Fungal infections are a serious complication after living donor liver transplantation, with an incidence of around 22%. Candida species are the most common cause, followed by Aspergillus. Risk factors for invasive fungal infections include prolonged antibiotic use, parenteral nutrition, ICU stay, and graft-related complications. Diagnosis relies on culture, antigen detection, PCR and imaging. Voriconazole is recommended for Aspergillus, while echinocandins are first-line for Candida. Fluconazole prophylaxis is commonly used but has limitations including resistance and drug interactions. Targeted prophylaxis based on risk factors may be most effective approach.
- Infections are a major cause of death for kidney transplant patients, accounting for around 15-20% of post-transplant mortality. The most common infections are cytomegalovirus (CMV) and Pneumocystis pneumonia (PCP).
- CMV infection and disease are still frequent despite prophylaxis and preemptive treatment. PCP is now rare due to universal long-term prophylaxis. Bacterial pneumonia also occurs in around 5% of kidney transplant recipients and carries a high mortality risk, especially for nosocomial infections.
- Vaccination of transplant candidates and recipients is important for prevention of pneumonia. However, live vaccines should generally be avoided in transplant patients for the
Community Acquired Pneumonia is an inflammatory lung condition caused by infection. It is defined as pneumonia occurring outside of a hospital setting. Respiratory infections are the leading cause of doctor visits. Streptococcus pneumoniae is the most common pathogen identified, causing around 46% of cases. Risk factors include older age, smoking, lung disease, and conditions that impair immunity or clearance of secretions. Diagnosis involves assessing severity, likely pathogens, and testing sputum, blood, or urine depending on the suspected germ. Most cases are treated initially with antibiotics at home or in the hospital depending on severity. Vaccines can help prevent many types of community acquired pneumonia.
This document discusses Candida infections in the ICU, including epidemiology, risk factors, pathogenesis, diagnosis, and treatment. Some key points:
- Candida species are the most common fungal pathogens in hospitals and ICUs, responsible for 17% of healthcare-associated infections. Non-albicans Candida species now account for around 50% of infections.
- Risk factors for invasive Candida infections include prolonged ICU stay, broad-spectrum antibiotic use, surgery, and underlying conditions like diabetes that impair immunity. Heavy Candida colonization is an independent risk factor.
- Diagnosis is challenging as symptoms mimic bacterial infections. Culture-based methods are slow. Biomarkers like beta-D-
This document discusses infections that can occur in organ transplant patients. It notes that over 40,000 organ transplants are performed annually worldwide, with high success rates. However, infections remain a major challenge for transplant recipients. The types and risks of infections vary depending on the transplanted organ and time since transplantation. In the first month after transplant, patients are most at risk for healthcare-associated infections. From 1-6 months, they are susceptible to opportunistic infections like CMV. After 6 months, most patients have well-functioning grafts but some remain at higher risk of infections. Close monitoring and a high index of suspicion are needed to manage infection risks in transplant patients over time.
1) Premature infants are at high risk of invasive fungal infections like candidiasis due to their relatively underdeveloped immune systems. Candida species are the most common cause, with C. albicans causing most neonatal infections.
2) Fungal colonization is common in VLBW infants and increases their risk of invasive infection. The GI tract is usually the initial site of colonization, which can progress to candidemia in 7-24% of cases.
3) Invasive candidiasis accounts for up to 12% of late-onset neonatal sepsis and carries a high mortality rate of 30%. Risk factors include low birth weight, broad spectrum antibiotic use, and central venous catheters
Hospital acquired infections, also known as nosocomial infections, are infections that patients acquire during the course of receiving treatment for other conditions within hospitals. Risk factors for hospital acquired infections can be iatrogenic (related to medical procedures), organizational (related to facility conditions), or patient-related (underlying illness/immunocompromised state). Common types include urinary tract infections, pneumonia, bloodstream infections, and surgical site infections. Diagnosis involves physical exams, cultures, and imaging tests. Treatment involves removing any invasive devices if possible, empiric use of broad-spectrum antibiotics/antifungals/antivirals, and consulting infectious disease specialists if needed. Preventing the spread of infections within hospitals remains an important
This document discusses guidelines for treating candidemia and invasive candidiasis in ICU patients. It recommends starting treatment with an echinocandin for both non-neutropenic and neutropenic patients. For non-neutropenic patients, fluconazole is an alternative if the patient is not critically ill and the Candida species is susceptible. Treatment should be given for 2 weeks after symptoms resolve and blood cultures clear. Source control through catheter removal is also recommended when possible.
ABSTRACT
Background: With the advances in medical care, invasive fungal
infections possess a significant health problem especially in
immunocompromised patients. These infections have varied aetiological
agents which are commonly found in soil, water, plant debris and organic
substrates. Aim: The overview of different fungal aetiological agents,
newer and rapid diagnostic modalities and overall treatment and
prevention options available is presented in this article. Methods:
Literature search was performed in PubMed by using MeSH terms
‘mycoses’ and ‘immunocompromised host’. Only relevant review articles
published within the last five years were considered. Google Scholar
search engine was also used. Results: Common invasive fungi include
Candida spp., Cryptococcus spp., Aspergillus spp., Trichosporon spp.,
Rhodotorula spp., Fusarium spp., Mucormycotina, Pheohyphomycosis
spp., Pneumocystis jirovecii, Scedosporium spp., and endemic mycoses
such as Penicillium, Histoplasma and Blastomyces. A high degree of
suspicion is required for early diagnosis and optimal management of these
infections. Conclusion: Early and rapid diagnosis of causative fungal
agents is required so that appropriate treatment can be initiated. Adequate
preventive measures must be applied in an immunocompromised host that
can prevent development of drug resistant super-infections.
- Infections are a major cause of death for kidney transplant patients, accounting for around 15-20% of post-transplant mortality. The most common infections are cytomegalovirus (CMV) and Pneumocystis pneumonia (PCP).
- CMV infection and disease are still frequent despite prophylaxis and preemptive treatment. PCP is now rare due to universal long-term prophylaxis. Bacterial pneumonia also occurs in around 5% of kidney transplant recipients and carries a high mortality risk, especially for nosocomial infections.
