scholarly journals DISSEMINATED FUNGAL INFECTION WITH ADRENAL INVOLVEMENT: REPORT OF TWO HIV NEGATIVE BRAZILIAN PATIENTS

2015 ◽  
Vol 57 (6) ◽  
pp. 527-530 ◽  
Author(s):  
Graziella Hanna PEREIRA ◽  
Valéria Pereira Barbosa LANZONI ◽  
Elisa Maria BEIRÃO ◽  
Artur TIMERMAN ◽  
Marcia de Souza Carvalho MELHEM
Keyword(s):  
Fungal Infection ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Clinical Forms ◽  
Hiv Negative

Paracoccidioidomycosis and histoplasmosis are systemic fungal infections endemic in Brazil. Disseminated clinical forms are uncommon in immunocompetent individuals. We describe two HIV-negative patients with disseminated fungal infections, paracoccidioidomycosis and histoplasmosis, who were diagnosed by biopsies of suprarenal lesions. Both were treated for a prolonged period with oral antifungal agents, and both showed favorable outcomes.

scholarly journals Analysis of cost of various topical and oral antifungal drugs for superficial fungal infections available in India

2021 ◽  
Vol 10 (12) ◽  
pp. 1348
Author(s):  
Spoorthy H. V. ◽  
L. Padma ◽  
Srividya B. P.
Keyword(s):  
Fungal Infection ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Drugs ◽  
Oral Dosage ◽  
Term Therapy ◽  
Maximum Cost ◽  
Cost Variation ◽  
Frequent Relapses ◽  
The Cost

Background: In tropical countries like India, superficial fungal infections are quite common and certain infections like tinea is rampantly spreading in epidemic proportions and frequent relapses after treatment have increased the need for long term therapy significantly increasing the cost of treatment, so the treatment of fungal infection can raise economic burden on the patient. The aim of the study was to analyze the cost variation of topical antifungal drugs and oral antifungal drugs of various brands for superficial fungal infection available in India.Methods: Cost in Indian Rupees (INR) of antifungal agents manufactured by different pharmaceutical companies in India was collected from the Current index of medical specialities (CIMS) October to December 2019. Minimum cost, maximum cost, cost ratio, cost variation was calculated.Results: In oral dosage form, fluconazole, Itraconazole show the maximum cost variation. In topical single drug therapy luliconazole, terbinafine show maximum cost variation.Conclusions: There is wide cost variation among antifungal agents available in Indian Market. There is need of strict actions for cost policy regulation and sensitization of doctor for selection of appropriate brand drugs. 

D-Index–Guided Early Antifungal Therapy Versus Empiric Antifungal Therapy for Persistent Febrile Neutropenia: A Randomized Controlled Noninferiority Trial

2020 ◽  
Vol 38 (8) ◽  
pp. 815-822 ◽  
Author(s):  
Yoshinobu Kanda ◽  
Shun-ichi Kimura ◽  
Masaki Iino ◽  
Takahiro Fukuda ◽  
Emiko Sakaida ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Fungal Infection ◽  
Antifungal Therapy ◽  
Invasive Fungal Infection ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Controlled Trial ◽  
Horizontal Line ◽  
Hematopoietic Stem ◽  
Randomized Controlled

PURPOSE Empiric antifungal therapy (EAT) is recommended for persistent febrile neutropenia (FN), but in most patients, it is associated with overtreatment. The D-index, calculated as the area surrounded by the neutrophil curve and the horizontal line at a neutrophil count of 500/μL, reflects both the duration and depth of neutropenia and enables real-time monitoring of the risk of invasive fungal infection in individual patients at no cost. We investigated a novel approach for patients with persistent FN called D-index–guided early antifungal therapy (DET), in which antifungal treatment is postponed until a D-index reaches 5,500 or the detection of positive serum or imaging tests, and compared it with EAT in this multicenter open-label noninferiority randomized controlled trial. PATIENTS AND METHODS We randomly assigned 423 patients who underwent chemotherapy or hematopoietic stem-cell transplantation for hematologic malignancies to the EAT or DET group. The prophylactic use of antifungal agents other than polyenes, echinocandins, or voriconazole was allowed. Micafungin at 150 mg per day was administered as EAT or DET. RESULTS In an intent-to-treat analysis of 413 patients, the incidence of probable/proven invasive fungal infection was 2.5% in the EAT group and 0.5% in the DET group, which fulfilled the predetermined criterion of noninferiority of the DET group (−2.0%; 90% CI, −4.0% to 0.1%). The survival rate was 98.0% versus 98.6% at day 42 and 96.4% versus 96.2% at day 84. The use of micafungin was significantly reduced in the DET group (60.2% v 32.5%; P < .001). CONCLUSION A novel strategy, DET, decreased the use and cost of antifungal agents without increasing invasive fungal infections and can be a reasonable alternative to empiric or preemptive antifungal therapy.

