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Background The HIV pandemic continues to cause a high burden of morbidity and mortality due to delayed diagnosis. Histoplasmosis is prevalent in Latin America and Colombia, is difficult to diagnose and has a high mortality. Here we determined the clinical characteristics and risk factors of histoplasmosis in people living with HIV (PLWH) in Pereira, Colombia. Materials and methods This was a retrospective cross-sectional study (2014–2019) involving two tertiary medical centers in Pereira, Colombia. People hospitalized with HIV were included. Histoplasma antigen detection was performed in urine samples. Probable histoplasmosis was defined according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group/National Institute of Allergy and Infectious Diseases Mycoses Study Group criteria. Results 172 HIV-infected patients were analyzed. Histoplasmosis was confirmed in 29% (n = 50/172) of patients. The logistic regression analysis showed that the risk factors for histoplasmosis were pancytopenia (OR 4.1, 95% CI 1.6–10.3, P = 0.002), 46 IU/L (OR 3.2, 95% CI 1.3–8, P = 0.010). Conclusions Histoplasmosis is highly prevalent in hospitalized patients with HIV in Pereira, Colombia. The clinical findings are nonspecific, but there are some clinical abnormalities that can lead to suspicion of the disease, early diagnosis and prompt treatment. Urine antigen detection is useful for diagnosis, but is not widely available. An algorithmic approach is proposed for low-resource clinical settings.

As neutropenic patients with haematological cancer are not typically included in randomized controlled trials (RCTs) of candidaemia, there is low quality of evidence regarding the management of this common opportunistic mycosis in this patient population, which is at high risk for poor outcomes. Herein we identify the gaps in knowledge that are not addressed by the modern RCTs and candidaemia guidelines, and outline some considerations for the future clinical research agenda in candidaemia/invasive candidiasis in haematological patients.

Background As the global coronavirus pandemic (COVID-19) spreads across the world, new clinical challenges emerge in the hospital landscape. Among these challenges, the increased risk of coinfections is a major threat to the patients. Although still in a low number, due to the short time of the pandemic, studies that identified a significant number of hospitalised patients with COVID-19 who developed secondary fungal infections that led to serious complications and even death have been published. Objectives In this scenario, we aim to determine the prevalence of invasive fungal infections (IFIs) and describe possible associated risk factors in patients admitted due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Patients/methods We designed an open prospective observational study at the Rey Juan Carlos University Hospital (Mostoles, Spain), during the period from February 1 to April 30, 2020. Results In this article, we reported seven patients with COVID-19-associated pulmonary aspergillosis (CAPA) who had a poor prognosis. Severely ill patients represent a high-risk group; therefore, we must actively investigate the possibility of aspergillosis in all of these patients. Larger cohort studies are needed to unravel the role of COVID-19 immunosuppressive therapy as a risk factor for aspergillosis. Conclusions As the pandemic continues to spread across the world, further reports are needed to assess the frequency of emergent and highly resistant reemergent fungal infections during severe COVID-19. These coinfections are leading a significant number of patients with COVID-19 to death due to complications following the primary viral disease.

Talaromycosis marneffei (Penicilliosis marneffei) caused by a thermally dimorphic fungus, Talaromyces (Penicillium) marneffei is emerging as an important systemic opportunistic mycosis in HIV infected patients in several countries in Southeast Asia and in northeast India. This study presents an update on epidemiological and clinical aspects of talaromycosis marneffiei in India. A thorough search of literature was done in Medline, PubMed, and Google Scholar, for accessing relevant data. Fifty-three cases of this disease have originated from the Manipur State. Several cases have been reported from Assam, a few are also known from Meghalaya, Mizoram, Nagaland, Sikkim, Delhi and Maharashtra. Clinical manifestations of disseminated infection in AIDS patients are fever, anemia, weight loss, weakness, lymphadenopathy, hepatosplenomegaly, respiratory signs, and characteristic skin lesions. The bamboo rat (Cannomys badius) has been found to be a natural host of Talaromyces (Penicillium) marneffei in Manipur. It is noteworthy that one of the ten T. marneffei isolates from bamboo rats shared the genotype with a human isolate from that area providing evidence for common source of infection for the rats and humans and host to host transmission. Natural reservoir of T. marneffei has not been established, though it has been demonstrated that the fungus can survive in sterile soil for several weeks, but only for a few days in unsterile soil. There is need for comprehensive investigation of T. marneffei infection in humans, and for occurrence of the fungus in bamboo rats and in soils of the rat burrows in India employing conventional and molecular techniques.