- Vaccination of transplant candidates and recipients is important for prevention of pneumonia. However, live vaccines should generally be avoided in transplant patients for the
Community Acquired Pneumonia is an inflammatory lung condition caused by infection. It is defined as pneumonia occurring outside of a hospital setting. Respiratory infections are the leading cause of doctor visits. Streptococcus pneumoniae is the most common pathogen identified, causing around 46% of cases. Risk factors include older age, smoking, lung disease, and conditions that impair immunity or clearance of secretions. Diagnosis involves assessing severity, likely pathogens, and testing sputum, blood, or urine depending on the suspected germ. Most cases are treated initially with antibiotics at home or in the hospital depending on severity. Vaccines can help prevent many types of community acquired pneumonia.
This document discusses Candida infections in the ICU, including epidemiology, risk factors, pathogenesis, diagnosis, and treatment. Some key points:
- Candida species are the most common fungal pathogens in hospitals and ICUs, responsible for 17% of healthcare-associated infections. Non-albicans Candida species now account for around 50% of infections.
- Risk factors for invasive Candida infections include prolonged ICU stay, broad-spectrum antibiotic use, surgery, and underlying conditions like diabetes that impair immunity. Heavy Candida colonization is an independent risk factor.
- Diagnosis is challenging as symptoms mimic bacterial infections. Culture-based methods are slow. Biomarkers like beta-D-
This document discusses infections that can occur in organ transplant patients. It notes that over 40,000 organ transplants are performed annually worldwide, with high success rates. However, infections remain a major challenge for transplant recipients. The types and risks of infections vary depending on the transplanted organ and time since transplantation. In the first month after transplant, patients are most at risk for healthcare-associated infections. From 1-6 months, they are susceptible to opportunistic infections like CMV. After 6 months, most patients have well-functioning grafts but some remain at higher risk of infections. Close monitoring and a high index of suspicion are needed to manage infection risks in transplant patients over time.
1) Premature infants are at high risk of invasive fungal infections like candidiasis due to their relatively underdeveloped immune systems. Candida species are the most common cause, with C. albicans causing most neonatal infections.
2) Fungal colonization is common in VLBW infants and increases their risk of invasive infection. The GI tract is usually the initial site of colonization, which can progress to candidemia in 7-24% of cases.
3) Invasive candidiasis accounts for up to 12% of late-onset neonatal sepsis and carries a high mortality rate of 30%. Risk factors include low birth weight, broad spectrum antibiotic use, and central venous catheters
Hospital acquired infections, also known as nosocomial infections, are infections that patients acquire during the course of receiving treatment for other conditions within hospitals. Risk factors for hospital acquired infections can be iatrogenic (related to medical procedures), organizational (related to facility conditions), or patient-related (underlying illness/immunocompromised state). Common types include urinary tract infections, pneumonia, bloodstream infections, and surgical site infections. Diagnosis involves physical exams, cultures, and imaging tests. Treatment involves removing any invasive devices if possible, empiric use of broad-spectrum antibiotics/antifungals/antivirals, and consulting infectious disease specialists if needed. Preventing the spread of infections within hospitals remains an important
This document discusses guidelines for treating candidemia and invasive candidiasis in ICU patients. It recommends starting treatment with an echinocandin for both non-neutropenic and neutropenic patients. For non-neutropenic patients, fluconazole is an alternative if the patient is not critically ill and the Candida species is susceptible. Treatment should be given for 2 weeks after symptoms resolve and blood cultures clear. Source control through catheter removal is also recommended when possible.
ABSTRACT
Background: With the advances in medical care, invasive fungal
infections possess a significant health problem especially in
immunocompromised patients. These infections have varied aetiological
agents which are commonly found in soil, water, plant debris and organic
substrates. Aim: The overview of different fungal aetiological agents,
newer and rapid diagnostic modalities and overall treatment and
prevention options available is presented in this article. Methods:
Literature search was performed in PubMed by using MeSH terms
‘mycoses’ and ‘immunocompromised host’. Only relevant review articles
published within the last five years were considered. Google Scholar
search engine was also used. Results: Common invasive fungi include
Candida spp., Cryptococcus spp., Aspergillus spp., Trichosporon spp.,
Rhodotorula spp., Fusarium spp., Mucormycotina, Pheohyphomycosis
spp., Pneumocystis jirovecii, Scedosporium spp., and endemic mycoses
such as Penicillium, Histoplasma and Blastomyces. A high degree of
suspicion is required for early diagnosis and optimal management of these
infections. Conclusion: Early and rapid diagnosis of causative fungal
agents is required so that appropriate treatment can be initiated. Adequate
preventive measures must be applied in an immunocompromised host that
can prevent development of drug resistant super-infections.
FOURNIER’S GANGRENE: REVIEW OF 57 CASES IN TERTIARY INSTITUTIONAnil Haripriya
Fournier’s gangrene which is a rapidly progressive, fulminant polymicrobial synergistic infection of the perineum and genitals is now changing its pattern. Both genders can be affected and the mortality is still high (around10%). The clinical presentation in many patients in early stage may not be prominent. Thus rapid and accurate diagnosis is must for prompt treatment. Extensive surgical debridement and broad spectrum intravenous antibiotic remains the mainstay of treatment in order to reduce the morbidity and mortality.
The role of viral infection in the pathogenesis of post transplant malignancy...Mohamed Yassine Keniz
Viral infections are very common in kidney transplant recipients due to their immunosuppressed state. Herpesviruses like CMV are among the most frequent, while hepatitis B/C and BK virus also commonly infect transplant patients. The immunosuppression needed to prevent graft rejection also allows opportunistic viruses to cause disease and promotes reactivation of latent viruses. Certain viruses are directly oncogenic, such as EBV which can cause post-transplant lymphoproliferative disorder. Minimizing immunosuppression where possible can help reduce cancer risk in transplant recipients.
Nosocomial infections (NIs), also known as hospital-acquired infections, develop in patients during or after a hospital stay. NIs can be caused by a patient's own microflora or by contact with other carriers such as medical staff or other patients. Common sites of NI include the respiratory, digestive, and urinary tracts. Risk factors include invasive medical procedures, antibiotic overuse contributing to resistant strains, and inadequate sanitation. Preventing the spread of NIs requires proper diagnosis, treatment, surveillance, hygiene practices such as disinfection and sterilization, and staff education.
