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Infectious Diseases

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… vancomycin 1 g IV q12h if suspect line infection, known colonization MRSA, Gram-positive blood culture, or hypotension third line —add antifungal if febrile after 4–7 days and hemodynamically unstable ( fluconazole 400 mg IV daily, itraconazole 200 mg IV daily, amphotericin B 0.5–1 mg/kg IV daily over 4 h, caspofungin …

Recombinant Human Granulocyte-Macrophage Colony-Stimulating Factor (rhu GM-CSF) as Adjuvant Therapy for Invasive Fungal Diseases.

BackgroundSargramostim (yeast-derived, glycosylated recombinant human granulocyte-macrophage colony-stimulating factor [rhu GM-CSF]) augments innate and adaptive immune responses and accelerates hematopoietic recovery of chemotherapy-induced neutropenia. However, considerably less is known about its efficacy as adjunctive immunotherapy against invasive fungal diseases (IFDs).MethodsThe clinical courses of 15 patients with pediatric malignancies and IFDs treated adjunctively with sargramostim at a single institution were analyzed in a retrospective cohort review. Further, a systematic review of

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… Clinically doing well and in remission almost 12 y later. 4 yo M | Medulloblastoma | Hematogenous meningoencephalitis ( Candida albicans ) | No | Yes | Sargramostim 100 µg/m 2 /dose TIW x4 mo | Fluconazole, caspofungin, LAmB | Medulloblastoma resection complicated by posterior fossa syndrome, prolonged … Chen 2017 (California) [ 20 ] | 16 yo M | Germinoma of pituitary and pineal gland | Ventriculitis/abscess ( Aspergillus fumigatus ) | No | Yes (prior voriconazole, caspofungin) | Sargramostim 100 µg/m 2 /dose TIW x16 mo (approximate total duration) | Voriconazole, caspofungin, amphotericin B | Due to …

Successful management of chronic disseminated candidiasis in hematologic patients treated with high-dose liposomal amphotericin B: a retrospective study of the SEIFEM registry.

PURPOSE: Chronic disseminated candidiasis (CDC) is a complication of Candida infection in immunocompromised patients, involving the liver and spleen, and rarely other organs. The aim of the study is to identify the best antifungal drug for hematologic immunocompromised patients with CDC. METHODS: In this multicentric retrospective study, the charts of 20 patients with CDC following cytotoxic agent protocols for hematological malignancies, diagnosed from 2003 to 2013, were analyzed. The response to systemic antifungal therapy within 90 days from CDC diagnosis and the possible delay in chemothe

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… Finally, 5/20 (25 %) patients were treated with echinocandins (caspofungin 50 mg/day in 4/5; anidulafungin 100 mg/day in 1/5). … Another retrospective series, published by Ellis et al. in 2006, compared the efficacy and safety of caspofungin and L-AmB in treating hepatosplenic candidosis. …

Evaluation and Management of Bacterial and Fungal Infections Occurring in Patients with a Hematological Malignancy: A 2011 Update

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… relapse of their invasive fungal infection when caspofungin was administered long-term posttransplant [ 101 ]. … Despite these issues many experts frequently will prescribe initial treatment with voriconazole plus caspofungin, or liposomal amphotericin B and caspofungin [ 240 ]. …

Pulmonary aspergillosis: diagnosis and treatment.

Aspergillus species are the most frequent cause of fungal infections of the lungs with a broad spectrum of clinical presentations including invasive pulmonary aspergillosis (IPA) and chronic pulmonary aspergillosis (CPA). IPA affects immunocompromised populations, which are increasing in number and diversity with the advent of novel anti-cancer therapies. Moreover, IPA has emerged as a complication of severe influenza and coronavirus disease 2019 in apparently immunocompetent hosts. CPA mainly affects patients with pre-existing lung lesions and is recognised increasingly frequently among patie

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… In vitro and in animal models, caspofungin displays a paradoxical effect ( i.e. decreased efficacy at increased concentrations), of uncertain clinical relevance [ 82 ]. … Clinical evidence for caspofungin monotherapy in the first-line and salvage therapy of invasive Aspergillus infections. Mycoses 2016; 59: 480–493. doi: 10.1111/myc.12477 86. Kirkpatrick WR, Perea S, Coco BJ, et al. …

Infectious Diseases

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… q8h second line —add vancomycin 1 g IV q12 h if suspect line infection, known colonization MRSA, Gram-positive blood culture, or hypotension third line —add antifungal if febrile after 5 days ( fluconazole 400 mg IV daily, itraconazole 200 mg IV daily, amphotericin B 0.5–1 mg/kg IV daily over 4 h, caspofungin …

Management of Pneumocystis Jirovecii pneumonia in HIV infected patients: current options, challenges and future directions.