This report describes the isolation of two environmental fungi: Rhodotorula mucilaginosa and Trichosporon jirovecii accompanied by Pseudomonas aeruginosa and Escherichia coli from a dog with bronchotracheitis. All microorganisms were isolated routinely from a mucopurulent discharge, obtained during bronchoscopy from laryngotracheal area. The initial identification of yeasts was confirmed by API Candida and by molecular analysis of internal transcribed spacer region. Administered antimicrobial treatment with Marbofloxacin and Canizol has brought the improvement in the dogs' health status. The final results of control mycological culture were negative. Most probably underlying hypothyroidism and the use of steroids were the factors predisposing this patient to opportunistic infection of mixed aetiology. As far as we are concerned, this is the first case of dogs' respiratory tract infection caused by R. mucilaginosa and T. jirovecii.

Invasive Candidiasis (IC) and candidemia (as its most frequent manifestation) have become the main cause of opportunistic mycosis at hospital settings. This study, made by members of the Colombian Association of Infectious Diseases (ACIN), was aimed at providing a set of recommendations for the management, follow-up and prevention of IC / candidemia and mucous membrane candida infection in adult, pediatric and neonatal patients in a hospital setting, including the hemato-oncological and critical care units. All the data obtained through an exhaustive search were reviewed and analyzed in a comprehensive manner by all the members of the group, and the recommendations issued are being made after a careful review of the scientific literature available and the consensus of all specialists involved; the emergence of Candida Spp. problem is highlighted and a correct orientation to health professionals regarding the management of patients with candidiasis is provided in a rational and practical way, emphasizing patient evaluation, diagnostic strategies, prophylaxis, empirical treatment, directed treatment and preventative therapy. Resumen La Candidiasis Invasora (CI) y la candidemia, como su manifestación más frecuente, se ha convertido en la principal causa de micosis oportunista a nivel hospitalario. Este manuscrito realizado por miembros de la Asociación Colombiana de Infectología (ACIN), tuvo como objetivo proporcionar un conjunto de recomendaciones para manejo, seguimiento y prevención de la CI/candidemia y de la infección candidiásica de mucosas, en población adulta, pediátrica y neonatal, en un entorno hospitalario, incluyendo las unidades hemato-oncológicas y unidades de cuidado crítico. Todos los datos obtenidos mediante una búsqueda exhaustiva, fueron revisados y analizados de manera amplia por todos los miembros del grupo, y las recomendaciones emitidas se elaboraron luego de la evaluación de la literatura científica disponible, y el consenso de todos los especialistas involucrados, reconociendo el problema de la emergencia de las infecciones por Candida Spp. y brindando una correcta orientación a los profesionales de la salud sobre el manejo de pacientes con enfermedad candidiásica, de una forma racional y práctica, enfatizando en la evaluación del paciente, estrategias de diagnóstico, profilaxis, tratamiento empírico, tratamiento dirigido y terapia preventiva.

AIM: Candidiasis is the leading opportunistic mycosis in HIV and AIDS patients. METHOD: In order to determine its prevalence in patients with different CD4+ T cell categories in the Nylon Health District in Douala, a cross-sectional study was carried out whereby 304 HIV positive individuals were recruited between March and August, 2007. They were divided into two groups; those on highly active antiretroviral therapy (HAART) and those not on HAART. Three samples constituting mouth, vaginal/urethral swabs and urine were collected from each subject. RESULTS: A total of 204 (67.1%) [95% confidence interval (CI): 0.618-0.724] of these patients had more than one predisposing condition to candidiasis, with those on antibiotic therapy having the highest prevalence (63.7%) followed by pregnant patients (7.3%) (P < 0.05). Candidiasis was more common in patients with low CD4+ T cell count (

Aspergillus is a ubiquitous fungus which can cause a variety of clinical syndromes. This fungus has emerged as agent of systemic infections and has therefore gained considerable public health importance. This paper describes two cases of invasive aspergillosis caused by A. fumigatus in immuno-suppressed patients and underscores the importance of early identification of Aspergillus infection associated with systemic lupus erythematosus and cardiac postoperative complications.

Fusariosis, an emerging opportunistic mycosis caused by Fusarium species, carries a high mortality rate in immunocompromised patients. The dismal prognosis of patients with fusariosis is aggravated by the limited therapeutic options. Here we give an overview of the epidemiology, pathogenesis, clinical manifestations, antifungal susceptibility and management of fusariosis.