This study examined the risk of serious infection in patients with rheumatoid arthritis (RA) and interstitial lung disease (ILD). The study identified 181 RA patients with ILD between 1998-2014. It found that these patients faced a high risk of serious infections requiring hospitalization, with an overall rate of 7.4 infections per 100 person-years. The risk was highest for patients with organizing pneumonia ILD (27.1 per 100 person-years) and lower for nonspecific interstitial pneumonia and usual interstitial pneumonia. Use of high-dose prednisone (>10mg per day) was also linked to greater infection risk. Identifying patients at highest risk could help reduce infection-related morbidity.
This document summarizes important viral pathogens affecting solid organ transplant recipients. It discusses several common viruses like CMV, HHV-6, EBV, adenovirus, and BKV polyomavirus. It notes their clinical manifestations and impacts in transplant recipients. The document also reviews prevention and treatment strategies for many of these viruses, including vaccination, antiviral prophylaxis, and immunosuppression management. Meta-analyses show antiviral prophylaxis is effective at preventing CMV infection and disease, and may reduce indirect effects like other infections and rejection.
The document discusses treatment of invasive fungal infections. It begins by defining invasive fungal infections and describing the epidemiology. Common fungi that cause invasive infections include Aspergillus and Candida. Risk factors include prolonged neutropenia from chemotherapy or hematopoietic stem cell transplants. Available antifungal drug classes are discussed along with their mechanisms of action including azoles, polyenes, and echinocandins. Treatment recommendations from clinical guidelines are summarized for conditions like candidemia and invasive aspergillosis.
This document discusses the management of severe viral pneumonia in the ICU. It begins with an introduction that outlines the major concerns of viral pneumonia for intensivists due to high mortality and morbidity rates. It then discusses the various viruses that can cause respiratory infections in the ICU such as influenza, RSV, adenovirus, SARS-CoV, and others. The pathophysiology, clinical presentation, diagnostic tools including imaging and labs, and treatment approaches including antiviral therapy, corticosteroids, oxygenation and ventilation are summarized. Non-invasive ventilation is discussed as a first-line treatment for acute respiratory failure but criteria for NIV failure requiring intubation are also provided.
Management of Fungal Infection with Voriconazole Ppt.pptxYuliaDjatiwardani2
Antifungal Therapy.
Voriconazole is used to treat serious fungal or yeast infections, such as aspergillosis (fungal infection in the lungs), candidemia (fungal infection in the blood), esophageal candidiasis (candida esophagitis), or other fungal infections (infections in the skin, stomach, kidney, bladder, or wounds).
This document discusses viral pneumonia. It begins by describing a case of a 54-year-old woman admitted to the ICU in respiratory distress following a febrile illness. Testing showed mild renal failure and normal blood counts. She was started on antivirals, antibiotics, and oxygen supplementation. She was intubated but improved and was extubated on day 7. The document then discusses viral pneumonia in more detail, covering causes, diagnosis, treatment and outcomes. It emphasizes the importance of viral pneumonia and discusses emerging viruses as a cause.
This document provides information on approaching and evaluating patients with potential infectious diseases. It discusses taking an exposure and social history, performing a physical exam focusing on vital signs, lymph nodes, skin, and foreign bodies. Diagnostic testing options are outlined including lab tests, imaging, and pathogen-specific tests. Empirical antibiotic therapy is recommended for common infections like pneumonia based on presentation. Community-acquired pneumonia causes are discussed. Hospital-acquired pneumonia treatment typically involves antibiotics until culture results are available. Infective endocarditis typically involves bacterial vegetation on heart valves.
Clinical analysis of 228 patients with pulmonary fungal diseases iWilheminaRossi174
Clinical analysis of 228 patients with pulmonary fungal diseases in China
Abstract
Background: Due to the lack of specific clinical manifestations and imaging features, the diagnosis of pulmonary fungal diseases is difficult. This study aims to investigate the clinical features of pulmonary fungal diseases.
Methods: We retrospectively analyzed the demographics, types of fungus,radiological characteristics,underlying diseases, the usage of steroid and immunosuppresants, laboratory tests of 228patients with pulmonary fungal disease diagnosed by pathological examination or laboratory culture from October 2011 to July 2018in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology.
Results: A total of 228 patients, had a median age of 49years, which included 130 (57%) males and 98(43%) females. The most common fungal species identified were aspergillus (39.5 %), cryptococcus (18.4%), and mucormycosis (3.5 %).The main imaging findings were nodules or mass in 144 patients (63.2%), cavitation in 57 patients (25%),consolidation shadows or ground glass infiltrates in 15 patients (6.6%), and reverse halo sign in 12 patients (5.3%). The main infection sites were right upper lobe (26.8%), right lower lobe (21.5%) and the bronchus infection were 18 (7.9%) persons. For the underlying diseases, the prevalence of diseases was pulmonary tuberculosis (17.5%), bronchiectasis (16.2%), diabetes mellitus (9.2%) and the previous thoracic malignancy (6.6%) was common. The number of patients using steroid was 50% and the number of patients using immunosuppressant was 7%.
Conclusions: The imaging findings and the underlying diseases of patients should be taken into account when making diagnosis of pulmonary funga1disease for the purpo se to speculate the probable fungal pathogen and choose the most appropriate diagnostic tool.
Keywords:Pulmonary fungal disease; pathogen; imaging manifestation; Underlying disease; Clinical analysis; Chinese
(pneumomycosis; pulmonary mycosis?)invasive mould infection (IMI)Invasive fungal infections (IFIs),invasive aspergillosis
invasive mold disease, invasive aspergillosis, diabetes mellitus.
1. INTRODUCTION
In environment, the fungi produce small spores that are routinely inhaled and rapidly cleared from the normal host. However after long standing inhalation makes people more vulnerable to get effected .Moreover pulmonary fungal diseases are an opportunistic infection that predominantly attacks immunocompromised just as immunocompetent patients, however extensive utilization of gluccocorticoids and chemotherapeutics utilizes in patients make the pulmonary fungal disease no longer an uncommon occurrence. The complex underlying conditions such as pulmonary tuberculosis, bronchectasis, COPD and diabetes mellitus in the patients of pulmonary fungal disease and the non-specific nature of pathogen can confound identification and lead to under diagnosis. Due to its vague nature the dia ...
