Single Large Dose (15 Mg/Kg) Amphotericin B Lipid Complex (L-AmB) as Prophylaxis of Fungal Infections during Induction Chemotherapy in Acute Non Lymphoid Leukemia (ANLL).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 4611-4611
Author(s):  
Anna Chierichini ◽  
Susanna Fenu ◽  
Marina Persiani ◽  
Stefania Cortese ◽  
Maria Iris Cassetta ◽  
...  
Keyword(s):  
Single Dose ◽  
Fungal Infection ◽  
Induction Chemotherapy ◽  
Primary Endpoint ◽  
Large Dose ◽  
Fungal Infections ◽  
Dose Range ◽  
High Dose ◽  
Number Of Patients ◽  
Single Large Dose

Abstract In ANLL, during intensive induction,invasive fungal infections (IFI) related to prolonged neutropenia,mucosal damage,steroids, geographical and center variations is the main factor wich can influence disease outcome The optimal prophylactic regimen has not yet to be identified. The AmB lipid formulations let to treat IFI in refractory or intolerant patients. The efficacy of these drugs appears to be related both to improved tissue penetration along with sustained bioactivity of drug levels in lung, brain, kidneys, liver and spleen.(Anaissie et al.2004).On this basis,, in a cohort of adult (>18y) ANLL patients,during induction,we applied a pilot study for IFI prophylaxis in the aim to test the efficacy and safety of a single large dose of L-AmB.The primary endpoint was to evaluate the incidence of documented or suspected fungal infection during and up to four weeks after prophylaxis discontinuation.PATIENTS: From September 2004 to May 2005 18 consecutive adult ANLL (4 APL) patients −12 M,6 F, median age 56 y (range 39–75)- entered in this study. Intensive induction chemotherapy included standard /high dose cytosine-arabinoside + antracyclines +etoposide or fludarabine and retinoic acid + antracyclines in the 4 APL. METHODS: The criteria of inclusion were:1)neutropenia (PMN <0.5 109/L) longer than 10 days 2) initial surveillance coltures, mannano and galattomammano antigens negative 3) no fever and/or clinical infection features. At the day after induction end, patients received L-AmB(AMBISOME, GILEAD®) at the dosage of 15 mg/kg i.v as single dose. A second single dose was repeated after 15 days in those cases which were persistently neutropenic,but did not meet the criteria of suspected fungal infections. RESULTS:13 (72%) patients achieved complete hematological remission,1 was resistant and 4 died during induction aplasia. (2 for Aspergillosis). Overall median neutropenia duration was 22 d (range 17 – 45). The median dosage of L- AmB administered was 900 mg x dose( range 750 – 900);a second single dose at the same dosage was given in four cases. During L-AmB infusion, 2 patients had CTC grade II allergy, treated by i.v. steroids, thus drug infusion could be completed; no patient had renal or hepatic toxicity.Of the 18 enrolled patients,14 (80%) met the primary endpoint of the studys since none of them developed fungal infection, while the remaining 4 cases had IFI: 2 Candida spp.sepsis and 2 invasive Aspergillosis.On the basis of these encouraging clinical results, in further consecutive 5 patients we tested L-AmB PK profile at the following times: 0,12,24 hour,7th and 14 th day from drug administration.The median L-AmB PK results (lower standard rate 0,15mg/l + − standard deviation) are: 0 h < 0,15 1 h 8,92 +/− 4,25 4 h 51,26 +/− 26,7 24 h 3,92 +/− 11,77 7° d 1,39 +/− 1,97 14° d 0,27 +/− 0,092 CONCLUSION:despite the low number of patients involved,in our experience a single large L-AmB dose (15mg/kg) did show an effective and safe approach for the IFI prophylaxis, since 80% of treated patients did not experience fungal infection;furthemore preliminary kinetic results show high plasma levels that are slowly eliminated. These data have to be confirmed in larger series of ANLL adult patients to define which may be the best dosage to achieve a good and prolonged tissue concentrations.

