Invasive mold infections: recent advances in management approaches.
ABSTRACT An increasing number of patients are undergoing transplantation procedures or receiving aggressive immunosuppression and chemotherapy. The growing population of immunocompromised hosts has led to a rise in the prevalence of invasive fungal infections (IFIs) due to yeasts and molds. Recent trends suggest that patients are acquiring infections with non-Candida albicans species, non-Aspergillus fumigatus species and non-Aspergillus molds such as Fusarium species, Scedosporium species and Zygomycetes. There are also a few reports of resistance to standard azole and echinocandin therapy, and some Aspergillus (A. ustus, A. terreus) and Scedosporium species are inherently resistant to polyenes. Early diagnosis and appropriate treatment of mold infections are important to improve outcomes. The use of high-resolution computed tomography scanning and new diagnostic tools such as the galactomannan and beta-glucan tests help early detection of IFIs. With the changing epidemiology of fungal infections and emergence of rare pathogens, and with the availability of a larger number of antifungal drugs, new management strategies are evolving to effectively treat invasive mold infections.
Article: Safety and efficacy of liposomal amphotericin B for the empirical therapy of invasive fungal infections in immunocompromised patients.[show abstract] [hide abstract]
ABSTRACT: Liposomal amphotericin B is a "true" liposomal formulation of amphotericin B with greatly reduced nephrotoxicity and minimal infusion-related toxicity. This broad spectrum polyene is well tolerated and effective against most invasive fungal infections. In view of the current limitations on diagnostic capability of invasive fungal infections, most clinicians are often compelled to use antifungal drugs in an empiric manner; liposomal amphotericin B continues to play an important role in the empiric management of invasive fungal infections, despite the recent availability of several other drugs in the azole and echinocandin classes.Infection and Drug Resistance 01/2012; 5:9-16.
Article: Fungal cerebral abscess in a diabetic patient successfully treated with surgery followed by prolonged antifungal therapy.[show abstract] [hide abstract]
ABSTRACT: Intracranial fungal masses are uncommon diseases, but their incidence is increasing, most often due to the prolonged survival of patients with different immunodeficiencies. The management of patients with intracranial fungal masses included stereotactic biopsy for diagnosis, partial or radical surgery excision and prolonged antifungal therapy. We report the case of a 51-year-old diabetic man with a history of psoas abscess due to Candida albicans 1 year before the onset of neurological symptoms, including headache and generalized tonoclonic seizures. Magnetic resonance imaging showed a single lesion located in the right parietal lobe with mass effect, surrounding edema and enhancement after injection of gadolinium. The material was purulent. Direct microscopic examination showed hyaline, branched and septate hyphae compatible with fungal elements. Fungal infections, especially due to Candida species, should be considered in diabetic patients with parenchymal brain abscesses. Radical excision followed by prolonged antifungal therapy based on fluconazole or amphotericin B is necessary to improve the prognosis of this type of patients.Revista Iberoamericana de Micología 02/2010; 27(1):6-9. · 1.16 Impact Factor