The report on CNS Pseudallescheria boydii infection from Turkey by Alpaydin et al. [1] is very interesting. Alpaydin et al. reported a female patient with disseminated Pseudallescheria boydii species complex infection. The patient also has CNS involvement. In fact, Pseudallescheria boydii becomes an important cause of opportunistic mycosis, especially in immunocompromised patients and for those undergoing transplantation [2]. However, the CNS infection by Pseudallescheria boydii can also be seen in immunocompetent host, especially those with the problem of near-drowning [3]. There are many concerns in management of the patient. First, the diagnosis can be easily mistaken. Histologically, very high similarity to Aspergillus spp. can result in misdiagnosis. Second, the treatment of the patients is usually not successful. High fatality rate can be expected. Nevertheless, due to the availability of the new effective antifungal drug voriconazole, the treatment becomes more effective [4]. However, Alapydin et al. reported a case of infection due to Pseudallescheria boydii species complex (not Pseudallescheria boydii). Indeed, this complex comprises many species which might probably display distinct antifungal susceptibility profiles. Due to the increased numbers of immunocomprised hosts, the risk of getting this infection is increased and awareness of this infection, which can lead to early diagnosis and prompt treatment, by practitioner is required.

Cutaneous fusariosis is an opportunistic mycosis in immunocompromised patients. We present a novel variation of an immunocompromised patient who developed fusariosis in a previously irradiated site. Irradiation led to atrophy, contraction, fibrosis, barrier disruption, and an altered dermal environment in which the infection developed. Significantly, this is the first case report of fusariosis in a previously irradiated site of an immunocompromised patient. Treatment included debridement and voriconazole.

Geotrichum candidum was cultured from the tonsils of a free-ranging weaner pig that was presented with lethargy and inappetence. Histopathology indicated pyogranulomatous tonsillitis with intralesional fungal hyphae and arthrospores. Geotrichosis is a rare, opportunistic mycosis of immunocompromised hosts, usually human beings.

Con el descubrimiento del virus de la inmunodeficiencia humana (VIH) en 1981, la frecuencia de las infecciones oportunistas en pacientes inmunodeprimidos, especialmente los infectados por el VIH, ha experimentado un notable incremento. Dentro de éstas se encuentran las de etiología fúngica, las cuales presentan un alto grado de mortalidad si no son diagnosticadas y tratadas a tiempo. En nuestro país con la instauración de la terapia antirretroviral altamente efectiva a partir del año 2001, se ha notado una reducción significativa en la morbilidad y la mortalidad por infecciones oportunistas, en particular por las micosis, muy comunes en este tipo de pacientes. En el presente estudio se realizó el diagnóstico micológico procedente de pacientes infectados por el VIH/sida, durante el período comprendido entre enero 2005 y diciembre de 2009. De un total de 1173 muestras biológicas procesadas, solamente resultaron positivas 324 para un 27,6% de positividad. La candidiasis orofaríngea y la meningoencefalitis criptococóccica fueron las infecciones diagnosticadas con una mayor incidencia. En las muestras analizadas la concordancia en la positividad entre el examen directo y el examen por cultivo micológico fue de un 56,2%, lo que confirma la importancia del empleo del examen directo en la visualización de estructuras fúngicas a partir de muestras clínicas. With the discovery of the human immunodeficiency virus (HIV) in 1981, the frequency of the opportunistic infections in the immunosuppressed patients, especially the infected ones by the HIV, it has experienced a notable increase. Inside these there are those of micotic aetiology, which present a high grade of mortality, if they are not diagnosed and treated on time. In our country with the instauration of the highly effective antirretroviral therapy since the year 2001, a significant reduction has been seen in the morbidity and the mortality of the opportunistic infections, specialle those caused by fungus, in this type of patients. In the present study the positividad was analyzed in the mycological diagnosis realized by conventional methods of the different clinical samples received in the National Laboratory of Reference of Mycology, from patients infected with HIV/aids during the period between January 2005 and December 2009. Of a whole of 1173 biological samples processed only 324 turned out positive, for 27, 6 % of positivity, being the oropharingeal candidiasis and the cryptococcal meningoencefalitis, those of major incidence observed. In the clinical samples analyzed, a concordance of 56,2 % was obtained in the positividad of the samples studied by means of direct examination and mycologycal cultures, which confirms the importance of direct preparations of clinical samples for the visualization of fungal elements from clinical samples.

