Current updates on fungal endocarditis

Fungal endocarditis (FE) is a rare disease but in recent years its incidence as well as mortality is increasing particularly in developing nations. Candida and Aspergillus species occupy the prominent position as etiological agents of this invasive disease. Intravenous devices such as pacemakers, central line related thrombosis and prolonged use of antibiotics are major risk factors for FE. The epidemiology of endocarditis cases is also evolving over time with exceptionally rare species causing more invasive disease. Research over the last decade has also delineated the underlying pathogenic mechanism of FE. Improved understanding of these mechanisms will help to combat the increasing problem of antimicrobial drug resistance. The diagnosis of FE is dependent on the sensitivity and specificity of the method as fungi generally do not grow well in blood cultures. More advanced techniques including molecular and immunological assays now play a central role in accurate identification of causative fungal pathogens especially in culture negative scenario. In developing nations such as India, blood culture reports are generally negative due to prior antibiotic therapy. Echocardiography has emerged as the potential imaging technique for identifying invasive endocarditis including small masses of vegetation or abscess. Successful treatment often requires both the surgical interventions and prolonged antifungal therapy. In the present review, we briefly highlight the mechanisms of pathogenesis of this rare emerging disease along with the risk factors involved, the diagnostic criteria and the treatment strategy.     

Prosthetic valve endocarditis.

During 1965 to 1982, 32 episodes of infective endocarditis on prosthetic valves in 30 patients were treated at this hospital. In early endocarditis (presenting within four months of operation) staphylococci were the organisms most commonly responsible. Early endocarditis appears to be declining in incidence and is largely preventable; sternal sepsis was the main predisposing factor, requiring urgent and effective treatment. Streptococci were the most common organisms in late onset disease, but as with natural valve endocarditis a wide range or organisms was responsible. All but one of the patients with early onset disease were treated conservatively, but mortality was high; prompt surgical replacement of infected prostheses is probably indicated in such patients. Medical management was effective in most patients with late onset disease, and for them early surgical intervention may not be justified.     

Amplification reaction to bacterial DNA for diagnosing infective endocarditis

The aim of this study was to evaluate the usefulness of broad-range bacterial PCR in infective endocarditis of bacterial etiology, and to determine its specificity and sensitivity. Twenty five blood samples were taken for analysis from patients with infective endocarditis and acquired valvular heart disease. Infective endocarditis was diagnosed according to Duke criteria. There were two control groups consisting of patients with acquired valvular heart disease: 10 patients with urinary tract infection and 15 patients without. Three different primer pairs for the region of the gene coding for 16S rRNA were tested, to find the most specific one. The highest specificity was found for F/R primers, as the relevant amplified PCR product was present in every blood sample with infective endocarditis, and also in 4 out of 10 patients with urinary tract infection. Broad-range PCR in bacterial endocarditis is a fast, sensitive and inexpensive tool for the detection of bacteria, but it is far more prone to contamination than species specific-PCR. However, in controlled conditions it may be valuable in the identification of non-specific infection allowing for a more rapid clinical diagnosis of endocarditis.     

Fungal Endocarditis Observed Over an 8-Year Period and a Review of the Literature

Background

Fungal endocarditis (FE) is a “modern” disease that is considered an emerging cause of infective endocarditis (IE). The most frequently identified fungal pathogens are Candida spp., which are responsible for up to two-thirds of all cases; the remaining cases are due to Aspergillus spp., Histoplasma capsulatum or, more rarely, other yeasts and moulds.

Objectives

To describe the prevalence, clinical characteristics and outcome of FE diagnosed in a single tertiary centre and review the literature concerning FE.

Design and setting

An 8-year retrospective review of the case records of patients attending a single Italian University Centre and diagnosed as having definite or probable IE as defined by the modified Duke criteria.

Results

Six patients were identified from 229 episodes of IE: five cases involved a prosthetic valve, and one a native valve of an intravenous drug user. Five cases were caused by Candida spp. (two by C. albicans, one each by C. lusitaniae, C. dubliniensis and C. glabrata) and one by Aspergillus flavus. Three patients were treated by means of surgery plus antifungal therapy; two received antifungal therapy alone. Three patients survived, but only the patient with Aspergillus endocarditis was followed up for a long time.

Conclusions

FE is difficult to diagnose but generally associated with healthcare infections. The optimal treatment is poorly characterised, and international collaborative studies are urgently needed to evaluate newer antifungal agents.     

