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ABSTRACT: Nocardia spp. is a rare isolate in extra-pulmonary clinical specimens. We describe the first case of olecranon bursitis caused by Nocardia asiatica. The patient, a traveller returning from Thailand was successfully treated with linezolid.
Journal of clinical microbiology 05/2013; · 4.16 Impact Factor
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Martin Hoenigl,
Wiebke Duettmann,
Reinhard B Raggam,
Katharina Seeber,
Katharina Troppan,
Sonja Fruhwald,
Florian Prueller,
Jasmin Wagner,
Thomas Valentin,
Ines Zollner-Schwetz,
Albert Wölfler, Robert Krause
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ABSTRACT: Voriconazole plasma concentrations (VPCs) vary widely and concentrations outside the therapeutic range are associated with either worse outcome in invasive aspergillosis (IA), or increased toxicity. The primary goal of this cohort study conducted in a real life setting was to identify potential factors associated with inadequate VPCs in ICU patients and patients with haematological malignancies. Within a period of 12 months trough VPCs were obtained and analyzed with high performance liquid chromatography, the adequate range was defined from 1.5-5.5 mg/L. VPCs <1.5 were defined as low whereas VPCs >5.5 mg/L as potentially toxic. A total of 221 trough VPCs were obtained in 61 patients receiving voriconazole. 124/221 VPCs (56%) were found to be low. Multivariate analysis revealed that low VPCs were significantly associated with clinical failure of voriconazole, prophylactic usage, younger age, underlying haematological malignancy, concomitant proton-pump-inhibitor (PPI, pantoprazole was used in 88% of patients) and absence of side effects. Low VPCs remained an independent predictor of clinical failure of voriconazole. The defined adequate range was reached in 79/221 (36%) VPCs. In 18 samples (8%) potentially toxic levels were measured. Multivariate analysis revealed higher body mass index (BMI), absence of haematological malignancy, therapeutic application and diarrhoea as factors associated with potentially toxic VPCs. Neurotoxic adverse events occurred in six patients and were mostly associated with VPCs in the upper quartile of our defined adequate range. In conclusions potential factors like younger age, prophylaxis, underlying haematological malignancy, BMI and concomitant PPI should be considered within the algorithm of voriconazole treatment.
Antimicrobial Agents and Chemotherapy 04/2013; · 4.84 Impact Factor
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ABSTRACT: Data on diagnostic performance of Galactomannan (GM) testing in patients under mould-active regimens are limited. Whether sensitivity of GM testing for diagnosing breakthrough invasive aspergillosis (IA) is decreased under antifungal prophylaxis/therapy remains therefore a point of discussion. We retrospectively analysed GM test results in patients who were admitted with underlying haematological malignancies to two Divisions of the Medical University Hospital of Graz, Austria, between 2009 and 2012. Only cases of probable and proven IA that were diagnosed by other methods than GM testing were included (time of diagnosis = day 0). We compared GM results of patients with/without therapy/prophylaxis for the period of 2 weeks prior (week -2) until 3 weeks postdiagnosis. A total of 76 GM test results in nine patients were identified. Six patients had received antifungal therapy/prophylaxis from week -2, whereas three patients were treated with therapy from the time of diagnosis at week 0. GM testing was positive in 45/76 (59%) of samples. Sensitivity of GM testing for detection of proven or probable IA at week -1 and 0 was 77% and 79% in patients with mould-active regimens. We conclude that GM testing might be a useful diagnostic method for breakthrough IA in patients receiving mould-active prophylaxis/therapy.
Mycoses 02/2013; · 2.25 Impact Factor
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Mycoses 01/2013; · 2.25 Impact Factor
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ABSTRACT: Cerebral Aspergillosis is the most lethal manifestation of infection due to Aspergillus species arising most commonly as hematogenous dissemination from a pulmonary focus, direct extension from paranasal sinus infection or direct inoculation through trauma and surgery of the central nervous system (CNS). Voriconazole is currently considered the standard of treatment of CNS aspergillosis with liposomal amphotericin B being the next best alternative. Neurosurgical resection of infected cerebral tissue in addition to antifungal therapy is frequently performed in patients with CNS aspergillosis to prevent neurological deficits and improve outcome. Aspergillus endophthalmitis may occur endogenously mostly from a pulmonary focus or exogenously following eye surgery or trauma. Although amphotericin B is still described as the primary therapy, voriconazole is increasingly considered the first line treatment of Aspergillus endophthalmitis. Vitrectomy is recommended in most cases of Aspergillus endophthalmitis.
