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Fungal Epidemiology
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Fungal Epidemiology

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

Deadline for manuscript submissions: closed (31 May 2019) | Viewed by 67676

Special Issue Editors

Dr. Tom M. Chiller

E-Mail Website
Guest Editor
Centers for Disease Control and Prevention, Atlanta, GA, USA
Interests: emerging and infectious zoonotic diseases; infectious disease; epidemiology; mycosis; antifungal
Dr. Brendan R. Jackson

E-Mail Website
Guest Editor
Mycotic Diseases Branch, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
Interests: epidemiology; fungal diseases; public health; Coccidioides; Histoplasma; Blastomyces; Candida; Aspergillus; Mucormycetes; emerging infectious diseases
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Rapid global change continues to lead to the emergence of fungal diseases in new areas (and species), often with devastating consequences, as evidenced by the spread of chytridomycosis in reptiles and amphibians, white-nose syndrome in bats, and numerous crop and tree diseases. Emerging fungal infections of humans are increasingly recognized, many of which remain poorly understood and possess surprising characteristics. Key examples include, but are not limited to, the following: Healthcare transmission and outbreaks caused by multidrug-resistant Candida auris; Zoonotic cat-to-human transmission of the dimorphic fungus Sporothrix brasiliensis, which is spreading widely in cats in some countries; And an old pathogen which is taking on new characteristics as Aspergillus fumigatus infections resistant to all azole antifungals are increasingly observed worldwide.

The aim of this Special Issue is to characterize the epidemiology of emerging fungal diseases and fungal diseases with emerging characteristics through comprehensive reviews, original studies, and novel perspectives.

Dr. Tom M. Chiller
Dr. Brendan R. Jackson
Guest Editors

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Keywords

  • emerging fungal diseases
  • fungal prevalence
  • zoonotic fungal disease
  • emerging characteristics
  • interventions
  • public health

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Published Papers (7 papers)

