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Pulmonary fungal infections

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14 papers 0 to 25 followers
By Jason Mann No BS pulmonary critical care fellow
Thomas F Patterson, George R Thompson, David W Denning, Jay A Fishman, Susan Hadley, Raoul Herbrecht, Dimitrios P Kontoyiannis, Kieren A Marr, Vicki A Morrison, M Hong Nguyen, Brahm H Segal, William J Steinbach, David A Stevens, Thomas J Walsh, John R Wingard, Jo-Anne H Young, John E Bennett
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
August 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Matteo Bassetti, Elda Righi
The incidence of severe fungal infections has increased worldwide and represents a serious threat, especially among immunocompromised and critically ill patients. Most common pulmonary fungal infections include aspergillosis, cryptococcosis, and Pneumocystis jiroveci pneumonia. Among nosocomial bloodstream infections, Candida spp. is the most common isolated fungus. Mortality rates up to 60% in critically ill patients with Candida infections and 90% in hematological patients with invasive aspergillosis are reported...
October 2015: Seminars in Respiratory and Critical Care Medicine
Anurag N Malani, Lisa E Kerr, Carol A Kauffman
Voriconazole is an important agent in the antifungal armamentarium. It is the treatment of choice for invasive aspergillosis, other hyaline molds, and many brown-black molds. It is also effective for infections caused by Candida species, including those that are fluconazole resistant, and for infections caused by the endemic mycoses, including those that occur in the central nervous system. It has the advantage of being available in both an intravenous and an oral formulation that is well absorbed. Drawbacks to the use of voriconazole are that it has unpredictable, nonlinear pharmacokinetics with extensive interpatient and intrapatient variation in serum levels...
October 2015: Seminars in Respiratory and Critical Care Medicine
Nina M Clark, Shellee A Grim, Joseph P Lynch
Posaconazole, a fluorinated triazole antifungal drug, is approved by the U.S. Food and Drug Administration (FDA) for (1) prophylaxis against Aspergillus and Candida infections in immunocompromised patients at high risk for these infections and (2) oropharyngeal candidiasis (OPC), including cases refractory to fluconazole and/or itraconazole. The European Medicines Agency (EMA) has approved posaconazole for (1) treatment of aspergillosis, fusariosis, chromoblastomycosis, and coccidioidomycosis in patients who are refractory to or intolerant of other azoles or amphotericin B; (2) first-line therapy for OPC for severe disease or in those unlikely to respond to topical therapy; and (3) prophylaxis of invasive fungal infections in high-risk hematologic patients and stem cell transplant recipients...
October 2015: Seminars in Respiratory and Critical Care Medicine
Ar K Aung, Denis W Spelman, Philip J Thompson
In recent decades, sporotrichosis, caused by thermally dimorphic fungi Sporothrix schenckii complex, has become an emerging infection in many parts of the world. Pulmonary infection with S. schenckii still remains relatively uncommon, possibly due to underrecognition. Pulmonary sporotrichosis presents with distinct clinical and radiological patterns in both immunocompetent and immunocompromised hosts and can often result in significant morbidity and mortality despite treatment. Current understanding regarding S...
October 2015: Seminars in Respiratory and Critical Care Medicine
Meryl Twarog, George R Thompson
Coccidioidomycosis manifests as a variety of clinical manifestations and ranges in severity from asymptomatic exposure with resultant immunity to reinfection, to fulminant, and life-threatening disseminated disease. Primary coccidioidal pneumonia represents the most common clinical form of infection, and the incidence continues to increase. Within the endemic region, primary pulmonary coccidioidomycosis represents up to 29% of all community-acquired pneumonia emphasizing the frequency with which clinicians encounter this endemic mycosis...
October 2015: Seminars in Respiratory and Critical Care Medicine
Jeannina A Smith, Greg Gauthier
Blastomyces dermatitidis, the etiologic agent of blastomycosis, is a thermally dimorphic fungus that grows as a filamentous mold in the environment and as budding yeast in human tissue. This pathogen is endemic to North America, particularly in the states bordering the Mississippi and Ohio rivers, the Great Lakes, and the St. Lawrence Seaway. Infection with B. dermatitidis causes a broad array of clinical manifestations ranging from asymptomatic infection to fulminant sepsis with acute respiratory distress syndrome and death...
