Invasive infections are a major complication before liver transplantation(LT)and in the early phase after surgery.There has been an increasing prevalence of invasive fungal disease(IFD),especially among the sickest pa...Invasive infections are a major complication before liver transplantation(LT)and in the early phase after surgery.There has been an increasing prevalence of invasive fungal disease(IFD),especially among the sickest patients with decompensated cirrhosis and acute-on-chronic liver failure,who suffer from a profound state of immune dysfunction and receive intensive care management.In such patients,who are listed for LT,development of an IFD often worsens hepatic and extra-hepatic organ dysfunction,requiring a careful evaluation before surgery.In the post-transplant setting,the burden of IFD has been reduced after the clinical advent of antifungal prophylaxis,even if several major issues still remain,such as duration,target population and drug type(s).Nevertheless,the development of IFD in the early phase after surgery significantly impairs graft and patient survival.This review outlines presentation,prophylactic and therapeutic strategies,and outcomes of IFD in LT candidates and recipients,providing specific considerations for clinical practice.展开更多
The increased incidence of invasive and opportunistic mycoses is probably related to the growth of the immunocompromised population, such as people living with HIV. This study is a literature review that aims to analy...The increased incidence of invasive and opportunistic mycoses is probably related to the growth of the immunocompromised population, such as people living with HIV. This study is a literature review that aims to analyze the frequency of invasive fungal infections in people living with HIV. In most studies evaluated, <em>Pneumocystis</em> pneumonia was the most frequent invasive fungal infection among people living with HIV, and cryptococcosis was the second most frequent. Invasive fungal infections are associated with greater morbidity and mortality in people living with HIV. The most important highlighted information is that the lack of epidemiological data on fungal infections in the studied populations was reported by most studies. Therefore, there is a need for further studies to assess the frequency of invasive fungal infection in people living with HIV, which may serve as subsidies for the implementation of strategies for the prevention and management, with a consequent increase in the quality of life and reduction of morbidity/mortality in this population.展开更多
Objective:To investigate the diagnosis and treatment of invasive fungal infections(IFI) in the patients admitted to the Department of Obstetrics and Gynecology in Peking Union Medical College Hospital(PUMCH). Methods:...Objective:To investigate the diagnosis and treatment of invasive fungal infections(IFI) in the patients admitted to the Department of Obstetrics and Gynecology in Peking Union Medical College Hospital(PUMCH). Methods:The IFI data from the clinical laboratory and medical records of PUMCH from January,2003 to December, 2009 were studied retrospectively.The patients were classified by diagnostic criteria as confirmed,clinical-diagnosed or suspected cases,and classified by treatment protocols into surgery,chemotherapy or end-stage of malignant tumors.The distribution,pathogens,risk factors and treatment outcomes of IFIs in these patients were discussed. Results:The data of 220 obstetric-gynecologic cases of IFIs were retrieved(52 cases confirmed,11 clinical-diagnosed and 157 suspected).The incidence of confirmed urinogenital IFIs in obstetric-gynecologic patients was greater than overall incidence of urinogenital IFIs in PUMCH(46.2%vs.18.7%,P<0.001).The possible risk factors of IFIs in the obstetric-gynecologic patients included hypoalbuminemia(87.3%in all the confirmed and clinical -diagnosed patients),neutropenia(52.4%) and chemotherapy or radiotherapy(50.8%).The treatment effectiveness in the surgical,chemotherapeutic and end-stage patients were 100.0%(108/108),91.6%(87/95) and 52. 9%(9/17),respectively(P<0.001). Conclusion:The IFIs in the patients from the Department of Obstetrics and Gynecology had more severe cases, diverse risk factors,and special distribution of infection sites.The curative effect was excellent for those receiving surgery or chemotherapy.展开更多
