Fungal Diseases in Europe

A special issue of Journal of Fungi (ISSN 2309-608X).

Deadline for manuscript submissions: closed (28 February 2023) | Viewed by 11689

Special Issue Editors

1. Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
2. Instituto de Investigación Sanitaria Gregorio Marañón, 28007 Madrid, Spain
Interests: invasive fungal infections; solid organ transplant; endocarditis; aspergillosis; antifungal stewardship
Special Issues, Collections and Topics in MDPI journals
1. Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
2. Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
Interests: infection in solid organ transplant recipients, infection due to difficult to treat microorganisms, management of patients with bloodstream infections
1. Department of Health Sciences, University of Genoa, 16126 Genoa, Italy
2. Clinica Malattie Infettive, Ospedale Policlinico San Martino–IRCCS, 16132 Genoa, Italy
Interests: candidemia; invasive aspergillosis; rare mould infections; invasive candidiasis
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Fungal infections continue to pose a diagnostic and treatment challenge to clinicians and microbiologists worldwide. In recent years, there has been an increase in fungal infections, a change in risk factors and the emergence of antifungal-resistant pathogens. At the same time, in the diagnostic field, new independent culture techniques have been developed. For this reason, we are dedicating this Special Issue of the journal to review the latest research in the field of fungal infection in Europe.

We are looking forward to receiving original submissions of manuscripts from all over Europe, dealing with new risk factors associated with the development of fungal infection, fungal infection in special patient populations, the emergence of new antifungal resistant strains and description of outbreaks, the application of new diagnostic techniques and real-life studies describing clinical experience with new antifungals.

Sincerely,
Dr. Maricela Valerio Minero
Dr. Maddalena Giannella
Dr. Antonio Vena
Guest Editors

Manuscript Submission Information

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Fungi is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • invasive fungal infections
  • epidemiology
  • diagnosis
  • Europe

Published Papers (7 papers)