Aspergillus is a ubiquitous fungus which can cause a variety ofclinical syndromes. This fungus has emerged as agent of systemic infections and has therefore gained considerable public health importance. This paper describes two cases of invasive aspergillosis caused by A. fumigatus in immuno-suppressed patients and underscores the importance of early identification of Aspergillus infection associated with systemic lupus erythematosus and cardiac postoperative complications. Aspergillus é um fungo ubíquito que pode causar uma variedade de síndromes clínicas. Este fungo tem emergido como agente de infecções sistêmicas e tem conquistado considerável importância para saúde pública. Este trabalho descreve dois casos de aspergilose invasiva causada por A. fumigatus em pacientes imunossuprimidos e relata a importância da identificação precoce em infecção por Aspergillus associada ao lúpus eritematoso sistêmico e a complicações cardíacas pós-operatórias.

The increase in opportunistic mycosis as well as the emergence of antifungal resistance and the development of novel antifungal drugs necessitated the development of standard phenotypic drug resistance assays for fungi. Microdilution methods for testing yeasts (CLSI M27-A3 and EUCAST E.Def 7.2 assay) and filamentous fungi (CLSI M38-A2 and EUCAST E.Def 9.2 assay) are available. Disk diffusion assays for testing Candida (CLSI M44-A2) and nondermatophytic molds (CLSI M51-A) have also been standardized. Despite their availability and increasing knowledge of epidemiological cutoff values, these assays still have limitations. Most notably, clinical MIC breakpoints are as yet undetermined for some important drug–genus combinations. In an effort to standardize methodologies that might solve these problems as well as approaches that would support assay automation, techniques based on gradient strip method, colorimetric microdilution, agar dilution, flow cytometry, sterol quantitation, and isothermal microcalorimetry are also being studied. MALDI-TOF MS and genotypic assays are other approaches currently explored for detection of antifungal resistance.

Descrevemos um caso raro de aspergilose cerebral, como complicação de cirurgia para aneurisma cerebral, em paciente imunocompetente, e com sucesso no tratamento. A paciente, de 40 anos, havia sido submetida a craniotomia para clipagem de aneurisma da artéria pericalosa. Após cinco meses, no sitio cirúrgico, surgiram múltiplos abscessos por Aspergillus sp. Foram necessárias duas craniotomias para a retirada da massa fúngica e uso de anfotericina B. Após 14 anos de acompanhamento, a evolução mostra resolução da aspergilose, sem seqüela. O tratamento do abscesso cerebral por Aspergilus exige acompanhamento clínico contínuo, repetidas drenagens cirúrgicas intracranianas e o uso de anfotericina B no tratamento medicamentoso. We report an unusual case of brain aspergillosis with multiple recurrent abscess in a 40 years-old immunocompetent woman, with good therapeutical outcome. The patient presented a subaracnoid hemorhage caused by a ruptured pericalosal artery aneurysm and was submitted to a craniotomy for aneurysm surgery. Five months later, she developed multiple Aspergillus cerebral abscess. Two craniotomies and amphotericin B became necessary during treatment. Fourteen years later, she is asymptomatic. Treatment of brain aspergillosis abscess implied the combination of both surgical and drug therapy with amphotericin B.

The mucormycosis is an opportunistic mycosis which has a high rate of global mortality with a bad prognosis. The present clinical case shows a patient attended in the Intensive Care Unit because of a breathing insufficiency secondary to a pneumonia. Among his antecedents there is a larynx carcinoma totally remittent after chemo- and radiotherapy. He develops an infrapalpebral injury which spreads rapidly in a bilateral way acquiring a necrotic look that it did not have initially. Having that evolution, it is implemented a treatment with liposomal amphotericin B and granulocyte colony-stimulating factors after an injury biopsy, whose posterior cultive shows growing of Mucor. This kind of pathology must be initially suspected in all the patients with a neoplasia and its treatment must be early and agressive. At the moment the diagnosis is suspected there is a great tissue destruction and for that reason the patients usually die in spite of the instauration of aggressive therapies

