Radiologic Imaging Techniques for the Diagnosis and Management of Invasive Fungal Disease
Abstract
Invasive fungal diseases (IFDs) are an important cause of morbidity and mortality, especially in immunocompromised patients. Prompt antifungal therapy is essential for favorable outcomes, but clinical signs and symptoms are nonspecific and mycologic confirmation is often not possible. Radiographic testing is an important adjunct to the diagnosis and management of IFDs. Early imaging has been associated with improved survival, particularly in neutropenic patients with fungal pneumonia or acute invasive fungal sinusitis. This review summarizes common radiologic appearances of IFDs of the lung, sinu...
Source: Current Fungal Infection Reports - June 25, 2015 Category: Infectious Diseases Source Type: research
The Clinical Significance of Azole Antifungals’ Effects on the Liver and Transaminase Levels
Abstract
Various case reports have been published regarding the incidence of hepatotoxicity and the triazoles. To date, of the more commonly used triazoles, voriconazole has been liked to the highest incidence of transaminase elevations followed by posaconazole, fluconazole, and itraconazole, respectively. Discontinuation of each of the drugs has been shown to resolve the increase of transaminase levels; however, no clear guidance has been suggested on as to when discontinuation of therapy is warranted. Close monitoring particularly patients of Asian decent, underlying liver disease, bone marrow, or lung ...
Source: Current Fungal Infection Reports - June 21, 2015 Category: Infectious Diseases Source Type: research
Fundament and Prerequisites for the Application of an Antifungal TDM Service
Abstract
Therapeutic drug monitoring (TDM) involves the measurement of plasma or serum drug concentration to adapt dosages to achieve predefined target concentrations that are associated with optimal clinical response while minimizing the chance of encountering toxicity. Many papers in the field of antifungal drugs have focused on the evidence that supports the use of TDM thereby emphasizing the breakpoints or target concentrations in general literature. This review focuses on the process of TDM to inform health care workers on the fundaments and prerequisites that safeguard the good application of TDM. K...
Source: Current Fungal Infection Reports - May 7, 2015 Category: Infectious Diseases Source Type: research
Clinical Pharmacology of Itraconazole in Children and Adolescents
This article provides a brief overview of the pharmacology of itraconazole with focus on the available data in immunocompromised children and adolescents. (Source: Current Fungal Infection Reports)
Source: Current Fungal Infection Reports - April 21, 2015 Category: Infectious Diseases Source Type: research
Combination Therapy for the Treatment of Mucormycosis: Examining the Evidence
Abstract
Despite aggressive antifungal therapy and surgical intervention, mortality and clinical response rates for invasive mucormycosis infections remain suboptimal. Combination therapy with other antifungal agents, immunosuppressive drugs, and various other agents, have been studied as a means to improve outcomes. However, most clinical outcomes data evaluating combination therapy are from case series and case reports, and the majority of comparative data derives from in vitro models and animal studies. Thus, this review evaluates the rationale and risks of various combinations for the treatment of inv...
Source: Current Fungal Infection Reports - April 15, 2015 Category: Infectious Diseases Source Type: research
Therapeutic Drug Monitoring and Genotypic Screening in the Clinical Use of Voriconazole
Abstract
Voriconazole is an antifungal triazole that is the first-line agent for treatment of invasive aspergillosis. It is metabolized by CYP2C19, CYP2C9, and CYP3A4 and demonstrates wide interpatient variability in serum concentrations. Polymorphisms in CYP2C19 contribute to variability in voriconazole pharmacokinetics. Here, evidence is examined for the use of voriconazole therapeutic drug monitoring (TDM) and the role of CYP2C19 genotyping in voriconazole dosing. The majority of studies exploring the impact of voriconazole TDM on efficacy and safety have found TDM to be beneficial. However, most of th...
Source: Current Fungal Infection Reports - April 15, 2015 Category: Infectious Diseases Source Type: research
Fungal Biomarkers, Antifungal Susceptibility Testing, and Therapeutic Drug Monitoring—Practical Applications for the Clinician in a Tertiary Care Center
Abstract
Invasive fungal infections (IFIs) have increased steadily over the past several decades. The incidence of IFIs with reduced antifungal susceptibility or resistance is also on the rise. These IFIs carry significant morbidity and mortality. Among the many reasons for these poor outcomes have been the delays in diagnosis and adequate treatment of these infections. Therefore, considerable research has been directed towards earlier diagnostic strategies using biomarkers, the development and standardization of antifungal susceptible testing (AST), as well as therapeutic drug monitoring (TDM) of antifun...
Source: Current Fungal Infection Reports - April 14, 2015 Category: Infectious Diseases Source Type: research
The Eagle-Like Effect of the Echinocandins: Is It Relevant for Clinical Decisions?
Abstract
The Eagle effect is a paradoxical growth phenomenon long known to exist in vitro with specific antimicrobial agents, particularly the penicillins. More recent reports have indicated that this effect also exists when Candida or Aspergillus species are exposed to the echinocandin antifungals. While the majority of data for this effect exists for caspofungin, there are also reports that micafungin and anidulafungin may have a paradoxical growth effect in certain media or with particular pathogens. In efforts to reproduce the paradoxical growth curve in vivo, results with Candida have been varied. In...
Source: Current Fungal Infection Reports - April 9, 2015 Category: Infectious Diseases Source Type: research
Combination Therapy for Invasive Aspergillosis: Controversies and Conclusions
Abstract
Historically poor outcomes have generated many efforts toward improving outcomes of invasive pulmonary aspergillosis in immunosuppressed hosts, by improving prevention strategies, use of early diagnostics, and employing new antifungals, including combinations of drugs. The latter approach is supported by theoretical benefits in both the antimicrobial activity and pharmacologic properties of drugs, with in vitro and animal studies suggesting potential utility. Because drug combinations can also increase toxicities, interactions, and costs, demonstrating therapeutic effects in clinical trials is im...
Source: Current Fungal Infection Reports - April 9, 2015 Category: Infectious Diseases Source Type: research
