Emerging Fungal Pathogens: Evolving Challenges to Immunocompromised Patients

Thomas J. Walsh

doi:10.1128/9781555816940.ch15

Chapter 15 : Emerging Fungal Pathogens: Evolving Challenges to Immunocompromised Patients

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Affiliations: 1: Immunocompromised Host Section, Division of Clinical Sciences, National Cancer Institute, Building 10, Room I3N240, National Institutes of Health. Bethesda, MD 20892

Content Type: Monograph

Publication Year: 1998

Category: Clinical Microbiology

Book DOI: 10.1128/9781555816940

Chapter DOI: 10.1128/9781555816940.ch15

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Abstract:

Fungal pathogens are emerging as important causes of morbidity and mortality in immunocompromised patients. Among the well-known life-threatening and deeply invasive fungi are Candida albicans (the most common cause of disseminated nosocomial fungal infection), Aspergillus fumigatus (the most common cause of nosocomial fungal pneumonia), and Cryptococcus neoformans (the most common cause of central nervous system [CNS] mycosis in human immunodeficiency virus [HIV]-infected patients). Fusarium spp. are representative of the emerging group of hyaline molds, which cause respiratory and disseminated infections in immunocompromised patients. The dematiaceous molds represent a diverse group of fungal pathogens which share the presence of melanin-like pigments in the cell wall. Infections due to azole-resistant C. albicans and non-albicans Candida species, heretofore rare events, have become commonplace. During the past decade, substantial advances have been achieved in understanding of the pathogenesis, detection, and treatment of infections with this emerging pathogen. Such approaches may provide a model for understanding other emerging fungal pathogens. The infection presents with numerous necrotic lesions, which are papulonodular lesions that may simulate those of tuberculosis, leishmaniasis, cryptococcosis, or histoplasmosis in HIV-infected patients. This infection in severely immunocompromised patients with disseminated penicilliosis has been successfully managed with amphotericin B. For mild to moderate disease, there is increasing experience with therapeutic success with itraconazole. The fungal pathogens that have emerged during the past decade have developed in an expanding population of immunocompromised hosts, new antifungal selective pressures, and shifting environmental conditions.

Citation: Walsh T. 1998. Emerging Fungal Pathogens: Evolving Challenges to Immunocompromised Patients, p 221-232. In Scheld W, Armstrong D, Hughes J (ed), Emerging Infections 1. ASM Press, Washington, DC. doi: 10.1128/9781555816940.ch15

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Emerging Fungal Pathogens: Evolving Challenges to Immunocompromised Patients

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Figure 1.

Conceptual time line of fungal pathogens emerging during the past decade. Each curve coincides with the approximate period when an increased frequency of reports describing a given pathogen began to appear in tile literature.

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Figure 1.

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Figure 2.

Consitions associated with the development of mycoses due to emerging fungal pathogens.

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Figure 2.

Consitions associated with the development of mycoses due to emerging fungal pathogens.

References

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1. Allende, M. C.,, J. W., Lee,, P. Francis,, J. Garrett,, H. Dollenberg,, J. Berenguer,, C. A. Lyman,, P. A. Pizzo,, and T. J. Walsh. 1994. Dose-dependent antifungal activity and nephrotoxicity of amphotericin B colloidal dispersion in experimental pulmonary aspergillosis. Antimicrob. Agents Chemother. 38: 518– 522.

2. Anaissie, E.,, P. Body,, H. Kantarjian,, J. Ro,, S. E. Vartivarian,, R. Hopfer,, J. Hoy,, and K. Rolston. 1989. New spectrum of fungal infections in patients with cancer. Rev. Infect. Dis. 11: 369– 378.

3. Anaissie, E.,, A. Gokoslan,, R. Hachem,, and R. Rubin. 1992. Azole therapy for trichosporonosis: clinical evaluation of eight patients. experimental therapy for murine infection, and review. Clin. Infect. Dis. 15: 781– 787.

4. Anaissie, E.,, H. Kantarjian,, J. Ro,, R. Hopfer,, K. Rolston,, V. Fainstein,, and G. Bodey. 1988. The emerging role of Fusarium infections in patients with cancer. Medicine 67: 77– 83.

5. Anaissie, E. J.,, M. White,, O. Uzun,, C. Singer,, G. P. Bodey,, D. Matzke,, N. Azarnia,, and G. Lopez-Berestein. 1995. Amphote ricin B lipid complex (ABLC) versus amphotericin B (AMB) for treatment of hematogenous and invasive candidiasis: a prospecti ve, randomized, multicenter trial, abstr. LM21. p. 330. In Abstracts of the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy. American Society for Microbiology, Washington, D.C.

