Welcome
Fungi are everywhere around us; they are the most abundant form of life on the planet, counting about 12 million species worldwide. Only a small fraction of them cause disease in humans, but they are responsible for about a billion infections each year. At the same time, new fungi pathogenic to humans are emerging (such as Candida auris, the azole-resistant Aspergillus fumigatus, etc.) due to climate change and new environmental conditions.
Fungal infections are responsible for more than 1.5 million deaths each year, mostly in immunocompromised patients, while affecting the lives of many millions more. However, they remain a neglected topic by public health authorities, even though most deaths from fungal infections are preventable. It was not until October 2022 that the World Health Organization published the first list of priority fungal pathogens, to increase global interest in the infections they cause and their resistance to antifungal drugs.
The aims of the HSoMM are:
- The promotion of Medical Mycology in Greece and abroad.
- The encouragement and reinforcement of all research efforts and studies in Greece regarding prevention, diagnosis, and treatment of fungal infections.
- The collaboration with public and private institutions and organizations in Greece and abroad, for the progress of Medical Mycology.
Case of the month
A 74-year-old patient with a history of chronic obstructive pulmonary disease (COPD), atrial fibrillation, chronic kidney disease, and arterial hypertension presented to the emergency department due to worsening dyspnea. Chest radiography revealed the presence of bilateral pleural effusions, and drainage procedures were performed to improve the patient’s respiratory function. Additionally, atelectatic changes were observed in the right lower lobe.
Laboratory findings upon admission included: Hematocrit: 29%, Hemoglobin: 9 g/dL, white blood cells (WBCs): 11,000/μL (neutrophils = 86%, lymphocytes = 11%, monocytes = 3%), platelets: 347,000/μL, CRP: 6 mg/dL, urea: 129 mg/dL, creatinine: 2.5 mg/dL, glucose: 100 mg/dL.
Antibiotic therapy was initiated, and the patient’s condition remained stable. After seven days, while CRP initially showed a declining trend (5th day: 2.8 mg/dL), it subsequently increased to 22 mg/dL. Further laboratory findings revealed: WBCs: 16,000/μL (neutrophils = 90%, lymphocytes = 8%, monocytes = 2%), platelets: 130,000/μL, urea: 183 mg/dL, creatinine: 3.1 mg/dL, glucose: 180 mg/dL Cultures from the drainage fluid remained negative throughout hospitalization. However, a fungus was isolated from the patient’s urine and peripheral blood. The fungus was resistant to echinocandins and fluconazole, as demonstrated by the antifungal susceptibility testing, and it tested positive for urease. The Gram stain showed characteristic fungal morphology. The central venous catheter was subsequently removed and sent for culture, which also yielded the same fungus.
On the 12th day of hospitalization, the patient’s condition worsened, with CRP: 17 mg/dL, WBCs: 23,000/μL (neutrophils = 92%, lymphocytes = 1%, monocytes = 1%), platelets: 40,000/μL. Unfortunately, the patient passed away.
[Case Editor: Anastasia Spiliopoulou, Assistant Professor of Microbiology, Medical School, University of Patras].
Based on the Gram stain morphology, urease test, and antifungal susceptibility profile, which fungus is most likely responsible?
Α. Candida auris
Β. Candida parapsilosis
C. Trichosporon asahii
D. Fusarium spp.
