Implications of Evolving and Emerging Pharmacokinetic-Pharmacodynamic Research for Triazoles and Echinocandins
AbstractPurpose of ReviewClinicians should be encouraged to use pharmacokinetic-pharmacodynamic (PK-PD) studies to optimize antifungal drug dosing in the absence of robust comparative effectiveness data or in cases where evidence of causality has not yet been firmly established. The purpose of this article is to review how new triazole and echinocandin PK-PD studies have contributed to our current understanding of antifungal selection and dose optimization against invasive fungal infections. Emerging infections such asC. auris and novel antifungal drugs such as rezafungin will also be highlighted. Future research endeavors...
Source: Current Fungal Infection Reports - May 18, 2020 Category: Infectious Diseases Source Type: research
Diagnosis of Invasive Aspergillosis in Intensive Care Unit Patients
AbstractPurpose of ReviewInvasive aspergillosis is a frequent opportunistic infection in the intensive care unit. Diagnostic strategies within this setting are not well-defined.Recent FindingsIn the absence of histopathological proof, estimation of likelihood of disease is required, based on a combination of host factors with clinical, microbiological and radiologic findings. Importantly, the at-risk critically ill population has expanded beyond the classical immunosuppressed patients. Clinical features are non-specific, yet overt organ failure is associated with an increased risk and should raise the suspicion of invasive...
Source: Current Fungal Infection Reports - May 15, 2020 Category: Infectious Diseases Source Type: research
Review of the Current Management of Urinary Tract Infections due to Fluconazole-Resistant and Non-Albicans Candida Species
AbstractPurpose of ReviewThe management of fungal infections is challenging, especially given the continued increase in fluconazole resistance and prevalence of non-albicansCandida spp. Urinary tract infections due to non-albicans and fluconazole-resistantCandida are particularly problematic given the uncertainty in determining true infection from colonization and the limited number of antifungal agents with adequate penetration to the site of infection. While our understanding of mechanisms of resistance and pharmacokinetics and pharmacodynamics continues to improve, it is combatted by the emergence of novel, difficult-to...
Source: Current Fungal Infection Reports - May 15, 2020 Category: Infectious Diseases Source Type: research
Antifungal and Oral Anticancer Therapy Drug Interactions
AbstractPurpose of ReviewIn the past 5 years, there has been a significant expansion in the oncology arsenal. These new oncolytic therapies are being incorporated with traditional cytotoxic chemotherapy or used as single-agent therapy. Disease states such as acute and chronic leukemias have seen some the largest therapy expansion in de cades. Frequently, these patients often necessitate the use of antifungals in either the prophylaxis or treatment setting. This review provides a brief overview of recently approved oncolytic therapies and the drug-drug interactions (DDIs) that clinicians encounter when managing antifungal...
Source: Current Fungal Infection Reports - May 6, 2020 Category: Infectious Diseases Source Type: research
White Piedra, a Rare Superficial Mycosis: an Update
AbstractPurpose of ReviewWhite piedra (WP) is a rare superficial mycosis that has been poorly described in the literature. This review aims to summarize our current understanding ofTrichosporon spp. infection and WP.Recent FindingsTrichosporon spp. are part of the human skin microbiome. The mechanism of hair shaft infection and nodule ultrastructure has been identified. Trichoscopy is an important diagnostic tool. Besides the classical WP signs, atypical presentations and concomitant diseases have also been described. Combination of systemic and topical antifungals is more effective than topical therapy alone.SummaryMost c...
Source: Current Fungal Infection Reports - May 5, 2020 Category: Infectious Diseases Source Type: research
Updates in the Treatment of Breakthrough Mold Infections
AbstractPurpose of ReviewPatients on antifungal therapy who develop breakthrough mold infections pose significant treatment challenges for clinicians. Treatment of these infections demands a multimodal approach, including a thorough patient assessment, immune restoration, and evaluation for nonadherence and drug –drug interactions. However, limited clinical trial data are available to guide therapeutic decision-making.Recent FindingsOrganisms associated with breakthrough mold infection have historically includedAspergillus species and the Mucorales; however, rare and resistant molds are increasing in prevalence. Treatmen...
Source: Current Fungal Infection Reports - April 29, 2020 Category: Infectious Diseases Source Type: research
Combat Trauma –Related Invasive Fungal Wound Infections
AbstractPurpose of ReviewThis review highlights research from the past 5 years on combat trauma-related invasive fungal wound infections (IFIs) with a focus on risk stratification to aid patient management, microbiology, and diagnostics.Recent FindingsA revised classification scheme stratifies wounds into three risk groups: IFI, high suspicion of IFI, and low suspicion of IFI. This stratification is based on persistence of wound necrosis and laboratory fungal evidence, presence of signs/symptoms of deep soft-tissue infections, and the need for antifungals. Use of this classification could allow for prioritization of anti...
Source: Current Fungal Infection Reports - April 15, 2020 Category: Infectious Diseases Source Type: research
Invasive Fungal Infections of the Central Nervous System in Immune-Competent Hosts
AbstractPurpose of ReviewFungal infections of the central nervous system (CNS) occur more commonly in immunosuppressed individuals. However, they are being recognized in apparently immune-competent hosts in recent times. Understanding the risk factors, characters of the fungus, and pathogenesis is important.Recent FindingsFungal infections of CNS in apparently immune-competent hosts are described following neurosurgical procedures, head trauma, patients exposed to contaminated devices/drugs, or natural disasters. Disruption of the meninges and blood-brain barrier and direct inoculation of the fungal spores into the subarac...
