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1.
BMC Infect Dis ; 20(1): 817, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33167878

RESUMO

BACKGROUND: Gastrointestinal (GI) mucormycosis is a rare and often deadly form of mucormycosis. Delayed diagnosis can lead to an increased risk of death. Here, we report a case of GI mucormycosis following streptococcal toxic shock syndrome in a virologically suppressed HIV-infected patient. CASE PRESENTATION: A 25-year-old Thai woman with a well-controlled HIV infection and Grave's disease was admitted to a private hospital with a high-grade fever, vomiting, abdominal pain, and multiple episodes of mucous diarrhea for 3 days. On day 3 of that admission, the patient developed multiorgan failure and multiple hemorrhagic blebs were observed on all extremities. A diagnosis of streptococcal toxic shock was made before referral to Siriraj Hospital - Thailand's largest national tertiary referral center. On day 10 of her admission at our center, she developed feeding intolerance and bloody diarrhea due to bowel ischemia and perforation. Bowel resection was performed, and histopathologic analysis of the resected bowel revealed acute suppurative transmural necrosis and vascular invasion with numerous broad irregular branching non-septate hyphae, both of which are consistent with GI mucormycosis. Peritoneal fluid fungal culture grew a grayish cottony colony of large non-septate hyphae and spherical sporangia containing ovoidal sporangiospores. A complete ITS1-5.8S-ITS2 region DNA sequence analysis revealed 100% homology with Rhizopus microsporus strains in GenBank (GenBank accession numbers KU729104 and AY803934). As a result, she was treated with liposomal amphotericin B. However and in spite of receiving appropriate treatment, our patient developed recurrent massive upper GI bleeding from Dieulafoy's lesion and succumbed to her disease on day 33 of her admission. CONCLUSION: Diagnosis of gastrointestinal mucormycosis can be delayed due to a lack of well-established predisposing factors and non-specific presenting symptoms. Further studies in risk factors for abdominal mucormycosis are needed.


Assuntos
Trato Gastrointestinal/microbiologia , Doença de Graves/complicações , Infecções por HIV/complicações , Mucormicose/complicações , Rhizopus/genética , Choque Séptico/complicações , Infecções Estreptocócicas/complicações , Streptococcus pyogenes/isolamento & purificação , Adulto , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , DNA Fúngico/genética , Evolução Fatal , Feminino , Infecções por HIV/virologia , Humanos , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Choque Séptico/diagnóstico , Choque Séptico/microbiologia , Infecções Estreptocócicas/diagnóstico , Infecções Estreptocócicas/microbiologia , Síndrome , Tailândia
2.
BMC Infect Dis ; 20(1): 755, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054720

RESUMO

BACKGROUND: Saksenaea species (spp.) are uncommon causes of mucormycosis but are emerging pathogens mostly associated with trauma and soil contamination often in immunocompetent hosts. Due to lack of sporulation in the laboratory, diagnosis and susceptibility testing is difficult so optimal treatment regimens are unknown. CASE PRESENTATION: A 67 year-old man from the Northern Territory in Australia, with a history of eosinophilic granulomatosis with polyangiitis, developed disseminated Saksenaea infection after initially presenting with symptoms consistent with bacterial pyelonephritis. Despite a delay in diagnosis; with aggressive surgical management and dual therapy with amphotericin B and posaconazole, he survived. CONCLUSIONS: We describe an unusual case of disseminated infection with a favourable outcome to date.


Assuntos
Mucormicose/diagnóstico , Mucormicose/etiologia , Idoso , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Granulomatose com Poliangiite/etiologia , Humanos , Hospedeiro Imunocomprometido , Masculino , Mucormicose/tratamento farmacológico , Mucormicose/cirurgia , Northern Territory , Triazóis/uso terapêutico
3.
BMC Infect Dis ; 20(1): 770, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33076815

RESUMO

BACKGROUND: Orbital mucormycosis is a rare but potentially severe and troublesome invasive fungal infection that could be occurred even in healthy individuals. The initial clinical presentation is similar to bacterial pre-septal or septal cellulitis, especially in early stages. CASE PRESENTATION: Herein, we describe the successful management of a series of five cases presenting with orbital mucormycosis in previously healthy children. CONCLUSIONS: Orbital mucormycosis is extremely rare in healthy children and maybe life-threatening when diagnosis delayed given a similar clinical presentation with bacterial septal cellulitis. Intravenous antifungal therapy with amphotericin B and timely surgical drainage is live-saving.


