Background and Purpose:Scedosporium apiospermum, a soil-dwelling fungus, is typically associated with localized infections, such as skin infections and osteomyelitis. However, it can also cause invasive central nervous system infections, including brain abscesses, particularly in immunocompromised individuals. Such infections are rare in immunocompetent individuals and often occur following trauma or environmental exposure. This report aimed to present a case of a fatal S. apiospermum brain abscess in an immunocompetent adult male, highlighting diagnostic and management challenges. Case presentation:A 48-year-old immunocompetent male presented with a three-day history of persistent holo-cranial headache and left-sided weakness. Twenty days earlier, the patient had fallen into a sewer, likely exposing him to fungal pathogens. Initial imaging revealed a large right frontal intracranial lesion. Surgical resection of the abscess was performed, and antifungal therapy with voriconazole was initiated. Intraoperative findings revealed a thick, non-vascular abscess capsule containing yellow pus. Postoperative KOH mount confirmed fungal elements (hyaline septate hyphae). Despite aggressive management in the intensive care unit, including antifungal therapy, antibiotics, and supportive care, the patient developed septic shock and succumbed to cardiac arrest within 48 h of surgery. Conclusion:This case underscores the rapid progression and severity of S. apiospermum infections in immunocompetent individuals, even with early surgical and medical intervention. It emphasizes the need for heightened clinical suspicion in cases involving trauma with potential environmental exposure. Prompt diagnosis, effective antifungal therapy, and multidisciplinary management are essential to improve outcomes in such cases.
Background and Purpose:Rapid and accurate identification of molds is critical in clinical microbiology, particularly for immunocompromised patients at increased risk of fungal infections. Traditional methods, such as culture and microscopy, are time-consuming and may lack species-level specificity. The matrix-assisted laser desorption/ionization time-of-flight mass spectrometry matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) provides a promising alternative due to its speed and accuracy. This study aimed to standardize Vitek MS for mold identification and compare its effectiveness with traditional phenotypic methods, assessing its reliability, turnaround times, and cost-effectiveness in clinical settings. Materials and Methods:A retrospective examination of 248 anonymized mold isolates was conducted at Hinduja Hospital, with 182 isolates successfully revived. Both Vitek MS and phenotypic techniques were used to identify the molds, and the concordance rate between the two methods was calculated. Results:Vitek MS accurately identified 169 out of the 182 isolates, yielding a concordance rate of 92.85% with phenotypic methods. Of the remaining isolates, 1 was misidentified, 4 could not be identified, and 8 were not represented in the database. Conclusion:Vitek MS proved to be a highly accurate and time-efficient tool for mold identification, enhancing clinical diagnostics. Expansion of its database is crucial for broader mold identification. This study supported integration of Vitek MS into routine laboratory practice, aiding in timely antifungal treatment, improving patient outcomes, and assisting in outbreak detection and public health management.
Background and Purpose:Invasive fungal infections have high morbidity and mortality rates, with Candida species being the leading cause in hospitalized patients. Virulence factors, such as adhesion, enzyme secretion, and biofilm formation, play a major role in Candida pathogenesis. This study hypothesized that virulence factors in localized Candida infections behave differently than those in systemic infections. Materials and Methods:This study compared invasive and non-invasive Candida clinical isolates in terms of biofilm formation and enzymatic activity in. Biofilm mass and metabolic activity were assessed using crystal violet and XTT assays, while phospholipase and protease activities were measured in specific media. Qualitative biofilm characterization was performed using scanning electron microscopy and scanning confocal laser microscopy. Results:Candida isolates from invasive infections showed higher bulk biofilm production and metabolic activity, compared to localized infection isolates. Bulk biofilm production and metabolic activity were notably higher in systemic infections, compared to those in localized infections. Non-albicans Candida species exhibited a higher biofilm-forming capacity and metabolic activity, emphasizing their potential for more invasive infections. Conversely, hydrolytic enzyme production was higher in localized infection isolates, compared to that in systemic infection. Phospholipase activity showed no significant differences. Conclusion:The differences in enzymatic activity observed in isolates from various anatomical sites underscores the importance of considering the infection context in assessing virulence These findings highlight the role of proteases and other factors in Candida invasiveness, contributing new insights into Candida virulence factors in Ecuador.