The discovery of the Human Immunodeficiency Virus (HIV) was led by the merge of clustered cases of Pneumocystis jirovecii Pneumonia (PCP) in otherwise healthy people in the early 80's.1,2 In the face of sophisticated treatment now available for HIV infection, life expectancy approaches normal limits. It has dramatically changed the natural course of HIV from a nearly fatal infection to a chronic disease.3-5 However, PCP still remains a relatively common presentation of uncontrolled HIV. Despite the knowledge and advances gained in the prevention and management of PCP infection, it continues to

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… Steroids likely blunt the inflammatory response (that includes the production of cytokines and other inflammatory markers and cells) to dying organisms that results in lung tissue damage during the early course of therapy. 57 Future directions and challenges Caspofungin Caspofungin is an echinocandin … Chin Med J 2009 122 996 999 19493430 61 Utili R Durante-Mangoni E Basilico C Efficacy of caspofungin addition to trimethoprim-sulfamethoxazole treatment for severe Pneumocystis pneumonia in solid organ transplant recipients Transplantation 2007 84 685 688 17893600 10.1097/01.tp.0000280546.91617.6c …

Critically Ill Immunosuppressed Host

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… Esophagitis Add fluconazole or caspofungin; consider adding acyclovir. Pneumonitis, diffuse or interstitial Add trimethoprim-sulfamethoxazole and azithromycin or levofloxacin or moxifloxacin (plus broad-spectrum antibiotics if the patient is granulocytopenic). … Esophagitis | Add fluconazole or caspofungin; consider adding acyclovir. Pneumonitis, diffuse or interstitial | Add trimethoprim-sulfamethoxazole and azithromycin or levofloxacin or moxifloxacin (plus broad-spectrum antibiotics if the patient is granulocytopenic). …

Mutations in immunodeficiency-related genes may increase the risk of infection after CAR-T-cell therapy: a report of two cases.

BackgroundChimeric antigen receptor T-cell therapy (CAR-T) has yielded unprecedented efficacy in B-cell malignancies. With the increasing use of CAR-T-cell therapy, infection has become one of the major concerns after CAR-T-cell infusion. Some patients even develop refractory or recurrent infections, posing challenges in treatment, prophylactic, and monitoring strategies. However, the mechanisms underlying the development of these infections were not clear.Case presentationWe report two cases of infection after CAR-T-cell therapy. Patient 1, diagnosed with multiple myeloma, received anti-B-cel

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… On Day 29, a positive urine culture result indicated Candida albicans infection, so antifungal agents were changed from voriconazole to caspofungin the following day. Although urine culture turned negative after caspofungin treatment, the patient’s symptoms were not relieved. … Therefore, amphotericin B liposomes were administered and overlapped with caspofungin for 2 days. The symptom of dysuria then gradually resolved; however, the patient developed refractory hypokalaemia even when the dosage of amphotericin B liposomes was reduced. …

9th Trends in Medical Mycology Held on 11-14 October 2019, Nice, France, Organized under the Auspices of EORTC-IDG and ECMM.

Dear Friends and Colleagues,It is a great honor and pleasure for us to invite you cordially to participate in the 9th Congress on Trends in Medical Mycology (TIMM-9) [...].

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… Two (2) patients received combined antifungal treatment with l -AmB and caspofungin, one (1) l -AmB and voriconazole, one (1) l -AmB and posaconazole and one (1) l -AmB, voriconazole and caspofungin. Three (3) patients received maintenance treatment with posaconazole. … We must also take into account the possibility, supported in recent years by multiple studies in real life, to approach the most aggressive and disseminated forms of mucormycosis with the combination of multiple drugs. l -Amb combined with caspofungin would appear to be preferable due to the lack of …

Amphotericin B Colloidal Dispersion Is Effective and Safe for the Treatment of Invasive Aspergillosis in Chinese Patients with Hematologic Disease: A Multicenter, Prospective, Observational, Real-World Study.