6. Bowden, R. A.,, M. Cays,, T. Gooley,, R. D. Mamelok,, and J. A. van Burik. 1996. Phase I study of amphotericin B colloidal dispersion for the treatment of invasive fun gal infections after marrow transplant. J. Infect. Dis. 173: 1208– 1215.

7. Chariyalertsak, S.,, T. Sirisanthana,, K. Supparatpinyo,, and K. E. Nelson. 1996. Seasonal variation of disseminated Penicillium marneffei infections in northern Thailand: a clue to the reservoir? J. Infect. Dis. 173: 1490– 1493.

8. Clark, J. M.,, R. R. Whitney,, S. J. Olsen,, R. J. George,, M. R. Swerdel,, L. Kunselman,, and D. P. Bonner. 1991. Amphotericin B lipid complex. therapy of experimental fungal infections in mice. Antimicrob. Agents Chemother. 35: 615– 621.

9. Dismukes, W. E. 1986. Blastomycosis: leave it to beaver. N. Engl. J. Med. 314: 575– 577. (Editorial.)

10. Francis, P.,, J. W. Lee,, A. Hoffman,, J. Peter,, A. Francesconi,, J. Bacher,, J. Shelhamer,, P. Pizzo,, and T. J. Walsh. 1994. Efficacy of unilamellar liposomal amphotericin B in treatment of pulmonary aspergillosis in persistently granulocytopenic rabbits: the potential role of bronchoalveolar lavage Dmannitol and galactomannan as markers of infections. J. Infect. Dis. 169: 356– 368.

11. Georgopapadakou, N. H.,, and T. J. Walsh. 1996. Antifungal therapy: chemotherapeutic targets and immunologic strategies. Antimicrob. Agents Chemother. 40: 279– 291.

12. Georgopapadakou, N. H.,, and T. J. Walsh. 1994. Human mycoses: drugs and targets for emerging pathogens. Science 264: 371– 372.

13. Girmenia, C.,, P. Martino,, F. De Bernardis,, G. Gentile,, M. Boccanera,, M. Monaco,, G. Antonucci,, and A. Cassone. 1996. Rising incidence of Candida parapsilosis fungemia in patients with hematologic malignancies: clinical aspects. predisposing factors, and differential pathogenicity of the causative strains. Clin. Infect. Dis. 23: 506– 514.

14. Gueho, E.,, M. T. Smith,, G. S. de Hoog,, G. Bilton-Grand,, R. Christen,, and W. H. Batenburgvan der Vegte. 1992. Contributions to a revision of the genus Trichosporon. Antonie Leeuwenhoek 61: 289– 316.

15. Hiemenz, J. W.,, and T. J. Walsh. 1996. Lipid formulations of amphotericin B: recent progress and future directions. Clin. Infect. Dis. 22( Suppl. 2): S133– S144.

16. Hoy, J.,, K. Hsu,, K. Rolston,, R. L. Hopfer,, M. Luna,, and G. P. Bodey. 1986. Trichosporon beigelii infection: a review. Rev. Infect. Dis. 8: 959– 967.

17. Kemker, B. J.,, P. F. Lehmann,, J. W. Lee,, and T. J. Walsh. 1991. Distinction of deep versus superficial clinical and nonclinical isolates of Trichosporon beigelii by isoenzymes and restriction fragment length polymorphisms of rDNA generated by polymerase chain reaction. J. Clin. Microbiol. 29: 1677– 1683.

18. Lee, J. W.,, G. A. Melcher,, M. G. Rinaldi,, P. A. Pizzo,, and T. J. Walsh. 1990. Patterns of morphologic variation among isolates of Trichosporon beigelii. J. Clin. Microbial. 28: 2823– 2827.

19. Lyman, C. A.,, S. J. N. Dni,, J. Nathanson,, C. E. Frasch,, P. A. Pizzo,, and T. J. Walsh. 1994. Detection and quantification of the glucuronoxylomannan-like polysaccharide antigen from clinical and nonclinical isolates of Trichosporon beigelii and implications for pathogenicity. J. Clin. Microbiol. 33: 126– 130.

20. Lyman, C. A.,, K. F. Garrett,, P. A. Pizzo,, and T. J. Walsh. 1994. Response of human polymorphonuclear leukocytes and monocytes to Trichosporon beigelii: host defense against an emerging pathogen. J. Infect. Dis. 170: 1557– 1565.

21. Martino, P.,, R. Gastaldi,, R. Raccah,, and C. Girmenia. 1994. Clinical patterns of Fusarium infections in immunocompromised patients. J. Infect. 28(Suppl. 1): 7– 15.

