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| Division of Bacterial and Mycotic Diseases, Mycotic Diseases Branch |
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| Home > Current Research |
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Current Research
Epidemiologic studies in immunocompromised hosts
Long-term goals
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To better define the burden of invasive aspergillosis, candidiasis, cryptococcosis, and other fungal infections in transplant recipients, persons with HIV infection, and other immunocompromised and debilitated hosts. |
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To monitor trends in the incidence of these diseases. |
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To evaluate risk factors for these infections. |
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To develop cost-effective strategies for the prevention of these infections. |
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To develop efficient models for surveillance and response that can be exported to developing countries. |
2004 Accomplishments
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Developed, competed, and awarded a five-year cooperative agreement for the Organ Transplant Infection Detection and Prevention Program to two consortia led by the University of Alabama, Birmingham [UAB] and the University of Pittsburgh, respectively. |
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Conducted active prospective surveillance for invasive fungal infections among solid organ transplant and hematopoietic stem cell transplant (HSCT) recipients through a network of 21 U.S. transplant centers (in collaboration with UAB and the Transnet Group). |
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Initiated a project to investigate risk factors for late-onset aspergillosis in HSCT recipients (in collaboration with the Center for International Blood and Marrow Transplant Research, UAB, and the Transnet Group) |
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Conducted active prospective surveillance for candidemia among hospitalized patients through a network of 11 hospitals in Brazil (in collaboration with the Federal Universities of Rio de Janeiro and Sao Paulo). |
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Completed analysis of data from two-year population-based surveillance for candidemia in the Barcelona region of Spain. The incidence of disease was lower in Spain than in the U.S. and antifungal drug resistance was rare (in collaboration with the National Center for Microbiology, Institute of Health, Madrid, Spain and the Hospital Valle del Hebron, Barcelona, Spain). |
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Completed analysis of trends in neonatal candidemia in the United States, including changes in pathogen distribution, using data from the National Nosocomial Infections Surveillance System. The incidence of disease appears to be decreasing among extremely low birthweight infants, and the predominant etiologic agents continue to be Candida species susceptible to azole antifungal agents. |
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Completed analysis of data from two-year population-based surveillance for cryptococcosis among persons living in the Johannesburg region of South Africa. The incidence of disease among persons living with HIV and AIDS was 95 per 100,000 population. Our data highlight the significant morbidity and mortality associated with cryptococcosis in South Africa (in collaboration with the National Health Laboratory Service, South Africa). |
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Completed a cost-effectiveness analysis of primary prophylaxis for the prevention of cryptococcal meningitis among HIV-infected persons in Thailand. Fluconazole prophylaxis is cost saving compared to no prophylaxis in Thailand, and may also be cost-effective in other countries with a high incidence of AIDS-associated opportunistic fungal infections (in collaboration with the CDC HIV-AIDS Collaboration and the Ministry of Public Health, Thailand). |
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Completed an interim analysis quantifying the variation in institution-specific rates of invasive aspergillosis among transplant recipients. Many factors may explain variations in rates between institutions and these will need to be normalized before center-to-center comparisons can be made (in collaboration with UAB and the Transnet group). |
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Published a report describing the results of active population-based surveillance for candidemia. The incidence of disease was 10 per 100,000 population, with 28% of infections being acquired before admission to hospital. Only 1% of Candida albicans isolates were resistant to fluconazole compared to 7% of C. glabrata, and 6% of C. tropicalis isolates (in collaboration with Emerging Infections Program [EIP] sites in the state of Connecticut [33 hospitals] and in Baltimore, MD [14 hospitals]). |
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Published a report describing the epidemiologic and molecular characterization of Candida parapsilosis bloodstream infections in a community hospital. 26% of healthcare workers surveyed demonstrated hand colonization with C. parapsilosis. Outbreak strain isolates demonstrated reduced susceptibility to fluconazole (in collaboration with the Mississippi State Department of Health). |
Return to Top Epidemiologic studies of community-acquired fungal infections
Long term goals
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To establish active surveillance in order to better define the burden of community-acquired fungal infections in the United States and abroad. |
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To evaluate risk factors for these infections. |
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To develop cost-effective strategies for the prevention of these infections. |
2004 Accomplishments
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Investigated an outbreak of acute histoplasmosis among industrial plant workers in Nebraska. The source of the outbreak was confirmed and removed; additional ‘high-risk’ activities were identified and personnel training at the plant was improved (in collaboration with Nebraska Department of Health and Human Services and NIOSH, Cincinnati, OH). |
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Completed analysis of National Electronic Telecommunications System for Surveillance (NETSS) data for 1998-2002. Factors associated with the increased incidence of coccidioidomycosis in Arizona were identified. A model was developed and is now being used to establish whether large outbreaks can be predicted from seasonal weather patterns (in collaboration with the Arizona Department of Health Services and University of Arizona, Tucson, AZ). |
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Published a report describing an outbreak of coccidioidomycosis among workers at an archeological site in Northeastern Utah. This report documents a new endemic focus of the disease (in collaboration with Utah Department of Health and the University of Arizona, Tucson, AZ). |
