Invasive fungal infections of face – A diagnostic challenge: Case series and review

Invasive fungal infections (IFIs) cause significant morbidity, mortality, and increased cost of care in patients with hematological malignancies, prolonged (i.e. >7-10 days) treatment induced neutropenia, and other disease states causing underlying immunosuppression. One strategy often used to combat the development of invasive infections is the use of antifungal agents as prophylaxis in at risk patients. Posaconazole is an oral triazole with a useful spectrum of activity against many fungal pathogens of concern in patients at risk for the development of IFIs. Posaconazole is only available in oral formulation and therapeutic drug monitoring may provide value due to variable absorption and serum concentrations. Clinical efficacy and pharmacoeconomic data have demonstrated the utility of posaconazole in the treatment of oropharyngeal candidiasis and for prophylaxis in patients at risk for development of IFIs. Several organizations or expert groups involved in developing guidelines for the management of IFIs recommend posaconazole anti-fungal prophylaxis in patients with AML or MDS and chemotherapy induced neutropenia or significant GVHD. In addition, nonrandomized studies (largely of salvage therapy) and case series suggest that posaconazole may be effective as treatment for invasive aspergillosis, zygomycosis, and coccidiomycosis. Further, small case series or individual case reports suggest activity against other less commonly encountered filamentous fungi and Histoplasma.

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Invasive fungal infections in kiney and liver transplant recipientes in a center in northeast Brazil

Research Society and Development ◽

10.33448/rsd-v10i10.18699 ◽

2021 ◽

Vol 10 (10) ◽

pp. e86101018699

Author(s):

Pablo Eliack Linhares de Holanda ◽

Claudia Maria Costa de Oliveira ◽

Teresinha do Menino Jesus Silva Leitão ◽

José Huygens Parente Garcia ◽

Maria Danielly de Almeida Sousa ◽

...

Keyword(s):

Liver Transplant ◽

Fungal Infections ◽

Case Series ◽

Invasive Fungal Infections ◽

Liver Transplants ◽

Case Series Study ◽

Amphotericin B Deoxycholate ◽

Liver Transplant Recipients ◽

Series Study

Objective: Describe the main invasive fungal infections (IFIs) after kidney and liver transplantation at a referral center, as well as their evolution, treatment, and clinical features. Material and Methods: This was a retrospective, observational, descriptive, case series study involving IFIs diagnosed between January 2012 and December 2019 in kidney and liver transplant recipients. Results: Among 769 kidney transplants, only 1 patient received the organ from a living donor and the other transplants were from deceased donors. 15 IFIs were diagnosed (7 histoplasmoses, 4 cryptococcoses, 3 candidemias, and 1 aspergillosis), while in 673 liver transplants, 8 IFIs were diagnosed (6 candidemias, 1 murcomycosis, and 1 cryptococcosis). Of the total 23 patients, 6 (26%) had infection diagnosed within 6 months after transplantation. The primary immunosuppressive regimen used was tacrolimus (82.6%), prednisone (82.6%), and mycophenolate (56.5%). Amphotericin B deoxycholate was the leading antifungal agent used for treatment, with nephrotoxicity in 80% of the cases. In the clinical follow-up, 14 patients progressed to cure (60.9%) and 9 to death (39.1%). A worsening of renal function was observed in most patients in the present study. Conclusion: Candidemia, histoplasmosis, and cryptococcosis were the most frequent IFIs, with the majority occurring later, 6 months after transplantation, and associated with high mortality.

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