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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
11

Estimating host species and spatial variation in infection with the fungal pathogen that causes snake fungal disease

Conley, Dane Alexander 14 December 2023 (has links)
Emerging wildlife diseases represent a serious threat to conservation efforts. Impacts of emerging multi-host pathogens can vary greatly among species as well as geographically, and understanding which populations will be at greatest risk is essential for conserving biodiversity. Snake fungal disease (SFD), caused by the fungal pathogen Ophidiomyces ophidiicola, is responsible for lethal infections in snakes and has contributed to the decline of multiple North American snake populations. However, which species are most affected by this disease and how infections vary regionally remains unknown. Here we sampled 44 different species across 14 sites throughout the Southeastern and Mid-Atlantic United States. We found a strong effect of latitude on both pathogen prevalence and severity, with more severe infections at more northern latitudes. We also found high variability in pathogen prevalence and infection severity among species. There was a strong positive relationship between pathogen prevalence and disease severity, suggesting that SFD is not just highly prevalent in some populations but also highly virulent. More broadly, our results support that SFD likely has continued impacts on snake populations with some species experiencing greater disease than others attributed to spatial and host variation. / Master of Science / Conserving biodiversity is a significant challenge. Wildlife species are under multiple threats including habitat loss, changing climate, species introductions, pollution, and infectious diseases. Emerging wildlife diseases can pose a major problem for wildlife as they often go undetected until they cause substantial declines for the affected species, sometimes leading to population extirpations and extinction events. Snake fungal disease (SFD) is an emerging disease caused by the fungal pathogen Ophidiomyces ophidiicola, which has contributed to the decline of some North American snake populations. However, little is known about differences in infection, transmission, and host responses to SFD in a broader community context. To investigate the dynamics of this pathogen, we collected swab samples from 44 species from a total of 14 sites in New Jersey, Virginia, North Carolina, South Carolina, Georgia, Florida, and Louisiana. We sampled individual snakes to examine variation over a geographic gradient and among species. We found high variability among sites with more severe disease at northern sites. There was also high variability among species and some populations experienced both high pathogen prevalence and disease severity. Our results show that SFD is highly variable within snake communities and may still be causing population level effects.
12

ENVIRONMENTAL ASSOCIATIONS OF OPHIDIOMYCES OPHIODIICOLA PRESENCE, THE CAUSITIVE AGENT OF SNAKE FUNGAL DISEASE

Nicholas Gerald Friedeman (12469515) 27 April 2022 (has links)
<p>  </p> <p>Emerging pathogenic fungi have become a topic of conservation concern due to declines seen in several host taxa. One newly emerging fungal pathogen, <em>Ophidiomyces ophiodiicola</em>, has been well documented as the causative agent of Snake Fungal Disease (SFD). SFD has been found in a variety of snake species across the United States, including the Eastern Massasauga (<em>Sistrurus catenatus</em>), a federally threatened rattlesnake species. Most work to date has involved detecting SFD for diagnosis of infection through direct sampling from snakes. Attempts to detect <em>O. ophiodiicola</em> in the environment to better understand its distribution, seasonality, and habitat associations are lacking. I collected topsoil and ground water samples from four macrohabitat types in northern Michigan at a site where SFD infection has been seen in Eastern Massasauga. I used a quantitative PCR (qPCR) assay targeting the internal transcribed spacer region (ITS) developed for diagnosis of SFD after extracting DNA from samples. <em>Ophidiomyces</em> DNA was successfully detected in topsoil, with minimal to no detection in groundwater samples. The frequency in which <em>Ophidiomyces</em> was detected in a sample did not differ between habitats, but samples grouped seasonally showed higher detection occurring during mid-summer. Investigation of the correlation of environmental parameters on <em>Ophidiomyces</em> occurrence recovered no relationships. Our data suggests that season has some effect on the presence of <em>Ophidiomyces</em>. Differences between habitats may exist but are likely more dependent on the time of sampling and currently uninvestigated soil parameters. These findings build on our understanding of <em>Ophidiomyces</em> ecology and epidemiology and inform where snakes like the Eastern Massasauga may be encountering the fungal pathogen. Furthermore, they assist with developing conservation practices aimed at reducing <em>O. ophiodiicola </em>exposure in imperiled snake species. </p>
13

