Fungal update. Liise-anne Pirofski, M.D. Albert Einstein College of Medicine
|
|
- Berenice Randall
- 5 years ago
- Views:
Transcription
1 Liise-anne Pirofski, M.D. Albert Einstein College of Medicine Fungal update
2 No disclosures
3 Patient 1: Pregnant woman in the intensive care unit on antibacterial therapy for 10 days NB: Not actual patient
4 What is the treatment of choice? A. Echinocandin B. Fluconazole C. Amphotericin B formulation
5 SUMMARY: IDSA guidelines on treatment of candidemia and candidiasis * Candidemia Suspected candidiasis CNS disease Endopthalmitis Neutropenic Non-neutropenic All patients Caveat/s Echinocandin or LAmB LAmB, caspofungin or voriconazole Fluconazole 800, then 400 or echinocandin Fluconazole 800, then 400 or echinocandin LAmB +/- 5FC then fluconazole AmB + 5FC; fluconazole ; surgery Endocarditis LAmB 3-5 mg/kg +/- 5FC; Am-b +/- 5FC; echinocandin Oropharyngeal Fluconazole Esophageal Fluconazole ; echinocandin; AmB Prophylaxis Fluconazole 400; posaconazole Liver tx: fluconazole or LAmB x 7-14d post surgery Remove catheter C. parapsilosis fluconazole Pregnancy: AmB AmB- renal toxicity 50% Evidence-based recommendations adapted from:
6 Candida drug susceptibility Fluconazole Itraconazole Voriconazole Posaconazole Flucytosine (5FC) Amphotericin B (AmB) C. albicans S S S S S S S C. tropicalis S S S S S S S Candins C. parapsilosis S S S S S S S to R C. glabrata S (DD) to R S (DD) to R S (DD) to R S (DD) to R S S to I S C. krusei R S (DD) to R S (DD) to R S (DD) to R I to R S to I S C. lusitaniae S S S S S S to R S I intermediately susceptible; R resistant; S susceptible; S-DD susceptible dose-dependent Redrawn from:
7 Considerations in treating Candida Candidemia Look for a source Restore barrier Remove catheter/s Treat early Treatment choice Severity of illness» Severe versus less severe» Neutopenic versus not neutropenic Candida species» C. parapsilosis - use fluconazole» C. glabrata use an echinocandin» Unknown use an echinocandin Challenge Early diagnostic tools lacking Caveat Pseudohyphae - 37 o C Disease reflects a disruption in the normal host-microbe relationship
8 Candida infection and disease Invasive candidiasis Disseminated candidiasis Hepatosplenic candidiasis Oro-pharyngeal candidiasis Surgery; Radiation Catheters; Antibiotics Immune impairment Vaginitis Mucocutaneous candidiasis Asymptomatic Colonization Disease WEAK Loss of barrier Immunodeficiency Immune response STRONG Excess inflammation Inappropriate response
9 Patient 2: HIV-infected patient, recently begun on ART Provided by Peter Pappas, UAB
10 Patient 3: Patient on steroids with acute onset of fever, cough, headache Can J Infect Dis Med Microbiol Spring; 20(1): NB: Not actual patient
11 Which fungus is responsible? A. B. XX C. XX
12 Cryptococcosis HIV Non-HIV IRIS C. neoformans Risk: profound CD4 deficiency (<50) Clinical features: presentation can be indolent; CSF can lack inflammatory features C. gattii Risk: increased (HIV) in recent study (Cao, Emerg Infect Dis (2011)) Risk: SOT*, steroids; XHIM Clinical features: high CSF OP, protein, CSF cell count (Chau BMC Infect Dis (2010)) Risk: Oral steroids; smoking; invasive cancer; lung disease (Cao, Emerg Infect Dis (2011)) Clinical features: fever, cough, headache ART-associated: no previous CN; apparent worsening HIV; evidence of CN (pulmonary; CNS; skin) Unmasking (paradoxical): previous CN; inflammatory manifestations (painful adenopathy; >50 cells CSF; expanding CNS or pulmonary lesions) (Haddow, Lancet Infect Dis (2010)) Provided by Peter Pappas, UAB * Early post-transplant disease unrecognized disease or donor-related infection (Sun, CID, 2020))
13 Cryptococcus: treatment HIV-infected Non-HIVinfected SOT IRIS Pregnancy CNS AmB + 5FC x 2 weeks (can use LAmB or ABLC), then Fluconazole 400 for 8 weeks, then 200 (until CD4>100 and undetectable VL for 3 mos) Start ART 2-10 weeks Consider immune modulators: Interferon (Pappas, JID (2004); Armstrong-James, Am J Transplant (2010)) AmB + 5FC x 4 weeks, then Fluconazole 200 for 6-12 months LAmB (or ABLC) + 5FC x 2 weeks, then Fluconazole x 8 weeks, then for 6-12 months Same as CNS; consider steroids for increased ICP, CNS inflammation AmB or LFAmB +/- 5FC (Category C); fluconazole after delivery Non- CNS Dissemination - like CNS No dissemination Fluconazole 400 (6-12 mos Fluconazole 400 (6-12 mos); consider steroids Same as CNS; consider steroids for increased ICP, CNS inflammation
14 Cryptococcus SOT-associated disease HIV-associated disease IRIS Asthma C. gattii C. neoformans normal patient Asymptomatic Latency Disease WEAK Immunodeficiency Immune response STRONG Reconstitution
15 Patient 4: Patient with rheumatoid arthritis on TNF inhibitor with fever and confusion NB: Not actual patient
16 Where did the patient visit? A. XXX B. XXXX C. XXX
17 Histoplasma Endemic, dimorphic fungus Yeast in tissue; mould in environment Temperate zones Ohio & Mississippi River valleys Species H. capsulatum var capsulatum (U.S.) H. capsulatum var duboisii (Africa) Disease syndromes Pneumonia Acute (often resolves without therapy) Chronic Disseminated disease Blood smear c.php?p=61749&sid=221a774c2bdfa7ba5ef8798ffc6 aa857 Risk factors Being in endemic area Caves Chicken coops Immune impairment HIV/AIDS TNF inhibitors
