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  1. Article ; Online: A Diagnostic Approach to Fungal Pneumonia: An Infectious Diseases Perspective.

    Azar, Marwan M

    Chest

    2023  Volume 165, Issue 3, Page(s) 559–572

    Abstract: Although bacteria significantly exceed fungi as the most common cause of lower respiratory tract infection, the incidence of fungal pneumonia is increasing because of a growing at-risk population of immunocompromised individuals as well as anthropogenic ... ...

    Abstract Although bacteria significantly exceed fungi as the most common cause of lower respiratory tract infection, the incidence of fungal pneumonia is increasing because of a growing at-risk population of immunocompromised individuals as well as anthropogenic global heating and environmental disruption. When a patient presents with a clinical syndrome of pneumonia, a constellation of factors must be considered to determine the probability of a fungal pneumonia, including host factors, epidemiologic exposures, suggestive radiographic patterns, and the presence of a non-resolving pneumonia. In addition, knowledge of clinically important fungal pathogens, their epidemiology, and associated clinical syndromes are key in guiding appropriate diagnostic testing and result interpretation, and ultimately rendering a correct diagnosis of a fungal pneumonia. This article aims to provide a framework for the evaluation and appropriate diagnostic testing of patients with suspected fungal pneumonia.
    MeSH term(s) Humans ; Mycoses/diagnosis ; Pneumonia/diagnosis ; Pneumonia/microbiology ; Communicable Diseases ; Respiratory Tract Infections ; Immunocompromised Host ; Influenza, Human
    Language English
    Publishing date 2023-10-07
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1032552-9
    ISSN 1931-3543 ; 0012-3692
    ISSN (online) 1931-3543
    ISSN 0012-3692
    DOI 10.1016/j.chest.2023.10.005
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Current Concepts in the Diagnosis and Management of Pneumocystis Pneumonia in Solid Organ Transplantation.

    Trubin, Paul A / Azar, Marwan M

    Infectious disease clinics of North America

    2023  Volume 37, Issue 3, Page(s) 617–640

    Abstract: Pneumocystis infection manifests predominantly as an interstitial pneumonia in immunocompromised patients. Diagnostic testing in the appropriate clinical context can be highly sensitive and specific and involves radiographic imaging, fungal biomarkers, ... ...

    Abstract Pneumocystis infection manifests predominantly as an interstitial pneumonia in immunocompromised patients. Diagnostic testing in the appropriate clinical context can be highly sensitive and specific and involves radiographic imaging, fungal biomarkers, nucleic acid amplification, histopathology, and lung fluid or tissue sampling. Trimethoprim-sulfamethoxazole remains the first-choice agent for treatment and prophylaxis. Investigation continues to promote a deeper understanding of the pathogen's ecology, epidemiology, host susceptibility, and optimal treatment and prevention strategies in solid organ transplant recipients.
    MeSH term(s) Humans ; Pneumonia, Pneumocystis/diagnosis ; Pneumonia, Pneumocystis/drug therapy ; Pneumonia, Pneumocystis/prevention & control ; Pneumocystis carinii ; Organ Transplantation/adverse effects ; Trimethoprim, Sulfamethoxazole Drug Combination/therapeutic use ; Immunocompromised Host
    Chemical Substances Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2)
    Language English
    Publishing date 2023-05-02
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1077676-x
    ISSN 1557-9824 ; 0891-5520
    ISSN (online) 1557-9824
    ISSN 0891-5520
    DOI 10.1016/j.idc.2023.03.005
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  3. Article ; Online: A fast-track to fungal diagnosis: the potential of molecular diagnostics for fungi at the point of care.

    Trubin, Paul / Azar, Marwan M

    Expert review of molecular diagnostics

    2023  Volume 24, Issue 3, Page(s) 143–146

    MeSH term(s) Humans ; Pathology, Molecular ; Point-of-Care Systems ; Fungi/genetics ; Polymerase Chain Reaction
    Language English
    Publishing date 2023-11-29
    Publishing country England
    Document type Editorial
    ZDB-ID 2112530-2
    ISSN 1744-8352 ; 1473-7159
    ISSN (online) 1744-8352
    ISSN 1473-7159
    DOI 10.1080/14737159.2023.2287504
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  4. Article ; Online: The respiratory syncytial virus vaccines are here: Implications for solid organ transplantation.

    Trubin, Paul / Azar, Marwan M / Kotton, Camille N

    American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

    2024  

    Abstract: In 2023, the Food and Drug Administration approved 2 recombinant subunit respiratory syncytial virus (RSV) vaccines based on prefusion RSV F glycoproteins for the prevention of RSV-associated lower respiratory tract disease. These vaccines were ... ...

