Fungi such as Cryptococcus, Histoplasma and Coccidiodes can survive antifungal therapy by residing asymptomatically in the prostate of immunocompromised patients, in some cases leading to relapse
A meta-analysis by Pourbaix et al found a overall risk ratio of 1.41 when comparing risk of IFI in smokers to non-smokers, particularly for infections caused by dimorphic fungi such as histoplasmosis, blastomycosis and coccidioidomycosis
Lobomycosis (AKA lacaziosis) is an implantation mycosis endemic to the Amazon basin, caused by Lacazia loboi. Nodular keloid lesions grow slowly and can cause disfigurement. Biopsy of lesions shows many thick-walled yeast cells forming chains, which may co-occur with other infections (e.g. leprosy, leishmaniasis) or squamous cell carcinoma.
Histoplasmosis can present in a variety of ways, making it difficult to diagnose. Dr Staffolani and colleagues carried out a systematic review of 835 cases of histoplasmosis (including 45 clusters) from the literature, among immunocompetent patients who had recently returned from an endemic area. Manifestations included fever (91%), cough (55%), constitutional symptoms (58%), headache (52%) and chest pain (41%).
Dr Barantsevich and colleagues describe a series of 49 trauma patients at an ICU in Moscow from whom Candida auris was isolated. Fluconazole resistance was widespread. However, no isolates were recovered by monthly swabbing of the hospital environment, healthcare workers’ hands and devices.
The World Health Organisation has updated its Essential Medicines List to the Histoplasma antigen test, which can be used on urine to diagnose histoplasmosis in 48 hours. Rolling out this test worldwide could save up to 48,000 lives in 5 years.
Cryptococcosis is well known as a complication of HIV/AIDS, but it can also affect those who are immunosuppressed for other reasons. Dr Marr and colleagues describe a set of 138 patients from the US. Around half (49%) had CNS involvement but only just over a quarter (27.8%) had a fever.
Lateral flow rapid diagnostics are sorely needed for many fungal infections. Scientists at the University of Manchester evaluated LDBio’s Aspergillus IgG test on patients at the National Aspergillosis Centre (UK). Compared to existing diagnostics, this test was more sensitive (91.6%) and more specific (98.0%) for chronic pulmonary aspergillosis
Blastomycosis is a rare fungal infection caused by inhaling spores of the fungus Blastomyces dermatitidis
Antifungal treatment can be useful for patients with severe asthma and fungal sensitisation, but this is limited by a lack of prevalence data. Two new papers aim to address this for Sweden (Backman et al) and 13 countries across Africa (Kwizera et al).