology, and management given the new movement toward evidence-based guidelines., Recent Findings: The term rhinosinusitis reflects the concurrent inflammatory and infectious processes that affect the nasal passages and the contiguous paranasal sinuses. The most recent classification scheme is intended primarily to guide clinical research and divides rhinosinusitis into four categories: acute bacterial rhinosinusitis, chronic sinusitis with nasal polyposis, chronic rhinosinusitis with nasal polyposis, and allergic fungal rhinosinusitis. The goals of treatment include reduction of mucosal edema, reestablishment of sinus ventilation, and eradication of infecting pathogens. Multiple therapies are available for the management of chronic rhinosinusitis, including antibiotics, hypertonic and isotonic saline irrigations or sprays, topical and systemic glucocorticords, antileukotriene agents, and endoscopic sinus surgery., Summary: Rhinosinusitis is a common medical problem that interferes with patient quality of life and loss of work productivity. Because of the heterogeneity that underlies its pathology, no one treatment regimen exists for the management of rhinosinusitis.

Aims: Clinical presentation can provide a clue to the subcategories of fungal rhinosinusitis (FRS); however, tissue examination provides accurate classification. The aim was to analyse the incidence and histopathological spectrum of FRS., Methods and Results: A retrospective analysis of all the cases of rhinosinusitis reported in the last 5 years was carried out. Haematoxylin and eosin-stained sections along with special stains such as periodic acid-Schiff and Grocott's were examined. These cases were subclassified based on the presence of allergic mucin, mycelial elements and tissue reaction. Out of a total of 665 cases of rhinosinusitis, 284 (42.7%) were of FRS. On histopathological examination they were broadly categorized as: (i) non-invasive FRS (n = 171, 60.2%), which included 160 cases (56.3%) of allergic fungal rhinosinusitis (AFRS) and eleven (3.9%) of fungal ball; (ii) invasive FRS (n = 101, 35.6%), which included 48 cases (16.9%) of chronic invasive granulomatous FRS, four (1.4%) of chronic invasive FRS and 49 (17.3%) of acute fulminant FRS; and (iii) mixed pattern FRS, comprising 12 cases (4.25%)., Conclusions: AFRS is the most common type of FRS. Cases with mixed reaction pattern suggest that different types of FRS represent a progressive spectrum of disease. An exact histopathological categorization of FRS is important as regards treatment.

Deaths caused by systemic mycoses such as paracoccidioidomycosis, cryptococcosis, histoplasmosis, candidiasis, aspergillosis, coccidioidomycosis and zygomycosis amounted to 3,583 between 1996-2006 in Brazil. When analysed as the underlying cause of death, paracoccidioidomycosis represented the most important cause of deaths among systemic mycoses (approximately 51.2%). When considering AIDS as the underlying cause of death and the systemic mycoses as associated conditions, cryptococcosis (50.9%) appeared at the top of the list, followed by candidiasis (30.2%), histoplasmosis (10.1%) and others. This mortality analysis is useful in understanding the real situation of systemic mycoses in Brazil, since there is no mandatory notification of patients diagnosed with systemic mycoses in the official health system.

Recent years have seen the release of multiple new systemic antifungal agents, significantly increasing options for the treatment of most serious fungal infections. Newly available drugs include those in the echinocandin class, including caspofungin, micafungin, and anidulafungin, as well as the newer generation triazoles, voriconazole and posaconazole. Ordering of these agents is variably restricted, depending on a given institution's policies, and all are costly. In this review we examine the available evidence and outline the role of newer antifungal medications in several common and/or important situations, including invasive and mucocutaneous Candida infection, febrile neutropenia, invasive aspergillosis, zygomycosis, and endemic mycoses.

