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Clinics in Chest Medicine

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https://www.readbyqxmd.com/read/28797496/diagnosis-and-treatment-of-fungal-chest-infections
#1
EDITORIAL
Eva M Carmona, Andrew H Limper
No abstract text is available yet for this article.
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797495/emergence-of-the-molds-other-than-aspergillus-in-immunocompromised-patients
#2
REVIEW
Sana Arif, John R Perfect
Immunocompromised patients are at high risk for invasive fungal infections (IFIs); although Aspergillus remains the most common IFI caused by molds, other fungi, such as Mucorales, dematiaceous molds, and Fusarium spp, are being seen with increasing frequency. Presentations can vary, but sinopulmonary and disseminated infections are common. Our understanding of the pathogenesis of these infections is rudimentary. Fungal cultures and histopathology remain the backbone of diagnostics, as no good serologic markers are available...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797494/laboratory-diagnostics-for-fungal-infections-a-review-of-current-and-future-diagnostic-assays
#3
REVIEW
Poornima Ramanan, Nancy L Wengenack, Elitza S Theel
This article reviews the current diagnostic approaches, both serologic and molecular, for the detection of fungi associated with pulmonary disease. Classic serologic techniques, including immunodiffusion and complement fixation, both of which remain a cornerstone for fungal diagnostic testing, are reviewed and their performance characteristics presented. More recent advances in this field, including novel lateral-flow assays for fungal antigen detection, are also described. Molecular techniques for fungal identification both from culture and directly from patient specimens, including nucleic acid probes, mass spectrometry-based methods, nucleic acid amplification testing, and traditional and broad-range sequencing, are discussed and their performance evaluated...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797493/allergic-and-noninvasive-infectious-pulmonary-aspergillosis-syndromes
#4
REVIEW
Eavan G Muldoon, Mary E Strek, Karen C Patterson
Aspergillus spp are ubiquitous in the environment, and inhalation of Aspergillus spores is unavoidable. An intact immune system, with normal airway function, protects most people from disease. Globally, however, the toll from aspergillosis is high. The literature has largely focused on invasive aspergillosis, yet the burden in terms of chronicity and prevalence is higher for noninvasive Aspergillus conditions. This article discusses allergic aspergilloses and provides an update on the diagnosis and management of allergic bronchopulmonary aspergillosis, including in patients with cystic fibrosis, and an update on severe asthma with fungal sensitization...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797492/fungal-infections-after-lung-transplantation
#5
REVIEW
Cassie C Kennedy, Raymund R Razonable
Infection remains a significant source of morbidity and mortality after lung transplant, including fungal infection. Various antifungal prophylactic agents are administered for a variable duration after transplant with the goal of preventing invasive fungal infections. Alternatively, some programs target the use of antifungal agents only in those colonized with Aspergillus spp. Despite prophylaxis or preemptive therapy, a significant number of invasive fungal infections occur after lung transplant. Risk factors for fungal infections include single lung transplant, pretransplant Aspergillus colonization, environmental risks, structural lung disease such as cystic fibrosis, augmented immunosuppression, sinus disease, and use of indwelling airway stents...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797491/candidemia-in-the-intensive-care-unit
#6
REVIEW
Oleg Epelbaum, Rachel Chasan
Candidemia presents several challenges to the intensive care unit (ICU) community. Recognition and treatment of this infection is frequently delayed, with dramatic clinical deterioration and death often preceding the detection of Candida in blood cultures. Identification of individual patients at the highest risk for developing candidemia remains an imperfect science; the role of antifungal therapy before culture diagnosis is yet to be fully defined in the ICU. The absence of well-established molecular techniques for early detection of candidemia hinders efforts to reduce the heavy clinical and economic impact of this infection...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797490/fungal-pneumonia-in-patients-with-hematologic-malignancy-and-hematopoietic-stem-cell-transplantation
#7
REVIEW
Alisha Y Young, Miguel M Leiva Juarez, Scott E Evans
