Mantar Enfeksiyonları
Özet
Doğal afetler sonrası mantar enfeksiyonları, bakteri kaynaklı enfeksiyonlar kadar sık görülmemekle birlikte, özellikle bağışıklığı baskılanmış bireylerde veya kontamine yaraları olan hastalarda mukormikoz etkeni başta olmak üzere mantar enfeksiyonları ciddi riskler taşır. Bu enfeksiyonlar erken dönemde bakteriyel enfeksiyonlarla karışabilmekte ve bu durum tanı ve tedavi süreçlerini geciktirebilmektedir. Dünya’da yaşanan pek çok afet sonrasında; Kolombiya’daki Armero Yanardağ patlamasında, Joplin, Missouri Kasırgası gibi afetlerde mukormikozun nekrotizan fasiit ve yüksek mortalite oranlarına yol açtığı belirtilmiştir. Bununla birlikte aspergilloz ve fusaryoz başta olmak üzere pek çok dematiyöz mantarın da etken olduğu enfeksiyonlar, meydana gelen afet türü ve bu afetin gerçekleştiği coğrafyanın iklim özelliklerine göre geniş bir dağılım gösterebilmektedir. Bu noktada klinik örneklerin toplanması, mikrobiyolojik tanı yöntemleri, tanımlama ve duyarlılık sonuçlarının doğru yorumlanarak etken-kontaminasyon ayrımının doğru yapılması son derece önemlidir.
Afet sonrası teşhis ve tedavi gecikmeleri enfeksiyon oranlarını arttırmakta ve sağlık hizmetlerine erişimdeki zorluklar enfeksiyon yönetimini karmaşık hale getirebilmektedir. Antibiyotik kullanımı, steroid tedavileri ve diyabet gibi kronik hastalıklarla daha da sık görülen mantar enfeksiyonları, doğru tedavinin gecikmemesi açısından mutlaka göz önünde bulundurulmalı, antifungal tedavi ve gerekli durumda cerrahi müdahalelerle enfeksiyon kontrol altına alınmalıdır. Vaktinde yapılan doğru tanımlama ve duyarlılık sonuçları yalnız hastaların iyileşmelerine katkıda bulunmakta kalmayıp, ülkelerin epidemiyolojik verilerini oluşturarak gelecekteki afet durumlarında karşılaşılabilecek olası patojenler için ön fikir vermesi açısından kritik bir öneme sahiptir.
Fungal infections after natural disasters, while not as common as bacterial infections, pose serious risks, especially for immunocompromised individuals or patients with contaminated wounds, and mucormycosis is one of the main concerns in these cases. These infections can often be mistaken for bacterial infections in the early stages, leading to delays in diagnosis and treatment. Following numerous disasters worldwide, such as the Armero volcanic eruption in Colombia and the Joplin, Missouri tornado, mucormycosis has been linked to necrotizing fasciitis and high mortality rates. Additionally, infections caused by fungi like aspergillosis, fusariosis, and many dematiaceous fungal infections show wide geographical distribution depending on the type of disaster and the climate of the affected region. Collecting clinical samples, using microbiological diagnostic methods, and accurately interpreting identification and susceptibility results to distinguish pathogens from contaminants are crucial in these settings.
Delays in diagnosis and treatment post-disaster increase infection rates, and difficulties in accessing healthcare complicate infection management. Fungal infections, which are more frequently observed with antibiotic use, steroid treatments, and chronic diseases like diabetes, must be considered to avoid treatment delays. Antifungal therapy and, when necessary, surgical interventions are essential to control these infections. Accurate and timely identification and susceptibility testing not only aid in patient recovery but also contribute to the epidemiological data of countries, providing critical insights into potential pathogens for future disaster scenarios.
Referanslar
Gayas MA, Ahmad RA, Gugjoo MB, Handoo N. Fungal wound infections: Mini review. Pharma Innovation 2018;7(1):295-298.
Ivers LC, Ryan ET. Infectious diseases of severe weather-related and flood-related natural disasters. Curr Opin Infect Dis 2006;19(5):408-414.