The distribution of the recessus orbitalis across flatfishes (order: Pleuronectiformes)

The recessus orbitalis is an accessory organ of flatfishes functioning in the protrusion of the eyes. This character, along with cranial asymmetry and a forward insertion of the dorsal fin, have been considered synapomorphies for the Pleuronectiformes. New dissections and examination of images taken in the wild show that the recessus orbitalis is present in all representatives of Pleuronectoidei examined but is absent in the single species of Psettoidei dissected. Psettoidei, the most primitive pleuronectiform lineage, contains three recognized species; thus, the absence of the recessus orbitalis in this whole lineage is unclear without further dissections. Ancestral character estimation at the family level for the recessus orbitalis indicates that the recessus orbitalis was likely absent in the common ancestor of Pleuronectiformes but was most likely present in the common ancestor of the Pleuronectoidei. Given that so few species of flatfishes have been assessed for the recessus orbitalis to date, additional characterization of the distribution of the recessus orbitalis across flatfishes will further inform what states this character may have and if it is a synapomorphy of Pleuronectiformes or simply a derived character state of Pleuronectoidei.     

Primary cutaneous melanoma in Black patients: An analysis of 2464 cases from the National Cancer Database 2004–2018

Melanoma in Black patients carries a poor prognosis. Due to its rarity, melanoma in this population has not been well characterized. This study evaluates survival predictors in Black patients with melanoma. This was a retrospective cohort study of Black patients with cutaneous melanoma from the National Cancer Database 2004–2018. Of the 2464 cases, melanoma was more common among females than males (57.1% vs. 42.9%, p < .001). Median Breslow depth was 1.8 mm (interquartile range 0.4–4.4). Lower extremities were the most common location (52.8%), followed by upper extremities (13.1%) along with otherwise specified/overlapping/other (13.1%), then by trunk (11.8%), and lastly head and neck (9.2%). Stage at diagnosis was I (30.7%), II (27.5%), III (24.1%), and IV (17.7%). Ulceration was observed in 41.4% of lesions. Acral lentiginous melanoma (ALM) was the most common specific histologic subtype (20.3%), followed by superficial spreading melanoma (9.4%). After adjusting for confounders, higher stages and primary site on the head and neck were the strongest independent predictors of worse overall survival. Melanoma in Black patients is most likely to appear on the lower extremities. A large portion (41.8%) presented with stage III or IV disease. ALM was the most common specific histologic subtype.     

A case study of human exacerbation of the invasive species problem: transport and establishment of polygyne fire ants in Tallahassee, Florida, USA

Understanding how exotic invasive species are spread is fundamental for ecology and conservation biology. Human transport has become one of the primary modes of dispersal for exotic species. We examined how the multiple queen, or polygyne, social form of the fire ant Solenopsis invicta is spread along roadsides in Tallahassee, Florida, USA. We then determined the likely source of this expanding population, which was a central soil depot. A survey of road maintenance practices in counties of several southeastern states and Texas revealed that the use of a central soil depot is a common practice. Road maintenance therefore may be the primary source for the establishment of new polygyne fire ant populations in this region and elsewhere. Control efforts focused on the soil depots will help to limit further spread of polygyne fire ants and perhaps other invasive organisms, particularly invasive weeds.     

神经胶质瘤生物标志物研究进展

神经胶质瘤(glioma)是最常见的原发性脑肿瘤,占颅内肿瘤的81%。神经胶质瘤的诊断手段与预后评估主要以影像学为主,但因神经胶质瘤的浸润性生长特点,影像学不能完全作为诊断及预后评估依据。因此,发现和鉴定全新生物标志物对神经胶质瘤的诊断、治疗和预后评估显得尤为重要。最新研究结果表明,在神经胶质瘤患者组织和血液中,多种生物标志物可用于神经胶质瘤的辅助诊断和预后评估。其中,诊断标志物包括IDH1/2基因突变、BRAF基因突变与融合、p53基因突变、端粒酶活性增加、循环肿瘤细胞和非编码RNA等。预后标志物包括1p/19p共缺失、MGMT基因启动子甲基化及基质金属蛋白酶-28、胰岛素样生长因子结合蛋白-2和CD26的表达上调和Smad4的表达下调。本文重点介绍了上述神经胶质瘤生物标志物在诊断和预后评估方面的最新研究进展。     

Infective Endocarditis in the U.S., 1998–2009: A Nationwide Study

Background

Previous studies based on local case series estimated the annual incidence of endocarditis in the U.S. at about 4 per 100,000 population. Small-scale studies elsewhere have reported similar incidence rates. However, no nationally-representative population-based studies have verified these estimates.

