Overview on common fungal infections, recovered in Baghdad teaching hospitals in five years
DOI:
https://doi.org/10.22317/imj.v4i2.819Keywords:
Baghdad teaching hospital, Acute Myeliod leukemia, Invasive fungal infectionAbstract
Objective: To evaluate the burden of invasive fungal infections , recovered in a group of patients who were non responsive to antibiotic therapy and have been referred from some Iraqi hospitals in five years interval in a clinical and microbiological scope.
Methods:
Samples were collected during from the 25th of May 2012 to 5th of November 2017 enrolled 1444 Iraqi adult patients who referred by hematology-oncology unit, medical wards, bone marrow transplant unit and respiratory care unit with some other cases received from other hospitals in the capital Baghdad. samples from any infected sites were sent to the central medical mycology lab to identify the causative fungi using wet mount, direct examination, culture and sensitivity tests, biochemical and some serological examinations as galactomannan testing for invasive aspergillosis and PCR test to detect some pathological properties of a group of Aspergillus species.
Results
Although (26,6%) 387 samples revealed no fungal isolates most of them were of blood culture. The commonest fungus noticed in all samples was Cryptococcus neoformans in the first place 646 samples (38.63%), the next was Candida albicans and non albicans in 594 samples (35.52%).Aspergillus species in 252 samples (15.07%) ,Penicillium 27 samples (1.61%) ,Gieotrichum candidum15 samples (0.89),Zygomycetes and Rhizopus 20 (1.18% ),Trichosporon and Rhodotorula glutinis yeasts 14 )0.83%(, Sporothrixes schenkii 5(0.29%),2(0.11%) two cases of systemic mycosis one Histoplasma capsulatum and the other is Coccidiomycosis immitus .
Conclusions: The incidence of fungal infection is greatly increased in Iraq in relation to global and local risk factors with tendency for multiple fungal isolates in one patient. represents a major health problem in a wide variety of disease conditions ranging from hematology oncology to uncontrolled diabetic cases. with high case of fatality among hematological malignancies with neutropenia.
References
1. Wingard JR. New approaches to invasive fungal infections in acute leukemia and hematopoietic stem cell transplant patients. Best Pract Res Clin Haematol. 2007; 20:99-107
2 . Almirante B, Rodriguez D, Park BJ, et al. Epidemiology and predictors of mortality in cases of Candida bloodstream infec¬tion: results from population-based surveillance, Barcelona, Spain, from 2002 to 2003. J Clin Microbiol. 2005 ; 43:1829-1835
3 . Bow EJ, Loewen R, Cheang MS, Schacter B. Invasive fungal disease in adults undergoing remission-induction therapy for acute myeloid leukemia: the pathogenetic role of the antileuke¬mic regimen. Clin Infect Dis. 1995 ; 21:361-369
4. Mikulska M, Calandra T, Sanguinetti M, et al. Third European Conference on Infections in Leukemia Group. The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: recommendations from the Third European Conference on Infections in Leukemia. Crit Care 2010;14:R222.
5. Thursky K, Byrnes G, Grigg A, Szer J, Slavin M. Risk factors for post-engraftment invasive aspergillosis in allogeneic stem cell transplantation. Bone Marrow Transplant.2004; 34:115-121
6. Muhlemann K, Wenger C, Zenhausern R, Tauber MG. Risk factors for invasive aspergillosis in neutropenic patients with hematologic malignancies. Leukemia.2005; 19:545-550
7. Kobayashi R, Kaneda M, Sato T, Suzuki D, Ichikawa M, Ariga T. Evaluation of risk factors for invasive fungal infection after allogeneic stem cell transplantation in pediatric patients. J Pediatr Hematol Oncol.2007; 29:786-791
8. Pagano L, Girmenia C, Mele L, Ricci P, Tosti ME, Nosari A, et al. Infections caused by filamentous fungi in patients with hematologic malignancies. A report of 391 cases by GIMEMA Infection Program. GIMEMA Infection Program; Gruppo Italiano Malattie Ematologiche dell’Adulto. Haematologica 2001; 86:862-70.
9. Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34:909-17
10. Chen KY, Ko SC, Hsueh PR, et al. Pulmonary fungal infections. Emphasic on microbiology spectra, patient outcome, and prognosis factors. Chest. 2001; 120:177-184
11. Hsiao H.H., Tsai H.J., Liu Y.C., Tseng Y.T., Lu P.L., Yang W.C., Liu T.C., Lin S.F. Invasive fungal infections in patients with acute leukemia. Kaohsuing J. Med. Sci. 2006;22:217–222
12. Mitsutoshi Kurosawa, Masakatsu Yonezumi, Satoshi Hashino,et al. Epidemiology and treatment outcome of invasive fungal infections in patients with hematological malignancies. international Journal of Hematology 2012 96 ; 748-757
13. Marr KA, Carter RA, Crippa F, et al. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34:909–17.
14. Cuenca-Estrella M, Bernal-Martinez L, Buitrago MJ, et al. Update on the epidemiology and diagnosis of invasive fungal infection. Int J Antimicrob Agents. 2008;32(Suppl 2):S143–7
15. Mühlemann K, Wenger C, Zenhäusern R, et al. Risk factors for invasive aspergillosis in neutropenic patients with hematologic malignancies. Leukemia. 2005;19:545–50.
16. Donhuijsen K, Petersen P, Schmid KW. Trend reversal in the frequency of mycoses in hematological neoplasias. Dtsch Ärztebl Int. 2008;105:501–6
17. Maschmeyer G, Link H, Hiddemann W, et al. Pulmonary infiltrations in febrile patients with neutropenia: risk factors and outcome under empirical antimicrobial therapy in a randomized multicenter study. Cancer. 1994;73:2296–304
18. Seyyed A.A,Sanas H,Mahshid L.2018.The study on rate of morbidity of fungal infection exiting in educational hospitals Iran.comparitive clinical pathology.p1-6.
19. Wiley, J. M., Smith, N., Leventhal, B. G., Graham, M. L., Strauss, L. C., Hurwitz, C. A. et al. Invasive fungal disease in pediatric acute leukemia patients with fever and neutropenia during induction chemotherapy: a multivariate analysis of risk factors.
Journal of Clinical Oncology .1990;8, 280–6
20. Laura J. Schmertmann,Lazoio Irinli et al.The mycobiome of australian tree hollowss in relation to the Cryptococcus gattii and C.neoformans species complexes.Ecology and evolution .2019 ,9:9684-9700.
21. Rwaa, M. A., Wifaq M.ALwattar, Ali M.Jawad.Detection Of Galactomannan Antigen in The Serum Of Iraqi Patients with Invasive Aspergillosis. Journal of faculty of medicine .2016;2, 370–6.
22. Soukeina Gheith, Fatma Saghrouni, Wadiaa Bannour,etal. Characteristics of Invasive Aspergillosis in Neutropenic Haematology Patients (Sousse, Tunisia). Mycopathologia 2014 , 177 : 281-289
23. Kami M, Murashige N, Fujihara T, Sakagami N, Tanaka Y. The mechanism for low yield of blood culture in invasive aspergillosis; the clinical importance of antigen detection tests revisited. Bone Marrow Transplant 2005;36:85-86
24. Treger, T. R., Visscher, D. W., Bartlett, M. S. & Smith, J. W. Diagnosis of pulmonary infection caused by Aspergillus: usefulness of respiratory cultures. Journal of Infectious Diseases .1985;152, 572–6
25.Muhlemann K, Wenger C, Zenhausern R, Tauber MG. Risk factors for invasive aspergillosis in neutropenic patients with hematologic malignancies. Leukemia 2005;19:545-50
26.Grow WB, Moreb JS, Roque D, et al. Late onset of invasive Aspergillus infection in bone marrow transplant patients at a university hospital. Bone Marrow Transplant. 2002;29:15-19
27. Ninin E, Milpied N, Moreau P, et al. Longitudinal study of bacterial, viral, and fungal infections in adult recipients of bone marrow transplants. Clin Infect Dis. 2001;33:41-47
28. Anaissie E69.J, Stratton SL, Dignani MC, Lee CK, Mahfouz TH, Rex JH, et al. Cleaning patient shower facilities: a novel approach to reducing patient exposure to aerosolized Aspergillus species and other opportunistic molds. Clin Infect Dis 2002;35:86-8
29. Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB. Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis 2003;36:1103-10.