18 Histoplasma Diagnosis Culture Bone marrow Serology Skin testing (epidemiology) Treatment Discontinue immunomodulator Amphotericin B Itraconazole BAL Bone marrow aspirate Peripheral blood smear Images provided by Peter Pappas, UAB
19 Patient 5: Patient 10 months after liver transplant with flu-like illness after travel to Los Cabos CDC/Dr. Lucille K. Georg NB: Not actual patient
20 What is this? KOH sputum Liver biopsy
21 Coccidioides Endemic, dimorphic fungus Potential agent of bioterror: Category C Disease syndromes Pulmonary Pneumonia (often self-limited) Cavitary Fever, arthralgia (Valley Fever) Disseminated Bone, skin CNS Pneumonitis Diagnosis Histopathology Culture Serology Treatment Amphotericin B Azoles Risk factors Being in endemic area HIV/AIDS Transplant Species C. immitis: California C. posadasii: Arizona, Texas, South America, Northern Mexico ographic_distribution_of_coccidioidomycosi s_02.png pitulo20/capitulo70/contenidocapitulo-en.html
22 Patient 6: HIV-infected child with skin lesions NB: Not actual patient
23 Which is the most likely vector? A. XXXX B. XXXX C. XXXX
24 Penicillium Dimorphic fungus Yeast in tissue, mould in environment Southeast Asia Bamboo rat Disease syndromes Pulmonary Cutaneous Disseminated Diagnosis Histopathology Culture Treatment Amphotericin B Itraconazole (caveat: IRIS after ARV) Risk factors for disease Being in endemic area HIV/AIDS Species Penicilllium marneffei 8/1/11
25 Dimorphic fungi Disseminated disease HIV-associated disease Pulmonary disease Cutaneous manifestations Asymptomatic Latency Disease WEAK Reactivation latency STRONG Immunological response Immune response
26 Patient 7: Patient with stem cell transplant and pneumonia NB: Not actual patient
27 Aspergillus Environmental mould Ubiquitous (everywhere) Decaying matter Nosocomial sites Disease syndromes Allergic Aspergilloma Invasive sinus Invasive pulmonary Species A. fumigatus (85-90%) A. nidulans (5-10%) A. niger, A. terreus, A. nidulans (< 5%) Diagnosis Imaging Histopathology Antigen detection -glucan, galactomannan Most useful in following HSCT recipients Need better early detection Risk factors Neutropenia Neutrophil defects (CGD) Corticosteroids Organ transplantation Bone marrow Lung > liver HIV/AIDS Marta Feldmesser, Einstein, Infect Immun 73 (2005): cover art
28 Aspergillus: treatment Treatment Restore immune status IDSA guidelines - Antifungal therapy Voriconazole Amphotericin B Echinocandins Considerations and caveats When invasive disease is suspected, therapy should be initiated while diagnostic evaluation is undertaken Treat for a long time Prophylaxis recommended in high risk patients Future directions Earlier diagnosis advancing, but not there yet Prognosis is improving Adjunctive immunotherapy with interferon- is a consideration (IDSA guidelines)
29 Aspergillus pathogenesis Invasive sinus disease Invasive pulmonary CNS aspergillosis Sinusitis Allergic alveolitis Cutaneous manifestations Allergic bronchopulmonary aspergillosis Asymptomatic Colonization Disease WEAK Hyphae Tissue damage from microbe STRONG Immune response Tissue damage from inflammation Immune response
30 Patient 8: Diabetic patient with sinusitis g.aspx?searchstr=maxillary+sinusitis&searchtype=2&fullte xtstr=maxillary+sinusitis&resourceid=505&narrowing=yes NB: Not actual patient
31 The same fungus might be identified in which patient? A. A clean-up crew member working in the San Fernando Valley after the earthquake B. A clean-up crew member working in Joplin, Missouri after the tornado C. A tree cutter working in the Pacific Northwest D. A construction worker in Arizona
32 Zygomycetes Environmental moulds Soil, decaying matter, debris Inhaled Ingested trauma Disease syndromes Cutaneous Pulmonary Gastric Rhinocerebral Disseminated Diagnosis Clinical suspicion Histopathology Culture Treatment /78/4/1449 Amphotericin B, debridement Posaconazole under investigation Risk factors for disease Neutropenia (ANC < 1000) Corticosteroids Organ transplantation Desferoxamine therapy Ketoacidosis Trauma Malnutrition Prognosis Dismal Species Mucoraceae Mucor Rhizopus Cuninghamellaceae Cunninghamella
33 Another important mould Mould Fusarium spp. Ubiquitous, decaying soil Risk for disease Immune impairment Contact lens paraphernalia Disease Keratitis (2006 outbreak) Pulmonary Disseminated» Skin lesions Diagnosis Blood cultures (30-50%) Treatment Voriconazole um/eisen.html
34 Summary 1: Basic groups of fungi Yeasts Ubiquitous Cryptococcus Candida Dimorphic Histoplasma Cocciodiodes Blastomycetes (Penicillium) Moulds Aspergillus Zygomycetes Mucor Rhizopus Fusarium
35 Summary 2: Fungal acquisition Environment (nearly all) Epidemiology reflects environmental distribution Important exceptions Organ-related transplant-associated disease Reactivation of (long) latent state Person to person (an exception) Candida albicans
