Antifungal management in cancer patients

Abstract

Invasive fungal infections (IFI) are a major cause of morbidity and mortality in cancer patients receiving myelotoxic chemotherapy. Established risk factors are previous fungal infection, neutropenia exceeding 10 days, older age, active cancer, corticosteroid therapy, administration of broad spectrum antibiotics, allogeneic HSCT, central venous catheter and organ dysfunction. The strategies to manage IFI comprise chemoprophylaxis, preemptive, empirical and directed antifungal therapy. Benefit of antifungal prophylaxis has been proven for fluconazole (400 mg/d) in allogeneic transplant recipients, and for posaconazole (600 mg/d) in patients during AML/MDS induction chemotherapy as well as in patients with GvHD. Pre-emptive therapy based on sensitive diagnostic non-culture methods needs further validation in larger randomized studies before becoming a standard. Empirical antifungal therapy is well established and should consist of either liposomal amphotericin B, itraconazole, voriconazole, or caspofungin. In patients with documented invasive aspergillosis, therapy with voriconazole is the treatment of choice. Liposomal amphotericin B is a good alternative candidate and caspofungin is reserved for salvage treatment. Invasive candidiasis should be treated with caspofungin or one of the lipid based amphotericin B formulations. Since non-albicans species are increasingly observed, the use of fluconazole is reserved for "stable", non-neutropenic patients.

Pain Management for Children during Bone Marrow and Stem Cell Transplantation

“…However, this treatment is not without multiple comorbidities, including the potential for significant nausea and vomiting, graft-versus-host disease, bacterial/viral/fungal infections, and gastrointestinal and pulmonary complications (Gassas, Sung, Doyle, Clarke, & Saunders, 2003; Messina et al, 2008; Staber, Langner, Dornbusch, & Neumeister, 2007; Styczynski & Gil, 2008; Vogelsang & Dala, 2002). Many of the complications after transplantation are associated with pain that requires careful consideration and treatment in this vulnerable population.…”

Successful management of postpneumonectomy Aspergillus pleural empyema by combined surgical and anti-fungal treatment with voriconazole and caspofungin

“…mainly affect the immunocompromised host, e.g. patients undergoing chemotherapy, solid organ transplantation or those suffering from human immunodeficiency syndrome virus (HIV) infection 5 . Aspergillus pleural empyema has been reported following bronchial stump leak after lung surgery 6,7 .…”

“…patients undergoing chemotherapy, solid organ transplantation or those suffering from human immunodeficiency syndrome virus (HIV) infection. 5 Aspergillus pleural empyema has been reported following bronchial stump leak after lung surgery. 6,7 In order to close the leak, the Aspergillus infection must be controlled and maintenance of this closure is important to prevent reinfection.…”

Fundamentals of paracoccidioidomycosis treatment

“…The immune mechanisms that lead to the emergence of PCM in patients with cancer are not yet well understood, but it is believed that old age, corticosteroid therapy, administration of broad-spectrum antibiotics, and neutropenia exceeding 10 days are contributory to the establishment of the fungal infection [Almyroudis and Segal, 2009;Bohme et al, 1999;Gonzalez et al, 2008b;Staber et al, 2007;Stefani et al, 2006]. Thus, a systematic research of PCM in patients with cancer, leading to an early diagnosis and thereby increasing the chances of a successful treatment, is needed [Bohme et al, 1999;Pato et al, 2007].…”