Though rhinosinusitis is a common disorder, controversies surround the categorization of chronic rhinosinusitis (CRS) and the role of fungus in CRS. The diagnosis of each category is important for optimum therapy and predicting the course. Based on histopathological findings, fungal rhinosinusitis (FRS) can be broadly divided into two categories: the invasive and non-invasive depending on invasion of the mucosal layer. Three types of FRS are tissue-invasive: acute invasive, chronic invasive, & granulomatous. The two non-invasive FRS disorders are fungal ball, and fungus related eosinophilic rhinosinusitis including allergic fungal rhinosinusitis (AFRS). The distinction of granulomatous from chronic invasive type is not beyond controversy as both types have a chronic course and predominant orbital involvement. Maximum confusion surrounds the entity of fungus-related eosinophilic rhinosinusitis, and the definition of AFRS. In the diagnosis of AFRS, the detection of fungi in allergic mucin is considered important, although hyphae are sparse in sinus content. This leads to confusion in definition of this entity, especially with the description of two more closely related entities--eosinophilic fungal rhinosinusitis (EFRS) and eosinophilic mucin rhinosinusitis (EMRS). Recently reports of histologic invasion in possible cases of AFRS were also documented. Currently, there are more questions than answers concerning the categorization of FRS.

During our investigations of the microflora in NRW (Duisburg, Düsseldorf and Essen incl. the greenhouse of the Botanical Garden) in 2007 and 2008, we were able to collect and identify about 55 species on trees, bushes and ornamental plants as parasites and saprophytes. Some of these species are new for Germany or have been only rarely found until now. Most of the species belong the Ascomycotina, Basidiomycotina and Deuteromycotina for example Arthrocladiella mougeotii (Lév.) Vassilkov. on Lycium barbarum L., Caudospora taleola (Fr.) Starb on Quercus robur L., Colletotrichum coffeanum F. Noak on Coffea arabica L. (new for Germany) Colletotrichum trichellum (Fr.) Duke on Hedera helix L., Erysiphe buhrii U. Braun on Lychnis cf. coronaria (L.) Desr. (Anamorph. Oidium dianthi Jacz.), Erysiphe spec. on Acer opalus Mill (new host), Erysiphe flexuosa (Peck) U. Braun & S. Takam. on Aesculus spec. (new for Europe)), Erysiphe heraclei DC. on Tinguarra montana (Webb ex Christ ) A.Hansen & G.Kunkel, Erysiphe necator Schwein. = Uncinula necator (Schwein.) Burrill on Cissus cf. rhombifolia Vahl. (new for NRW), Erysphe trifolii Grev. on Trigonella caerulea (L.) Ser., Golovinomyces cichoracearum (DC.) V.P.Gelyuta (Oidium spec.) on Argyranthemum pinnatifidum (L.f.) R.T. Lowe (new host), Lobatopedis foliicola P.M. Kirk on Quercus robur L. (new for NRW), Lophodermium juniperinum (Fr.) de Not. on Juniperus communis L., Mamiania coryli De Not. on Corylus avellana L., Marssonina juglandis (Lib.) Magnus on Juglans regia L., Oidium hortensia Jørst on Philadelphus coronarius L., Oidium spec. on Dahlia variabilis (Willd.) Desf. (new for Germany), Oidium longipes Noordeloos & Loerak on Petunia hybrida Vilm., Oidium pedilanthi M. Yen on Pedilanthus titymaloides (L.) Poit, Oidium pedaliacearum H.D. Shin sp. nov. (= Oidium sesami H.D. Shin) on Ibicella lutea (Lindl.) van Eselt. (= Martynia lutea Lindl.), Passalora pastinacae (Sacc.) U. Braun = Pseudocercosporella pastinacae (P. Karst.) U. Braun (new for Germany) on Pastinaca sativa L., Podosphaera tridactyla (WalIr.) de Bary on Prunus laurocerasus L., Septoria cornicola Desm. on Cornus sanguinea L., Stigmina tinea (Sacc.) M.B.Ellis on Viburnum opulus L., Torula herbarum (Pers.) Link on Potentilla argentea L., etc. All species are located in the herbarium Mycotheca parva collection G.B. Feige and N. Ale-Agha.