Methods and Findings

Using the 1998–2009 Nationwide Inpatient Sample, which provides diagnoses from about 8 million U.S. hospitalizations annually, we examined endocarditis hospitalizations, bacteriology, co-morbidities, outcomes and costs. Hospital admissions for endocarditis rose from 25,511 in 1998 to 38, 976 in 2009 (12.7 per 100,000 population in 2009). The age-adjusted endocarditis admission rate increased 2.4% annually. The proportion of patients with intra-cardiac devices rose from 13.3% to 18.9%, while the share with drug use and/or HIV fell. Mortality remained stable at about 14.5%, as did cardiac valve replacement (9.6%). Other serious complications increased; 13.3% of patients in 2009 suffered a stroke or CNS infection, and 5.5% suffered myocardial infarction. Amongst cases with identified pathogens, Staphylococcus aureus was the most common, increasing from 37.6% in 1998 to 49.3% in 2009, 53.3% of which were MRSA. Streptococci were mentioned in 24.7% of cases, gram-negatives in 5.6% and Candida species in 1.0%. We detected no inflection in hospitalization rates after changes in prophylaxis recommendations in 2007. Mean age rose from 58.6 to 60.8 years; elderly patients suffered higher rates of myocardial infarction and death, but slightly lower rates of Staphylococcus aureus infections and neurologic complications. Our study relied on clinically diagnosed cases of endocarditis that may not meet strict criteria. Moreover, since some patients are discharged and readmitted during a single episode of endocarditis, our hospitalization figures probably slightly overstate the true incidence of this illness.

Conclusions

Endocarditis is more common in the U.S. than previously believed, and is steadily increasing. Preventive efforts should focus on device-associated and health-care-associated infections.     

Bacterial Endocarditis with Candida Albicans Superinfection

Clinical and pathological features of two fatal cases of bacterial endocarditis with Candida albicans superinfection are described. One patient presented with combined Streptococcus viridans and Candida endocarditis of the aortic valve. The second patient, an addict to paregoric injected intravenously, developed Staphylococcus aureus of the tricuspid valve with eventual Candida endocarditis. The responsible organisms were identified from blood cultures during the hospital course, and by culture or tissue section of postmortem material. Candida endocarditis has emerged as a disease entity in the past 20 years. The incidence is increasing and patients with bacterial endocarditis are among those at risk. Antibiotic therapy appeared to facilitate the development of Candida endocarditis in these two cases.     

The invasive green crab and Japanese shore crab: behavioral interactions with a native crab species,the blue crab

Blue crabs, Callinectes sapidus (Rathbun), are an ecologically and commercially important species along the East coast of North America. Over the past century and a half, blue crabs have been exposed to an expanding set of exotic species, a few of which are potential competitors. To test for interactions with invasive crabs, juvenile C. sapidus males were placed in competition experiments for a food item with two common non-indigenous crabs, the green crab Carcinus maenas (L.) and the Japanese shore crab, Hemigrapsus sanguineus (De Haan). Agonistic interactions were evaluated when they occurred. In addition, each species’ potential to resist predators was examined by testing carapace strength. Results showed that C. maenas was a superior competitor to both C. sapidus and H. sanguineus for obtaining food, while the latter two species were evenly matched against each other. Regarding agonism, C. sapidus, was the “loser” a disproportionate number of times. C. sapidus carapaces also had a significantly lower breaking strength. These experiments suggest that both as a competitor, and as potential prey, juvenile blue crabs have some disadvantages compared with these common sympatric exotic crab species, and in areas where these exotics are common, juvenile native blue crabs may be forced to expend more energy in conflict that could be spent foraging, and may be forced away from prime food items toward less optimum prey.     

Preventing Death from HIV-Associated Cryptococcal Meningitis: The Way Forward

Cryptococcal meningitis (CM), a fungal disease caused by Cryptococcus species, is one of the most common opportunistic infections among persons with HIV/AIDS. The highest burden of disease is in sub-Saharan Africa and Southeast Asia, where limited access to antiretroviral treatment and appropriate antifungal therapy contributes to high mortality rates. Increasing focus has been placed on earlier detection and prevention of disease. Primary prophylaxis and screening may provide a survival benefit and can be cost-effective in settings where CM prevalence is high. The development of a new point-of-care cryptococcal antigen assay has the potential to transform both disease prevention and diagnosis.     