30. Annissis ,EJ.Opportunistic mycosis in the immunocompromized host :experience at a cancer center and review clin.infect.Dis.1992;,14(suppi.l):S43-S53,
31. Jutta Auberger, Cornelia Lass-Flörl, Hanno Ulmer,et al. Significant alterations in the epidemiology and treatment outcome of invasive fungal infections in patients with hematological malignancies. international Journal of Hematology. 2008 ;88: 508-515
32. Mor M, Gilad G, Kornreich L, et al. Invasive fungal infections in pediatric oncology. Pediatr Blood Cancer 2011;56:1092-7
33. Pagano L , Caira M, Candoni A,etal. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica. 2006 Aug;91(8):1068-75
34. Brakhage AA. Systemic fungal infections caused by Aspergillus species: epidemiology, infection process and virulence determinants. Curr Drug Targets. 2005;6:875–86
35. Pfaller MA and Diekema DJ. Rare and emerging opportunistic fungal pathogens: concern for resistance beyond Candida albicans and Aspergillus fumigatus. J Clin Microbiol.2004; 42: 4419-4431
36. Pappas PG, Alexander BD, Andes DR, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network Clin Infect Dis. 2010;50(8):1101
2 . Almirante B, Rodriguez D, Park BJ, et al. Epidemiology and predictors of mortality in cases of Candida bloodstream infec¬tion: results from population-based surveillance, Barcelona, Spain, from 2002 to 2003. J Clin Microbiol. 2005 ; 43:1829-1835
3 . Bow EJ, Loewen R, Cheang MS, Schacter B. Invasive fungal disease in adults undergoing remission-induction therapy for acute myeloid leukemia: the pathogenetic role of the antileuke¬mic regimen. Clin Infect Dis. 1995 ; 21:361-369
4. Mikulska M, Calandra T, Sanguinetti M, et al. Third European Conference on Infections in Leukemia Group. The use of mannan antigen and anti-mannan antibodies in the diagnosis of invasive candidiasis: recommendations from the Third European Conference on Infections in Leukemia. Crit Care 2010;14:R222.
5. Thursky K, Byrnes G, Grigg A, Szer J, Slavin M. Risk factors for post-engraftment invasive aspergillosis in allogeneic stem cell transplantation. Bone Marrow Transplant.2004; 34:115-121
6. Muhlemann K, Wenger C, Zenhausern R, Tauber MG. Risk factors for invasive aspergillosis in neutropenic patients with hematologic malignancies. Leukemia.2005; 19:545-550
7. Kobayashi R, Kaneda M, Sato T, Suzuki D, Ichikawa M, Ariga T. Evaluation of risk factors for invasive fungal infection after allogeneic stem cell transplantation in pediatric patients. J Pediatr Hematol Oncol.2007; 29:786-791
8. Pagano L, Girmenia C, Mele L, Ricci P, Tosti ME, Nosari A, et al. Infections caused by filamentous fungi in patients with hematologic malignancies. A report of 391 cases by GIMEMA Infection Program. GIMEMA Infection Program; Gruppo Italiano Malattie Ematologiche dell’Adulto. Haematologica 2001; 86:862-70.
9. Marr KA, Carter RA, Crippa F, Wald A, Corey L. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34:909-17
10. Chen KY, Ko SC, Hsueh PR, et al. Pulmonary fungal infections. Emphasic on microbiology spectra, patient outcome, and prognosis factors. Chest. 2001; 120:177-184
11. Hsiao H.H., Tsai H.J., Liu Y.C., Tseng Y.T., Lu P.L., Yang W.C., Liu T.C., Lin S.F. Invasive fungal infections in patients with acute leukemia. Kaohsuing J. Med. Sci. 2006;22:217–222
12. Mitsutoshi Kurosawa, Masakatsu Yonezumi, Satoshi Hashino,et al. Epidemiology and treatment outcome of invasive fungal infections in patients with hematological malignancies. international Journal of Hematology 2012 96 ; 748-757
13. Marr KA, Carter RA, Crippa F, et al. Epidemiology and outcome of mould infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2002;34:909–17.
14. Cuenca-Estrella M, Bernal-Martinez L, Buitrago MJ, et al. Update on the epidemiology and diagnosis of invasive fungal infection. Int J Antimicrob Agents. 2008;32(Suppl 2):S143–7
15. Mühlemann K, Wenger C, Zenhäusern R, et al. Risk factors for invasive aspergillosis in neutropenic patients with hematologic malignancies. Leukemia. 2005;19:545–50.
16. Donhuijsen K, Petersen P, Schmid KW. Trend reversal in the frequency of mycoses in hematological neoplasias. Dtsch Ärztebl Int. 2008;105:501–6
17. Maschmeyer G, Link H, Hiddemann W, et al. Pulmonary infiltrations in febrile patients with neutropenia: risk factors and outcome under empirical antimicrobial therapy in a randomized multicenter study. Cancer. 1994;73:2296–304
18. Seyyed A.A,Sanas H,Mahshid L.2018.The study on rate of morbidity of fungal infection exiting in educational hospitals Iran.comparitive clinical pathology.p1-6.