Background: Invasive fungal diseases are important causes of morbidity and mortality. Clarity and uniformity in defining these infections are important factors in improving the quality of clinical studies. A standard set of definitions strengthens the consistency and reproducibility of such studies., Methods: After the introduction of the original European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) Consensus Group definitions, advances in diagnostic technology and the recognition of areas in need of improvement led to a revision of this document. The revision process started with a meeting of participants in 2003, to decide on the process and to draft the proposal. This was followed by several rounds of consultation until a final draft was approved in 2005. This was made available for 6 months to allow public comment, and then the manuscript was prepared and approved., Results: The revised definitions retain the original classifications of "proven," "probable," and "possible" invasive fungal disease, but the definition of "probable" has been expanded, whereas the scope of the category "possible" has been diminished. The category of proven invasive fungal disease can apply to any patient, regardless of whether the patient is immunocompromised, whereas the probable and possible categories are proposed for immunocompromised patients only., Conclusions: These revised definitions of invasive fungal disease are intended to advance clinical and epidemiological research and may serve as a useful model for defining other infections in high-risk patients.

We sought to determine the approach to antifungal prophylaxis, and diagnostic and therapeutic practices for the management of invasive aspergillosis in liver transplant recipients. Data were collected by an electronic survey questionnaire sent to all active liver transplant programs in North America; 63% (67/106) of the sites completed the survey. Overall, 91% of the sites employed antifungal prophylaxis; 28% used universal prophylaxis and 72% targeted it toward high-risk patients. Fluconazole was the most commonly used agent for universal and targeted prophylaxis. The leading choice for mold-active agents for antifungal prophylaxis was the echinocandins. Combination therapy was used as primary therapy for invasive aspergillosis in 47%, and as salvage in 80%. Thus, a vast majority of the surveyed programs employ antifungal prophylaxis and most use targeted prophylaxis. Consideration of these practices could guide clinical trial design to optimize antifungal prophylaxis in these patients. Our findings also merit investigations to better define the role of diagnostic assays and combination therapeutic strategies for invasive aspergillosis in liver transplant recipients.

Introduction: Fungal infection is increasingly common in critical illness with severe sepsis, but the influence of invasive fungal infection (IFI) on severe sepsis is not well understood. The aim of this study was to investigate the impact that IFI has on the outcomes of critically ill surgical patients with severe sepsis in China by means of matched cohort analysis; we also evaluated the epidemiologic characteristics of IFI in this population., Methods: Records for all admissions to 10 university hospital surgical intensive care units (ICUs) from December 2004 to November 2005 were reviewed. Patients who met criteria for severe sepsis were included. IFI was identified using established criteria based on microbiologic or histological evidence. A matched cohort study was conducted to analyze the relationship between IFI and outcomes of severe sepsis., Results: A total of 318 patients with severe sepsis were enrolled during the study period, of whom 90 (28.3%) were identified as having IFI. A total of 100 strains of fungi (58% Candida albicans) were isolated from these patients. Independent risk factors for IFI in patients with severe sepsis included mechanical ventilation (>3 days), Acute Physiology and Chronic Health Evaluation score, coexisting infection with both gram-positive and gram-negative bacteria, and urethral catheterization (>3 days). Compared with the control cohort, IFI was associated with increased hospital mortality (P < 0.001), high hospital costs (P = 0.038), and prolonged stay in the ICU (P < 0.001) and hospital (P = 0.020)., Conclusion: IFI is frequent in patients with severe sepsis in surgical ICUs and is associated with excess risk for hospital mortality, longer ICU and hospital stays, and greater consumption of medical resources.

The Congo red staining properties of Candida organisms in clinical tissue specimens have not, to the best of our knowledge, previously been reported. The objective of this study was to determine if the Congo red staining characteristics of Candida vs. Histoplasma, Pityrosporum and Blastomyces could provide useful diagnostic information. Archival tissue specimens that contained Histoplasma, Pityrosporum, Candida and Blastomyces were stained with Congo red. The results of the Congo red staining were compared with the diagnoses which were originally rendered on the tissue. Nine out of nine cases (100%) of Blastomyces were Gomori methenamine silver (GMS) positive and Congo red positive, seven out of seven cases (100%) of Histoplasma were GMS positive and Congo red negative, and eight out of eight cases (100%) that had Pityrosporum were GMS positive and Congo red positive; these results corroborate with previously described staining patterns for each respective organism. Nine out of nine cases (100%) that had Candida were GMS positive and Congo red negative. Differential Congo red staining of Candida organisms can provide a rapid and accurate method of diagnosis in tissue specimens vs. Blastomyces and Pityrosporum, but not vs. Histoplasma.

