The relationship between opportunistic pulmonary fungal infections and CD4 count levels among HIV-seropositive patients in Calabar, Nigeria.

Jan 2013

Ogba OM, Abia-Bassey LN, Epoke J.

Source

Department of Medical Microbiology/Parasitology, University of Calabar Teaching Hospital, Calabar, Nigeria.

Abstract

BACKGROUND:

Most HIV-seropositive people who develop AIDS die from an opportunistic infection, such as pulmonary mycosis, rather than the HIV infection itself. Data on the pattern of respiratory mycoses and the immunological profile of HIV-seropositive patients in Nigeria are scarce and uncoordinated, so we investigated respiratory mycosis and CD4 count among HIV-seropositive and AIDS patients attending the antiretroviral clinics at the University of Calabar Teaching Hospital and Lawrence Henshaw Hospital in Calabar, Nigeria.

METHOD:

From May 2009 to July 2010 we carried out a prospective study of 331 individuals with respiratory symptoms, of whom 272 were HIV seropositive, aged 17-75 years and able to produce sputum and 59 were HIV non-reactive. Relevant samples were collected and subjected to direct microscopy, fungal culture and serology.

RESULTS:

The overall prevalence of pulmonary mycoses was 36.0%, the most prevalent fungal pathogen being Candida albicans (11.8%). Pneumocystis jirovecii (7.4%) was confirmed as an important opportunistic fungal agent in HIV-infected individuals in Calabar. Patients aged 25-34 years were at the highest risk of pulmonary mycosis (43.9%). HIV-positive patients with mycoses had lower mean CD4 counts (142.3 ± 100.1 cells µl(-1)) than those without mycoses (435.4 ± 249.1 cells µl(-1)) (t = 10.5, p = 0.00).

CONCLUSION:

Opportunistic pulmonary infections arise more frequently in HIV patients with lower CD4 counts. A more detailed comparative study with other opportunistic infections may help formalize the use of CD4 count as an indicator of HIV/AIDS with opportunistic mycoses.

PubMed

Fungus, Fungus every where

Those with a love for mushrooms, about 30 people, got a hands-on lesson Friday on how to grow and sell their own Shiitake mushrooms.

Dr. Omon Isikhuemhen from North Carolina A&T University, has taught the class at the North Carolina Cooperative Extension office for the past eight years.

“Surry County is most lucky in that you have good trees and good people,” said Isikhuemhen. “We want you to be able to grow so many mushrooms that you can’t eat them all and will need to sell them.”

He said growing mushrooms is an inexpensive project, except for the mushroom spawn, which can be costly. But, through a grant from the United States Department of Agriculture, the spawn is free to growers who will agree to inoculate 200 logs. That caused a big groan in the room and only a handful in the class said they were willing to do that many logs. He said it has to be 200 logs so that the USDA can count them as a grower.

“You cannot have three logs and then call me for advice,” said Iskihuemhen with a laugh.

Class participants were asked to bring in 4-foot oak logs that were 4- to 8-inches in diameter.

Carl Massey, who came to take the class again, attended the first class eight years ago. He has been growing them ever since. He also grows Portobella mushrooms and has 10 acres of grapes. Massey said because of an ice storm, he is down to only 40 logs now. He came back to class in order to get more spawn.

Massey said when he first started out eight years ago, the process hadn’t been streamlined, but now there are some new tools, such as an inoculator and a drill bit that is the perfect size to drill holes in the logs.

“They’ve learned and we’ve learned,” said Massey.

He said he takes what few mushrooms are growing now and dries them out before freezing them. He said when he takes them out of the freezer and rehydrates them, they taste just as good as fresh.

Dwight Seal, who was also at the class, has 400 to 500 logs that are producing mushrooms. He sells his mushrooms to local restaurants.

Seal actually started out growing mushrooms while attending Appalachian State University 25 years ago. He loves mushrooms so much, that he likes to go foraging for wild mushrooms.

Elkin’s Mayor Lestine Hutchens said she wanted to take the class because it sounded like a fun thing to learn how to do.

“I love mushrooms. When you stop learning, you stop living. When I was working, I never had time to do stuff like this. And, you meet such interesting people,” said Hutchens.

Extension Agent Joanna Radford said everyone that signed up for the class showed up.

“I’m pleasantly surprised with the turnout today. I’m very excited to see so many people interested in growing mushrooms,” said Radford.