36 Summary 3: Fungal disease Infection is common Disease is rare Epidemics can follow natural disasters Earthquakes Tsunamis Tornados Hurricanes Most often occurs in those with: Intravenous catheters (impaired barrier immunity) Broad-spectrum antibiotics Intensive care units Cytotoxic chemotherapy HIV/AIDS Bottom line Most with disease have impaired immunity
37 Summary 4: Antifungal therapy Restore barrier Reverse immunosuppression Treat for a (very) long time New directions Combination therapy Immune-based therapy Polyenes act on membrane Amphotericin B Echinocandins act on cell wall Pneumocandins Azoles act on membrane Flucytosine acts on nucleus (DNA & RNA)
38 IDSA guidelines for fungi
39 Additional slides of fungi to know for the boards
40 Another dimorphic mycosis (1) Sporothrix shenkii Ubiquitous Disease Occupational Gardening Lymphocutaneous Osteoarticular Treatment Local iodide Systemic Amphoterin B itraconazole
41 Another dimorphic fungus (2) Blastomyces dermatitidis Endemic, dimorphic fungus Risk factors Being in endemic region Contact with soil, debris Disease syndromes Dogs; humans Pulmonary Disseminated Cutaneous (skin lesions) Treatment Amphotericin B (severe, disseminated disease) Itraconazole Image provided by Peter Pappas, UAB
42 Something else to think about
43 The future: Immunotherapy for fungal disease INCREASE Immune stimulation Control fungal burden Immune stimulation Interferon- Antibody therapies Vaccines Immune suppression Inhibitors of Th1 & Th17 Antibody therapies Steroids DECREASE Immune stimulation Fungal burden controlled WEAK RESPONSE Candidemia Cryptococcosis (non-iris) Aspergillosis (non-allergic) Histoplasmosis (disseminated) Pneumocystis Moulds STRONG RESPONSE Candida vaginitis IRIS-associated cryptococcosis Allergic aspergillosis Histoplasmosis Pneumocystis (after treatment) Cutaneous mycoses
Common Fungi. Catherine Diamond MD MPH
Common Fungi Catherine Diamond MD MPH Birth Month and Day & Last Four Digits of Your Cell Phone # BEFORE: http://tinyurl.com/kvfy3ts AFTER: http://tinyurl.com/lc4dzwr Clinically Common Fungi Yeast Mold
More informationCase Studies in Fungal Infections and Antifungal Therapy
Case Studies in Fungal Infections and Antifungal Therapy Wayne L. Gold MD, FRCPC Annual Meeting of the Canadian Society of Internal Medicine November 4, 2017 Disclosures No financial disclosures or industry
More informationMANAGEMENT OF HOSPITAL-ACQUIRED FUNGAL INFECTIONS
MANAGEMENT OF HOSPITAL-ACQUIRED FUNGAL INFECTIONS Paul D. Holtom, MD Associate Professor of Medicine and Orthopaedics USC Keck School of Medicine Numbers of Cases of Sepsis in the United States, According
More informationCondition First line Alternative Comments Candidemia Nonneutropenic adults
Recommendations for the treatment of candidiasis. Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America. Condition First line Alternative
More informationEpidemiology and Laboratory Diagnosis of Fungal Diseases
Medical Mycology (BIOL 4849) Summer 2007 Dr. Cooper Epidemiology of Mycoses Epidemiology and Laboratory Diagnosis of Fungal Diseases Mycosis (pl., mycoses) - an infection caused by a fungus Two broad categories
More informationFungal infections in ICU. Tang Swee Fong Department of Paediatrics Universiti Kebangsaan Malaysia
Fungal infections in ICU Tang Swee Fong Department of Paediatrics Universiti Kebangsaan Malaysia Epidemiology of invasive fungal infections - US +300% Martin GS, et al. N Engl J Med 2003;348:1546-1554
More informationAntifungals and current treatment guidelines in pediatrics and neonatology
Dragana Janic Antifungals and current treatment guidelines in pediatrics and neonatology Dragana Janic. University Children`s Hospital, Belgrade, Serbia 10/10/17 Hotel Crowne Plaza, Belgrade, Serbia; www.dtfd.org
More informationFungal infection in the immunocompromised patient. Dr Kirsty Dodgson
Fungal infection in the immunocompromised patient Dr Kirsty Dodgson Aims Discuss different types of fungi Overview of types of clinical infections Clinical Manifestations Fungus Includes Moulds Aspergillus
More informationRheem Totah, Office H172M, Ph Office hours MWF 11:30 12:20 or by arrangement
Rheem Totah, Office H172M, Ph 206-543-9481 rtotah@uw.edu Office hours MWF 11:30 12:20 or by arrangement Date/Time Topic Readings Mon March 26 Antifungal agents Foye s Chapter 40 Wed March 28 Antifungal
More informationLecture 7: Mycoses Caused by Dimorphic Fungi, Part I
BIOL 4849 Medical Mycology Summer 2006 Histoplasmosis Lecture 7: Mycoses Caused by Dimorphic Fungi, Part I u Most common endemic mycotic disease in the United States u Two different varieties (actually
More informationEpidemiology of Fungal Diseases
Lecture 2 Epidemiology of Fungal Diseases Disclaimer: This lecture slide presentation is intended solely for educational purposes. Many of the images contained herein are the property of the original owner,
More informationCigna Drug and Biologic Coverage Policy
Cigna Drug and Biologic Coverage Policy Subject Voriconazole Effective Date... 3/15/2018 Next Review Date... 3/15/2019 Coverage Policy Number... 4004 Table of Contents Coverage Policy... 1 General Background...
