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antifungal combination therapy

M Chen, J L Zhuang, M H Duan, W Zhang, J Li, T N Zhu, H C Cai, X X Cao, J Feng, C Yang, Y Zhang, L Zhang, D B Zhou, B Han
Objective: To Evaluate the efficacy and safety of posaconazole as primary prevention of invasive fungal disease (IFD) in patients with severe aplastic anemia (SAA) treated with anti-thymus/lymphocyte immunoglobulin (ATG/ALG) combined with cyclosporine intensive immunosuppressive therapy (IST). Methods: A retrospective analysis of clinical data of 58 SAA patients who received IST of anti-thymocyte immunoglobulin combining cyclosporine and antifungal prophylaxis during April 2013 to May 2017 in Peking Union Medical College Hospital was performed...
February 14, 2018: Zhonghua Xue Ye Xue za Zhi, Zhonghua Xueyexue Zazhi
Anjan Debnath, Andrew T Nelson, Angélica Silva-Olivares, Mineko Shibayama, Dionicio Siegel, James H McKerrow
Primary amebic meningoencephalitis (PAM) is a fatal infection caused by the free-living ameba Naegleria fowleri , popularly known as the "brain-eating ameba." The drugs of choice in treating PAM are the antifungal amphotericin B and an antileishmanial miltefosine, but these are not FDA-approved for this indication and use of amphotericin B is associated with severe adverse effects. Moreover, very few patients treated with the combination therapy have survived PAM. Therefore, development of efficient drugs is a critical unmet need to avert future deaths of children...
2018: Frontiers in Microbiology
Javier Martínez-Casanova, Nuria Carballo, Sonia Luque, Luisa Sorli, Santiago Grau
Azole antifungals have frequently been linked to the presence of hepatotoxicity, but there is scarce information on cross-toxicity between these drugs or on the possibility of using some of them when this type of toxicity occurs. We report the case of a 64-year-old man with invasive aspergillosis (IA) leading to spondylodiscitis with neurological involvement. Early management included intravenous (iv) voriconazole, which had to be interrupted after 1 week due to liver damage. Therapeutic drug monitoring (TDM) of voriconazole showed that the plasma concentration was within the therapeutic range...
2018: Infection and Drug Resistance
H Tligui, W Oudaina, S El Ftouh, F Madda, L Hesseissen
Human cutaneous infections due to Rhodotorula species as an emerged pathogens yeasts are rarely reported, particularly in skin folds, with the ability to infect immunocompromised as well as immunocompetent patient. In present case, we describe a fungal cutaneous infection due to Rhodotorula mucilaginosa in immunocompromised child, the patient has been diagnosed with retinoblastoma; the diagnosis was established by the cytological and clinical examination. However, the cytological examination found fungal forms...
March 15, 2018: Journal de Mycologie Médicale
Luc V C Brun, Jean Jacques Roux, Ghislain E Sopoh, Julia Aguiar, Miriam Eddyani, Wayne M Meyers, Dirk Stubbe, Marie T Akele Akpo, Françoise Portaels, Bouke C de Jong
Background: Basidiobolomycosis is a rare subcutaneous mycosis, which can be mistaken for several other diseases, such as soft tissue tumors, lymphoma, or Buruli ulcer in the preulcerative stage. Microbiological confirmation by PCR for Basidiobolus ranarum and culture yield the most specific diagnosis, yet they are not widely available in endemic areas and with varying sensitivity. A combination of histopathological findings, namely, granulomatous inflammation with giant cells, septate hyphal fragments, and the Splendore-Hoeppli phenomenon, can confirm basidiobolomycosis in patients presenting with painless, hard induration of soft tissue...
