12 research outputs found
Update on therapeutic approaches for invasive fungal infections in adults
Invasive fungal infections are increasingly encountered with the expansion of iatrogenic immunosuppression, including not only solid organ and hematopoietic stem cell transplant recipients but also patients with malignancies or autoimmune diseases receiving immunomodulatory therapies, such as Bruton Tyrosine Kinase (BTK) inhibitor. Their attributable mortality remains elevated, part of which is a contribution from globally emerging resistance in both molds and yeasts. Because antifungal susceptibility test results are often unavailable or delayed, empiric and tailored antifungal approaches including choice of agent(s) and use of combination therapy are heterogeneous and often based on clinician experience with knowledge of hostâs net state of immunosuppression, prior antifungal exposure, antifungal side effects and interaction profile, clinical severity of disease including site(s) of infection and local resistance data. In this review, we aim to summarize previous recommendations and most recent literature on treatment of invasive mold and yeast infections in adults to guide optimal evidence-based therapeutic approaches. We review the recent data that support use of available antifungal agents, including the different triazoles that have now been studied in comparison to previously preferred agents. We discuss management of complex infections with specific emerging fungi such as Scedosporium spp., Fusarium spp., Trichosporon asahii , and Candida auris . We briefly explore newer antifungal agents or formulations that are now being investigated to overcome therapeutic pitfalls, including but not limited to olorofim, rezafungin, fosmanogepix, and encochleated Amphotericin B. We discuss the role of surgical resection or debridement, duration of treatment, follow-up modalities, and need for secondary prophylaxis, all of which remain challenging, especially in patients chronically immunocompromised or awaiting more immunosuppressive therapies
Helicobacter cinaedi bacteremia mimicking eosinophilic fasciitis in a patient with X-linked agammaglobulinemia
First Report of Isolation and Characterization of Aurantimonas altamirensis from Clinical Samplesâż
The genus Aurantimonas, proposed in 2003, encompasses four species from environmental sources, including Aurantimonas altamirensis, isolated from a cave wall in Spain. Here, we report what we believe are the first cases of the recovery of A. altamirensis from human clinical materials
Clinical Practice Guideline for Solid Organ Donation and Transplantation During the COVID-19 Pandemic
Background. The coronavirus 2019 (COVID-19) pandemic has disrupted health systems worldwide, including solid
organ donation and transplantation programs. Guidance on how best to screen patients who are potential organ donors
to minimize the risks of COVID-19 as well as how best to manage immunosuppression and reduce the risk of COVID-19
and manage infection in solid organ transplant recipients (SOTr) is needed. Methods. Iterative literature searches were
conducted, the last being January 2021, by a team of 3 information specialists. Stakeholders representing key groups
undertook the systematic reviews and generation of recommendations using a rapid response approach that respected
the Appraisal of Guidelines for Research and Evaluation II and Grading of Recommendations, Assessment, Development
and Evaluations frameworks. Results. The systematic reviews addressed multiple questions of interest. In this guidance
document, we make 4 strong recommendations, 7 weak recommendations, 3 good practice statements, and 3 statements
of âno recommendation.â Conclusions. SOTr and patients on the waitlist are populations of interest in the COVID-19
pandemic. Currently, there is a paucity of high-quality evidence to guide decisions around deceased donation assessments
and the management of SOTr and waitlist patients. Inclusion of these populations in clinical trials of therapeutic interventions,
including vaccine candidates, is essential to guide best practices.Medicine, Faculty ofPharmaceutical Sciences, Faculty ofNon UBCInfectious Diseases, Division ofMedicine, Department ofReviewedFacultyResearcherGraduat
Pulmonary mucormycosis in a patient with acute liver failure: A case report and systematic review of the literature
Perspectives on Scedosporium species and Lomentospora prolificans in lung transplantation: Results of an international practice survey from ESCMID fungal infection study group and study group for infections in compromised hosts, and European Confederation of Medical Mycology
Background Scedosporium species and Lomentospora prolificans (S/L) are the second most common causes of invasive mold infections following Aspergillus in lung transplant recipients. Methods We assessed the current practices on management of S/L colonization/infection of the lower respiratory tract before and after lung transplantation in a large number of lung transplant centers through an international practice survey from October 2016 to March 2017. Results A total of 51 respondents from 45 lung transplant centers (17 countries, 4 continents) answered the survey (response rate 58%). S/L colonization was estimated to be detected in candidates by 48% of centers. Only 18% of the centers used a specific medium to detect S/L colonization. Scedosporium spp. colonization was a contraindication to transplantation in 10% of centers whereas L prolificans was a contraindication in 31%; 22% of centers declared having had 1-5 recipients infected with S/L in the past 5 years. Conclusions This survey gives an overview of the current practices regarding S/L colonization and infection in lung transplant centers worldwide and underscores the need of S/L culture procedure standardization before implementing prospective studies