Assuntos
Mucormicose , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Celulite (Flegmão)/diagnóstico , Celulite (Flegmão)/tratamento farmacológico , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Mucormicose/etiologia , Doenças Orbitárias/diagnóstico , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/etiologia , Fatores de Risco
4.
Indian J Dent Res ; 31(4): 652-655, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33107473

RESUMO

Mucormycosis, caused by saprophytic fungi of the order Mucorales of the class zygomycetes, is a rare opportunistic fungal infection, which has a rapidly progressive and fulminant course with fatal outcome. Mucormycosis can result in an acute, rapidly advancing and occasionally fatal disease caused by different fungi typically found in the soil in association with decaying organic matter such as leaves, compost piles, or bread molds. Mucormycosis is not contagious and does not spread from person to person. We report a case of palatal perforation by rhino-maxillary mucormycosis in an immunocompromised patient. The patient was treated and had a good prognosis for such a fatal condition.


Assuntos
Mucormicose , Antifúngicos/uso terapêutico , Humanos , Maxila , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Palato , Úlcera/tratamento farmacológico
5.
J Mycol Med ; 30(4): 101046, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33067115

RESUMO

We present an uncommon case of isolated basal ganglia mucormycosis in a patient without any known cause of immunosuppression, but with a history of drug injection. The patient presented a good clinical and radiological response to antifungal treatment without aggressive surgical debridement (liposomal amphotericin B combined with isavuconazole for 4 weeks followed by isavuconazole as maintenance therapy for 10 months).


Assuntos
Infecções Fúngicas do Sistema Nervoso Central/etiologia , Mucormicose/etiologia , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/microbiologia , Anfotericina B/administração & dosagem , Infecções Fúngicas do Sistema Nervoso Central/diagnóstico , Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico , Infecções Fúngicas do Sistema Nervoso Central/microbiologia , Cocaína , Transtornos Relacionados ao Uso de Cocaína/complicações , Transtornos Relacionados ao Uso de Cocaína/tratamento farmacológico , Transtornos Relacionados ao Uso de Cocaína/microbiologia , Quimioterapia Combinada , Usuários de Drogas , Humanos , Imagem por Ressonância Magnética , Masculino , Abuso de Maconha/complicações , Abuso de Maconha/tratamento farmacológico , Abuso de Maconha/microbiologia , Pessoa de Meia-Idade , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Nitrilos/administração & dosagem , Piridinas/administração & dosagem , Abuso de Substâncias por Via Intravenosa/diagnóstico por imagem , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Triazóis/administração & dosagem
6.
Biochim Biophys Acta Gen Subj ; 1864(11): 129696, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32768460