22. Matsumoto, T.,, L. Ajello,, T. Matsuda,, P. J. Szaniszlo,, and T. J. Walsh. 1994. Developments in phaeohyphomycosis and hyalohyphomycosis. J. Med. Vet. Mycol. 32(Suppl. 1): 329– 349.

23. McManus, E. J.,, and J. M. Jones. 1985. Detection of a Trichosporon beigelii antigen cross-reactive with Cryptococcus neoformans capsular polysaccharide in serum from a patient with disseminated Trichosporon infection. J. Clin. Microbial. 21: 681– 685.

24. Melcher, G. P.,, K. D. Reed,, M. G. Rinaldi,, J. W. Lee,, P. A. Pizzo,, and T. J . Walsh. 1991. Demonstration of a cell wall antigen cross-reacting with cryptococcal polysaccharide in experimental disseminated trichosporonosis. J. Clin. Microbial. 29: 192– 196.

25. Melez, K. A.,, J. Cherry,, C. Sanchez,, R. B. Ettinger,, and T. J. Walsh. 1995. Successful outpatient treatment of Trichosporon beigelii peritonitis with oral fluconazole. Pediatr. Infect. Dis. J. 14: 1110– 1113.

26. Merz, W. G.,, J. E. Karp,, M. Hoagland,, M. Jett-Goheen,, J . M. Junkins,, and A. F. Hood. 1988. Diagnosis and successful treatment of fusariosis in the compromised host. J. Infect. Dis. 158: 1046– 1055.

27. Nguyen, M. H.,, J. E. Peacock, Jr.,, A. J. Morris,, D. C. Tanner,, M. L. Nguyen,, D. R. Snydman,, M. M. Wagener,, M. G. Rinaldi,, and V. L. Yu. 1996. The changing face of candidemia: emergence of non- Candida albicans species and anti fungal resistance. Am. J. Med. 100: 617– 623.

28. Pannuti, C.,, R. Gingrich,, M. A. Pfaller,, C. Kao,, and R. P. Wenzel. 1992. Nosocomial pneumonia in patients having bone marrow transplant. Attributable mortality and risk factors. Cancer 69: 2653– 2662.

29. Pappagianis, D. 1994. Marked increase in cases of coccidioidomycosis in Californi a: 1991, 1992, and 1993. Clin. Infect. Dis. 19( Suppl. 1): SI4– S18.

30. Patterson, T. F.,, P. Miniter,, J. Dijkstra,, F. C. Szoka, Jr.,, J. L. Ryan,, and V. T. Andriole. 1989. Treatment of experimental invasive aspergillosis with novel amphotericin B/cholesterol-sulfate complexes. J. Infect. Dis. 159: 717– 724.

31. Pittet, D.,, and R. P. Wenzel. 1995. Nosocomial bloodstream infections. Secular trends in rates, monality, and contribution to total hospital deaths. Arch. Intern. Med. 155: 1177– 1184.

32. Redding, S.,, J. Smith,, G. Farinacci,, M. Rinaldi, A Fothergill, J . Rhine-Chalberg, and M. praller. 1994. Resistance to Candida albicans to fluconazole during treatment of oropharyngeal candidiasis in patients with AIDS: documentation of in vitro susceptibility testing and DNA subtype analysis. Clin. Infect. Dis. 18: 240– 242.

33. Rex, J. H.,, M. G. Rinaldi,, and M. A. Pfaller. 1995. Resistance of Candida species to fluconazole. Antimicrob. Agents Chemother. 39: 1– 8.

34. Roilides, E.,, K. Uhlig,, D. Venzon,, P. A. Pizzo,, and T. J. Walsh. 1993. Enhancement of oxidative response and damage caused by human neutrophils to Aspergillus fumigatus hyphae by granulocyte colony-stimulating factor and gamma interferon. Infect. Immun. 61: 1185– 1193.

35. Sanglard, D.,, K. Kuchler,, F. Ischer,, J.-L. Pagani,, M. Monod,, and J. Bille. 1995. Mechanisms of resistance to azole antifungal agents in Candida albicans isolates from AIDS patients involve specific multidrug transporters. Antimicrob. Agents Chemother 39: 2378– 2386.

36. Sirisanthana, V.,, and T. Sirisanthana. 1995. Disseminated Penicillium marneffei infection in human immunodeficiency virus-infected children. Pediatr. Infect. Dis. J. 14: 935– 940.

37. Supparatpinyo, K.,, C. Khamwan,, V. Baosoung,, K. E. Nelson,, and T. Sirisanthana. 1994. Disseminated Penicillium mameffei infection in southeast Asia, Lancet 344: 110– 113.