More informationFungal Infection Pre-Infusion Data
Fungal Infection Pre-Infusion Data Registry Use Only Sequence Number: Date Received: CIBMTR Center Number: Event date: / / CIBMTR Form 2046 revision 5 (page 1 of 5). Last Updated May, 2018. Infection Episode
More informationAntifungal Update 2/22/12. Which is the most appropriate initial empirical therapy in a candidemic patient?
Antifungal Update B. Joseph Guglielmo, Pharm.D. Professor and Chair Department of Clinical Pharmacy School of Pharmacy University of California San Francisco 3/3 blood cultures are positive for an unidentified
More informationFungal Infection Post-Infusion Data
Fungal Infection Post-Infusion Data Registry Use Only Sequence Number: Date Received: CIBMTR Center Number: Event date: / / Visit: 100 day 6 months 1 year 2 years >2 years. Specify: CIBMTR Form 2146 revision
More informationADEQUATE ANTIFUNGAL USE FOR BLOODSTREAM INFECTIONS
ADEQUATE ANTIFUNGAL USE FOR BLOODSTREAM INFECTIONS COMMERCIAL RELATIONS DISCLOSURE 2500 9000 15000 Astellas Gilead Sciences Pfizer Inc Expert advice Speaker s bureau Speaker s bureau OUTLINE OF THE PRESENTATION
More informationAntifungal Update. Candida: In Vitro Antifungal Susceptibility Testing
Antifungal Update B. Joseph Guglielmo, Pharm.D. Professor and Chair Department of Clinical Pharmacy School of Pharmacy University of California San Francisco The patient spikes a new fever and 3/3 blood
More informationECMM Excellence Centers Quality Audit
ECMM Excellence Centers Quality Audit Person in charge: Department: Head of Department: Laboratory is accredited according to ISO 15189 (Medical Laboratories Requirements for quality and competence) Inspected
More informationHISTOPLASMOSIS - LABORATORY DIAGNOSIS IN VIETNAM
HISTOPLASMOSIS - LABORATORY DIAGNOSIS IN VIETNAM National Institute of Hygiene and Epidemiology, Hanoi, Vietnam, National Institute of Infectious Diseases, Tokyo, Japan, Bach Mai hospital, Vietnam, Military
More informationProphylaxis versus Diagnostics-driven approaches to treatment of Invasive fungal diseases. Y.L. Kwong Department of Medicine University of Hong Kong
Prophylaxis versus Diagnostics-driven approaches to treatment of Invasive fungal diseases Y.L. Kwong Department of Medicine University of Hong Kong Pathogenic yeast Candida Cryptococcus Trichosporon Pathogenic
More informationFungal biology. Fungal Infections. Fungal cell structure. Pathogenesis
Fungal Infections Once exotic and rare; now increasingly common Fungi are not virulent But they are good at taking advantage Opportunistic in many senses Fungal biology Eukaryotic (organized nucleus and
More informationUse of Antifungal Drugs in the Year 2006"
Use of Antifungal Drugs in the Year 2006" Jose G. Montoya, MD Associate Professor of Medicine Associate Chief for Clinical Affairs Division of Infectious Diseases Stanford University School of Medicine
More informationImproving Clinical Outcomes in Fungal Infection Control and Management
Improving Clinical Outcomes in Fungal Infection Control and Management DISCLAIMER The information within this CME/CE activity is for continuing education purposes only, and is not intended to substitute
More informationFungal biology. Pathogenesis. Fungal cell structure. Fungal Infections MID 25 & 26. Eukaryotic (organized nucleus and cell structure) Non-motile
Fungal Infections Once exotic and rare; now increasingly common Fungi are not virulent But they are good at taking advantage Opportunistic in many senses Fungal biology Eukaryotic (organized nucleus and
More informationAli Alabbadi. Sarah Jaar ... Nader
24 Ali Alabbadi Sarah Jaar... Nader Intro to Mycology *underlined text was explained in the lecture but is not found in the slides -mycology: the study of the mycoses of man (fungal infections) -less than
More informationManagement of fungal infection
Management of fungal infection HKDU symposium 17 th May 2015 Speaker: Dr. Thomas Chan MBBS (Hons), MRCP, FHKCP, FHKAM Synopsis Infection caused by fungus mycoses Skin infection by fungus is common in general
More informationTitle: Author: Speciality / Division: Directorate:
Antifungal guidelines for CANDIDIASIS INFECTIONS (Adults) Proven infection: Targeted antifungal therapy should be prescribed for: o Positive cultures from a sterile site with clinical or radiological abnormality
More informationNorth American Endemic Fungi
North American Endemic Fungi Boni Elizabeth Elewski, MD Chair Department of Dermatology University of Alabama at Birmingham James Elder Professor of Graduate Medical Education DISCLOSURE OF FINANCIAL RELATIONSHIPS
More informationVoriconazole October 2015 Risk Management Plan. Voriconazole
Voriconazole October 2015 VI.2 VI.2.1 Elements for a Public Summary Overview of disease epidemiology Invasive aspergillosis (IA) is the most devastating of Aspergillus related diseases, targeting severely
More informationAbout the Editor Gerri S. Hall, Ph.D.