Fungal pneumonias cause unacceptable morbidity among patients with hematologic malignancies (HM) and recipients of hematopoietic stem cell transplantation (HSCT). The high incidence of fungal pneumonias in HM/HSCT populations arises from their frequently severe, complex, and persistent immune dysfunction caused by the underlying disease and its treatment. The cytopenias, treatment toxicities, and other immune derangements that make patients susceptible to fungal pneumonia frequently complicate its diagnosis and increase the intensity and duration of antifungal therapy...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797489/approach-to-fungal-infections-in-human-immunodeficiency-virus-infected-individuals-pneumocystis-and-beyond
#8
REVIEW
Richard J Wang, Robert F Miller, Laurence Huang
Many fungi cause pulmonary disease in patients with human immunodeficiency virus (HIV) infection. Pathogens include Pneumocystis jirovecii, Cryptococcus neoformans, Aspergillus spp, Histoplasma capsulatum, Coccidioides spp, Blastomyces dermatitidis, Paracoccidioides brasiliensis, Talaromyces marneffei, and Emmonsia spp. Because symptoms are frequently nonspecific, a high index of suspicion for fungal infection is required for diagnosis. Clinical manifestations of fungal infection in HIV-infected patients frequently depend on the degree of immunosuppression and the CD4(+) helper T cell count...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797488/cryptococcal-lung-infections
#9
REVIEW
Kate Skolnik, Shaunna Huston, Christopher H Mody
Cryptococcus is among the most common invasive fungal pathogens globally and is one of the leading causes of acquired immunodeficiency virus-related deaths. Cryptococcus neoformans and Cryptococcus gattii are the most clinically relevant species and account for most cryptococcal disease. Pulmonary manifestations can range from mild symptoms to life-threatening infection. Treatment is tailored based on the severity of pulmonary infection, the presence of disseminated or central nervous system disease, and patient immune status...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797487/clinical-manifestations-and-treatment-of-blastomycosis
#10
REVIEW
Joseph A McBride, Gregory M Gauthier, Bruce S Klein
The causal agents of blastomycosis, Blastomyces dermatitidis and Blastomyces gilchristii, belong to a group of thermally dimorphic fungi that can infect healthy and immunocompromised individuals. Following inhalation of mycelial fragments and spores into the lungs, Blastomyces spp convert into pathogenic yeast and evade host immune defenses to cause pneumonia and disseminated disease. The clinical spectrum of pulmonary blastomycosis is diverse. The diagnosis of blastomycosis requires a high degree of clinical suspicion and involves culture-based and non-culture-based fungal diagnostic tests...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797486/diagnosis-and-management-of-coccidioidomycosis
#11
REVIEW
Luke M Gabe, Joshua Malo, Kenneth S Knox
Coccidioidomycosis is a leading cause of community-acquired pneumonia within its traditional endemic zone in the Southwestern United States and portions of Mexico and Central and South America. Its incidence has increased dramatically within the endemic region; its presence outside of the region, facilitated by a mobile society, is also now substantial. Although only a fraction of the incident disease progresses beyond subclinical illness, this proportion is large in absolute terms and causes substantial disease burden...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797485/clinical-perspectives-in-the-diagnosis-and-management-of-histoplasmosis
#12
REVIEW
Marwan M Azar, Chadi A Hage
With increasing numbers of travelers and immunocompromised patients, histoplasmosis, caused by the dimorphic fungus Histoplasma capsulatum, has become a disease of national extent. The clinical spectrum of histoplasmosis is very wide, in terms of disease cadence, onset, distribution, and severity. A multipronged approach is recommended for diagnosis. Manifestations that are always treated include moderate to severe acute pulmonary histoplasmosis, disseminated disease, and histoplasmosis in immunocompromised individuals...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797484/overview-of-treatment-approaches-for-fungal-infections
#13
REVIEW
Eva M Carmona, Andrew H Limper
Invasive fungal diseases cause high morbidity and mortality in an immunocompromised host. Antifungals are the drugs of choice and can be divided into 4 main groups: polyenes, azoles, echinocandins, and pyrimidine analogues. Each class has its specific mechanism of action, spectrum of activity, and pharmacokinetic and side effects. It is important to understand the precise use of the established and new antifungal agents to successfully manage these complex infections in an already tenuous and frail host. This article discusses the main characteristics, clinical uses, and secondary effects of the main antifungals used in clinical practice...
