Paediatric mucormycosis: tailoring surgical strategies to compliment antifungal chemotherapy. Different strokes for different folks

2020 ◽  
Vol 50 (1) ◽  
pp. 87-90
Author(s):  
Rohith Srinivas ◽  
Tarun John K Jacob ◽  
Promila Mohan Raj ◽  
Sophy Korula ◽  
Leni G Mathew
Keyword(s):  
Soft Tissue ◽  
Surgical Therapy ◽  
Antifungal Therapy ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Medical Conditions ◽  
Surgical Strategies ◽  
Clear Margin ◽  
Compromised Host ◽  
Antifungal Chemotherapy

Children manifesting soft-tissue fungal infections are uncommonly seen, more so the subgroup of invasive soft-tissue mucormycosis. Invasive fungal infections in various organs respond differently and are often complicated by an immune-compromised host. Repeated and aggressive clearance of disease till an infection-clear margin is obtained is the mainstay of surgical therapy. This is coupled with appropriate antifungal therapy and the management of any underlying medical conditions. From our experience, we propose a surgical algorithm for therapy of soft-tissue mucormycosis in children.

Salvage therapy with voriconazole for invasive fungal infections in patients failing or intolerant to standard antifungal therapy

2003 ◽  
Vol 76 (11) ◽  
pp. 1632-1637 ◽  
Author(s):  
L. R. Baden ◽  
J. T. Katz ◽  
J. A. Fishman ◽  
C. Koziol ◽  
A. DelVecchio ◽  
...  
Keyword(s):  
Antifungal Therapy ◽  
Salvage Therapy ◽  
Fungal Infections ◽  
Invasive Fungal Infections

scholarly journals Outpatient parenteral antifungal therapy (OPAT) for invasive fungal infections with intermittent dosing of liposomal amphotericin B

2020 ◽  
Vol 58 (7) ◽  
pp. 874-880
Author(s):  
Robert J van de Peppel ◽  
Alexander Schauwvlieghe ◽  
Ruth Van Daele ◽  
Isabel Spriet ◽  
Jan W van't Wout ◽  
...  
Keyword(s):  
The Netherlands ◽  
Amphotericin B ◽  
Antifungal Therapy ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Initial Response ◽  
Invasive Fungal Infections ◽  
Response To Treatment ◽  
Liposomal Amphotericin B

Abstract Triazole resistant A. fumigatus has been documented in many parts of the world. In the Netherlands, incidence is now above 10% and results in the need for long-term parenteral therapy with liposomal amphotericin B (LAmB). The long terminal half-life of LAmB suggests that intermittent dosing could be effective, making the application of outpatient antifungal therapy (OPAT) possible. Here, we report our experience with the use of OPAT for Invasive Fungal Infections (IFI). All adult patients treated with LAmB with a 2 or 3 times weekly administration via the outpatient departments in four academic tertiary care centers in the Netherlands and Belgium since January 2010 were included in our analysis. Patient characteristics were collected, as well as information about diagnostics, therapy dose and duration, toxicity, treatment history and outcome of the IFI. In total, 18 patients were included. The most frequently used regimen (67%) was 5 mg/kg 3 times weekly. A partial response to the daily treatment prior to discharge was confirmed by CT-scan in 17 (94%) of patients. A favorable outcome was achieved in 13 (72%) patients. Decrease in renal function occurred in 10 (56%) cases but was reversible in all and was treatment limiting in one patient only. The 100-day mortality and 1-year mortality after initiation of OPAT were 0% and 6%, respectively. In a selected population, and after confirmation of initial response to treatment, our data support the use of OPAT with LAmB for treatment of IFI in an intermittent dosing regimen.

