European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Fungal Infection Study Group (EFISG) and European Confederation of Medical Mycology (ECMM) 2013 joint guidelines on diagnosis and management of rare and emerging fungal diseases

Abstract

This guideline is the second in the line of three for fungal diseases by ESCMID and other societies. The guideline tried to follow the AGREE criteria for the development of clinical guidelines. This guideline serves as a European and potentially world-wide recommendation for the diagnosis and management of rare and emerging fungi. They include mucormycosis, hyalohyphomycosis (Fusarium, Paecilomyces, Scedosporium, etc.), phaeohyphomycosis (Alternaria, Bipolaris, Cladosporium, Rhinocladiella, etc.), and emerging yeasts (Saccharomyces, Trichosporon, Rhodotorula, etc.).

Treatment of invasive candidiasis: between guidelines and daily clinical practice

“…For a timely antifungal treatment, an empirical, fever-driven approach is often used [14]. This strategy, although largely adopted in the setting of patients with hematologic malignancies, did not show consistent efficacy in ICU patients.…”

“…Guidelines for the treatment of invasive candidiasis have been proposed by the Infectious Diseases Society of America (IDSA) in 2009 [8] and by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) [14] in 2012.…”

Successful Treatment of Gastrointestinal Mucormycosis in an Adult with Acute LeukemiA: Case Report and Literature Review

“…Amphotericin B deoxycholate-the only licensed antifungal for primary treatment of mucormycosis-has been used 1,11 , but the formulation is nephrotoxic and has been replaced by the lipid formulations such as liposomal amphotericin B or amphotericin B lipid complex, which are much less so. In fact, the recently published joint clinical guidelines from the European Society for Clinical Microbiology and Infectious Diseases and the European Confederation of Medical Mycology strongly recommend the immediate initiation of treatment with liposomal amphotericin B as the drug of choice at a dose of at least 5 mg/kg daily; the use of amphotericin B deoxycholate is discouraged 15,16 . Salvage treatment might be required because of intolerance to prior antifungal therapy or because of disease refractoriness.…”

“…Salvage treatment might be required because of intolerance to prior antifungal therapy or because of disease refractoriness. The addition of oral posaconazole, a broad-spectrum azole, at a starting dose (for the suspension) of 200 mg four times daily and then 400 mg twice daily, or (for the tablets) of 300 mg twice daily on day 1 and then 300 mg daily as part of combination therapy, is recommended for salvage treatment of mucormycosis 15 . Continuation of antifungal treatment until complete clinical response as demonstrated by imaging and resolution of risk factors is also advised 15 .…”

“…A combined approach of surgical and medical treatment is strongly recommended for patients with mucormycosis in general and with gastrointestinal mucormycosis in particular, because the infection is associated with high risk of perforation and exsanguination 1,15,[17][18][19][20] . Furthermore, the hallmark of mucormycosis is angioinvasion by the fungus, resulting in thrombosis and tissue necrosis that limit the penetration of antifungal agents to the site of infection, making antifungal therapy ineffective in vivo 21 .…”