A Trial of Itraconazole or Amphotericin B for HIV-Associated Talaromycosis

Le, Thuy; Kính, Nguyễn Văn; Cuc, Ngo Thi Kim; Tung, Nguyen Le Nhu; Lâm, Nguyễn Thị; Thuy, Pham Thanh; Cuong, Do Duy; Phuc, Pham T.H.; Vinh, Vũ Hải; Hanh, Doan Thi Hong; Tam, Vu Van; Thanh, Nguyen Tat; Thuy, Tran Phuong; Hang, Nguyen Thuy; Hoang, Long Bao; Nhan, Ho Thi; Wertheim, Heiman; Merson, Laura; Shikuma, Cecilia; Day, Jeremy; Châu, Nguyễn Văn Vĩnh; Farrar, Jeremy; Thwaites, Guy; Wolbers, Marcel

doi:10.1056/nejmoa1613306

Cited by 137 publications

(147 citation statements)

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“…It is the treatment of choice for mild to moderate disease manifestations (Table 4) [14,22,[49][50][51][52]. Mild cases of histoplasmosis with symptoms less than 4 weeks usually do not require antifungal treatment, while paracoccidioidomycosis, blastomycosis, sporotrichosis, and talaromycosis should be treated when diagnosed [14,22,50].…”

Section: Managementmentioning

confidence: 99%

“…Histoplasmosis and talaromycosis usually require a period of 2 weeks of induction therapy followed by 6-12 weeks of consolidated treatment, while paracoccidioidomycosis and sporotrichosis usually require long-term treatment of at least 12 months [14,51,52]. Generally, the duration should be guided by clinical improvement and radiological resolution.…”

Section: Duration Of Itraconazole Treatmentmentioning

confidence: 99%

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Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease

et al. 2018

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Systemic endemic mycoses cause high rates of morbidity and mortality in certain regions of the world and the real impact on global health is not well understood. Diagnosis and management remain challenging, especially in low-prevalence settings, where disease awareness is lacking. The main challenges include the variability of clinical presentation, the fastidious and slow-growing nature of the fungal pathogens, the paucity of diagnostic tests, and the lack of options and toxicity of antifungal drugs. Coccidioidomycosis and paracoccidioidomycosis are restricted to the Americas only, and while histoplasmosis and blastomycosis also occur predominantly in the Americas, these mycoses have also been reported on other continents, especially in sub-Saharan Africa. Talaromycosis is endemic in tropical and subtropical regions in South-East Asia and southern China. Systemic endemic mycoses causing pulmonary disease are usually acquired via the airborne route by inhalation of fungal spores. Infections can range from asymptomatic or mild with flu-like illnesses to severe pulmonary or disseminated diseases. Skin involvement is frequent in patients with paracoccidioidomycosis, blastomycosis, sporotrichosis, and talaromycosis and manifests as localized lesions or diffuse nodules in disseminated disease, but can also occur with other endemic mycoses. Culture and/or characteristic histopathology from clinical samples is the diagnostic standard for endemic mycoses. Immunological assays are often not available for the diagnosis of most endemic mycoses and molecular amplification methods for the detection of fungal nucleic acids are not standardized at present. The first-line treatment for mild to moderate histoplasmosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, and talaromycosis is itraconazole. Severe illness is treated with amphotericin B. Patients with severe coccidioidomycosis should receive fluconazole. Treatment duration depends on the specific endemic mycosis, the severity of disease, and the immune status of the patient, ranging between 6 weeks and lifelong treatment.

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Section: Managementmentioning

confidence: 99%

Section: Duration Of Itraconazole Treatmentmentioning

confidence: 99%

Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease

et al. 2018

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“…Antifungal treatment includes itraconazole and amphotericin B. Recently, a large study reported a better outcome for amphotericin B compared to itraconazole [66]. …”

Section: Pulmonary Fungal Infectionsmentioning

confidence: 99%

Pulmonary Diseases in Refugees and Migrants in Europe

et al. 2018

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More than 2 million people fleeing conflict, persecution, and poverty applied for asylum between 2015 and 2016 in the European Union. Due to this, medical practitioners in recipient countries may be facing a broader spectrum of conditions and unusual presentations not previously encountered, including a wide range of infections with pulmonary involvement. Tuberculosis is known to be more common in migrants and has been covered broadly in other publications. The scope of this review was to provide an overview of exotic infections with pulmonary involvement that could be encountered in refugees and migrants and to briefly describe their epidemiology, diagnosis, and management. As refugees and migrants travel from numerous countries and continents, it is important to be aware of the various organisms that might cause disease according to the country of origin. Some of these diseases are very rare and geographically restricted to certain regions, while others have a more cosmopolitan distribution. Also, the spectrum of severity of these infections can vary from very benign to severe and even life-threatening. We will also describe infectious and noninfectious complications that can be associated with HIV infection as some migrants might originate from high HIV prevalence countries in sub-Saharan Africa. As the diagnosis and treatment of these diseases can be challenging in certain situations, patients with suspected infection might require referral to specialized centers with experience in their management. Additionally, a brief description of noncommunicable pulmonary diseases will be provided.

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“…[1][2][3] In our previous study, five of the six patients with JAK2-mutated CHIP did not have any abnormalities in the complete blood count and thus would not have met the WHO criteria for either polycythemia vera or essential thrombocythemia. 4 In the current study, data regarding the complete blood count were available for patients from the Malmö Diet and Cancer prospective cohort study.…”

Section: Doi: 101056/nejmc1710381mentioning

confidence: 99%

“…To the Editor: Jaiswal and colleagues (July 13 issue) 1 report that the presence of clonal hematopoiesis of indeterminate potential (CHIP) was associated with coronary heart disease. However, the use of the JAK2 V617F mutation as a marker of CHIP may be misleading, particularly when the mutant allele burden is high (up to 52% in this study).…”

mentioning

confidence: 99%