OBJECTIVES: Liver transplant recipients have a high rate of postoperative infection, and identification of patients at high risk for bacterial and fungal infections will help prevent disease and improve long-term outcomes for them. This study aims to understand the composition, distribution, prognosis of bacterial and fungal infections within 2 months after liver transplantation and to analyze their risk factors. METHODS: The data of pathogen composition, distribution, and prognosis of bacterial and fungal infections among liver transplant recipients in the Third Xiangya Hospital of Central South University from May 2020 to October 2021 were collected, and the risk factors for these infections were analyzed. RESULTS: A total of 106 episodes of bacterial or fungal infections occurred in 71.4% of liver transplant recipients (75/105). Gram-negative bacteria were the dominant pathogenic bacteria (49/106, 46.2%), followed by Gram-positive bacteria (31/106, 29.2%). The most common Gram-negative bacterium was Acinetobacter baumannii (13/106, 12.3%). The most common Gram-positive bacterium was Enterococcus faecium (20/106, 18.9%). The most common infections were pulmonary (38/105, 36.2%) and multiple site infections (30/105, 28.6%). Six (6/105, 5.7%) patients with infections died within 2 months after liver transplantation. Univariate analysis showed that the model for end-stage liver disease (MELD) score ≥25, antibiotic use within half a month before transplantation, infections within 2 months prior to transplantation, intraoperative red blood cell infusion≥8 U, indwelling urinary tract catheter ≥4 days after transplantation, and the dosage of basiliximab use ≥40 mg were associated with infections. Multivariate logistic regression analysis revealed that only infections within 2 months prior to transplantation (OR=5.172, 95% CI 1.905-14.039, P<0.01) was an independent risk factor for bacterial and fungal infections after liver transplantation. Postoperative bacterial and fungal infections were reduced in liver transplant recipients receiving basiliximab ≥40 mg (OR=0.197, 95% CI: 0.051-0.762, P<0.05). CONCLUSIONS The incidence of bacterial and fungal infections is high in the early stage after liver transplantation, and the mortality after infection is significantly higher than that of non-infected patients. The most common infection is respiratory infection, and the dominant pathogens is Gram-negative bacteria. Patients infected within 2 months prior to liver transplantation are prone to bacterial and fungal infections. Standard use of basiliximab can reduce the incidence of infections after liver transplantation.
Bacteria ; Bacterial Infections/etiology* ; Basiliximab ; Communicable Diseases ; End Stage Liver Disease ; Gram-Negative Bacteria ; Gram-Positive Bacteria ; Humans ; Liver Transplantation/adverse effects* ; Mycoses/etiology* ; Risk Factors ; Severity of Illness Index

Bronchiolitis obliterans syndrome (BOS) after hematopoietic stem cell transplantation (HSCT) is a major cause of morbidity and mortality with limited treatment options. Lung transplantation (LTX) has been rarely reported as a treatment option for selected HSCT recipients with this problem. In the present study, we reported six patients who underwent LTX due to BOS after HSCT (two females, four males) from January 2012 to December 2014 in our center. The median time from HSCT to diagnosis of BOS was 2.5 years (ranging from 1 to 5 years). At a median time of 4 years (ranging from 2 to 5 years) after diagnosis of BOS, four patients received bilateral sequential LTX, and two patients received single LTX. One of the recipients suffered from mild acute rejection after LTX, another suffered from primary lung graft dysfunction on post-operation day 2, and three experienced fungal infections. The median time for follow-up after LTX was 19.5 months (ranging from 12 to 39 months). At present, all patients are alive with good functional capacity and no relapse of BOS and hematologic malignancy conditions. Patients who received bilateral LTX have better pulmonary functions than patients who received single LTX.
Adolescent ; Adult ; Bronchiolitis Obliterans ; etiology ; surgery ; Female ; Graft Rejection ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Lung ; diagnostic imaging ; pathology ; Lung Transplantation ; Male ; Mycoses ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo discuss the clinical diagnosis and treatment of cavernous sinus syndrome caused by fungal infection of sphenoid sinus.

METHODSThe clinical manifestations, imaging examination, operation methods and complications were analyzed retrospectively in 9 patients with fungal infection of sphenoid sinus treated between January 2007 and September 2012, and the clinical experience was summarized. The treatment methods included endoscopic operation combined with antifungal drugs, and the primary disease was treated actively at the same time.

