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antifungal hematology

Ricardo Ferrer, Rafael Zaragoza, Alejandro H Rodríguez, Emilio Maseda, Pedro Llinares, Santiago Grau, Francisco Álvarez-Lerma, Guillermo Quindós, Miguel Salavert, Rafael Huarte
BACKGROUND: Although the management of invasive fungal infection (IFI) has improved, a number of controversies persist regarding the approach to invasive fungal infection in non-neutropenic medical ward patients. AIMS: To identify the essential clinical knowledge to elaborate a set of recommendations with a high level of consensus necessary for the management of IFI in non-neutropenic medical ward patients. METHODS: A prospective, Spanish questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists (intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases) in IFI and belonging to six scientific national societies...
October 18, 2016: Revista Iberoamericana de Micología
Pedro Llinares, Isabel Ruiz, Rafael Zaragoza, Ricard Ferrer, Alejandro H Rodríguez, Emilio Maseda, Santiago Grau
BACKGROUND: Although in the past decade the management of invasive fungal infections has improved, a number of controversies persist regarding empirical antifungal treatment in critically-ill hematology patients. AIMS: To identify key clinical knowledge to elaborate a set of recommendations, with a high level of consensus, necessary for the approach to fungal infections in critically-ill hematology patients. METHODS: A Spanish prospective questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists in fungal invasive infections from six scientific national societies; intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases...
October 14, 2016: Revista Iberoamericana de Micología
Susanne Eigl, Martin Hoenigl, Birgit Spiess, Sven Heldt, Juergen Prattes, Peter Neumeister, Albert Wolfler, Jasmin Rabensteiner, Florian Prueller, Robert Krause, Mark Reinwald, Holger Flick, Dieter Buchheidt, Tobias Boch
In recent years galactomannan antigen testing (GM) and also Aspergillus PCR have become increasingly important for diagnosis of invasive aspergillosis (IA). Whether or not these tests need to be performed with bronchoalveolar lavage fluid (BALF; i.e., primary site of infection), or testing of blood samples is sufficient, remains, however, a matter of debate. We evaluated the diagnostic performance of GM ELISA, and Aspergillus PCR by using BALF samples and blood samples obtained at the same day from a total of 53 immunocompromised patients (16 with probable/proven IA and 37 with no evidence of IA according to the revised EORTC/MSG criteria; 38 patients with hematological malignancies were prospectively enrolled at the Medical University of Graz, Austria, 15 patients with mixed underlying diseases at the Mannheim University Hospital)...
October 14, 2016: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
Kotaro Miyao, Masashi Sawa, Mio Kurata, Ritsuro Suzuki, Reona Sakemura, Toshiyasu Sakai, Tomonori Kato, Satomi Sahashi, Natsuko Tsushita, Yukiyasu Ozawa, Motohiro Tsuzuki, Akio Kohno, Tatsuya Adachi, Keisuke Watanabe, Kaneyuki Ohbayashi, Yuichiro Inagaki, Yoshiko Atsuta, Nobuhiko Emi
Invasive fungal infection (IFI) is a major life-threatening problem encountered by patients with hematological malignancies receiving intensive chemotherapy. Empirical antifungal agents are therefore important. Despite the availability of antifungal agents for such situations, the optimal agents and administration methods remain unclear. We conducted a prospective phase 2 study of empirical 1 mg/kg/day liposomal amphotericin B (L-AMB) in 80 patients receiving intensive chemotherapy for hematological malignancies...
September 30, 2016: International Journal of Hematology
Livio Pagano, Alessandro Busca, Anna Candoni, Chiara Cattaneo, Simone Cesaro, Rosa Fanci, Gianpaolo Nadali, Leonardo Potenza, Domenico Russo, Mario Tumbarello, Annamaria Nosari, Franco Aversa
Invasive fungal infections (IFIs) are an important cause of morbidity and mortality in immunocompromised patients. Patients with hematological malignancies undergoing conventional chemotherapy, autologous or allogeneic hematopoietic stem cell transplantation are considered at high risk, and Aspergillus spp. represents the most frequently isolated micro-organisms. In the last years, attention has also been focused on other rare molds (e.g., Zygomycetes, Fusarium spp.) responsible for devastating clinical manifestations...
September 17, 2016: Blood Reviews
Andrea G Varon, Simone A Nouér, Gloria Barreiros, Beatriz Moritz Trope, Tiyomi Akiti, Marcio Nucci
Hematologic patients with superficial skin lesions on admission growing Fusarium spp. are at high risk to develop invasive fusariosis during neutropenia. We evaluated the impact of primary prophylaxis with a mold-active azole in preventing the occurrence of invasive fusariosis in these patients. From August 2008 to December 2014, patients with acute leukemia, aplastic anemia, or recipients of hematopoietic cell transplantation were screened on admission with dermatologic examination and direct exam and fungal culture of superficial skin lesions...
