PubMed · 13406708
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P S SAHNI. 1957. Pulmonary moniliasis.. https://doi.org/10.1016/s0022-3476(57)80260-1
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BACKGROUND AND OBJECTIVE: Our objective was to assess the frequency of fungal colonization and/or infection in critically ill patients admitted to intensive care units (ICUs) and to describe the characteristics and risk factors of those patients in whom fungi had been isolated. PATIENTS AND METHOD: Observational, multicenter study of patients admitted to 64 ICUs on March 23, June 22, and November 16, 1999. In these patients, the presence of fungi was investigated in some biological sample from the day of ICU admission to the day of assessment of fungal infection. Patients were classified as colonized or infected by fungi. RESULTS: A total of 1,562 patients were included: 686 in the first period, 567 in the second, and 309 in the third, with a mean of 24.4 patients per ICU (range, 9-62). Fungi were isolated in 456 biological samples from 248 patients (15.9 patients per each series of 100 controlled patients): lung in 183 (40.1%) cases, urine in 90 (19.7%) cases, and oropharynx in 46 (10.1%) cases. Fungi were isolated in blood cultures in 17 (3.7%) patients. Candida albicans was the most frequently isolated fungal species in all sites (68.9%). Isolation of fungi allowed a diagnosis of fungal infection in 121 patients (fungal infection rate, 7.7 episodes per 100 patients admitted to the ICU). Individual risk factors for fungal infection were as follows: previous use of antimicrobials (OR=5.01; 95% CI, 1.77-14.2); mechanical ventilation (OR=3.45; 95% CI, 1.61-7.40); urgent surgical procedures (OR = 2.44; 95% CI, 1.59-3.74); solid neoplasm (OR=2.32; 95% CI, 1.29-4.19); use of corticosteroids (OR = 1.88; 95% CI, 1.18-2.99); and APACHE II score (OR=1.05; 95% CI, 1.02-1.07). CONCLUSIONS: Fungi were isolated in 15.9% patients admitted to ICUs and they were the causative agents of infection in 7.7% of cases. Candida albicans predominated in all sites. Risk factors for fungal infection included previous use of antibiotics, mechanical ventilation, urgent surgery, solid tumor, use of corticosteroids, and intermediate severity of illness according to the APACHE II score.
In an open non-comparative study to evaluate the efficacy and safety of Acalypha wilkesiana ointment in superficial fungal skin diseases, 32 Nigerian patients with clinical and mycological evidence of superficial mycoses were recruited. Twelve patients defaulted and were lost to follow up, while one patient withdrew because of intolerable excoriation at the site of the lesion. Of the 19 patients that completed the trial, clinical cure was achieved in 73.3% of the patients. The ointment was very efficacious in the treatment of Tinea pedis, Pityriasis versicolor and Candida intetrigo where the cure rate was 100% in each condition. It is recommended that Acalypha ointment can be used for the treatment of these superficial mycoses.
Invasive candidiasis is a condition of major medical importance. Its incidence has increased dramatically over the last 50 years, reflecting increasingly interventional standards of medical care. Candida spp. are regularly reported to be the fourth commonest cause of bloodstream infection, and it is perceived that the incidence of invasive Candida spp. infections continues to increase. The global disease burden of invasive Candida spp. infections is difficult to quantify because of wide geographic variation. Data originating from the United States indicate that mortality from candidiasis has been falling since 1989. Data from several locations have shown that the dramatic increases in Candida spp. bloodstream infections seen during the 1980s were not sustained through the 1990s. Some authors have reported a decreasing incidence. The contribution of non-albicans Candida spp. to invasive infection is rising. Invasive infections with Candida spp. continue to represent a major economic burden, increasing both mortality and morbidity in an already expensive group of hospital patients. There remains much scope for ongoing and future research into the epidemiology and basic disease processes underlying these infections.