Source: Current Fungal Infection Reports - April 10, 2020 Category: Infectious Diseases Source Type: research
Skin Infections Caused by Emerging Candida Species
AbstractPurpose of ReviewSkin infections caused by yeasts are becoming more frequent, mainly the ones associated withCandida albicans. However, the non-albicansCandida species are emerging with new species that have lower susceptibility and greater resistance to antifungal agents. Therefore, the objective of this review is to learn about the newCandida emerging species that are causing skin infections, their diagnosis, and treatment.Recent FindingsNew emerging species that cause skin disease have been found such asC. duobushaemulonii,C. africana, andC. auris, the latter being a health problem due to its difficult identific...
Source: Current Fungal Infection Reports - March 26, 2020 Category: Infectious Diseases Source Type: research
Azole-Resistant Aspergillus and Echinocandin-Resistant Candida : What Are the Treatment Options?
AbstractPurpose of ReviewThis review summarizes current treatment options for echinocandin-resistantCandida spp. (ERC) and azole-resistantAspergillus fumigatus (ARAF), emphasizing recent in vitro/in vivo data, clinical reports, and consensus statements.Recent FindingsAdvances in ERC and ARAF treatment are limited to specific antifungal combinations and dose optimization but remain reliant on amphotericin products. Although novel antifungals may provide breakthroughs in the treatment of resistant fungi, these agents are not yet available. Early identification and appropriate treatment remain a paramount, albeit elusive, tas...
Source: Current Fungal Infection Reports - March 25, 2020 Category: Infectious Diseases Source Type: research
Coccidioidomycosis in Children and Adolescents: an Update
AbstractPurpose of ReviewCoccidioidomycosis is a systemic fungal infection endemic in Southwestern United States, Northern Mexico, Central and South America. Coccidioidal infection is not well characterized in pediatric population; but due to an increasing incidence in this age group, a special interest had surged to further describe clinical findings, treatment and clinical course of pediatric patients with coccidioidomycosis.Recent FindingsIn the last few years new data about coccidioidomycosis in children and adolescents has been published, including the report of increasing incidence in general population, making a hig...
Source: Current Fungal Infection Reports - March 11, 2020 Category: Infectious Diseases Source Type: research
Should Etest MICs for Yeasts Be Categorized by Reference (BPs/ECVs) or by Etest (ECVs) Cutoffs as Determinants of Emerging Resistance?
AbstractPurpose of ReviewTo summarize the potential clinical usefulness of available Etest echinocandin and amphotericin B ECVs in identifying non-WT-type yeasts.Recent FindingsIn lieu of breakpoints (predictors of clinical response), Etest echinocandin, triazoles, and amphotericin B ECVs have been recently established for certainCandida spp. Reference BPs are only available for echinocandins and triazoles and someCandida spp. The categorical agreement between Etest and reference MICs was mostly evaluated before adjustment of CLSI triazole/echinocandin BPs to current values or using various amphotericin B cutoffs.SummaryEt...
Source: Current Fungal Infection Reports - February 19, 2020 Category: Infectious Diseases Source Type: research
Molecular Characterization of Coccidioides spp. Strains Isolated from Patients in the Argentine Republic
AbstractPurpose of ReviewThis review summarizes the analysis of the internal transcribed spacers (ITS) sequencing ofCoccidioides spp. strains isolated in the endemic region of coccidioidomycosis in Argentina, to be able to associate the presence of a specific fungal genotype with a specific geographical region.Recent FindingsRecent studies have focused on the identification and genetic variability between and intraspecies as a tool to contribute to the coccidioidomycosis epidemiology; these findings may contribute to the specific identification of circulating strains ofCoccidioides spp. in Argentina.SummaryCoccidioides imm...
Source: Current Fungal Infection Reports - February 3, 2020 Category: Infectious Diseases Source Type: research
Diagnosis, Burden and Mortality of Pneumocystis jirovecii Pneumonia in Venezuela
AbstractPurpose of the ReviewThe aim of this work is to contribute to the knowledge of diagnosis, burden, and mortality of pneumocystosis orPneumocystis jirovecii pneumonia (PCP) in Venezuela.Recent FindingsHistorically, PCP diagnosis has been clinical and histopathological, but diagnosis based on PCP clinical suspicion, without confirmation of laboratory detection ofP. jirovecii, causes a significant negative impact on both morbidity and mortality of this disease. Risk estimation for PCP and mortality rates according to official records contrasts with the scarce epidemiological data and makes more difficult to have a real...
Source: Current Fungal Infection Reports - January 30, 2020 Category: Infectious Diseases Source Type: research
Could Fungicides Lead to Azole Drug Resistance in a Cross-Resistance Manner among Environmental Cryptococcus Strains?
AbstractPurpose of ReviewAcquired resistance among fungal strains is a growing concern. The reasons for the emergence of this phenomenon, with great clinical implications, are only partially explained and related to the frequent use of fluconazole prophylaxis or therapeutic regimens in medical practice, and evidence of environmental origin of resistance is warranted.Recent FindingsSoil exposed to azole fungicides may select acquired resistant fungal strains and improve the proliferation and maintenance of phenotypes in this environment. So far, the greatest focus on cross-resistance in relation to azoles is with genusAsper...
Source: Current Fungal Infection Reports - January 29, 2020 Category: Infectious Diseases Source Type: research