RESULTSAfter treatment, one patient with cavernous sinus thrombophlebitis had complications of ptosis, eyeball fixation and could only see the moving finger in the serious eye, while the contralateral eye regained normal vision. One patient with hypoproteinemia mucormycosis and diabetic remained blindness, eyeball fixation and ptosis in the left eye. In 3 patients, the vision was improved, but the eyeball movement was still limited. In another 3 patients, there was no significant recovery of vision, with one eye fixed in movement. The symptoms in 1 patient disappeared completely. All patients had no other systemic complications.

CONCLUSIONSCavernous sinus syndrome caused by the fungal infection of sphenoid sinus is rare. It is commonly happened in patients with systemic disease or immunocompromised patients. Early detection and parallel operation and continuous antifungal therapy can reduce the damage, but the prognosis is poor.

Adolescent ; Adult ; Aged ; Antifungal Agents ; therapeutic use ; Cavernous Sinus Thrombosis ; etiology ; therapy ; Child ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Mycoses ; complications ; Retrospective Studies ; Sphenoid Sinus ; Sphenoid Sinusitis ; complications ; Young Adult

Child ; Child, Preschool ; Humans ; Male ; Mycoses ; etiology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; drug therapy ; Rhinitis ; etiology ; Sinusitis ; etiology

OBJECTIVETo investigate the efficacy and tolerability of intravenous voriconazole on primary prevention in invasive fungal disease (IFD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

METHODSAt the time of conditioning regimen, patients without IFD was intravenously administered with voriconazole at a dose of 100 mg two times per day until neutrophils greater than 0.5×10⁹/L. Patients treated with oral fluconazole, 200 mg per day, were control group. The incidence and risk factors of IFD and side effects of medicines were evaluated.

RESULTSOf the total 227 patients, 33 (14.54%) had IFD within 3 months after allo-HSCT. There was significant difference on overall survival between patients with or without IFD by Kaplan-Meier survival curve (P=0.029). Of the 83 cases with intravenous voriconazole, 7 cases occurred IFD (8.43%). In contrast, the incidence of IFD in control group was 18.06% (26 out of 144). There was remarkable difference between the two groups (P=0.048). But there was no significant difference on risk factors of IFD between the two groups. In addition, the incidence of liver function abnormalities between the two groups was no difference. The ratio of auditory hallucination and visual impairment induced by voriconazole was not high.

CONCLUSIONIntravenous voriconazole on primary prevention for IFD after allo-HSCT is much better than oral fluconazole with well tolerability and satisfactory efficacy.

Administration, Intravenous ; Adolescent ; Adult ; Antifungal Agents ; administration & dosage ; therapeutic use ; Child ; Child, Preschool ; Female ; Fluconazole ; administration & dosage ; therapeutic use ; Follow-Up Studies ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Male ; Middle Aged ; Mycoses ; etiology ; prevention & control ; Postoperative Complications ; prevention & control ; Treatment Outcome ; Voriconazole ; administration & dosage ; therapeutic use ; Young Adult

OBJECTIVE: Observing the anatomic variation and measuring the bone volume of meatus and nasal cavity by analyzing the expression of paranasal sinus CT. Searching whether these variation and volume data are related to maxillary fungal ball. METHOD: Measuring the double side bone volume of middle meatus,nasal cavity and the rate of middle meatus volume in the same side of nasal cavity respectively in the normal group, the maxillary fungal ball group. Observing the anatomic variation and statistically evaluating the anatomic variation and volume of nasal cavity and nasal meatus. RESULT: In the maxillary fungal ball group, the affected side and the contralateral side volume of middle meatus,nasal cavity and the rate of middle meatus volume in the nasal cavity had no statistical difference (P>0.05); Comparing the middle meatus volume and the rate of middle meatus of the maxillary fungus ball group affected side and normal group,there was statistical difference (P<0. 05). In the maxillary fungal ball group and the normal group, the morbidity of deviation septum were 24. 24% and 33. 33%, the morbidity of OMC variation were 30. 3% and 26. 67% (P<0.05), the morbidity of nasal anatomic variation were 54. 55% and 60.00%, there was no statistical difference (P>0.05). CONCLUSION Maybe there is a correlation between the enlarged bone middle meatus and the maxillary fungal ball. There is no relationship between the nasal anatomic variation and the maxillary fungal ball.
Humans ; Mycoses ; etiology ; Nasal Cavity ; anatomy & histology ; microbiology ; Nasal Septum ; Paranasal Sinuses

