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Transplantation Dec 2021Lung transplantation is an important treatment option for various end-stage lung diseases. However, survival remains limited due to graft rejection and infections.... (Review)
Review
BACKGROUND
Lung transplantation is an important treatment option for various end-stage lung diseases. However, survival remains limited due to graft rejection and infections. Despite that fungal infections are frequent and carry a bad prognosis, there is currently no consensus on efficacy, optimal drug, route, or duration of antifungal prophylaxis. This narrative review summarizes current strategies for antifungal prophylaxis after lung transplantation.
METHODS
English language articles in Embase, Pubmed, UptoDate, and bibliographies were used to assess the efficacy and safety of available antifungal agents for prophylaxis in adult lung transplant recipients.
RESULTS
Overall, there are limited high-quality data. Universal prophylaxis is more widely used and may be preferable over targeted prophylaxis. Both formulations of inhaled amphotericin B and systemic azoles are effective at reducing fungal infection rates, yet with their own specific advantages and disadvantages. The benefit of combination regimens has yet to be proven. Considering the post-transplant timing of the onset of fungal infections, postoperative prophylaxis during the first postoperative months seems indicated for most patients.
CONCLUSIONS
Based on existing literature, universal antifungal prophylaxis with inhaled amphotericin B and systemic voriconazole for at least 3-6 mo after lung transplantation may be advisable, with a slight preference for amphotericin B because of its better safety profile.
Topics: Adult; Antifungal Agents; Humans; Lung Transplantation; Mycoses; Transplant Recipients; Voriconazole
PubMed: 33982907
DOI: 10.1097/TP.0000000000003717 -
Infectious Disease Clinics of North... Mar 2016Major patient groups at risk for invasive fungal infection are found in hematology, intensive care, and abdominal surgery units. The vast majority of invasive fungal... (Review)
Review
Major patient groups at risk for invasive fungal infection are found in hematology, intensive care, and abdominal surgery units. The vast majority of invasive fungal infections are candidemia, pulmonary aspergillosis, and pulmonary or sinunasal mucormycosis, the latter typically in the context of diabetes. Clinical presentation is highly variable and depends on host, fungus, and organs involved. Symptoms are unspecific and, outside of fungemia, diagnosis is established by radiographic imaging combined with microbiological, serologic, and histopathological workup. Complex prevention and management strategies have been developed, and it is recommended to follow institutional pathways to standardize diagnostic and therapeutic strategies.
Topics: Antifungal Agents; Humans; Mycoses
PubMed: 26739606
DOI: 10.1016/j.idc.2015.10.003 -
Current Opinion in Infectious Diseases Apr 2020This review aims to update on recent findings about epidemiology, risk factors and therapeutic options for fungi causing skin and soft tissue infections. The latest data... (Review)
Review
PURPOSE OF REVIEW
This review aims to update on recent findings about epidemiology, risk factors and therapeutic options for fungi causing skin and soft tissue infections. The latest data on emerging antifungal resistance are also discussed.
RECENT FINDINGS
In parallel with increased use of immunosuppression, the incidence of fungal infections is also on rise. This increase involves not only systemic infections but also infections with primary and secondary skin involvement. Antifungal resistance has become a major issue and covers several fungal pathogens including dermatophytes, Candida spp. and, Aspergillus fumigatus. Multidisciplinary usage of newly targeted, immunomodulatory therapies may predispose patients to have fungal infections through mimicking an immunosuppressed status caused by genetic factors or the disease itself. Nonimmunosupressed patients, although less frequently than those with immunosuppression may also be vulnerable.
SUMMARY
Physicians should be aware about skin and soft tissue findings related with systemic or locally occuring mycosis. Emerging antifungal resistance may hamper the success of the treatment. Antifungal susceptibility testing is advisable wherever available and particularly when a disseminated fungal infection is present.
Topics: Antifungal Agents; Dermatomycoses; Drug Resistance, Fungal; Humans; Mycoses; Soft Tissue Infections
PubMed: 31990815
DOI: 10.1097/QCO.0000000000000630 -
Kardiologia Polska Aug 2019Fungal endocarditis (FE) is an infrequent but a lethal condition. Candida and Aspergillus species are the 2 most commonly implicated pathogenic fungi. Clinical... (Review)
Review
Fungal endocarditis (FE) is an infrequent but a lethal condition. Candida and Aspergillus species are the 2 most commonly implicated pathogenic fungi. Clinical presentation is most often that of a fever of unknown origin, which is hard to differentiate from bacterial endocarditis. The diagnosis of FE is extremely challenging and now shifting towards molecular diagnostic techniques. Rapid and aggressive treatment with a combination of antifungal therapy and surgical debridement is imperative to improve outcomes.
Topics: Aspergillosis; Candidiasis; Endocarditis; Humans; Mycoses
PubMed: 31215523
DOI: 10.33963/KP.14869 -
Annual Review of Microbiology Oct 2021Ancient enzootic associations between wildlife and their infections allow evolution to innovate mechanisms of pathogenicity that are counterbalanced by host responses.... (Review)
Review
Ancient enzootic associations between wildlife and their infections allow evolution to innovate mechanisms of pathogenicity that are counterbalanced by host responses. However, erosion of barriers to pathogen dispersal by globalization leads to the infection of hosts that have not evolved effective resistance and the emergence of highly virulent infections. Global amphibian declines driven by the rise of chytrid fungi and chytridiomycosis are emblematic of emerging infections. Here, we review how modern biological methods have been used to understand the adaptations and counteradaptations that these fungi and their amphibian hosts have evolved. We explore the interplay of biotic and abiotic factors that modify the virulence of these infections and dissect the complexity of this disease system. We highlight progress that has led to insights into how we might in the future lessen the impact of these emerging infections.