- Mucormycosis is a life-threatening fungal infection caused by fungi of the order Mucorales. It mostly affects immunocompromised individuals, especially those with uncontrolled diabetes.
- The document discusses the epidemiology, risk factors, clinical manifestations, diagnosis, and management of mucormycosis. It emphasizes the importance of early diagnosis, aggressive surgical debridement of infected tissues, antifungal therapy typically with amphotericin B, and control of underlying conditions.
- Prompt treatment including surgical debridement and antifungal therapy can significantly improve survival rates for mucormycosis compared to antifungal therapy or surgery alone. However, mortality remains high due to
Immunosuppression to prevent infection risk.pptxRANJANEEMUTHU1
This document discusses strategies for optimizing immunosuppression after kidney transplantation to reduce infection risk. It begins by introducing the increased risk of infection that transplant recipients face due to lifelong immunosuppression. It then discusses challenges in diagnosing infections in this population and outlines various factors that influence infection risk over time. The document explores approaches to risk stratification and describes how different immunosuppressive agents can impact specific infection risks. It proposes strategies for individualizing immunosuppression based on risk, including reducing immunosuppression in cases of over-suppression or clinical stability. The goal is to minimize infection risk through judicious immunosuppression management tailored to each patient.
Immunosuppression to prevent infection risk.pptxRANJANEEMUTHU1
This document discusses strategies for optimizing immunosuppression after kidney transplantation to reduce infection risk. It begins by introducing the increased risk of infection that transplant recipients face due to lifelong immunosuppression. It then discusses challenges in diagnosing infections in this population and outlines various factors that influence infection risk over time. The document explores approaches to risk stratification and describes how different immunosuppressive agents can impact specific infection risks. It proposes strategies for individualizing immunosuppression based on risk, including reducing immunosuppression in cases of over-suppression or clinical stability. The goal is to minimize infection risk through judicious immunosuppression management tailored to each patient.
In this presentation, we delve into the realm of opportunistic gastrointestinal pathogens, shedding light on the often underestimated threats they pose to human health. These microorganisms, while typically harmless in healthy individuals, can turn perilous in situations where the host's immune system is compromised or when environmental conditions become conducive to their proliferation. We will explore the factors that render individuals susceptible to these infections, ranging from immunosuppression to suboptimal hygiene practices. By understanding the key players in opportunistic infections, including notorious culprits like Clostridium difficile, Candida species, Norovirus, and Giardia, we aim to equip our audience with valuable insights for prevention and management strategies. Join us in this journey as we unmask the covert adversaries within our gastrointestinal tract.
The document discusses viral pneumonia, providing details on:
1) Common viruses that cause viral pneumonia include influenza, respiratory syncytial virus, parainfluenza, and adenovirus.
2) Diagnostic tests for viral pneumonia include viral culture, antigen detection, PCR, chest x-rays, and analyzing white blood cell counts and other biomarkers.
3) Treatment involves antiviral medications like oseltamivir, while prevention includes vaccines for influenza.
Healthcare-associated infections (HAIs) are infections acquired during medical care. The document discusses the etiology, epidemiology, clinical presentation, diagnosis, and management of HAIs. The three main types are bloodstream infections, pneumonia, and urinary tract infections. Risk factors include underlying illness, invasive devices like ventilators or catheters, and prolonged hospital stays. Diagnosis involves cultures of infected sites and imaging when needed. Treatment involves removing unnecessary devices, giving empiric antibiotics, and later streamlining based on culture results. Management also requires addressing any complications.
Nosocomial infections, also known as hospital-acquired infections, are infections that patients acquire during the course of receiving treatment for other conditions within a healthcare setting. The document discusses the epidemiology, sources, common microorganisms, types of infections, diagnosis, treatment and prevention of nosocomial infections. It notes that approximately 2 million patients suffer from hospital-acquired infections annually worldwide, with around 100,000 deaths. Common types of nosocomial infections mentioned include urinary tract infections, respiratory infections, surgical site infections, ventilator-associated pneumonia, and septicemia. Prevention strategies focus on proper hand hygiene, limiting unnecessary procedures and devices, and following infection control protocols.
Nosocomial fungal infections are infections acquired in a healthcare setting. Candida species are a common cause of nosocomial fungal infections, with C. albicans being the most frequent cause. However, non-albicans Candida species are emerging as more drug-resistant species due to selective pressure from antifungal treatments. Catheter-associated urinary tract infections are a frequent type of nosocomial Candida infection, which can be difficult to diagnose due to the challenges differentiating colonization from true infection based on urine culture results alone.
Post-transplant lymphoproliferative disorder (PTLD) is a B-cell proliferation disorder caused by Epstein-Barr virus infection due to immunosuppression after organ transplantation. The risk of PTLD is higher with more intense immunosuppression and occurs earlier. Treatment involves reducing immunosuppression to allow the immune system to control the proliferation. PTLD ranges from benign B-cell hyperplasia to aggressive lymphoma and has high mortality if not treated by reducing immunosuppression.
Non alcoholic steatohepatitis METABOLIC APPROACH 3.pptxAhmadRbeeHefni
This document provides an overview of metabolic approaches to managing nonalcoholic steatohepatitis (NASH). It discusses the relationship between NASH, obesity, and diabetes and recommends treating comorbidities like these early. Emerging therapies discussed include glucagon-like peptide-1 receptor agonists (GLP-1 RAs) like semaglutide and liraglutide, which can resolve NASH and improve fibrosis through effects on the liver, pancreas, adipose tissue, and gut. Sodium-glucose cotransporter-2 inhibitors are also highlighted for their antioxidant effects in reducing oxidative stress in multiple organs including the liver. The document emphasizes the importance of lifestyle modifications like weight loss and exercise
Non alcoholic steatohepatitis METABOLIC APPROACH.pptxAhmadRbeeHefni
- Adipose tissue functions as a metabolic organ that regulates processes throughout the body through secretion of hormones and metabolites.
- In a healthy state, adipose tissue expands through hyperplasia of small adipocytes and maintains low inflammation.
