Therapeutic Drug Monitoring of Posaconazole: an Update
Abstract
Posaconazole is a second-generation triazole agent with a potent and broad antifungal activity. In addition to the oral suspension, a delayed-release tablet and intravenous formulation with improved pharmacokinetic properties have been introduced recently. Due to the large interindividual and intraindividual variation in bioavailability and drug-drug interactions, therapeutic drug monitoring (TDM) is advised to ensure adequate exposure and improve clinical response for posaconazole. Here, we highlight and discuss the most recent findings on pharmacokinetics and pharmacodynamics of posaconazole in...
Source: Current Fungal Infection Reports - May 6, 2016 Category: Infectious Diseases Source Type: research
Improved Radiographic Imaging of Invasive Fungal Disease: The Cornerstone to Antifungal Stewardship in the Hematology Units?
Abstract
Empirical or fever-driven antifungal treatment strategies are widely recognized to result in overtreatment of patients and excessive cost. As a result, diagnostic-driven approaches for managing invasive fungal diseases (IFDs) in hematology units have been proposed that rely on early non-specific radiologic findings frequent testing with non-culture-based biomarkers (e.g., galactomannan, PCR) as a trigger for antifungal treatment. However, the performance of these non-culture-based biomarker tests varies significantly from one center to the next, and their sensitivity is reduced by prior antifunga...
Source: Current Fungal Infection Reports - April 13, 2016 Category: Infectious Diseases Source Type: research
Evolution of Cryptococcal Antigen Testing: What Is New?
Abstract
Over the last decade, an upsurge in both the frequency and severity of fungal infections due to the HIV/AIDS epidemic and the use of immunosuppressive therapy has occurred. Even diagnostic methods like culture and microscopy, which have low sensitivity and longer turnaround times, are not widely available, leading to delays in timely antifungal therapy and detrimental patient outcomes. The evolution of cryptococcal antigen (CrAg) testing to develop inexpensive and more sensitive methods to detect cryptococcal antigen is significant. These newer tests employ immunoassays as part of point-of-care p...
Source: Current Fungal Infection Reports - April 11, 2016 Category: Infectious Diseases Source Type: research
Point of Care Testing for the Diagnosis of Fungal Infections: Are We There Yet?
Abstract
Diagnostic tools for invasive fungal infections have continuously improved within the last decades. Nowadays, cultural methods, antigen testing, and molecular tests, such as polymerase chain reaction, are widely used. These methods, however, are accompanied with different limitations as various availability, various turnaround time or high costs. A new generation of point-of-care test has shown promising results in various studies and may overcome some of these limitations. We therefore reviewed the literature for the most promising new point-of-care tests for invasive aspergillosis (Aspergillus-...
Source: Current Fungal Infection Reports - April 6, 2016 Category: Infectious Diseases Source Type: research
Impact of New Diagnostic Approaches for Invasive Candidiasis on Antifungal Stewardship
Conclusions
Eight studies were identified of which five had sufficient information to be included in the review. Despite the limitations of the various studies and the different methodologies employed, the studies all produced similar conclusions. Compared to conventional methods and baseline stewardship activities, the integration of RDTs for IC and real-time decision support, mainly through antifungal stewardship, was associated with decreased mortality, more optimal use of antifungals, and reduced healthcare costs. However, larger clinical studies are needed to confirm these trends. (Source: Current ...
Source: Current Fungal Infection Reports - April 3, 2016 Category: Infectious Diseases Source Type: research
Next-Generation Sequencing in the Mycology Lab
Abstract
New state-of-the-art techniques in sequencing offer valuable tools in both detection of mycobiota and in understanding of the molecular mechanisms of resistance against antifungal compounds and virulence. Introduction of new sequencing platform with enhanced capacity and a reduction in costs for sequence analysis provides a potential powerful tool in mycological diagnosis and research. In this review, we summarize the applications of next-generation sequencing techniques in mycology. (Source: Current Fungal Infection Reports)
Source: Current Fungal Infection Reports - March 16, 2016 Category: Infectious Diseases Source Type: research
The European Paediatric Mycology Network (EPMyN): Towards a Better Understanding and Management of Fungal Infections in Children
Abstract
The European Paediatric Mycology Network (EPMyN) was launched in 2014 to create a European platform for research and education in the field of paediatric mycology. The EPMyN aims to address the lack of paediatric specific evidence and knowledge needed to (1) improve the management and outcome of invasive fungal infections in children and neonates and to (2) enhance and develop paediatric antifungal stewardship programmes. (Source: Current Fungal Infection Reports)
Source: Current Fungal Infection Reports - February 26, 2016 Category: Infectious Diseases Source Type: research
Important Mycoses in Children in South America
Abstract
Invasive fungal disease (IFD) is an important infection with high rates of morbidity and mortality in hospitalized patients. Data on incidence, risk factors, and mortality of IFD in the pediatric population, mainly in South America, are scarce. The aim of this paper was to review the literature about the most important IFD in pediatrics in South America. We searched three electronic databases (Medline, Lilacs, and Cochrane databases) for studies published between 2012 and 2015; case reports and editorial were excluded. Twenty-two articles were found on Candida spp. infections; eight on Paracoccid...