Sequence analysis provides a valuable alternative to phenotypic identification of moulds, especially for isolates lacking characteristic morphology. In this comparative prospective study, isolates that could not be identified by standard phenotypic criteria within 5 days (n = 244) were subjected to sequence analysis and further in-depth phenotypic investigations. Comparison of sequence-based with extended phenotypic identification revealed that sequence analysis was more precise in 52.0% of the isolates; in 38.6% of the isolates, both methods gave concordant results. The construction of a database consisting of high-quality sequences allowed improvement of sequence-based identification. Based on these results, we propose a diagnostic algorithm for the effective use of both phenotypic and genetic procedures for identification of moulds in the diagnostic laboratory.

Fungal sinusitis was once considered a rare disorder but is now reported with increasing frequency throughout the world. The classification of fungal sinusitis has evolved in the past two decades, and this entity is now thought to comprise five subtypes. Acute invasive fungal sinusitis, chronic invasive fungal sinusitis, and chronic granulomatous invasive fungal sinusitis make up the invasive group, whereas noninvasive fungal sinusitis is composed of allergic fungal sinusitis and fungus ball (fungal mycetoma). These five subtypes are distinct entities with different clinical and radiologic features. The treatment strategies for the subtypes are also different, as are their prognoses. An understanding of the different types of fungal sinusitis and knowledge of their particular radiologic features allow the radiologist to play a crucial role in alerting the clinician to use appropriate diagnostic techniques for confirmation. Prompt diagnosis and initiation of appropriate therapy are essential to avoid a protracted or fatal outcome., ((c) RSNA, 2007.)

The Second FEBS Advanced Lecture Course on Human Fungal Pathogens: Molecular Mechanisms of Host-Pathogen Interactions and Virulence, organized by Christophe d'Enfert (Institut Pasteur, France), Anita Sil (UCSF, USA), and Steffen Rupp (Fraunhofer, IGB, Germany), occurred May 2007 in La Colle sur Loup, France. Here we review the advances presented and the current state of knowledge in key areas of fungal pathogenesis.

A Nordic External Quality Assessment programme in medical mycology was established in 2005. In order to monitor not 'best practice' but the level of routine diagnostics, specimens were designed to resemble clinical samples and laboratories were asked to handle the samples like routine samples. Five simulated clinical samples were distributed to 59 participating Nordic laboratories of clinical microbiology. The specimens contained the following microorganisms: 1) Candida glabrata and C. albicans in a ratio of 1:20; 2) Cryptococcus neoformans; 3) Aspergillus fumigatus, C. albicans and Enterobacter cloacae; 4) C. tropicalis, Klebsiella pneumonia and Enterococcus faecium; 5) None. 66% of the laboratories failed to detect the C. glabrata isolate in sample no. 1. 34% of the laboratories reporting susceptibility results incorrectly reported the Cryptococcus neoformans isolate as fluconazole susceptible. 24% of the laboratories failed to detect Aspergillus fumigatus in specimen no. 3 despite the accompanying clinical information notifying that it was a BAL sample from a neutropenic patient in an ICU. In conclusion, this distribution of simulated clinical samples illustrates that the traditional quality assessment programmes may give a false sense of satisfactory performance, that mycological diagnosis is difficult, and that there is a need of further improvement and attention.