Background and Purpose:With the increasing number of fungal infections due to antibiotic use and growing numbers of immunocompromised patients, it has become imperative to understand the nature of these infections. Fungal infections, however, remain largely understudied and underdiagnosed, especially when it comes to co-infections with other organisms. This study aimed to compare inflammatory biomarkers in fungal pneumonia patients with and without bacterial co-infections and analyze the frequencies of the causative bacterial and fungal organisms. Materials and Methods:This retrospective study used electronic medical records from patients diagnosed with fungal pneumonia from January 2013 to December 2023. Fungal and bacterial etiologies were identified with International Classification of Diseases-10 codes and summarized with descriptive statistics. Baseline characteristics, comorbidities, and length of stay were analyzed using descriptive statistics and the Chi-squared test. Inflammatory biomarkers, including C-reactive protein, erythrocyte sedimentation rate, procalcitonin, white blood cell count, body temperature, ferritin, and electrolytes, were collected using Current Procedural Terminology codes and compared using Chi-squared test between patients diagnosed with fungal pneumonia alone or with fungal pneumonia and bacterial co-infection. Results:A total of 1,024 patients were diagnosed with fungal pneumonia. The most common diagnosis among the patients was unspecified mycosis. Moreover, the most common organism-specific mycotic disease was pneumocystosis. Comorbidities, including diabetes and chronic inflammatory disease, were more common in patients with co-infection (p < 0.05). None of the inflammatory biomarkers investigated were statistically significant. Conclusion:Lack of specificity of most fungal organisms responsible for pneumonia highlights the critical lack of specific diagnostic methods for fungal diseases. The results show that inflammatory biomarkers are not significantly different between fungal pneumonia patients with and without bacterial co-infections.
Background and Purpose:Pathogenic fungi, including both true and opportunistic pathogens, pose significant health risks, particularly in immunocompromised individuals. Species, such as Candida albicans, Aspergillus fumigatus, and Cryptococcus neoformans, cause fatal infections and frequently develop resistance to conventional antifungal therapies. Limitations of current antifungal medications, such as drug toxicity, resistance development, and environmental concerns, highlight the urgent need for novel therapeutic strategies. Earthworm extracts, particularly those derived from Eisenia fetida, have been recognized as a promising alternative in traditional Chinese medicine. This study aimed to assess the antifungal effects of a peptide extract from E. fetida against these opportunistic fungal pathogens. Materials and Methods:The earthworm extract was obtained from E. fetida through electroporation and centrifugation to isolate bioactive components. Composition of the extract was analyzed in detail; accordingly, protein content was determined using the Bradford and Kjeldahl methods, fat content was measured via Soxhlet extraction, and moisture, dry matter, and ash contents were also quantified to provide a comprehensive profile. To evaluate antifungal activity, fungal cultures of A. fumigatus, C. albicans, and C. neoformans were grown on Sabouraud dextrose agar. The disk diffusion method was used to assess antifungal activity by measuring inhibition zones surrounding extract-containing disks. A dilution series of the E. fetida extract was also prepared to further analyze antifungal effects. The broth microdilution method was employed to determine the minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) for each fungal species, providing quantitative data on the effectiveness of the extract. Results:The coelomic fluid extracted from E. fetida contained 60.03% protein, 8.136% fat, 6.91% ash, 6.03% moisture, and 8.65% dry matter. Disk diffusion assays revealed significant inhibition of A. fumigatus and C. albicans, with the extract exhibiting stronger effects at higher concentrations. In broth microdilution assays, the extract achieved MIC/MFC values of 12.5%/25% against A. fumigatus and 3.125%/6.25% against Candida albicans. However, its efficacy against C. neoformans was lower, while the commercial antifungal drug, itraconazole, demonstrated superior efficacy against all tested strains. Conclusion:Earthworm extracts, rich in antimicrobial peptides, exhibit promising antifungal properties, particularly against C. albicans. Although not as effective as itraconazole, the potential of the extract as a safer and environmentally friendly alternative underscores its significance in antifungal research. Further studies are needed to enhance its efficacy and broaden its antifungal spectrum, potentially leading to new, sustainable strategies for managing fungal infections.