Current pharmaceutical design 12/2012; · 4.41 Impact Factor
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ABSTRACT: In this small study, the LightCycler® SeptiFast, and the SepsiTest™ were compared with blood culture. The SeptiFast showed a higher sensitivity (42.9%) and specificity (88.2%) when compared to blood culture than the SepsiTest™ (28.6 and 85.3%). The SeptiFast provides more species specific results, although the identification panel is smaller.
Journal of microbiological methods 12/2012; · 2.43 Impact Factor
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Martin Hoenigl,
Reinhard B Raggam,
Jasmin Wagner,
Thomas Valentin,
Eva Leitner,
Katharina Seeber,
Ines Zollner-Schwetz,
Werner Krammer,
Florian Prüller,
Andrea J Grisold, Robert Krause
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ABSTRACT: OBJECTIVES: Soluble urokinase plasminogen activator receptor (suPAR) serum concentrations have recently been described to reflect the severity status of systemic inflammation. In this study, the diagnostic accuracy of suPAR, C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) to predict bacteremia in patients with systemic inflammatory response syndrome (SIRS) was compared. METHODS: A total of 132 patients with SIRS were included. In 55 patients blood cultures had resulted positive (study group 1, Gram positive bacteria: Staphylococcus aureus and Streptococcus spp., n=15; study group 2, Gram-negative bacteria, n=40) and 77 patients had negative blood culture results (control group, n=77). Simultaneously with blood cultures suPAR, CRP, PCT, IL-6 and white blood count (WBC) were determined. RESULTS: SuPAR values were significantly higher in study group 1 (median 8.11; IQR 5.78-15.53; p=0.006) and study group 2 (median 9.62; IQR 6.52-11.74; p<0.001) when compared with the control group (median 5.65; IQR 4.30-7.83). ROC curve analysis revealed an AUC of 0.726 for suPAR in differentiating SIRS patients with bacteremia from those without. The biomarkers PCT and IL-6 showed comparable results. Regarding combinations of biomarkers multiplying suPAR, PCT and IL-6 was most promising and resulted in an AUC value of 0.804. Initial suPAR serum concentrations were significantly higher (p=0.028) in patients who died within 28days than in those who survived. No significant difference was seen for PCT, IL-6 and CRP. CONCLUSION: In conclusion, suPAR, IL-6 and PCT may contribute to predicting bacteremia in SIRS patients.
Clinical biochemistry 11/2012; · 2.02 Impact Factor
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The Journal of infection 10/2012; · 4.13 Impact Factor
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Martin Hoenigl,
Thomas Valentin,
Katharina Seeber,
Helmut J F Salzer,
Ines Zollner-Schwetz,
Holger Flick,
Reinhard B Raggam,
Jasmin Wagner,
Andrea J Grisold,
Christopher Spreizer, Robert Krause
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ABSTRACT: Although amoebic liver abscess due to Entamoeba histolytica is one of the most common parasitic infections worldwide, invasive disease remains uncommon in industrialized countries. Metronidazole is the standard of care for complicated and uncomplicated invasive amoebiasis. Puncture of amebic liver abscesses is a treatment option primarily for complicated abscesses (localized in left lobe, multiple, and/or pyogenic abscesses). The role of image-guided percutaneous puncture in initially uncomplicated liver abscess formations still remains unanswered. A subset of patients with uncomplicated amoebic liver abscesses, however, fails to respond to conservative treatment alone.We report two cases of amoebic liver abscess formations in Austrian travelers. Two males, aged 67 and 43, presented with fever, chills and fatigue. Four months prior to admission both patients travelled together to Goa, India, for 4 weeks. Computed tomography showed uncomplicated liver abscess formations and serology for E. histolytica was positive in both patients. Therapy with metronidazole 500 mg four times daily was initiated. Computed tomography then showed an increase in size of liver abscess formations in both patients after 13 and 10 days of intravenous metronidazole therapy, respectively. Patient 1 developed pleural effusion and patient 2 additional liver abscess formations. Therefore CT-guided percutaneous therapeutic catheter drainage of liver abscess formations was performed in both patients without complications. Real time PCR of abscess drainage was positive for E. histolytica in both patients. After completion of metronidazole, paromomycin 500 mg three times daily was initiated for seven days for elimination of cysts and both patients were discharged without further complaints. This report highlights that conservative monotherapeutic treatment alone may not be sufficient in some patients with initially uncomplicated E. histolytica liver abscess. Implementation of additional image guided percutaneous puncture may reduce mortality and disease related costs.