Andresen D, Donaldson A, Choo L, Knox A, Klaassen M, Ursic C, et al. Multifocal cutaneous mucormycosis complicating polymicrobial wound infections in a tsunami survivor from Sri Lanka. Lancet 2005;365(9462):876-878.
Snell BJ, Tavakoli K. Necrotizing fasciitis caused by Apophysomyces elegans complicating soft-tissue and pelvic injuries in a tsunami survivor from Thailand. Plast Reconstr Surg 2007;119(1):448-449.
Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis 2008;47(4):503-509.
Benedict K, Park BJ. Invasive fungal infections after natural disasters. Emerg Infect Dis 2014;20(3):349-355.
Patiño JF, Castro D, Valencia A, Morales P. Necrotizing soft tissue lesions after a volcanic cataclysm. World J Surg 1991;15(2):240-247.
Neblett Fanfair R, Benedict K, Bos J, Bennett SD, Lo YC, Adebanjo T, et al. Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011. N Engl J Med 2012;367(23):2214-2225.
Maegele M, Gregor S, Yuecel N, Simanski C, Paffrath T, Rixen D, et al. One year ago not business as usual: wound management, infection and psychoemotional control during tertiary medical care following the 2004 tsunami disaster in Southeast Asia. Crit Care 2006;10(2):R50.
Petrini B, Farnebo F, Hedblad MA, Appelgren P. Concomitant late soft tissue infections by Cladophialophora bantiana and Mycobacterium abscessus following tsunami injuries. Med Mycol 2006;44(2):189-192.
Garzoni C, Emonet S, Legout L, Benedict R, Hoffmeyer P, Bernard L, et al. Atypical infections in tsunami survivors. Emerg Infect Dis 2005;11(10):1591-1593.
Kemmerly S, Scott F, Vallabhaneni S, Rao CY, Reed D, Garcia-Diaz J et al. Assessing invasive mold infections, mold exposures and personal protective equipment use among immunocompromised New Orleans residents after Hurricane Katrina. Infectious Diseases Society of America 2006 Annual Meeting Conference Paper. 2006.
Nakamura Y, Utsumi Y, Suzuki N, Nakajima Y, Murata O, Sasaki N, et al. Multiple Scedosporium apiospermum abscesses in a woman survivor of a tsunami in northeastern Japan: a case report. J Med Case Rep 2011;5:526.
Bayramgürler D, Bilen N, Namli S, Altinas SL, Apaydin R. The effects of 17 August Marmara earthquake on patient admittances to our dermatology department. J Eur Acad Dermatol Venereol 2002;16(3):249-252.
Igusa R, Narumi S, Murakami K, Kitawaki Y, Tamii T, Kato M, et al. Escherichia coli pneumonia in combination with fungal sinusitis and meningitis in a tsunami survivor after the Great East Japan Earthquake. Tohoku J Exp Med 2012;227(3):179-184.
Shao J, Wan Z, Li R, Yu J. Species identification and delineation of pathogenic Mucorales by Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry. J Clin Microbiol 2018;56(4):e01886-17.
Schoch CL, Seifert KA, Huhndorf S, Robert V, Spouge JL, Levesque CA, et al. Nuclear ribosomal internal transcribed spacer (ITS) region as a universal DNA barcode marker for Fungi. Proc Natl Acad Sci USA 2012;109(16):6241-6.
Guo P, Chen J, Tan Y, Xia L, Zhang W, Li X, et al. Comparison of molecular and MALDI-TOF MS identification and antifungal susceptibility of clinical Fusarium isolates in Southern China. Front Microbiol 2022;13:992582.
Ekmen H, Erbakan N. Miçetoma (Madura ayağı) Memleketimizde kültürel teşhisi yapılan 3 vaka. Mikrobiyol Bült 1967;1(3):149-154.
Koc AN, Uksal U, Oymak O. Case report. Successfully treated subcutaneous infection with Sporothrix schenckii in Turkey. Mycoses 2001;44:330-333.