Dothiepin for depression: single nightly dosage

1977 ◽  
Vol 15 (23) ◽  
pp. 92-92
Keyword(s):  
Single Dose ◽  
Depressed Patient ◽  
Large Dose ◽  
Half Life ◽  
Dosage Regimen ◽  
The Body ◽  
Dry Mouth ◽  
Blurred Vision ◽  
Depressed Patients ◽  
Single Large Dose

Depressed patients tend to be forgetful, and for them a simple dosage regimen is particularly appropriate. The use of a single daily dosage depends on the drug having a relatively long (over 36 hours) half-life in the body and being tolerated in a single large dose. Many tricyclic anti-depressives fulfil these requirements provided that the single dose is given before the patient goes to bed. Unwanted effects such as dry mouth and blurred vision, which are troublesome during the day, are not a problem during sleep. The sedative actions of many of these drugs can help the insomniac depressed patient who might otherwise need a separate hypnotic.

Rituximab, methotrexate (MTX), procarbazine, and vincristine (R-MPV) followed by consolidation high-dose chemotherapy (HDC) and autologous stem-cell transplant (ASCT) for newly diagnosed primary CNS lymphoma (PCNSL).

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 2008-2008 ◽  
Author(s):  
Antonio Marcilio Padula Omuro ◽  
Denise Correa ◽  
Craig Moskowitz ◽  
Matthew J. Matasar ◽  
Lisa Marie DeAngelis ◽  
...  
Keyword(s):  
Induction Chemotherapy ◽  
Primary Endpoint ◽  
Primary Cns Lymphoma ◽  
Unknown Etiology ◽  
Cns Lymphoma ◽  
High Dose ◽  
Cell Transplant ◽  
Newly Diagnosed ◽  
Induction Regimen

2008 Background: In our previous study in newly diagnosed PCNSL, induction chemotherapy with MTX and cytarabine followed by consolidation HDC (carmustine, etoposide, cytarabine, melphalan [BEAM]) with ASCT without radiotherapy resulted in only 50% of pts transplanted, reflecting low efficacy of induction chemotherapy, and short intent-to-treat (ITT) median PFS (=6m). In this phase II trial, we sought to optimize this strategy by utilizing a more effective induction regimen (R-MPV) and a more aggressive HDC regimen (Soussain et al). Methods: Pts received 5-7 cycles of R-MPV (MTX: 3.5g/m2) and if a partial or complete response was achieved, HDC with thiothepa, cyclophosphamide and busulfan was given, followed by ASCT and no radiotherapy. The primary endpoint was ITT 1 year event-free survival (promising: 75%, non-promising: 50%; 90% power, significance=0.05). Follow-up included comprehensive neuropsychological evaluation. Results: Accrual has been completed (N=32 pts, median age 57 [range 23-67], median KPS=80). Following R-MPV, 17 pts achieved a CR, 13 pts a PR and two pts progressed. A total of 25 (78%) pts were transplanted; the reasons for not receiving transplant were progressive disease (N=2), poor performance status/ physician’s decision (N= 2), mobilization failure (N=1) and consent withdrawn (N= 2). One pt who withdrew consent relapsed and received HDCASCT for salvage. Two (8%) pts died from early complications of ASCT (Stevens-Johnson: one, sepsis: one) and one pt experienced a fatal late colitis of unknown etiology. In the ITT population, the median EFS and OS have not been reached after a median follow-up of 22 months. The 1 year EFS was 78% (95%CI 58-90) and the 2y OS was 76% (95% CI 54-89). No pt has developed delayed neurotoxicity. Conclusions: R-MPV induction regimen resulted in improved response rates, allowing 78% of pts to receive HDC-ASCT. Although more toxic, this regimen resulted in excellent disease control and survival in the ITT population, far exceeding the efficacy of our previous transplant study. The primary endpoint was met, warranting further investigation.

Neonatal candidosis: clinical picture, management controversies and consensus, and new therapeutic options

2002 ◽  
Vol 49 (suppl_1) ◽  
pp. 69-73 ◽  
Author(s):  
Eugene Leibovitz
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Amphotericin B ◽  
Fungal Infections ◽  
Dose Range ◽  
High Dose ◽  
Pharmacokinetic Studies ◽  
High Morbidity ◽  
First Line ◽  
Candida Infections