Source: Current Fungal Infection Reports - February 20, 2016 Category: Infectious Diseases Source Type: research
Delivery of Antifungal Agents from Bone Cement
This article provides an overview of bone cement as a delivery system for antifungal agents in vitro and in clinical reports. (Source: Current Fungal Infection Reports)
Source: Current Fungal Infection Reports - January 30, 2016 Category: Infectious Diseases Source Type: research
The Changing Landscape for Paediatric Regulation of Pharmaceutical Agents with a Focus on Antifungal Agents
Abstract
The limited paediatric specific data for pharmaceutical agents has been a persistent issue for over a century. Since the late 1990s, two of the world’s largest regulatory agencies, the Food and Drug Administration and the European Medicines Agency, have made concerted efforts backed by federal legislation aimed to improve the availability of paediatric data for many pharmaceutical agents. In the same time frame, there has been considerable research and development of new antifungal agents to help combat life-threatening invasive fungal disease. The evolving landscape of pharmaceutical regulatio...
Source: Current Fungal Infection Reports - January 25, 2016 Category: Infectious Diseases Source Type: research
Antifungal Penetration into the Nail and New Topicals for Onychomycosis
Abstract
Onychomycosis is a common and difficult to treat infection, owing predominately to the limited penetration of topical drugs to the site of infection. Systemic drugs are not an option for all patients due to adverse events and drug-drug interactions. In this article, we review the nail penetration and clinical efficacy data of topical drugs, including older agents such as ciclopirox and amorolfine, as well as the newer agents, efinaconazole and tavaborole. Additionally, we describe some unresolved questions in the management of onychomycosis. (Source: Current Fungal Infection Reports)
Source: Current Fungal Infection Reports - January 21, 2016 Category: Infectious Diseases Source Type: research
Cryptococcal Antigen Screening and Treatment: The Current State of Global Screening Programs to Prevent Death from Cryptococcal Infection
Abstract
Cryptococcal meningitis (CM) is the leading cause of death among people with AIDS. The World Health Organization issued a conditional recommendation in 2011 for countries to consider serum cryptococcal antigen (CrAg) screening in patients with CD4 count <100 cells/μL in order to identify those at risk for CM and to treat them preemptively with fluconazole to prevent progression to CM. This paper outlines the evidence behind CrAg screening, the prevalence of CrAg in various settings, and our current understanding of the state of CrAg screening programs. A growing number of countries are incorp...
Source: Current Fungal Infection Reports - October 19, 2015 Category: Infectious Diseases Source Type: research
Progressive Disseminated Histoplasmosis and HIV/AIDS: a Dermatological Perspective
Abstract
Progressive disseminated histoplasmosis (PDH) occurs as a result of internal spread of Histoplasma capsulatum from the lungs to organs rich in monocytes. This typically occurs in immunosuppressed patients, such as those with HIV/AIDS. Skin involvement is found in 10 % of all patients with PDH in the USA and in up to 25 % of those with AIDS. Crusted papular or plaque-like lesions are most common, with others being nodular, pustular, ulcerated, vegetative, acneiform, or wart-like. Lesions may be caused by the fungus itself or an immune response to the infection, such as erythema nodosum or erythe...
Source: Current Fungal Infection Reports - October 3, 2015 Category: Infectious Diseases Source Type: research
Pneumocystis Pneumonia in Solid Organ Transplant Recipients
Abstract
Pneumocystis pneumonia (PCP) remains an important opportunistic infection among solid organ transplant (SOT) recipients. The diagnosis of PCP should be considered in patients with new onset of fever, pulmonary symptoms, and hypoxemia. The introduction of PCP prophylaxis for SOT recipients has dramatically modified the epidemiological landscape of this infection; we are currently experiencing the era of “late PCP,” where the majority of cases occur more than 12 months after transplantation in patients with PCP risk factors in whom prophylaxis has been discontinued....
Source: Current Fungal Infection Reports - September 30, 2015 Category: Infectious Diseases Source Type: research
Typing of Fungi in an Outbreak Setting: Lessons Learned
Abstract
Typing is applied to highlight the genetic relationships between environmental and clinical fungal isolates involved in colonization or infection. A variety of techniques can be used to type fungi, depending on the epidemiological question and the available equipment. The use of typing techniques during clinical fungal outbreak investigations demonstrated patient-to-patient propagation in dermatophytoses outbreaks, patient-to-health-care worker and health-care worker-to-patient transmission in yeast infection outbreaks, airborne patient-to-patient transmission of the non-cultivable Pneumocystis j...
Source: Current Fungal Infection Reports - September 28, 2015 Category: Infectious Diseases Source Type: research