Kantarcıoğlu AS, Yücel A. Cerrahpaşa Tıp Fakültesi Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı'nda tanımlanmış olan pseudallescheriasis olguları ve Avrupa Tıp Mitolojisi Konfederasyonu (ECMM) Pseudallescheriasis Çalışma Grubu. Cerr Tıp Fak Derg 2005;36(2):90-96.
Murray P, Rosenthal K, Pfaller M et al. Supericial and cutaneous mycoses. Pp: 607-61. In: Murray P, Rosenthal K, Pfaller M et al. Medical Microbiology 2016, 8th ed. Elsevier.
Ryan KJ, Ray CG et al. Dermatophytes, Sporothrix, and other superficial and subcutaneous fungi. Pp: 719-729. In: Ryan KJ, Ray CG et al. Sherris Medical Microbiology. 2016, 6th ed. Mc Graw Hill Education.
Kidd SE, Abdolrasouli A, Hagen F. Fungal Nomenclature: Managing change is the name of the game. Open Forum Infect Dis 2023;10(1):ofac559.
Suárez JA, Cerrud B, Pachar M, Patiño LH, Reidy J, Chace A, et al. Human Lobomycosis Caused by Paracoccidioides (Lacazia) loboi, Panama, 2022. Emerg Infect Dis 2023;29(12):2513-2517.
de Hoog GS, Dukik K, Monod M, Packeu A, Stubbe D, Hendrickx M, et al. Toward a novel multilocus phylogenetic taxonomy for the dermatophytes. Mycopathol 2017;182(1-2):5-31.
Murray P, Rosenthal K, Pfaller M et al. Subcutaneous mycoses. Pp: 617-626. In: Murray P, Rosenthal K, Pfaller M et al. Medical Microbiology. 2016, 8th ed. Elsevier.
Referanslar
Gayas MA, Ahmad RA, Gugjoo MB, Handoo N. Fungal wound infections: Mini review. Pharma Innovation 2018;7(1):295-298.
Ivers LC, Ryan ET. Infectious diseases of severe weather-related and flood-related natural disasters. Curr Opin Infect Dis 2006;19(5):408-414.
Andresen D, Donaldson A, Choo L, Knox A, Klaassen M, Ursic C, et al. Multifocal cutaneous mucormycosis complicating polymicrobial wound infections in a tsunami survivor from Sri Lanka. Lancet 2005;365(9462):876-878.
Snell BJ, Tavakoli K. Necrotizing fasciitis caused by Apophysomyces elegans complicating soft-tissue and pelvic injuries in a tsunami survivor from Thailand. Plast Reconstr Surg 2007;119(1):448-449.
Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B-based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis 2008;47(4):503-509.
Benedict K, Park BJ. Invasive fungal infections after natural disasters. Emerg Infect Dis 2014;20(3):349-355.
Patiño JF, Castro D, Valencia A, Morales P. Necrotizing soft tissue lesions after a volcanic cataclysm. World J Surg 1991;15(2):240-247.
Neblett Fanfair R, Benedict K, Bos J, Bennett SD, Lo YC, Adebanjo T, et al. Necrotizing cutaneous mucormycosis after a tornado in Joplin, Missouri, in 2011. N Engl J Med 2012;367(23):2214-2225.
Maegele M, Gregor S, Yuecel N, Simanski C, Paffrath T, Rixen D, et al. One year ago not business as usual: wound management, infection and psychoemotional control during tertiary medical care following the 2004 tsunami disaster in Southeast Asia. Crit Care 2006;10(2):R50.
Petrini B, Farnebo F, Hedblad MA, Appelgren P. Concomitant late soft tissue infections by Cladophialophora bantiana and Mycobacterium abscessus following tsunami injuries. Med Mycol 2006;44(2):189-192.
Garzoni C, Emonet S, Legout L, Benedict R, Hoffmeyer P, Bernard L, et al. Atypical infections in tsunami survivors. Emerg Infect Dis 2005;11(10):1591-1593.
