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------=_NextPart_01C2D2AB.B6ECAD80 Content-Location: file:///C:/15195993/Diagnosis_files/pres.xml Content-Transfer-Encoding: quoted-printable Content-Type: text/xml; charset="utf-8" ------=_NextPart_01C2D2AB.B6ECAD80 Content-Location: file:///C:/15195993/Diagnosis_files/slide0116.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Diagnosis of Mycoses
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Diagnosis of Systemic Mycoses and New Therapeutic Options
Mahmoud A. Ghannou= m, Ph.D.
Professor and Director
Center for Medical Mycology
Case Western Reser= ve University
Cleveland, Ohio, U= SA
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This Lecture Will Cover:
<= span style=3D'font-size:94%'>•Epidemiology of fungal infections
<= span style=3D'font-size:94%'>•Susceptibility pattern of fungal isolates
<= span style=3D'font-size:94%'>•Mortality due to fungal infections
<= span style=3D'font-size:94%'>•Difficulty in diagnosis
•Need for new broad spectrum antifungals to = respond to the changes
<= span style=3D'font-size:94%'>•Review of voriconazole, the new triazole
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Fun= gal Infections as Emerging Diseases
•Recent years have witnessed an increase in fungal infections = •Predisposing factors:  use of broad-spectr= um antibiotics, immunosuppressive agents, indwelling catheters and hospitalization •Increase first documented in the 80’s by Wey et al. (Arch. Intern. Med. 148:2642-2645, 1999) •More recently by Edmond et al. (Clin. Infect. Dis. 29:239-244, 1999)
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Sur= veillance and Control of Pathogens of Epidemiologic Importance
•49 hospitals across the U.S. (geographic diversity= ) = surveyed over a 3-year period •Cases of nosocomial bloodstream infections were <= span style=3D'font-size:94%'>surveyed •A nosocomial bloodstream infection was defined as occurring in critically ill patient when one or= more cultures of blood drawn at least 48 hours = after admission yielded a pathogenic organism.
Edmond et al.  Clin. Infect. Dis.  (1999) 29:239-244
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Rank order of nosocomial bloodstream pathogens and the associated crude mortality among the 49 hos= pitals
•         = ;         No. of         = ;          = ;   Crude
•  Ran= k Pathogen         = ;         isolates        = ;  %        mortality (%)
•    1        Coagulase-negative staphylococci     3,908         31.9 21
•    2 staphylococcus aureus         = ;            &n= bsp; 1,928        = ;  15.7      25 <= /div>
•    3 Enterococci     1,354         = ;  11.1   32
•    <= b>4 Candida species        934=         = ;    7.6     &= nbsp;     40
•    5 Escherichia coli        700=         = ;   5.7        24
•    6 Klebsiella species        662=         = ;   5.4 27
•    7 Enterobacter species        557=         = ;   4.5 28
•    8 Pseudomonas species        542=         = ;   4.4 33
•    9 Serratia species        177=         = ;   1.4 26
•  10<= span style=3D'mso-tab-count:1;width:5.64%'> Viridans streptococci        173=         = ;    1.4 23
Edmond et al.  Clin. Infect. Dis.  (1999).  29:239-244
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Distribution of nosocomial bloodstream infections due to Candida species by geographic region among the 49 hospitals
•        = ;            &n= bsp;   Northeast    Northwest    Southeast    Southwest =
•Candida species      (n =3D 288)     (n =3D 121)      (n =3D 351)    (n =3D 164)&#= 13;
•
•C. albicans        = ;            46        = ;      56        = ;         51        = ;        70
•C. glabrata        = ;           26        = ;       17        = ;         18        = ;        15
•C. krusei        = ;            &n= bsp;    4        = ;         3        = ;           4        = ;          1
•C. parapsilosis        = ;       8        = ;        12        = ;        13        = ;          5
•C. tropicalis        = ;          16        = ;       10        = ;        23        = ;          9
•Other        = ;            &n= bsp;          1        = ;         3        = ;          4        = ;          1
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Surveillance and Control of Pathogens of Epidemiologic Importance
•Yeasts continue to be important causes of <= /span>nosocomial bloodstream infections. •Importantly, they are associated with the highest mortality (40%). •Sizeable fraction of infections are caused by Candida spp. other than Candida albicans. <= /i>•The proportion of Candida= isolates other than C. albicans varied with geographic region.
Conclusions:
Edmond et al.  Clin. Infect. Dis.  (1999)  29:239-244
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Epid= emiology of Fungal Infections
•    Meis et al.  Diag. Microbiol. Infect. Dis.  39 (2000) 215-223, 26 Countries globally, 40 Institutions, 1997-1998, 20900 Isolates
Distribution of yeast isolates globally
C. albicans, 68.7%
C. glabrata, 9.9%
C. tropicalis, 4.16%
C. parapsilosis, 3.6%
C. krusei, 1.6%
C. species, 4.8%
Other yeast, 7%
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Species distribution of Candida= bloodstream isolates: Different regions of the world
•C. albicans 55         60        = ;          45        = ;           58
•C. glabrata        = ;             21a        = ;            &n= bsp; 12        = ;            6        = ;           10
•C. parapsilosis        = ;       11        = ;        16        25b 19b
•C. tropicalis   9          6          16c   7
•C. krusei   2          2        = ;             1        = ;            1
•Candida spp.   2        = ;          4     &nb= sp;            =    7        = ;            5
        = ;            &n= bsp;            = ;            &n= bsp;         % Isolates by geographic area&= #13;
   Species        = ;            &n= bsp;   U.S.        = ;   Canada    &nbs= p; Latin America   &nb= sp; Europe
         (n =3D 589)      (n =3D 161)        (n =3D 132)         (n =3D302) =
a P £ 0.01 compared to prevalence in other geographic areas.
bP £ 0.001 compared to prevalence in the United States= .
cP £ 0.03 compared to prev= alence in other geographic areas.
Pfaller et al.  SENTRY Program, 1997 to 1999
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