September 26, 2016: Antimicrobial Agents and Chemotherapy
Lourdes Vazquez
Invasive fungal infections (IFIs) represent significant complications in patients with hematological malignancies. Chemoprevention of IFIs may be important in this setting, but most antifungal drugs have demonstrated poor efficacy, particularly in the prevention of invasive aspergillosis. Antifungal prophylaxis in hematological patients is currently regarded as the gold standard in situations with a high risk of infection, such as acute leukemia, myelodysplastic syndromes, and autologous or allogeneic hematopoietic stem cell transplantation...
2016: Mediterranean Journal of Hematology and Infectious Diseases
Alessandro Busca, Livio Pagano
Invasive fungal infections (IFI) represent a major hindrance to the success of hematopoietic stem cell transplantation (HSCT), contributing substantially to morbidity and infection-related mortality. During the most recent years several reports indicate an overall increase of IFI among hematologic patients, in particular, invasive aspergillosis, that may be explained, at least partially, by the fact that diagnoses only suspected in the past, are now more easily established due to the application of serum biomarkers and early use of CT scan...
2016: Mediterranean Journal of Hematology and Infectious Diseases
Sali Priyanka Akhilesh, Yadav Kamal Sunder, Pande Prasad, George Mary Asha, Agarwal Mohan, Mehta Hitesh
Appendiceal mucormycosis is a rare life-threatening infection seen in immunocompromised patients. It is usually seen in chemotherapy induced neutropenia in patients with hematological malignancies. Clinically, the symptoms and signs may be masked due to ongoing corticosteroids. The condition may mimic bacterial appendicitis and the less serious condition, typhlitis. The disease demands prompt surgical debulking and aggressive antifungal treatment. However, surgery is delayed due to the poor performance status and severe neutropenia...
2016: Case Reports in Surgery
Voon Ong, Grayson Hough, Michael Schlosser, Ken Bartizal, James M Balkovec, Kenneth D James, B Radha Krishnan
Fungal infections pose a significant public health burden with high morbidity and mortality. CD101 is a novel echinocandin under development for the treatment and prevention of systemic Candida infections. Preclinical studies were conducted to evaluate the metabolic stability, plasma protein binding, pharmacokinetics, toxicity, and efficacy of CD101 at various dose levels. CD101 was stable to biotransformation in rat/monkey/human liver microsomes and rat/monkey/dog/human hepatocytes. In vitro studies suggest minimal interaction with recombinant cytochrome P450 enzymes (IC50 values >10 μM)...
September 12, 2016: Antimicrobial Agents and Chemotherapy
Maria N Gamaletsou, Blandine Rammaert, Marimelle A Bueno, Nikolaos V Sipsas, Brad Moriyama, Dimitrios P Kontoyiannis, Emmanuel Roilides, Valerie Zeller, Saad J Taj-Aldeen, Michael Henry, Vidmantas Petraitis, David W Denning, Olivier Lortholary, Thomas J Walsh
Aspergillus arthritis is a debilitating form of invasive aspergillosis. Little is known about its epidemiology, clinical manifestations, laboratory features, treatment, and prognosis. Cases of Aspergillus arthritis were reviewed in the English literature from 1967 through 2015 for variables of arthritis with Aspergillus spp. recovered from joint and/or adjacent bone, underlying conditions, symptoms, signs, inflammatory biomarkers, diagnostic imaging, management, and outcome. Among 31 evaluable cases, 87% were males and 13% pediatric...
September 8, 2016: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
J T Ramos, L Francisco, Z Daoud
Invasive fungal infections (IFI) are a major cause of morbidity and mortality in immunocompromised adults and children. The purpose of this review was to update the epidemiological, clinical and therapeutic options in children, and to compare them with the adult population. Although there are important differences, the epidemiology, clinical features and risk factors for IFI have many similarities. Patient at risk include neutropenic hematology children, in whom Candida spp. y Aspergillus spp. predominate; primary immunodeficiencies, particularly chronic granulomatous disease with high susceptibility for Aspergillus spp...
September 2016: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
Keiji Okinaka
Although many new antifungals have become commercially available since 2000, candidemia remains an important public health issue because of its poor prognosis. Some studies have suggested that early antifungal therapy is associated with decreased mortality; however, it is difficult to promptly diagnose candidemia because of the poor sensitivity of blood cultures. Thus, prophylaxis against Candida infection is recommended in patient groups in whom the risk of infection is high, such as allogeneic hematopoietic stem cell transplant recipients or those undergoing intensive remission-induction chemotherapy for acute leukemia...