This study aimed to assess whether genetic variants of dendritic cell-associated C-type lectine-1(Dectin-1),Toll-like receptor 2(TLR2),Toll-like receptor 4(TLR4),and myeloid differentiation primary response 88(MyDHH)i...This study aimed to assess whether genetic variants of dendritic cell-associated C-type lectine-1(Dectin-1),Toll-like receptor 2(TLR2),Toll-like receptor 4(TLR4),and myeloid differentiation primary response 88(MyDHH)influence the susceptibility to pulmonary invasive fungal disease(IFD)in patients with acute myeloid leukemia(AML)from a Chinese Han population.Eight single nucleotide polymorphisms(SNPs)of Dectin-1(rs 16910526,rs3901533,and rs7309123),TLR2(rs5743708),TLR4(rs4986790 and rs4986791)and MyD88(rs4988453 and rs4988457)in the genomic DNA of 172 adult AML patients were genotyped.Pulmonary IFD was diagnosed as proven or probable according to the 2008 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 guidelines.SNPs that were significant in the univariate analysis were further analyzed using the multiple logistic regression analysis to determine their association with the occurrence of pulmonary IFD.The mRNA expression of Dectin-1 was detected according to the genotype by quantitative realtime PCR(qRT-PCR),and the correlation of this expression with the occurrence of pulmonary IFD in AML patients was analyzed.Two Dectin-1 intron SNPs(rs3901533 and rs7309123)were found to be significantly associated with the susceptibility to pulmonary IFD in AML patients in a Chinese Han population.Significant associations were noted between pulmonary IFD and Dectin-1 rs3901533 dominant model(G/T+G/G vs.T/T,OR:2.158;95%Cl:1.109-4.2,P=0.02),Dectin-1 rs3901533 G allele(OR:2.201;95%Cl:1.206-4.019,P=0.01),or Dectin-1 rs7309123 C allele(OR:1.919;95%Cl:1.047-3.518,P=0.03).There were no significant associations between pulmonary IFD and the remaining Dectin-1 SNPs(rs 16910526),TLR2(rs5743708),TLR4(rs4986790 and rs4986791)or MyDHH(rs4988453 and rs4988457).In conclusion,two Dectin-1 SNPs(rs3901533 and rs7309123)are associated with increased susceptibility to pulmonary IFD in AML patients in a Chinese Han population.展开更多
With increasing morbidity and mortality from chronic liver disease and acute liver failure,the need for liver transplantation is on the rise.Most of these patients are extremely vulnerable to infections as they are im...With increasing morbidity and mortality from chronic liver disease and acute liver failure,the need for liver transplantation is on the rise.Most of these patients are extremely vulnerable to infections as they are immune-compromised and have other chronic co-morbid conditions.Despite the recent advances in practice and improvement in diagnostic surveillance and treatment modalities,a major portion of these patients continue to be affected by post-transplant infections.Of these,fungal infections are particularly notorious given their vague and insidious onset and are very challenging to diagnose.This mini-review aims to discuss the incidence of fungal infections following liver transplantation,the different fungi involved,the risk factors,which predispose these patients to such infections,associated diagnostic challenges,and the role of prophylaxis.The population at risk is increasingly old and frail,suffering from various other co-morbid conditions,and needs special attention.To improve care and to decrease the burden of such infections,we need to identify the at-risk population with more robust clinical and diagnostic parameters.A more robust global consensus and stringent guidelines are needed to fight against resistant microbes and maintain the longevity of current antimicrobial therapies.展开更多
There has been an increasing incidence of fungal infections in recent years.Rarely joints are also affected by fungal infections.Mainly,these infections develop in prosthetic joints,but sometimes native joints are als...There has been an increasing incidence of fungal infections in recent years.Rarely joints are also affected by fungal infections.Mainly,these infections develop in prosthetic joints,but sometimes native joints are also involved.Candida infections are mostly reported,but patients may also develop infections secondary to non-Candida fungi,especially Aspergillus.Diagnosis and management of these infections is challenging and may involve multiple surgical interventions and prolonged antifungal therapy.Despite this,these infections are associated with high morbidity and mortality.This review described the clinical features,risk factors,and therapeutic interventions required to manage fungal arthritis.展开更多
