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Banana peel culture as an indigenous medium to induce sporulation for identification

March 13 2017

More fungi are known as human pathogens now and these include newer and rarer species. Identifying these species from growth on conventional culture media tends to be challenging due to the absence of characteristic features. An indigenous and cheap culture medium, similar to the natural substrate of these fungi is needed to aid diagnosis in a conventional laboratory setting. Kindo and colleagues (2016) developed a media using sterilised banana peel as substrate for the growth and isolation of some rare fungi. This was done by taking unidentifiable fungi on primary isolation media and inoculating them on banana peel pieces along with few sterile coverslips, covered and kept at room temperature for 10-15 days. An un-inoculated separate plate of sterilised banana peel served as the negative control. Fungi grown were then identified microscopically based on their characteristic morphology. The researchers were able to identify six of the rarer human pathogenic ascomycetes (Lasiodiplodia theobromae, Macrophomina phaseolina, Nigrospora sphaerica, Chaetomium murorum), coelomycetes (Nattrassia mangiferae) and basidiomycetes (Schizophyllum commune) fungi. This method was found to be easy, affordable and effective. Other methods of inducing fungi to sporulate include plating onto potato dextrose agar, Czapek Dox agar, or directly sending for sequencing.
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February 28 2017

Estimates never before attempted show the number of people affected by serious fungal diseases in 14 of the worst affected countries across the globe have just been published *. Experts believe they give a stark reminder of the huge disconnect between the lack of fungal public health programs worldwide and the wealth of scientific research information on fungal disease now available. In a themed issue of journal European Journal of Clinical Microbiology and Infectious Diseases, the number of people affected by serious fungal diseases has been estimated for 832 million people in 14 countries in Asia, the Americas, Europe and North Africa. These estimates show that between 1.8-3 per cent of the population of each country are affected by some of the most serious types of fungal disease, which can cause chronic illness and death in the most extreme cases. The countries scrutinised are Pakistan, Bangladesh, South Korea, the Philippines, Thailand, and Uzbekistan, Ecuador, Canada, Peru, Guatemala, Chile; Portugal and Algeria and Egypt.
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Lymphadenitis and streaking not always Streptococci

February 23 2017

A useful summary paper recently published by Brandon Cohen and colleagues from New York reminds us that not all lymphadenitis is streptococcal and may be fungal. Streptococcal lymphadenitis with streaking presents as linear erythema extending proximally towards the regional lymph nodes. It may progress rapidly leading to serious complications including streptococcal toxic shock syndrome and therefore warrants systemic antibiotics. While Streptococcus pyogenes is the commonest bacterial cause of superficial lymphatic vessel inflammation in immunocompetent people, other bacterial and non-bacterial aetiologies can have similar presentations (ie Staphylococcus aureus and Pasteurella multocida). Recognition of these other aetiologies- though challenging- is important to avoid misdiagnosis, delay in administration of appropriate treatments and unnecessary systemic antibiotics.
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Delivering on Antimicrobial Resistance Agenda Not Possible without Improving Diagnostic Capabilities

January 31 2017

Ignorance of fungal disease and lack of diagnostics across the world is causing doctors to unknowingly overprescribe antibiotics a new report warns. Experts from GAFFI (the Global Action Fund for Fungal Infections) caution that we will lose the battle against antibiotic resistance unless doctors better understand how to suspect fungal disease and have proper access to the appropriate testing for it. In a paper published today in the cutting edge US journal Emerging Infectious Diseases (click here for paper), several leading authors from GAFFI warn of the gross misuse of antibacterial antibiotics, because doctors treat without knowing what is wrong with their patients. The authors focus on scenarios, all common, where the lack of the best diagnostic tests prevent the correct antimicrobial being given.
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Prevalence, clinical and economic burden of mucormycosis-related hospital admissions in the US

January 23 2017

There were 555 cases of mucormycosis in hospital among 47 million inpatient episodes, a prevalence of 0.16 per 10,000 discharges. The median length of stay was ~17 days and mean cost was $112,419. Mucormycosis is an uncommon, opportunistic fungal infection primarily caused by Mucorales, a filamentous fungus of the Mucormycetes class. This fungal infection particularly affects patients with diabetes mellitus (especially following ketoacidosis), or those with hematologic malignancies on chemotherapy (especially with neutropenia), stem cell and solid organ transplants. The study used the Premier’s Perspective™ Comparative Database, a large, U.S hospital based database covering more than 560 participating hospitals across the U.S and 104 million patients. Data was collected from January 2005 to June 2014. Mucormycosis related-hospitalisations were identified with an ICD-9 code of 17.7 or a positive laboratory microbiology result for Mucorales. Laboratory results were only available from 2009 and for about 37% of the hospitals. All eligible encounters needed at least one prescription of amphotericin B or posaconazole to qualify for a mucormycosis-related hospitalisation. The clinical and economic outcomes assessed included death at discharge, length of stay, and re-admission rates at 1 and 3 months. The cost for hospitalisation included all supplies, labour, depreciation of equipment, etc. All costs were inflated to 2014 USD.
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