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Oliver A. Cornelyon behalf of The ECMM/ISHAM Working Group
FungiscopeRare Invasive Fungal Infection in India
Background
Factors that are prerequisites for the development of IFI• Exposure to fungi• Host acquisition of potential pathogen• Competition with microbial flora• Disruption of skin or mucous membrane barriers• Sufficient growth to overcome host defenses
Risk factors• Prolonged immunosuppression (HIV/AIDS, cancer, SOT, HSCT)• central venous catheter, mechanical ventilation, parenteral
nutrition, burns• Diabetes mellitus• Broad-spectrum antibiotics
Fungiscope™
Factors that are prerequisites for the development of IFI• Exposure to fungi• Host acquisition of potential pathogen• Competition with microbial flora• Disruption of skin or mucous membrane barriers• Sufficient growth to overcome host defenses
Risk factors• Prolonged immunosuppression (HIV/AIDS, cancer, SOT, HSCT)• central venous catheter, mechanical ventilation, parenteral
nutrition, burns• Diabetes mellitus• Broad-spectrum antibiotics
Background – Fungal Pathogens
YeastCandidaCryptococcusTrichosporon
MoldsAspergillusFusariumMucormycosis
AbsidiaMucorRhizopusCunninghamella
ScedosporiumDematiaceous moulds
AlternariaExophilia
Dimorphic fungi
Fungiscope™
AspergillusFusariumMucormycosis
AbsidiaMucorRhizopusCunninghamella
ScedosporiumDematiaceous moulds
AlternariaExophilia
Increasing number of patients at risk for fungal infections worldwide Increasing incidence of invasive infections caused by rare fungi
Dimorphic fungiHistoplasma capsulatumBlastomyces dermatitidis
Fungiscope – Goals
• Collect epidemiological and clinical data on invasive
infections caused by emerging fungal pathogens
• Provide data for analysis of risk factors and treatment
strategies to guide treatment recommendations
• Build a biobank of emerging fungi
• Collaborate with other groups for joint analyses
Fungiscope™
• Collect epidemiological and clinical data on invasive
infections caused by emerging fungal pathogens
• Provide data for analysis of risk factors and treatment
strategies to guide treatment recommendations
• Build a biobank of emerging fungi
• Collaborate with other groups for joint analyses
Fungiscope – Publication Example
Fungiscope™
• N=233 cases• 11 countries• Death associated with:
• Corticosteroids (HR 2.11, 95% CI 1.18–3.76, p 0.01)• Persistent neutropenia (HR 2.70, 95% CI 1.57–4.65, p <0.001)• D-AmB (HR 1.83, 95% CI 1.06–3.16, p 0.03)
Nucci M et al. Clin Microbiol Infect 2014 (20): 580-585.
Eligibility Criteria
Inclusion
Invasive fungal infection documented by at least one of the following• Culture• Histology• Antigen detection• PCR-based detection of fungal DNA
Aspergillus
Fungiscope™
Invasive fungal infection documented by at least one of the following• Culture• Histology• Antigen detection• PCR-based detection of fungal DNA
Exclusion
• Infection due to Aspergillus, Candida, Cryptococcus neoformans,Pneumocystis jiroveci
• Endemic fungal infection such as coccidioidomycosis orhistoplasmosis
• Colonisation or other non-invasive infection
Aspergillus
Project Overview
www.fungiscope.net
Registration and Password [email protected]
Electronic Case Report Form
Fungiscope™
Electronic Case Report Form
Diagnostics FungiThekCulture/Biopsy
Banking
FungiQuestDatabase
Search
TherapeuticDrug
Monitoring
StatisticalAnalysis
Add a new patient
Fungiscope – Case Report Form
Fungiscope™
Start the survey Risk Factors Diagnostic Procedures Clinical Signs and Symptoms Site of Infection Mycological Evidence Treatment Outcome
Fungiscope – Quality Control
Investigator
Medical Documentalist60%
30%
NIFI=606
Active PartnerNIFI=522
Other registriesNIFI=84
Fungiscope Partnersfrom 58 countries
Fungiscope™
Medical Documentalist
ID Specialist
FungiThek FungiQuest
30%
404 valid
NIsolate=104
FungiThek
Diagnostic laboratories
Central storage of isolates
Diagnosis of rare IFI
Fungiscope™
Diagnostic laboratories
Macroscopic andmicroscopic
identification
