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Around 7% of NTM-LD patients develop CPA, especially older male smokers with COPD and low BMI

April 16 2018

Dr Jhun and colleagues in Seoul recently published a large case series of 566 patients with non-tuberculous mycobacterial lung disease (NTM-LD) in which ~7% went on to develop chronic pulmonary aspergillosis (CPA), of whom just under half died. Patients developing CPA were more likely to be older male smokers with a low BMI and a history of prior lung disease and/or steroid treatment.
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Hypercalcaemia as an early warning sign for Pneumocystis pneumonia among renal transplant recipients

April 10 2018

Dr Ling and colleagues describe an outbreak of PJP among four Australian patients who had received renal transplants several years before. In each case the infection was accompanied by a rise in serum calcium, and risk factors in their medical histories included CMV infection, use of glucocorticoids and renal failure/rejection.
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New CrAG lateral flow assay from Liming Bio has high sensitivity (98%) but poor PPV (50%)

April 03 2018

CrAG screening is recommended by the WHO for HIV+ patients with a CD4 count <100 cells/μl, in order to reduce mortality from cryptococcal meningitis. Dr Edward Mpoza and colleagues in Uganda found that a New CrAG lateral flow assay from Liming Bio (China) has high sensitivity (98%) but poor specificity (90%) and positive predictive value (50%) among HIV+ patients in Kampala.
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Microsporidia is an underdiagnosed cause of keratoconjuctivitis

March 29 2018

Microsporidia are close relatives of fungi that cause a minority of eye infections, but cases are often misdiagnosed as atypical adenoviral keratoconjunctivitis. Clinicians should routinely check for Gram-positive spores and check whether lesions can be removed by debridement. A standardised protocol for susceptibility testing of these species would be beneficial.
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Utility of beta-D-glucan (BDG) testing in fungal eye infections

March 23 2018

Dr Kolomeyer and colleagues from the University of Pennsylvania describe a case of Candida albicans endophthalmitis in a 19-year-old male with a history of drug use and a positive serum 1,3-β-D-glucan (BDG) test. They urge ophthalmologists to consider using BDG testing as an adjunctive test in cases of suspected fungal eye infections, especially when fever is also present or when the patient has a history of drug use.
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