Clinical microbiological case: infection imitating lymphocutaneous sporotrichosis during pregnancy in a healthy woman from the south-eastern USA.

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Safdar A.

Clin Microbiol Infect. 2003 Mar;9(3):221, 244-6.

A novel defect in interferon-gamma secretion in patients with refractory nontuberculous pulmonary mycobacteriosis.

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Safdar A, Armstrong D, Murray HW.

Ann Intern Med. 2003 Mar 18;138(6):521.

Infectious diarrhea in the southeastern United States, 1998-2000.

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Safdar A.

Clin Infect Dis. 2003 Feb 15;36(4):533-4.

Breakthrough Scedosporium apiospermum (Pseudallescheria boydii) brain abscess during therapy for invasive pulmonary aspergillosis following high-risk allogeneic hematopoietic stem cell transplantation. Scedosporiasis and recent advances in antifungal therapy.

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Safdar A, Papadopoulos EB, Young JW.

Transpl Infect Dis. 2002 Dec;4(4):212-7.

Abstract

Systemic scedosporiasis due to the anamorph or asexual form Scedosporium apiospermum (Pseudallescheria boydii) has become an important cause of opportunistic mycosis, especially in patients undergoing high-risk hematopoietic stem cell transplantation. We report a case of rapidly progressive cerebellar hyalohyphomycosis due to Scedosporium apiospermum in an allogeneic marrow graft recipient receiving treatment for severe graft-versus-host disease. This fatal breakthrough intracranial abscess, due to amphotericin B-resistant (minimum inhibitory concentration > 16 micro g/ml) mold, developed during the course of systemic antifungal therapy given for multicentric pulmonary aspergillosis. Despite treatment with high-dose Abelcet (10 mg/kg daily), free amphotericin B was not detected in postmortem cerebellar tissue. A broad-spectrum triazole-based agent (voriconazole/UK-109, 496–Vfend), and a novel fungal cell wall inhibitor, an echinocandin/pneumocandin analog (caspofungin/MK-0991–Cancidas), which exhibit excellent in vitro activity against most clinical Pseudallescheria boydii-Scedosporium apiospermum isolates, have recently become available in the United States and may provide much needed treatment options for patients at risk.

Clinical microbiological case: severe relapsing septal panniculitis in a healthy man from the south-eastern USA.

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Safdar A, McEvoy PL, Burns RG, Perfect JR.

Clin Microbiol Infect. 2002 Dec;8(12):801-2; 830-2.

Antimicrobial activities against 84 Listeria monocytogenes isolates from patients with systemic listeriosis at a comprehensive cancer center (1955-1997).

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Safdar A, Armstrong D.

J Clin Microbiol. 2003 Jan;41(1):483-5.

Abstract

Listeriosis is a serious complication in patients undergoing treatment for cancer. We present antimicrobial susceptibility profiles of 84 clinical Listeria monocytogenes isolates. During 1955 to 1997, in vitro susceptibility for penicillin (97.6%), ampicillin (90.7%), erythromycin (98.8%), tetracycline (96.9%), and gentamicin (98.0%) remained unchanged. All isolates were susceptible to amikacin, ciprofloxacin, imipenem, rifampin, trimethoprim-sulfamethoxazole (TMP-SMX), and vancomycin. High prevalence of clindamycin resistance (96.2%) was unexpected. Ampicillin plus gentamicin is standard therapy for systemic listerosis, and TMP-SMX may be used for patients with beta-lactam intolerance. In vitro susceptibility profiles for carbapenem and fluoronated quinolone are promising, although clinical validation is critically needed before routine use is advocated, especially for listeric patients with severe cellular immune defects.

Profound interferon gamma deficiency in patients with chronic pulmonary nontuberculous mycobacteriosis.

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Safdar A, White DA, Stover D, Armstrong D, Murray HW.

Am J Med. 2002 Dec 15;113(9):756-9.

Acute bacterial endocarditis during granulocytopenia in an allogenic marrow transplant recipient.

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Safdar A, Childs BH, Keefe D, Sepkowitz KA.

Am J Med. 2000 Oct 15;109(6):514-5.

Treatment for coccidioidomycosis in pregnancy?

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Busowski JD, Safdar A.

Postgrad Med. 2001 Mar;109(3):76-7.

Prospective study of Candida species in patients at a comprehensive cancer center.

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Safdar A, Chaturvedi V, Cross EW, Park S, Bernard EM, Armstrong D, Perlin DS.

Antimicrob Agents Chemother. 2001 Jul;45(7):2129-33.

Abstract

Since most nosocomial systemic yeast infections arise from the endogenous flora of the patient, we prospectively evaluated the species stratification and antifungal susceptibility profile of Candida spp. associated with heavy colonization and systemic infection in patients at Memorial Sloan-Kettering Cancer Center in New York. A total of 349 Candida isolates were obtained from 223 patients during the later half of 1998. Cancer was the most common underlying disease, occurring in 91% of the patients, including 61.8% with organ and 23.7% with hematological malignancies; 4.4% of the patients had AIDS. Candida albicans was the predominant species (67.3%); among 114 non-albicans Candida spp., C. glabrata (45.6%) was the most frequent, followed by C. tropicalis (18.4%), C. parapsilosis (16.6%), and C. krusei (9.6%). The overall resistance to triazole-based agents among all yeast isolates was 9.4 and 10.8% for fluconazole and itraconazole, respectively. A total of 5% of C. albicans strains were resistant to triazole antifungals, whereas 30.8 and 46.2% of C. glabrata strains were resistant to fluconazole (MIC > or = 64 microg/ml) and itraconazole (MIC > or = 1 microg/ml), respectively. A significant association was observed between prior treatment with triazole and isolation of fluconazole-resistant C. albicans (P = 0.005, OR 36), although this relationship was not seen in C. glabrata isolates (P = 0.4). This study reinforces the importance of periodic, prospective surveillance of clinical fungal isolates to determine appropriate prophylactic, empiric, and preemptive antifungal therapy for the highly susceptible patient population.