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Research

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11 pages, 430 KiB  
Article
Fungal Diseases in Taiwan—National Insurance Data and Estimation
by Yu-Shan Huang, David W. Denning, Shu-Man Shih, Chao A. Hsiung, Un-In Wu, Hsin-Yun Sun, Pao-Yu Chen, Yee-Chun Chen and Shan-Chwen Chang
J. Fungi 2019, 5(3), 78; https://doi.org/10.3390/jof5030078 - 21 Aug 2019
Cited by 8 | Viewed by 4072
Abstract
The burden of fungal diseases based on the real-world national data is limited. This study aimed to estimate the Taiwan incident cases with selected fungal diseases in 2013 using the National Health Insurance Research Database (NHIRD) which covered 99.6% of the 23.4 million [...] Read more.
The burden of fungal diseases based on the real-world national data is limited. This study aimed to estimate the Taiwan incident cases with selected fungal diseases in 2013 using the National Health Insurance Research Database (NHIRD) which covered 99.6% of the 23.4 million population. Over 80,000 incident cases were found and the majority were superficial infections including vulvovaginal candidiasis (477 per 100,000 adult women) and oral candidiasis (90 cases per 100,000 population). Common potentially life-threating fungal diseases were Pneumocystis pneumonia (5.35 cases per 100,000 population), candidemia (3.68), aspergillosis (2.43) and cryptococcal meningitis (1.04). Of the aforementioned cases cancer patients contributed 30.2%, 42.9%, 38.6% and 22.2%, respectively. Of 22,270 HIV-infected persons in NHIRD in 2013, four common diseases were Pneumocystis pneumonia (28.3 cases per 1000 HIV-infected patients), oral candidiasis (17.6), esophageal candidiasis (6.06) and cryptococcal meningitis (2.29). Of pulmonary aspergillosis 32.9% occurred in patients with chronic pulmonary diseases and 26.3% had a prior diagnosis of tuberculosis. There are some notable gaps related to insurance claim data. Cutaneous, urinary tract and eye fungal infections were not captured. Full article
(This article belongs to the Special Issue Fungal Epidemiology)
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13 pages, 4096 KiB  
Article
Diagnosis of Progressive Disseminated Histoplasmosis in Advanced HIV: A Meta-Analysis of Assay Analytical Performance
by Diego H. Caceres, Martha Knuth, Gordana Derado and Mark D. Lindsley
J. Fungi 2019, 5(3), 76; https://doi.org/10.3390/jof5030076 - 18 Aug 2019
Cited by 51 | Viewed by 5564
Abstract
Histoplasmosis is an important cause of mortality in people with advanced HIV, especially in countries with limited access to diagnostic assays. Histoplasmosis can be diagnosed using culture, histopathology, and antibody, antigen, and molecular assays. Several factors may affect the analytical performance of these [...] Read more.
Histoplasmosis is an important cause of mortality in people with advanced HIV, especially in countries with limited access to diagnostic assays. Histoplasmosis can be diagnosed using culture, histopathology, and antibody, antigen, and molecular assays. Several factors may affect the analytical performance of these laboratory assays, including sample type, clinical stage of the disease, and previous use of antifungal treatment, among others. Here we describe the results of a systematic literature review, followed by a meta-analysis of the analytical performances of the diagnostic laboratory assays employed. Our initial search identified 1631 references, of which 1559 references were excluded after title and abstract screening, leaving 72 references identified as studies relevant to the validation of histoplasmosis diagnostic assays. After evaluating the full text, 30 studies were selected for final review, including one paper not identified in the initial search. The meta-analysis for assay analytical performance shows the following results for the overall sensitivity (Sen) and specificity (Spe) of the various methods evaluated: Culture, Sen 77% (no data for specificity calculation); antibody detection assays, Sen 58%/Spe 100%; antigen detection assays, Sen 95%/Spe 97%; and DNA detection assays (molecular), Sen 95%/Spe 99%. Of the 30 studies reviewed, nearly half (n = 13) evaluated Histoplasma antigen assays, which were determined to be the most accurate methodology for diagnosis of progressive disseminated histoplasmosis in advanced HIV (inverse of the negative likelihood ratio was 13.2). Molecular assays appear promising for accurate diagnosis of histoplasmosis, but consensus on exact techniques is needed. Cultures showed variable sensitivity related to sample type and laboratory handling. Finally, antibody assays presented high specificity but low sensitivity. This poor sensitivity is most likely due the highly immunosuppressed state of this patient population. Diagnostic assays are crucial for accurate diagnosis of progressive disseminated histoplasmosis (PDH) with advanced HIV disease. Full article