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Published a report describing a large outbreak of acute histoplasmosis among students attending a high school in Indiana in November 2001. The outbreak was associated with disruption of soil in a school courtyard known to be a bird-roosting site (in collaboration with Indiana State Department of Health, and NIOSH, Cincinnati, OH). |
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Published a report describing an outbreak of acute histoplasmosis among two groups of visitors to a popular tourist cave in northern Costa Rica. Like workers removing bird or bat guano from buildings, persons who explore caves should use personal protective equipment to help prevent infection (in collaboration with the Integrated Center for Health, Costa Rica). |
Return to To Mycologic and molecular biologic research
Long term goals
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To develop DNA sequence based methods for identification and sub-specific strain typing of important fungal pathogens. |
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To develop rapid molecular and immunological tests for the diagnosis of invasive fungal infections. |
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To develop improved methods for determination of the in vitro susceptibility of yeasts and molds to antifungal agents. |
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To assess the usefulness of these novel procedures in the evaluation of disease outbreaks, surveillance, and prevention programs. |
2004 Accomplishments
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Initiated a project to establish an in vitro Candida biofilm model to characterize biofilm formation and investigate mechanisms of drug resistance. Antifungal catheter-lock solutions will be evaluated as a means of preventing catheter-related infections. |
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Initiated a project to evaluate novel serologic tests for the diagnosis of disseminated histoplasmosis in HIV-infected persons (in collaboration with the Hospital General San Juan de Dios, Guatemala). |
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Initiated a project to evaluate the utility of the DiversiLab rep-polymerase chain reaction (PCR) system for the identification and sub-specific strain typing of medically important yeasts (in collaboration with Bacterial Bar Codes, Inc., Houston, TX). |
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Continued a program to develop a repository of serum specimens from transplant recipients to facilitate the development and evaluation of novel molecular and antigen detection tests for invasive aspergillosis in HSCT recipients (in collaboration with the Emory University School of Medicine, Atlanta). |
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Completed analysis of data from a study that attempted to correlate outcome of Candida bloodstream infections among patients treated with amphotericin B with results of in vitro susceptibility tests of this agent. None of the in vitro test formats studied generated results that correlated significantly with therapeutic success or failure (in collaboration with EIP sites in the state of Connecticut [33 hospitals] and in Baltimore, MD [14 hospitals]). |
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Completed an assessment of the ribosomal large subunit D1-D2, internal transcribed spacer (ITS) 1, and ITS 2 regions as targets for DNA sequence-based identification of Aspergillus species and for their differentiation from other fungi of medical importance. |
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Completed a comparative evaluation of multilocus strain typing (MLST) and Southern blot hybridization with the repetitive element probe Ca3 for the molecular sub-typing of Candida albicans isolates from HIV-infected persons with oropharyngeal candidiasis in the United States and India. Sequence-based subtyping of C. albicans permitted more objective interpretation and facilitated inter-laboratory comparisons of results (in collaboration with the V.P. Chest Institute, Delhi, India). |
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Published a report describing a method for the rapid quantification of azole drug resistance gene expression in Candida albicans by reverse transcriptase LightCycler PCR and fluorescent probe hybridization. |
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Published a report describing the molecular characterization of azole drug resistance gene expression in isolates of Candida albicans that exhibit the trailing growth phenomenon in susceptibility tests with fluconazole. |
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Published a report describing the application of a novel ergosterol quantification method to the characterization of molecular mechanisms of itraconazole drug resistance in isolates of Aspergillus fumigatus. |
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Published a multicenter evaluation of a proposed standard reference procedure for the in vitro determination of susceptibility of dermatophytes (Trichophyton, Microsporum and Epidermophyton species) to antifungal drugs (in collaboration with the NCCLS sub-committee on antifungal susceptibility testing and Case Western Reserve University, Cleveland, OH). |
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Published an international interlaboratory comparison of proposed standard reference procedures for the in vitro determination of susceptibility of Aspergillus and Candida species to the new echinocandin antifungal agent, caspofungin (in collaboration with the NCCLS sub-committee on antifungal susceptibility testing and the University of Aberdeen, Scotland). |
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Published a report describing the development and evaluation of a PCR-based system using species-specific oligonucleotide probes for rapid identification of Aspergillus species and for their differentiation from other fungi of medical importance. |
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Published a report describing the use of specific oligonucleotide probes to resolve discrepant results for Candida species identification. |
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Published a report describing the development and evaluation of a typing system for Penicillium marneffei strains based on analysis of polymorphic microsatellite markers. |
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Published a report describing the characterization of several phenotypic markers of virulence among Candida parapsilosis isolates from an outbreak in an intensive care unit; this work demonstrated that biofilm production by the outbreak strains was greater than that of sporadic isolates (in collaboration with the University Hospitals of Cleveland and Case Western Reserve University, Cleveland, OH). |
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Date: November 15, 2005
Content source: Coordinating Center for Infectious Diseases / Division of Bacterial and Mycotic Diseases |
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