About the Editor Gerri S. Hall, Ph.D. Dr. Hall s professional career has been focused on clinical microbiology: direct clinical activities of various areas such as bacteriology, mycobacteria, STD testing,
More informationFungal Infections. Alessandro Diana November 22th 2007
Fungal Infections Alessandro Diana November 22th 2007 alessandro.diana@ne.ch Topics Aspergillosis Candidiasis Cryptococcosis Histoplasmosis Coccidioidomycosis Blastomyocosis Sporotrichosis Pneumocystis
More informationInvasive Fungal Infections in Solid Organ Transplant Recipients
Outlines Epidemiology Candidiasis Aspergillosis Invasive Fungal Infections in Solid Organ Transplant Recipients Hsin-Yun Sun, M.D. Division of Infectious Diseases Department of Internal Medicine National
More informationEpidemiology and ecology of fungal diseases
Epidemiology and ecology of fungal diseases Healthcare Focus on: - individual - diagnosis - treatment Public Health Focus on: - population - prevention The nature of fungi Kingdom Fungi (lat. fungus, -i)
More informationTOWARDS PRE-EMPTIVE? TRADITIONAL DIAGNOSIS. GALACTOMANNAN Sensitivity 61% Specificity 93% Neg Predict Value >95% β-d-glucan Neg Predict Value 100% PCR
TOWARDS PRE-EMPTIVE? GALACTOMANNAN Sensitivity 61% Specificity 93% Neg Predict Value >95% TRADITIONAL DIAGNOSIS β-d-glucan Neg Predict Value 100% PCR diagnostics FUNGAL BURDEN FIRST TEST POSITIVE FOR ASPERGILLOSIS
More informationCURRENT AND NEWER ANTI-FUNGAL THERAPIES- MECHANISMS, INDICATIONS, LIMITATIONS AND PROBLEMS. Dr AMIT RAODEO DM SEMINAR
CURRENT AND NEWER ANTI-FUNGAL THERAPIES- MECHANISMS, INDICATIONS, LIMITATIONS AND PROBLEMS Dr AMIT RAODEO DM SEMINAR Introduction The incidence of invasive fungal infections in critically ill intensive
More informationAntifungal Update 2/24/11. Which is the most appropriate initial empirical therapy in a candidemic patient?
Antifungal Update B. Joseph Guglielmo, Pharm.D. Professor and Chair Department of Clinical Pharmacy School of Pharmacy University of California San Francisco The patient spikes a new fever and 3/3 blood
More informationWHICH ANTIFUNGAL AGENT IS THE CHOICE FOR SUSPECTED FUNGAL INFECTIONS?
WHICH ANTIFUNGAL AGENT IS THE CHOICE FOR SUSPECTED FUNGAL INFECTIONS? Assoc. Prof. Dr. Serkan SENER Acibadem University Medical School Department of Emergency Medicine, Istanbul Acibadem Ankara Hospital,
More informationAntifungal drugs Dr. Raz Muhammed
Antifungal drugs 13. 12. 2018 Dr. Raz Muhammed 2. Flucytosine (5-FC) Is fungistatic Is a synthetic pyrimidine antimetabolite Is often used in combination with amphotericin B in the treatment of systemic
More informationCurrent Options in Antifungal Pharmacotherapy
Current Options in Antifungal Pharmacotherapy John Mohr, Pharm.D., Melissa Johnson, Pharm.D., Travis Cooper, Pharm.D., James S. Lewis, II, Pharm.D., and Luis Ostrosky-Zeichner, M.D. Infections caused by
More informationESCMID Online Lecture Library. by author
How To Best Use Antifungal Agents Cornelia Lass-Flörl Division of Hygiene and Medical Microbiology Innsbruck Medical University ESCMID SUMMER SCHOOL 2012 Epidemiology Diagnosis Roadmap Antifungal drugs
More informationAntifungal Stewardship. Önder Ergönül, MD, MPH Koç University, School of Medicine, Istanbul 6 October 2017, ESGAP course, Istanbul
Antifungal Stewardship Önder Ergönül, MD, MPH Koç University, School of Medicine, Istanbul 6 October 2017, ESGAP course, Istanbul 1 2 Objectives What do we know? Invasive Candida and Aspergillosis Impact
More informationIntroduction. Study of fungi called mycology.
Fungi Introduction Study of fungi called mycology. Some fungi are beneficial: ex a) Important in production of some foods, ex: cheeses, bread. b) Important in production of some antibiotics, ex: penicillin
More informationCase. Fungal infections for the community provider. Case. Case. April 25, 2014 Peter V. Chin-Hong M.D. Infectious Diseases UCSF UCSF
Case Fungal infections for the community provider April 25, 2014 Peter V. Chin-Hong M.D. Infectious Diseases UCSF peter.chin-hong@ucsf.edu UCSF A 38-year-old African-American female financial analyst is
More informationFungi are eukaryotic With rigid cell walls composed largely of chitin rather than peptidoglycan (a characteristic component of most bacterial cell
Antifungal Drugs Fungal infections (Mycoses) Often chronic in nature. Mycotic infections may be superficial and involve only the skin (cutaneous mycoses extending into the epidermis) Others may penetrate
More informationFungal Infections. Fungal Infections
Fungal Infection in the Immune Competent Host Steven L. Primack, MD Fungal Infection in the Immune Competent Host Steven L. Primack, MD Department of Radiology Oregon Health & Science University Fungal
More informationUpdate from the Laboratory: Clinical Identification and Susceptibility Testing of Fungi and Trends in Antifungal Resistance 13
Fungal Infections Preface: Fungal Infections Luis Ostrosky-Zeichner and Jack D. Sobel xiii The Global Burden of Fungal Diseases 1 Snigdha Vallabhaneni, Rajal K. Mody, Tiffany Walker, and Tom Chiller Fungal
More informationFungal and Viral Infections
CHAPTER 89 Fungal and Viral Infections Palash Samanta, Ghady Haidar, Minh Ly Nguyen, Cornelius J. Clancy, and M. Hong Nguyen FUNGAL INFECTIONS Fungal Pathogens Medically relevant fungi are classically