PURPOSE: Invasive aspergillosis (IA) causes significant morbidity and mortality in hematologic patients. This study aimed to evaluate the efficacy and safety profile of amphotericin B colloidal dispersion (ABCD) for IA in this high-risk population. PATIENTS AND METHODS: This multicenter, prospective, observational study enrolled hematologic patients with IA. Eligible patients received ABCD for up to 28 days or until investigator-assessed clinical response or intolerance. The primary outcome was clinical response rate, and the secondary outcome was 28-day all-cause mortality following the last

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… Of the 78.46% of patients who received prior antifungal prophylaxis or treatment, voriconazole was the most commonly used agent (44.62%, 29/65), followed by posaconazole (24.62%, 16/65) and caspofungin (18.46%, 12/65). … receiving GM testing 43 (66.15) Serum GM positive/tested 4/36 (11.11) Plasma GM positive/tested 3/6 (50.00) BALF GM positive/tested 0/1 (0.00) ECOG score, n (%) 0–2 61 (93.85) 3–4 4 (6.15) Previous antifungal prevention or treatment, n (%) 51 (78.46) Voriconazole 29 (44.62) Posaconazole 16 (24.62) Caspofungin …

Impact of Hyperglycemia and Diabetes Mellitus on Breakthrough Mucormycosis Outcomes in Patients with Hematologic Malignancies-Complex and Intriguing Associations.

Mucormycosis (MCR) is frequently associated with diabetic ketoacidosis and hyperglycemia, as well as hematologic malignancies (HMs) and hematopoietic stem cell transplantation (HSCT). However, little is known about the effect of hyperglycemia on MCR outcomes in patients with HMs. We therefore conducted a retrospective cohort study of adult patients hospitalized with MCR and HM or HSCT (n = 103) at MD Anderson Cancer Center from April 2000 through to April 2020. Twenty-three patients (22%) had documented episodes of severe hyperglycemia. Sixty patients had >5 serum glucose measurements within 2

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… Abbreviations: ALC = absolute lymphocyte count, ANC = absolute neutrophil count, APACHE II = Acute Physiologic Assessment and Chronic Health Evaluation II, CAS = caspofungin, DM = diabetes mellitus, GvHD = graft-versus-host disease, HSCT = hematopoietic stem cell transplant, ICU = intensive care unit … Combination polyene-caspofungin treatment of rhino-orbital-cerebral mucormycosis. Clin. Infect. Dis. 2008;47:364–371. doi: 10.1086/589857. 29. Mendoza-Ayala R., Tapia R., Salathe M. Spontaneously resolving pulmonary mucormycosis. Clin. Infect. Dis. 1999;29:1335–1336. doi: 10.1086/313472. 30. …

Infections in Hospitalized Cancer Patients.

Cancer patients are at an increased risk of developing infections that are primarily treatment-driven but may also be malignancy-driven. While cancer treatments such as chemotherapy, radiotherapy, and surgery have been known to improve malignancy morbidity and mortality, they also have the potential to weaken immune defenses and induce periods of severe cytopenia. These adverse effects pave the way for opportunistic infections to complicate a hospitalized cancer patient's clinical course. Understanding the risk each patient inherently has for developing a bacterial, fungal, or viral infection

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… In addition to azoles, antifungal treatment against Aspergillus infections includes caspofungin and other echinocandins [ 65 ]. However, it is important to note there have been reports of caspofungin failing to prevent aspergillosis [ 66 ]. … Open-label, randomized comparison of itraconazole versus caspofungin for prophylaxis in patients with hematologic malignancies. Antimicrob Agents Chemother. 2006;50(1):143–147. doi: 10.1128/AAC.50.1.143-147.2006. 66. …

Infectious Complications of Cancer Therapy

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… Global distribution and outcomes for Candida species causing invasive candidiasis: results from an international randomized double-blind study of caspofungin versus amphotericin B for the treatment of invasive candidiasis. … Differential activity of triazoles in two-drug combinations with the echinocandin caspofungin against Aspergillus fumigatus. J Antimicrob Chemother. 2003;51:1423–1425. doi: 10.1093/jac/dkg242. 193. Dannaoui E., Lortholary O., Dromer F. …

10th Trends in Medical Mycology Held on 8 to 11 October 2021, Aberdeen, Scotland, Organized by the European Confederation of Medical Mycology (ECMM).

Plenary Sessions: [...].