目的:评价艾沙康唑(ISA)治疗侵袭性真菌感染(IFI)的疗效和安全性,为临床治疗策略的选择提供循证依据。方法:检索Embase、PubMed、Web of Science、the Cochrane Library、维普数据库、中国知网、万方数据库和中国生物医学文献服务系统等...目的:评价艾沙康唑(ISA)治疗侵袭性真菌感染(IFI)的疗效和安全性,为临床治疗策略的选择提供循证依据。方法:检索Embase、PubMed、Web of Science、the Cochrane Library、维普数据库、中国知网、万方数据库和中国生物医学文献服务系统等,检索时限均为建库至2023年5月,获取ISA治疗IFI的随机对照试验(RCT)、队列研究和病例对照研究(观察组患者使用ISA单药治疗,对照组患者使用伏立康唑或两性霉素B单药治疗)。对纳入的文献进行质量评价、资料提取,应用RevMan 5.4.1软件进行Meta分析。结果:共纳入3项RCT、3项队列研究和1项病例对照研究,包括914例患者。Meta分析结果表明,观察组与对照组患者总有效率(RR=1.00,95%CI=0.84~1.17,P=0.96)、全因死亡率(RR=0.95,95%CI=0.76~1.18,P=0.62)的差异均无统计学意义。安全性方面,观察组患者的总体不良反应发生率低于对照组(RR=0.76,95%CI=0.58~0.99,P=0.05);其中视觉异常(RR=0.47,95%CI=0.34~0.67,P<0.0001)、肝功能损伤(RR=0.56,95%CI=0.38~0.83,P=0.004)的发生率明显低于对照组,差异有统计学意义;但两组患者神经系统不良反应发生率的差异无统计学意义(RR=1.04,95%CI=0.83~1.31,P=0.71)。结论:ISA治疗IFI的疗效与伏立康唑相近,整体安全性优于伏立康唑,尤其是肝功能损伤、视觉异常的发生率低于伏立康唑,但临床应用过程中仍需要关注其神经系统不良反应。展开更多
文摘Invasive infections are a major complication before liver transplantation(LT)and in the early phase after surgery.There has been an increasing prevalence of invasive fungal disease(IFD),especially among the sickest patients with decompensated cirrhosis and acute-on-chronic liver failure,who suffer from a profound state of immune dysfunction and receive intensive care management.In such patients,who are listed for LT,development of an IFD often worsens hepatic and extra-hepatic organ dysfunction,requiring a careful evaluation before surgery.In the post-transplant setting,the burden of IFD has been reduced after the clinical advent of antifungal prophylaxis,even if several major issues still remain,such as duration,target population and drug type(s).Nevertheless,the development of IFD in the early phase after surgery significantly impairs graft and patient survival.This review outlines presentation,prophylactic and therapeutic strategies,and outcomes of IFD in LT candidates and recipients,providing specific considerations for clinical practice.
文摘The increased incidence of invasive and opportunistic mycoses is probably related to the growth of the immunocompromised population, such as people living with HIV. This study is a literature review that aims to analyze the frequency of invasive fungal infections in people living with HIV. In most studies evaluated, <em>Pneumocystis</em> pneumonia was the most frequent invasive fungal infection among people living with HIV, and cryptococcosis was the second most frequent. Invasive fungal infections are associated with greater morbidity and mortality in people living with HIV. The most important highlighted information is that the lack of epidemiological data on fungal infections in the studied populations was reported by most studies. Therefore, there is a need for further studies to assess the frequency of invasive fungal infection in people living with HIV, which may serve as subsidies for the implementation of strategies for the prevention and management, with a consequent increase in the quality of life and reduction of morbidity/mortality in this population.
文摘Objective:To investigate the diagnosis and treatment of invasive fungal infections(IFI) in the patients admitted to the Department of Obstetrics and Gynecology in Peking Union Medical College Hospital(PUMCH). Methods:The IFI data from the clinical laboratory and medical records of PUMCH from January,2003 to December, 2009 were studied retrospectively.The patients were classified by diagnostic criteria as confirmed,clinical-diagnosed or suspected cases,and classified by treatment protocols into surgery,chemotherapy or end-stage of malignant tumors.The distribution,pathogens,risk factors and treatment outcomes of IFIs in these patients were discussed. Results:The data of 220 obstetric-gynecologic cases of IFIs were retrieved(52 cases confirmed,11 clinical-diagnosed and 157 suspected).The incidence of confirmed urinogenital IFIs in obstetric-gynecologic patients was greater than overall incidence of urinogenital IFIs in PUMCH(46.2%vs.18.7%,P<0.001).The possible risk factors of IFIs in the obstetric-gynecologic patients included hypoalbuminemia(87.3%in all the confirmed and clinical -diagnosed patients),neutropenia(52.4%) and chemotherapy or radiotherapy(50.8%).The treatment effectiveness in the surgical,chemotherapeutic and end-stage patients were 100.0%(108/108),91.6%(87/95) and 52. 9%(9/17),respectively(P<0.001). Conclusion:The IFIs in the patients from the Department of Obstetrics and Gynecology had more severe cases, diverse risk factors,and special distribution of infection sites.The curative effect was excellent for those receiving surgery or chemotherapy.