Those who will become mushroom growers were encouraged to sell their mushrooms to Pilot Mountain Pride.

Read more: Mount Airy News – Fungus fungus every where 

Developments in novel breath tests for bacterial and fungal pulmonary infection.

Chambers ST, Scott-Thomas A, Epton M.

Source

aDepartment of Pathology, University of Otago, Christchurch bDepartment of Infectious Diseases cDepartment of Respiratory Medicine, Christchurch Hospital, Christchurch, New Zealand.

Abstract

PURPOSE OF REVIEW:

Breath testing has developed over the last 20 years. New techniques that can identify fingerprints for specific diseases and specific markers of respiratory pathogens have been applied to breath analysis. This review discusses the recent advances in breath analysis for the diagnosis of bacterial and fungal lower respiratory tract infections.

RECENT FINDINGS:

The current techniques continue to develop rapidly, but preconcentration techniques are needed to analyse many target volatile organic compounds for most systems. Breath testing with an electronic nose is promising for the diagnosis of tuberculosis (TB), and specific volatiles identifiable by gas chromatography with mass spectrometry have been identified in breath for Mycobacterium tuberculosis, Pseudomonas aeruginosa and Aspergillus fumigatus, but are found at very low concentrations in breath. Contamination from the environment is an ongoing confounding influence. Exhaled breath condensate (EBC) is disappointing as a diagnostic sample.

SUMMARY:

Careful attention needs to be paid to the sensitivity and specificity of a technique and confounding from the environment. The role of technologies such as selected ion flow tube-mass spectrometry is emerging. The electronic nose requires further validation for TB. The identification of specific microbial biomarkers aids the quest for improved accuracy. EBC is currently of limited value.

Lippincott, Williams & Wilkins

Definition of Fungus

Definition of Fungus

Fungus: A single-celled or multicellular organism. Fungi can be true pathogens (such as histoplasmosis and coccidioidomycosis) that cause infections in healthy persons or they can be opportunistic pathogens (such as aspergillosis, candidiasis, and cryptococcosis) that cause infections in immunocompromised persons (including cancer patients, transplant recipients, and persons with AIDS). An example of a common fungus is the yeast organism which causesthrush and diaper rash (diaper dermatitis). Fungi are also used for the development of antibiotics, antitoxins, and other drugs used to control various human diseases.

Medterms

Five types of Skin Fungus

Five types of Skin Fungus

It’s not everyone’s favorite subject — and understandably so. For most people, developing an unsightly skin fungus may be pretty embarrassing. But such infections are actually very common. For instance, it’s estimated that at any one time in the United States, at least one in five people have athlete’s food, a particular type of skin fungus .

Still, for many, the sight of — or mere idea of — a fungus living in one’s skin is repulsive. But if you can distance yourself from the disgust, fungus is actually pretty fascinating. Once thought to be plants (mushrooms are still sorted among vegetables in the supermarket, after all), fungi’s distinct cell walls and lack of chlorophyll distinguish them today as their own kingdom consisting of at least 80,000 species.

Most of the types of fungus we’ll discuss are molds known as dermatophytes. These dermatophytes like to set up camp on skin because they feast on keratin, a strong, fibrous protein that makes up much of your skin (as well as nails and hair, where fungus can also thrive).

One of the most important things to keep in mind is that, besides keratin, fungus loves two things: warmth and moisture. This is why it so often holes up on sweaty feet. Skin fungus is contagious and can spread most commonly among people, but you can also get it from animals and clothes and fabrics (and even soil).

We’ll go through some of the common types of skin fungus and also look at signs of getting them and how to treat them.

1.) Tinea Pedis (Athlete’s Foot)

2.)  Candidiasis

3.)  Tinea Verisicolor

4.)  Tinea Corporis

5.) Tinean Cruris (Jock Itch)

Discovery Fit & Health

How to Identify the Various Types of Yeast Infections

How to Identify the Various Types of Yeast Infections

February 14, 2012

BY AMANDA SMITH

Candida albicans is a type of bacterial fungus that is present in every one of us in various areas of the body. When an imbalance occurs in the body causing the so-called bad bacteria to grow, this enables the fungus to grow and thrive resulting in a yeast infection. A yeast infection can occur in numerous areas of the body and each area can have various symptoms. These symptoms may sometimes be difficult to diagnose because they are similar to that of other illnesses or diseases.