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28797483/when-to-consider-the-possibility-of-a-fungal-infection-an-overview-of-clinical-diagnosis-and-laboratory-approaches
#14
REVIEW
Cassandra M Batzlaff, Andrew H Limper
Fungal infections are an important and increasingly prevalent cause of disease in certain patient populations. These infections can occur both in immune-compromised and immune-competent individuals. Because the number of patients who are immunocompromised is steadily growing, it is vital for clinicians to consider fungal disease in the differential diagnosis of these patients. This article reviews the epidemiology and approach to diagnosis of a variety of fungal infections.
September 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28477646/pulmonary-disease-in-non-pulmonary-malignancy
#15
EDITORIAL
Guang-Shing Cheng, Jennifer D Possick
No abstract text is available yet for this article.
June 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28477645/palliative-and-end-of-life-care-for-patients-with-malignancy
#16
REVIEW
Kathleen M Akgün
Patients with cancer continue to have unmet palliative care needs. Concurrent palliative care is tailored to the needs of patients as well as their families to relieve suffering. Specialty palliative care referral is associated with improved symptom management, improved end-of-life quality, and higher family-rated satisfaction. Optimal timing for palliative care referral has not been determined. Barriers to palliative care referral include workforce limitations, provider attitudes and perceptions, and potential ethnic and racial disparities in access to palliative care...
June 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28477644/acute-respiratory-failure-in-patients-with-hematologic-malignancies
#17
REVIEW
Anne-Sophie Moreau, Olivier Peyrony, Virginie Lemiale, Lara Zafrani, Elie Azoulay
Acute respiratory failure occurs in up to 50% of patients treated for hematologic malignancies and is associated with a high case fatality rate. Because of residual organ dysfunction and time spent receiving respiratory care, underlying disease control is affected. Early admission to an intensive care unit for acute respiratory failure has proven benefit because it is the best place for rapid implementation of noninvasive diagnostic and therapeutic strategies. This article reviews the clinical approach and diagnostic strategies for acute respiratory failure in patients with hematologic malignancies...
June 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28477643/critical-care-prognosis-and-outcomes-in-patients-with-cancer
#18
REVIEW
Ayman O Soubani
Advances in cancer treatment and patient survival are associated with increasing number of these patients requiring intensive care. Over the last 2 decades, there has been a steady improvement in the outcomes of critically ill patients with cancer. This review provides data on the use of the intensive care unit (ICU) and short and long-term outcomes of critically ill patients with cancer, the ICU system practices that influence patients outcomes, and the role of the different clinical variables in predicting the prognosis of these patients...
June 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28477642/diagnostic-evaluation-of-pulmonary-abnormalities-in-patients-with-hematologic-malignancies-and-hematopoietic-cell-transplantation
#19
REVIEW
Bianca Harris, Alexander I Geyer
Pulmonary complications (PC) of hematologic malignancies and their treatments are common causes of morbidity and mortality. Early diagnosis is challenging due to host risk factors, clinical instability, and provider preference. Delayed diagnosis impairs targeted treatment and may contribute to poor outcomes. An integrated understanding of clinical risk and radiographic patterns informs a timely approach to diagnosis and treatment. There is little prospective evidence guiding optimal modality and timing of minimally invasive lung sampling; however, a low threshold for diagnostic bronchoscopy during the first 24 to 72 hours after presentation should be a guiding principle in high-risk patients...
June 2017: Clinics in Chest Medicine
https://www.readbyqxmd.com/read/28477641/pulmonary-function-and-pretransplant-evaluation-of-the-hematopoietic-cell-transplant-candidate
#20
REVIEW
Guang-Shing Cheng
Pretransplant pulmonary function tests provide baseline data by which to reference subsequent respiratory impairment, as well as important prognostic information, for the hematopoietic cell transplant (HCT) recipient. Abnormalities in forced expiratory volume in 1 second and diffusing capacity of carbon monoxide are associated with early respiratory failure and increased all-cause mortality after allogeneic HCT. These parameters have been incorporated into risk assessment calculators that may aid in clinical decision making...
June 2017: Clinics in Chest Medicine
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