RESUMO

BACKGROUND: It has been reported that the genes coding for NADP-dependent glutamate dehydrogenases (NADP-GDHs) showed a cause-effect relationship with Yeast-Hypha (YH) reversible transition in a zygomycete Benjaminiella poitrasii. As YH transition is significant in human pathogenic fungi for their survival and proliferation in the host, the NADP-GDHs can be explored as antifungal drug targets. METHODS: The yeast-form specific BpNADPGDH I and hyphal-form specific BpNADPGDH II of B. poitrasii were purified by heterologous expression in E. coli BL-21 cells and characterized. The structural analogs of L-glutamate, dimethyl esters of isophthalic acid (DMIP) and its derivatives were designed, synthesized and screened for inhibition of NADP-GDH activity as well as YH transition in B. poitrasii, and also in human pathogenic Candida albicans strains. RESULTS: The BpNADPGDH I and BpNADPGDH II were found to be homo-hexameric proteins with native molecular mass of 282 kDa and 298 kDa, respectively and subunit molecular weights of 47 kDa and 49 kDa, respectively. Besides the distinct kinetic properties, BpNADPGDH I and BpNADPGDH II were found to be regulated by cAMP-dependent- and Calmodulin (CaM) dependent- protein kinases, respectively. The DMIP compounds showed a more pronounced effect on H-form specific BpNADPGDH II and inhibited YH transition as well as growth in B. poitrasii and C. albicans strains. CONCLUSION: The present study will be useful to design and develop antifungal drugs against dimorphic human pathogens using glutamate dehydrogenase as a target. SIGNIFICANCE: Glutamate dehydrogenases can be explored as a target against human pathogenic fungi.


Assuntos
Antifúngicos/farmacologia , Inibidores Enzimáticos/farmacologia , Desidrogenase de Glutamato (NADP+)/antagonistas & inibidores , Desidrogenase de Glutamato (NADP+)/metabolismo , Mucorales/enzimologia , Animais , Antifúngicos/química , Desenho de Fármacos , Inibidores Enzimáticos/química , Proteínas Fúngicas/antagonistas & inibidores , Proteínas Fúngicas/química , Proteínas Fúngicas/metabolismo , Desidrogenase de Glutamato (NADP+)/isolamento & purificação , Humanos , Mucorales/química , Mucorales/efeitos dos fármacos , Mucorales/metabolismo , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Fosforilação/efeitos dos fármacos , Ovinos
7.
BMC Infect Dis ; 20(1): 614, 2020 Aug 18.
Artigo em Inglês | MEDLINE | ID: mdl-32811466

RESUMO

BACKGROUND: The most common aetiological agents of mucormycosis are Rhizopus, Mucor, Apophysomyces and Lichtheimia. Apophysomyces is comparatively rare, as it has been reported in less than 3% of mucormycosis cases. The genus Apophysomyces includes six species, and only A. elegans, A. mexicanus, A. variabilis and A. ossiformis have been reported to cause infections in both immunocompetent and immunocompromised patients. CASE PRESENTATION: We present a case of a 46-year-old male patient with bilateral blepharoedema, corneal opacity in the left eye and poorly controlled diabetes mellitus. The patient was subjected to total maxillectomy, exenteration of the left orbit and treatment with liposomal amphotericin B. Direct mycological analysis with KOH 10% revealed hyaline, coenocytic, long and wide hyphae. Apophysomyces ossiformis was identified from maxillary biopsy using 18S-ITS1-5.8S-ITS2-28S rRNA gene amplification and sequencing. The patient requested to be transferred to another hospital to continue treatment, where he died on the ninth day after admittance. CONCLUSION: To the best of our knowledge, this is the first case of rhino-orbital mucormycosis due to A. ossiformis with a fatal outcome. This case reveals the need to identify the fungus causing mucormycosis with molecular methods to identify adequate treatment therapies for patients with this infection.


Assuntos
Complicações do Diabetes/microbiologia , Mucorales/genética , Mucormicose/complicações , Doenças Orbitárias/complicações , Rinite/complicações , Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Biópsia , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/cirurgia , Evolução Fatal , Humanos , Hospedeiro Imunocomprometido , Masculino , Maxila/microbiologia , Maxila/patologia , Maxila/cirurgia , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Mucormicose/microbiologia , Mucormicose/cirurgia , Doenças Orbitárias/tratamento farmacológico , Doenças Orbitárias/microbiologia , Doenças Orbitárias/cirurgia , RNA Ribossômico 28S/genética , Rinite/tratamento farmacológico , Rinite/microbiologia , Rinite/cirurgia
8.
An Bras Dermatol ; 95(5): 623-626, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32616336

RESUMO

The authors report a rare case of primary cutaneous mucormycosis caused by Mucor irregularis and cutaneous Klebsiella pneumoniae infections in a 67-year-old Chinese woman. After the administration of liposomal amphotericin B combined with cefoperazone/sulbactam sodium, the patient recovered. Invasive fungal infection combined with cutaneous bacterial infection should receive attention.