INITIAL ASSESSMENT AND EFFECTS OF SNAKE FUNGAL DISEASE ON POPULATIONS OF SNAKES IN KENTUCKY

Mckenzie, Jennifer 01 January 2018 (has links)
Pathogenic fungi are increasingly associated with epidemics in wildlife populations and represent a significant threat to global biodiversity. Snake fungal disease is an emerging disease caused by the fungus, Ophidiomyces ophiodiicola, and appears to be widespread in the eastern United States. Yet an evaluation of field diagnostics, and an understanding of the population-level consequences of the disease, are lacking. First, I evaluated the use of clinical signs to predict the presence of O. ophiodiicola across season and snake habitat affiliation (aquatic or terrestrial) and I compared two sampling methods to see if collection method impacts PCR result. Overall, snakes with clinical signs had a higher probability of testing positive regardless of season or habitat association. However, terrestrial snakes had a lower overall probability of testing positive for O. ophiodiicola compared to aquatic snakes. I found no significant difference between sampling methods. Second, I used Passive Integrated Transponder (PIT) telemetry, and multistate capture-mark-recapture modelling to determine if SFD affects the short-term survival, movement, and behavior of wild snakes. I found no difference in short-term survival for snakes with SFD. Snakes with SFD spend more time surface-active and have lower permanent emigration and temporary immigration rates than snakes without SFD.
14

Prey availability and snake fungal disease as drivers of timber rattlesnake habitat selection across multiple spatial scales

Tutterow, Annalee McCulloh January 2020 (has links)
No description available.
15

Host-pathogen interactions and conservation implications of snake fungal disease over broad geographical scales

Blanvillain, Gaelle Jh 27 June 2024 (has links)
Emerging infectious diseases represent a threat to biodiversity, posing significant challenges to wildlife conservation globally. Infectious diseases can cause population declines, local extirpations and, in rare cases, complete species extinction. Among emerging pathogens, pathogenic fungi have been responsible for drastic declines in several high-profile vertebrate taxa, such as Batrachochytrium dendrobatidis causing chytridiomycosis in many species of amphibians worldwide. Recently, an emerging infectious disease, 'snake fungal disease' (SFD), caused by the fungal pathogen Ophidiomyces ophidiicola, is affecting the health of snake populations in North America by causing skin infections which can be fatal. Given the potential impact of this disease on snake biodiversity worldwide, compounded by the pressure of anthropogenic stressors that already jeopardize the viability of many snake populations, there is a clear need for ecological research in this understudied system. This dissertation is comprised of 4 data chapters focusing on the disease dynamics of snake fungal disease in Europe, and the factors resulting in differential infection. In chapter 2, I develop a large field-based data collection in 10 countries in Europe to investigate the presence of disease hotspots and the variation of disease prevalence across host species, and to examine the pathogen genotypes that are present on the landscape. I found isolated areas of disease hotspots, and models including an interactive effect of host species and which pathogen clade are present on the landscape were best at explaining disease prevalence. In chapter 3, I perform a virulence challenge assay using 120 corn snakes (Pantherophis guttatus) and 7 strains of O. ophidiicola (3 collected from Europe, 4 from the USA). This experiment reveals that pathogen genotypes associated with higher disease prevalence in Europe also have higher pathogen virulence, and that different strains from the USA show variation in virulence. These results also match both physiological host responses measured in the lab and landscape patterns of disease. In chapter 4, I explore two mitigation-driven snake translocation projects in Europe that were complicated due to O. ophidiicola outbreaks. One snake species, N. tessellata, appears highly susceptible to SFD, indicating that under stressful conditions, O. ophidiicola can cause mortality regardless of pathogen genotype, and that this snake species may be important in pathogen maintenance. Finally in chapter 5, I report the presence of a different fungal pathogen in Spain, Parannannizziopsis sp., never reported in wild snakes in Europe before. Broadly, my dissertation demonstrates coevolutionary relationships between hosts and pathogens and has important implications to snake conservation over large scales. / Doctor of Philosophy / Biodiversity conservation is under significant threat globally due to the ever-growing human population. Threats such as habitat loss, climate change, pollution and infectious diseases are all important factors that are affecting wildlife populations. Snakes, and specifically infectious diseases of snakes, have been understudied compared to that of other types of wildlife in Europe. My dissertation focuses on understanding the disease ecology and conservation implications of snake fungal disease, an infectious disease that can be life-threatening to snakes. I first developed a study of this disease in multiple countries over three years to understand how common the disease is across the landscape, which species of snakes are most infected, and how severe skin infections are. I found specific areas in Europe where disease prevalence is high and attributed these higher disease areas to specific snake species and fungal strains that interact together to cause higher infection rates (chapter 2). Secondly, I designed a controlled experimental study in the laboratory to test the capacity of different pathogenic strains, collected in Europe and the USA, to harm its host. I chose a single host species, the corn snake (Pantherophis guttatus) to test this question. I found that different pathogen strains vary in their ability to cause severe disease, and these results were confirmed with field observations. I also found that one strain collected from coastal Virginia is able to cause more severe disease when compared to all other strains (chapter 3). Finally, I found that under captive stress, strains that might not be able to cause severe disease in the wild can lead to snake mortality, specifically in one snake species that might be more susceptible than others (chapter 4). Broadly, this dissertation describes complex interactions between snakes and fungal pathogens and has relevance to reptile conservation.
16