Gene expression and methylation profiles identified CXCL3 and CXCL8 as key genes for diagnosis and prognosis of colon adenocarcinoma

Colon adenocarcinoma (COAD) is one of the most common malignant tumors with high morbidity and mortality rates worldwide. Due to the poor clinical outcomes, it is indispensable to investigate novel biomarkers for the diagnosis and prognosis of COAD. The aim of this study is to explore key genes as potential biomarkers for the diagnosis and prognosis of COAD for clinical utility. Gene expression profiles (GSE44076 and GSE44861) and gene methylation profile (GSE29490) were analyzed to identify the aberrantly methylated-differentially expressed genes by R language and Perl software. Function enrichments were performed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway. Moreover, hub genes were identified through protein–protein interaction (PPI) network. Besides, key genes were found by the module analysis and The Cancer Genome Atlas (TCGA) survival analysis. Finally, TCGA data and quantitative real-time polymerase chain reaction (RT-qPCR) was used to validate the key genes involved in COAD. Our study found two hypomethylation-high-expression genes (CXCL3 and CXCL8) in COAD tissues compared with the adjacent normal tissues. These results were also confirmed by RT-qPCR with 25 pairs of COAD and adjacent normal tissues. Meanwhile, low expression of the two genes was associated with poor survival in patients with COAD. CXCL3 and CXCL8 may serve as key genes in the diagnosis and prognosis for COAD.     

Prognostic analysis of Behçet’s disease with aortic regurgitation or involvement

Background

Aortic regurgitation is the most common cardiovascular damage in Chinese patients with Behçet’s disease (BD) and is usually associated with aortic disease. These patients are easily misdiagnosed, and their prognosis is poor, even after surgical treatment. This study aimed to analyse potential factors that can improve the prognosis of BD patients with aortic regurgitation and/or aortic involvement.

Methods

Twenty-two patients with diagnosed or suspected BD as well as aortic regurgitation and/or aortic involvement in our hospital from 2012 through 2017 were collected in this study. Their clinical characteristics were listed, and the diagnosis of BD was evaluated by two different criteria sets. The influences of surgical treatment and immunosuppressive therapy (IST) on their prognosis were also explored.

Results

The diagnostic positive rate of the International Criteria for Behçet’s Disease was higher than that of the International Study Group criteria (kappa value 0.31, p?<?0.05), indicating that the diagnostic consistency between the criteria sets was poor. There was no significant difference in survival between patients who had undergone ≤?1 operation and those with ≥?2 operations. Aortic valve replacement alone or in combination with aortic root replacement had no significant effect on the incidence of reoperation or death, but IST did significantly reduce this incidence (p?<?0.05). However, there was no significant difference in the occurrence of reoperation or death between preoperative and postoperative IST versus postoperative IST only.

Conclusion

IST significantly improved the prognosis of BD patients with aortic regurgitation and/or aortic involvement.

     

THE DIAGNOSIS AND TREATMENT OF MENINGITIS

Treatment of meningitis is no longer a question of the administration of antimeningococcal serum and awaiting results. Today there is at hand an ever expanding armamentarium of drugs effective on various bacteria, rickettsia and some of the larger viruses. The skillful use of these singly or in combination offers an excellent prognosis in most forms of bacterial meningitis. Tuberculous meningitis continues to present a poor outlook, but this has been improved with more intensive therapy. More effective agents are needed in the treatment of this disease.“Shotgun” therapy may be indicated in critically ill patients prior to accurate bacteriological diagnosis; it is more important that therapy should include an effective agent or combination of agents than to attempt to determine in advance the most potent form of specific therapy. Partially treated purulent meningitis may be confused with aseptic meningitis. There is at present no effective therapeutic agent for the viral meningitides, but the prognosis is favorable in most of these diseases without specific therapy.     

Identifying conservation priority ponds of an endangered minnow, <Emphasis Type="Italic">Pseudorasbora pumila</Emphasis>, in the area invaded by <Emphasis Type="Italic">Pseudorasbora parva</Emphasis>

We investigated the occurrence pattern of the pond-living endangered cyprinid, Pseudorasbora pumila, and also compared its habitat characteristics with those of the congeneric invasive species, Pseudorasbora parva, in the contact zone. Comparison of 16 environmental variables among the P. pumila habitats, P. parva habitats, and unoccupied ponds revealed that conductivity was a common limitation factor of distribution of both species. We found that emergent vegetation occupancy along the pond bank was the most important factor determining P. pumila occurrence and that ponds with steep banks may have a low probability of containing P. parva. We constructed a logistic regression model to predict the establishment risk of P. parva in ponds occupied by P. pumila. The model demonstrated that more than half of the ponds exhibited a high establishment risk of P. parva. Principal component analysis using six parameters selected from stepwise logistic regression analysis revealed that seven unoccupied ponds had the potential to sustain P. pumila, suggesting that our study site is capable of supporting more P. pumila populations and expanding the current range.     