Assuntos
Coinfecção , Mucormicose , Idoso , Antifúngicos/uso terapêutico , Coinfecção/tratamento farmacológico , Feminino , Humanos , Klebsiella pneumoniae , Mucor , Mucormicose/complicações , Mucormicose/tratamento farmacológico , Pele
10.
BMC Gastroenterol ; 20(1): 61, 2020 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-32143639

RESUMO

BACKGROUND: Mucormycosis is rare, life-threatening fungal infection. Frequently observed in those patients having underlying immunosuppression such as, diabetes, organ transplantation, Human immunodeficiency virus (HIV) infection, and elevated serum iron. However, invasive intestinal mucormycosis occurring in immunocompetent individuals without the traditional risk factors is extremely rare clinical phenomenon. CASE PRESENTATION: We report a 40-year-old male patient who presented with 1 week history of diffuse abdominal pain and high grade fever, associated with vomiting and frequent loose stools. Has history of chronic alcohol ingestion. Otherwise, no past history of chronic medical illness, nor he had contact with individuals with similar illness. He was in a septic shock with multiple organ failure up on presentation to emergency room. Physical examination revealed icterus sclera with abdominal tenderness. He was immediately resuscitated using crystalloids, supported with inotrope, and antibiotics. Histopathological examination of tissue sample from colonic ulcer biopsy revealed invasive intestinal mucormycosis. Patient showed full clinical and histopathological resolution after course of parenteral Liposomal Amphotercin B. CONCLUSION: This case highlights the fact that, despite its life-threatening nature, it's possible to treat patients with invasive intestinal mucormycosis with aggressive antifungal and supportive care without surgical intervention, provided that all the necessary supportive care were initiated early and the disease was diagnosed early and appropriate medical management was initiated timely. In addition, it's important to consider intestinal mucormycosis even in patients who are immunocompetent without traditional risk factors.


Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Colite/diagnóstico , Colite/tratamento farmacológico , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Adulto , Biópsia , Colite/microbiologia , Colite/patologia , Suscetibilidade a Doenças , Diagnóstico Precoce , Serviço Hospitalar de Emergência , Humanos , Masculino , Mucormicose/patologia , Insuficiência de Múltiplos Órgãos/microbiologia , Fatores de Risco , Choque Séptico/microbiologia , Tempo para o Tratamento
11.
J Craniofac Surg ; 31(4): e321-e324, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32028364

RESUMO

The authors present their experience about clinical evidences that include patients with an untreated diabetes who developed rhino-orbito-cerebral mucormycosis (ROCM). They were treated with endoscopic sinus surgery and medical treatment with intravenous, intradural therapy, and sinus washes with amphotericin B. The ROCM is a disease with a rapid evolution and an increase in mortality rate, especially if the fungus enters the cranial cavity. Therefore, it would be necessary in all diabetic patients with sinus symptoms, headaches, visual changes, suspect a mucormycosis, and perform a careful radiology assessment and a nasal endoscopy. Often, despite an early diagnosis and rapid treatment for ROCM, it is not possible to stem the disease, which ends with the patient's death.


Assuntos
Anfotericina B/uso terapêutico , Antifúngicos/uso terapêutico , Complicações do Diabetes , Mucormicose/cirurgia , Doenças Orbitárias/cirurgia , Doenças dos Seios Paranasais/cirurgia , Idoso , Diabetes Mellitus , Endoscopia , Humanos , Masculino , Pessoa de Meia-Idade , Mucormicose/complicações , Mucormicose/tratamento farmacológico , Doenças Orbitárias/complicações , Doenças Orbitárias/tratamento farmacológico , Doenças dos Seios Paranasais/complicações , Doenças dos Seios Paranasais/tratamento farmacológico
13.
J Postgrad Med ; 66(1): 48-50, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31929312

RESUMO

Gastrointestinal mucormycosis is a rare form of invasive mucormycosis with high fatality rate due to difficulty in establishing its diagnosis. The classic risk-factors include immunosuppression and metabolic derangement. A case of ileocecal mucormycosis following intracardiac repair of congenital heart disease in a 17-year-old boy is described here who lacked the typical risk-factors for mucormycosis. Ileocecal mucormycosis affecting an individual without the classic risk-factors is uncommon.