38. Supparatpinyo, K.,, K. E. Nelson,, W. G. Merz,, B. J. Breslin,, C. R. Cooper, Jr.,, C. Khamwan,, and T. Sirisanthana, 1993. Response to antifungal therapy by human immunodeficiency virus-infected patients with disseminated Penicillium marneffei infections and in vitro susceptibilities of isolates from clinical specimens. Antimicrob. Agents Chemother. 37: 2407– 2411.

39. Vanden Bossche, R.,, P. Manchal,, F. C. Odds,, L. Le Jeune,, and M.-C. Coene. 1992. Characterization of an azole-resistant Candida glabrata isolate. Antimicrob. Agents Chemother. 36: 2602– 2610.

40. Vanittanakom, N.,, C. R. Cooper, Jr.,, S. Chariyalertsak,, S. Youngchim,, K. E. Nelson,, and T. Sirisanthana. 1996. Restriction endonuc1ease analysis of Penicillium marneffei. J. Clin. Microbiol 34: 1834– 1836.

41. Walsh, T. J.,, A. Francesconi,, M. Kasai,, and S. Chanock. 1995. PCR and single-strand conformational polymorphism for recognition of medically important opportunistic fungi. J. Clin. Microbiol. 33: 3216– 3220.

42. Walsh, T. J.,, K. Garrett,, E. Feuerstein,, M. Girton,, M. Allende,, J. Bacher,, A. Francesconi,, R. Schaufele,, and P. A. Pizzo. 1995. Therapeutic monitoring of experimental invasive pulmonary Aspergillosis by ultrafast computerized tomography, a novel, noninvasive method for measuring responses to antifungal therapy. Antimicrob. Agents Chemother. 39: 1065– 1069.

43. Walsh, T. J.,, M. Kasai,, A. Francesconi,, D. Landsman,, and S. J. Chanock. 1997. New evidence that Candida albicans possesses additional ATP-binding cassette MDR-like genes that may mediate fluconazole resistance. J. Med. Vet. Mycol. 35: 133– 138.

44. Walsh, T. J.,, W. Lee,, G. P. Melcher,, E. Navarro,, J. Bacher,, D. Callender,, K. D. Reed,, T. Wu,, G. Lopez.Berestein, and P. A. Pizzo. 1992. Experimental disseminated trichosporonosis in persistenly granulocytopenic rabbits: implications for palhogenesis, diagnosis, and treatment of an emerging opportunistic infection. J. Infect. Dis. 166: 121– 133.

45. Walsh, T. J.,, G. Melcher,, M. Rinaldi,, J. Lecciones,, D. McGough,, J. Lee,, D. Callender,, M. Rubin,, and P. A. Pizzo. 1990. Trichosporon beigelii: an emerging pathogen resistant to amphotericin B. J. Clin. Microbiol. 28: 1616– 1622.

46. Walsh, T. J.,, G. P. Melcher,, J. W. Lee,, and P. A. Pizzo. 1993. Infections due to Trichosporon species: new concepts in mycology, pathogenesis, diagnosis, and treatment. Curr Top. Med. Mycol. 5: 79– 113.

47. Walsh, T. J.,, K. R. Newman,, M. Moody,, R. C. Wharton,, and J. C. Wade. 1996. Trichosporonosis in patients with neoplastic disease. Medicine 65: 268– 279.

48. Walsh, T. J.,, J. Peter,, D. A. McGough,, A. W. Fothergill,, M. G. Rinaldi,, and P. A. Pizzo. 1995. Activities of amphotericin B and antifungal azoles alone and in combination against Pseudallescheria boydii. Antimicrob. Agents Chemother. 39: 1361– 1364.

49. Walsh, T. J.,, P. Whitcomb,, S. Piscitelli,, W. D. Figg,, S. Hill,, S. J. Chanock,, P. Jarosinski,, R. Gupta,, and P. A. Pizzo. Safety, tolerance. and pharmacokinetics of ampholericin B lipid complex in children with hepatosplenic candidiasis. Antimicrob. Agents Chemother., in press.

50. Wey, S. B.,, M. Mori,, M. A. Pfaller,, R. F. Woolson,, and R. P. Wenzel. 1988. Hospital acquired candidemia: the attributable mortality and excess length of stay. Arch. Intern. Med. 148: 2642– 2645.

51. Wood, G. M.,, J. G. McCormack,, D. B. Muir,, D. H. Ellis,, M. F. Ridley,, R. Pritchard,, and M. Harrison. 1992. Clinical features of human infection with Scedosporium inflatum. Clin. Infect. Dis. 14: 1027– 1033.

Tables

Emerging Fungal Pathogens: Evolving Challenges to Immunocompromised Patients

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Table 1

Classification of representative emerging fungal pathogens a

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Table 1

Classification of representative emerging fungal pathogens a