Browsing by Author "Schwartz, Ilan S"

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Open Access
Black Box Warning: Large Language Models and the Future of Infectious Diseases Consultation.
(Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2023-11) Schwartz, Ilan S; Link, Katherine E; Daneshjou, Roxana; Cortés-Penfield, Nicolás
Large language models (LLMs) are artificial intelligence systems trained by deep learning algorithms to process natural language and generate text responses to user prompts. Some approach physician performance on a range of medical challenges, leading some proponents to advocate for their potential use in clinical consultation and prompting some consternation about the future of cognitive specialties. However, LLMs currently have limitations that preclude safe clinical deployment in performing specialist consultations, including frequent confabulations, lack of contextual awareness crucial for nuanced diagnostic and treatment plans, inscrutable and unexplainable training data and methods, and propensity to recapitulate biases. Nonetheless, considering the rapid improvement in this technology, growing calls for clinical integration, and healthcare systems that chronically undervalue cognitive specialties, it is critical that infectious diseases clinicians engage with LLMs to enable informed advocacy for how they should-and shouldn't-be used to augment specialist care.
Open Access
Blastomyces helicus, a New Dimorphic Fungus Causing Fatal Pulmonary and Systemic Disease in Humans and Animals in Western Canada and the United States.
(Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2019-01) Schwartz, Ilan S; Wiederhold, Nathan P; Hanson, Kimberly E; Patterson, Thomas F; Sigler, Lynne
Background
Blastomyces helicus (formerly Emmonsia helica) is a dimorphic fungus first isolated from a man with fungal encephalitis in Alberta, Canada. The geographic range, epidemiology, and clinical features of disease are unknown.
Methods
We reviewed human and veterinary isolates of B. helicus identified among Blastomyces and Emmonsia isolates at the University of Alberta Microfungus Collection and Herbarium, University of Texas Health San Antonio's Fungus Testing Laboratory, and Associated Regional and University Pathologists Laboratories. Isolates were selected based on low Blastomyces dermatitidis DNA probe values and/or atypical morphology. Species identification was confirmed for most isolates by DNA sequence analysis of the internal transcribed spacer with or without D1/D2 ribosomal RNA regions. Epidemiological and clinical data were analyzed.
Results
We identified isolates from 10 human and 5 veterinary cases of B. helicus infection; all were referred from western regions of Canada and the United States. Isolates remained sterile in culture, producing neither conidia nor sexual spores in the mycelial phase, but often producing coiled hyphae. Isolates were most frequently cultured from blood and bronchoalveolar lavage in humans and lungs in animals. Most infected persons were immunocompromised. Histopathological findings included pleomorphic, small or variably sized yeast-like cells, with single or multiple budding, sometimes proliferating to form short, branching, hyphal-like elements. Disease carried a high case-fatality rate.
Conclusions
Blastomyces helicus causes fatal pulmonary and systemic disease in humans and companion animals. It differs from B. dermatitidis in morphological presentation in culture and in histopathology, by primarily affecting immunocompromised persons, and in a geographic range that includes western regions of North America.
Open Access
Coronavirus Disease 2019-Associated Invasive Fungal Infection.
(Open forum infectious diseases, 2021-12) Baddley, John W; Thompson, George R; Chen, Sharon C-A; White, P Lewis; Johnson, Melissa D; Nguyen, M Hong; Schwartz, Ilan S; Spec, Andrej; Ostrosky-Zeichner, Luis; Jackson, Brendan R; Patterson, Thomas F; Pappas, Peter G
Coronavirus disease 2019 (COVID-19) can become complicated by secondary invasive fungal infections (IFIs), stemming primarily from severe lung damage and immunologic deficits associated with the virus or immunomodulatory therapy. Other risk factors include poorly controlled diabetes, structural lung disease and/or other comorbidities, and fungal colonization. Opportunistic IFI following severe respiratory viral illness has been increasingly recognized, most notably with severe influenza. There have been many reports of fungal infections associated with COVID-19, initially predominated by pulmonary aspergillosis, but with recent emergence of mucormycosis, candidiasis, and endemic mycoses. These infections can be challenging to diagnose and are associated with poor outcomes. The reported incidence of IFI has varied, often related to heterogeneity in patient populations, surveillance protocols, and definitions used for classification of fungal infections. Herein, we review IFI complicating COVID-19 and address knowledge gaps related to epidemiology, diagnosis, and management of COVID-19-associated fungal infections.