Wiener klinische Wochenschrift 10/2012; · 0.81 Impact Factor
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ABSTRACT: The galactomannan (GM) Enzyme Immunoassay (EIA) is an upcoming tool not only for diagnosis but also monitoring of invasive Aspergillosis (IA). Various studies were performed over the last years to apply such a promis-ing instrument correctly. New findings show the potential of this test to segregate affected patients into treatment res-ponders and non-responders at a time point as early as 7– 14 days after initiation of antifungal therapy. Current data suggest that serial GM testing in patients receiving antifun-gal therapy for IA is essential as GMI kinetics may offer the clinician a substantial support in decision making concern-ing early therapeutic stratifications. The correct interpreta-tion of GM EIA results with respect to the individual context of the patient is, however, absolutely necessary. The follow-ing review shall give an overview about the GM-EIA as a tool for IA monitoring and therapy stratification.
Current Fungal Infection Reports 09/2012;
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International journal of infectious diseases: IJID: official publication of the International Society for Infectious Diseases 07/2012; · 2.17 Impact Factor
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ABSTRACT: Primary epiploic appendagitis (PEA) is a rare cause of abdominal acute or subacute complaints. Diagnosis of PEA is made with ultrasonography (US) or when computed tomography (CT) reveals a characteristic lesion.
We report on two patients with PEA. In one patient PEA was first seen with US and confirmed with contrast enhanced CT, and in the second patient CT without contrast enhancement demonstrated PEA. In both patients an outpatient recovery with conservative non-surgical treatment is described.
Medical personnel should be aware of this rare disease, which mimics many other intra-abdominal acute and subacute conditions. A correct diagnosis of PEA with imaging procedures enables conservative and successful outpatient management avoiding unnecessary surgical intervention and additional costs.
Medical science monitor: international medical journal of experimental and clinical research 06/2012; 18(6):CS48-51. · 1.70 Impact Factor
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Martin Hoenigl,
Volker Strenger,
Walter Buzina,
Thomas Valentin,
Christoph Koidl,
Albert Wölfler,
Katharina Seeber,
Angelika Valentin,
Anna T Strohmeier,
Ines Zollner-Schwetz,
Reinhard B Raggam,
Christian Urban,
Cornelia Lass-Flörl,
Werner Linkesch, Robert Krause
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ABSTRACT: Fulfilment of host factors defined by the revised European Organization for the Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria is required for establishing the diagnosis of possible or probable invasive fungal infection (IFI). This case-control study evaluates EORTC/MSG host factors among patients with haematological malignancies.
Fifty-eight patients with haematological malignancies who developed probable (n = 38) or proven (n = 20) IFI over a 5 year period were retrospectively evaluated regarding EORTC/MSG host factors. Results were compared with those obtained from patients with haematological malignancies who did not develop IFI (116 patients who received systemic antifungal prophylaxis or empirical therapy and 116 patients who did not; all data collected in 2010).
Fourteen patients had invasive yeast infection and 44 patients had invasive mould infection (IMI). Prolonged neutropenia (35/58, 60% versus 29/116, 25%), prolonged systemic corticosteroid (cut-off 21 days: 13/58, 22% versus 6/116, 5%; cut-off 14 days: 18/58, 31% versus 9/116, 8%) and T cell suppressive therapy (35/44, 80% versus 69/116, 59%) were significantly associated with development of IFI/IMI in our cohort. Previous allogeneic stem cell transplantation (SCT; >6 months prior to episode) was not significantly associated with development of IMI (8/44, 18% versus 22/116, 19%), while recent SCT (<6 months prior to episode) was (11/44, 25% versus 12/116, 10%).