2018: Case Reports in Pathology
Bhupesh Bagga, Savitri Sharma, Sai Jeevan Madhuri Guda, Ritu Nagpal, Joveeta Joseph, Kodiganti Manjulatha, Ashik Mohamed, Prashant Garg
BACKGROUND: Pythium insidiosum is a parafungus that causes keratitis resembling fungal keratitis. This study compares outcome in a large cohort of patients with P insidiosum keratitis treated with antifungal drugs, to a pilot group treated with antibacterial antibiotics. METHODS: Between January 2014 and December 2016, 114 patients with culture positive P insidiosum keratitis were included in the study. A subset of culture isolates was tested in vitro for response to nine antibacterial antibiotics by disc diffusion and E test...
March 15, 2018: British Journal of Ophthalmology
Síle F Molloy, Cecilia Kanyama, Robert S Heyderman, Angela Loyse, Charles Kouanfack, Duncan Chanda, Sayoki Mfinanga, Elvis Temfack, Shabir Lakhi, Sokoine Lesikari, Adrienne K Chan, Neil Stone, Newton Kalata, Natasha Karunaharan, Kate Gaskell, Mary Peirse, Jayne Ellis, Chimwemwe Chawinga, Sandrine Lontsi, Jean-Gilbert Ndong, Philip Bright, Duncan Lupiya, Tao Chen, John Bradley, Jack Adams, Charles van der Horst, Joep J van Oosterhout, Victor Sini, Yacouba N Mapoure, Peter Mwaba, Tihana Bicanic, David G Lalloo, Duolao Wang, Mina C Hosseinipour, Olivier Lortholary, Shabbar Jaffar, Thomas S Harrison
BACKGROUND: Cryptococcal meningitis accounts for more than 100,000 human immunodeficiency virus (HIV)-related deaths per year. We tested two treatment strategies that could be more sustainable in Africa than the standard of 2 weeks of amphotericin B plus flucytosine and more effective than the widely used fluconazole monotherapy. METHODS: We randomly assigned HIV-infected adults with cryptococcal meningitis to receive an oral regimen (fluconazole [1200 mg per day] plus flucytosine [100 mg per kilogram of body weight per day] for 2 weeks), 1 week of amphotericin B (1 mg per kilogram per day), or 2 weeks of amphotericin B (1 mg per kilogram per day)...
March 15, 2018: New England Journal of Medicine
Raza Aly, Tate Winter, Steve Hall, Tracey Vlahovic
Dermatophytoma is a little-known, difficult to treat fungal infection that complicates onychomycosis. First described by Roberts and Evans in the late 1990's, dermatophytoma presents as a dense concentration of fungal hyphae within or under the nail plate and is generally white or yellow/brown in color, and linear (streaks) or round (patches) in shape; primary etiologic organisms are dermatophytes. Oral antifungals have limited success in treating dermatophytoma owing to difficulties accessing and penetrating what is hypothesized to be a fungal biofilm...
March 1, 2018: Journal of Drugs in Dermatology: JDD
Sergio Álvarez-Pérez, Marta E García, José L Blanco
Combination therapy has become popular in clinical practice, but limited data on the effects of combinations of antifungal agents is still available for most fungal pathogens. We studied the in vitro response of 30 genetically diverse clinical strains of the basidiomycetous lipophilic yeast Malassezia pachydermatis obtained from cases of canine otitis to several amphotericin B (AMB)-azole combinations. Broth microdilution checkerboard tests revealed that AMB antagonized the effects of itraconazole (ITC) and voriconazole (VRC) in 50% and 6...
March 8, 2018: Medical Mycology: Official Publication of the International Society for Human and Animal Mycology
Svetlana S Efimova, Evgeny G Chulkov, Olga S Ostroumova
The effects of local anesthetics (LAs), namely, lidocaine (LDC), prilocaine (PLC), mepivacaine (MPV), bupivacaine (BPV), procaine (PC), and tetracaine (TTC), on the steady-state transmembrane conductance induced by the cis-side addition of the antifungal polyene macrolide antibiotic, nystatin (NYS), in planar lipid bilayers were studied. The addition of TTC to model membranes comprising DOPC and cholesterol (33 mol%) led to a nearly twenty-fold increase in the steady-state NYS-induced membrane conductance...
