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Rare fungal infectious agents: a lurking enemy
In the expanding population of immunocompromised patients and those treated in intensive care units, rare fungal infectious agents have emerged as important pathogens, causing invasive infections associated with high morbidity and mortality. These infections may present either as de novo or as break...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
F1000Research
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664977/ https://www.ncbi.nlm.nih.gov/pubmed/29152230 http://dx.doi.org/10.12688/f1000research.11124.1 |
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author | Skiada, Anna Pavleas, Ioannis Drogari-Apiranthitou, Maria |
author_facet | Skiada, Anna Pavleas, Ioannis Drogari-Apiranthitou, Maria |
author_sort | Skiada, Anna |
collection | PubMed |
description | In the expanding population of immunocompromised patients and those treated in intensive care units, rare fungal infectious agents have emerged as important pathogens, causing invasive infections associated with high morbidity and mortality. These infections may present either as de novo or as breakthrough invasive infections in high-risk patients with hematologic malignancies receiving prophylactic or empirical antifungal therapy or in patients with central venous catheters. Diagnosis and treatment are challenging. Physicians should have a high index of suspicion because early diagnosis is of paramount importance. Conventional diagnostic methods such as cultures and histopathology are still essential, but rapid and more specific molecular techniques for both detection and identification of the infecting pathogens are being developed and hopefully will lead to early targeted treatment. The management of invasive fungal infections is multimodal. Reversal of risk factors, if feasible, should be attempted. Surgical debridement is recommended in localized mold infections. The efficacy of various antifungal drugs is not uniform. Amphotericin B is active against most yeasts, except Trichosporon, as well as against Mucorales, Fusarium, and some species of Paecilomyces and dimorphic fungi. The use of voriconazole is suggested for the treatment of trichosporonosis and scedosporiosis. Combination treatment, though recommended as salvage therapy in some infections, is controversial in most cases. Despite the use of available antifungals, mortality remains high. The optimization of molecular-based techniques, with expansion of reference libraries and the possibility for direct detection of resistance mechanisms, is awaited with great interest in the near future. Further research is necessary, however, in order to find the best ways to confront and destroy these lurking enemies. |
format | Online Article Text |
id | pubmed-5664977 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | F1000Research |
record_format | MEDLINE/PubMed |
spelling | pubmed-56649772017-11-17 Rare fungal infectious agents: a lurking enemy Skiada, Anna Pavleas, Ioannis Drogari-Apiranthitou, Maria F1000Res Review In the expanding population of immunocompromised patients and those treated in intensive care units, rare fungal infectious agents have emerged as important pathogens, causing invasive infections associated with high morbidity and mortality. These infections may present either as de novo or as breakthrough invasive infections in high-risk patients with hematologic malignancies receiving prophylactic or empirical antifungal therapy or in patients with central venous catheters. Diagnosis and treatment are challenging. Physicians should have a high index of suspicion because early diagnosis is of paramount importance. Conventional diagnostic methods such as cultures and histopathology are still essential, but rapid and more specific molecular techniques for both detection and identification of the infecting pathogens are being developed and hopefully will lead to early targeted treatment. The management of invasive fungal infections is multimodal. Reversal of risk factors, if feasible, should be attempted. Surgical debridement is recommended in localized mold infections. The efficacy of various antifungal drugs is not uniform. Amphotericin B is active against most yeasts, except Trichosporon, as well as against Mucorales, Fusarium, and some species of Paecilomyces and dimorphic fungi. The use of voriconazole is suggested for the treatment of trichosporonosis and scedosporiosis. Combination treatment, though recommended as salvage therapy in some infections, is controversial in most cases. Despite the use of available antifungals, mortality remains high. The optimization of molecular-based techniques, with expansion of reference libraries and the possibility for direct detection of resistance mechanisms, is awaited with great interest in the near future. Further research is necessary, however, in order to find the best ways to confront and destroy these lurking enemies. F1000Research 2017-10-31 /pmc/articles/PMC5664977/ /pubmed/29152230 http://dx.doi.org/10.12688/f1000research.11124.1 Text en Copyright: © 2017 Skiada A et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Review Skiada, Anna Pavleas, Ioannis Drogari-Apiranthitou, Maria Rare fungal infectious agents: a lurking enemy |
title | Rare fungal infectious agents: a lurking enemy |
title_full | Rare fungal infectious agents: a lurking enemy |
title_fullStr | Rare fungal infectious agents: a lurking enemy |
title_full_unstemmed | Rare fungal infectious agents: a lurking enemy |
title_short | Rare fungal infectious agents: a lurking enemy |
title_sort | rare fungal infectious agents: a lurking enemy |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5664977/ https://www.ncbi.nlm.nih.gov/pubmed/29152230 http://dx.doi.org/10.12688/f1000research.11124.1 |
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