Diagnostic methods for invasive fungal diseases in patients with hematologic malignancies

Riwes, Mary; Wingard, John R.

doi:10.1586/ehm.12.53

Cited by 25 publications

(19 citation statements)

References 71 publications

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“…This is a rare cohort given the recent increase in use of mold-active antifungal therapy and the wider availability of newer non-invasive IFD diagnostic methods, which facilitate earlier diagnosis of IFD and allow for a preemptive treatment approach in hematologic malignancy patients. 18 Our findings demonstrated that there was no association between MBL levels o1000 ng/mL and IFD. Although MBL levels tended to be lower in the IFD positive than the IFD-free group, the difference was not significant.…”

Section: Discussioncontrasting

confidence: 43%

Association of mannose-binding lectin levels and invasive fungal disease in hematologic malignancy patients receiving myelosuppressive chemotherapy or allogeneic hematopoietic stem cell transplantation

Riwes

Leather

Neal

et al. 2016

Bone Marrow Transplant

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Several studies have suggested an association of mannose-binding lectin (MBL) deficiency with infections. In this study, we investigated the association between MBL deficiency and invasive fungal disease (IFD) in hematologic malignancy patients receiving myelosuppressive chemotherapy or hematopoietic stem cell transplant. MBL levels were quantified at the start of treatment in 152 patients who were followed for 6 months and scored as developing IFD or not. Forty-five patients (29.6%) developed IFD, of which 21 (46.7% of IFD cases and 13.8% of patients) were proven or probable IFD. Fifty-nine (38.8%) had MBL levels <1000 ng/mL. The rates of all IFD in patients with MBL levels below and above 1000 ng/mL were 33.9% and 26.9%, respectively (P=0.356). The rates of proven or probable IFD in patients with MBL levels below and above 1000 ng/mL were 11.9% and 15.1%, respectively (P=0.579). MBL levels <1000 ng/mL were not predictors of death (P=0.233). As expected, IFD was associated with death (P<0.0001). Our findings indicate that MBL levels <1000 ng/mL were not associated with an increased risk of developing IFD or overall survival.

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Section: Discussioncontrasting

confidence: 43%

Association of mannose-binding lectin levels and invasive fungal disease in hematologic malignancy patients receiving myelosuppressive chemotherapy or allogeneic hematopoietic stem cell transplantation

Riwes

Leather

Neal

et al. 2016

Bone Marrow Transplant

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“…The problem is that a biopsy is an invasive procedure, and the risk between an injury and potential benefits should be considered. For that reasons, such an intervention is limited in questionable cases [23]. The standard staining with haematoxylin and eosin is mostly sufficient for the detection of Aspergillus hyphae [24].…”

Section: Diagnostic Methods To Prove Fungal Infectionmentioning

confidence: 99%

Early diagnosis and treatment of invasive aspergillosis as a main determinant of outcome – review of literature according to the presented case report

Borys¹,

Piwowarczyk²,

Sysiak³

et al. 2017

Ann Agric Environ Med

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Although. Aspergillus spp infection is not the major cause of morbidity in Intensive Care Units (ICUs), mortality among patients treated for it is tremendous. Moreover, invasive aspergillosis (IA) is an independent risk factor of hospital costs and length of stay. The prevalence of this disease is inversely correlated with the immunocompetence of individuals; for instance, the incidence of IA among patients with leukemia is estimated as high as 12.7%. Although there is a significant improvement in the antifungal armamentarium, the appropriate treatment is still being given too late, mostly because of late diagnosis. As well as the diagnosis, the criteria for recognition of IA constitute a challenge. Objective. The aim of this review, based on a case report, is to introduce the problem of poor diagnosis and treatment of IA, especially in the critical care settings. The presented scenario is an example which assists in showing the evidence-based medicine (EBM) approach to the treatment of fungal infections. Furthermore, to demonstrate the appropriate approach to diagnosis and treatment of invasive aspergillosis, the guidelines of The European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) are presented. Conclusions. According to presented literature, Galactomannan assay enables early diagnosis and remains a specific and sensitive tool to diagnose Asppergillosis, both in serum and BAL fluid. The guidelines recommend voriconazole as a first line treatment in IA. Failure to detect and implement proper antifungal treatment may lead to fatal consequences, as in the presented case.

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“…Voriconazole, posaconazole, caspofungin and lipid formulations of Amphotericin B are the common choices for treatment and prophylaxis of IFDs in haematology patients, also being administered empirically to patients with febrile neutropenia persisting 3–7 days after treatment with broad‐spectrum antibacterials. Advances in molecular diagnostic testing and detection of the serum biomarkers β‐glucan and galactomannan have facilitated prompt, targeted treatment and early initiation of pre‐emptive therapy 12 . The selection of antifungal drug depends on the type, site and severity of fungal infection, potential for organ toxicity and possible interaction with other drugs.…”

Section: Epidemiology Of Invasive Fungal Diseases In Haematological Mmentioning

confidence: 99%

“…Advances in molecular diagnostic testing and detection of the serum biomarkers β-glucan and galactomannan have facilitated prompt, targeted treatment and early initiation of pre-emptive therapy. 12 The selection of antifungal drug depends on the type, site and severity of fungal infection, potential for organ toxicity and possible interaction with other drugs. Caspofungin is the drug of choice for treatment of invasive candidiasis, voriconazole for invasive aspergillosis and lipid formulation of amphotericin B for zygomycosis; however, combination therapy using two or more of these agents is increasingly common.…”

Section: Common Fungal Pathogens Treatment and Changing Patterns Of mentioning

confidence: 99%

Adoptive T‐cell therapy for fungal infections in haematology patients

Deo

Gottlieb

2015

Clin & Trans Imm

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The prolonged immune deficiency resulting from haematopoietic stem cell transplant and chemotherapy predisposes to a high risk of invasive fungal infections. Despite the recent advances in molecular diagnostic testing, early initiation of pre-emptive antifungal therapy and the use of combination pharmacotherapy, mortality from invasive mould infections remain high among recipients of allogeneic stem cell transplant. The increasing incidences of previously rare and drug-resistant strains of fungi present a further clinical challenge. Therefore, there is a need for novel strategies to combat fungal infections in the immunocompromised. Adoptive therapy using in vitro-expanded fungus-specific CD4 cells of the Th-1 type has shown clinical efficacy in murine studies and in a small human clinical study. Several techniques for the isolation and expansion of fungus-specific T cells have been successfully applied. Here we discuss the incidence and changing patterns of invasive fungal diseases, clinical evidence supporting the role of T cells in fungal immunity, methods to expand fungus-specific T cells in the laboratory and considerations surrounding the use of T cells for fungal immunotherapy.

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Diagnostic methods for invasive fungal diseases in patients with hematologic malignancies

Cited by 25 publications

References 71 publications

Association of mannose-binding lectin levels and invasive fungal disease in hematologic malignancy patients receiving myelosuppressive chemotherapy or allogeneic hematopoietic stem cell transplantation

Association of mannose-binding lectin levels and invasive fungal disease in hematologic malignancy patients receiving myelosuppressive chemotherapy or allogeneic hematopoietic stem cell transplantation

Early diagnosis and treatment of invasive aspergillosis as a main determinant of outcome – review of literature according to the presented case report

Adoptive T‐cell therapy for fungal infections in haematology patients

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