Assuntos
Hemorragia Gastrointestinal/etiologia , Íleo/lesões , Perfuração Intestinal , Mucormicose/diagnóstico , Adolescente , Antifúngicos/uso terapêutico , Colectomia , Enterobacter aerogenes/isolamento & purificação , Cardiopatias Congênitas/cirurgia , Humanos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Mucormicose/complicações , Mucormicose/tratamento farmacológico , Peritonite/tratamento farmacológico , Peritonite/microbiologia , Complicações Pós-Operatórias
14.
Intern Med ; 59(2): 261-266, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31941872

RESUMO

Mucormycosis has emerged as the third-most common fungal mycosis and is one of the most fatal molds. We herein report a case study of a 30-year-old woman who was a veterinarian, specializing in livestock, who developed disseminated mucormycosis during induction therapy for acute lymphoblastic leukemia. We successfully used a radical approach for treatment, including a surgical procedure and allogeneic transplantation, with continuous administration of antifungal agents. Reports of successful treatments are extremely rare, and our case has had the longest documented remission from disseminated disease. We speculate that our case's occupational environment may represent a risk factor for development of mucormycosis.


Assuntos
Doenças dos Trabalhadores Agrícolas/tratamento farmacológico , Antifúngicos/uso terapêutico , Transplante de Células-Tronco Hematopoéticas/métodos , Mucormicose/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Médicos Veterinários , Doença Aguda , Adulto , Animais , Humanos , Hospedeiro Imunocomprometido , Gado , Masculino , Infecções Oportunistas/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/terapia , Transplante Homólogo/métodos , Resultado do Tratamento
16.
Trop Doct ; 50(1): 87-90, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31928201

RESUMO

Children manifesting soft-tissue fungal infections are uncommonly seen, more so the subgroup of invasive soft-tissue mucormycosis. Invasive fungal infections in various organs respond differently and are often complicated by an immune-compromised host. Repeated and aggressive clearance of disease till an infection-clear margin is obtained is the mainstay of surgical therapy. This is coupled with appropriate antifungal therapy and the management of any underlying medical conditions. From our experience, we propose a surgical algorithm for therapy of soft-tissue mucormycosis in children.


Assuntos
Antifúngicos/uso terapêutico , Infecções Fúngicas Invasivas/tratamento farmacológico , Infecções Fúngicas Invasivas/cirurgia , Mucormicose/tratamento farmacológico , Mucormicose/cirurgia , Algoritmos , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Lactente , Masculino
17.
Mycoses ; 63(4): 343-351, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31876327

RESUMO

OBJECTIVES: Mucormycosis is a difficult-to-diagnose life-threatening disease with high morbidity and mortality. Adherence to guidelines that lead through complex management and support clinical decisions is however rarely reported. By applying the EQUAL Score, our study evaluates the management of mucormycosis at the University Hospital of Cologne, Germany. METHODS: We performed a retrospective chart review of patients with mucormycosis at the University Hospital of Cologne. Data collection comprised items for quality assessment in mucormycosis management according to the EQUAL Mucormycosis Score and economics. RESULTS: Of 29 patients identified, 27 were documented retrospectively. Eight patients of 18 with neutropenia (>10 days) or receiving allogeneic stem cell transplantation (44.4%) received mould active prophylaxis. Chest CT was done in 21 patients (77.8%), while BAL and direct microscopy of BAL fluid was performed in 22 patients (81.5%), culture in 22 (81.5%) and fungal PCR in 24 (88.9%). First-line treatment was liposomal amphotericin B in 19 patients (70.4%). Isavuconazole or posaconazole with therapeutic drug monitoring was used in four (14.8%) and in one patient (3.7%), respectively. In our cohort, crude mortality was 51.9% (n = 14) with a median survival time of 113 days. During the management of the 27 patients, 450 points (53.8%) of the maximum EQUAL Mucormycosis Score were achieved (median 15 points, range 6-30). CONCLUSIONS: We observed management of mucormycosis aligning with current guidelines and hope to encourage other groups to use the EQUAL Score in routine clinical settings. Future studies will evaluate whether guideline adherence in mucormycosis management improves patient outcome.