March 8, 2018: Colloids and Surfaces. B, Biointerfaces
Mesrop Ayrapetyan, Paul Googe, Puneet Jolly, Kara Levinson, Elena Popowitch, Anne M Lachiewicz
A 61-year-old Caucasian man presented with papules on his left forearm and hand three months after liver transplantation: images from physical exam, pathology and microbiology are presented. Skin biopsy confirmed the presence of fungal elements within the hair shaft, which is consistent with Majocchi granuloma, also known as nodular granulomatous perifolliculitis. A combination of fungal culture, microscopic morphology, and gene sequencing was used to identify the causative organism. The patient recovered with appropriate systemic antifungal therapy...
March 7, 2018: Transplant Infectious Disease: An Official Journal of the Transplantation Society
E Blanchard, F Gabriel, C Jeanne-Leroyer, V Servant, P-Y Dumas
INTRODUCTION: Invasive pulmonary aspergillosis (IPA) is an important cause of morbidity and mortality in a wide range of patients. Early recognition and diagnosis have become a major focus in improving the management and outcomes of this life-threatening disease. BACKGROUND: IPA typically occurs during a period of severe and prolonged neutropenia. However, solid organ transplant recipients, patients under immunosuppressive therapy or hospitalized in intensive care units are also at risk...
February 22, 2018: Revue des Maladies Respiratoires
Cornelius J Clancy, M Hong Nguyen
Blood cultures are positive for Candida species in < 50% and < 20% of hematogenously disseminated and intra-abdominal candidiasis, respectively. Non-culture tests such as mannan, anti-mannan antibody, Candida albicans germ tube antibody (CAGTA), 1,3-β-d-glucan (BDG), the T2Candida nanodiagnostic panel, and polymerase chain reaction (PCR) are available for clinical use, but their roles in patient care are uncertain. Sensitivity/specificity of combined mannan/anti-mannan, BDG, T2Candida and PCR for candidemia are ~80%/80%, ~80%/80%, ~90%/98%, and ~90%/90%, respectively...
February 19, 2018: Journal of Fungi (Basel, Switzerland)
Cornelius J Clancy, Peter G Pappas, Jose Vazquez, Marc A Judson, Dimitrios P Kontoyiannis, George R Thompson, Kevin W Garey, Annette Reboli, Richard N Greenberg, Senu Apewokin, G Marshall Lyon, Luis Ostrosky-Zeichner, Alan H B Wu, Ellis Tobin, M Hong Nguyen, Angela M Caliendo
Background: Blood cultures are approximately 50% sensitive for diagnosing invasive candidiasis. The T2Candida nanodiagnostic panel uses T2 magnetic resonance and a dedicated instrument to detect Candida directly within whole blood samples. Methods: Patients with Candida albicans, Candida glabrata, Candida parapsilosis, Candida tropicalis, or Candida krusei candidemia were identified at 14 centers using diagnostic blood cultures (dBCs). Follow-up blood samples were collected concurrently for testing by T2Candida and companion cultures (cBCs)...
February 9, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Suguru Uemura, Akihiro Tamura, Nobuyuki Yamamoto, Atsuro Saito, Sayaka Nakamura, Takahiro Fujiwara, Teppei Tahara, Aiko Kozaki, Kenji Kishimoto, Toshiaki Ishida, Daiichiro Hasegawa, Yasunori Muraosa, Katsuhiko Kamei, Yoshiyuki Kosaka
Disseminated fusariosis is a fatal infection in immunocompromised hosts. However, the optimal antifungal treatment for disseminated fusariosis has not yet been established. We report a case of disseminated fusariosis after chemotherapy for acute lymphoblastic leukemia, presenting with multiple skin, lung, and kidney lesions and cerebrospinal fluid invasion. The combination therapy of liposomal amphotericin B and caspofungin resolved disseminated fusariosis successfully.