Invasive Fungal Infection in Febrile Patients with Hematologic Malignancies Undergoing Chemotherapy in Iran

2019 ◽  
Vol 19 (3) ◽  
pp. 302-307 ◽  
Author(s):  
Saba Sheikhbahaei ◽  
Alireza Mohammadi ◽  
Roya Sherkat ◽  
Alireza Emami Naeini ◽  
Majid Yaran ◽  
...  
Keyword(s):  
Blood Culture ◽  
Antifungal Therapy ◽  
Fungal Infections ◽  
Hematologic Malignancy ◽  
Hematologic Malignancies ◽  
Fungal Species ◽  
Antifungal Prophylaxis ◽  
Invasive Fungal Infections ◽  
Severe Neutropenia ◽  
Candida Spp

Background: Patients with hematological malignancies undergoing cytotoxic chemotherapy are susceptible to develop invasive fungal infections particularly Aspergillus and Candida spp. Early detection of these infections is required to start immediate antifungal therapy and increase the survival of these patients. Method: Our study included consecutive patients of any age with hematologic malignancies who were hospitalized to receive chemotherapy and suffer from persistent fever (rectal temperature >38.5°C) for more than 5 days despite receiving broad-spectrum antibiotics. A whole blood sample was taken and sent for blood culture. PCR was also conducted for Aspergillus and Candida species. Results: One hundred and two patients were investigated according to the inclusion criteria. The most common hematologic malignancy was AML affecting 38 patients (37.2%). Six patients were diagnosed with invasive fungal infections (A. fumigatus n=3, C. albicans n=2, A. flavus n=1) by PCR (5.8%) while blood culture showed fungus only in 1 patient. Three more cases were known as probable IFI since they responded to antifungal therapy but the PCR result was negative for them. AML was the most prevalent malignancy in IFI patients (83.3%) and odds ratio for severing neutropenia was 21.5. Odds for each of the baseline characteristics of patients including gender, age>60, diabetes mellitus, previous IFI, history of using more than 3 antibiotics, antifungal prophylaxis, episodes of chemotherapy> 8 and chemotherapy regimen of daunarubicin+cytarabine were calculated. Conclusion: We found that multiplex real-time PCR assay is more accurate than blood culture in detecting fungal species and the results are prepared sooner. Among all factors, the only type of cancer (AML) and severe neutropenia, were found to be risk factors for the development of fungal infections in all hematologic cancer patients and previous IFI was a risk factor only AML patients.

PCR-Based Liposomal Amphotericin B Treatment Following Allogeneic Stem Cell Transplantation Is a Safe Treatment Strategy: Preliminary Results of a Prospective Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 192-192 ◽  
Author(s):  
Holger Hebart ◽  
L. Klingspor ◽  
Thomas Klingebiehl ◽  
Juergen Loeffler ◽  
J. Tollemar ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplantation ◽  
Antifungal Therapy ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Post Transplantation ◽  
Pcr Screening ◽  
Group A ◽  
Empirical Antifungal Therapy ◽  
Group B

Abstract A prospective randomized multi-center trial was initiated comparing PCR-based preemptive and empirical antifungal therapy with AmBisome in patients after allogeneic stem cell transplantation. A total of 408 patients were randomized at the time of transplant to the antifungal treatment strategy. PCR screening was planned twice weekly during stay in hospital and once weekly after discharge until day 100 post-transplantation. Antifungal prophylaxis consisted of up to 200 mg fluconazole/day. Antifungal therapy was initiated in the PCR group in PCR+ patients with signs of infection and patients with 2 consecutive positive PCR results, and in the empirical treatment group (group B) after 120 hours of febrile neutropenia not responding to broad-spectrum antibacterial therapy. Antifungal treatment consisted of AmBisome at 3 mg/kg for 3 days (loading dose) followed by AmBisome at 1 mg/kg in clinically stable patients, AmBisome at 3 mg/kg was continued in clinically unstable patients. Treatment was stopped according to pre-defined study rules. The two arms were well balanced with regard to age, gender, donor type, underlying disease and stage, and conditioning regimens applied. Out of 403 evaluable patients 196 were randomized to group A and 207 to group B. AmBisome therapy was initiated in 109 patients in group A and in 76 patients in group B (P<0.05). Eleven patients in group A and 16 patients in group B developed proven invasive fungal infections (IFI), overall mortality at 100 and 180 days was not different. Survival curves demonstrated a lower mortality until day 30 post-transplantation for patients receiving PCR-based antifungal therapy with AmBisome (deaths in group A, n=4; group B, n=13; P=0.03). During this early time period when regular PCR-screening was performed, only 1 patient in group A (candidiasis) and 5 patients in group B (invasive aspergillosis, n=1; candidiasis, n=4) succumbed to IFI (P=0.1). This study prospectively compared PCR-based versus empirical antifungal therapy with AmBisome after allogeneic SCT. A reduction in early mortality and a trend for a lower rate of proven invasive fungal infections was documented until day 30 post-transplantation indicating that close fungal PCR monitoring allows to stratify patients at high risk for the subsequent development of invasive fungal infections. Survival at day 100 and 180 post-transplantation was not different.