Assuntos
Fidelidade a Diretrizes/estatística & dados numéricos , Mucormicose , Adulto , Antifúngicos/uso terapêutico , Feminino , Alemanha , Hospitais de Ensino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Mucormicose/diagnóstico , Mucormicose/tratamento farmacológico , Estudos Retrospectivos , Adulto Jovem
18.
J Pediatr Hematol Oncol ; 42(4): e202-e206, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31815886

RESUMO

BACKGROUND: Outcomes of childhood hematolymphoid malignancies have improved several fold because of immunosuppressive chemotherapy and broad-spectrum antibiotics for managing febrile neutropenia. An apparent trade-off has been an increase in invasive fungal disease (IFD), affecting multiple organs. We report the diagnostic and therapeutic challenges in 8 children with lymphoid cancers who developed intracranial (IC) fungal abscesses between 2010 and 2017. METHODS: Children below 15 years of age undergoing treatment for leukemia/lymphoma with clinicoradiologic and microbiologic evidence of IC fungal abscess were included. Demographic details, clinical profile, and management were retrospectively audited. Treatment was guided by European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) definitions for IFD with therapeutic drug monitoring (TDM)-directed azole dosing, and surgical intervention. RESULTS: Eight patients (4 B-cell acute lymphoblastic leukemia, 2 relapsed B-cell acute lymphoblastic leukemia, and 2 non-Hodgkin lymphoma) were eligible for analysis. Proven, probable, and possible IFDs were seen in 2 (25%), 4 (50%), and 2 (25%) patients, respectively. Proven IFDs were invasive mucormycosis with remaining having mold infections. Cerebrospinal fluid galactomannan was positive in all 4 patients in whom it was tested. TDM was possible in 5/8 (63%) patients. Antifungal therapy was given for a median period of 4.2 months with 5 (63%) patients having complete resolution. Three (37%) patients expired, of which 2 were attributable to IFDs. CONCLUSIONS: IC fungal abscesses in children can cause significant morbidity and mortality in children with hematolymphoid cancers. Evaluation of cerebrospinal fluid galactomannan may help in early diagnosis and therapy. Prolonged antifungal therapy steered by TDM can help achieve resolution in some cases.


Assuntos
Antifúngicos/administração & dosagem , Infecções Fúngicas do Sistema Nervoso Central/tratamento farmacológico , Linfoma não Hodgkin/tratamento farmacológico , Mucormicose/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras B/tratamento farmacológico , Adolescente , Antifúngicos/farmacocinética , Infecções Fúngicas do Sistema Nervoso Central/líquido cefalorraquidiano , Criança , Pré-Escolar , Feminino , Humanos , Linfoma não Hodgkin/líquido cefalorraquidiano , Linfoma não Hodgkin/mortalidade , Masculino , Mananas/líquido cefalorraquidiano , Mucormicose/líquido cefalorraquidiano , Leucemia-Linfoma Linfoblástico de Células Precursoras B/líquido cefalorraquidiano , Leucemia-Linfoma Linfoblástico de Células Precursoras B/mortalidade , Estudos Retrospectivos
19.
J Microbiol Immunol Infect ; 53(1): 106-114, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29449166