More informationPROGRESSI NELLA TERAPIA ANTIFUNGINA. A tribute to Piero Martino
PROGRESSI NELLA TERAPIA ANTIFUNGINA A tribute to Piero Martino 1946-2007 ITALIAN ICONS IERI, OGGI, E DOMANI IERI, OGGI, E DOMANI IERI, OGGI, E DOMANI 1961 CAUSES OF DEATH IN PATIENTS WITH MALIGNANCIES
More informationAn Update in the Management of Candidiasis
An Update in the Management of Candidiasis Daniel B. Chastain, Pharm.D., AAHIVP Infectious Diseases Pharmacy Specialist Phoebe Putney Memorial Hospital Adjunct Clinical Assistant Professor UGA College
More informationTreatment of rare and emerging fungal infections. EFISG Educational Workshop 15 th ECCMID April 2, 2005, Copenhagen
Treatment of rare and emerging fungal infections EFISG Educational Workshop 15 th ECCMID April 2, 2005, Copenhagen Helen Sambatakou Lecturer in Medicine and Infectious Diseases, University of Athens, Greece
More informationCurrent options of antifungal therapy in invasive candidiasis
Current options of antifungal therapy in invasive candidiasis Saloua Ladeb Bone Marrow Transplant Center Tunis HAMMAMET 24 th April 2012 DEFINITION One or more positive results on blood culture for Candida
More informationAntifungal Resistance in Asia: Mechanisms, Epidemiology, and Consequences
5th MMTN Conference 5-6 November 2016 Bangkok, Thailand 10:20-10:45, 6 Nov, 2016 Antifungal Resistance in Asia: Mechanisms, Epidemiology, and Consequences Yee-Chun Chen, M.D., PhD. Department of Medicine,
More informationCandida auris: an Emerging Hospital Infection
National Center for Emerging and Zoonotic Infectious Diseases Candida auris: an Emerging Hospital Infection Paige Armstrong MD MHS Epidemic Intelligence Service Officer Mycotic Diseases Branch Association
More informationNationwide survey of treatment for pediatric patients with invasive fungal infections in Japan
J Infect Chemother (2013) 19:946 950 DOI 10.1007/s10156-013-0624-7 ORIGINAL ARTICLE Nationwide survey of treatment for pediatric patients with invasive fungal infections in Japan Masaaki Mori Received:
More informationGAFFI Fact Sheet. Disseminated histoplasmosis
F GAFFI Fact Sheet Disseminated histoplasmosis ION NS ACT ALOR ECTIO B O F F L G ND L IN FU NGA FU Disseminated histoplasmosis is a sub- acute infection that may be diagnosed in patients with impaired
More informationFungal Meningitis. Stefan Zimmerli Institute for infectious diseases University of Bern Friedbühlstrasse Bern
Fungal Meningitis Stefan Zimmerli Institute for infectious diseases University of Bern Friedbühlstrasse 51 3010 Bern Death due to infectious diseases in sub-saharan Africa Park BJ. Et al AIDS 2009;23:525
More informationDr Kaniz Fatema. FCPS (Medicine), MD (Critical Care Medicine) Associate Professor Dept of Critical Care Medicine BIRDEM General Hospital
Dr Kaniz Fatema FCPS (Medicine), MD (Critical Care Medicine) Associate Professor Dept of Critical Care Medicine BIRDEM General Hospital 65-years old lady HTN (15 yrs) Adult Still s Disease (2 mon)
More informationFungal Infection in the ICU: Current Controversies
Fungal Infection in the ICU: Current Controversies Andrew F. Shorr, MD, MPH, FCCP, FACP Washington Hospital Center Georgetown University, Washington, DC Disclosures I have served as a consultant to, researcher/investigator
More informationAntifungal therapies differences in agents
Antifungal therapies differences in agents The basic Fungi are eukaryotes Eukaryote = an organism whose cells contain complex structures enclosed within membrane. Most Common Fungal Pathogens Dermatophytes
More informationUpdated Guidelines for Management of Candidiasis. Vidya Sankar, DMD, MHS April 6, 2017
Updated Guidelines for Management of Candidiasis Vidya Sankar, DMD, MHS April 6, 2017 Statement of Disclosure I have no actual or potential conflict of interest in relation to this presentation Outline
More information8/2/10. Sanaz Jalali, Jennifer Demler, Jeremy King. Histoplasmosis is an intracellular mycotic infection of the reticuloendothelial system.
Histoplasmosis is an intracellular mycotic infection of the reticuloendothelial system. Type of chronic respiratory infection http://www.eregimens.com/regimens/antifungal%20general.htm Sanaz Jalali, Jennifer
More informationFungal infections and critically ill adults
Martin Beed FRCA FFICM DM Richard Sherman MRCP FRCA FFICM Stephen Holden MSc FRCPath 1A02,2C03 Key points The incidence of fungal diseases in critically ill patients is thought to be increasing, most commonly
More informationUse of Antifungals in the Year 2008
Use of Antifungals in the Year 2008 Jose G. Montoya, MD Associate Professor of Medicine Associate Chief for Clinical Affairs Division of Infectious Diseases Stanford University School of Medicine Diagnosis
More informationPrimary Antifungal Prophylaxis in Adult Hematopoietic Stem Cell Transplant Recipients: Current Therapeutic Concepts
Primary Antifungal Prophylaxis in Adult Hematopoietic Stem Cell Transplant Recipients: Current Therapeutic Concepts Dorothy McCoy, Pharm.D., Daryl D. DePestel, Pharm.D., and Peggy L. Carver, Pharm.D. In
More informationClinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America
IDSA GUIDELINES Clinical Practice Guidelines for the Management of Candidiasis: 2009 Update by the Infectious Diseases Society of America Peter G. Pappas, 1 Carol A. Kauffman, 2 David Andes, 4 Daniel K.
