Prophylaxis and Treatment of Invasive Aspergillosis: Who and How of Prophylaxis, Treatment, and New Therapies

AbstractPurpose of reviewTo discuss the approach to antifungal prophylaxis and treatment for invasive aspergillosis in immunocompromised patients with hematologic malignancies, hematopoietic stem cell transplant, and solid organ transplant recipients.Recent findingsPrimary prophylaxis againstAspergillus is recommended for patients with acute myelogenous leukemia receiving remission-induction chemotherapy. Posaconazole or voriconazole are appropriate antifungal agents. A new formulation of itraconazole (SUBA-itraconazole) is an alternative option. Breakthrough infections on isavuconazole prophylaxis have been recently reported. For liver transplant recipients, targeted prophylaxis is recommended in the presence of certain risk factors.Voriconazole and isavuconazole are the preferred agents for the treatment of invasive aspergillosis. Isavuconazole, a novel extended-spectrum triazole with activity againstAspergillus andMucorales, was found to be non-inferior compared to voriconazole. Combination of voriconazole with an echinocandin is generally not recommended. Reduction in immunosuppression is recommended as part of the management of invasive aspergillosis. The adjunctive use of interferon- γ may be considered in patients with severe or refractory disease, although a benefit has not been clearly demonstrated.SummaryThe approach to prevention and treatment of invasive aspergillosis has evolved along with changes in immunosuppressive treatment and introduction of novel ant...
Source: Current Treatment Options in Infectious Diseases - Category: Infectious Diseases Source Type: research

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AbstractQuizartinib is a tyrosine kinase inhibitor selectively targeting the FMS-like tyrosine kinase 3 (FLT3) receptor that has been developed for the treatment of acute myeloid leukaemia (AML). The Phase 3 QuANTUM-R study investigated the efficacy of quizartinib monotherapy in patients with relapsed/refractoryFLT3-ITD mutation-positive AML. The clinical course of four QuANTUM-R participants exemplifies issues specific to quizartinib treatment and is described here. Patient 1 wasFLT3-ITD mutation-negative at AML diagnosis, but becameFLT3-ITD mutation-positive during treatment that included several lines of chemotherapy an...
Source: Clinical Drug Investigation - Category: Drugs & Pharmacology Source Type: research
We report a series of 12 cases of oral aspergillosis with an age range from 21 to 63 years (mean, 42 y), 7 women, 5 men, whose underlying diseases were acute myeloid leukemia (n  = 9) and chronic myeloid leukemia in blastic crisis (n = 3). Primary sites and symptoms were: 2 cases in the nasal cavity presenting as rhinorrhea and fever, 5 cases in the paranasal sinus (2 with pain, 1 with fever and 2 with pain and fever), and 5 cases in the oral mucosa who presented on ly with pain. All cases localized in paranasal sinuses were detected by computed tomography while in the nasal cavity; however, none were detected by i...
Source: Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics - Category: ENT & OMF Authors: Source Type: research
Conference abstracts
Source: The Aspergillus Website - updates - Category: Respiratory Medicine Authors: Source Type: news
Conference abstracts
Source: The Aspergillus Website - updates - Category: Respiratory Medicine Authors: Source Type: news
AbstractPurposeInvasive pulmonary aspergillosis (IPA) is a dreadful event in patients with hematological malignancies (HM). Recent advances have standardized diagnostic, prophylactic and curative therapeutic strategies. We sought to assess whether these advances actually translate into improved survival in critically ill patients with acute respiratory failure and IPA.MethodsThis was a retrospective, multicenter study. Adult patients with HM, IPA, admitted to the ICU for acute respiratory failure over a 20-year period (January 1998 –December 2017) were included. A cox regression model was used to identify variables i...
Source: Intensive Care Medicine - Category: Intensive Care Source Type: research
Conference abstracts
Source: The Aspergillus Website - updates - Category: Respiratory Medicine Authors: Source Type: news
Conference abstracts
Source: The Aspergillus Website - updates - Category: Respiratory Medicine Authors: Source Type: news
Conference abstracts
Source: The Aspergillus Website - updates - Category: Respiratory Medicine Authors: Source Type: news
We will present a 42 year old woman with acute myeloid leukaemia and pulmonary aspergillosis. She was treated with several antifungal agents, including 3 triazoles. Voriconazole, posaconazole, and isavuconazole all led to hepatocellular liver injury. Voriconazole administration led to a peak alanine aminotransferase (ALT) value of 1793 U/l (normal range 9 – 59 U/l). After posaconazole and isavuconazole treatment, ALT rose over 500 U/l. The typical course of events, exclusion of differential diagnoses, and normalization of the liver function tests (LFTs) after stopping the triazoles were highly suspicious for a drug-i...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
Conclusion: This prospective multicenter study provides information on the current incidence and outcome of IFD in the real life setting. Practice variation between the centers may help to ultimately improve antifungal management in children at highest risk for IFDs. Introduction Available data on the incidence and outcome of invasive fungal diseases (IFD) in children treated for a hematological malignancy or undergoing allogeneic hematopoietic stem cell transplantation (HSCT) are mostly based on single site, retrospective studies or on studies performed prior to the availability of newer compounds such as broad-sp...
Source: Frontiers in Microbiology - Category: Microbiology Source Type: research
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