The clinical manifestation of acute invasive fungal sinusitis was associated with facial pain,altered sense of smell, blindness and headache. Physical examinations show that dark brown nasal secretions with bone resorption in paranasal sinus. Radiographi parameters showed uneven density in paranasal sinus and intraorbital extension. Fungus smears and pathological examination can make a definitive diagnosis.
Acute Disease ; Facial Pain ; etiology ; Fungi ; isolation & purification ; Headache ; etiology ; Humans ; Mycoses ; complications ; pathology ; Paranasal Sinuses ; Sinusitis ; complications ; microbiology ; pathology

OBJECTIVETo investigate the clinical features of invasive fungal infections (IFI) in the pediatric intensive care unit (PICU) and, to provide a basis for the effective prevention and treatment of IFI.

METHODSRetrospective analysis was performed on the clinical features and treatment outcomes of 38 children with IFI who were admitted to the PICU of Wuhan Children's Hospital between January 2009 and August 2012.

RESULTSPulmonary fungal infection (89%) was the most common among the 38 cases. Before diagnosis of IFI, all patients had severe underlying diseases and received several broad-spectrum antibiotics, including carbapenems, which were used in 95% of cases; 47% of all cases had been treated with corticosteroids systemically; all patients had received invasive operations, and 47% of them had undergone endotracheal intubation and mechanical ventilation. None of these cases had either typical clinical symptoms and signs or specific imaging findings. Fifty-six strains of fungi were isolated, with Candida albicans (41%), Aspergilli (25%), and Mucor (20%) being the most common ones. All patients received timely antifungal therapies, 15 cases were cured and 16 cases showed improvements, with a response rate of 82%, and the rate of adverse events was 16%.

CONCLUSIONSIn the PICU, the respiratory tract is the most common site of IFI infection, and Candida albicans is the leading pathogen. Severe underlying diseases, use of broad-spectrum antibiotics and corticosteroids, and invasive operations are the main risk factors for IFI in the PICU. Early diagnosis and timely treatment with high-performance antifungal drugs can improve the prognosis in children with IFI.

Female ; Humans ; Infant ; Intensive Care Units, Pediatric ; Male ; Mycoses ; diagnosis ; drug therapy ; etiology ; Retrospective Studies

Acupuncture Therapy ; Adult ; Female ; Foot Diseases ; complications ; microbiology ; Humans ; Lymphedema ; etiology ; therapy ; Mycoses ; complications ; microbiology

OBJECTIVETo evaluate the efficacy and safety of antifungal prophylaxis of itraconazole in patients with acute myeloid leukemia (AML) to probe the relationship of the antifungal effect and the adverse events with serum concentration.

METHODSFrom April 2009 to May 2011, a total of 310 courses from 112 patients referred to our institute were enrolled in this study; of them, 297 courses were eligible for analysis. Eligible cases were randomized into oral group and injection/oral group according to different chemotherapy of induction and consolidation. Blood samples were collected at different time points for measurements of serum itraconazole levels. The morbidity of IFI and the adverse events were analyzed.

RESULTSThe morbidities of IFI in injection/oral and oral groups were 10.1% and 20.9%, respectively (P=0.010). 7 and 9 cases in injection/oral and oral groups, respectively were withdrawn from the study because of adverse events, and the difference between these two groups was of no significance. Serum itraconazole levels of injection/oral and oral groups were 672(299-1097) μg/L and 534(210-936) μg/L, respectively (P<0.01).

CONCLUSIONAntifungal prophylaxis with itraconazole in AML patients was effective and safe. Prophylactic effect with injection/oral itraconazole was superior to oral itraconazole solution; moreover, prophylactic effect of itraconazole was highly correlated with its serum level.

Adolescent ; Adult ; Antibiotic Prophylaxis ; Antifungal Agents ; therapeutic use ; Female ; Humans ; Itraconazole ; blood ; therapeutic use ; Leukemia, Myeloid, Acute ; drug therapy ; microbiology ; Male ; Middle Aged ; Mycoses ; etiology ; prevention & control ; Young Adult