More informationApproach to Fungal Infections
Approach to Fungal Infections Michelle A. Barron, M.D. Professor of Medicine Division of Infectious Diseases University of Colorado Denver Disclosures Research Investigation with Astellas Pharma, US I
More informationHistoplasmosis. Disease Etiology: Disease Transmission: Reservoirs: Specific Microbial Characteristics: By: Ernest Aguilar
Histoplasmosis By: Ernest Aguilar Disease Etiology: Histoplasmosis is an infection resulting from the inhalation of spores belonging to the fungus Histoplasma capsulatum. [1] This one of three fungi that
More informationHAEMATOLOGY ANTIFUNGAL POLICY
HAEMATOLOGY ANTIFUNGAL POLICY PROPHYLAXIS Primary Prophylaxis Patient Group Patients receiving intensive remissioninduction chemotherapy for Acute Leukaemia (excluding patients receiving vinca alkaloids)
More informationESCMID Online Lecture Library. by author. Salvage Therapy of Invasive Aspergillosis Refractory to Primary Treatment with Voriconazole
Salvage Therapy of Invasive Aspergillosis Refractory to Primary Treatment with Voriconazole J.A. Maertens, hematologist, MD, PhD University Hospital Gasthuisberg Leuven, Belgium Current guidelines: first-line
More informationWe are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists. International authors and editors
We are IntechOpen, the world s leading publisher of Open Access books Built by scientists, for scientists 3,800 116,000 120M Open access books available International authors and editors Downloads Our
More informationAntifungals in Invasive Fungal Infections: Antifungals in neutropenic patients
BVIKM-SBIMC La Hulpe, 6 November 2008 Antifungals in Invasive Fungal Infections: Antifungals in neutropenic patients Johan Maertens, MD Acute Leukemia and SCT Unit University Hospital Gasthuisberg Catholic
More informationHow Can We Prevent Invasive Fungal Disease?
How Can We Prevent Invasive Fungal Disease? Chris Kibbler Professor of Medical Microbiology University College London And Royal Free Hospital, London, UK Invasive Aspergillosis 2 - Acquisition Preventive
More informationEarly Diagnosis and Therapy for Fungal Infections
Early Diagnosis and Therapy for Fungal Infections Debra Goff PharmD, FCCP Clinical Associate Professor Infectious Disease Specialist The Ohio State University Medical Center Columbus Ohio, USA The Ohio
More informationManagement Strategies For Invasive Mycoses: An MD Anderson Perspective
Management Strategies For Invasive Mycoses: An MD Anderson Perspective Dimitrios P. Kontoyiannis, MD, ScD, FACP, FIDSA Professor of Medicine Director of Mycology Research Program M. D. Anderson Cancer
More information2046: Fungal Infection Pre-Infusion Data
2046: Fungal Infection Pre-Infusion Data Fungal infections are significant opportunistic infections affecting transplant patients. Because these infections are quite serious, it is important to collect
More informationFungi. Eucaryotic Rigid cell wall(chitin, glucan) Cell membrane ergosterol Unicellular, multicellular Classic fungus taxonomy:
MYCOLOGY Mycology I Fungi Eucaryotic Rigid cell wall(chitin, glucan) Cell membrane ergosterol Unicellular, multicellular Classic fungus taxonomy: Morphology Spore formation FFungi Yeast Mold Yeastlike
More informationUpdate zu EUCAST 2012 Cornelia Lass-Flörl
Update zu EUCAST 2012 Cornelia Lass-Flörl Frühjahrstagung 2012 Paul-Ehrlich-Gesellschaft Sektion Antimykotische Chemotherapie Bonn, 4./5. Mai 2012 Agenda 1. Breakpoints 2. Rationale documents and technical
More informationNew triazoles and echinocandins: mode of action, in vitro activity and mechanisms of resistance
For reprint orders, please contact reprints@expert-reviews.com New triazoles and echinocandins: mode of action, in vitro activity and mechanisms of resistance Expert Rev. Anti Infect. Ther. 7(8), 981 998
More informationMicafungin, a new Echinocandin: Pediatric Development
Micafungin, a new Echinocandin: Pediatric Development Andreas H. Groll, M.D. Infectious Disease Research Program Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology University
More informationAntifungal Agents - Cresemba (isavuconazonium), Vfend. Prior Authorization Program Summary
Antifungal Agents - Cresemba (isavuconazonium), Noxafil (posaconazole), Vfend (voriconazole) Prior Authorization Program Summary FDA APPROVED INDICATIONS DOSAGE 1,2,14 Drug FDA Indication(s) Dosing Cresemba
More informationnumber Done by Corrected by Doctor د.حامد الزعبي
number Fungi#1 Done by نرجس الس ماك Corrected by مهدي الشعراوي Doctor د.حامد الزعبي Introduction to Mycology -Terms: -Medical Mycology: The study of mycosis and their etiological agents -Mycosis: Disease
More informationMANAGEMENT OF PULMONARY MYCOSIS
MANAGEMENT OF PULMONARY MYCOSIS Eva Van Braeckel, MD, PhD Dpt. of Respiratory Medicine UZ Gent PENTALFA KU Leuven 03.03.2016 MANAGEMENT OF PULMONARY MYCOSIS 1. Antifungals 1. Acute invasive pulmonary aspergillosis
More informationPAGL Inclusion Approved at January 2017 PGC
Guideline for the prophylaxis and treatment of fungal infections in Haematology patients 1. Introduction PAGL Inclusion Approved at January 2017 PGC Haematology, CHUGGS June 2016 This guideline sets out
More informationAntifungal Pharmacotherapy
Interpreting Antifungal Susceptibility Testing: Science or Smoke and Mirrors A. W. F O T H E R G I L L, M A, M B A U N I V E R S I T Y O F T E X A S H E A L T H S C I E N C E C E N T E R S A N A N T O
More informationInvasive Fungal Infections
C H A P T E R 18 Invasive Fungal Infections Ayesha J Sunavala, Rajeev Soman The four most important fungi producing invasive fungal infections (candida, cryptococcus, aspergillus and mucor) are commonly
More informationTreatment and Prophylaxis
Treatment and Prophylaxis Andreas H. Groll, M.D. Infectious Disease Research Program Center for Bone Marrow Transplantation and Department of Pediatric Hematology/Oncology University Children s Hospital
More informationChapter 18. Fungal Diseases of the Lung. Mosby items and derived items 2011, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.