scholarly journals Study on management of fungal infections of nose and parnasal sinuses

2018 ◽  
Vol 5 (1) ◽  
pp. 45
Author(s):  
Prasad A. Kelkar ◽  
Jyoti V. Hirekerur
Keyword(s):  
Fungal Infection ◽  
Paranasal Sinuses ◽  
Antifungal Agents ◽  
Opportunistic Infections ◽  
Fungal Infections ◽  
Detailed Examination ◽  
Fungal Sinusitis ◽  
Allergic Fungal Sinusitis ◽  
Adequate Dose ◽  
Nose And Paranasal Sinuses

<p class="abstract"><strong>Background:</strong> From last few years, the fungal infection has been increasing due to greatly enhanced international traffic and as opportunistic infections in consequence of use of powerful cytotoxic drugs. The disease invariably occurs in diabetics, usually with ketoacidosis, immune compromised patients. Hence, we planned to undertake the present study to evaluate a standard method of management of fungal infections of nose and paranasal sinuses.</p><p class="abstract"><strong>Methods:</strong> A detailed examination of the nose and pranasal sinuses was carried out in the department of ENT. The patients were continuously monitored with pulse oximetry and ECG monitor. In all patients, nasal endoscopy was performed.  </p><p class="abstract"><strong>Results:</strong> In this study, fungal infections of the nose and paranasal sinuses were found to be common between 20 and 50 years of age. Aspergillosis was the commonest sinonasal fungal infection followed by allergic fungal sinusitis, rhinosporidiosis and mucormycosis.</p><p class="abstract"><strong>Conclusions:</strong> Early detection, proper and adequate dose of antifungal agents, timely surgical intervention in the form of debridement and sphenoethmoidectomy and orbital exenteration improve the survival rate in the disease of sinonasal fungal infections.</p><p> </p>

scholarly journals Living Bacterial Microneedles for Fungal Infection Treatment

Research ◽  
2020 ◽  
Vol 2020 ◽  
pp. 1-9 ◽  
Author(s):  
Fengyuan Wang ◽  
Xiaoxuan Zhang ◽  
Guopu Chen ◽  
Yuanjin Zhao
Keyword(s):  
Fungal Infection ◽  
Food Processing ◽  
Bacterial Infections ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Therapeutic Effects ◽  
Fungal Cell ◽  
Infection Treatment ◽  
Associated Proteins ◽  
Encapsulated Bacteria

Fungal infections are everlasting health challenges all over the world, bringing about great financial and medical burdens. Here, inspired by the natural competition law of beneficial bacteria against other microbes, we present novel living microneedles (LMNs) with functionalized bacteria encapsulation for efficient fungal infection treatment. The chosen beneficial bacterial components, Bacillus subtilis (B. subtilis), which are naturally found on the human skin and widely used for food processing, can get nutrients from the skin and escape from the immune system with the help of microneedles. Besides, the encapsulated B. subtilis can continuously produce and secrete various potential antifungal agents which can directly bind to fungal cell surface-associated proteins and destruct the cell membranes, thus avoiding drug resistance. After immobilization in the LMNs, the bacteria can stay within the LMNs without invasion and the encapsulated bacteria together with microneedles can be removed after application. Thus, the side effects, especially the risk for subsequent bacterial infections, are controlled to a minimum to ensure security. In addition, strong penetrability of the microneedles enhances penetration of antifungal agents, and their heights can be adjusted according to the infected depth to acquire better therapeutic effects. These features make the LMNs potentially valuable for clinical applications.