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Research

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10 pages, 1235 KiB  
Article
Gaining an Understanding of Pneumocystosis in Wales
by Jonathan Ayling-Smith, Matthijs Backx, Elizabeth Grant, Rishi Dhillon, Jamie Duckers, Kerenza Hood and P. Lewis White
J. Fungi 2023, 9(6), 660; https://doi.org/10.3390/jof9060660 - 13 Jun 2023
Cited by 1 | Viewed by 909
Abstract
Pneumocystis pneumonia (PcP) is a serious complication of many significant immunocompromising conditions. Prior incidence estimates in Wales are based on PcP’s presentation in the HIV and transplant populations. The objectives were to describe the incidence of PcP in Wales using laboratory reporting measures [...] Read more.
Pneumocystis pneumonia (PcP) is a serious complication of many significant immunocompromising conditions. Prior incidence estimates in Wales are based on PcP’s presentation in the HIV and transplant populations. The objectives were to describe the incidence of PcP in Wales using laboratory reporting measures and assess the impact of underlying immunosuppression cause on mortality. All positive PCR results for PcP between 2015 and 2018 were identified. The total number of unique positives with clinical and radiological correlation was 159 patients, a mean of 39.75 annually. The healthcare records of these patients were reviewed. The mortality at one month was 35.2% and 49.1% at one year. HIV remains the commonest cause of immunosuppression but has lower mortality than non-HIV conditions (12% vs. 59% at one year, p < 0.00001). Non-HIV conditions were categorised as life-threatening and non-life threatening but had a non-significant mortality (66% vs. 54%; p = 0.149), highlighting the negative impact of PcP. An incidence of PcP in Wales of 1.23–1.26 cases per 100,000 has been identified, 32–35% greater than the upper limit previously estimated. There is high mortality in non-HIV patients regardless of immunosuppression cause. A heightened awareness of PcP in these groups will hasten diagnosis and potentially improve mortality. Full article
(This article belongs to the Special Issue Fungal Diseases in Europe)
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20 pages, 993 KiB  
Article
Epidemiology of Mucormycosis in Greece; Results from a Nationwide Prospective Survey and Published Case Reports
by Maria Drogari-Apiranthitou, Anna Skiada, Ioannis Panayiotides, Timoleon-Achilleas Vyzantiadis, Aikaterina Poulopoulou, Myrto Christofidou, Anastasia Antoniadou, Emmanuel Roilides, Elias Iosifidis, Vassiliki Mamali, Athina Argyropoulou, Styliani Sympardi, Nikoletta Charalampaki, Nikolaos Antonakos, Paraskevi Mantzana, Zafeiria Mastora, Ourania Nicolatou-Galitis, Maria Orfanidou, Zoi-Dorothea Pana, Ioannis Pavleas, Angelos Pefanis, Vissaria Sakka, Anastasia Spiliopoulou, Maria Stamouli, Polydoros Tofas, Eleni Vagiakou and George Petrikkosadd Show full author list remove Hide full author list
J. Fungi 2023, 9(4), 425; https://doi.org/10.3390/jof9040425 - 29 Mar 2023
Cited by 2 | Viewed by 1824
Abstract
Mucormycosis has emerged as a group of severe infections mainly in immunocompromised patients. We analysed the epidemiology of mucormycosis in Greece in a multicentre, nationwide prospective survey of patients of all ages, during 2005–2022. A total of 108 cases were recorded. The annual [...] Read more.
Mucormycosis has emerged as a group of severe infections mainly in immunocompromised patients. We analysed the epidemiology of mucormycosis in Greece in a multicentre, nationwide prospective survey of patients of all ages, during 2005–2022. A total of 108 cases were recorded. The annual incidence declined after 2009 and appeared stable thereafter, at 0.54 cases/million population. The most common forms were rhinocerebral (51.8%), cutaneous (32.4%), and pulmonary (11.1%). Main underlying conditions were haematologic malignancy/neutropenia (29.9%), haematopoietic stem cell transplantation (4.7%), diabetes mellitus (DM) (15.9%), other immunodeficiencies (23.4%), while 22.4% of cases involved immunocompetent individuals with cutaneous/soft-tissue infections after motor vehicle accident, surgical/iatrogenic trauma, burns, and injuries associated with natural disasters. Additionally, DM or steroid-induced DM was reported as a comorbidity in 21.5% of cases with various main conditions. Rhizopus (mostly R. arrhizus) predominated (67.1%), followed by Lichtheimia (8.5%) and Mucor (6.1%). Antifungal treatment consisted mainly of liposomal amphotericin B (86.3%), median dose 7 mg/kg/day, range 3–10 mg/kg/day, with or without posaconazole. Crude mortality was 62.8% during 2005–2008 but decreased significantly after 2009, at 34.9% (p = 0.02), with four times fewer haematological cases, fewer iatrogenic infections, and fewer cases with advanced rhinocerebral form. The increased DM prevalence should alert clinicians for timely diagnosis of mucormycosis in this patient population. Full article
(This article belongs to the Special Issue Fungal Diseases in Europe)
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11 pages, 537 KiB  
Article
High Incidence of Candidemia in Critically Ill COVID-19 Patients Supported by Veno-Venous Extracorporeal Membrane Oxygenation: A Retrospective Study
by Francesco Alessandri, Giancarlo Ceccarelli, Giuseppe Migliara, Valentina Baccolini, Alessandro Russo, Carolina Marzuillo, Mariateresa Ceparano, Giovanni Giordano, Pierfrancesco Tozzi, Gioacchini Galardo, Giammarco Raponi, Claudio Mastroianni, Mario Venditti, Francesco Pugliese and Gabriella d’Ettorre
J. Fungi 2023, 9(1), 119; https://doi.org/10.3390/jof9010119 - 14 Jan 2023
Cited by 8 | Viewed by 1331
Abstract
Background: The incidence of candidemia in severe COVID-19 patients (0.8–14%) is two- to ten-fold higher than in non-COVID-19 patients. Methods: This retrospective analysis aimed to analyse the incidence of bloodstream infections (BSI) due to Candida in a cohort of COVID-19 patients supported with [...] Read more.
Background: The incidence of candidemia in severe COVID-19 patients (0.8–14%) is two- to ten-fold higher than in non-COVID-19 patients. Methods: This retrospective analysis aimed to analyse the incidence of bloodstream infections (BSI) due to Candida in a cohort of COVID-19 patients supported with ECMO. Results: Among 138 intubated and ventilated patients hospitalized for ≥10 days in the intensive care unit of a teaching hospital, 45 (32.6%) patients received ECMO support, while 93 patients (67.4%) did not meet ECMO criteria and were considered the control group. In the ECMO group, 16 episodes of candidaemia were observed, while only 13 in patients of the control group (36.0% vs. 14.0%, p-value 0.004). It was confirmed at the survival analysis (SHR: 2.86, 95% CI: 1.39–5.88) and at the multivariable analyses (aSHR: 3.91, 95% CI: 1.73–8.86). A higher candida score seemed to increase the hazard for candidemia occurrence (aSHR: 3.04, 95% CI: 2.09–4.42), while vasopressor therapy was negatively associated with the outcome (aSHR: 0.15, 95% CI: 0.05–0.43). Conclusions: This study confirms that the incidence of candidemia was significantly higher in critically ill COVID-19 patients supported with VV-ECMO than in critically ill COVID patients who did not meet criteria for VV-ECMO. Full article
(This article belongs to the Special Issue Fungal Diseases in Europe)
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12 pages, 1618 KiB  
Article
Candida Genotyping of Blood Culture Isolates from Patients Admitted to 16 Hospitals in Madrid: Genotype Spreading during the COVID-19 Pandemic Driven by Fluconazole-Resistant C. parapsilosis
by Judith Díaz-García, Ana Gómez, Marina Machado, Luis Alcalá, Elena Reigadas, Carlos Sánchez-Carrillo, Ana Pérez-Ayala, Elia Gómez-García de la Pedrosa, Fernando González-Romo, María Soledad Cuétara, Coral García-Esteban, Inmaculada Quiles-Melero, Nelly Daniela Zurita, María Muñoz Algarra, María Teresa Durán-Valle, Aída Sánchez-García, Patricia Muñoz, Pilar Escribano, Jesús Guinea and on behalf of the CANDIMAD Study Group
J. Fungi 2022, 8(11), 1228; https://doi.org/10.3390/jof8111228 - 21 Nov 2022
Cited by 8 | Viewed by 1503 | Correction
Abstract
Background: Candidaemia and invasive candidiasis are typically hospital-acquired. Genotyping isolates from patients admitted to different hospitals may be helpful in tracking clones spreading across hospitals, especially those showing antifungal resistance. Methods: We characterized Candida clusters by studying Candida isolates (C. albicans, [...] Read more.
Background: Candidaemia and invasive candidiasis are typically hospital-acquired. Genotyping isolates from patients admitted to different hospitals may be helpful in tracking clones spreading across hospitals, especially those showing antifungal resistance. Methods: We characterized Candida clusters by studying Candida isolates (C. albicans, n = 1041; C. parapsilosis, n = 354, and C. tropicalis, n = 125) from blood cultures (53.8%) and intra-abdominal samples (46.2%) collected as part of the CANDIMAD (Candida in Madrid) study in Madrid (2019–2021). Species-specific microsatellite markers were used to define the genotypes of Candida spp. found in a single patient (singleton) or several patients (cluster) from a single hospital (intra-hospital cluster) or different hospitals (widespread cluster). Results: We found 83 clusters, of which 20 were intra-hospital, 49 were widespread, and 14 were intra-hospital and widespread. Some intra-hospital clusters were first detected before the onset of the COVID-19 pandemic, but the number of clusters increased during the pandemic, especially for C. parapsilosis. The proportion of widespread clusters was significantly higher for genotypes found in both compartments than those exclusively found in either the blood cultures or intra-abdominal samples. Most C. albicans- and C. tropicalis-resistant genotypes were singleton and presented exclusively in either blood cultures or intra-abdominal samples. Fluconazole-resistant C. parapsilosis isolates belonged to intra-hospital clusters harboring either the Y132F or G458S ERG11p substitutions; the dominant genotype was also widespread. Conclusions: the number of clusters—and patients involved—increased during the COVID-19 pandemic mainly due to the emergence of fluconazole-resistant C. parapsilosis genotypes. Full article
(This article belongs to the Special Issue Fungal Diseases in Europe)
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Review