- Metabolically unhealthy obesity is characterized by remodeling of adipose tissue, with increased hypertrophy of adipocytes, changing levels of secreted factors, and elevated inflammation. This stressed state of adipose tissue contributes to insulin resistance and other metabolic complications.
FOURNIER’S GANGRENE: REVIEW OF 57 CASES IN TERTIARY INSTITUTIONAnil Haripriya
Fournier’s gangrene which is a rapidly progressive, fulminant polymicrobial synergistic infection of the perineum and genitals is now changing its pattern. Both genders can be affected and the mortality is still high (around10%). The clinical presentation in many patients in early stage may not be prominent. Thus rapid and accurate diagnosis is must for prompt treatment. Extensive surgical debridement and broad spectrum intravenous antibiotic remains the mainstay of treatment in order to reduce the morbidity and mortality.
The role of viral infection in the pathogenesis of post transplant malignancy...Mohamed Yassine Keniz
Viral infections are very common in kidney transplant recipients due to their immunosuppressed state. Herpesviruses like CMV are among the most frequent, while hepatitis B/C and BK virus also commonly infect transplant patients. The immunosuppression needed to prevent graft rejection also allows opportunistic viruses to cause disease and promotes reactivation of latent viruses. Certain viruses are directly oncogenic, such as EBV which can cause post-transplant lymphoproliferative disorder. Minimizing immunosuppression where possible can help reduce cancer risk in transplant recipients.
Nosocomial infections (NIs), also known as hospital-acquired infections, develop in patients during or after a hospital stay. NIs can be caused by a patient's own microflora or by contact with other carriers such as medical staff or other patients. Common sites of NI include the respiratory, digestive, and urinary tracts. Risk factors include invasive medical procedures, antibiotic overuse contributing to resistant strains, and inadequate sanitation. Preventing the spread of NIs requires proper diagnosis, treatment, surveillance, hygiene practices such as disinfection and sterilization, and staff education.
This study examined the risk of serious infection in patients with rheumatoid arthritis (RA) and interstitial lung disease (ILD). The study identified 181 RA patients with ILD between 1998-2014. It found that these patients faced a high risk of serious infections requiring hospitalization, with an overall rate of 7.4 infections per 100 person-years. The risk was highest for patients with organizing pneumonia ILD (27.1 per 100 person-years) and lower for nonspecific interstitial pneumonia and usual interstitial pneumonia. Use of high-dose prednisone (>10mg per day) was also linked to greater infection risk. Identifying patients at highest risk could help reduce infection-related morbidity.
This document summarizes important viral pathogens affecting solid organ transplant recipients. It discusses several common viruses like CMV, HHV-6, EBV, adenovirus, and BKV polyomavirus. It notes their clinical manifestations and impacts in transplant recipients. The document also reviews prevention and treatment strategies for many of these viruses, including vaccination, antiviral prophylaxis, and immunosuppression management. Meta-analyses show antiviral prophylaxis is effective at preventing CMV infection and disease, and may reduce indirect effects like other infections and rejection.
The document discusses treatment of invasive fungal infections. It begins by defining invasive fungal infections and describing the epidemiology. Common fungi that cause invasive infections include Aspergillus and Candida. Risk factors include prolonged neutropenia from chemotherapy or hematopoietic stem cell transplants. Available antifungal drug classes are discussed along with their mechanisms of action including azoles, polyenes, and echinocandins. Treatment recommendations from clinical guidelines are summarized for conditions like candidemia and invasive aspergillosis.
This document discusses the management of severe viral pneumonia in the ICU. It begins with an introduction that outlines the major concerns of viral pneumonia for intensivists due to high mortality and morbidity rates. It then discusses the various viruses that can cause respiratory infections in the ICU such as influenza, RSV, adenovirus, SARS-CoV, and others. The pathophysiology, clinical presentation, diagnostic tools including imaging and labs, and treatment approaches including antiviral therapy, corticosteroids, oxygenation and ventilation are summarized. Non-invasive ventilation is discussed as a first-line treatment for acute respiratory failure but criteria for NIV failure requiring intubation are also provided.
Management of Fungal Infection with Voriconazole Ppt.pptxYuliaDjatiwardani2
Antifungal Therapy.
Voriconazole is used to treat serious fungal or yeast infections, such as aspergillosis (fungal infection in the lungs), candidemia (fungal infection in the blood), esophageal candidiasis (candida esophagitis), or other fungal infections (infections in the skin, stomach, kidney, bladder, or wounds).
This document discusses viral pneumonia. It begins by describing a case of a 54-year-old woman admitted to the ICU in respiratory distress following a febrile illness. Testing showed mild renal failure and normal blood counts. She was started on antivirals, antibiotics, and oxygen supplementation. She was intubated but improved and was extubated on day 7. The document then discusses viral pneumonia in more detail, covering causes, diagnosis, treatment and outcomes. It emphasizes the importance of viral pneumonia and discusses emerging viruses as a cause.
This document provides information on approaching and evaluating patients with potential infectious diseases. It discusses taking an exposure and social history, performing a physical exam focusing on vital signs, lymph nodes, skin, and foreign bodies. Diagnostic testing options are outlined including lab tests, imaging, and pathogen-specific tests. Empirical antibiotic therapy is recommended for common infections like pneumonia based on presentation. Community-acquired pneumonia causes are discussed. Hospital-acquired pneumonia treatment typically involves antibiotics until culture results are available. Infective endocarditis typically involves bacterial vegetation on heart valves.
Clinical analysis of 228 patients with pulmonary fungal diseases iWilheminaRossi174
Clinical analysis of 228 patients with pulmonary fungal diseases in China
Abstract
Background: Due to the lack of specific clinical manifestations and imaging features, the diagnosis of pulmonary fungal diseases is difficult. This study aims to investigate the clinical features of pulmonary fungal diseases.
Methods: We retrospectively analyzed the demographics, types of fungus,radiological characteristics,underlying diseases, the usage of steroid and immunosuppresants, laboratory tests of 228patients with pulmonary fungal disease diagnosed by pathological examination or laboratory culture from October 2011 to July 2018in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology.
