Practice Guidelines for the Treatment of Coccidioidomycosis

Galgiani, John N.; Ampel, Neil M.; Catanzaro, Antonino; Johnson, Royce H.; Stevens, David A.; Williams, Pamela R. D.

doi:10.1086/313747

Cited by 248 publications

(157 citation statements)

References 25 publications

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“…Although the overall mortality of this group of patients was much higher than that of patients without coccidioidomycosis, it did not reach statistical significance. The treatment of patients with coccidioidal infection followed the published guidelines for treatment of coccidioidomycosis (20), which proved to be satisfactory. One patient, improving from a severe coccidioidal illness, died suddenly.…”

Section: Discussionmentioning

confidence: 94%

Coccidioidomycosis After Renal Transplantation in an Endemic Area

Braddy¹,

Heilman

Blair

2006

American Journal of Transplantation

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Coccidioidomycosis is an endemic fungal infection of the desert southwestern United States of particular concern for immunosuppressed renal transplant recipients. The clinical course of coccidioidomycosis can be severe in immunosuppressed patients, with high rates of dissemination and mortality, and antifungal prophylaxis is routinely administered to high-risk patients. We sought to determine the impact of coccidioidomycosis on patients who received their renal transplant at our hospital in Phoenix, Arizona. A retrospective records review of the first 205 patients who received a renal transplant between June 1999 and December 2003 identified 6 patients (3%) who had contracted coccidioidomycosis after transplantation. All six cases occurred more than 6 months after transplantation. Two of these six patients had disseminated coccidioidomycosis. Two patients, one with pulmonary infection and one with disseminated infection, died. None of the six patients with coccidioidomycosis after transplantation had identified risk factors before transplantation. No high-risk patient who received targeted antifungal prophylaxis had a reactivation of coccidioidomycosis after transplantation. Treatment for acute rejection and induction with antithymocyte globulin did not appear to increase the risk of subsequent coccidioidomycosis.

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Section: Discussionmentioning

confidence: 94%

Coccidioidomycosis After Renal Transplantation in an Endemic Area

Braddy¹,

Heilman

Blair

2006

American Journal of Transplantation

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“…The only other organism for which the guidelines mention combination therapy is coccidiodomycoses (71). AmB is often selected for treatment of patients with respiratory failure due to Coccidioides immitis or rapidly progressive coccidioidal infections.…”

Section: Dual Combinations In the Practice Guidelines For Aspergillosmentioning

confidence: 99%

Combination Treatment of Invasive Fungal Infections

et al. 2005

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The persistence of high morbidity and mortality from systemic fungal infections despite the availability of novel antifungals points to the need for effective treatment strategies. Treatment of invasive fungal infections is often hampered by drug toxicity, tolerability, and specificity issues, and added complications often arise due to the lack of diagnostic tests and to treatment complexities. Combination therapy has been suggested as a possible approach to improve treatment outcome. In this article, we undertake a historical review of studies of combination therapy and also focus on recent studies involving newly approved antifungal agents. The limitations surrounding antifungal combinations include nonuniform interpretation criteria, inability to predict the likelihood of clinical success, strain variability, and variations in pharmacodynamic/pharmacokinetic properties of antifungals used in combination. The issue of antagonism between polyenes and azoles is beginning to be addressed, but data regarding other drug combinations are not adequate for us to draw definite conclusions. However, recent data have identified potentially useful combinations. Standardization of assay methods and adoption of common interpretive criteria are essential to avoid discrepancies between different in vitro studies. Larger clinical trials are needed to assess whether combination therapy improves survival and treatment outcome in the most seriously debilitated patients afflicted with life-threatening fungal infections

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“…In most affected persons, however, illness is self-limited, spherule proliferation is arrested, and markers of cellular immunity against antigens of Coccidioides spp. become evident (4,9,18). Recovery from an initial infection nearly always produces long-lived and complete immunity to illness from a second infection, a fact which has motivated extensive efforts to discover specific coccidioidal antigens which may induce protection when administered as vaccines (1,10,13,30,34).…”

mentioning

confidence: 99%

Protein Expression Profiling of Coccidioides posadasii by Two-Dimensional Differential In-Gel Electrophoresis and Evaluation of a Newly Recognized Peroxisomal Matrix Protein as a Recombinant Vaccine Candidate

et al. 2006

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Coccidioides posadasii and Coccidioides immitis are dimorphic, soil-dwelling pathogenic ascomycetes endemic to the southwestern United States. Infection can result from inhalation of a very few arthroconidia, but following natural infection, long-lived immunity is the norm. Previous work in the field has shown that spherule-derived vaccines afford more protection than those from mycelia. We have used two-dimensional differential in-gel electrophoresis coupled with nano-high-performance liquid chromatography-tandem mass spectrometry to directly assess both absolute abundance and differential expression of proteins in the spherule and the mycelial phases of C. posadasii with the intent to identify potential vaccine candidates. Peptides derived from 40 protein spots were analyzed and a probable identity was assigned to each. One spherule-abundant protein, identified as Pmp1, showed homology to allergens from Aspergillus fumigatus and other fungi, all of which exhibit similarity to yeast thiol peroxidases. Recombinant Pmp1 was reactive with serum from individuals with both acute and protracted disease, and evoked protection in two murine models of infection with C. posadasii. These results demonstrate the utility of proteomic analysis as a point of discovery for protective antigens for possible inclusion in a vaccine candidate to prevent coccidioidomycosis.

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Practice Guidelines for the Treatment of Coccidioidomycosis

Cited by 248 publications

References 25 publications

Coccidioidomycosis After Renal Transplantation in an Endemic Area

Coccidioidomycosis After Renal Transplantation in an Endemic Area

Combination Treatment of Invasive Fungal Infections

Protein Expression Profiling of Coccidioides posadasii by Two-Dimensional Differential In-Gel Electrophoresis and Evaluation of a Newly Recognized Peroxisomal Matrix Protein as a Recombinant Vaccine Candidate

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