Abstract Candida infections are increasingly being recognized as a major cause of septicaemia in neonatal intensive care units, and are associated with high morbidity (25%) and mortality (25–54%). Low birth weight pre-term infants are especially vulnerable to this devastating disease. The most frequently encountered fungal infections are caused by Candida albicans, Candida parapsilosis and, rarely, by Candida tropicalis. Amphotericin B (with or without flucytosine) is the treatment of choice for Candida infections in neonates. Conventional amphotericin B use is often limited by its severe side effects, although these tend to be fewer in neonates than in adults. Possible alternatives to amphotericin B include triazoles (such as fluconazole) and lipid preparations of amphotericin B. Liposomal encapsulation of amphotericin B has been shown to decrease the toxicity of the drug while maintaining its antifungal activity. The liposomal formulation AmBisome has proved to be effective in the treatment of severe fungal infections in adult and paediatric immunocompromised patients who fail to respond to conventional amphotericin B. The experience with AmBisome in the treatment of fungal infections in neonates is limited, and the drug has been used mainly in infants either failing conventional amphotericin B or having intolerable toxicity. Pharmacokinetic studies have not yet been performed in neonates. Three uncontrolled studies published between 1997 and 1998 on AmBisome (dose range 1–7 mg/kg/day) in the treatment of neonatal candidosis revealed that the drug was effective and safe. New information is accumulating on the safe use of high-dose AmBisome (5–7 mg/kg/day) in very low birth weight infants, and successful use of the drug as first-line therapy of neonatal candidosis. These promising results suggest a potential role for AmBisome as an additional first-line treatment of systemic candidosis in neonates.

scholarly journals Refractory hypercalcaemia associated with disseminated Cryptococcus neoformans infection

2021 ◽  
Vol 2021 ◽  
Author(s):  
Jasmine Jiang Zhu ◽  
William J Naughton ◽  
Kim Hay Be ◽  
Nicholas Ensor ◽  
Ada S Cheung
Keyword(s):  
Fungal Infection ◽  
Cryptococcus Neoformans ◽  
Fungal Infections ◽  
Effective Therapy ◽  
Differential Diagnoses ◽  
High Dose ◽  
List Type ◽  
Immunocompromised Patients ◽  
Severe Hypercalcaemia

Summary Hypercalcaemia is a very common endocrine condition, yet severe hypercalcaemia as a result of fungal infection is rarely described. There are have only been two reported cases in the literature of hypercalcaemia associated with Cryptococcus infection. Although the mechanism of hypercalcaemia in these infections is not clear, it has been suggested that it could be driven by the extra-renal production of 1-alpha-hydroxylase by macrophages in granulomas. We describe the case of a 55-year-old woman with a 1,25-OH D-mediated refractory hypercalcaemia in the context of a Cryptococcus neoformans infection. She required treatment with antifungals, pamidronate, calcitonin, denosumab and high-dose glucocorticoids. A disseminated fungal infection should be suspected in immunosuppressed individuals presenting with hypercalcaemia. Learning point In immunocompromised patients with unexplained hypercalcaemia, fungal infections should be considered as the differential diagnoses; Glucocorticoids may be considered to treat 1,25-OH D-driven hypercalcaemia; however, the benefits of lowering the calcium need to be balanced against the risk of exacerbating an underlying infection; Fluconazole might be an effective therapy for both treatment of the hypercalcaemia by lowering 1,25-OH D levels as well as of the fungal infection.

scholarly journals A pharmacoepidemiology study of local fungal infections in skin and venereal diseases outpatient department of a rural tertiary care hospital

2020 ◽  
Vol 9 (4) ◽  
pp. 616
Author(s):  
Preety Bansal ◽  
Seema Baishnab
Keyword(s):  
Fungal Infection ◽  
Fungal Infections ◽  
Tertiary Care ◽  
Antifungal Drugs ◽  
Care Hospital ◽  
Dermatology Department ◽  
Number Of Patients ◽  
Common Skin ◽  
Cutaneous Fungal Infection ◽  
Number Of Males

