whole-genome-sequencing-candida-glabrata-for-detection-markers

Whole Genome Sequencing of <em>Candida glabrata</em> for Detection of Markers of Antifungal Drug Resistance

Candida glabrata can rapidly acquire mutations that result in drug resistance, especially to azoles and echinocandins. Identification of genetic mutations ...

Australian National University Medical School

A woman presenting with recurrent purpura fulminans was eventually found to have inflammatory bowel disease. We suggest the inflammatory state resulted in a deficiency of functional protein C.

What may underlie recurrent purpura fulminans?

Nocardia species are aerobic Gram-positive bacteria that are ubiquitous in the environment. Infection usually occurs through inhalation or direct cutaneous inoculation of the organism. It has been reported that infection is more common in warm, dry climates. Cerebral nocardiosis is an uncommon clinical entity, representing only 2% of all cerebral abscesses. It is an illness associated with significant morbidity and mortality.

A cluster of nocardial brain abscesses.

To determine the population incidence and clinical features of Escherichia coli bacteraemia in Canberra, Australia.

Escherichia coli bacteraemia in Canberra: incidence and clinical features.

Test and teach. Chronic soft tissue inflammation following accidental inoculation with a sheep vaccine. Diagnosis: Immune response to mineral oil and Mycobacterium antigens in vaccine strain (Gudair) of Mycobacterium avium subsp.paratuberculosis.

Mycoplasma hominis most frequently causes diseases of the genitourinary tract. Extragenital infections are uncommon, with almost all occurring in immunosuppressed persons or those predisposed due to trauma or surgery. We present the case of a previously well man who developed an M. hominis-associated parapharyngeal abscess following acute Epstein-Barr virus infection.

Mycoplasma hominis-associated parapharyngeal abscess following acute Epstein-Barr virus infection in a previously immunocompetent adult.

Antimicrobial resistance among community-acquired isolates of Escherichia coli is increasing globally, with international travel emerging as a risk for colonisation and infection. The aim was to determine the rate and duration of colonisation with resistant E. coli following international travel. One hundred and two adult hospital staff and contacts from Canberra, Australia, submitted perianal/rectal swabs before and following international travel. Swabs were cultured selectively to identify E. coli resistant to gentamicin, ciprofloxacin and/or third-generation cephalosporins. Those with resistant E. coli post-travel were tested monthly for persistent colonisation. Colonisation with antibiotic-resistant E. coli increased significantly from 7.8% (95% confidence interval [CI] 3.8-14.9) pre-travel to 49% (95% CI 39.5-58.6) post-travel. Those colonised were more likely to have taken antibiotics whilst travelling; however, travel remained a risk independent of antibiotic use. Colonisation with resistant E. coli occurred most frequently following travel to Asia. While over half of those carrying resistant E. coli post-travel had no detectable resistant strains two months after their return, at least 18% remained colonised at six months. Colonisation with antibiotic-resistant E. coli occurs commonly after international travel, and can be persistent. Medical practitioners should be aware of this risk, particularly when managing patients with suspected Gram-negative sepsis.

Colonisation with Escherichia coli resistant to "critically important" antibiotics: a high risk for international travellers.

We report a case of Scedosporium apiosporum brain abscesses in an immunocompetent 69-year-old man with a history of silicosis. Delayed diagnosis and institution of antifungal therapy was associated with neurological impairment, with subsequent complications resulting in death, highlighting the need for early diagnostic aspiration of brain abscesses non-responsive to antibiotics. We propose that, in the absence of identifiable immunosuppression, silicosis may have been a contributing factor to the development of central nervous system infection.

Scedosporium apiospermum brain abscesses in an immunocompetent man with silicosis.

Long-term persistence of multidrug-resistant Enterobacteriaceae after travel.

Population-based studies conducted in single regions or countries have identified significant changes in the epidemiology of invasive group B streptococcus (GBS) infection. However, no studies have concurrently compared the epidemiology of GBS infections among multiple different regions and countries over time. The study objectives were to define the contemporary incidence and determinants of GBS bloodstream infection (BSI) and assess temporal changes in a multi-national population.

The changing epidemiology of group B streptococcus bloodstream infection: a multi-national population-based assessment.

