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Der Internist Jul 2019Invasive aspergillosis, mucormycosis, and cryptococcosis are severe opportunistic infections in patients with long phases of neutropenia and also after allogeneic stem... (Review)
Review
BACKGROUND
Invasive aspergillosis, mucormycosis, and cryptococcosis are severe opportunistic infections in patients with long phases of neutropenia and also after allogeneic stem cell and organ transplantation. Due to the late appearance of clinical signs and the often poor outcome, these diseases require special attention and proactive interventions.
MATERIAL AND METHODS
Published guidelines and selected current literature were reviewed for this article.
RESULTS
Invasive aspergillosis and mucormycosis are typically observed in the upper and lower airways of severely immunocompromized patients. When invasive fungal diseases are suspected, sectional imaging and, if possible, serological testing should be performed as soon as possible. If imaging or serological tests confirm the suspected diagnosis, pre-emptive antimycotic treatment should be started and further confirmation of the diagnosis sought via microbiological and/or histological investigations. Treatment depends on comedication, comorbidity and risk factors, primarily with voriconazole, isavuconazole and liposomal amphotericin B. With the advent of antiretroviral treatment, a decrease of cryptococcosis cases in people with human immunodeficiency virus was observed; however, increasing cases have been reported in patients with new forms of immunosuppression. Cryptococcus spp. predominantly cause central nervous system infections but also pneumonia and bloodstream infections. Diagnostics include blood and cerebrospinal fluid cultures and antigen tests. First line treatment consists of a combination therapy with amphotericin B and flucytosine.
CONCLUSION
An interdisciplinary approach with microbiologists, infectious diseases specialists and radiologists is needed for diagnostics and treatment of invasive fungal diseases.
Topics: Antifungal Agents; Aspergillosis; Humans; Mucormycosis; Mycoses; Neutropenia; Opportunistic Infections
PubMed: 31119309
DOI: 10.1007/s00108-019-0618-3 -
Methods in Molecular Biology (Clifton,... 2017The detection of fungal elements and their characterization in patient specimens provides fundamental information. On histological sections fungi are most frequently...
The detection of fungal elements and their characterization in patient specimens provides fundamental information. On histological sections fungi are most frequently seen on skin or mucosal surfaces or as mycotic thrombi or emboli that can occlude both arteries and veins in surgical specimen from immunocompromised patients or tissues obtained from autopsies. Microbial culture continues to be the central method for diagnosing fungal infection but is complemented by histomorphology using specific stains capable of identifying previously unsuspected fungal infections or for evaluating tissue invasion. These stains employ oxidizing reagents to create aldehyde binding sites on polysaccharides (1,2-glycol groups) of fungal cell walls for either Schiff's reagent or Silver ions. Gomori methenamine silver (GMS) and Periodic acid-Schiff (PAS) or their modifications are the most commonly used for tissue sections and in cytology specimens.
Topics: Humans; Mycoses; Staining and Labeling; Tissue Embedding
PubMed: 27837504
DOI: 10.1007/978-1-4939-6515-1_9 -
Trends in Parasitology Oct 2021
Topics: Batrachochytrium; Classification; Mycoses
PubMed: 34023213
DOI: 10.1016/j.pt.2021.04.014 -
Nature Microbiology Jul 2017
Topics: Biomedical Research; Capital Financing; Food Supply; Global Health; Health Policy; Humans; Mycoses; Neglected Diseases; Plant Diseases
PubMed: 28741610
DOI: 10.1038/nmicrobiol.2017.120 -
Annals of the American Thoracic Society Oct 2021
Topics: Antifungal Agents; Humans; Mycoses
PubMed: 33901407
DOI: 10.1513/AnnalsATS.202103-300LE -
Indian Journal of Medical Microbiology 2023Patients with hematologic malignancies (HM) carries a significant risk of developing invasive fungal infection (IFI) and are associated with a high risk of attributable... (Review)
Review
BACKGROUND
Patients with hematologic malignancies (HM) carries a significant risk of developing invasive fungal infection (IFI) and are associated with a high risk of attributable morbidity and mortality.
OBJECTIVES
This review has highlighted the importance of diagnosis and management of invasive fungal infections in highly immunocompromised Hemato-Oncology patients.
CONTENT
IFI continues to be a therapeutic issue in immunocompromised HM patients despite of many advancements in the field of fungal diagnosis and therapies. Non-specific and often overlapping signs and symptoms render fungal infections clinically undifferentiated from bacterial infections. Definite diagnosis requires microbiological diagnostic procedures in addition to imaging techniques. Many international committees have formulated definitions to aid in the diagnosis of IFI in immunocompromised patients and assigned 3 levels of probability to the diagnosis "proven," "probable," and "possible" IFI. Early specific risk-based antifungal strategies such as prophylaxis, pre-emptive and empirical therapies, are common practices in HM patients. For low-risk patients, fluconazole is recommended as primary prophylaxis, while, posaconazole and voriconazole are recommended for high-risk patients. Emerging antifungal-resistant IFIs and breakthrough fungal infections are the new threat to these heavily immunosuppressed patients. Antifungal agents such as azoles have variable pharmacokinetics leading to uncertainty in the drug dose-exposure relationship, especially in the initiation phase. TDM (therapeutic drug monitoring) of voriconazole is strongly recommended.