Background: Fungal infections of the skin were the 4th most common skin disease in 2010 affecting 984 million people. An estimated 20-25% of the world’s population has some form of fungal infection. Dermatophytes are fungi that cause superficial infections of the skin, commonly referred to as tinea infections.Methods: This was a prospective and an observational study conducted from February 2018 to January 2019 in Dermatology Department. Prescriptions included all newly diagnosed patients with cutaneous fungal infection of both sex who attended dermatology OPD. Factors considered were sociodemographic parameters, the disease encountered and number of patients in each group and number of patients who received antifungal therapy (oral and topical) etc.Results: 1000 prescriptions were analysed of patients between 18 to 65 years of age with cutaneous fungal infections. There were a greater number of males (57.4%) than females (42.6%). The average number of antifungal drugs prescribed per prescription was 2.33. Majority of the patients were prescribed itraconazole (82.30%) followed by terbinafine (9.70%) and fluconazole (8.0%).Conclusions: The most common oral antifungal drug used was itraconazole. Ketoconazole and Terbinafine were the most commonly used topical agents respectively.

scholarly journals Open-Label, Randomized Comparison of Itraconazole versus Caspofungin for Prophylaxis in Patients with Hematologic Malignancies

2006 ◽  
Vol 50 (1) ◽  
pp. 143-147 ◽  
Author(s):  
Gloria N. Mattiuzzi ◽  
Gladys Alvarado ◽  
Francis J. Giles ◽  
Luis Ostrosky-Zeichner ◽  
Jorge Cortes ◽  
...  
Keyword(s):  
Fungal Infection ◽  
Induction Chemotherapy ◽  
Invasive Fungal Infection ◽  
Fungal Infections ◽  
Randomized Study ◽  
Hematologic Malignancies ◽  
Antifungal Prophylaxis ◽  
Myelogenous Leukemia ◽  
Open Label ◽  
Grade 3

ABSTRACT Invasive fungal infection remains the most common cause of infectious death in acute leukemia. In this open-label, randomized study, we compared the efficacy and safety of caspofungin with that of intravenous itraconazole for antifungal prophylaxis in patients undergoing induction chemotherapy for acute myelogenous leukemia or myelodysplastic syndrome. Of 200 patients, 192 were evaluable for efficacy (86 for itraconazole, 106 for caspofungin). Duration of prophylaxis (median, 21 days [range, 1 to 38 days]), demographics, and prognostic factors were similar in both groups. Ninety-nine patients completed antifungal prophylaxis without developing fungal infection (44 [51%] with itraconazole, 55 [52%] with caspofungin). Twelve patients developed documented invasive fungal infections, five in the itraconazole group (four with candidemia and one with Aspergillus pneumonia), and seven in the caspofungin group (two with candidemia, two with disseminated trichosporon species, two with Aspergillus pneumonia, and one with disseminated Fusarium spp). Two patients in the itraconazole group and four in the caspofungin group died of fungal infection (P = 0.57). Grade 3 to 4 adverse event rates were comparable between groups; the most common event in both was reversible hyperbilirubinemia. No evidence of cardiovascular toxicity from intravenous itraconazole was noted among patients older than 60. In conclusion, intravenous itraconazole and caspofungin provided similar protection against invasive fungal infection during induction chemotherapy, and both drugs were well tolerated.

scholarly journals EFFICACY OF ARIPIPRAZOLE IN TREATMENT OF SCHIZOPHRENIA IN POPULATION OF CENTRAL INDIA

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Omprakash Raichandani ◽  
Abdul Faheem Khan ◽  
Sapna Raichandani
Keyword(s):  
Schizoaffective Disorder ◽  
Dose Range ◽  
Central India ◽  
High Dose ◽  
Low Doses ◽  
Morning Dose ◽  
Old Patients ◽  
Group I ◽  
Number Of Patients ◽  
Group Ii

Background: During the past decade, there has been some progress in the pharmacotherapy of schizophrenia and schizoaffective disorder. Aripiprazole is recommended at a dose of between 10 and 15 mg/day in the treatment of schizophrenia, with a dose range considered to be effective, between 10 and 30 mg/day. Objective: To study the efficacy and safety of Aripiprazole in low doses of 15 mg versus high doses of 30 mg in the treatment of Schizophrenia. Methods: Total 60 new and old patients (who are not on any treatment) between 18-60 years of either gender who meet the diagnostic criteria as per DSM-IV classification for schizophrenia and schizoaffective disorder. Patients were randomly divided into 2 groups on single blind study criteria. Group-I: Aripiprazole 15 mg once a day, morning dose for 6 weeks. Group-II: Aripiprazole 30 mg once a day, morning dose for 6 weeks. Efficacy assessment included at baseline and at 6 weeks end study scoring on PANSS, EPRS and CGI. Results: In both the groups aripiprazole showed the efficacy by improving the number of patients. In group-I, 20 patients has shown the improvement in overall scores of all scales. In group-II, 16 patients have shown the improvement in overall scores in different scales. Conclusions: Aripiprazole is effective in schizophrenia and schizoaffective disorder, low doses of 15 mg is equally effective as high dose of 30 mg. Keywords: Efficacy, Aripiprazole & Schizophrenia.

