Wednesday, June 8, 2011

Pheohyphomycosis is a new human pathogen - Nizam's Institute of Medical Sciences finds fungal infection as root cause of death in 10 per cent of patients

Syed Akbar
Hyderabad, June 5: The seemingly harmless fungi can be as dangerous as the superbug bacteria or killer viruses, as new fungal species of human pathogen have emerged making diagnosis quite difficult.
Doctors at the city-based Nizam's Institute of Medical Sciences have found a new silent killer in fungi, the organisms that are difficult to be detected when infected people are live. They have found that pheohyphomycosis has emerged as a new human pathogen in recent times.
Digging into post-mortem reports of over 20 years, the NIMS team has found that fungal infections were responsible for one out of every 10 deaths without a definitive clinical diagnosis.
The fungal infections are capable of damaging the brain, heart, blood vessels, kidneys, spleen, liver, lungs and digestive tract. Invasive and disseminated fungal infections leading to involvement of multiple
organs and central nervous system caused the deaths.
These infections can be diagnosed only in a post mortem examination as existing diagnostic modalities are not sensitive to detect them while the patients are alive. Thus, in a majority of such cases neither the
treating doctor nor the patient knows what actually is the health issue and which organism is responsible for the disease.
The team of pathologists including Dr C Sundaram and Dr Aruna K Prayaga studied as many as 401 autopsies done over a period of two decades and identified fungal infections in 35 (8.7 per cent) of these
cases. Leukaemia was the commonest risk factor while the commonest pathogen in the study, published in the Indian Journal of Pathology and Microbiology, emerged out to be Aspergillus sp. The commonest
single organ involved was brain.
The doctors found newer fungal pathogens like non-albicans Candida, various species of Zygomycetes and Penicillium species as being increasingly reported over the last 10 years. In a majority of the patients, fungal infection was not suspected ante-mortem (before death). 
Though there was no change in the fungi species reported during the last 20 years, infections due to P. jirovecii, Rhodotorula glutinis and Pheohyphomycosis were encountered of late, indicating the change
in trend of the infections.
The NIMS team attributes the rising trend in fungal infection to variability of climatic conditions in the country. The newer chemotherapeutic and antibiotic modalities, transplant facilities, stay in critical care units are additional factors which contribute to the overall increase in the incidence of fungal infections.

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