Topics: Humans; Antifungal Agents; Voriconazole; Invasive Fungal Infections; Mycoses; Neoplasms
PubMed: 37356843
DOI: 10.1016/j.ijmmb.2023.01.011 -
The Lancet. Infectious Diseases Nov 2017Fungi often infect mammalian hosts via the respiratory route, but traumatic transcutaneous implantation is also an important source of infections. Environmental exposure... (Review)
Review
Fungi often infect mammalian hosts via the respiratory route, but traumatic transcutaneous implantation is also an important source of infections. Environmental exposure to spores of pathogenic fungi can result in subclinical and unrecognised syndromes, allergic manifestations, and even overt disease. After traumatic cutaneous inoculation, several fungi can cause neglected mycoses such as sporotrichosis, chromoblastomycosis, mycetoma, entomophthoramycosis, and lacaziosis. Most of these diseases have a subacute to chronic course and they can become recalcitrant to therapy and lead to physical disabilities, including inability to work, physical deformities, and amputations. For many years, paracoccidioidomycosis was considered the most prevalent endemic systemic mycosis in the Americas, but this situation might be changing with recognition of the worldwide presence of Histoplasma capsulatum. Both paracoccidioidomycosis and histoplasmosis can mimic several infectious and non-infectious medical conditions and lead to death if not recognised early and treated. Cutaneous implantation and systemic mycoses are neglected diseases that affect millions of individuals worldwide, especially in low-income countries where their management is suboptimum because challenges in diagnosis and therapeutic options are substantial issues.
Topics: Endemic Diseases; Global Health; Humans; Mycoses; Neglected Diseases; Opportunistic Infections
PubMed: 28774696
DOI: 10.1016/S1473-3099(17)30306-7 -
Annals of Internal Medicine Dec 2022
Topics: Humans; Mycoses; Endemic Diseases
PubMed: 36410005
DOI: 10.7326/M22-2371 -
Current Opinion in Microbiology Aug 2021The allergic airway diseases chronic rhinosinusitis (CRS), allergic fungal rhinosinusitis (AFRS), asthma, allergic bronchopulmonary mycosis/aspergillosis (ABPM/A), and... (Review)
Review
The allergic airway diseases chronic rhinosinusitis (CRS), allergic fungal rhinosinusitis (AFRS), asthma, allergic bronchopulmonary mycosis/aspergillosis (ABPM/A), and cystic fibrosis (CF) share a common immunological signature marked by T2 and T17 cell predominant immune responses, the production of IgE antibody, and a typical inflammatory cell infiltrate that includes eosinophils and other innate immune effector cells. Severe forms of these disorders have long been recognized as being related to hypersensitivity reactions to environmental fungi. Increasingly however,environmental fungi are assuming a more primary role in the etiology of these disorders, with airway mycosis, a type of non-invasive airway fungal infection, recognized as an essential driving factor in at least severe subsets of allergic airway diseases. In this review, we consider recent progress made in understanding the immune mechanisms that drive airway mycosis-related diseases, improvements in immune-based diagnostic strategies, and therapeutic approaches that target key immune pathways.
Topics: Aspergillosis, Allergic Bronchopulmonary; Humans; Immunity; Mycoses; Respiratory System; Sinusitis
PubMed: 34052540
DOI: 10.1016/j.mib.2021.04.009 -
APMIS : Acta Pathologica,... Jul 2022Animal models of invasive fungal infections have been developed and are applied in a huge number of different animal species for a number of research purposes, for... (Review)
Review
Animal models of invasive fungal infections have been developed and are applied in a huge number of different animal species for a number of research purposes, for example, the study of pathogenesis, defense mechanisms, and therapeutic strategies. From the different models, which in most cases are based on the same fungal species and often the same strain, as in spontaneous human infections, fundamental results and knowledge of the diagnosis, progression, prophylaxis, and therapy have been achieved. However, in all models, one should be critical with respect to mimicking the disease entity of humans, which is often the focus of the research. In many of the models for instance, the time course is different to the one of humans, and in others, the propensity for localization and containment in specific organs does not parallel the situation in humans. Nevertheless, many animal models of invasive mycoses have proven valuable in a number of research areas. With regard to new generations of anti-mycotic drugs, the models play an essential role in demonstrating antifungal activity, as well as in demonstrating the absence of toxic side effects, a critical step which cannot be accomplished by in vitro studies.
Topics: Animals; Antifungal Agents; Invasive Fungal Infections; Models, Animal; Mycoses
PubMed: 33644890
DOI: 10.1111/apm.13110