Invasive Aspergillosis Masquerading as Catastrophic Antiphospholipid Syndrome

Robinett, Kathryn S.; Weiler, Bethany; Verceles, Avelino C.

doi:10.4037/ajcc2013659

Cited by 8 publications

(4 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Fifth, routine autopsy would have increased the number of cases of IA diagnosis. Autopsy studies have shown that IA is the most frequently missed infection diagnosis in patients requiring ICU admission [ 15 , 49 , 50 ]. Sixth, we did not consider environmental sources of IA, such as construction work contaminating hospital air [ 51 , 52 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes

et al. 2015

View full text Add to dashboard Cite

IntroductionInvasive aspergillosis (IA) is a fungal infection that particularly affects immunocompromised hosts. Recently, several studies have indicated a high incidence of IA in intensive care unit (ICU) patients. However, few data are available on the epidemiology and outcome of patients with IA in this setting.MethodsAn observational study including all patients with a positive Aspergillus culture during ICU stay was performed in 30 ICUs in 8 countries. Cases were classified as proven IA, putative IA or Aspergillus colonization according to recently validated criteria. Demographic, microbiologic and diagnostic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation.ResultsA total of 563 patients were included, of whom 266 were colonized (47%), 203 had putative IA (36%) and 94 had proven IA (17%). The lung was the most frequent site of infection (94%), and Aspergillus fumigatus the most commonly isolated species (92%). Patients with IA had higher incidences of cancer and organ transplantation than those with colonization. Compared with other patients, they were more frequently diagnosed with sepsis on ICU admission and more frequently received vasopressors and renal replacement therapy (RRT) during the ICU stay. Mortality was 38% among colonized patients, 67% in those with putative IA and 79% in those with proven IA (P < 0.001). Independent risk factors for death among patients with IA included older age, history of bone marrow transplantation, and mechanical ventilation, RRT and higher Sequential Organ Failure Assessment score at diagnosis.ConclusionsIA among critically ill patients is associated with high mortality. Patients diagnosed with proven or putative IA had greater severity of illness and more frequently needed organ support than those with Aspergillus spp colonization.

show abstract

Section: Discussionmentioning

confidence: 99%

Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes

et al. 2015

View full text Add to dashboard Cite

show abstract

“…The diagnosis is difficult because 30% to 50% patients show no evidence of the fungus in blood and sputum cultures. Test for galactomannan, a polysaccharide of the Aspergillus cell wall, which can be performed on various biologic specimens, is a useful diagnostic tool [ 58 , 59 ]. Pneumocystis jiroveci pneumonia (PJP) is a fungal opportunistic infection unfrequently observed in profound immunosuppressed SLE patients.…”

Section: Lung Infections In Systemic Rheumatic Diseasesmentioning

confidence: 99%

Lung Infections in Systemic Rheumatic Disease: Focus on Opportunistic Infections

Franco

Lucchino

Spaziante

et al. 2017

IJMS

View full text Add to dashboard Cite

Systemic rheumatic diseases have significant morbidity and mortality, due in large part to concurrent infections. The lung has been reported among the most frequent sites of infection in patients with rheumatic disease, who are susceptible to developing pneumonia sustained both by common pathogens and by opportunistic microorganisms. Patients with rheumatic disease show a peculiar vulnerability to infectious complications. This is due in part to intrinsic disease-related immune dysregulation and in part to the immunosuppressive treatments. Several therapeutic agents have been associated to a wide spectrum of infections, complicating the management of rheumatic diseases. This review discusses the most frequent pulmonary infections encountered in rheumatic diseases, focusing on opportunistic agents, consequent diagnostic challenges and appropriate therapeutic strategies.

show abstract

“…Invasive aspergillosis (IA) is the most severe infection caused by A. fumigatus and occurs when fungal growth, most commonly originating in the lung, disseminates to other parts of the body via the bloodstream (Latge, 1999 ). A. fumigatus is an opportunistic pathogen primarily affecting immunocompromised individuals, and unfortunately, infections have become more common due to the increased usage of immunosuppressive drugs to treat autoimmune disorders and to increase the success of organ transplantation surgery (Robinett et al, 2013 ; Neofytos et al, 2018 ; Latge and Chamilos, 2019 ). Even when aggressively treated with first and second-line antifungal medication, mortality rates can exceed 50% in IA patients (Latge, 1999 ; Lin et al, 2001 ).…”

Section: Introductionmentioning

confidence: 99%

Genome-Wide Association for Itraconazole Sensitivity in Non-resistant Clinical Isolates of Aspergillus fumigatus

Zhao¹,

Watanabe

et al. 2021

Front. Fungal Biol.

View full text Add to dashboard Cite

Aspergillus fumigatus is a potentially lethal opportunistic pathogen that infects over ~200,000 people and causes ~100,000 deaths per year globally. Treating A. fumigatus infections is particularly challenging because of the recent emergence of azole-resistance. The majority of studies focusing on the molecular mechanisms underlying azole resistance have examined azole-resistant isolates. However, isolates that are susceptible to azoles also display variation in their sensitivity, presenting a unique opportunity to identify genes contributing to azole sensitivity. Here, we used genome-wide association (GWA) analysis to identify loci involved in azole sensitivity by analyzing the association between 68,853 SNPs and itraconazole (ITCZ) minimum inhibitory concentration (MIC) in 76 clinical isolates of A. fumigatus from Japan. Population structure analysis suggests the presence of four distinct populations, with ITCZ MICs distributed relatively evenly across populations. We independently conducted GWA when treating ITCZ MIC as a quantitative trait and a binary trait, and identified two SNPs with strong associations in both analyses. These SNPs fell within the coding regions of Afu2g02220 and Afu2g02140. We functionally validated Afu2g02220 by knocking it out using a CRISPR/Cas9 approach, because orthologs of this gene are involved in sterol modification and ITCZ targets the ergosterol biosynthesis pathway. Knockout strains displayed no difference in growth compared to the parent strain in minimal media, yet a minor but consistent inhibition of growth in the presence of 0.15 μg/ml ITCZ. Our results suggest that GWA paired with efficient gene deletion is a powerful and unbiased strategy for identifying the genetic basis of complex traits in A. fumigatus.

show abstract

Invasive Aspergillosis Masquerading as Catastrophic Antiphospholipid Syndrome

Cited by 8 publications

References 10 publications

Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes

Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcomes

Lung Infections in Systemic Rheumatic Disease: Focus on Opportunistic Infections

Genome-Wide Association for Itraconazole Sensitivity in Non-resistant Clinical Isolates of Aspergillus fumigatus

Contact Info

Product

Resources

About