Kemmerly S, Scott F, Vallabhaneni S, Rao CY, Reed D, Garcia-Diaz J et al. Assessing invasive mold infections, mold exposures and personal protective equipment use among immunocompromised New Orleans residents after Hurricane Katrina. Infectious Diseases Society of America 2006 Annual Meeting Conference Paper. 2006.
Nakamura Y, Utsumi Y, Suzuki N, Nakajima Y, Murata O, Sasaki N, et al. Multiple Scedosporium apiospermum abscesses in a woman survivor of a tsunami in northeastern Japan: a case report. J Med Case Rep 2011;5:526.
Bayramgürler D, Bilen N, Namli S, Altinas SL, Apaydin R. The effects of 17 August Marmara earthquake on patient admittances to our dermatology department. J Eur Acad Dermatol Venereol 2002;16(3):249-252.
Igusa R, Narumi S, Murakami K, Kitawaki Y, Tamii T, Kato M, et al. Escherichia coli pneumonia in combination with fungal sinusitis and meningitis in a tsunami survivor after the Great East Japan Earthquake. Tohoku J Exp Med 2012;227(3):179-184.
Shao J, Wan Z, Li R, Yu J. Species identification and delineation of pathogenic Mucorales by Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry. J Clin Microbiol 2018;56(4):e01886-17.
Schoch CL, Seifert KA, Huhndorf S, Robert V, Spouge JL, Levesque CA, et al. Nuclear ribosomal internal transcribed spacer (ITS) region as a universal DNA barcode marker for Fungi. Proc Natl Acad Sci USA 2012;109(16):6241-6.
Guo P, Chen J, Tan Y, Xia L, Zhang W, Li X, et al. Comparison of molecular and MALDI-TOF MS identification and antifungal susceptibility of clinical Fusarium isolates in Southern China. Front Microbiol 2022;13:992582.
Ekmen H, Erbakan N. Miçetoma (Madura ayağı) Memleketimizde kültürel teşhisi yapılan 3 vaka. Mikrobiyol Bült 1967;1(3):149-154.
Koc AN, Uksal U, Oymak O. Case report. Successfully treated subcutaneous infection with Sporothrix schenckii in Turkey. Mycoses 2001;44:330-333.
Kantarcıoğlu AS, Yücel A. Cerrahpaşa Tıp Fakültesi Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dalı'nda tanımlanmış olan pseudallescheriasis olguları ve Avrupa Tıp Mitolojisi Konfederasyonu (ECMM) Pseudallescheriasis Çalışma Grubu. Cerr Tıp Fak Derg 2005;36(2):90-96.
Murray P, Rosenthal K, Pfaller M et al. Supericial and cutaneous mycoses. Pp: 607-61. In: Murray P, Rosenthal K, Pfaller M et al. Medical Microbiology 2016, 8th ed. Elsevier.
Ryan KJ, Ray CG et al. Dermatophytes, Sporothrix, and other superficial and subcutaneous fungi. Pp: 719-729. In: Ryan KJ, Ray CG et al. Sherris Medical Microbiology. 2016, 6th ed. Mc Graw Hill Education.
Kidd SE, Abdolrasouli A, Hagen F. Fungal Nomenclature: Managing change is the name of the game. Open Forum Infect Dis 2023;10(1):ofac559.
Suárez JA, Cerrud B, Pachar M, Patiño LH, Reidy J, Chace A, et al. Human Lobomycosis Caused by Paracoccidioides (Lacazia) loboi, Panama, 2022. Emerg Infect Dis 2023;29(12):2513-2517.
de Hoog GS, Dukik K, Monod M, Packeu A, Stubbe D, Hendrickx M, et al. Toward a novel multilocus phylogenetic taxonomy for the dermatophytes. Mycopathol 2017;182(1-2):5-31.
Murray P, Rosenthal K, Pfaller M et al. Subcutaneous mycoses. Pp: 617-626. In: Murray P, Rosenthal K, Pfaller M et al. Medical Microbiology. 2016, 8th ed. Elsevier.