Strategies of Drug Delivery for Deep Fungal Infection: A Review

2020 ◽  
Vol 8 (5) ◽  
pp. 372-390
Author(s):  
Zhongyi Ma ◽  
Xiaoyou Wang ◽  
Chong Li
Keyword(s):  
Drug Delivery ◽  
Fungal Infection ◽  
Antifungal Agents ◽  
Water Solubility ◽  
Fungal Infections ◽  
Antifungal Drugs ◽  
Treatment Needs ◽  
Drug Bioavailability ◽  
Delivery Strategies ◽  
Deep Fungal Infection

: The deep fungal infection poses serious threats to human health, mainly due to the increase in the number of immunocompromised individuals. Current first-line antifungal agents such as Amphotericin B, Fluconazole and Itraconazole, may decrease the severity of fungal infection to some extent, but the poor drug bioavailability, drug toxicity and poor water solubility seriously restrict their clinical utility. This review focuses on the study of drug delivery strategies for the treatment of deep fungal infections. We summarize the drug delivery strategies recently reported for the treatment of deep fungal infection, and explain each part with research examples. We discuss the use of pharmaceutical approaches to improve the physicochemical properties of the antifungal drugs to provide a basis for the clinical application of antifungal drugs. We then highlight the strategies for targeting drug delivery to the infection sites of fungi and fungal surface moieties, which have the potential to get developed as clinically relevant targeted therapies against deep fungal infections. It is worth noting that the current research on fungal infections still lags behind the research on other pathogens, and the drug delivery strategy for the treatment of deep fungal infections is far from meeting the treatment needs. Therefore, we envision the potential strategies inspired by the treatment of diseases with referential pathology or pathophysiology, further enriching the delivery of antifungal agents, providing references for basic research of fungal infections. Lay Summary: The deep fungal infections pose serious threats to the health of immunodeficiency patients. It is worth noting that the current research on fungi is still lagging behind that on other pathogens. The drug delivery strategies for the treatment of deep fungal infections are far from meeting the treatment needs. We summarize the recently reported drug delivery strategies for treating deep fungal infection, and envision the potential strategies to further enrich the delivery of antifungal agents.

The Importance of Fluconazole in Treatment of Endogenous Endophtalmitis in Patients Prior Treated Using Negative Pressure Therapy for Wound Closure Contaminated with Meticillin-resistant Staphylococcus aureus

2017 ◽  
Vol 68 (7) ◽  
pp. 1598-1601 ◽  
Author(s):  
Anisia Iuliana Alexa ◽  
Roxana Ciuntu ◽  
Alina Cantemir ◽  
Nicoleta Anton ◽  
Ciprian Danielescu ◽  
...  
Keyword(s):  
Antifungal Agents ◽  
Fungal Infections ◽  
Prolonged Treatment ◽  
Endogenous Endophthalmitis ◽  
Pressure Therapy ◽  
First Case ◽  
Severe Infections ◽  
Pars Plana ◽  
Delay In Treatment ◽  
Vitreous Biopsy

Severe infections with C. albicans should be treated promptly with antifungal agents, any delay in treatment increases the risk of endophthalmitis. The systemic Amphotericin B therapy is the gold standard in the treatment of endophthalmitis, but in the case of fungal infections it has not yet been determined. Numerous studies have shown that the use of Fluconazole is effective in the treatment of fungal endophthalmitis. In this paper, we report two cases (3 eyes) that have been presented for the same accusations of significant decrease of AV (visual acuity), ocular pain and blepharospasm suddenly installed, both of which required urgent antibiotic and intravenous antifungal treatment. Both are diagnosed with endogenous endophthalmitis and vitreous biopsy + VPP (pars plana vitrectomy) are performed, with a negative result of the vitreous culture. In both situations the treatment was with antibiotic and systemic antifungals. Postoperatively, evolution was favorable in the first case and less favorable in the second one. The prognosis depends on the virulence of the microorganisms and the time elapsed until initiation of the treatment. Also, the presence of risk factors such as diabetes, sepsis, recent abdominal surgery (C. Albicans is part of the comesary flora of the digestive tract) have influenced the prognosis decisively. Severe infections with C. albicans should be promptly treated with antifungal agents, any delay in treatment increases the risk of endophthalmitis. Even when prolonged treatment of candidemia is instituted, 3% of patients can develop endogenous endophthalmitis, so ocular evaluation is particularly important for patients immobilized in anesthesia and intensive care units.