    Abstract In 2023, the Food and Drug Administration approved 2 recombinant subunit respiratory syncytial virus (RSV) vaccines based on prefusion RSV F glycoproteins for the prevention of RSV-associated lower respiratory tract disease. These vaccines were subsequently recommended for individuals ≥60 years of age using shared clinical decision-making by the Center for Disease Control and Prevention's Advisory Committee on Immunization Practices. The development, deployment, and uptake of respiratory virus vaccines are of particular importance for solid organ recipients who are at higher risk of infectious complications and poor clinical outcomes, including from RSV-associated lower respiratory tract disease, compared to patients without immunocompromise. This review aims to summarize what is currently known about the burden of RSV disease in solid organ transplantation, to describe the currently available tools to mitigate the risk, and to highlight considerations regarding the implementation of these vaccines before and after transplantation. We also explore areas of unmet need for organ transplant recipients including questions of RSV vaccine effectiveness and safety, inequities in disease and vaccine access based on race and socioeconomic status, and expansion of coverage to immunocompromised individuals below the age of 60 years.
    Language English
    Publishing date 2024-02-08
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2060594-8
    ISSN 1600-6143 ; 1600-6135
    ISSN (online) 1600-6143
    ISSN 1600-6135
    DOI 10.1016/j.ajt.2024.02.003
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  5. Article ; Online: Lung infections due to emerging fungal pathogens.

    Machiavello Roman, Francisco J / Pischel, Lauren / Azar, Marwan M

    Current opinion in pulmonary medicine

    2024  Volume 30, Issue 3, Page(s) 258–265

    Abstract: Purpose of review: This review highlights the epidemiology, pathogenesis and clinical management of pulmonary infections caused by emerging fungal organisms.: Recent findings: Emerging fungal infections have arisen as a result of population and ... ...

    Abstract Purpose of review: This review highlights the epidemiology, pathogenesis and clinical management of pulmonary infections caused by emerging fungal organisms.
    Recent findings: Emerging fungal infections have arisen as a result of population and environmental changes. An enlarging pool of immunocompromised hosts on triazole antifungal prophylaxis has led to an increased incidence of non- Aspergillus molds, such as Fusarium , Scedosporium and Lomentospora spp. Advances in diagnostic capabilities led to the identification of the Emergomyces genus and non- dermatitidis Blastomyces species, which have a significant disease burden in Africa and the Middle East. Climate change has contributed to changing the distribution of previously confined endemic mycoses, like coccidioidomycosis and talaromycosis. These emerging organisms pose important diagnostic and therapeutic challenges.
    Summary: Newly recognized pathogenic fungi and established endemic mycoses with expanding geographic boundaries have become important agents of pulmonary disease. There is a dearth of clinical evidence on the appropriate management of these infections.
    MeSH term(s) Humans ; Mycoses/diagnosis ; Mycoses/drug therapy ; Mycoses/epidemiology ; Fungi ; Antifungal Agents/therapeutic use ; Pneumonia/drug therapy ; Lung
    Chemical Substances Antifungal Agents
    Language English
    Publishing date 2024-02-15
    Publishing country United States
    Document type Review ; Journal Article
    ZDB-ID 1285505-4
    ISSN 1531-6971 ; 1070-5287 ; 1078-1641
    ISSN (online) 1531-6971
    ISSN 1070-5287 ; 1078-1641
    DOI 10.1097/MCP.0000000000001059
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  6. Article ; Online: A Patient With Type 1 Diabetes and Acute Rhinosinusitis.

    Machiavello Roman, Francisco J / Azar, Marwan M / Trubin, Paul A

    JAMA

    2024  

    Language English
    Publishing date 2024-04-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2958-0
    ISSN 1538-3598 ; 0254-9077 ; 0002-9955 ; 0098-7484
    ISSN (online) 1538-3598
    ISSN 0254-9077 ; 0002-9955 ; 0098-7484
    DOI 10.1001/jama.2024.0642
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  7. Article ; Online: Clinical outcomes of SARS-CoV-2 infection in kidney transplant recipients on belatacept: a single-center experience.

    Feller, Fionna / Azar, Marwan M / Marvin, Jennifer / Cohen, Elizabeth / Virmani, Sarthak / Malinis, Maricar

    Transplant infectious disease : an official journal of the Transplantation Society

    2024  Volume 26, Issue 2, Page(s) e14253

    MeSH term(s) Humans ; Abatacept/therapeutic use ; Kidney Transplantation/adverse effects ; COVID-19 ; SARS-CoV-2 ; Immunosuppressive Agents/adverse effects ; Transplant Recipients
    Chemical Substances Abatacept (7D0YB67S97) ; Immunosuppressive Agents
    Language English
    Publishing date 2024-02-13
    Publishing country Denmark
    Document type Letter
    ZDB-ID 1476094-0
    ISSN 1399-3062 ; 1398-2273
    ISSN (online) 1399-3062
    ISSN 1398-2273
    DOI 10.1111/tid.14253
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  8. Article ; Online: Laboratory Diagnosis for SARS-CoV-2 Infection.

    Christensen, Bianca B / Azar, Marwan M / Turbett, Sarah E

    Infectious disease clinics of North America

    2022  Volume 36, Issue 2, Page(s) 327–347

    Abstract: The optimal diagnostic test for SARS-CoV-2 infection should be selected based on a patient's clinical syndrome and presentation in relation to symptom onset. Molecular testing, most often reverse-transcriptase polymerase chain reaction, offers the ... ...