October 2015: Seminars in Respiratory and Critical Care Medicine
Fabio Nucci, Simone A Nouér, Domenico Capone, Elias Anaissie, Marcio Nucci
Fusarium species are frequent agents of onychomycosis and fungal keratitis, and occasional agents of invasive disease. The clinical spectrum of fusariosis in the lungs includes allergic disease (allergic bronchopulmonary fusariosis), hypersensitivity pneumonitis, colonization of a preexisting cavity, and pneumonia. Fusarial pneumonia occurs almost exclusively in severely immunocompromised patients, especially acute leukemia patients and recipients of allogeneic cell transplantation. In such patients, invasive fusariosis is usually disseminated, and pneumonia occurs in almost 50% of cases...
October 2015: Seminars in Respiratory and Critical Care Medicine
François Danion, Claire Aguilar, Emilie Catherinot, Alexandre Alanio, Susan DeWolf, Olivier Lortholary, Fanny Lanternier
Mucormycosis is a rare, though increasingly prevalent, life-threatening fungal disease caused by Mucorales. The incidence has increased over the last decade and its mortality remains high at around 50%. Mucormycosis occurs mostly in patients with diabetes mellitus and/or in the context of immunosuppression resulting from chemotherapy for hematological malignancy, hematopoietic stem cell transplantation, or solid-organ transplantation. In this situation, lung and rhino-orbito-cerebral infections are the most frequent localizations of the disease...
October 2015: Seminars in Respiratory and Critical Care Medicine
C C Chang, T C Sorrell, S C-A Chen
Inhalation of Cryptococcus into the respiratory system is the main route of acquisition of human infection, yet pulmonary cryptococcosis goes mostly unrecognized by many clinicians. This delay in diagnosis, or misdiagnosis, of lung infections is due in part to frequently subtle clinical manifestations such as a subacute or chronic cough, a broad differential of diagnostic possibilities for associated pulmonary masses (cryptococcomas) and, on occasion, negative respiratory tract cultures. Hematogenous dissemination from the lung can result in protean manifestations, the most severe of which is meningoencephalitis...
October 2015: Seminars in Respiratory and Critical Care Medicine
Nathan P Wiederhold, Thomas F Patterson
Resistance to the azole antifungals itraconazole, voriconazole, and posaconazole in Aspergillus species is a growing concern. This is especially alarming for A. fumigatus, where acquired resistance has been documented in patients with invasive disease caused by this species that were exposed to these agents, as well as in azole-naive individuals. The primary mechanisms of resistance that have been described in clinical strains include different point mutations in the CYP51A gene, which encodes the enzyme responsible for converting lanosterol to ergosterol via demethylation...
October 2015: Seminars in Respiratory and Critical Care Medicine
Kevin S Gregg, Carol A Kauffman
Invasive aspergillosis remains an often fatal, difficult-to treat infection in immunocompromised patients. Patients not classically defined as immunocompromised, especially those in an intensive care unit setting, also develop invasive aspergillosis. Clinical clues suggesting angioinvasion and radiographic modalities, especially computed tomographic scans, combined with newer non-culture-based diagnostic techniques, have allowed earlier recognition of invasive aspergillosis. Although mortality remains high, it has greatly decreased over the past 15 years...
October 2015: Seminars in Respiratory and Critical Care Medicine
Marisa H Miceli, Johan Maertens
An established diagnosis of invasive aspergillus is seldom achieved premortem. Conventional laboratory diagnostic methods such as culture and microscopy, although very useful when positive, are insensitive and time-consuming, resulting in late diagnosis and treatment and contributing to high mortality rates. As a result, routine antifungal prophylaxis and early empirical treatment have been recommended. The use of sensitive and rapid non-culture-based diagnostic assays for the detection of Aspergillus antigens (using commercially available tests to detect galactomannan and 1, 3 β-D-glucan) or detection of genomic DNA sequences may allow a shift in emphasis from empirical to preemptive therapy, especially when substantiated by suggestive radiological findings...
October 2015: Seminars in Respiratory and Critical Care Medicine
Carol A Kauffman
No abstract text is available yet for this article.
October 2015: Seminars in Respiratory and Critical Care Medicine
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