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18 pages, 961 KiB  
Review
Phaeohyphomycosis in Solid Organ Transplant Recipients: A Case Series and Narrative Review of the Literature
by Davide Lo Porto, Andrea Cona, Francesca Todaro, Elena De Carolis, Francesca Cardinale, Neha Hafeez, Giuseppina Di Martino, Pier Giulio Conaldi, Maurizio Sanguinetti, Paolo Antonio Grossi and Alessandra Mularoni
J. Fungi 2023, 9(3), 283; https://doi.org/10.3390/jof9030283 - 21 Feb 2023
Cited by 1 | Viewed by 1518
Abstract
Phaeohyphomycosis comprises a variety of infections caused by pigmented fungi. Solid organ transplant (SOT) recipients are particularly at risk of invasive infections due to their prolonged immunosuppression. Here, we describe three cases of phaeohyphomycosis in SOT recipients who were successfully treated with surgical [...] Read more.
Phaeohyphomycosis comprises a variety of infections caused by pigmented fungi. Solid organ transplant (SOT) recipients are particularly at risk of invasive infections due to their prolonged immunosuppression. Here, we describe three cases of phaeohyphomycosis in SOT recipients who were successfully treated with surgical excision and/or antifungal therapy. We additionally carried out a narrative review of the literature on phaeohyphomycosis in 94 SOT recipients from 66 published studies describing 40 different species of fungi. The most reported fungus was Alternaria (21%). The median time from transplant to diagnosis was 18 months (IQR 8.25–48), and kidney transplants were the most reported. Antifungal regimens were not homogeneous, though there was a prevalence of itraconazole- and voriconazole-based treatments. Clinical outcomes included recovery in 81% and death in 5% of infected SOT recipients. Susceptibility testing was done in 26.6% of the cases, with heterogeneous results due to the variety of species isolated. While the wide diversity of dematiaceous fungi and their host range make it difficult to offer a uniform approach for phaeohyphomycosis, an early diagnosis and therapy are critical in preventing the dissemination of disease in the immunocompromised host. Full article
(This article belongs to the Special Issue Fungal Diseases in Europe)
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Other