Results: A total of 228 patients, had a median age of 49years, which included 130 (57%) males and 98(43%) females. The most common fungal species identified were aspergillus (39.5 %), cryptococcus (18.4%), and mucormycosis (3.5 %).The main imaging findings were nodules or mass in 144 patients (63.2%), cavitation in 57 patients (25%),consolidation shadows or ground glass infiltrates in 15 patients (6.6%), and reverse halo sign in 12 patients (5.3%). The main infection sites were right upper lobe (26.8%), right lower lobe (21.5%) and the bronchus infection were 18 (7.9%) persons. For the underlying diseases, the prevalence of diseases was pulmonary tuberculosis (17.5%), bronchiectasis (16.2%), diabetes mellitus (9.2%) and the previous thoracic malignancy (6.6%) was common. The number of patients using steroid was 50% and the number of patients using immunosuppressant was 7%.
Conclusions: The imaging findings and the underlying diseases of patients should be taken into account when making diagnosis of pulmonary funga1disease for the purpo se to speculate the probable fungal pathogen and choose the most appropriate diagnostic tool.
Keywords:Pulmonary fungal disease; pathogen; imaging manifestation; Underlying disease; Clinical analysis; Chinese
(pneumomycosis; pulmonary mycosis?)invasive mould infection (IMI)Invasive fungal infections (IFIs),invasive aspergillosis
invasive mold disease, invasive aspergillosis, diabetes mellitus.
1. INTRODUCTION
In environment, the fungi produce small spores that are routinely inhaled and rapidly cleared from the normal host. However after long standing inhalation makes people more vulnerable to get effected .Moreover pulmonary fungal diseases are an opportunistic infection that predominantly attacks immunocompromised just as immunocompetent patients, however extensive utilization of gluccocorticoids and chemotherapeutics utilizes in patients make the pulmonary fungal disease no longer an uncommon occurrence. The complex underlying conditions such as pulmonary tuberculosis, bronchectasis, COPD and diabetes mellitus in the patients of pulmonary fungal disease and the non-specific nature of pathogen can confound identification and lead to under diagnosis. Due to its vague nature the dia ...
- Mucormycosis is a life-threatening fungal infection caused by fungi of the order Mucorales. It mostly affects immunocompromised individuals, especially those with uncontrolled diabetes.
- The document discusses the epidemiology, risk factors, clinical manifestations, diagnosis, and management of mucormycosis. It emphasizes the importance of early diagnosis, aggressive surgical debridement of infected tissues, antifungal therapy typically with amphotericin B, and control of underlying conditions.
- Prompt treatment including surgical debridement and antifungal therapy can significantly improve survival rates for mucormycosis compared to antifungal therapy or surgery alone. However, mortality remains high due to
Immunosuppression to prevent infection risk.pptxRANJANEEMUTHU1
This document discusses strategies for optimizing immunosuppression after kidney transplantation to reduce infection risk. It begins by introducing the increased risk of infection that transplant recipients face due to lifelong immunosuppression. It then discusses challenges in diagnosing infections in this population and outlines various factors that influence infection risk over time. The document explores approaches to risk stratification and describes how different immunosuppressive agents can impact specific infection risks. It proposes strategies for individualizing immunosuppression based on risk, including reducing immunosuppression in cases of over-suppression or clinical stability. The goal is to minimize infection risk through judicious immunosuppression management tailored to each patient.
Immunosuppression to prevent infection risk.pptxRANJANEEMUTHU1
This document discusses strategies for optimizing immunosuppression after kidney transplantation to reduce infection risk. It begins by introducing the increased risk of infection that transplant recipients face due to lifelong immunosuppression. It then discusses challenges in diagnosing infections in this population and outlines various factors that influence infection risk over time. The document explores approaches to risk stratification and describes how different immunosuppressive agents can impact specific infection risks. It proposes strategies for individualizing immunosuppression based on risk, including reducing immunosuppression in cases of over-suppression or clinical stability. The goal is to minimize infection risk through judicious immunosuppression management tailored to each patient.
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Fungal infections post LDLT.pptx
1. C
FUNGAL INFECTIONS POST
LIVING DONOR LIVER
TRANSPLANT
BY
Yasmine Mahmoud Massoud
Associate Professor of Tropical Medicine,
Faculty of Medicine ASU
Liver Transplant Hepatologist at Ain Shams
Center for Organ Transplantation
2. Agenda
Timeline of infections after liver transplant
Definition of IFI, Fungal colonization
Incidence and burden of IFI
Most common causative organisms
Common clinical manifestations of invasive
fungal infections
Risk factors for Invasive fungal infections
Diagnosis of fungal infections
Highlight on treatment of fungal infections
Antifungal Prophylaxis and it’s limitations
Take home messages
3. Introduction
• Infection following living-donor liver transplantation (LDLT) is a serious problem
with a high mortality rate reaching 50%. Factors associated with high risk of
acquiring infection post LDLT, include the difficulty of surgery, poor patient’s
condition, and the immunosuppressive drugs.
• Bacterial infections are the most common reaching about 48 %, followed by
fungal infections 22 %, and viral reaching 12 %.
Mohamed F Montasser, Nadia A Abdelkader, Sara M Abdelhakam, Hany Dabbous, Iman F Montasser, Yasmine M
Massoud et al. Bacterial infections post-living-donor liver transplantation in Egyptian hepatitis C virus-cirrhotic
patients: A single-center study World J Hepatol. 2017 Jul 18; 9(20): 896–904.
5. Important definitions
Fungal colonization is defined as the presence of fungus before LT without clinical
symptoms or evidence of infection within 3 months of transplantation.
Proven IFI is defined as a positive fungal culture or histological analysis of a tissue
specimen taken from a disease site, or appearance of fungal or hyphal elements in
a biopsy from a sterile site.
Probable and Possible IFIs are defined based on specific host factors, clinical
features of fungal infection, and mycological evidence from culture and
microscopic analysis and indirect tests, such as antigen detection.