Pharmacokinetics (PK) of 2 Dosing Regimens of Palifermin in Patients (Pts) with Hematologic Malignancies (HM) Undergoing High-Dose Chemoradiotherapy and Hematopoietic Stem Cell Transplantation (HSCT).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5294-5294 ◽  
Author(s):  
Parnian Zia-Amirhosseini ◽  
Margaret Salfi ◽  
Dieter Elhardt ◽  
Jeff Aycock ◽  
Tsui Chern Cheah ◽  
...  
Keyword(s):  
Single Dose ◽  
Phase 1 ◽  
Dose Range ◽  
Volume Of Distribution ◽  
High Dose ◽  
Karnofsky Performance Score ◽  
Open Label ◽  
Hematopoietic Stem ◽  
Dosing Regimens ◽  
Parameter Values

Abstract For pts with HM undergoing HSCT, oral mucositis (OM) is a frequent and debilitating complication that negatively impacts treatment outcomes, patient quality of life, and healthcare resources. Palifermin reduces the incidence and duration of severe OM in the HSCT setting. This phase 1 open-label study assessed the PK of 2 palifermin dosing regimens. Methods: Pts were 18 to 76 years old with HM and a Karnofsky performance score ≥70%. Palifermin was administered intravenously once daily as follows: 60 mcg/kg/day [d] for 3 consecutive days on d -11, -10, and -9 before conditioning (total body irradiation [TBI] + etoposide + cyclophosphamide) and following HSCT on d 0, 1 and 2 (part A) and a single dose of 180 mcg/kg (part B) before conditioning on d -11 and after HSCT on d 0. In part A (6 total doses), PK parameters were assessed after the 1st, 3rd, 4th, and 6th doses. In part B (2 total doses), assessments were made after each dose administration (d -11 and d 0). Results: In part A, 13 pts received palifermin; in part B, 12 pts received the single dose on d -11 and 11 pts received the single dose on d 0. For both dosing regimens, palifermin concentrations declined rapidly (≥98% decrease) in the first 30 minutes postdose, followed by a slight increase in mean concentrations between 1 and 4 hours and then a terminal decay phase. Respective mean (SD) PK parameter values for the 2 dosing regimens are shown in Table 1. In part A, mean AUC0-t values were comparable between doses 1 and 3 (within 15%) and 1 and 4 (within 1%). In part B, mean PK parameter values were similar (within 10% of each other) between doses 1 and 2. The mean AUC after the first 180 mcg/kg dose in part B was approximately 4-fold higher than that after the first 60 mcg/kg dose in part A. Mean half-life values ranged between 3.3 to 5.7 hours in part A and the value was 5.4 hours in part B. Conclusion: The PK data in pts receiving HSCT were consistent with approximately dose-linear PK in the dose range of 60 and 180 mcg/kg, with no observed accumulation, based on AUC, after 3 daily doses of 60 mcg/kg in this pt population in the HSCT setting. Table 1 Dose Number (Dosing Day) n AUC0-t (hr x ng/mL) mean (SD) Clearance (mL/hr/kg) mean (SD) Vss (mL/kg) mean (SD) a Accurate computations of clearance (CL) and volume of distribution at steady state (Vss) were not possible for some concentration-time profiles. Part A - 60 mcg/kg/day x 3 consecutive days 1st dose (day -11) 9–13 34.3 (15.9) 1730a (497) 5320a (2330) 3rd dose(day -9) 13 39.8 (36.4) - - 4th dose(day 0) 11–13 34.8 (22.5) 2030a (862) 3870a (2080) 6th dose(day 2) 13 21.2 (15.1) - - Part B - 180 mcg/kg/day x 1 day 1st dose(day -11) 12 140 (50.9) 1460 (600) 4290 (3270) 2nd dose(day 0) 11 143 (71.8) 1770 (1290) 4270 (4700)

scholarly journals Taurine supplementation for prevention of stroke-like episodes in MELAS: a multicentre, open-label, 52-week phase III trial

