How to treat fungal infections in ICU patients

Fungal infections represent a major burden in the critical care setting with increasing morbidity and mortality. Candidiasis is the leading cause of such infections, with C. albicans being the most common causative agent, followed by Aspergillosis and Mucormycosis. The diagnosis of such infections is cumbersome requiring increased clinical vigilance and extensive laboratory testing, including radiology, cultures, biopsies and other indirect methods. However, it is not uncommon for definitive evidence to be unavailable. Risk and host factors indicating the probability of infections may greatly help in the diagnostic approach. Timely and adequate intervention is important for their successful treatment. The available therapeutic armamentarium, although not very extensive, is effective with low resistance rates for the newer antifungal agents. However, timely and prudent use is necessary to maximize favorable outcomes.
Source: BMC Infectious Diseases - Category: Infectious Diseases Authors: Source Type: research

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ConclusionsOur data indicate significant differences in the immunomodulatory potency of different antimycotics. While fluconazole had the highest anti-inflammatory potential, conventional amphotericin even increased cytokine release. This preliminary information might have clinical implication, since cytokine dysregulation plays a major role in the pathogenesis and outcome of fungal infections. Clinical studies are warranted to confirm our findings.
Source: Infection - Category: Infectious Diseases Source Type: research
Invasive fungal infections, such as aspergillosis, candidiasis and cryptococcosis, have significantly increased among immunocompromised people. To tackle these infections the first and most decisive step is the accurate identification of the causal pathogen. Routine identification of invasive fungal infections has progressed away from culture-dependent methods towards molecular techniques, including DNA barcoding, a highly efficient and widely used diagnostic technique. Fungal DNA barcoding previously relied on a single barcoding region, the internal transcribed spacer region (ITS). However, this allowed only for 75% of al...
Source: Frontiers in Microbiology - Category: Microbiology Source Type: research
Abstract The cell wall (CW) and plasma membrane are fundamental structures that define cell shape and support different cellular functions. In pathogenic fungi, such as Aspegillus fumigatus, they not only play structural roles but also are important for virulence and immune recognition. Both the CW and the plasma membrane remain as attractive drug targets to treat fungal infections, such as the Invasive Pulmonary Aspergillosis (IPA), a disease associated with high morbimortality in immunocompromised individuals. The low efficiency of echinocandins that target the fungal CW biosynthesis, the occurrence of environme...
Source: Current Protein and Peptide Science - Category: Biochemistry Authors: Tags: Curr Protein Pept Sci Source Type: research
AbstractPurpose of ReviewThere is significant interindividual variability in the development and progression of fungal diseases, most notably invasive pulmonary aspergillosis (IPA). The integration of individual traits into clinically valid procedures to predict the risk and progression of infection, and the efficacy of antifungal prophylaxis and therapy, will change the current healthcare landscape regarding the management of patients at risk of IPA and, likely, other fungal infections.Recent FindingsOver the last decade, an expanding number of common polymorphisms associated with IPA have been reported, adding to the inf...
Source: Current Fungal Infection Reports - Category: Infectious Diseases Source Type: research
Invasive aspergillosis (IA) is a life-threatening infection that mainly occurs in immunocompromised patients. Here, we compared the novel Aspergillus-specific galactomannoprotein (GP) enzyme-linked immunosorbent assay (ELISA) (Euroimmun Medizinische Labordiagnostika AG) to the established Platelia Aspergillus galactomannan (GM) ELISA (Bio-Rad Laboratories) for the detection of IA. A total of 267 serum samples from 45 cases of proven and 4 episodes of probable IA (according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Inf...
Source: Journal of Clinical Microbiology - Category: Microbiology Authors: Tags: Mycology Source Type: research
l C Abstract Invasive aspergillosis caused by intrinsically resistant non-fumigatus Aspergillus species displays a poor outcome in immunocompromised patients. The polyene antifungal amphotericin B (AmB) remains to be "gold standard" in the treatment of invasive fungal infections. Aspergillus terreus is innately resistant to AmB, in vivo and in vitro. Till now, the exact mode of action in polyene resistance is not well understood. This review highlights the underlying molecular basis of AmB resistance in A. terreus, displaying data obtained from AmB susceptible A. terreus and AmB resistant A. terreus stra...
Source: Fungal Genetics and Biology - Category: Biology Authors: Tags: Fungal Genet Biol Source Type: research
AbstractPurpose of ReviewThe incidence of invasive aspergillosis has increased substantially over the past few decades, accompanied by a change in susceptibility patterns ofAspergillus fumigatus with increasing resistance observed against triazole antifungals, including voriconazole and isavuconazole, the most commonly used antifungal agents for the disease. Culture-based methods for determining triazole resistance are still the gold standard but are time consuming and lack sensitivity. We sought to provide an update on non-culture-based methods for detecting resistance patterns toAspergillus.Recent FindingsNew molecular-b...
Source: Current Fungal Infection Reports - Category: Infectious Diseases Source Type: research
kar A Abstract Bruton's tyrosine kinase inhibitor ibrutinib has become a leading therapy against chronic lymphoid leukemia. Recently, ibrutinib has been associated with the occurrence of invasive fungal infections, in particular invasive aspergillosis. The mechanisms underlying the increased susceptibility to fungal infections associated with ibrutinib exposure are currently unknown. Innate immunity, in particular polymorphonuclear neutrophils, represents the cornerstone of anti-Aspergillus immunity however the potential impact of ibrutinib on neutrophils has been little studied. Our study investigated the respons...
Source: Haematologica - Category: Hematology Authors: Tags: Haematologica Source Type: research
ConclusionsAirborne fungal spore levels tended to be higher during the period with heavier construction works involving demolition and excavation, during which the incidence of IA was significantly higher as well. We recommend monitoring airborne fungal spore levels during construction periods in hospitals with immunocompromised patients. Subsequently, the effect of airborne fungal spore level monitoring in reducing hospital-acquired IA should be evaluated.
Source: Antimicrobial Resistance and Infection Control - Category: Infectious Diseases Source Type: research
CONCLUSIONS: The optimal cut-off value depends on the local incidence and clinical pathway. At a prevalence of 12% a hypothetical population of 1000 patients will consist of 120 patients with IA. At a cut-off value of 0.5 14 patients with IA will be missed and there will be 167 patients incorrectly diagnosed with IA. If we use the test at a cut-off value of 1.0, we will miss 26 patients with IA. And there will be 62 patients incorrectly diagnosed with invasive aspergillosis. The populations and results were very heterogeneous. Therefore, interpretation and extrapolation of these results has to be performed with caution. A ...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
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