Topics: Amphibians; Animals; Chytridiomycota; Mycoses; Virulence
PubMed: 34351790
DOI: 10.1146/annurev-micro-052621-124212 -
Annals of the American Thoracic Society Oct 2021
Topics: Antifungal Agents; Humans; Mycoses
PubMed: 33901414
DOI: 10.1513/AnnalsATS.202104-445LE -
The Lancet. Global Health Nov 2021Talaromycosis (penicilliosis) is an invasive mycosis that is endemic in tropical and subtropical Asia. Talaromycosis primarily affects individuals with advanced HIV... (Review)
Review
Talaromycosis (penicilliosis) is an invasive mycosis that is endemic in tropical and subtropical Asia. Talaromycosis primarily affects individuals with advanced HIV disease and other immunosuppressive conditions, and the disease disproportionally affects people in low-income and middle-income countries, particularly agricultural workers in rural areas during their most economically productive years. Approximately 17 300 talaromycosis cases and 4900 associated deaths occur annually. Talaromycosis is highly associated with the tropical monsoon season, when flooding and cyclones can exacerbate the poverty-inducing potential of the disease. Talaromycosis can present as localised or disseminated disease, the latter causing cutaneous lesions that are disfiguring and stigmatising. Despite up to a third of diagnosed cases resulting in death, talaromycosis has received little attention and investment from regional and global funders, policy makers, researchers, and industry. Diagnostic and treatment modalities remain extremely insufficient, however control of talaromycosis is feasible with known public health strategies. This Viewpoint is a global call for talaromycosis to be recognised as a neglected tropical disease to alleviate its impact on susceptible populations.
Topics: Asia; Humans; Mycoses; Neglected Diseases; Public Health; Tropical Medicine
PubMed: 34678201
DOI: 10.1016/S2214-109X(21)00350-8 -
Mycoses Jan 2024Invasive fungal diseases (IFDs) play an important role in the supportive care of paediatric patients with acute leukaemia and those undergoing allogeneic haematopoietic... (Review)
Review
Invasive fungal diseases (IFDs) play an important role in the supportive care of paediatric patients with acute leukaemia and those undergoing allogeneic haematopoietic cell transplantation, and they are associated with significantly decreased overall survival rates in affected individuals. Relative to adults, children and adolescents are distinct in terms of host biology, predisposing conditions, presentation and epidemiology of fungal diseases, and in the pharmacology of antifungal agents. The paediatric development of antifungal agents has moved forward in a coordinated manner, and major advances have been made regarding concepts and recommendations for the prevention and treatment of IFDs. However, antifungal therapy is increasingly complex, and a solid knowledge of the available options is needed more than ever for successful management. This narrative review provides a summary of the paediatric development of agents that have been recently approved (anidulafungin, posaconazole) or are in advanced stages of development (isavuconazole). It also reviews the emerging evidence for the efficacy of echinocandins for prophylaxis of invasive aspergillosis, presents new data on alternative dosing regimens of echinocandins and voriconazole, and provides a brief overview of new antifungal agents in clinical development that are expected to be developed for paediatric patients.
Topics: Adolescent; Humans; Child; Antifungal Agents; Mycoses; Echinocandins; Anidulafungin; Invasive Fungal Infections
PubMed: 37789721
DOI: 10.1111/myc.13654 -
The New Microbiologica May 2023Although progress has led to a drop in infections, meningitis still represents a threat worldwide, affecting some areas more than others. As a medical emergency, it... (Review)
Review
Although progress has led to a drop in infections, meningitis still represents a threat worldwide, affecting some areas more than others. As a medical emergency, it requires prompt recognition and treatment. Moreover, diagnosis relies on invasive methods, while representing a tug-of-war with timely therapeutic interventions, since delays are burdened by mortality and life-long sequalae. While counterbalancing the overuse of antimicrobials, it is imperative to assess correct interventions in order to optimize treatments and reduce negative outcomes. Because the drop in mortality and consequences has been consistent, although not as impactful as with other vaccine-preventable diseases, the WHO has traced a roadmap detailing actions to reduce the meningitis burden by 2030. There are currently no updated guidelines, whereas novel diagnostic methods as well as pharmacological interventions are increasing, along with the shifting epidemiology. In light of the above, this paper wishes to summarize existing data and evidences and suggest potential novel solutions to a complex problem.
Topics: Humans; Central Nervous System; Meningitis; Mycoses
PubMed: 37247231
DOI: No ID Found -
Current Allergy and Asthma Reports May 2024Fungal sensitizations have been associated with hypersensitivity reactions with variable levels of evidence available to link types of fungi with human disease. We... (Review)
Review
PURPOSE OF THE REVIEW
Fungal sensitizations have been associated with hypersensitivity reactions with variable levels of evidence available to link types of fungi with human disease. We conducted systematic reviews of the literature to identify the strength of evidence linking lesser-studied fungi for which there are commercially available extracts to identify populations in which they were useful in clinical practice.
RECENT FINDINGS
Excluding five fungi for which hundreds of articles were identified, there are 54 articles on the remaining fungi with clinical data. For 12 of the fungi, the prevalence of fungal sensitization varies in different hypersensitivity disorders due to factors related to geographic areas, age, and other underlying medical conditions. There were no studies linking seven genera to human disease. Most of the commercially available fungal extracts are uncommonly associated with hypersensitivity reactions in humans. Specific extracts may be useful in particular disease states such as allergic fungal sinusitis or allergic bronchopulmonary mycosis, or when routine testing fails to identify a cause of uncontrolled disease, such as in asthma.
Topics: Humans; Fungi; Hypersensitivity; Antigens, Fungal; Allergens; Mycoses
PubMed: 38575791
DOI: 10.1007/s11882-024-01144-y