We conclude that host factors according to revised EORTC/MSG criteria were significantly associated with the development of IFI/IMI in our patients. Previous allogeneic SCT was not a predisposing host factor for the development of IMI. Concerning prolonged corticosteroid treatment, a cut-off of 14 days seems preferable to the proposed cut-off.
Journal of Antimicrobial Chemotherapy 05/2012; 67(8):2029-33. · 5.07 Impact Factor
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ABSTRACT: Myzetome der Lunge bestehen aus rundlichen Massen von Myzelien und Hyphen, Fibrin und Granulozyten, die sich in Höhlenbildungen
der Lunge festsetzen und diese teilweise und ohne Gewebsinvasion ausfüllen. Die Begriffe pulmonales Myzetom und Pilzball werden
häufig synonym verwendet. Pulmonale Myzetome werden gewöhnlich durch Schimmelpilze vom Aspergillustyp, in seltenen Fällen auch durch Mucor oder Hefepilze vom Typ Candida hervorgerufen und entstehen durch kolonsierendes Wachstum in vorgeschädigtem Lungengewebe. Hämoptysen sind dabei das häufigste
Symptom. Da die systemische und lokale Wirksamkeit von Antimykotika nicht gesichert ist, sollte bei schweren Hämoptysen der
chirurgischen Therapie der Vorzug gegeben werden, soferne die Lungenfunktion nicht limitierend eingeschränkt ist. Eine Resektion
im Sinne einer Lobektomie oder Pneumonektomie ist allerdings mit erhöhter Mortalität verbunden, sodass für Risikopatienten
Kavernostomie und Kavernoplastik Alternativen darstellen können.
Pulmonary mycetomas, or fungus balls, consist of spherical masses of mycelia and hyphae, fibrin and granulocytes that grow
and partly fill cavitary lesions without invading tissue. They are usually caused by molds of the Aspergillus species, rarely by Mucor or yeast fungi such as Candida species, that colonize damaged lung tissue. Hemoptysis is the most frequent symptom. Since systemic and local administration
of antifungal agents is of uncertain efficacy, resectional surgery should be the treatment of choice in cases of severe hemoptysis,
if lung function is not severely compromised. As pulmonary resection in the form of lobectomy or pneumonectomy is associated
with raised mortality, cavernostomy and cavernoplasty may be options for high-risk patients.
Wiener Medizinische Wochenschrift 04/2012; 157(19):466-472.
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Wiener klinische Wochenschrift Education 04/2012; 2(1):1-10.
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Martin Hoenigl,
Reinhard B Raggam,
Helmut J F Salzer,
Thomas Valentin,
Angelika Valentin,
Ines Zollner-Schwetz,
Anna T Strohmeier,
Katharina Seeber,
Albert Wölfler,
Heinz Sill, Robert Krause
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ABSTRACT: Posaconazole (PCZ) is a triazole antifungal agent that has broad activity against pathogenic fungi and is increasingly used for prophylaxis and treatment of invasive mould infections (IMIs). PCZ is only available as an oral formulation, with varying absorption from the gastrointestinal tract. However, reports correlating PCZ plasma concentrations (PPCs) with breakthrough IMIs are rare. In this study, PPCs were analysed in a prospective, observational, single-centre study and the correlation of PPCs with breakthrough IMIs in patients with haematological malignancies was evaluated. Risk factors associated with low PPCs were further evaluated. A total of 109 PPCs were measured in 34 cases receiving PCZ prophylaxis (n=31) or treatment (n=3). Levels below the target of 0.5 μg/mL were detected in 24 (71%) of the 34 cases; in 15 (63%) of these 24 cases concentrations were found to be <0.20 μg/mL. Three patients receiving PCZ prophylaxis met the criteria of breakthrough infection. Notably, prior to development of IMI, PPCs were below the target in all three individuals. Associated risk factors for insufficient PPCs varied from previous reports. In conclusion, these data demonstrate that therapeutic drug monitoring of PCZ is mandatory in all patients with haematological malignancies as low PPCs are common and may be associated with development of IMIs.