Chapter 18 Fungal Diseases of the Lung 1 YLS S M AC Figure 18-1. Fungal disease of the lung. Cross-sectional view of alveoli infected with Histoplasma capsulatum. AC, alveolar consolidation; M, alveolar
More informationAspergillus species. The clinical spectrum of pulmonary aspergillosis
Pentalfa 3 maart 2016 The clinical spectrum of pulmonary aspergillosis Pascal Van Bleyenbergh, Pneumologie UZ Leuven Aspergillus species First described in 1729 * >250 species * ubiquitous Inhalation of
More informationESCMID Online Lecture Library. by author
The antibacterial experience: indications for clinical use of antimicrobial combinations To prevent the emergence of resistant organisms (tuberculosis) To treat polymicrobial infections (abdominal complicated
More informationCurrent and Emerging Azole Antifungal Agents
CLINICAL MICROBIOLOGY REVIEWS, Jan. 1999, p. 40 79 Vol. 12, No. 1 0893-8512/99/$04.00 0 Copyright 1999, American Society for Microbiology. All Rights Reserved. Current and Emerging Azole Antifungal Agents
More informationMycology Reference Centre, Leeds Information for Service Users 2017
The Leeds Teaching Hospitals NHS Trust NHS Mycology Reference Centre, Leeds Information for Service Users 2017 Contents Contents...1 The Mycology Reference Centre...1 Request Forms... 1 Specimen Transportation...
More information9/7/2018. Faculty. Overcoming Challenges in the Management of Invasive Fungal Infections. Learning Objectives. Faculty Disclosure
Faculty Overcoming Challenges in the Management of Invasive Fungal James S. Lewis II, PharmD, FIDSA ID Clinical Pharmacy Coordinator Oregon Health and Science University Departments of Pharmacy and Infectious
More informationFungi GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER NUMBER 53: Author Moi Lin Ling, MBBS, FRCPA, CPHQ, MBA
GUIDE TO INFECTION CONTROL IN THE HOSPITAL CHAPTER NUMBER 53: Fungi Author Moi Lin Ling, MBBS, FRCPA, CPHQ, MBA Chapter Editor Ziad A. Memish, MD, FRCPC, FACP Cover heading - Topic Outline Topic outline
More informationVoriconazole. Voriconazole VRCZ ITCZ
7 7 8 7 8 fluconazole itraconazole in vitro in vivo Candida spp. C. glabrata C. krusei Cryptococcus neoformans in vitro Aspergillus spp. in vitro in vivo Aspergillus fumigatus Candida albicans C. krusei
More informationInvasive Fungal Infections in Critically Ill Patients. Dr Ravinder Kaur Director Professor&HOD Department of Microbiology,LHMC
Invasive Fungal Infections in Critically Ill Patients Dr Ravinder Kaur Director Professor&HOD Department of Microbiology,LHMC Invasive fungal infections(ifis) Major causes of morbidity and mortality in
More informationThe Differentiation of Yeast and Yeast-Like Forms in Human Tissues. Introduction. Histochemical Stains Used to Detect Fungi. Histopathologic Diagnoses
The Differentiation of Yeast and Yeast-Like Forms in Human Tissues Gary W. Procop, MD Chair, Clinical Pathology Staff, Anatomic Pathology Director, Molecular Microbiology, Mycology, and Parasitology Cleveland
More informationThe incidence of invasive fungal infections
AN EPIDEMIOLOGIC UPDATE ON INVASIVE FUNGAL INFECTIONS * Michael A. Pfaller, MD ABSTRACT *Based on a presentation given by Dr Pfaller at a symposium held in conjunction with the 43rd Interscience Conference
More informationSolid organ transplant patients
M.6 Meet-the-expert sessions Solid organ transplant patients Martin Iversen, Denmark José M. Aguado, Spain Copenhagen, Sunday 13 October 2013 Conflict of interest disclosure In the past 5 years, J.M.A.
More informationFungal Diseases of the Respiratory System
Fungal Diseases of the Respiratory System Histoplasmosis(cave disease) Dr. Hala Al Daghistani Histoplasmosis is a disease caused by the fungus Histoplasma capsulatum. Histoplasma capsulatum, is usually
More informationInvasive Aspergillosis in India: Unique Challenges. Dr Rajeev Soman Consultant Physician PD Hinduja Hospital Mumbai
Invasive Aspergillosis in India: Unique Challenges Dr Rajeev Soman Consultant Physician PD Hinduja Hospital Mumbai Aspergillus Challenges Capable of surviving & thriving in all the diverse environmental
More information