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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...

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Autores principales: Skiada, Anna, Pavleas, Ioannis, Drogari-Apiranthitou, Maria
Formato: Online Artículo Texto
Lenguaje:English
Publicado: F1000Research 2017
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.
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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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