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As the first part of an update to the clinical practice guideline on the management of histoplasmosis in adults, children, and pregnant people, developed by the Infectious Diseases Society of America, we present 4 updated recommendations. These recommendations span treatment of asymptomatic Histoplasma pulmonary nodules (histoplasmomas), mild acute pulmonary histoplasmosis, and moderate acute pulmonary histoplasmosis. The panel's recommendations are based on evidence derived from systematic...

Abstract Background Multiplex polymerase chain reaction (PCR)-based targeted next-generation sequencing (tNGS) is a promising tool for distinguishing lower respiratory tract infections in clinical practice, and its detectable pathogen spectrum can cover more than 95% of clinical cases, but there is limited information on systematic evaluation of the clinical use of multiplex PCR-based tNGS (mp-tNGS) in invasive pulmonary aspergillosis (IPA) cases....

Background: Candida species are the most common cause of invasive fungal disease, and children with hematologic malignancy are at increased risk. Non- albicans Candida (NAC) now account for more than half of all invasive candidiasis (IC) and carry a worse prognosis. We aimed to compare the epidemiology, risk factors, organ dissemination, biomarkers and outcomes in IC based on the species implicated and...

Abstract Follow-up of previously healthy patients surviving cryptococcal meningitis found that cryptococcal antigen could be detected for >1 year in serum from 38 of 44 (86%) patients and in cerebrospinal fluid (CSF) from 20 of 31 patients (67%), far beyond the time of culture conversion. The speed of titer decline, measured as the number of days for a 2-fold drop in titer to occur, was slower in serum than in CSF. The speed of decline of antigen titers was much slower in...

Abstract Cryptococcus is an opportunistic fungal pathogen that can cause disseminated infection with predominant central nervous system involvement in patients with compromised immunity. Biologics are increasingly used in the treatment of neoplasms and autoimmune/inflammatory conditions and the prevention of transplant rejection, which may affect human defense mechanisms against cryptococcosis. In this review, we comprehensively investigate the association between cryptococcosis...

This meta-analysis demonstrated very high diagnostic performance of PCR assays when used as screening tests for Pneumocystis pneumonia in high-risk patient groups, regardless of HIV status. qPCR on bronchoalveolar lavage fluid samples provided optimal sensitivity, closely followed by qPCR on induced sputum, while also providing adequate specificity., Graphical abstractThis graphical abstract is also available at Tidbit:...

Among solid organ transplant recipients taking belatacept, 15% developed invasive fungal diseases. The most common invasive fungal diseases were aspergillosis (56%) and candidiasis (22%). The infected cohort was more likely to receive basiliximab, undergo lung transplantation, or identify as White. Higher rates of aspergillosis were seen in this lung cohort than previously reported.

Mucormycosis is a rare and devastating angioinvasive infection that can be challenging to diagnose due to the low sensitivity of current noninvasive diagnostics and the lack of a “gold standard” reference test. We describe a retrospective case series of children with suspected mucormycosis where plasma microbial cell-free DNA testing was utilized in the diagnostic evaluation to illustrate the ways in which microbial cell-free DNA testing can noninvasively contribute to the evaluation and...

Abstract We studied patients diagnosed with aspergillosis based on positive bronchoalveolar lavage (BAL) Aspergillus galactomannan (GM) who had follow-up BAL sampling within 180 days. GM trend and clinical outcome were concordant in only 60% (30/50). While useful for the initial diagnosis, BAL GM trending does not always correlate with treatment response.

Abstract Combination antifungal therapy for invasive mucormycosis remains controversial and is inconsistently defined in prior studies. In a cohort of immunocompromised patients with invasive mucormycosis, we found no difference in 6-week mortality with upfront nor salvage combination therapy compared to monotherapy.

Histoplasmosis is an endemic and invasive mycosis caused by Histoplasma capsulatum. We conducted a retrospective study comparing non-HIV immunosuppressed patients with a historical cohort of HIV and histoplasmosis. We included 199 patients with proven or probable histoplasmosis, of which 25.1% were non-HIV. Diabetes mellitus, chronic kidney disease, hematologic neoplasms, rheumatologic diseases and transplants were more frequent among non-HIV patients (p<0.01). Death after diagnosis...

Histoplasma capsulatum, the etiological agent for histoplasmosis, is a dimorphic fungus that grows as a mold in the environment and as a yeast in human tissues. It has a broad global distribution with shifting epidemiology during recent decades. While in immunocompetent individuals infection is usually self-resolving, solid organ transplant recipients are at increased risk of symptomatic disease with dissemination to extrapulmonary tissue. Diagnosis of histoplasmosis relies on direct...

To theEditor—Invasive fusariosis (IF) is a severe opportunistic mold infection that often results in poor outcomes, especially for patients with hematological malignancies [1–4]. Skin involvement is the second most common manifestation of IF after pulmonary involvement [1–3]. While in vitro studies showed synergistic effects of the squalene epoxidase inhibitor terbinafine (TRB) when combined with triazoles [5] or liposomal amphotericin B (L-Amb) [6] against various fungal pathogens,...

Abstract Among 1107 cryptococcosis cases from the French surveillance network (2005–2020), the proportion of HIV-seronegative individuals has recently surpassed that of HIV-seropositive individuals. We observed marked differences in patient characteristics, disease presentations, cryptococcal antigen results, infecting species, and mortality according to HIV serostatus.

Mucormycosis is an emerging disease primarily affecting the immunocompromised host, but scarce evidence is available for solid organ transplant recipients (SOTR). We systematically reviewed 183 cases occurring in SOTR, exploring epidemiology, clinical characteristics, causative pathogens, therapeutic approaches, and outcomes. Kidney transplants accounted for half of the cases, followed by heart (18.6%), liver (16.9%) and lung (10.4%). Diagnosis showed a dichotomous distribution, with 63.7%...

Abstract Background Geographically endemic fungi can cause significant disease among solid organ transplant (SOT) recipients. We provide an update on the epidemiology, clinical presentation and outcomes of 5 endemic mycoses in SOT recipients. Methods Multiple databases were reviewed from inception through May 2023 using key words for endemic fungi (e.g. Coccidioidomycosis or Coccidioides,...