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10 pages, 634 KiB  
Brief Report
Pneumocystis jirovecii Pneumonia Diagnostic Approach: Real-Life Experience in a Tertiary Centre
by Cristina Veintimilla, Ana Álvarez-Uría, Pablo Martín-Rabadán, Maricela Valerio, Marina Machado, Belén Padilla, Roberto Alonso, Cristina Diez, Patricia Muñoz and Mercedes Marín
J. Fungi 2023, 9(4), 414; https://doi.org/10.3390/jof9040414 - 28 Mar 2023
Cited by 2 | Viewed by 1791
Abstract
Pneumocystis jirovecii pneumonia (PJP) in immunocompromised patients entails high mortality and requires adequate laboratory diagnosis. We compared the performance of a real time-PCR assay against the immunofluorescence assay (IFA) in the routine of a large microbiology laboratory. Different respiratory samples from HIV and [...] Read more.
Pneumocystis jirovecii pneumonia (PJP) in immunocompromised patients entails high mortality and requires adequate laboratory diagnosis. We compared the performance of a real time-PCR assay against the immunofluorescence assay (IFA) in the routine of a large microbiology laboratory. Different respiratory samples from HIV and non-HIV-infected patients were included. The retrospective analysis used data from September 2015 to April 2018, which included all samples for which a P. jirovecii test was requested. A total of 299 respiratory samples were tested (bronchoalveolar lavage fluid (n = 181), tracheal aspirate (n = 53) and sputum (n = 65)). Forty-eight (16.1%) patients fulfilled the criteria for PJP. Five positive samples (10%) had only colonization. The PCR test was found to have a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 96%, 98%, 90% and 99%, compared to 27%, 100%, 100% and 87%, for the IFA, respectively. PJ-PCR sensitivity and specificity were >80% and >90% for all tested respiratory samples. Median cycle threshold values in definite PJP cases were 30 versus 37 in colonized cases (p < 0.05). Thus, the PCR assay is a robust and reliable test for the diagnosis PJP in all respiratory sample types. Ct values of ≥36 could help to exclude PJP diagnosis. Full article
(This article belongs to the Special Issue Fungal Diseases in Europe)
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5 pages, 603 KiB  
Case Report
First Report of Neocucurbitaria unguis-hominis Keratitis
by Nerea Sáenz-Madrazo, Azucena Baeza, Jesús Guinea, Pablo Martín-Rabadán, Alejandro Ruiz-Velasco-Santacruz and José Luis Urcelay
J. Fungi 2023, 9(1), 8; https://doi.org/10.3390/jof9010008 - 21 Dec 2022
Cited by 1 | Viewed by 1676
Abstract
Coelomycetous fungi are among the emerging causes of infections and have been involved in many kinds of infections, including keratitis and endophtalmitis. Here, we present the first case of keratitis caused by Neocucurbitaria unguis-hominis, a coelomycetous fungus belonging to the family Cucurbitariaceae. In [...] Read more.
Coelomycetous fungi are among the emerging causes of infections and have been involved in many kinds of infections, including keratitis and endophtalmitis. Here, we present the first case of keratitis caused by Neocucurbitaria unguis-hominis, a coelomycetous fungus belonging to the family Cucurbitariaceae. In this case report, we describe the clinical presentation of a 56-year-old woman, a regular contact lens wearer, who was treated for pain in her right eye and fixed spot vision after an injury with plant debris. On examination, a corneal ulcer was observed, the foreign body was removed, and topical eye-drop therapy was started. After an initial improvement, the patient returned three weeks later due to a recurrence of discomfort in her right eye, observing the persistence of the corneal ulcer. Corneal scrapings were taken for culture, growing a filamentous fungus after seven days, which was identified by sequencing the fungal internal transcribed spacer region. It should be noted that microbiological identification of the coelomycetes in the clinical laboratory is not easy because of their difficulty in sporulating, making molecular techniques based on the amplification and sequencing of appropriate phylogenetic markers essential. Identification of these fungi is mandatory in order to optimise treatment due to the difficulty in eradicating them with antifungal treatment, requiring surgery in 50% of cases. Full article
(This article belongs to the Special Issue Fungal Diseases in Europe)
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