    Abstract The optimal diagnostic test for SARS-CoV-2 infection should be selected based on a patient's clinical syndrome and presentation in relation to symptom onset. Molecular testing, most often reverse-transcriptase polymerase chain reaction, offers the highest sensitivity and specificity during acute infection, whereas antigen testing can also be useful for acute diagnosis when rapid turnaround of results is necessary or if molecular testing is unavailable. Serologic testing is often reserved for identifying individuals with prior or late COVID-19 infection.
    MeSH term(s) COVID-19/diagnosis ; Humans ; Molecular Diagnostic Techniques ; SARS-CoV-2
    Language English
    Publishing date 2022-02-01
    Publishing country United States
    Document type Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 1077676-x
    ISSN 1557-9824 ; 0891-5520
    ISSN (online) 1557-9824
    ISSN 0891-5520
    DOI 10.1016/j.idc.2022.02.002
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  9. Article ; Online: Antiviral Treatment of Coronavirus Disease-2019 Pneumonia.

    Radcliffe, Christopher / Malinis, Maricar / Azar, Marwan M

    Clinics in chest medicine

    2022  Volume 44, Issue 2, Page(s) 279–297

    Abstract: Direct acting antivirals and monoclonal antibodies reduce morbidity and mortality associated with severe acute respiratory syndrome coronavirus 2 infection. Persons at higher risk for disease progression and hospitalized patients with coronavirus disease- ...

    Abstract Direct acting antivirals and monoclonal antibodies reduce morbidity and mortality associated with severe acute respiratory syndrome coronavirus 2 infection. Persons at higher risk for disease progression and hospitalized patients with coronavirus disease-2019 (COVID-19) benefit most from available therapies. Following an emphasis on inpatient treatment of COVID-19 during the early pandemic, several therapeutic options were developed for outpatients with COVID-19. Additional clinical trials and real-world studies are needed to keep pace with the evolving pandemic.
    MeSH term(s) Humans ; COVID-19 ; Antiviral Agents/therapeutic use ; Hepatitis C, Chronic ; Pneumonia ; Coronavirus
    Chemical Substances Antiviral Agents
    Language English
    Publishing date 2022-11-28
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 447455-7
    ISSN 1557-8216 ; 0272-5231
    ISSN (online) 1557-8216
    ISSN 0272-5231
    DOI 10.1016/j.ccm.2022.11.008
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  10. Article ; Online: Atypical pneumonia testing in transplant recipients.

    Feller, Fionna / Trubin, Paul / Malinis, Maricar / Vogel, Joshua S / Merwede, Jacob / Peaper, David R / Azar, Marwan M

    Transplant infectious disease : an official journal of the Transplantation Society

    2024  , Page(s) e14256

    Abstract: Background: The incidence of atypical pneumonia among immunocompromised patients is not well characterized. Establishing a diagnosis of atypical pneumonia is challenging as positive tests must be carefully interpreted. We aimed to assess the test ... ...

    Abstract Background: The incidence of atypical pneumonia among immunocompromised patients is not well characterized. Establishing a diagnosis of atypical pneumonia is challenging as positive tests must be carefully interpreted. We aimed to assess the test positivity rate and incidence of atypical pneumonia in transplant recipients.
    Methods: A retrospective cohort study was conducted at the Yale New Haven Health System in Connecticut. Adults with solid organ transplant, hematopoietic stem cell transplant (HSCT), or chimeric antigen receptor T-cell, who underwent testing for atypical pathogens of pneumonia (Legionella pneumophilia, Mycoplasma pneumoniae, Chlamydia pneumoniae, and Bordetella pertussis) between January 2016 and August 2022 were included. Positive results were adjudicated in a clinical context using pre-defined criteria. A cost analysis of diagnostic testing was performed.
    Results: Note that, 1021 unique tests for atypical pathogens of pneumonia were performed among 481 transplant recipients. The testing positivity rate was 0.7% (n = 7). After clinical adjudication, there were three cases of proven Legionella and one case of possible Mycoplasma infection. All cases of legionellosis were in transplant recipients within 1-year post-transplantation with recently augmented immunosuppression and lymphopenia. The possible case of Mycoplasma infection was in an HSCT recipient with augmented immunosuppression. The cost of all tests ordered was $50,797.73.
    Conclusion: The positivity rate of tests for atypical pneumonia was very low in this transplant cohort. An algorithmic approach that targets testing for those with compatible host, clinical, radiographic, and epidemiologic factors, and provides guidance on test selection and test interpretation, may improve the diagnostic yield and lead to substantial cost savings.
    Language English
    Publishing date 2024-03-02
    Publishing country Denmark
    Document type Journal Article
    ZDB-ID 1476094-0
    ISSN 1399-3062 ; 1398-2273
    ISSN (online) 1399-3062
    ISSN 1398-2273
    DOI 10.1111/tid.14256
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