Background and Objectives: The aim of this study was to evaluate the incidence and outcome of invasive fungal infections (IFI) in patients with hematologic malignancies., Design and Methods: This was a retrospective cohort study of patients admitted between 1999 and 2003 to 18 hematology wards in Italy. Each participating center provided information on all patients with newly diagnosed hematologic malignancies admitted during the survery period and on all episodes of IFI experienced by these patients., Results: The cohort was formed of 11,802 patients with hematologic malignacies: acute leukemia (myeloid 3012, lymphoid 1173), chronic leukemia (myeloid 596, lymphoid 1104), lymphoma (Hodgkin's 844, non-Hodgkin's 3457), or multiple myeloma (1616). There were 538 proven or probable IFI (4.6%); 373 (69%) occurred in patients with acute myeloid leukemia. Over half (346/538) were caused by molds (2.9%), in most cases Aspergillus spp. (310/346). The 192 yeast infections (1.6%) included 175 cases of candidemia. Overall and IFI-attributable mortality rates were 2% (209/11802) and 39% (209/538), respectively. The highest IFI-attributable mortality rates were associated with zygomycosis (64%) followed by fusariosis (53%), aspergillosis (42%), and candidemia (33%)., Interpretation and Conclusions: Patients with hematologic malignancies are currently at higher risk of IFI caused by molds than by yeasts, and the incidence of IFI is highest among patients with acute myeloid leukemia. Aspergillus spp are still the most common pathogens, followed by Candida spp. Other agents are rare. The attributable mortality rate for aspergillosis has dropped from 60-70% to approximately 40%. Candidemia-related mortality remains within the 30-40% range reported in literature although the incidence has decreased.

Prevention of invasive fungal infections (IFIs) in orthotopic liver transplant (OLT) recipients utilizing postoperative systemic antifungal prophylaxis, typically with fluconazole, is justified among those at high risk for IFI. Use of postoperative antifungal prophylaxis for low-risk OLT recipients is widely practiced but not universally accepted nor supported by data. We conducted a prospective observational study among 200 OLT recipients who were at low risk for IFI and did not receive postoperative antifungal prophylaxis. Patients were considered low risk if they had /=units of 40 blood products or return to the operating room for intra-abdominal bleeding; return to the operating room for anastomotic leak or vascular insufficiency; preoperative serum creatinine of >/=2 mg/dL; and perioperative Candida colonization. Patients were followed 100 d post-transplantation for evidence of IFI. Of 193 eligible patients, 7 (4%) developed an IFI. Three (2%) IFIs were due to Candida spp. and potentially preventable by standard fluconazole prophylaxis. Three patients developed invasive aspergillosis; one developed late onset disseminated cryptococcosis. Liver transplant recipients at low risk for IFI can be identified utilizing pre-determined criteria, and post-transplantation antifungal prophylaxis can be routinely withheld in these patients.

This paper presents the results of the researches carried out on the subject of the diseases on herbs such as lemon balm and peppermint focusing on the health status of the plants grown in the region of Malopolska. The field and laboratory research proved that perpetrators of the diseases on the examined plants were fungi species with the numerical majority. On lemon balm septoria leaf spot (Septoria melissae) was most often observed. Moreover, fungal genera of different taxonomic groups were detected. Alternaria, Epicoccum, Fusarium, and Sclerotinia sclerotiorum occurred most often on the medicinal plant samples. The disease mint rust Puccinia menthae, has caused major problems for the peppermint growers. In the populations of fungi found on the diseased leaves the dominating were Alternaria, Epicoccum and Sphaceloma menthae. It has been stated that among all fungi isolated from lemon balm, the species Fusarium avenaceum had the highest pathogenicity to seedlings (80% of diseased seedlings). For peppermint plants the highest pathogenicity had species Epicoccum purpurascens, and caused 82% of diseased seedlings. Conducted evaluation of health status of plants showed that the lemon balm mean disease index was yearly differentiated and was the highest in 2003 (44.39). For peppermint, the highest disease index was in third year of cultivation (62.75) and was statistically higher than in previous years.

A stepwise evaluation of patients who have CRS allows a management approach that is tailored to each individual patient and to the specific type of disease.