Mucormycosis is the second most common cause of invasive mould infection and causes disease in diverse hosts, including those who are immuno-competent. We conducted a multicentre retrospective study of proven and probable cases of mucormycosis diagnosed between 2004-2012 to determine the epidemiology and outcome determinants in Australia. Seventy-four cases were identified (63 proven, 11 probable). The majority (54.1%) were caused by Rhizopus spp. Patients who sustained trauma were more likely to have non-Rhizopus infections relative to patients without trauma (OR 9.0, p 0.001, 95% CI 2.1-42.8). Haematological malignancy (48.6%), chemotherapy (42.9%), corticosteroids (52.7%), diabetes mellitus (27%) and trauma (22.9%) were the most common co-morbidities or risk factors. Rheumatological/autoimmune disorders occurred in nine (12.1%) instances. Eight (10.8%) cases had no underlying co-morbidity and were more likely to have associated trauma (7/8; 87.5% versus 10/66; 15.2%; p <0.001). Disseminated infection was common (39.2%). Apophysomyces spp. and Saksenaea spp. caused infection in immuno-competent hosts, most frequently associated with trauma and affected sites other than lung and sinuses. The 180-day mortality was 56.7%. The strongest predictors of mortality were rheumatological/autoimmune disorder (OR = 24.0, p 0.038 95% CI 1.2-481.4), haematological malignancy (OR = 7.7, p 0.001, 95% CI 2.3-25.2) and admission to intensive care unit (OR = 4.2, p 0.02, 95% CI 1.3-13.8). Most deaths occurred within one month. Thereafter we observed divergence in survival between the haematological and non-haematological populations (p 0.006). The mortality of mucormycosis remains particularly high in the immuno-compromised host. Underlying rheumatological/autoimmune disorders are a previously under-appreciated risk for infection and poor outcome.

Mucormycosis in Australia: contemporary epidemiology and outcomes.

Antifungal susceptibilities of non-Aspergillus filamentous fungal pathogens cannot always be inferred from their identification. Here we determined, using the Sensititre(®) YeastOne(®) YO10 panel, the in vitro activities of nine antifungal agents against 52 clinical isolates of emergent non-Aspergillus moulds representing 17 fungal groups in Australia. Isolates comprised Mucorales (n = 14), Scedosporium/Lomentospora spp. (n = 18) and a range of hyaline hyphomycetes (n = 9) and other dematiaceous fungi (n = 11). Excluding Verruconis gallopava, echinocandins demonstrated poor activity (MICs generally >8 mg/L) against these moulds. Lomentospora prolificans (n = 4) and Fusarium spp. (n = 6) demonstrated raised MICs to all antifungal drugs tested, with the lowest being to voriconazole and amphotericin B (AmB), respectively (geometric mean MICs of 3.4 mg/L and 2.2 mg/L, respectively). All Scedosporium apiospermum complex isolates (n = 14) were inhibited by voriconazole concentrations of ≤0.25 mg/L, followed by posaconazole and itraconazole at ≤1 mg/L. Posaconazole and AmB were the most active agents against the Mucorales, with MIC90 values of 1 mg/L and 2 mg/L, respectively, for Rhizopus spp. For dematiaceous fungi, all isolates were inhibited by itraconazole and posaconazole concentrations of ≤0.5 mg/L (MIC90, 0.12 mg/L and 0.25 mg/L, respectively), but voriconazole and AmB also had in vitro activity (MIC90, 0.5 mg/L and 1 mg/L, respectively). Differences in antifungal susceptibility within species and between species within genera support the need for testing individual patient isolates to guide therapy. The Sensititre(®) YeastOne(®) offers a practical alternative to the reference methodology for susceptibility testing of moulds.

Antifungal susceptibilities of non-Aspergillus filamentous fungi causing invasive infection in Australia: support for current antifungal guideline recommendations.

Article	Year
What may underlie recurrent purpura fulminans? The Medical journal of Australia\| PubMed ID: 17407438	2007
A cluster of nocardial brain abscesses. Surgical neurology\| PubMed ID: 17586220	2007
Escherichia coli bacteraemia in Canberra: incidence and clinical features. The Medical journal of Australia\| PubMed ID: 18279126	2008
Test and teach. Chronic soft tissue inflammation following accidental inoculation with a sheep vaccine. Diagnosis: Immune response to mineral oil and Mycobacterium antigens in vaccine strain... Pathology\| PubMed ID: 18985526	2008
Mycoplasma hominis-associated parapharyngeal abscess following acute Epstein-Barr virus infection in a previously immunocompetent adult. Journal of clinical microbiology\| PubMed ID: 19641070	2009
Colonisation with Escherichia coli resistant to "critically important" antibiotics: a high risk for international travellers. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology\| PubMed ID: 20835879	2010
Scedosporium apiospermum brain abscesses in an immunocompetent man with silicosis. Medical mycology case reports\| PubMed ID: 24432222	2013
Long-term persistence of multidrug-resistant Enterobacteriaceae after travel. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America\| PubMed ID: 26276882	2015
The changing epidemiology of group B streptococcus bloodstream infection: a multi-national population-based assessment. Infectious diseases (London, England)\| PubMed ID: 26759190	2016
Mucormycosis in Australia: contemporary epidemiology and outcomes. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases\| PubMed ID: 26806139	2016
Antifungal susceptibilities of non-Aspergillus filamentous fungi causing invasive infection in Australia: support for current antifungal guideline recommendations. International journal of antimicrobial agents\| PubMed ID: 27562696	2016

Karina J. Kennedy

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