Invasive fungal infections in acute leukemia

Abstract

Invasive fungal infection (IFI) is among the leading causes for morbidity, mortality, and economic burden for patients with acute leukemia. In the past few decades, the incidence of IFI has increased dramatically. The certainty of diagnosis of IFI is based on host factors, clinical evidence, and microbiological examination. Advancement in molecular diagnostic modalities (e.g. non-culture-based serum biomarkers such as b-glucan or galactomannan assays) and high-resolution radiological imaging has improved our diagnostic approach. The early use of these diagnostic tests assists in the early initiation of preemptive therapy. Nonetheless, the complexity of IFI in patients with leukemia and the limitations of these diagnostic tools still mandate astute clinical acumen. Its management has been further complicated by the increasing frequency of infection by non-Aspergillus molds (e.g. zygomycosis) and the emergence of drug-resistant fungal pathogens. In addition, even though the antifungal armamentarium has expanded rapidly in the past few decades, the associated mortality remains high. The decision to initiate antifungal treatment and the choice of antifungal therapy requires careful consideration of several factors (e.g. risk stratification, local fungal epidemiologic patterns, concomitant comorbidities, drugdrug interactions, prior history of antifungal use, overall cost, and the pharmacologic profile of the antifungal agents). In order to optimize our diagnostic and therapeutic management of IFI in patients with acute leukemia, further basic research and clinical trials are desperately needed.

A meta‐analysis of survival factors in rhino‐orbital‐cerebral mucormycosis—has anything changed in the past 20 years?

“…In total, 210 case reports were identified from the literature search and reviewed, of which 175 contained sufficient clinical data to be analysed. These were derived from a total of 140 papers (some papers contained multiple case reports) . Larger case series were usually excluded due to a lack of chronological data (refer to Figure for PRISMA flow diagram).…”

Current status of antifungal resistance and its impact on clinical practice

“…The choice of antifungal therapy should be based on risk stratification, local fungal epidemiological patterns, drug‐drug interactions, concomitant comorbidities, prior history of antifungal use, and the pharmacological profile of the anti‐fungal armamentarium (Bhatt et al , ). Among the different Candida species, C. albicans azole resistance rates are generally low.…”

Antifungal Susceptibility of Candida Species Isolated from Cancer Patients with Oral Lesions Undergoing Chemotherapy

“…The frequency of Candida species in cancer patients is associated with the type of cancer, immune system, and antibiotic resistance rates (17). The increasing incidence of colonization with Candida species due to decreased susceptibility to first-generation azoles (such as fluconazole) suggests the use of newer antifungal drugs.…”