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… Antifungal susceptibility profiles according to the EUCAST E.Def 9.3.2 method were determined for amphotericin B (AMB), itraconazole, voriconazole, posaconazole, isavuconazole, terbinafine, anidulafungin, caspofungin and micafungin. … From 2015, the in vitro susceptibility to nine antifungal agents, including fluconazole, voriconazole, itraconazole, posaconazole, caspofungin, micafungin, anidulafungin, amphotericin B and 5-flucytosine, was determined using Sensititre YeastOneTM YO10 methodology (Thermo Scientific, Cleveland, OH, USA …

Antifungal agents for preventing fungal infections in non-neutropenic critically ill patients.

BACKGROUND: Invasive fungal infections are important causes of morbidity and mortality among critically ill patients. Early institution of a … ared ketoconazole versus placebo. One trial compared anidulafungin with placebo. One trial compared caspofungin to placebo. Two trials compared micafungin to placebo. One trial compared amphotericin B to placebo. Two trials compared nystatin to placebo and one trial compared the effect of clotrimazole, ketoconazole, nystatin and no treatment. We found two new …

Epidemiological profile and clinical outcomes of patients with mucormycosis: the multicenter retromucor study from Türkiye (2004-2024).

PURPOSE: Mucormycosis is a rapidly progressive angioinvasive fungal infection with limited large-scale outcome data. We aimed to describe the epidemiology, clinical spectrum, treatment strategies, and predictors of outcomes in adult patients with proven mucormycosis in Türkiye. METHODS: We conducted a nationwide, retrospective study of 280 adults diagnosed with proven mucormycosis between 2004 and 2024 across 27 tertiary centers. Case definitions were applied according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortiu

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… Combination regimens pairing polyenes with azoles or echinocandins such as caspofungin have demonstrated limited benefit in refractory cases [ 11 ]. … Reed C, Bryant R, Ibrahim AS, Edwards JE Jr, Filler SG, Goldberg R, Spellberg B (2008) Combination polyene-caspofungin treatment of rhino‐orbital‐cerebral mucormycosis. Clin Infect Dis 47(3):364–371. 10.1086/589857 12. …

Fungal, Viral, and Other Oddball Infections and the Immunosuppressed Patient

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… Echinocandins include caspofungin and micafungin, and these fungicidals inhibit the synthesis of beta-1,3-D-glucan, which results in fungal cell wall disruption. Polyenes include amphotericin B, which inhibits ergosterol, an essential component of fungal cell wall. … Candida in Blood All patients with candidemia or invasive candidiasis should be treated with a loading dose of either fluconazole (triazoles) or caspofungin (echinocandins). …

Improved outcome for AML patients over the years 2000-2014.

Few recent studies from registries have reported an improvement in overall survival of younger patients with acute myeloid leukemia (AML). However, reasons for this improvement are not defined. We analyzed the therapeutic course and outcome of 976 patients treated by intensive chemotherapy between 2000 and 2014. The number of patients receiving allogeneic stem cell transplantation in first or second response significantly increased over time whereas autologous transplantation was progressively abandoned. In the 513 younger patients, there were no differences in first complete response, inducti

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… With regards to prophylaxis of invasive fungal infections during induction chemotherapy, fluconazole was used in the earlier period followed by voriconazole or caspofungin in 2003 and then, posaconazole in 2008 22 , 23 . … Chabrol A Prophylaxis of invasive aspergillosis with voriconazole or caspofungin during building work in patients with acute leukemia Haematologica 2010 95 996 1003 10.3324/haematol.2009.012633 20007135 PMC2878800 23. …

Seasonal clustering of sinopulmonary mucormycosis in patients with hematologic malignancies at a large comprehensive cancer center.

BackgroundInvasive Mucorales infections (IMI) lead to significant morbidity and mortality in immunocompromised hosts. The role of season and climatic conditions in case clustering of IMI remain poorly understood.MethodsFollowing detection of a cluster of sinopulmonary IMIs in patients with hematologic malignancies, we reviewed center-based medical records of all patients with IMIs and other invasive fungal infections (IFIs) between January of 2012 and August of 2015 to assess for case clustering in relation to seasonality.ResultsA cluster of 7 patients were identified with sinopulmonary IMIs (

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… Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group, Dx Diagnosis, Resp. failure – respiratory failure, AML Acute Myeloid Leukemia, CP Chest pain, GGO Ground glass opacity, CT Chest tomography, BAL Bronchoalveolar lavage, Vori Voriconazole, Caspo Caspofungin … Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group, Dx Diagnosis, Resp. failure – respiratory failure, AML Acute Myeloid Leukemia, CP Chest pain, GGO Ground glass opacity, CT Chest tomography, BAL Bronchoalveolar lavage, Vori Voriconazole, Caspo Caspofungin …