Yeast infections can be caused by numerous things including having a weakened immune system, being diabetic, taking antibiotics, eating a poor diet full of carbohydrates and sugary foods, and poor hygiene.

Genital Yeast Infection

The most common type of yeast infection that we hear about the most is a vaginal yeast infection in women. A vaginal yeast infection can occur for the same reasons as listed above, along with being on birth control or being pregnant. If you suspect that you have a vaginal yeast infection, you should look for the following symptoms:

• Burning/itching sensation around the vaginal area
• A white thick discharge that may sometimes resemble that of cottage cheese
• Burning during urination
• Pain during sexual intercourse

These symptoms can be treated with homemade natural remedies and/or over the counter topical creams and ointments. The symptoms may disappear with treatment, however if an underlying cause is behind the yeast infection, that will need to be addressed as well. Seventy five percent of women will experience a yeast infection some time within their life.

A man can develop the same type of yeast infection in his genital area. He may experience the same type of symptoms as a woman, along with red spots located around the head of the penis. Males are a lot less likely to develop this type of yeast infection, but it is possible.

Oral Thrush

Oral thrush is a type of yeast infection that develops inside of the mouth. People that wear dentures or smoke are more susceptible to develop oral thrush than those who don’t. This problem can be very painful and can even cause problems with eating and drinking. Symptoms of oral thrush include: white lesions or patches on the tongue or inside of the cheeks that may become painful and even bleed, a thick coating covering the top of the tongue, loss of taste, and cracking red skin in the corners of the mouth. If oral thrush is not treated properly, it may spread to the throat and esophagus causing more severe problems.

Systemic Yeast Infection

Systemic candidiasis is when a yeast infection enters into the blood stream. This type of infection is typically found in people suffering from A.I.D.S. or Cancer. When this happens, the infection can spread to other organs, including the brain and can even be fatal. Symptoms of systemic candidiasis can include a fever, decreased blood pressure, an increase in heart rate, multi-organ failure, and meningitis. This is the most serious type of yeast infection and needs to be treated immediately.

Nail fungus

A yeast infection can make an appearance on both your fingernails and toenails. When this happens, the nails will typically turn to either a yellow or green color and possible loss of the nail all together. This type of infection may be difficult to diagnose due to the small amount of symptoms that may be present. Many over the counter fungal medications are available for use on the nails, however this type of yeast infection can sometimes be more difficult to treat and may require a stronger prescription medication to get rid of the infection.

Intestinal Yeast Infection

A yeast infection can form easily on the inside of the intestines. This is typically caused by a poor diet. When a person consumes a diet that is high in sugars and carbohydrates, the yeast will feed on them, causing yeast growth. An intestinal yeast infection can exhibit a variety of symptoms, however these symptoms are synonymous with other gastrointestinal problems, making it difficult to diagnose.

Some of the symptoms of intestinal yeast growth may include:

• Diarrhea
• Increased gas
• Unexplained weight loss
• Migraines
• Depression
• Overall discomfort

In order for an intestinal yeast infection to be properly diagnosed, a doctor may need to run some tests before treatment can begin. These tests may include a blood test or a fecal matter test. This type of infection can be difficult to diagnose even for a physician.

Skin Infection

The Candida fungus is present all over the skin making it possible for yeast growth to occur in areas where there is an increase in moisture and heat, especially in the arm pits, groin area, and skin folds. If these areas are not kept clean and dry, a yeast infection may occur causing symptoms inclusive of a red rash, an itching sensation, and burning.

This type of infection can be prevented by keeping these areas clean and dry at all times. Obese people are especially susceptible to getting these types of yeast infections. Over the counter powders, creams and sprays are available to treat these types of candida infections. If a yeast infection occurs frequently, a prescription medication may be needed.

It is always important to take note of what symptoms you are experiencing. If you believe that you have a yeast infection, there are numerous natural remedies and over the counter remedies that you can try. If these fail to rid your body of the infection, medical help should be sought to get stronger treatment. If symptoms persist of get worse, you should see your doctor to ensure that the problem is not something more serious. Yeast infections are very common among people of all age, especially those who have a weakened immune system.

Embarrassment should not be a reason to avoid seeing a doctor if you believe that you have a yeast infection that will not go away with basic treatment, and failure to undergo the appropriate treatment may lead to aggravated health conditions.