Open Access
Diagnosis of Breakthrough Fungal Infections in the Clinical Mycology Laboratory: An ECMM Consensus Statement.
(Journal of fungi (Basel, Switzerland), 2020-10) Jenks, Jeffrey D; Gangneux, Jean-Pierre; Schwartz, Ilan S; Alastruey-Izquierdo, Ana; Lagrou, Katrien; Thompson Iii, George R; Lass-Flörl, Cornelia; Hoenigl, Martin; European Confederation of Medical Mycology (ECMM) Council Investigators
Breakthrough invasive fungal infections (bIFI) cause significant morbidity and mortality. Their diagnosis can be challenging due to reduced sensitivity to conventional culture techniques, serologic tests, and PCR-based assays in patients undergoing antifungal therapy, and their diagnosis can be delayed contributing to poor patient outcomes. In this review, we provide consensus recommendations on behalf of the European Confederation for Medical Mycology (ECMM) for the diagnosis of bIFI caused by invasive yeasts, molds, and endemic mycoses, to guide diagnostic efforts in patients receiving antifungals and support the design of future clinical trials in the field of clinical mycology. The cornerstone of lab-based diagnosis of breakthrough infections for yeast and endemic mycoses remain conventional culture, to accurately identify the causative pathogen and allow for antifungal susceptibility testing. The impact of non-culture-based methods are not well-studied for the definite diagnosis of breakthrough invasive yeast infections. Non-culture-based methods have an important role for the diagnosis of breakthrough invasive mold infections, in particular invasive aspergillosis, and a combination of testing involving conventional culture, antigen-based assays, and PCR-based assays should be considered. Multiple diagnostic modalities, including histopathology, culture, antibody, and/or antigen tests and occasionally PCR-based assays may be required to diagnose breakthrough endemic mycoses. A need exists for diagnostic tests that are effective, simple, cheap, and rapid to enable the diagnosis of bIFI in patients taking antifungals.
Open Access
Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management.
(Clinical microbiology reviews, 2023-07) Thompson, George R; Jenks, Jeffrey D; Baddley, John W; Lewis, James S; Egger, Matthias; Schwartz, Ilan S; Boyer, Johannes; Patterson, Thomas F; Chen, Sharon C-A; Pappas, Peter G; Hoenigl, Martin
Fungal endocarditis accounts for 1% to 3% of all infective endocarditis cases, is associated with high morbidity and mortality (>70%), and presents numerous challenges during clinical care. Candida spp. are the most common causes of fungal endocarditis, implicated in over 50% of cases, followed by Aspergillus and Histoplasma spp. Important risk factors for fungal endocarditis include prosthetic valves, prior heart surgery, and injection drug use. The signs and symptoms of fungal endocarditis are nonspecific, and a high degree of clinical suspicion coupled with the judicious use of diagnostic tests is required for diagnosis. In addition to microbiological diagnostics (e.g., blood culture for Candida spp. or galactomannan testing and PCR for Aspergillus spp.), echocardiography remains critical for evaluation of potential infective endocarditis, although radionuclide imaging modalities such as ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography are increasingly being used. A multimodal treatment approach is necessary: surgery is usually required and should be accompanied by long-term systemic antifungal therapy, such as echinocandin therapy for Candida endocarditis or voriconazole therapy for Aspergillus endocarditis.