RESUMO

BACKGROUND/PURPOSE: This study was aimed to investigate clinical characteristics and treatment outcomes of pulmonary invasive fungal infection (IFI) among patients with hematological malignancy. METHODS: All patients with hematological malignancy who were treated at a medical centre from 2008 to 2013 were evaluated. Pulmonary IFI was classified according to the European Organization for Research and Treatment of Cancer 2008 consensus. RESULTS: During the study period, 236 (11.3%) of 2083 patients with hematological malignancy were diagnosed as pulmonary IFI, including 41 (17.4%) proven, 75 (31.8%) probable, and 120 (50.8%) possible cases. Among the 116 patients of proven and probable cases of pulmonary IFI, aspergillosis alone (n = 90, 77.6%) was predominant, followed by cryptococcosis alone (n = 9, 7.8%), and mucormycosis (n = 4, 3.4%). The overall incidence of patients with pulmonary IFI was 5.9 per 100 patient-years. The highest incidence (per 100 patient-year) was found in patients with acute myeloid leukaemia (13.7) followed by acute lymphoblastic leukaemia (11.3), and myelodysplastic syndrome/severe aplastic anaemia (6.7). Fourteen (5.9%) of the 236 patients with pulmonary IFI died within 12 weeks after diagnosis of pulmonary IFI. Univariate analysis revealed that elderly age (>65 years) (P = 0.034), lack of response to anti-fungal treatment (P < 0.001), and admission to the intensive care unit (ICU) (P < 0.001) were predictors of poor prognosis. However, only admission to the ICU was an independent predictor of poor prognosis for 12-week mortality (P = 0.022) based on multivariate analysis. CONCLUSION: Patients with acute leukaemia and myelodysplastic syndrome/severe aplastic anaemia were at high risk of pulmonary IFI.


Assuntos
Antifúngicos/uso terapêutico , Neoplasias Hematológicas/complicações , Infecções Fúngicas Invasivas/tratamento farmacológico , Pneumopatias Fúngicas/tratamento farmacológico , Centros Médicos Acadêmicos , Fatores Etários , Idoso , Aspergilose/tratamento farmacológico , Criptococose/tratamento farmacológico , Feminino , Neoplasias Hematológicas/microbiologia , Humanos , Hospedeiro Imunocomprometido , Incidência , Pneumopatias Fúngicas/microbiologia , Masculino , Pessoa de Meia-Idade , Mucormicose/tratamento farmacológico , Fatores de Risco , Taiwan , Resultado do Tratamento
20.
Support Care Cancer ; 28(5): 2157-2161, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31410599

RESUMO

A 5-year-old patient treated for acute lymphoblastic leukaemia (ALL) developed proven pulmonary invasive fungal disease (IFD) due to Actinomucor elegans. While completing ALL treatment according to AIEOP ALL protocol 2009 for further 15 months, antifungal treatment with liposomal amphotericin B and intermittent additional posaconazole was continued until immune reconstitution 7 months after the end of ALL treatment. Repeated imaging guided treatment decisions. Twenty-six and 19 months after the end of ALL treatment and antifungal treatment, respectively, the patient is still in the first complete remission and shows no signs of active invasive fungal disease (IFD).


Assuntos
Anfotericina B/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Infecções Fúngicas Invasivas/tratamento farmacológico , Pneumopatias Fúngicas/tratamento farmacológico , Mucormicose/tratamento farmacológico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Antifúngicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Asparaginase/administração & dosagem , Pré-Escolar , Ciclofosfamida/administração & dosagem , Citarabina/administração & dosagem , Daunorrubicina/administração & dosagem , Humanos , Pneumopatias Fúngicas/microbiologia , Masculino , Mercaptopurina/administração & dosagem , Metotrexato/administração & dosagem , Mucorales/isolamento & purificação , Leucemia-Linfoma Linfoblástico de Células Precursoras/microbiologia , Prednisona/administração & dosagem , Indução de Remissão , Triazóis/uso terapêutico , Vincristina/administração & dosagem
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