Introduction: Graft rejection and infection remain major morbidities following orthotopic liver transplantation (OLT). Rejection treatment may be associated with an increased rate of infectious complications. The aim of this study was to determine the relationship between rejection, rejection therapy and the risk of associated infections., Materials and Methods: A retrospective study of all adult patients undergoing OLT between July 1987 and July 1997 at a single university medical centre was carried out. Data for all transplant recipients were collected using predetermined definitions for infectious complications., Results: One hundred OLTs were performed on 98 patients (two patients received a second transplant). The cohort consisted of 33 women and 65 men with a mean age of 47 years. Seventy-eight patients developed a total of 228 infectious episodes: 107 bacterial, 101 viral, 17 fungal and 3 protozoan. The majority of infections occurred within the first month of OLT. Thirty patients without rejection developed 42 infectious episodes, whereas 70 patients with at least one treated rejection episode developed 186 infectious episodes. The overall rate of infection was 44.4 episodes per 1000 patient-days in the 30 days before rejection, and 94.4 episodes per 1000 patient-days in the 30 days following rejection treatment., Conclusions: Infections occurred more frequently during the first month post-transplantation. Following OLT, rejection is associated with a higher incidence of infection, mainly of viral origin, concurrent with increased immunosuppressive therapy.

Objective: To assess the impact of documented and clinically suspected bacterial infection precipitating ICU admission on in-hospital mortality in patients with hematological malignancies., Design and Setting: Prospective observational study in a 14-bed medical ICU at a tertiary university hospital., Patients: A total of 172 consecutive patients with hematological malignancies admitted to the ICU for a life-threatening complication over a 4-year period were categorized into three main groups according to their admission diagnosis (documented bacterial infection, clinically suspected bacterial infection, nonbacterial complications) by an independent panel of three physicians blinded to the patient's outcome and C-reactive protein levels., Results: In-hospital and 6-months mortality rates in documented bacterial infection (n=42), clinically suspected bacterial infection (n=40) vs. nonbacterial complications (n=90) were 50.0% and 42.5% vs. 65.6% (p=0.09 and 0.02) and 56.1% and 48.7% vs. 72.1% (p=0.11 and 0.02), respectively. Median baseline C-reactive protein levels in the first two groups were 23 mg/dl and 21.5 mg/dl vs. 10.7 mg/dl (p<0.001 and p=0.001) respectively. After adjustment for the severity of critical and underlying hematological illness and the duration of hospitalization before admission documented (OR 0.20; 95% CI 0.06-0.62, p=0.006) and clinically suspected bacterial infection (OR 0.18; 95% CI 0.06-0.53, p=0.002) were associated with a more favorable outcome than nonbacterial complications., Conclusions: Severely ill patients with hematological malignancies admitted to the ICU because of documented or clinically suspected bacterial infection have a better outcome than those admitted with nonbacterial complications. These patients should receive advanced life-supporting therapy for an appropriate period of time.

In recent years, mycoses have emerged as important infections in clinical practice. This phenomenon is explained by the ever growing number of immunocompromised patients and the increasing number of people travelling in areas where fungal diseases are endemic. Head and neck infections are common in disseminated mycoses and may simulate carcinoma or cause upper airway obstruction. The most frequent causative yeasts or yeast-like organisms include Candida albicans, Cryptococcus neoformans, Histoplasma capsulatum var capsulatum, Blastomyces dermatitidis, Paracoccidioides brasiliensis and Coccidioides immitis. Other causative fungal pathogens include Aspergillus fumigatus and less frequently, Rhizopus oryzae and Rhinosporidium seeberi. Since in most cases their pathophysiology is similar, those microorganisms share a common clinical pathological presentation. Symptoms such as dysphonia or dysphagia associated with hyperplastic and ulcerative lesions on endoscopic examination should prompt biopsies. A purulent or granulomatous inflammatory tissue reaction with pseudoepitheliomatous hyperplasia warrants caution since it may lead to a mistaken diagnosis of carcinoma. The pathologist must look carefully for microorganisms with Grocott and PAS stains. The causative agent can be identified if the pathologist is aware of the risk. Positive culture is needed to institute adequate treatment.