Hive

Fungal super-infections turn killer in burns cases

Jan 2012

NEW DELHI: Fungal infections have been found to be a significant cause of death in burns cases, a new study has revealed. Ironically, these infections result from the use of powerful third-generation antibiotics that destroy all bacteria while allowing fungi present in the environment and the gastrointestinal tract to grow unchecked.

A study by doctors at Safdarjung Hospital, published in the medical journal ‘Burns’, shows 12 out of 100 burn injury patients included in the research had fungal infection. The mortality rate among the infected patients was found to be 66.7%. Most of the patients found positive for fungal infection were on three or more higher antibiotics, given either as a combination or over a period of 10 days. “Of this, the commonest were carbapenems and monobactums followed by Piperacillin and Tazobactum,” states the report. Safdarjung Hospital has the largest dedicated burns unit in Asia with an average of 2000 admissions every year.

One of the lead authors of the study, who did not want to be named, said the ubiquity of fungi in the environment along with the suppression of normal bacteria causes the fungal super-infection in burns. “The broad spectrum antibiotics destroy bacteria which grow on the dead tissues in the wound area. But the fungi, which are present in the system, get a chance to proliferate. They turn pathogenic, leading to infection and even death,” he said. Extreme age groups – children and the elderly – diabetes, inhalation injury, prolonged hospital stay and other risk factors increase the chances of fungal infection in the wound.

Experts say that till a few years ago, the burnt surface was considered to be a suitable site for opportunistic colonization and invasion by bacteria which could be checked by early wound excision and skin grafting and the use of antibiotic therapy. But now, anti-fungal therapy is being mulled in view of the increasing incidence of fungal infection in patients.

A senior doctor said, “A lot of effort has been put into treating life threatening bacterial septicemia in burns but often the bacterial culture is negative yet the patient’s condition deteriorates. Fever, sepsis and even death occur as a consequence. No attention was paid towards the cause of this increasing mortality for a long time. Our investigations suggest that all such patients are usually suffering from fungal infection, and this was confirmed with positive biopsy results. Early closure of wound can be effective in fighting this and decreasing the risk.”

Times of India

Invasive Fungal Infections Among Ventilated HSCT Patients in the ICU

Invasive Fungal Infections Among Ventilated HSCT Patients in the ICU

Invasive fungal infection (IFI) is associated with high morbidity and high mortality in hematopoietic stem cell transplantation (HSCT) patients. Chen-Yiu Hung, of the Department of Thoracic Medicine at Chang Gung Memorial Hospital in Taipei, Taiwan, and colleagues, sought to assess the characteristics and outcomes of HSCT patients with IFIs who are undergoing mechanical ventilation (MV) at a single institution in Taiwan.
 
The researchers  performed an observational retrospective analysis of IFIs in HSCT patients undergoing MV in an intensive care unit (ICU) from 2000 to 2009. The characteristics of these HSCT patients and risk factors related to IFIs were evaluated. The status of discharge, length of ICU stay, date of death and cause of death were also recorded.
 
There were 326 HSCT patients at the Linkou Chang-Gung Memorial Hospital (Taipei, Taiwan) during the study period. Sixty of these patients (18 percent) were transferred to the ICU and placed on mechanical ventilators. A total of 20 of these 60 patients (33 percent) had IFIs. Multivariate analysis indicated that independent risk factors for IFI were admission to an ICU more than 40 days after HSCT, graft versus host disease (GVHD), and high dose corticosteroid (p < 0.01 for all). The overall ICU mortality rate was 88 percent (53 of 60 patients), and was not significantly different for patients with IFIs (85 percent) and those without IFIs (90 percent, p = 0.676).

The researchers concluded that there was a high incidence of IFIs in HSCT patients requiring MV in the ICU in their study cohort. The independent risk factors for IFI are ICU admission more than 40 days after HSCT, GVHD, and use of high-dose corticosteroid. Their research was published in BMC Infectious Diseases.

Reference: Hung C-Y, et al. Invasive fungal infection among hematopoietic stem cell transplantation patients with mechanical ventilation in the intensive care unit. BMC Infectious Diseases 2012, 12:44 doi:10.1186/1471-2334-12-44

 Infection Control Today

Salon trip could lead to fungal infection

Feb 23, 2012

COLLIER COUNTY, FL –

You could end up in your doctor’s office with a fungal infection after getting a pedicure if your salon doesn’t clean its instruments properly.