According to Invasive Fungal Infections Cooperative Group in Europe and the Mycoses Study Group in the United States (MSG)
6. Incidence and burden of IFI
IFIs occur in 7–42% of patients post liver transplant
IFIs are associated with high mortality of 65% to 90% for invasive
aspergillosis and 30% to 50% for candidiasis
Morbidity and mortality post transplant is attributed to:
• Delay in diagnosis
• Nonspecific clinical features
• Fastidious nature of these organisms
• Lack of consensus on prophylactic regimens
• Rise of antifungal resistant species
Min Liu, Zhijun Zhu and Liying Sun Risk Factors of Invasive Fungal Infection in Recipients After Liver Transplantation: A
Systematic Review and Meta-Analysis: Front. Med., 04 October 2021
7. Causative
organisms
• Candida Species
Candidiasis is the most frequent fungal infection
encountered after orthotopic liver transplantation and the
leading cause of invasive fungal infection.
Candida albicans was the most common isolated species
followed by Candida glabrata and Candida tropicalis.
Antifungal prophylaxis with fluconazole has resulted in a
shift in epidemiology resulting in a shift in infections
towards non-C. albicans species (e.g., Candida glabrata and
Candida krusei
Mark Pedersen and Anil Seetharam Infections after orthotopic liver transplantation. Clinical and
experimental Hepatology Vol 4, Issue 4, P347-360, December 01, 2014
8. Causative
organisms
• Aspergillus
Aspergillus is the second most common fungal
infection after orthotopic liver transplantation
and account for approximately one quarter of
invasive fungal infections after transplant.
Mark Pedersen and Anil Seetharam. Infections after orthotopic liver transplantation.
Clinical and experimental Hepatology Vol 4, Issue 4, P347-360, December 01, 2014
9. Causative
organisms
• Cryptococcus
Cryptococcus neoformans is the third most
common fungal infection after liver
transplantation and most common cause of
meningitis in transplant recipients.
Inhalation of fungal spores can result in
symptomatic pneumonia or asymptomatic
infection often with dissemination to other body
sites, most commonly the central nervous system,
distant organs or involvement of another single
organ (e.g., lymph node)
Mark Pedersen and Anil Seetharam. Infections after orthotopic liver
transplantation. Clinical and experimental Hepatology Vol 4, Issue 4, P347-360,
December 01, 2014
10. Causative
organisms
• Pneumocystis jiroveci
Pneumocystis jiroveci is a well-established
opportunistic pathogen whose incidence is
recognized in immunosuppressed patients after
solid organ transplant. Patient with
pneumocystis infection may present with fever,
shortness of breath, and nonproductive cough
• Wang E.H. Partovi N. Levy R.D. Shapiro R.J. Yoshida E.M.Greanya E.D. Pneumocystis
pneumonia in solid organ transplant recipients: not yet an infection of the past.
Transpl Infect Dis. 2012; 14: 519-525
11. Causative
organisms
• Mucormycosis
Mucormycoses can cause local infections with
direct extension and rarely angioinvasive or
disseminated infections. The incidence of
infection in liver transplant recipients ranges from
0% to 1.6%.
Patients with iron overload syndromes, either
from transfusion or hemochromatosis, have
increased risk of mucormycosis,
• Getrikkos G. and Skiada A. et al. Epidemiology and clinical manifestations of
mucormycosis. J Infect Dis. 2012; 54: S23-S34
12. Causative
organisms
• Histoplasma, Blastomyces and Coccidioides
species
Endemic Fungi in certain areas in the US
Endemic mycoses in SOTRs are rare with overall
incidence estimated to be 0.2%
Outside these regions, cases may represent
remote travel, reactivation, or donor- derived
Presentation ranges from indolent pulmonary
infection to acute respiratory distress
syndrome(ARDS) and extrapulmonary
dissemination to the skin, osteoarticular system,
CNS and genitourinary system
Scolarici, M.; Jorgenson, M.; Saddler, C.; Smith, J. Fungal Infections in Liver Transplant
Recipients. J. Fungi 2021, 7, 524.
14. Risk factors for Invasive fungal infections
The predisposition of IFI in LTR is influenced by the host factors, environment and fungal factors.
Identification of risk factors for the LTR is very important in order to stratify the antifungal
prophylaxis
Risk factors specific to liver transplant recipients include anastomotic leak, repeat laparotomy,
choledochojejunostomy. hepatic artery thrombosis and bile leaks.
Other factors include Broad-spectrum antibiotic therapy, parenteral nutrition, prolonged
neutropenia, ICU stay, diabetes, high MELD
Ferrarese A, Cattelan A, Cillo U, Gringeri E, Russo FP, Germani G, Gambato M, Burra P, Senzolo M. Invasive fungal infection before and after liver transplantation. World J
Gastroenterol 2020; 26(47): 7485-7496 [PMID: 33384549 DOI: 10.3748/wjg.v26.i47.7485]
15. Risk factors for
Candida and
Aspergillus
FQ: Fluoroquinolone
HLA: Human leukocyte
antigen
CMV: Cytomegalovirus
HD: Hemodialysis
LT: Liver transplant
16.
17. Diagnosis of fungal infections
• Invasive Candidiasis
The critical step in IC diagnosis is consideration.
Blood cultures remain the gold standard for diagnosis of candidemia
yet with significant limitations
Beta-D-glucan (BDG) but positivity may occur in infection with
Aspergillus and Pneumocystis species
T2 Candida assay has also emerged as a non-culture-based diagnostic
test performed directly on blood to detect the five most common
pathogenic Candida species (C. albicans, C. glabrata, C. parapsilosis, C.
tropicalis, and C. krusei)
PCR
18. Diagnosis of fungal infections
• Invasive pulmonary aspergillosis
Diagnosis is made with the use of high-resolution computed
tomography (CT).
Early: nodular opacity with surrounding attenuation, or ‘halo sign.
Late: nodular lesions, diffuse pulmonary infiltrates, consolidation, or
ground-glass opacities.
19. Diagnosis of fungal infections
• Disseminated Aspergillosis
Aspergillus infections disseminate beyond the lungs in approximately
50–60% of liver transplant recipients.
Aspergillus galactomannan (GM) sensitivity ranges from 30% to 100%,
with a specificity of approximately 85%.
β-D glucan (BDG) sensitivity ranges from 50% to 87.5% (thus a good
test to rule out infection).
Combination of the two tests can be useful for identifying false-positive
reactions
20. Diagnosis of fungal infections
Specific Aspergillus PCR assay
Diagnoses invasive aspergillosis with very good outcomes (100%
sensitivity and 89% specificity).