International journal of antimicrobial agents 04/2012; 39(6):510-3. · 3.03 Impact Factor
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ABSTRACT: To date, no outbreak of carbapenemase-producing bacteria has been reported for Austria. While outbreaks of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae have been increasingly reported, no outbreak caused by KPC-producing Klebsiella oxytoca has been described yet, to the best of our knowledge. We report an outbreak of KPC-producing K. oxytoca. In 5 months, 31 KPC-producing Klebsiella oxytoca strains were isolated from five patients. All patients were admitted to the same medical intensive care unit in Austria.
Antimicrobial Agents and Chemotherapy 01/2012; 56(4):2158-61. · 4.84 Impact Factor
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ABSTRACT: Regulatory T cells (Tregs) as key players of the immune system are exposed to numerous triggers including exogenous and endogenous factors. Autonomous nerve activity, melatonin, hormones such as vitamin D and glucocorticoids as well as the exposure to sunlight and microorganisms shape our immunological profile. The complexity of this system is highlighted by the power of each single trigger but more impressive by influencing each others function and potentials directly and indirectly. However, while monocausal correlations of single triggers on Tregs have been studied at length, there is much less known about the impact of numerous coexistent triggers on the dynamics of Treg activity. It can be hypothesized that the dynamics of Treg activity plays a crucial role for the control of our immune system. Therefore it is of the utmost importance that a new translational, multi- and interdisciplinary approach finds its way into future research efforts, which should lead to a more comprehensive and holistic view on the complex immunoregulatory mechanisms and to act in the sense of public health.
Medical Hypotheses 12/2011; 77(6):1145-7. · 1.39 Impact Factor
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ABSTRACT: Galactomannan (GM) is a polysaccharide component of the cell wall of Aspergillus spp. and is released into the host's circulation by growing hyphae. GM testing of patients with hematological malignancies has been rarely considered in recent epidemiologic studies of invasive mould infections (IMIs). The aim of the investigation was to analyze the impact of GM testing on the reported prevalence of IMI by comparing detection rates of IMI before and after the introduction of this diagnostic procedure. Prevalence of IMI was assessed by conducting a prospective single-centre study over seven months in 2010. Results obtained were then compared to those obtained with a representative collection of patients assessed by the same investigators at the same institution over seven months in 2007, i.e., prior to the introduction of GM testing. We found that, in general, detection rates of invasive aspergillosis (IA) and invasive mould infections increased significantly after the introduction of GM analysis. This study may therefore indicate that GM testing has a significant impact on the reported prevalence of IMI. Broad usage of such testing in patients with hematological malignancies may be able to produce a realistic picture of IMI rates when current diagnostic criteria are applied.
Medical mycology: official publication of the International Society for Human and Animal Mycology 09/2011; 50(3):266-9. · 2.13 Impact Factor
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ABSTRACT: Medical students are at risk for occupational needlestick injuries (NSIs) which can result in substantial health consequences and psychological stress. Therefore, an open online survey among final year medical students from Austria, Germany, and the United Kingdom (UK) was conducted. The aim of the study was to evaluate risk-awareness and reporting behavior regarding needlestick injury (NSI), post-exposure prophylaxis, and level of education regarding the transmission of HIV through NSIs. Of 674 medical students, 226 (34%) reported at least one NSI during medical school. Respondents from Austria and Germany experienced a significantly higher number of NSIs in comparison to respondents from the UK. Seventy-six respondents (34%) did not report their most recent injury to an employee health office. Almost one third were not familiar with reporting procedures in case of a NSI and 45% of the study population feared that reporting an injury might have an adverse effect on their study success. 176 respondents (78%) who had suffered a NSI were not aware of the patient's HIV status. Education regarding NSIs and HIV transmission reduced the actual risk of experiencing a NSI significantly. These data indicate that medical students are at high risk of suffering NSIs during medical school. The rate of nonreporting of such injuries to an employee health service is alarmingly high. Improved medical curricula including precise recommendations may contribute to a more efficient prevention of occupational HIV infection in medical students.
International journal of hygiene and environmental health 06/2011; 214(5):407-10. · 2.64 Impact Factor