ATCATTAGTGATTGCCTTTATAGGCTTATAACTATATCCACTTACACCTGTGAACTGTTCTACTACTTGACGCAAGTCGAGTATTTTTACAAACAATGTGTAATGAACGTCGTTTTATTATAACAAAATAAAACTTTCAACAACGGATCTCTTGGCTCTCGCATCGATGAAGAACGCAGCGAATTGCGATAAGTAATGTGAATTGCAGAATTCAGTGAATCATCGAATCTTTGAACGCAGCTTGCGCTCCTGGTATTCCGGAGAGCATGCCTGTTTCAGGACTACCCGCTGAACTTCGCATCGATGAAGAACGCAGCGAATTGCGATAAGTAATGTGAATTGCAGATGAGCTTGGCTCTCGCATCGATGAAGAACGCAGCGAATTGCGATAAGTAATGTGAATTGCAGAATTCAGTGAATCATCGAATCTTTGAACGCAGCTTGCGCTCCTGGTATTCCGGAGAGCATGCCTGTTTCAGGACTACCCGCTGAACTTCGCATCGATGAAGAACGCAGCGAATTGCGATAAGTAATGTGAATTGCAGATGATCTCGCATCGATGAAGAACGCAGCGAATTGCGATAAGTAATGTGAATTGCAGAATTCAGTGAATCATCGAATCTTTGAACGCAGCTTGCGCTCCTGGTATTCCGGAGAGCATGCCTGTTTCAGGACTACCCGCTGAACTTCGCATCGATGAAGAAC
Mass SpectrometrySequencing
Reference databaseLink specimens to clinical and demographic data
Manage requests for specimen use
FungiQuest
Diagnosis of rare IFI
www.fungiquest.netSearch the database
Fungiscope™
Browse through cases
Fusarium
FungiQuest – ExampleFungiQuest – Example
Fungiscope™
Partner Sites in India
Fungiscope™
Slide nur zur Info
Atul Patel
Arunaloke ChakrabartiRitesh AgarwalJagdish Chander
Mammen Chandy
Anuradha ChowdharySameer BakhshiLalit KumarNeelam Sood
Fungiscope™
Atul Patel
Anil KumarPurnima ParthasarathySunil Bhat
Subramanian SwaminathanAnupma Jyoti Kindo
Mammen Chandy
Prakash Yegneswaran
Sarala MenonOm ShrivastavDhanashree Kelkar-GalwankarSangmesh Chavanda C.S. Sharma
Dipak Thamke
Philip A. Thomas
Central Laboratory in India
Anuradha ChowdaryVallabhbhai Patel Chest InstituteDepartment of Medical MycologyUniversity of DelhiDelhi
Delhi
Fungiscope™
Anuradha ChowdaryVallabhbhai Patel Chest InstituteDepartment of Medical MycologyUniversity of DelhiDelhi
404 Valid Cases from 24 Countries
Cases111
7752
37191818161413
GermanyIndia
Czech RepublicRussiaFranceAustria
ItalyCanada
BrazilSlovakia
Fungiscope™
1353333221111111
SlovakiaIsrael
BelgiumHungaryRomania
TurkeyCroatia
ThailandAustralia
CubaDenmark
FinlandGreece
The NetherlandsUSA
404 Cases – Demographic Features
Indian=77
Othern=327
Median Age 48 51
77287
14
5
2
1
1
1
8
Caucasian
Asian
American Indian orAlaska Native
Sub-SaharanAfrican/Afro-American
Hispanic/Latino
North African
Arabic
Unknown
Caucasian
Asian
American Indian orAlaska Native
Sub-Saharan African/Afro-American
Cases (n)
Fungiscope™
Median AgeAge Min-Max 2-78 0-83
Gender (Female %) 26 37Weight (kg) 63 69Height (cm) 163 170
77287
14
5
2
1
1
1
8
Caucasian
Asian
American Indian orAlaska Native
Sub-SaharanAfrican/Afro-American
Hispanic/Latino
North African
Arabic
Unknown
Sub-Saharan African/Afro-American
Hispanic/Latino
North African
Arabic
Unknown
Other India
Distribution of Types of Fungi
327 cases from countries otherthan India
77 cases from India
Fungiscope™
Risk Factors in 327 Cases (other than India)
Other (n=327)
%
Fungiscope™
Risk Factors
India (n=77)
%
Other (n=327)
Fungiscope™
Site of Infection (other than India)
%
Other (n=327)
Fungiscope™
Site of Infection
India (n=77) Other (n=327)
%
Fungiscope™
Treatment
0 0.5 1 0 0.5 1 0 0.5 1
Prophylaxis Empiric Targeted
Mucoromycotina
Fusarium
Yeast
Fungiscope™
India (n=77)Other (n=327)
Penicillium/Paecilomyces
Dematiaceae
Scedosporium
Other
Favorable Outcome
0 0.5 1
Favorable Outcome
Mucoromycotina
Fusarium
Yeast
Fungiscope™
Penicillium/Paecilomyces
Dematiaceae
Scedosporium
Other
India (n=77)Other (n=327)
Overall Mortality
Overall mortality
0 0.5 1
Mucoromycotina
Fusarium
Yeast
Fungiscope™
India (n=77)Other (n=327)
Penicillium/Paecilomyces
Dematiaceae
Scedosporium
Other
Conclusion
Fungiscope provides
• A platform for fruitful collaboration
• Efficient method for collecting patient information
• Immediate diagnostic and therapeutic services
Fungiscope™
Fungiscope provides
• A platform for fruitful collaboration
• Efficient method for collecting patient information
• Immediate diagnostic and therapeutic services
Global Emerging Fungal Infection RegistryInitiated in 2003
ISHAM and ECMM Working Groupwww.fungiscope.net
ChairO.A. CornelyCoordinationD. SeidelM.J.G.T. VehreschildK. WahlersClinicalsurveys.netJ.J. Vehreschild
DocumentationF. MüllerCulture BankingH. WisplinghoffMolecular BiologyS. De HoogV. Rickerts
HistopathologyB. MarkiefkaThoracic SurgeryK. HekmatPharmacokineticsF. Farowski
Supported by unrestricted grants fromAstellas Pharma, Gilead Sciences, MSD/Merck, and Pfizer Pharma GmbH
Become a Fungiscope Collaborator
Global Emerging Fungal Infection RegistryInitiated in 2003
ISHAM and ECMM Working Groupwww.fungiscope.net
Send an Email to [email protected] contribute your rare cases of invasive fungal infection
Fungiscope™
Send an Email to [email protected] contribute your rare cases of invasive fungal infection