Potential of Nanoparticles in Combating Candida Infections

2019 ◽  
Vol 16 (5) ◽  
pp. 478-491 ◽  
Author(s):  
Faizan Abul Qais ◽  
Mohd Sajjad Ahmad Khan ◽  
Iqbal Ahmad ◽  
Abdullah Safar Althubiani
Keyword(s):  
Targeted Delivery ◽  
Recent Progress ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Fold Increase ◽  
Antifungal Drugs ◽  
Low Toxicity ◽  
Candida Infections ◽  
Made In

Aims: The aim of this review is to survey the recent progress made in developing the nanoparticles as antifungal agents especially the nano-based formulations being exploited for the management of Candida infections. Discussion: In the last few decades, there has been many-fold increase in fungal infections including candidiasis due to the increased number of immunocompromised patients worldwide. The efficacy of available antifungal drugs is limited due to its associated toxicity and drug resistance in clinical strains. The recent advancements in nanobiotechnology have opened a new hope for the development of novel formulations with enhanced therapeutic efficacy, improved drug delivery and low toxicity. Conclusion: Metal nanoparticles have shown to possess promising in vitro antifungal activities and could be effectively used for enhanced and targeted delivery of conventionally used drugs. The synergistic interaction between nanoparticles and various antifungal agents have also been reported with enhanced antifungal activity.

Antifúngicos poliénicos. Mecanismo de acción y aplicaciones

2020 ◽  
Vol 63 (2) ◽  
pp. 7-17
Author(s):  
Evelyn Rivera-Toledo ◽  
Alan Uriel Jiménez-Delgadillo ◽  
Patricia Manzano-Gayosso
Keyword(s):  
Antifungal Activity ◽  
Key Words ◽  
Secondary Metabolism ◽  
Amphotericin B ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Variable Number ◽  
Therapeutic Failure ◽  
Morbidity And Mortality ◽  
Clinical Use

The first compounds with specific antifungal activity were identified in the middle of the last century as a product of the secondary metabolism of bacteria of the order Actinomycetales, and their clinical use significantly diminished the morbidity and mortality associated with severe fungal infections. Many of such biosynthetic compounds are characterized by a chemical polygenic structure, with a variable number of carbon-carbon double bonds. Currently, besides polygenic antimycotics, there are other antifungal agents, such as the azole compounds, that have less toxicity in patients; however, cases of therapeutic failure with such compounds have been documented, therefore, the use of polygenics is still the best alternative in such cases. This review presents data about the properties and applications of antifungal-polygenic compounds using amphotericin B as a model. Key words: Amphotericin B; antifungal polyenes; ergosterol

scholarly journals The Prediction and Prognosis of Fungal Infection in Lung Transplant Recipients—A Retrospective Cohort Study in South Korea

2021 ◽  
Vol 7 (8) ◽  
pp. 639
Author(s):  
Yae-Jee Baek ◽  
Yun-Suk Cho ◽  
Moo-Hyun Kim ◽  
Jong-Hoon Hyun ◽  
Yu-Jin Sohn ◽  
...  
Keyword(s):  
Cohort Study ◽  
South Korea ◽  
Fungal Infection ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Lung Transplant ◽  
Fungal Infections ◽  
Transplant Recipients ◽  
Tertiary Center ◽  
Lung Transplant Recipients

(1) Background: Lung transplant recipients (LTRs) are at substantial risk of invasive fungal disease (IFD), although no consensus has been reached on the use of antifungal agents (AFAs) after lung transplantation (LTx). This study aimed to assess the risk factors and prognosis of fungal infection after LTx in a single tertiary center in South Korea. (2) Methods: The study population included all patients who underwent LTx between January 2012 and July 2019 at a tertiary hospital. It was a retrospective cohort study. Culture, bronchoscopy, and laboratory findings were reviewed during episodes of infection. (3) Results: Fungus-positive respiratory samples were predominant in the first 90 days and the overall cumulative incidence of Candida spp. was approximately three times higher than that of Aspergillus spp. In the setting of itraconazole administration for 6 months post-LTx, C. glabrata accounted for 36.5% of all Candida-positive respiratory samples. Underlying connective tissue disease-associated interstitial lung disease, use of AFAs before LTx, a longer length of hospital stay after LTx, and old age were associated with developing a fungal infection after LTx. IFD and fungal infection treatment failure significantly increased overall mortality. Host factors, antifungal drug resistance, and misdiagnosis of non-Aspergillus molds could attribute to the breakthrough fungal infections. (4) Conclusions: Careful bronchoscopy, prompt fungus culture, and appropriate use of antifungal therapies are recommended during the first year after LTx.

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