(This article belongs to the Special Issue Fungal Epidemiology)
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7 pages, 401 KiB  
Article
Antifungal Resistance in Clinical Isolates of Aspergillus spp.: When Local Epidemiology Breaks the Norm
by Mercedes Romero, Fernando Messina, Emmanuel Marin, Alicia Arechavala, Roxana Depardo, Laura Walker, Ricardo Negroni and Gabriela Santiso
J. Fungi 2019, 5(2), 41; https://doi.org/10.3390/jof5020041 - 21 May 2019
Cited by 23 | Viewed by 3919
Abstract
Aspergillosis is a set of very frequent and widely distributed opportunistic diseases. Azoles are the first choice for most clinical forms. However, the distribution of azole-resistant strains is not well known around the world, especially in developing countries. The aim of our study [...] Read more.
Aspergillosis is a set of very frequent and widely distributed opportunistic diseases. Azoles are the first choice for most clinical forms. However, the distribution of azole-resistant strains is not well known around the world, especially in developing countries. The aim of our study was to determine the proportion of non-wild type strains among the clinical isolates of Aspergillus spp. To this end, the minimum inhibitory concentration of three azoles and amphotericin B (used occasionally in severe forms) was studied by broth microdilution. Unexpectedly, it was found that 8.1% of the isolates studied have a diminished susceptibility to itraconazole. This value turned out to be similar to the highest azole resistance rate reported in different countries across the world. Full article
(This article belongs to the Special Issue Fungal Epidemiology)
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8 pages, 237 KiB  
Article
Changing Epidemiology of Invasive Candidiasis in Children during a 10-Year Period
by Maria Noni, Angeliki Stathi, Ilia Vaki, Aristea Velegraki, Levantia Zachariadou and Athanasios Michos
J. Fungi 2019, 5(1), 19; https://doi.org/10.3390/jof5010019 - 22 Feb 2019
Cited by 21 | Viewed by 3845
Abstract
Candida species are a common cause of invasive infection in neonates and children. The aim of our study was to evaluate the epidemiology and microbiology of invasive candidiasis (IC) in the largest tertiary Greek pediatric hospital during a 10-year period. A retrospective cohort [...] Read more.
Candida species are a common cause of invasive infection in neonates and children. The aim of our study was to evaluate the epidemiology and microbiology of invasive candidiasis (IC) in the largest tertiary Greek pediatric hospital during a 10-year period. A retrospective cohort study was performed from January 2008 to December 2017. Identification of species and antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) methodology. During the study period, 178 cases of IC were recorded. The tissue distribution included blood (87.1%), cerebrospinal (7.9%), peritoneal (3.9%) and pleural fluids (1.1%). Candida albicans and Candida parapsilosis (sensu lato) were the most frequently isolated species (47.8% and 28.7% respectively). From period 2008–2012 to period 2013–2017, a significant decrease in IC rates was detected (0.21 cases/1000 hospitalization days VS 0.11 cases/1000 hospitalization days, P = 0.040), while median minimum inhibitory concentrations (MICs) of amphotericin B were significantly increased for both C. albicans and C. parapsilosis (sl) (P = 0.037 and P = 0.004 respectively). The decrease in IC rates may reflect the increased awareness as well as the effective infection control initiatives and antifungal interventions. However, the significant increase in the MICs for amphotericin B and echinocandins such as caspofungin, raises concerns about their common use as first-line treatment. Epidemiologic monitoring is, therefore, critically important in order to evaluate and optimize therapeutic protocols for IC in pediatric populations. Full article
(This article belongs to the Special Issue Fungal Epidemiology)

