Introduction: Invasive fungal infections affecting the central nervous system (CNS) are a major health concern worldwide associated with high mortality rates. Their increased incidence is largely due to an increase in the vulnerable immunocompromised population, changing environmental factors, and development of more accurate diagnostic methods. The aim of this article is to identify fungal causes of CNS infections that are recently emerging or have the potential to become emerging pathogens in the near future, as well as their clinical characteristics, including: Candida auris, Trichosporon spp., Blastomyces spp., Sporothrix spp., Talaromyces marneffei, Lomentospora prolificans, and Scedosporium spp. Methods: A review of the literature in PubMed in the last ten years was conducted to identify central nervous system infections caused by each of these fungi. Results: The review identified 10 cases caused by C. auris, 5 cases by Trichosporon spp., 82 cases by Blastomyces spp., 36 cases by Sporothrix spp., 21 cases by T. marneffei, 22 cases by Lomentospora prolificans, and 42 cases by Scedosporium spp. Discussion: The exact burden of these diseases remains difficult to ascertain, but their apparent rise underscores the urgent need for improved diagnostic, treatment, and management strategies against CNS fungal pathogens to improve outcomes against these life-threatening infections.
11 November 2019 in Journal of Neonatal-Perinatal Medicine
BACKGROUND: Nasal trauma due to nasal CPAP (nCPAP) use is a commonly reported complication in infants under 1500 g of birth weight and 32 weeks of gestation. With the rise of nCPAP as the gold standard for non-invasive respiratory support, preventive measures should be considered. OBJECTIVE: To assess the prevalence and risk factors of nasal injury in very low birth weight (VLBW) preterm infants with nCPAP. METHODS: We retrospectively analyzed neonates hospitalized between 2012 and 2017, with less than 1500 g and 32 weeks of gestational age who received more than 12 hours of nCPAP. Demographic, antenatal and clinical data, along with information regarding respiratory support and nCPAP complications, were collected. We used Fischer’s classification to grade nasal trauma. RESULTS: A total of 135 infants were evaluated. Mean gestational age was 28 weeks (SD 2) and mean birth weight 1072 g (SD 239). Nasal trauma was reported in 65% of patients and it was of stage I, II and III in 49%, 16% and 1% of patients, respectively. The multivariate logistic regression revealed that the risk of trauma was greater in neonates with a longer duration of nCPAP ventilation (OR = 1.098, 95% CI: 1.055–1.142; p < 0.001) and in patients submitted to oxygen therapy (OR = 3.174, 95% CI: 1.014–9.929, p = 0.004). The median of days after nCPAP administration until the onset of an identifiable lesion was 4. CONCLUSION: Nasal trauma is a frequent complication in VLBW preterm infants using nCPAP for long periods. Preventive measures in patients who are at greater risk of skin breakdown are of major clinical importance for a better outcome.
4 April 2025 in Travel Medicine and Infectious Disease
This study aimed to describe the epidemiology, clinical presentation, and management of Campylobacter sp. and Salmonella sp. infections in a tertiary hospital in Northern Portugal (2010–2020) and identify factors associated with reporting, invasive disease, and hospitalization. A retrospective review included patients with Campylobacter sp. (2015–2020) or Salmonella sp. infections (2010–2020). Reported cases were cross-referenced with the National Epidemiological Surveillance System. A total of 742 patients were included: 342 with Campylobacter sp., 392 with non-typhoidal Salmonella (NTS), and 15 with typhoidal Salmonella (TS). Immunosuppression was present in 16.7% of cases. NTS infections were invasive in 21.4% of cases, compared to 4.0% for Campylobacter. Macrolide resistance in Campylobacter reached 10%, particularly in C. coli, while multidrug resistance (MDR) was observed in 37.8% of NTS isolates. Immunocompromised patients accounted for over 70% of relapses in Campylobacter disease. Reporting rates were low: 32.8% for NTS, 30.6% for Campylobacter, and 14.3% for TS. Reporting was associated with male sex, no immunosuppression, hospitalization, and non-MDR organisms. In conclusion, immunocompromised patients face higher risks of invasive and relapsing disease. High rates of MDR in NTS limit treatment options. Underreporting remains significant, underscoring the need for improved awareness and reporting to inform public health strategies.
Tuberculosis (TB) is a global health threat, especially in HIV patients who may experience immune reconstitution inflammatory syndrome (IRIS) upon Mycobacterium tuberculosis infection. Diagnosing and defining IRIS in non‐HIV patients remains challenging. A 63‐year‐old male with acute leukaemia underwent induction therapy with a regimen containing fludarabine. Febrile neutropenia led to further investigations, revealing non‐cavitary pulmonary TB, prompting anti‐tuberculosis therapy (ATT) alongside resumed leukaemia treatment with sorafenib. Persistent extra‐pulmonary TB, specifically lymph node involvement, were observed and IRIS was suspected, evidenced by enlarged lymphadenopathies, scrofula, and skin lesions that developed during the 13‐month course of ATT, with no recurrence after its cessation. This article explores a case of lymph node TB‐associated paradoxical IRIS in a non‐HIV leukaemia patient, revealing the intricate interplay between tuberculosis and haematological malignancies and emphasizing the lack of standardized diagnostic criteria and treatment consensus. Challenges in lymph node TB diagnosis and management highlight the need for tailored therapeutic approaches. The report explores the potential immunomodulatory effects of fludarabine and sorafenib, questioning their roles in TB‐IRIS. This case illuminates TB‐IRIS dynamics in non‐HIV patients, urging further research and collaborative efforts to enhance understanding and outcomes. As medical complexities persist, personalized therapeutic approaches and advancements in TB‐IRIS research are crucial.