基金the National Natural Science Foundation of China(No.81500105).
文摘This study aimed to assess whether genetic variants of dendritic cell-associated C-type lectine-1(Dectin-1),Toll-like receptor 2(TLR2),Toll-like receptor 4(TLR4),and myeloid differentiation primary response 88(MyDHH)influence the susceptibility to pulmonary invasive fungal disease(IFD)in patients with acute myeloid leukemia(AML)from a Chinese Han population.Eight single nucleotide polymorphisms(SNPs)of Dectin-1(rs 16910526,rs3901533,and rs7309123),TLR2(rs5743708),TLR4(rs4986790 and rs4986791)and MyD88(rs4988453 and rs4988457)in the genomic DNA of 172 adult AML patients were genotyped.Pulmonary IFD was diagnosed as proven or probable according to the 2008 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 guidelines.SNPs that were significant in the univariate analysis were further analyzed using the multiple logistic regression analysis to determine their association with the occurrence of pulmonary IFD.The mRNA expression of Dectin-1 was detected according to the genotype by quantitative realtime PCR(qRT-PCR),and the correlation of this expression with the occurrence of pulmonary IFD in AML patients was analyzed.Two Dectin-1 intron SNPs(rs3901533 and rs7309123)were found to be significantly associated with the susceptibility to pulmonary IFD in AML patients in a Chinese Han population.Significant associations were noted between pulmonary IFD and Dectin-1 rs3901533 dominant model(G/T+G/G vs.T/T,OR:2.158;95%Cl:1.109-4.2,P=0.02),Dectin-1 rs3901533 G allele(OR:2.201;95%Cl:1.206-4.019,P=0.01),or Dectin-1 rs7309123 C allele(OR:1.919;95%Cl:1.047-3.518,P=0.03).There were no significant associations between pulmonary IFD and the remaining Dectin-1 SNPs(rs 16910526),TLR2(rs5743708),TLR4(rs4986790 and rs4986791)or MyDHH(rs4988453 and rs4988457).In conclusion,two Dectin-1 SNPs(rs3901533 and rs7309123)are associated with increased susceptibility to pulmonary IFD in AML patients in a Chinese Han population.
文摘With increasing morbidity and mortality from chronic liver disease and acute liver failure,the need for liver transplantation is on the rise.Most of these patients are extremely vulnerable to infections as they are immune-compromised and have other chronic co-morbid conditions.Despite the recent advances in practice and improvement in diagnostic surveillance and treatment modalities,a major portion of these patients continue to be affected by post-transplant infections.Of these,fungal infections are particularly notorious given their vague and insidious onset and are very challenging to diagnose.This mini-review aims to discuss the incidence of fungal infections following liver transplantation,the different fungi involved,the risk factors,which predispose these patients to such infections,associated diagnostic challenges,and the role of prophylaxis.The population at risk is increasingly old and frail,suffering from various other co-morbid conditions,and needs special attention.To improve care and to decrease the burden of such infections,we need to identify the at-risk population with more robust clinical and diagnostic parameters.A more robust global consensus and stringent guidelines are needed to fight against resistant microbes and maintain the longevity of current antimicrobial therapies.
文摘There has been an increasing incidence of fungal infections in recent years.Rarely joints are also affected by fungal infections.Mainly,these infections develop in prosthetic joints,but sometimes native joints are also involved.Candida infections are mostly reported,but patients may also develop infections secondary to non-Candida fungi,especially Aspergillus.Diagnosis and management of these infections is challenging and may involve multiple surgical interventions and prolonged antifungal therapy.Despite this,these infections are associated with high morbidity and mortality.This review described the clinical features,risk factors,and therapeutic interventions required to manage fungal arthritis.