Review

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25 pages, 1201 KiB  
Review
A Guide to Investigating Suspected Outbreaks of Mucormycosis in Healthcare
by Kathleen P. Hartnett, Brendan R. Jackson, Kiran M. Perkins, Janet Glowicz, Janna L. Kerins, Stephanie R. Black, Shawn R. Lockhart, Bryan E. Christensen and Karlyn D. Beer
J. Fungi 2019, 5(3), 69; https://doi.org/10.3390/jof5030069 - 24 Jul 2019
Cited by 51 | Viewed by 10849
Abstract
This report serves as a guide for investigating mucormycosis infections in healthcare. We describe lessons learned from previous outbreaks and offer methods and tools that can aid in these investigations. We also offer suggestions for conducting environmental assessments, implementing infection control measures, and [...] Read more.
This report serves as a guide for investigating mucormycosis infections in healthcare. We describe lessons learned from previous outbreaks and offer methods and tools that can aid in these investigations. We also offer suggestions for conducting environmental assessments, implementing infection control measures, and initiating surveillance to ensure that interventions were effective. While not all investigations of mucormycosis infections will identify a single source, all can potentially lead to improvements in infection control. Full article
(This article belongs to the Special Issue Fungal Epidemiology)
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19 pages, 2142 KiB  
Review
Emerging Fungal Infections: New Patients, New Patterns, and New Pathogens
by Daniel Z.P. Friedman and Ilan S. Schwartz
J. Fungi 2019, 5(3), 67; https://doi.org/10.3390/jof5030067 - 20 Jul 2019
Cited by 258 | Viewed by 23795
Abstract
The landscape of clinical mycology is constantly changing. New therapies for malignant and autoimmune diseases have led to new risk factors for unusual mycoses. Invasive candidiasis is increasingly caused by non-albicans Candida spp., including C. auris, a multidrug-resistant yeast with the potential [...] Read more.
The landscape of clinical mycology is constantly changing. New therapies for malignant and autoimmune diseases have led to new risk factors for unusual mycoses. Invasive candidiasis is increasingly caused by non-albicans Candida spp., including C. auris, a multidrug-resistant yeast with the potential for nosocomial transmission that has rapidly spread globally. The use of mould-active antifungal prophylaxis in patients with cancer or transplantation has decreased the incidence of invasive fungal disease, but shifted the balance of mould disease in these patients to those from non-fumigatus Aspergillus species, Mucorales, and Scedosporium/Lomentospora spp. The agricultural application of triazole pesticides has driven an emergence of azole-resistant A. fumigatus in environmental and clinical isolates. The widespread use of topical antifungals with corticosteroids in India has resulted in Trichophyton mentagrophytes causing recalcitrant dermatophytosis. New dimorphic fungal pathogens have emerged, including Emergomyces, which cause disseminated mycoses globally, primarily in HIV infected patients, and Blastomyces helicus and B. percursus, causes of atypical blastomycosis in western parts of North America and in Africa, respectively. In North America, regions of geographic risk for coccidioidomycosis, histoplasmosis, and blastomycosis have expanded, possibly related to climate change. In Brazil, zoonotic sporotrichosis caused by Sporothrix brasiliensis has emerged as an important disease of felines and people. Full article
(This article belongs to the Special Issue Fungal Epidemiology)
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23 pages, 1389 KiB  
Review
Invasive Aspergillosis by Aspergillus flavus: Epidemiology, Diagnosis, Antifungal Resistance, and Management
by Shivaprakash M. Rudramurthy, Raees A. Paul, Arunaloke Chakrabarti, Johan W. Mouton and Jacques F. Meis
J. Fungi 2019, 5(3), 55; https://doi.org/10.3390/jof5030055 - 1 Jul 2019
Cited by 186 | Viewed by 14526
Abstract
Aspergillus flavus is the second most common etiological agent of invasive aspergillosis (IA) after A. fumigatus. However, most literature describes IA in relation to A. fumigatus or together with other Aspergillus species. Certain differences exist in IA caused by A. flavus and [...] Read more.
Aspergillus flavus is the second most common etiological agent of invasive aspergillosis (IA) after A. fumigatus. However, most literature describes IA in relation to A. fumigatus or together with other Aspergillus species. Certain differences exist in IA caused by A. flavus and A. fumigatus and studies on A. flavus infections are increasing. Hence, we performed a comprehensive updated review on IA due to A. flavus. A. flavus is the cause of a broad spectrum of human diseases predominantly in Asia, the Middle East, and Africa possibly due to its ability to survive better in hot and arid climatic conditions compared to other Aspergillus spp. Worldwide, ~10% of cases of bronchopulmonary aspergillosis are caused by A. flavus. Outbreaks have usually been associated with construction activities as invasive pulmonary aspergillosis in immunocompromised patients and cutaneous, subcutaneous, and mucosal forms in immunocompetent individuals. Multilocus microsatellite typing is well standardized to differentiate A. flavus isolates into different clades. A. flavus is intrinsically resistant to polyenes. In contrast to A. fumigatus, triazole resistance infrequently occurs in A. flavus and is associated with mutations in the cyp51C gene. Overexpression of efflux pumps in non-wildtype strains lacking mutations in the cyp51 gene can also lead to high voriconazole minimum inhibitory concentrations. Voriconazole remains the drug of choice for treatment, and amphotericin B should be avoided. Primary therapy with echinocandins is not the first choice but the combination with voriconazole or as monotherapy may be used when the azoles and amphotericin B are contraindicated. Full article
(This article belongs to the Special Issue Fungal Epidemiology)
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