Antifungal therapy in invasive fungal infections

2010 ◽  
Vol 10 (5) ◽  
pp. 522-530 ◽  
Author(s):  
Sharon C-A Chen ◽  
E Geoffrey Playford ◽  
Tania C Sorrell
Keyword(s):  
Antifungal Therapy ◽  
Fungal Infections ◽  
Invasive Fungal Infections

scholarly journals COMPARISON OF THREE DISTINCT PROPHYLACTIC AGENTS AGAINST INVASIVE FUNGAL INFECTIONS IN PATIENTS UNDERGOING HAPLO-IDENTICAL HEMATOPOIETIC STEM CELL TRANSPLANTATION AND POST-TRANSPLANT CYCLOPHOSPHAMIDE

2015 ◽  
Vol 7 ◽  
pp. e2015048 ◽  
Author(s):  
Jean Elcheikh
Keyword(s):  
Stem Cell ◽  
Adverse Events ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Antifungal Therapy ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Haematopoietic Stem Cell ◽  
Serious Adverse Events ◽  
Hematopoietic Stem

Over the past decade, invasive fungal infections (IFI) have remained an important problem in patients undergoing allogeneic haematopoietic stem cell transplantation (Allo-HSCT). The optimal approach for prophylactic antifungal therapy has yet to be determined.We conducted a retrospective, bi-institutional comparative clinical study, and compared the efficacy and safety of micafungin 50mg/day (iv) with those of fluconazole (400mg/day) or itraconazole 200mg/day (iv) as prophylaxis for adult patients with various haematological diseases receiving haplo-identical allogeneic stem cell transplantation (haplo).Overall, 99 patients were identified; 30 patients received micafungin, and 69 patients received fluconazole or itraconazole. After a median follow-up of 13 months (range: 5-23), Proven or probable IFIs were reported in 3 patients (10%) in the micafungin group and 8 patients (12%) in the fluconazole or itraconazole group. Fewer patients in the micafungin group had invasive aspergillosis (1 [3%] vs. 5 [7%], P=0.6). A total of 4 (13%) patients in the micafungin group and 23 (33%) patients in the fluconazole or itraconazole group received empirical antifungal therapy (P = 0.14).No serious adverse events related to treatment were reported by patients and there was no treatment discontinuation because of drug-related adverse events in both groups.Despite the retrospective design of the study and limited sample, it contributes reassuring data to confirm results from randomised clinical trials, and to define a place for micafungin in prophylaxis after haplo.

Cochrane review: Antifungal therapy in infants and children with proven, probable or suspected invasive fungal infections

2010 ◽  
Vol 5 (4) ◽  
pp. 1916-1998
Author(s):  
Christopher C Blyth ◽  
Katherine Hale ◽  
Pamela Palasanthiran ◽  
Tracey O'Brien ◽  
Michael H Bennett
Keyword(s):  
Antifungal Therapy ◽  
Fungal Infections ◽  
Cochrane Review ◽  
Invasive Fungal Infections ◽  
Infants And Children ◽  
In Infants And Children
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