2016: Medical Mycology Journal
Abraham Yacoub, Kiran K Soni, Lysenia Mojica, Jane Mai, Jamie Morano, C Wayne Cruse, Ramon L Sandin, Sowmya Nanjappa, Chandrashekar Bohra, Ganesh Gajanan, John N Greene
BACKGROUND: Opportunistic fungal infections caused by Aspergillus and Candida followed by infections with Fusarium, Rhizopus, Mucor, and Alternaria species are an important cause of morbidity and mortality in patients with hematological malignancies. Cutaneous mucormycosis infections are rare, and the incidence, outcomes, and factors associated with survival in the setting of hematological malignancies are not clear. METHODS: A literature search was conducted for all cases of primary cutaneous mold infections in patients with hematological malignancy, of which 50 cases were found...
July 2016: Cancer Control: Journal of the Moffitt Cancer Center
Shannon M Cohn, Hanumantha R Pokala, Jane D Siegel, John E McClay, David Leonard, Jeannie Kwon, Charles F Timmons, Naomi J Winick
PURPOSE: This study describes a standardized screening protocol for diagnosis of invasive mold infections in pediatric oncology patients with neutropenia and prolonged or recurrent fever. METHODS: A retrospective chart review was performed of children receiving intensive chemotherapy for hematologic malignancies who developed invasive mold infections from 2004 to 2011. Characteristics and outcomes were compared before and after implementation of the screening protocol in November 2006...
August 12, 2016: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
Mario Fernández-Ruiz, Jesús Guinea, Mireia Puig-Asensio, Óscar Zaragoza, Benito Almirante, Manuel Cuenca-Estrella, José María Aguado
Fungemia due to rare yeasts constitutes an emerging but poorly investigated condition. Data on risk factors, clinical features, therapy, and outcome of episodes of fungemia due to rare (non-Candida, non-Cryptococcus) yeasts were analyzed in a population-based surveillance program conducted in 29 Spanish hospitals between May 2010 and April 2011. Species identification (DNA sequencing) and antifungal susceptibility testing (EUCAST and CLSI methods) were centrally performed. Fourteen out of 767 episodes of fungemia (1...
August 4, 2016: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
Silvia Arancia, Silvia Sandini, Antonietta Vella, Maurizio Sanguinetti, Sandro Norelli, Flavia De Bernardis
Aspergillus species are the cause of invasive mold infections in immunocompromised patients: Aspergillus fumigatus, A. flavus and A. terreus account for most cases of invasive aspergillosis (IA). As certain species are associated with higher mortality and vary in their resistance to antifungal therapy, diagnosis requires increasingly rapid molecular methods that enable sensitive detection and species discrimination. We have developed PCR and Multiplex PCR assays for the detection of six medically important Aspergillus spp...
July 25, 2016: New Microbiologica
Juliette Guitard, Marie-Dominique Tabone, Yaye Senghor, Cyrille Cros, Didier Moissenet, Karine Markowicz, Nadia Valin, Guy Leverger, Christophe Hennequin
OBJECTIVES: ß-D-glucan assay (BDG) has been added to the EORTC/MSG criteria for the diagnosis of invasive fungal infections (IFI), but data from pediatric populations are scarce. The aim of this study was to evaluate BDG performances in a cohort of hemato-oncological children with hematological malignancy at risk for IFI. METHODS: 113 patients were included through an 18-month period. In addition to routine IFI screening, BDG was assayed once a week. IFIs were classified using EORTC/MSG criteria w/o including the BDG results...
July 21, 2016: Journal of Infection
Domenico Albano, Giovanni Bosio, Mattia Bertoli, Giulia Petrilli, Francesco Bertagna
Hepatosplenic candidiasis is a fungal infection, which mostly affects patients with hematologic malignancies such as leukemia. The pathogenesis of this infection is not clear yet, and the liver is the most commonly affected organ. Diagnosis of hepatosplenic candidiasis can be only established via biopsy, since computed tomography (CT) scan, ultrasonography, and magnetic resonance imaging (MRI) yield non-specific results. The role of fluorine-18 fluorodeoxyglucose positron emission tomography /computed tomography ((18)F-FDG PET/CT) in diagnosis of hepatosplenic candidiasis remains undetermined, considering a few evidences in the literature...
2016: Asia Ocean J Nucl Med Biol
Raffaele M Bernardo, Ananta Gurung, Dhanpat Jain, Maricar F Malinis
BACKGROUND The clinical presentation of mucormycosis can vary widely based on various host factors. Among malignancy- and bone marrow transplant-associated infections, the lungs are the most common site of infection. Involvement of the gastrointestinal tract is less frequently encountered. The clinical presentation is often nonspecific, and cultures typically yield no growth, making the diagnosis challenging. CASE REPORT We present a case of isolated hepatic mucormycosis in the setting of neutropenic fever and abdominal pain following induction chemotherapy for the treatment of acute myeloid leukemia...
2016: American Journal of Case Reports
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