The Effect Of Virus Induced Gene Silencing Of Fas Associated Factor1 In Blumeria Graminis Infected Barley

Bozhanaj, Kreshnik 01 October 2009 (has links) (PDF)
Cereal loss due to fungal pathogens is an ongoing setback in agriculture. Elucidating plant&rsquo / s resistance and susceptibility mechanisms against these cereal killers, promises progress in agriculture. In the way of understanding barley resistance against fungus Blumeria Graminis we silenced FAS-Associated Factor 1 (FAF1) gene in its mRNA level with Virus Induced Gene Silencing (VIGS) technique. Previous research in our lab had shown an augmentation in mRNA levels of FAF1 gene in fungus infected wheat, suggesting a role of this gene in the resistance mechanism. We hypothesized that the apoptotic role of FAF1 protein in metazoan is conserved in plants by including FAF1 as a factor in hypersensitive response. Barley lines Pallas01 and Pallas03 which are respectively resistant and susceptible against fungus Blumeria graminis hordei 103 (Bgh103) were used for fungal inoculations after FAF1 silencing, to test if the hypersensitive response against fungus Bgh103 was prevented. In this aspect the formation of death lesions on the Pallas01 leaf due to fungal resistance was not prevented demonstrating that FAF1 silencing with VIGS in the resistant Pallas01 line of barley is not sufficient to stop apoptosis. On the other hand the FAF1-silenced barley susceptible line Pallas03 became more sensitive to fungal stress based on conidia (body part of the fungus) counting after trypan blue staining of the infected leaves. In the C-terminus of FAF1 an ubiquitin like domain-X (UBX) is found, which is the cause of stress sensitivity based on the reported data obtained about this domain&rsquo / s loss of function in other proteins. These results suggest that FAF1 is a catalyst in the hypersensitive response and its loss of function makes barley more susceptible to fungal stress. On the other hand a short mRNA homology was found among FAF1 and many pathogen disease related proteins making this homology a possible target site for VIGS of FAF1 generated siRNAs, which might cause some other protein to be responsible for the barley susceptibility against the fungus.
17

Native Valve Candida Metapsilosis Endocarditis Following a Ruptured Appendix: A Case Report

Sanku, Koushik, Youssef, Dima 01 January 2022 (has links)
complex has been further divided into , , and . is considered to be the least virulent fungi of the complex. Candida endocarditis is uncommon but is associated with a very high mortality rate. Prosthetic or previously damaged valves act as common targets, but native, structurally normal valves are seldom affected. We hereby present a case of endocarditis involving a native aortic valve in an immunocompetent 55-year-old male who was successfully treated with surgical valve replacement and antifungal therapy.
18

Patossistema caupi X Macrophomina phaseolina: método de detecção em sementes, esporulação e controle do patógeno. / The pathosystem cowpea x Macrophomina phaseolina: detection in seeds, esporulation and pathogen control.