Vera Occhipinti gets a pedicure every other month. This time when the dark red nail polish came off, her podiatrist found something she never expected.

“A slight fungus under the dark nail polish,” said Occhipinti.

While Occhipinti has no idea how she got the fungus, she says it easily could have come from her nail salon.

Dr Elena Cibula says Occhipinti is not alone.

The podiatrist has treated several patients with fungal and bacterial infections that came from dirty salon instruments like nail clippers, whirlpools, even the brush of the nail polish.

“If they use instrument one person that had fungus infection and do not disinfect it, it can spread,” said Cibula.

Under state law salons must follow strict guidelines when it comes to cleaning instruments.

Sheila Greer at Polished Nail Boutique says she sanitizes everything to keep anything from spreading.

NBC2 found dozens of inspection reports for salons in Lee and Collier counties that failed to comply with proper cleaning procedures.

We checked out one of those salons, Bohemia Beauty Salon in Naples. According to the report, there was no cleaning solution at all.

The owner didn’t want to go on camera, but says since the inspection they have hired a new nail technician who cleans everything between clients.

If you want to make sure your feet stay fungus-free you should always bring your own tools to the salon. You can also bring your own nail polish. Some places will even give you a discount.

Occhipinti will have to get pricey treatment to get rid of her fungus and make sure it doesn’t spread.

She says now she’ll think twice before getting her nails done.

NBC2

Several Conditions Mimic Nail Fungus in Children

Feb 2012

By: JEFFREY EISENBERG, Family Practice News Digital Network

As a pediatric dermatologist, Dr. Robert A. Silverman is all too familiar with this scenario: A child is referred to him with a diagnosis of nail fungus, and the parents are frustrated that the oral antifungal agents did not work.

What bothers him the most is not the antifungals, but that the patients didn’t need them to begin with because the child didn’t have a fungal infection, he said at the annual Hawaii Dermatology Seminar, sponsored by Skin Disease Education Foundation (SDEF). Several conditions of the nail in children can easily be mistaken for fungal infections.

Dr. Silverman of the department of pediatrics at Georgetown University Medical Center in Washington discussed how to distinguish fungal disease mimics from other pediatric nail conditions in children.

Onychomycosis, the most common nail infection in adults, is not all that common in children, Dr. Silverman said. Studies have shown the prevalence in children to be less than 3% in developed countries, although it is increased among children who have Down syndrome and HIV, or children from households with moccasintype Trichophyton rubrum. Clinical variants are similar to those that occur in adults, such as white superficial onychomycosis, distal lateral subungual onychomycosis, proximal subungual onychomycosis, and endonyx onychomycosis.

Other conditions that may be mistaken for fungal infections include:

• Psoriasis. Nail findings in patients who have psoriasis can be misinterpreted as fungal disease. Telltale signs of psoriasis in the nails, however, are large, irregular pits and the oil spot sign.

• Subungual tumors. These include subungual exostosis and onychomatricoma. These benign growths push on the skin surface, leading to separation of the nail. “Some people think fungus when it’s really a tumor of the underlying bone,” Dr. Silverman said.

• Pachyonychia congenita. Though often confused with fungal disease, this condition, which involves a single thickened toenail, is somewhat rare. “If someone came in with a thick toenail, I’d culture him or her,” Dr. Silverman said. “If the culture is negative, then you have to start thinking of these other conditions.”

• Alopecia areata. Children may have nail signs of alopecia areata before hair loss occurs. In alopecia areata, the nail surface is studded to near confluence with tiny pits, also known as Scotch plaid nails. Also, the nail will have lost its luster and has a sandpaperlike texture.

“If you see what looks like alopecia areata of the nail, but don’t see any hair findings, you ought to scrape the nail to rule out fungus, because fungus can look like alopecia areata of the nails,” Dr. Silverman said. “And, of course, then you would want to treat it.”

Treatment for fungal infections requires the use of an oral agent for 6-12 weeks, so Dr. Silverman emphasized the importance of obtaining a culture. “If you’re going to treat someone for that length of time, it makes sense to know exactly what you’re treating,” he said.

Also, Dr. Silverman said, any time he sees that a child’s parent appears to have a fungal infection, he considers that to be a red flag when trying to diagnose the patient.

Family