19. Wiley, J. M., Smith, N., Leventhal, B. G., Graham, M. L., Strauss, L. C., Hurwitz, C. A. et al. Invasive fungal disease in pediatric acute leukemia patients with fever and neutropenia during induction chemotherapy: a multivariate analysis of risk factors.
Journal of Clinical Oncology .1990;8, 280–6
20. Laura J. Schmertmann,Lazoio Irinli et al.The mycobiome of australian tree hollowss in relation to the Cryptococcus gattii and C.neoformans species complexes.Ecology and evolution .2019 ,9:9684-9700.
21. Rwaa, M. A., Wifaq M.ALwattar, Ali M.Jawad.Detection Of Galactomannan Antigen in The Serum Of Iraqi Patients with Invasive Aspergillosis. Journal of faculty of medicine .2016;2, 370–6.
22. Soukeina Gheith, Fatma Saghrouni, Wadiaa Bannour,etal. Characteristics of Invasive Aspergillosis in Neutropenic Haematology Patients (Sousse, Tunisia). Mycopathologia 2014 , 177 : 281-289
23. Kami M, Murashige N, Fujihara T, Sakagami N, Tanaka Y. The mechanism for low yield of blood culture in invasive aspergillosis; the clinical importance of antigen detection tests revisited. Bone Marrow Transplant 2005;36:85-86
24. Treger, T. R., Visscher, D. W., Bartlett, M. S. & Smith, J. W. Diagnosis of pulmonary infection caused by Aspergillus: usefulness of respiratory cultures. Journal of Infectious Diseases .1985;152, 572–6
25.Muhlemann K, Wenger C, Zenhausern R, Tauber MG. Risk factors for invasive aspergillosis in neutropenic patients with hematologic malignancies. Leukemia 2005;19:545-50
26.Grow WB, Moreb JS, Roque D, et al. Late onset of invasive Aspergillus infection in bone marrow transplant patients at a university hospital. Bone Marrow Transplant. 2002;29:15-19
27. Ninin E, Milpied N, Moreau P, et al. Longitudinal study of bacterial, viral, and fungal infections in adult recipients of bone marrow transplants. Clin Infect Dis. 2001;33:41-47
28. Anaissie E69.J, Stratton SL, Dignani MC, Lee CK, Mahfouz TH, Rex JH, et al. Cleaning patient shower facilities: a novel approach to reducing patient exposure to aerosolized Aspergillus species and other opportunistic molds. Clin Infect Dis 2002;35:86-8
29. Wisplinghoff H, Seifert H, Wenzel RP, Edmond MB. Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States. Clin Infect Dis 2003;36:1103-10.
30. Annissis ,EJ.Opportunistic mycosis in the immunocompromized host :experience at a cancer center and review clin.infect.Dis.1992;,14(suppi.l):S43-S53,
31. Jutta Auberger, Cornelia Lass-Flörl, Hanno Ulmer,et al. Significant alterations in the epidemiology and treatment outcome of invasive fungal infections in patients with hematological malignancies. international Journal of Hematology. 2008 ;88: 508-515
32. Mor M, Gilad G, Kornreich L, et al. Invasive fungal infections in pediatric oncology. Pediatr Blood Cancer 2011;56:1092-7
33. Pagano L , Caira M, Candoni A,etal. The epidemiology of fungal infections in patients with hematologic malignancies: the SEIFEM-2004 study. Haematologica. 2006 Aug;91(8):1068-75
34. Brakhage AA. Systemic fungal infections caused by Aspergillus species: epidemiology, infection process and virulence determinants. Curr Drug Targets. 2005;6:875–86
35. Pfaller MA and Diekema DJ. Rare and emerging opportunistic fungal pathogens: concern for resistance beyond Candida albicans and Aspergillus fumigatus. J Clin Microbiol.2004; 42: 4419-4431
36. Pappas PG, Alexander BD, Andes DR, et al. Invasive fungal infections among organ transplant recipients: results of the Transplant-Associated Infection Surveillance Network Clin Infect Dis. 2010;50(8):1101
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Published
2020-06-26
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1.
Ali Al-Wattar WM. Overview on common fungal infections, recovered in Baghdad teaching hospitals in five years. Iraq Med J [Internet]. 2020 Jun. 26 [cited 2024 Nov. 23];4(2). Available from: https://iraqmedj.org/index.php/imj/article/view/819
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