Athayde Sobrinho, Candido 14 January 2005 (has links)
Apesar da espécie Vigna unguiculata (L.) Walp. ser bastante rústica e estar adaptada às condições adversas de clima e solo brasileiros, seu rendimento é muito baixo. Diversas causas têm sido levantadas para explicar esse comportamento; entre elas destacam-se as doenças fúngicas, sobretudo aquelas cujos patógenos são transmitidos por sementes, em especial a podridão cinzenta do caule, causada por Macrophomina phaseolina (Tassi) Goid. A abordagem analítica desse patossistema revelou alguns problemas emergentes. Entre eles, destacam-se: a) desconhecimento da qualidade sanitária das sementes de caupi, utilizadas para semeadura; b) desunifomidade na metodologia usada para detectar os patógenos presentes nas semente; c) dificuldade na esporulação do patógeno, máxime de alguns isolados reticentes em esporular em meios artificiais de cultivo, cujo comportamento dificulta os trabalhos de seleção de genótipos resistentes; d) carência de medidas de controle do patógeno, que empreguem práticas naturais, como uso de sementes sadias, de indutores de resistência e de cultivares resistentes, de fácil uso e passível de adoção por parte dos produtores. Na estruturação da matriz lógica do presente estudo, referidos problemas foram transformados em objetivos. Os trabalhos foram conduzidos no Departamento de Entomologia, Fitopatologia e Zoologia Agrícola da ESALQ/USP, em Piracicaba-SP. Os resultados indicaram o teste de sanidade de sementes de caupi empregando o método do papel de filtro com restrição hídrica utilizando NaCl a -0,8Mpa, como o mais adequado para detecção dos fungos presentes nas sementes de caupi, especialmente M. phaseolina. A análise sanitária das amostras de sementes originadas de vários estados brasileiros revelou que, em 62% das amostras analisadas, o fungo M. phaseolina estava presente, sendo as amostras originadas do estado da Paraíba, Piauí, Pará e Bahia as que apresentaram maiores níveis de incidência do patógeno. Os melhores níveis de esporulação do patógeno foram conseguidos com a combinação de sobreposição de discos de folhas de trigo ao meio BDA, com temperatura de 25oC. Quanto à identificação de indutores de resistência, capazes de controlar M. phaseolina, os resultados revelaram que o acibenzolar-S-metil (ASM) foi o mais eficiente, quando comparado com quitosana e com um produto silicatado derivado de rocha micronizada (PSiM), apresentando um controle residual por mais de 40 dias após a semeadura. A maior eficiência verificada pelo ASM ocorreu devido a sua capacidade de ativar mecanismos bioquímicos de defesa, configurando-se em efetivo ativador da resistência induzida nas plantas de caupi, por atuar na cinética de importantes enzimas relacionadas à defesa, como a fenilalanina amônia-liase, peroxidase e quitinase. Quanto à reação de cultivares de caupi à doença, foi possível verificar razoável nível de resistência de algumas cultivares, tendo sido consideradas resistentes Mulato, Guariba e Maratauã. / Notwithstanding the specie Vigna unguiculata (L.) Walp is sufficiently rustic and adapted to the adverse conditions of the Brazilian soil and climate, its improvement is very low. Many causes have been raised in order to explain such behavior; among them the fungal diseases stand out, over all those whose pathogens are transmitted by the seeds especially the charcoal rot disease caused by Macrophomina phaseolina (Tassi) Goid. The analytical approach of such pathosystem has revealed some emerging problems. Among them, it stands out: a) the ignorance of the sanitary quality of the cowpea seeds used for sowing; b) the non-uniformity in the used methodology in order to detect the pathogens, which are present in the seed; c) the difficult in pathogen sporulation, principally of some isolated reticent in forming spores in cultivation artificial environments whose behavior hampers the selection works of the resistant genotypes; d) lack of pathogen control measures, which utilize natural practices, such as the use of healthy seeds, resistance inducers and resistant cultivars of easy utilization and liable to adoption by the producers. In structuring the logical matrix of this study, such problems were transformed into objectives. The works were conducted at the Entomology, Phytopathology and Agricultural Zoology Departments of ESALQ/USP, in Piracicaba-SP. The results have pointed out the sanity test of the cowpea seeds through the method of filter paper with hydric restriction using NaCI - 0,8Mpa, as the most suitable for detecting the current fungus in cowpea seeds, especially M. phaseolina. The sanitary analysis of the seeds samples originated from several Brazilian states has revealed that in 63% of the analyzed samples, the fungus M. phaseolina was present, and the samples originated from the states of Paraíba, Piauí, Pará and Bahia were those that have presented higher incident levels of pathogen. The best levels of sporulation were obtained with the combination of the superposition of wheat leaves disks in the middle of BDA in 25ºC. As to the identification of the resistance inducers, capable of controlling the M. phaseolina, the results have revealed that the acinbezolar-S-methyl (ASM) was more efficient when compared to chitosan and with a silicate product originated from micronized rock (PsiM), presenting a residual control for more than 40 days after the sowing. The greatest efficiency ascertained by ASM has occurred due to its capacity of activate the defense biochemistries mechanisms, forming itself in an activator effect of the induced resistance in cowpea plants because it acts in the kinetic of important enzymes related to the defense, such as the phenylalanine ammonia-lyase, peroxidase and chitinase. As to the cowpea cultivars reaction to the disease, it was possible to ascertain a reasonable resistance level of some cultivars, and BR 14 Mulato, Guariba e Maratauã were considered as resistant.
19

