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PubMed1989

Systemic mycoses.

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Bibliographies as Topic↗
PubMed2003

Laboratory diagnosis of invasive mycoses.

Rising numbers of immunocompromised patients have led to an ever-increasing population at risk of invasive fungal disease. Much has been achieved in the laboratory diagnosis of these infections, such as advances in blood culture systems, and the development of new biochemical, antigen detection assays, and molecular methodologies. More standardized susceptibility testing guidelines provide for better therapeutic interventions. In an era of economic cutbacks in health care, future challenges include the development of cost-effective and technically simplified systems, which provide early detection and identification of common and emerging fungal pathogens. It will, however, take some time to establish the clinical relevance of these new methodologies in different patient populations.

Culture Media↗
PubMed1997

Efficacy of amphotericin B lipid complex injection (ABLC) in bone marrow transplant recipients with life-threatening systemic mycoses.

Bone marrow transplant (BMT) recipients are at increased risk of invasive fungal disease as a result of the profound neutropenia associated with transplantation. Amphotericin B lipid complex injection (ABLC, ABELCET) was developed to preserve the broad spectrum and fungicidal activity of conventional amphotericin B while avoiding its associated nephrotoxicity. ABLC was made available to physicians in an emergency-use program to treat seriously ill patients with advanced fungal infections who had failed to respond to previous systemic antifungal therapy (mostly amphotericin B), had experienced nephrotoxicity or severe acute toxicity due to amphotericin B or other drugs, or had pre-existing renal disease. Of 59 clinically evaluable BMT recipients with presumed or confirmed fungal infections, 31 (53%) responded to treatment: 23 (39%) were cured and eight (14%) improved. For 38 mycologically evaluable patients, pathogens were eradicated in 19 (50%). For 30 patients who began ABLC treatment with a serum creatinine > 221 mumol/l, significant reductions were observed at weeks 1 to 3 (P < 0.01) and 6 (P < 0.001). Trends in serum creatinine during ABLC therapy between autologous and allogeneic transplant recipients were similar. In summary, the results of this evaluation indicate that ABLC appears to be less nephrotoxic than conventional amphotericin B as well as an effective treatment for BMT recipients with presumed or confirmed fungal infections.

Adolescent↗
PubMed1999

Systemic mycoses during prophylactical use of liposomal amphotericin B (Ambisome) after liver transplantation.

We investigated the prophylactical administration of liposomal amphotericin B (Ambisome) in the early phase after liver transplantation (LTx). Fifty-eight patients received Ambisome prophylactically after LTx. Ambisome (1 mg kg-1 day-1) was given intravenously for 7 days after LTx. Immunosuppressive prophylaxis was cyclosporin A (CsA) based in 11 patients. Forty-seven patients had a tacrolimus-based immunosuppressive regimen. CsA and tacrolimus dosages were adjusted to trough levels of 150-250 ng ml-1 (EMIT) and 5-15 ng ml-1 (MEIA II) respectively. Three patients died from sepsis due to Aspergillus fumigatus infection. Reasons for a fatal outcome were foudroyant Aspergillus pneumonia in a patient transplanted for fulminant hepatic failure on post-operative day (pod) 8; Aspergillus sepsis with severe endocardidtis in a patient with two retransplantations for graft non/dysfunction on pod 24; and disseminated aspergillosis due to Aspergillus fumigatus in a patient retransplanted for primary non-function (pod 19). All three patients underwent haemofiltration for renal failure. One patient with Candida albicans sepsis (pod 4) recovered under increased dosage of Ambisome (3 mg kg-1 per day). Ambisome (1 mg kg-1 per day) seems to be beneficial against systemic Candida infections. However, the onset of systemic Aspergillus infections could not be prevented. Obviously, higher Ambisome doses appear to be necessary against Aspergillus. We recommend the use of Ambisome (3 mg kg-1 per day) for patients with risk factors such as graft dys-/non-function, retransplantation, haemofiltration and complicated acute liver failure to prevent invasive aspergillosis.

Adolescent↗
PubMed2005

An overview of antifungal drugs and their use for treatment of deep and superficial mycoses in animals.

Fungal infections are often challenging to manage, given the limited numbers of therapeutics and a general lack of applicable clinical literature for their use in a given animal species. This article reviews some of the underlying principles that can affect the therapeutic outcome for a given antifungal, and provides specific information from the literature that is intended to highlight the distinctive properties of the most commonly used antifungals in veterinary medicine to better facilitate their successful application in clinical practice.

Amphotericin B↗
PubMed2002

Endemic mycoses in patients with hematologic malignancies.

Histoplasmosis, blastomycosis, and coccidioidomycosis are uncommon, but often life-threatening infections in patients who have hematologic malignancies. Disease occurs either as a result of new infection after an environmental exposure or as a result of reactivation of a remote infection. Among patients who have hematologic malignancies, the greatest risk appears to be in those who have cellular immune deficiencies. Severe pulmonary infection and widespread disseminated infection are the most common manifestations of these infections in patients with hematologic malignancies. Early diagnosis is best accomplished by tissue biopsy with histopathologic evaluation for the distinctive tissue forms characteristic of these fungi; confirmation by growth in culture is essential, but slow for histoplasmosis and blastomycosis. Initial treatment in the immunosuppressed host should almost always be with amphotericin B rather than an azole. Azole antifungal agents can be used in those patients who respond quickly to amphotericin B and for those requiring long-term suppressive therapy.

Blastomycosis↗