Open Access
Global guideline for the diagnosis and management of candidiasis: an initiative of the ECMM in cooperation with ISHAM and ASM
(The Lancet Infectious Diseases, 2025-02) Cornely, Oliver A; Sprute, Rosanne; Bassetti, Matteo; Chen, Sharon C-A; Groll, Andreas H; Kurzai, Oliver; Lass-Flörl, Cornelia; Ostrosky-Zeichner, Luis; Rautemaa-Richardson, Riina; Revathi, Gunturu; Santolaya, Maria E; White, P Lewis; Alastruey-Izquierdo, Ana; Arendrup, Maiken C; Baddley, John; Barac, Aleksandra; Ben-Ami, Ronen; Brink, Adrian J; Grothe, Jan H; Guinea, Jesus; Hagen, Ferry; Hochhegger, Bruno; Hoenigl, Martin; Husain, Shahid; Jabeen, Kauser; Jensen, Henrik E; Kanj, Souha S; Koehler, Philipp; Lehrnbecher, Thomas; Lewis, Russell E; Meis, Jacques F; Nguyen, M Hong; Pana, Zoi D; Rath, Peter-Michael; Reinhold, Ilana; Seidel, Danila; Takazono, Takahiro; Vinh, Donald C; Zhang, Sean X; Afeltra, Javier; Al-Hatmi, Abdullah MS; Arastehfar, Amir; Arikan-Akdagli, Sevtap; Bongomin, Felix; Carlesse, Fabianne; Chayakulkeeree, Methee; Chai, Louis YA; Chamani-Tabriz, Leili; Chiller, Tom; Chowdhary, Anuradha; Clancy, Cornelius J; Colombo, Arnaldo L; Cortegiani, Andrea; Corzo Leon, Dora E; Drgona, Lubos; Dudakova, Anna; Farooqi, Joveria; Gago, Sara; Ilkit, Macit; Jenks, Jeffrey D; Klimko, Nikolai; Krause, Robert; Kumar, Anil; Lagrou, Katrien; Lionakis, Michail S; Lmimouni, Badre E; Mansour, Michael K; Meletiadis, Joseph; Mellinghoff, Sibylle C; Mer, Mervyn; Mikulska, Malgorzata; Montravers, Philippe; Neoh, Chin Fen; Ozenci, Volkan; Pagano, Livio; Pappas, Peter; Patterson, Thomas F; Puerta-Alcalde, Pedro; Rahimli, Laman; Rahn, Sebastian; Roilides, Emmanuel; Rotstein, Coleman; Ruegamer, Tamara; Sabino, Raquel; Salmanton-García, Jon; Schwartz, Ilan S; Segal, Esther; Sidharthan, Neeraj; Singhal, Tanu; Sinko, Janos; Soman, Rajeev; Spec, Andrej; Steinmann, Joerg; Stemler, Jannik; Taj-Aldeen, Saad J; Talento, Alida Fe; Thompson, George R; Toebben, Christina; Villanueva-Lozano, Hiram; Wahyuningsih, Retno; Weinbergerová, Barbora; Wiederhold, Nathan; Willinger, Birgit; Woo, Patrick CY; Zhu, Li-Ping
Open Access
Global guideline for the diagnosis and management of the endemic mycoses: an initiative of the European Confederation of Medical Mycology in cooperation with the International Society for Human and Animal Mycology.
(The Lancet. Infectious diseases, 2021-12) Thompson, George R; Le, Thuy; Chindamporn, Ariya; Kauffman, Carol A; Alastruey-Izquierdo, Ana; Ampel, Neil M; Andes, David R; Armstrong-James, Darius; Ayanlowo, Olusola; Baddley, John W; Barker, Bridget M; Lopes Bezerra, Leila; Buitrago, Maria J; Chamani-Tabriz, Leili; Chan, Jasper FW; Chayakulkeeree, Methee; Cornely, Oliver A; Cunwei, Cao; Gangneux, Jean-Pierre; Govender, Nelesh P; Hagen, Ferry; Hedayati, Mohammad T; Hohl, Tobias M; Jouvion, Grégory; Kenyon, Chris; Kibbler, Christopher C; Klimko, Nikolai; Kong, David CM; Krause, Robert; Lee Lee, Low; Meintjes, Graeme; Miceli, Marisa H; Rath, Peter-Michael; Spec, Andrej; Queiroz-Telles, Flavio; Variava, Ebrahim; Verweij, Paul E; Schwartz, Ilan S; Pasqualotto, Alessandro C
The global burden of the endemic mycoses (blastomycosis, coccidioidomycosis, emergomycosis, histoplasmosis, paracoccidioidomycosis, sporotrichosis, and talaromycosis) continues to rise yearly and these infectious diseases remain a leading cause of patient morbidity and mortality worldwide. Management of the associated pathogens requires a thorough understanding of the epidemiology, risk factors, diagnostic methods and performance characteristics in different patient populations, and treatment options unique to each infection. Guidance on the management of these infections has the potential to improve prognosis. The recommendations outlined in this Review are part of the "One World, One Guideline" initiative of the European Confederation of Medical Mycology. Experts from 23 countries contributed to the development of these guidelines. The aim of this Review is to provide an up-to-date consensus and practical guidance in clinical decision making, by engaging physicians and scientists involved in various aspects of clinical management.

Browsing by Author "Schwartz, Ilan S"

Background

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