Quantitative real-time PCR
Diagnoses invasive aspergillosis with sensitivity and specificity values of
67% and 100%, respectively, and can be used to monitor the fungal
response to infection management.
XiaLiu, Zongxin Ling, Lanjuan Li, Bing Ruan Invasive fungal infections in liver transplantation International Journal of Infectious
Diseases Volume 15, Issue 5, May 2011, Pages e298-e304
21. Diagnosis of fungal infections
• Cryptococcal disease should be considered recipients with fever,
headache, subacute mental status changes, or mass lesions in the lungs
or CNS
• Cryptococcal pneumonia
Could be difficult to identify on radiographic characteristics.
Sensitivity of cryptococcal antigen in cases of pneumonia is low.
• Cryptococcal CNS involvement
Classic signs of meningitis such as nuchal rigidity, photophobia, or
headache could be missing.
Detection of cryptococcal polysaccharide antigen in CSF and serum by
latex agglutination test
22. Diagnosis of fungal infections
• Pneumocystis jiroveci
Bilateral interstitial infiltrates are seen in chest X-ray.
If the microbial burden is high, pneumocystis organisms may be
identified from bronchoalveolar lavage fluid by direct
immunofluorescence using a fluorescein-conjugated monoclonal
antibody or by staining with toluidine blue.
23. Treatment of fungal infections
• The clinical keys of a successful treatment are early diagnosis and early
administration of appropriate antifungal treatment.
Invasive Candidiasis:
• Echinocandins (caspofungin, micafungin or anidulafungin) are the first
line for empirical, pre-emptive or proven treatment of IC.
• Fluconazole is considered as an oral alternative if the patient is not
critically ill or unlikely for fluconazole-resistant Candida infection.
• L AmpB should be considered if the first two are contraindicated as a
first-line treatment
Ferrarese A, Cattelan A, Cillo U, Gringeri E, Russo FP, Germani G, Gambato M, Burra P, Senzolo M. Invasive fungal infection before and after liver
transplantation. World J Gastroenterol 2020; 26(47): 7485-7496 [PMID: 33384549 DOI: 10.3748/wjg.v26.i47.7485]
24. Treatment of fungal infections
Invasive Aspergillosis
• Preferably treated with the triazole voriconazole. Alternative treatments
include LAmpB and isavuconazole.
• Voriconazole has improved the prognosis of patients suffering from
breakthrough CNS aspergillosis.
Pulmonary Invasive Aspergillosis
Echinocandins in combination with voriconazole
voriconazole has been associated with hepatic and renal dysfunction,
therefore therapeutic drug monitoring is essential
25. Treatment of fungal infections
Cryptococcal meningitis combination of liposomal amphotericin B or
amphotericin B lipid complex and flucytosine (5-FC) for at least 2 weeks
for the induction regimen, followed by fluconazole for 8 weeks for
consolidation therapy, and fluconazole for 6–12 months for
maintenance treatment.
26. Antifungal Prophylaxis
The main issue with antifungal prophylaxis is the lack of universal
consensus on the choice of antifungals, its duration, and type of
antifungal prophylaxis.
Risk factors should be organized to classify patients into specific risk
groups: low and high-risk groups.
Based on that, patients should receive:
• no prophylaxis
• Or targeted prophylaxis
Giannella M, Bartoletti M, Morelli M, Cristini F, Tedeschi S, Campoli C, et al. Antifungal prophylaxis in liver transplant recipients:
one size does not fit all. Transpl Infect Dis. 2016; 18: 538-544
27. Studies from 2014 till
2020 on antifungal
prophylaxis for liver
transplant recipients
28. Antifungal Prophylaxis
The various antifungals used for prophylaxis are azoles (fluconazole, itraconazole),
echinocandins and liposomal amphotericin B (L AmpB)
Fluconazole is the most administered prophylactic agent
Retrospective and prospective studies indicate that LTR with two or more risk factors are at
at substantially higher risk for IFI.
The incidence of IFI (0-4%) in low-risk LTR is too low to warrant systemic prophylaxis
• Verma A, Weigel KS, Dexter SYK, Dhawan A. Evolution in the Management of Invasive Fungal Infections in Liver Transplant Recipients.
OBM Transplantation 2018;2(2):009
29. Preventive strategies and recommendations for invasive fungal
infections in liver transplant recipients
Candida species Aspergillus species Cryptococcus species
Fluconazole, at least 400 mg daily for 4–
8 weeks after transplantation
Echinocandins in fluconazole resistant
candida
Lipid-associated amphotericin B, 1 mg/kg
for 5 days after transplantation
Lipid-associated amphotericin B, 1–5 mg/kg
or itraconazole 400 mg daily for 4 weeks
before and after liver transplantation in
patients with high-risk factors, especially those
with two or more risk factors or Echinocandins
High index of suspicion in
severely immunocompromised
individuals
Rational use of antibiotics Rational use of antibiotics Rational use of antibiotics
Selective digestive decontamination
Microbiological surveillance and
prevention of CMV disease
CMV disease prevention CMV disease prevention CMV disease prevention
Targeted therapy with fluconazole, based on
the presence of risk factors
30. Limitations to prophylaxis
Many studies indicate that prophylaxis for liver transplant recipients
results in a clear but limited reduction in proven IFIs but has no effect
on overall mortality.
Targeted prophylaxis is usually complicated by:
• Significantly higher proportion of non-C. albicans infection
• Increased potential for antifungal drug resistance
• Drug-associated toxicity
• Drug interactions between azoles and calcineurin inhibitors (CNI)
pose another challenge
• Verma A, Weigel KS, Dexter SYK, Dhawan A. Evolution in the Management of Invasive Fungal Infections in Liver Transplant Recipients. OBM
Transplantation 2018;2(2):009
31. Take home messages
Fungal infections following liver transplant remain an influential cause
of morbidity and mortality despite the low incidence.
Identifying patients at high risk for developing IFI can be of immense
help in decreasing the diagnostic delay and assure appropriate
prophylaxis.
Targeted prophylaxis appears to be superior to the universal approach.
A robust global consensus with stringent guidelines and an antifungal
stewardship are needed to develop an updated standard of care.