Chagas' disease and AIDS

Chagas' disease caused by Trypanosoma cruzi is an opportunistic infection in the setting of HIV/AIDS. Some individuals with HIV and chronic T. cruzi infection may experience a reactivation, which is most commonly manifested by meningoencephalitis. A reactivation myocarditis is the second most common manifestation. These presentations may be difficult to distinguish from toxoplasmosis in individuals with HIV/AIDS. The overlap of HIV and Trypanosoma cruzi infection occurs not only in endemic areas but also in non-endemic areas of North America and Europe where the diagnosis may be even more difficult. The pathological features, diagnosis and the role of cytokines in the pathogenesis of the disease are discussed.     

Candida pneumonia: What we know and what we don’t

The diagnosis of Candida pneumonia is a difficult one to make, and some experts often question whether the entity truly exists. This article assimilates the information currently available regarding Candida pulmonary infection to elucidate the presentation of the disease and the hosts in which it occurs. It also describes how to interpret the presence of Candida in respiratory secretions from both immunocompetent and immunocompromised patients. Finally, it describes how the diagnosis of Candida pneumonia can be made, which patients with suspected disease should be treated, and which antifungal agents should be used.     

AßT Amyloidogenesis: Unique,or Variation on a Systemic Theme

Abstract

For more than a century amyloid was considered to be an interesting, unique, but inconsequential pathologic entity that rarely caused significant clinical problems. We now recognize that amyloid is not one entity. In vivo it is a uniform organization of a disease, or process, specific protein co-deposited with a set of common structural components. Amyloid has been implicated in the pathogenesis of diseases affecting millions of patients. These range from Alzheimer's disease, adult-onset diabetes, consequences of prolonged renal dialysis, to the historically recognized systemic forms associated with inflammation and plasma cell disturbances. Strong evidence is emerging that even when deposited in local organ sites significant physiologic effects may ensue.

With emphasis on Aβ amyloid, we review the present definition, classification, and general in vivo pathogenetic events believed to be involved in the deposition of amyloids. This encompasses the need for an adequate amyloid precursor protein pool, whether precursor proteolysis is required prior to deposition, amyloidogenic amino acid sequences, fibrillogenic nucleating particles, and an in vivo microenvironment conducive to fibrillogenesis. The latter includes several components that seem to be part of all amyloids. The role these common components may play in amyloid accumulation, why amyloids tend to be associated with basement membranes, and how one may use these findings for anti-amyloid therapeutic strategies is also examined.     

Rarity, commonness, and patterns of species richness: the mammals of Mexico

Aim To determine whether rare or common species contribute most to overall patterns of spatial variation in extant species richness. Location Mexico. Methods Using data on the distribution of mammal species across Mexico at a quarter degree resolution, we ranked species from the most widespread to the most restricted (common‐to‐rare) within the study area, and from the most restricted to the most widespread (rare‐to‐common), and generated a sequence of patterns of species richness for increasing numbers of species. At each stage along both series of richness patterns, we correlated the species richness pattern for the subassemblage with that of the full assemblage. This allows comparison of subassemblages of the n most common with the n most rare species, in terms of how well they match the full assemblage richness pattern. Further analyses examined the effects on these patterns of correlation of the amount of raw information contained in the distributions of given numbers of rare and common species. Results For the mammals of Mexico the more widely distributed species contribute disproportionately to patterns of species richness compared with more restricted species, particularly for non‐volant species and endemic species. This is not simply a consequence of differences in the volumes of information contained in the distributions of rare and common species, with the disproportionate contribution of common species if anything being sharpened when these differences are taken into account. The pattern is most clearly demonstrated by endemic species, suggesting that the contribution of common species is clearest when the causes of rarity and commonness are limited to those genuinely resulting in narrow and widespread geographical ranges, respectively, rather than artificial (e.g. geopolitical) boundaries to the extents of study regions. Conclusions Perhaps surprisingly, an understanding of the determinants of overall patterns of species richness may gain most from consideration of why common species occur in some areas and are absent from others, rather than consideration of the distributions of rare species.