Introduction Opportunistic fungal organisms, such as Aspergillus and Candida species, tend to cause diseases in tuberculosis (TB) patients. Respiratory tract mycosis has clinical and radiological characteristics which are very similar to TB, thereby making the disease easily misdiagnosed. TB can be a predisposition to serious opportunistic fungal infections. Prolonged use of anti-TB drugs promotes the growth and reproduction of opportunistic fungi and, in turn, aggravates the course of the underlying process in the lung tissues. The study objective is to determine fungal coexistence with mycobacterium tuberculosis (MTB) in patients attending the Central Tuberculosis Reference Laboratory of the Health Center in Ghaemshahr city, Iran. Material and methods Twenty-five participants were recruited into the study during two months. For each patient, three successive morning samples during one month were collected into sterile wide-neck universal sputum mugs. Specimen collection was taken for analysis at the Laboratory. None of the participants in this study had been placed on anti-fungal therapy. Sputa samples were studied for fungal elements and MTB. Direct microscopy by three stainings – KOH + Calcofluor white, Gomori-methenamine-silver and Giemsa – and fungal culture were done on Sabouraud Dextrose agar. Analysis for acid-fast bacilli (AFB) was done by the Ziehl–Neelsen technique. Results A total of 75 fresh sputa samples were collected. Branching hyphae in 10 samples of 5 (20%) patients and pseudo-hyphae and blastoconidia in 12 samples of 5 (20%) patients were seen together with TB. Aspergillus flavus and Candida albicans were identified in the culture method and mycological exams. Discussion Mycotic disease is an important coexistence in patients with TB. Although active mycosis may be an independent marker of advanced immunosuppression, it may also act as a co-factor in accelerating and amplifying the clinical course of TB disease. It is necessary in TB patients to increase the cure rate considering coexistencing opportunistic infections.

Pulmonary mucormycosis is a opportunistic mycosis, typically occurring in immunocompromised or diabet-ic patients. It is characterized as an infection of the pulmonary parenchyma and larger bronchi, and involves extensive vascular thrombosis and tissue necrosis. A variety of CT findings have been reported, but tracheal involvement is extremely rare. We report the case of a patient with tracheal mucormycosis placing particular emphasis on the CT findings.

Summary The account given on two opportunistic fungal infections - cryptococcosis and Candida mycosis - is by no means exhaustive or complete. Such mycoses as aspergillosis, mucormycosis and others were neglected in this presentation, although their agents could likewise be cited as classical opportunists. Aspergillus fumigatus with its ubiquitous world-wide occurrence will usually cause disease in close connection with environmental and host factors, and the same seems to be true for some phycomycetes. To what extent alcoholism, addiction to drugs, promiscuity and other sequels of the present break-down of the established order of social life, will play their role in the spread and manifestation of fungal infections, remains to be investigated. It appears, however, that the fungal opportunists are already using the new opportunities to the disadvantage of their unfortunate human hosts. Zusammenfassung Die gegebene Ubersicht uber die „opportunistische” Pilzinfektion ist weder erschopfend noch vollstandig. Bestimmte Mykosen, wie Aspergillus-Mykose, Mucor-Mykose und andere wurden nicht behandelt, obwohl ihre Erreger ebenfalls als klassische Opportunisten anzusehen sind. So verursacht der weltweit verbreitete Aspergillus fumigatus Krankheitserscheinungen in enger Beziehung mit Wirts- und Umgebungsfaktoren. Gleiches gilt fur einige Phykomyzeten. In welchem Ausmaβ Alkoholismus, Rauschgifisucht, Promiskuitat und andere Folgen des gegenwartigen Zusammenbruchs einer festgefugten Sozialordnung eine zusatzliche Rolle % ei der Verbreitung und dem Auftreten von Pilzlinfektionen spielen werden, bleibt noch zu klaren. Die Pilzopportunisten scheinen jedoch die neuen Gelegenheiten zum Schaden ihrer bedauernswerten menschlichen Wirte bereits zu nutzen. Unter diesen und anderen Aspekten, insbesondere im Zusammenhang mit den Fortschritten der medikamentosen und apparativen Therapie, werden die menschlichenCryptococcus- und Candida-Mykosen erortert.

Invasive aspergillosis is encountered with increasing frequency in the immunocompromised host which results in a high rate of mortality. The antemortem diagnosis of this opportunistic mycosis is very difficult. Consequently, enzyme-linked immunosorbent assays and radioimmunoassays for circulating antigen have been developed (M.D. Richardson, L.O. White, R.C. Warren, 1979, Mycopathologia, 67:83; J.R. Sabetta, P. Miniter, V.T. Andriole, 1985, J. Infect. Dis., 152:946; M.H. Weiner, G.H. Talbot, S.L. Gerson, 1983, Ann. Intern. Med., 99:777).