Patossistema caupi X Macrophomina phaseolina: método de detecção em sementes, esporulação e controle do patógeno. / The pathosystem cowpea x Macrophomina phaseolina: detection in seeds, esporulation and pathogen control.

Candido Athayde Sobrinho 14 January 2005 (has links)
Apesar da espécie Vigna unguiculata (L.) Walp. ser bastante rústica e estar adaptada às condições adversas de clima e solo brasileiros, seu rendimento é muito baixo. Diversas causas têm sido levantadas para explicar esse comportamento; entre elas destacam-se as doenças fúngicas, sobretudo aquelas cujos patógenos são transmitidos por sementes, em especial a podridão cinzenta do caule, causada por Macrophomina phaseolina (Tassi) Goid. A abordagem analítica desse patossistema revelou alguns problemas emergentes. Entre eles, destacam-se: a) desconhecimento da qualidade sanitária das sementes de caupi, utilizadas para semeadura; b) desunifomidade na metodologia usada para detectar os patógenos presentes nas semente; c) dificuldade na esporulação do patógeno, máxime de alguns isolados reticentes em esporular em meios artificiais de cultivo, cujo comportamento dificulta os trabalhos de seleção de genótipos resistentes; d) carência de medidas de controle do patógeno, que empreguem práticas naturais, como uso de sementes sadias, de indutores de resistência e de cultivares resistentes, de fácil uso e passível de adoção por parte dos produtores. Na estruturação da matriz lógica do presente estudo, referidos problemas foram transformados em objetivos. Os trabalhos foram conduzidos no Departamento de Entomologia, Fitopatologia e Zoologia Agrícola da ESALQ/USP, em Piracicaba-SP. Os resultados indicaram o teste de sanidade de sementes de caupi empregando o método do papel de filtro com restrição hídrica utilizando NaCl a –0,8Mpa, como o mais adequado para detecção dos fungos presentes nas sementes de caupi, especialmente M. phaseolina. A análise sanitária das amostras de sementes originadas de vários estados brasileiros revelou que, em 62% das amostras analisadas, o fungo M. phaseolina estava presente, sendo as amostras originadas do estado da Paraíba, Piauí, Pará e Bahia as que apresentaram maiores níveis de incidência do patógeno. Os melhores níveis de esporulação do patógeno foram conseguidos com a combinação de sobreposição de discos de folhas de trigo ao meio BDA, com temperatura de 25oC. Quanto à identificação de indutores de resistência, capazes de controlar M. phaseolina, os resultados revelaram que o acibenzolar-S-metil (ASM) foi o mais eficiente, quando comparado com quitosana e com um produto silicatado derivado de rocha micronizada (PSiM), apresentando um controle residual por mais de 40 dias após a semeadura. A maior eficiência verificada pelo ASM ocorreu devido a sua capacidade de ativar mecanismos bioquímicos de defesa, configurando-se em efetivo ativador da resistência induzida nas plantas de caupi, por atuar na cinética de importantes enzimas relacionadas à defesa, como a fenilalanina amônia-liase, peroxidase e quitinase. Quanto à reação de cultivares de caupi à doença, foi possível verificar razoável nível de resistência de algumas cultivares, tendo sido consideradas resistentes Mulato, Guariba e Maratauã. / Notwithstanding the specie Vigna unguiculata (L.) Walp is sufficiently rustic and adapted to the adverse conditions of the Brazilian soil and climate, its improvement is very low. Many causes have been raised in order to explain such behavior; among them the fungal diseases stand out, over all those whose pathogens are transmitted by the seeds especially the charcoal rot disease caused by Macrophomina phaseolina (Tassi) Goid. The analytical approach of such pathosystem has revealed some emerging problems. Among them, it stands out: a) the ignorance of the sanitary quality of the cowpea seeds used for sowing; b) the non-uniformity in the used methodology in order to detect the pathogens, which are present in the seed; c) the difficult in pathogen sporulation, principally of some isolated reticent in forming spores in cultivation artificial environments whose behavior hampers the selection works of the resistant genotypes; d) lack of pathogen control measures, which utilize natural practices, such as the use of healthy seeds, resistance inducers and resistant cultivars of easy utilization and liable to adoption by the producers. In structuring the logical matrix of this study, such problems were transformed into objectives. The works were conducted at the Entomology, Phytopathology and Agricultural Zoology Departments of ESALQ/USP, in Piracicaba-SP. The results have pointed out the sanity test of the cowpea seeds through the method of filter paper with hydric restriction using NaCI – 0,8Mpa, as the most suitable for detecting the current fungus in cowpea seeds, especially M. phaseolina. The sanitary analysis of the seeds samples originated from several Brazilian states has revealed that in 63% of the analyzed samples, the fungus M. phaseolina was present, and the samples originated from the states of Paraíba, Piauí, Pará and Bahia were those that have presented higher incident levels of pathogen. The best levels of sporulation were obtained with the combination of the superposition of wheat leaves disks in the middle of BDA in 25ºC. As to the identification of the resistance inducers, capable of controlling the M. phaseolina, the results have revealed that the acinbezolar-S-methyl (ASM) was more efficient when compared to chitosan and with a silicate product originated from micronized rock (PsiM), presenting a residual control for more than 40 days after the sowing. The greatest efficiency ascertained by ASM has occurred due to its capacity of activate the defense biochemistries mechanisms, forming itself in an activator effect of the induced resistance in cowpea plants because it acts in the kinetic of important enzymes related to the defense, such as the phenylalanine ammonia-lyase, peroxidase and chitinase. As to the cowpea cultivars reaction to the disease, it was possible to ascertain a reasonable resistance level of some cultivars, and BR 14 Mulato, Guariba e Maratauã were considered as resistant.
20