2018 ◽  
Vol 90 (5) ◽  
pp. 529-536 ◽  
Author(s):  
Yutaka Ohsawa ◽  
Hiroki Hagiwara ◽  
Shin-ichiro Nishimatsu ◽  
Akihiro Hirakawa ◽  
Naomi Kamimura ◽  
...  
Keyword(s):  
Primary Endpoint ◽  
Genetic Disorder ◽  
Responder Rate ◽  
Phase Iii ◽  
High Dose ◽  
Mitochondrial Trna ◽  
Taurine Supplementation ◽  
Open Label ◽  
Phase Iii Trial ◽  
Number Of Patients

ObjectiveThe aim of this study was to evaluate the efficacy and safety of high-dose taurine supplementation for prevention of stroke-like episodes of MELAS (mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes), a rare genetic disorder caused by point mutations in the mitochondrial DNA that lead to a taurine modification defect at the first anticodon nucleotide of mitochondrial tRNALeu(UUR), resulting in failure to decode codons accurately.MethodsAfter the nationwide survey of MELAS, we conducted a multicentre, open-label, phase III trial in which 10 patients with recurrent stroke-like episodes received high-dose taurine (9 g or 12 g per day) for 52 weeks. The primary endpoint was the complete prevention of stroke-like episodes during the evaluation period. The taurine modification rate of mitochondrial tRNALeu(UUR) was measured before and after the trial.ResultsThe proportion of patients who reached the primary endpoint (100% responder rate) was 60% (95% CI 26.2% to 87.8%). The 50% responder rate, that is, the number of patients achieving a 50% or greater reduction in frequency of stroke-like episodes, was 80% (95% CI 44.4% to 97.5%). Taurine reduced the annual relapse rate of stroke-like episodes from 2.22 to 0.72 (P=0.001). Five patients showed a significant increase in the taurine modification of mitochondrial tRNALeu(UUR) from peripheral blood leukocytes (P<0.05). No severe adverse events were associated with taurine.ConclusionsThe current study demonstrates that oral taurine supplementation can effectively reduce the recurrence of stroke-like episodes and increase taurine modification in mitochondrial tRNALeu(UUR) in MELAS.Trial registration numberUMIN000011908.

scholarly journals Fungal infections in corn picker hand injury

2016 ◽  
Vol 144 (1-2) ◽  
pp. 52-55 ◽  
Author(s):  
Milana Obradovic-Tomasev ◽  
Mladen Jovanovic ◽  
Nada Vuckovic ◽  
Aleksandra Popovic
Keyword(s):  
Fungal Infection ◽  
Fungal Infections ◽  
Hand Injuries ◽  
Successful Outcome ◽  
Histopathological Analysis ◽  
Tissue Destruction ◽  
Candida Spp ◽  
Biopsy Material ◽  
Number Of Patients ◽  
Increased Risk

Introduction. Hand injuries caused by corn pickers are relatively rare but in most cases extensive, with massive tissue destruction. Severe wounds sustained during agricultural work are contaminated, with high incidence of infection. Objective. The aim of the study was to determine the frequency and type of fungal infection in corn picker injuries and their impact on the course and outcome of treatment. Methods. Corn picker hand injuries for the period 2006-2012 were analyzed. After setting up clinical suspicion, direct examination of repeated swabs and histopathological analysis of biopsy material were done in order to detect fungi. Results. From the total number of 60 patients, there was a fungal infection in nine of them (which makes 15% of the total number of patients). Aspergillus spp. was isolated in seven patients, Candida spp. in three, and Mucor spp. in one patient. None of the patients had increased risk factors for developing a fungal infection. In most cases, there was loss of graft and tissue necrosis in previously normally looking wound, after seven or more days. All patients were treated with repeated surgical debridement and concomitant parenteral and topical application of appropriate antifungal agents. There was no need for reamputation in any patient. Conclusion. A high degree of suspicion and a multidisciplinary approach are needed for early diagnosis of fungal infection. Confirmation of diagnosis and the initiation of surgical and appropriate antifungal therapy are essential for a successful outcome.

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