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Breakthrough Invasive Fungal Infections in Allogeneic Hematopoietic Stem Cell Transplantation

Despite the recent introduction of mold-active antifungal prophylaxis (MAP), breakthrough invasive fungal infections (b-IFI) still represent a possible complication and a cause of morbidity and mortality in hematological patients and allogeneic hematopoietic stem-cell transplantation recipients (HSC...

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Autores principales: Liberatore, Carmine, Farina, Francesca, Greco, Raffaella, Giglio, Fabio, Clerici, Daniela, Oltolini, Chiara, Lupo Stanghellini, Maria Teresa, Barzaghi, Federica, Vezzulli, Paolo, Orsenigo, Elena, Corti, Consuelo, Ciceri, Fabio, Peccatori, Jacopo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146885/
https://www.ncbi.nlm.nih.gov/pubmed/33925188
http://dx.doi.org/10.3390/jof7050347
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author Liberatore, Carmine
Farina, Francesca
Greco, Raffaella
Giglio, Fabio
Clerici, Daniela
Oltolini, Chiara
Lupo Stanghellini, Maria Teresa
Barzaghi, Federica
Vezzulli, Paolo
Orsenigo, Elena
Corti, Consuelo
Ciceri, Fabio
Peccatori, Jacopo
author_facet Liberatore, Carmine
Farina, Francesca
Greco, Raffaella
Giglio, Fabio
Clerici, Daniela
Oltolini, Chiara
Lupo Stanghellini, Maria Teresa
Barzaghi, Federica
Vezzulli, Paolo
Orsenigo, Elena
Corti, Consuelo
Ciceri, Fabio
Peccatori, Jacopo
author_sort Liberatore, Carmine
collection PubMed
description Despite the recent introduction of mold-active antifungal prophylaxis (MAP), breakthrough invasive fungal infections (b-IFI) still represent a possible complication and a cause of morbidity and mortality in hematological patients and allogeneic hematopoietic stem-cell transplantation recipients (HSCT). Data on incidence and type of b-IFI are limited, although they are mainly caused by non-fumigatus Aspergillus and non-Aspergillus molds and seem to depend on specific antifungal prophylaxis and patients’ characteristics. Herein, we described the clinical presentation and management of two cases of rare b-IFI which recently occurred at our institution in patients undergoing HSCT and receiving MAP. The management of b-IFI is challenging due to the lack of data from prospective trials and high mortality rates. A thorough analysis of risk factors, ongoing antifungal prophylaxis, predisposing conditions and local epidemiology should drive the choice of antifungal treatments. Early broad-spectrum preemptive therapy with a lipid formulation of amphotericin-B, in combination with a different mold-active azole plus/minus terbinafine, is advisable. The therapy would cover against rare azole-susceptible and -resistant fungal strains, as well as atypical sites of infections. An aggressive diagnostic work-up is recommended for species identification and subsequent targeted therapy.
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spelling pubmed-81468852021-05-26 Breakthrough Invasive Fungal Infections in Allogeneic Hematopoietic Stem Cell Transplantation Liberatore, Carmine Farina, Francesca Greco, Raffaella Giglio, Fabio Clerici, Daniela Oltolini, Chiara Lupo Stanghellini, Maria Teresa Barzaghi, Federica Vezzulli, Paolo Orsenigo, Elena Corti, Consuelo Ciceri, Fabio Peccatori, Jacopo J Fungi (Basel) Case Report Despite the recent introduction of mold-active antifungal prophylaxis (MAP), breakthrough invasive fungal infections (b-IFI) still represent a possible complication and a cause of morbidity and mortality in hematological patients and allogeneic hematopoietic stem-cell transplantation recipients (HSCT). Data on incidence and type of b-IFI are limited, although they are mainly caused by non-fumigatus Aspergillus and non-Aspergillus molds and seem to depend on specific antifungal prophylaxis and patients’ characteristics. Herein, we described the clinical presentation and management of two cases of rare b-IFI which recently occurred at our institution in patients undergoing HSCT and receiving MAP. The management of b-IFI is challenging due to the lack of data from prospective trials and high mortality rates. A thorough analysis of risk factors, ongoing antifungal prophylaxis, predisposing conditions and local epidemiology should drive the choice of antifungal treatments. Early broad-spectrum preemptive therapy with a lipid formulation of amphotericin-B, in combination with a different mold-active azole plus/minus terbinafine, is advisable. The therapy would cover against rare azole-susceptible and -resistant fungal strains, as well as atypical sites of infections. An aggressive diagnostic work-up is recommended for species identification and subsequent targeted therapy. MDPI 2021-04-28 /pmc/articles/PMC8146885/ /pubmed/33925188 http://dx.doi.org/10.3390/jof7050347 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Liberatore, Carmine
Farina, Francesca
Greco, Raffaella
Giglio, Fabio
Clerici, Daniela
Oltolini, Chiara
Lupo Stanghellini, Maria Teresa
Barzaghi, Federica
Vezzulli, Paolo
Orsenigo, Elena
Corti, Consuelo
Ciceri, Fabio
Peccatori, Jacopo
Breakthrough Invasive Fungal Infections in Allogeneic Hematopoietic Stem Cell Transplantation
title Breakthrough Invasive Fungal Infections in Allogeneic Hematopoietic Stem Cell Transplantation
title_full Breakthrough Invasive Fungal Infections in Allogeneic Hematopoietic Stem Cell Transplantation
title_fullStr Breakthrough Invasive Fungal Infections in Allogeneic Hematopoietic Stem Cell Transplantation
title_full_unstemmed Breakthrough Invasive Fungal Infections in Allogeneic Hematopoietic Stem Cell Transplantation
title_short Breakthrough Invasive Fungal Infections in Allogeneic Hematopoietic Stem Cell Transplantation
title_sort breakthrough invasive fungal infections in allogeneic hematopoietic stem cell transplantation
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146885/
https://www.ncbi.nlm.nih.gov/pubmed/33925188
http://dx.doi.org/10.3390/jof7050347
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