Therapy of Mucormycosis

Sipsas, Nikolaos V.; Gamaletsou, Maria N.; Anastasopoulou, Amalia; Kontoyiannis, Dimitrios P.

doi:10.3390/jof4030090

Cited by 170 publications

(189 citation statements)

References 120 publications

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“…Posaconazol e isavuconazol también son agentes activos de primera línea, mientras que combinaciones de anfotericina B liposomal con caspofungina o posaconazol son opciones para el tratamiento de rescate [17] . Asimismo, Roden et al demostraron en su análisis multivariado que la asociación de terapia antifúngica con cirugía aumentó significativamente las tasas de supervivencia (69%), mientras que el 97% de pacientes sin tratamiento fallecieron [11] , esto es respaldado por reportes como el de Sipsas et al [18] .…”

Section: Discussionunclassified

Mucormicosis diseminada en un paciente diabético: un reporte de caso

et al. 2019

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a Médico residente de Enfermedades Infecciosas y Tropicales; b Médico infectólogo; c Médico anátomo-patólogo; d Médico internista; e Médico-cirujano.Mucormicosis diseminada en un paciente diabético: un reporte de caso Disseminated mucormycosis in a diabetic patient: a case report RESUMEN La mucormicosis es una infección fúngica altamente mortal que se presenta en pacientes con algún grado de inmunosupresión, siendo la forma rinocerebral la más común. Es el primer reporte en el Perú de mucormicosis diseminada con compromiso multisistémico en un paciente con cetoacidosis diabética. Se presenta el caso de un varón de 47 años diabético procedente de la selva peruana con cuadro de insuficiencia respiratoria en ventilación mecánica. A su ingreso presenta leucocitosis, acidosis metabólica anion gap elevado, hiperglicemia e hipoalbuminemia. Posteriormente, es intervenido quirúrgicamente en tres oportunidades por presentar abdomen agudo con hallazgos en la patología de necrosis y perforación de varios órganos, falleciendo a los pocos días. Paciente se encontraba recibiendo su quinta dosis de anfotericina B deoxicolato. Se observaron hifas con angulación recta compatible con mucormicosis en estómago, intestino y pulmón. ABSTRACTMucormycosis is a highly lethal fungal infection occurring in patients with some degree of immunosuppression. The rhinocerebral form is the most frequent presentation. This is the first report in Peru of a case of disseminated mucormycosis in a patient with diabetic ketoacidosis. This is a 47-year-old diabetic male subject who was referred from the Amazon jungle and presented with respiratory insufficiency receiving mechanical ventilation. On admission, the patient had leukocytosis, metabolic acidosis with high anion gap, hyperglycemia, and hypoalbuminemia. Soon afterwards, the patient underwent surgery because of acute abdomen, and the anatomopathological examination revealed necrosis and hollow viscus perforation, and he ultimately died. At this time, he was receiving amphotericin B deoxycholate. Straight angle hyphae compatible with mucormycosis were found in stomach, intestine, and lungs.

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Section: Discussionunclassified

Mucormicosis diseminada en un paciente diabético: un reporte de caso

et al. 2019

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“…In addition to antifungal therapy, management requires aggressive surgical debridement of devitalized tissue due to the propensity of these molds to invade blood vessels and cause necrosis. Patient outcomes may be improved when these strategies are combined with early diagnosis and reversal of underlying risk factors when feasible [67]. Amphotericin B, posaconazole and isavuconazole have activity against the Mucorales molds; however current guidelines recommend a lipid formulation of amphotericin B as first-line therapy of mucormycosis [42,67].…”

Section: Invasive Moldsmentioning

confidence: 99%

“…The echinocandins do not have reliable in vitro activity against the Mucorales molds and should not be used as monotherapy; however, in one small, retrospective study, the addition of caspofungin to lipid formulation amphotericin B was superior to monotherapy [70]. Other retrospective reports have shown that combination therapy for mucormycosis offers no survival advantage compared to monotherapy, and at this time, is not recommended routinely [67].…”

Section: Invasive Moldsmentioning

confidence: 99%

Make Sure You Have a Safety Net: Updates in the Prevention and Management of Infectious Complications in Stem Cell Transplant Recipients

Santos

Rhee

Czapka

et al. 2020

JCM

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Hematopoietic stem cell transplant recipients are at increased risk of infection and immune dysregulation due to reception of cytotoxic chemotherapy; development of graft versus host disease, which necessitates treatment with immunosuppressive medications; and placement of invasive catheters. The prevention and management of infections in these vulnerable hosts is of utmost importance and a key "safety net" in stem cell transplantation. In this review, we provide updates on the prevention and management of CMV infection; invasive fungal infections; bacterial infections; Clostridium difficile infection; and EBV, HHV-6, adenovirus and BK infections. We discuss novel drugs, such as letermovir, isavuconazole, meropenem-vaborbactam and bezlotoxumab; weigh the pros and cons of using fluoroquinolone prophylaxis during neutropenia after stem cell transplantation; and provide updates on important viral infections after hematopoietic stem cell transplant (HSCT). Optimizing the prevention and management of infectious diseases by using the best available evidence will contribute to better outcomes for stem cell transplant recipients, and provide the best possible "safety net" for these immunocompromised hosts.

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“…Voriconazole is considered as the first-line therapy for the treatment of invasive aspergillosis [24,[63][64][65] and liposomal amphotericin B for mucormycosis in the Global guideline for the diagnosis and management of mucormycosis [66] presently under public consultation. Voriconazole is still considered as the first-line treatment for Scedosporium [67].…”

Section: Treatmentmentioning

confidence: 99%

Invasive mould infections in solid organ transplant patients: modifiers and indicators of disease and treatment response

et al. 2019

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Purpose Invasive mould infections, in particular invasive aspergillosis (IA), are comparatively frequent complications of immunosuppression in patients undergoing solid organ transplantation (SOT). Guidelines provide recommendations as to the procedures to be carried out to diagnose and treat IA, but only limited advice for SOT recipients. Methods Literature review and expert consensus summarising the existing evidence related to prophylaxis, diagnosis, treatment and assessment of response to IA and infections by Mucorales in SOT patients Results Response to therapy should be assessed early and at regular intervals. No indications of improvement should lead to a prompt change of the antifungal treatment, to account for possible infections by Mucorales or other moulds such as Scedosporium. Imaging techniques, especially CT scan and possibly angiography carried out at regular intervals during early and long-term follow-up and coupled with a careful clinical diagnostic workout, should be evaluated as diagnostic tools and outcome predictors, and standardised to improve therapy monitoring. The role of biomarkers such as the galactomannan test and PCR, as well as selected inflammation parameters, has not yet been definitively assessed in the SOT population and needs to be studied further. The therapeutic workup should consider a reduction of immunosuppressive therapy. Conclusions The role of immunosuppression and immune tolerance mechanisms in the response to invasive fungal infection treatment is an important factor in the SOT population and should not be underestimated. The choice of the antifungal should consider not only their toxicity but also their effects on the immune system, two features that are intertwined.

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Therapy of Mucormycosis

Cited by 170 publications

References 120 publications

Mucormicosis diseminada en un paciente diabético: un reporte de caso

Mucormicosis diseminada en un paciente diabético: un reporte de caso

Make Sure You Have a Safety Net: Updates in the Prevention and Management of Infectious Complications in Stem Cell Transplant Recipients

Invasive mould infections in solid organ transplant patients: modifiers and indicators of disease and treatment response

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