February 12, 2018: Pediatric Infectious Disease Journal
Jing Zhang, Xinyan Huang, Xin Zhang, Ying Zhu, Kang Liao, Jing Ma, Guangfa Wang, Yubiao Guo, Canmao Xie
RATIONALE: Recently, Talaromyces marneffei (T. marneffei) has been reported in human immunodeficiency virus (HIV)-negative patient with underlying diseases, such as oral cancer, colon cancer, haematological malignancies, connective tissue disease, diabetes mellitus, and corticosteroids or immunosuppressive agents. Similar to HIV-positive ones, such patients were observed with CD4 lymphocytopenia. PATIENT CONCERNS: We reported a case of a 45-year-old woman who was diagnosed with disseminated T...
December 2017: Medicine (Baltimore)
Mónika Homa, Palanisamy Manikandan, Veerappan Saravanan, Rajaraman Revathi, Raghavan Anita, Venkatapathy Narendran, Kanesan Panneerselvam, Coimbatore Subramanian Shobana, Mohammed Al Aidarous, László Galgóczy, Csaba Vágvölgyi, Tamás Papp, László Kredics
We report a case of a 59-year-old male patient with a postoperative fungal infection of the left eye. A dark-pigmented yeast, Exophiala dermatitidis (previously known as Wangiella dermatitidis), was identified from the culture of the biopsy taken from the posterior capsule. The infection was successfully eradicated by a combination of surgical and medical (i.e., voriconazole and fluconazole) treatment. This is the first report of successfully treated E. dermatitidis endophthalmitis, which demonstrates that a prompt and aggressive antifungal therapy combined with surgical intervention is necessary to prevent vision loss in cases of endophthalmitis due to Exophiala species...
January 27, 2018: Mycopathologia
Rita O Oladele, Felix Bongomin, Sara Gago, David W Denning
Cryptococcal disease remains a significant source of global morbidity and mortality for people living with HIV, especially in resource-limited settings. The recently updated estimate of cryptococcal disease revealed a global incidence of 223,100 cases annually with 73% of these cases being diagnosed in sub-Saharan Africa. Furthermore, 75% of the estimated 181,100 deaths associated with cryptococcal disease occur in sub-Saharan Africa. Point-of-care diagnostic assays have revolutionised the diagnosis of this deadly opportunistic infection...
December 2, 2017: Journal of Fungi (Basel, Switzerland)
Ananya Tupaki-Sreepurna, Bhavna T Jishnu, Vijayakishore Thanneru, Savitri Sharma, Anjana Gopi, Murugan Sundaram, Anupma Jyoti Kindo
Onychomycosis is a fungal nail infection which is relatively common and difficult to treat. Treatment modalities include nail avulsion, surgical debridement and combination therapy with oral and topical antifungal drugs. In spite of a host of available drugs, clinical cure rates remain discouraging. Drug toxicities, prolonged regimens, lack of patient compliance, and high keratin affinity of drugs are all contributive factors. Efinaconazole is a novel topical triazole antifungal agent that has shown excellent in vitro activity against both dermatophyte and non-dermatophyte fungi causing onychomycosis...
May 5, 2017: Journal of Fungi (Basel, Switzerland)
Eleftherios Mylonakis, Ioannis M Zacharioudakis, Cornelius J Clancy, M Hong Nguyen, Peter G Pappas
The performance of blood culture in monitoring candidemia clearance is hampered by its low sensitivity, especially during antifungal therapy. T2 Magnetic Resonance (T2MR) assay combines magnetic resonance with nanotechnology to identify whole Candida spp. cells. A multicenter clinical trial studied the performance of T2MR in monitoring candidemia clearance compared to blood culture. Adults with a blood culture positive for yeast were enrolled and had blood cultures and T2MR testing on prespecified days. Thirty-one patients completed the trial...
January 24, 2018: Journal of Clinical Microbiology
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