Infectious and bleeding complications in patients with hematological malignancies : Studies on diagnosis and prevention

Svensson, Tobias January 2017 (has links)
The overall aim of this thesis is to improve knowledge about the prevention of infectious and bleeding complications in patients with hematological malignancies, primarily in those with chronic lymphocytic leukemia (CLL) and myelodysplatic syndrome (MDS). Hypogammaglobulinemia, impaired production of immunoglobulins (Ig), is an established risk factor for infection, but the impact of IgG pure subclass deficiency (IgG subclass deficiency with adequate production of IgG, IgA, and IgM) has been debated. In a retrospective single institution study, we concluded that pure IgG subclass deficiency in CLL patients is rare and is not associated with an increased risk of infection. Hence, routine analysis of IgG subclasses in patients with CLL is not warranted. There is no consensus on recommending vaccination against Streptococcus pneumoniae to CLL patients mainly because comparative studies are lacking. In our randomized trial, the efficacy of a conjugated pneumococcal vaccine on immune response was superior or equal to a polysaccharide vaccine for all pneumococcal serotypes common for the two vaccines. A conjugate pneumococcal vaccine should therefore be included in vaccination programs for patients with CLL. Bronchoalveolar lavage (BAL) is a well-established invasive method to identify the cause of pulmonary infiltrates in immunocompromised patients. In a retrospective trial, we have studied the diagnostic yield of BAL in patients with hematological malignancies. We concluded that BAL is highly useful in either verifying or excluding some of the important respiratory tract infections affecting these patients, particularly invasive pulmonary aspergillosis (IPA) and Pneumocystis jirovecii pneumonia (PJP). However, standardized procedures for BAL sampling should be continually revised to avoid unnecessary microbiological tests. Thrombocytopenia, an adverse prognostic factor in patients with MDS, can be aggravated by azacitidine, first-line treatment for high-risk MDS. Eltrombopag, a thrombopoietin-receptor agonist (TPO-R), alleviates thrombocytopenia in patients with immune thrombocytopenic purpura (ITP). In a phase I clinical trial, we concluded that the combination of eltrombopag and azacitidine in high-risk MDS patients with thrombocytopenia is feasible and well tolerated in doses up to 200 mg eltrombopag daily.

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