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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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… Currently licensed echinocandins are caspofungin, anidulafungin and micafungin, which are available only as intravenous formulations. Rezafungin is a novel molecule of this class with prolonged half-life that can be administered once weekly [ 83 ]. … Clinical efficacy and safety of micafungin in Japanese patients with chronic pulmonary aspergillosis: a prospective observational study. Med Mycol 2011; 49: 688–693. doi: 10.3109/13693786.2011.561369 96. Kravitz JN, Berry MW, Schabel SI, et al. …

Infectious Diseases

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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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… Chest pain, GGO Ground glass opacity, CT Chest tomography, BAL Bronchoalveolar lavage, Vori Voriconazole, Caspo Caspofungin, LAMB Liposomal amphotericin, MM Multiple Myeloma, HCT Hematopoietic cell transplantation, + positive, PCR Polymerase chain reaction, DLBCL Diffuse large B cell lymphoma, Mica Micafungin … Chest pain, GGO Ground glass opacity, CT Chest tomography, BAL Bronchoalveolar lavage, Vori Voriconazole, Caspo Caspofungin, LAMB Liposomal amphotericin, MM Multiple Myeloma, HCT Hematopoietic cell transplantation, + positive, PCR Polymerase chain reaction, DLBCL Diffuse large B cell lymphoma, Mica Micafungin …

Antibiotic lock therapy for the treatment of peripherally inserted central venous catheter-related bloodstream infection in patients with hematological malignancies: a single center retrospective study.

Catheter-related bloodstream infections represent one of the most prevalent complications in patients with peripherally inserted central venous catheters (PICCs). The application of antibiotic lock therapy (ALT), particularly in patients with hematological malignancies, has not been well documented. We aim to share our experience on ALT for these patients and to evaluate its effectiveness and safety. All cases of patients with hematological malignancies who had PICC from January 2018 to October 2024 were retrospectively reviewed. Microbiologic data of PICC-related bloodstream infections (PRBSI

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… Antibiotic locks were prepared as follows [ 13 , 17 , 18 ]: vancomycin 10 mg/mL, amikacin 10 mg/mL, piperacillin/tazobactam 56.25 mg/mL, cefuroxime 150 mg/mL, cefoperazone/sulbactam 100 mg/mL, meropenem 50 mg/mL, biapenem 30 mg/mL, micafungin 5 mg/mL (Table 1 ). … The antimicrobials used as lock solutions included cefoperazone/sulbactam ( n = 7), piperacillin/tazobactam ( n = 7), vancomycin ( n = 6), biapenem ( n = 6), meropenem ( n = 3), cefuroxime ( n = 2), micafungin ( n = 2), and amikacin ( n = 1). …

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

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… However, most physicians begin to consider the use of empiric antifungal therapy (voriconazole, micafungin, or AmBisome) if a patient’s fever persists beyond 4–6 days of appropriate antibacterial antibiotics [ 11 , 13 ]. … The IDSA now recommend that an echinocandidin (e.g., caspofungin, anidulafungin, or micafungin) or lipid formulation of amphotericin B be utilized as a first-line therapy for most invasive candida infections [ 207 ]. …

Acute Liver Failure due to Disseminated Varicella Zoster Infection.

Acute liver failure (ALF) can be due to numerous causes and result in fatality or necessitate liver transplantation if left untreated. Possible etiologies of ALF include ischemia, venous obstruction, medications, toxins, autoimmune hepatitis, metabolic and infectious causes including hepatitis A-E, varicella-zoster virus (VZV), cytomegalovirus (CMV), herpes simplex virus (HSV), Epstein-Barr virus (EBV), and adenovirus with VZV being the most rarely reported. Pathognomonic skin lesions facilitate diagnosis of VZV hepatitis, but definitive diagnosis is secured with liver biopsy, tissue histopath

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… The patient was initiated on intravenous (IV) acyclovir, micafungin, vancomycin, aztreonam, and stress dose steroids for presumed disseminated herpes simplex with possible secondary bacterial infection and sepsis. …

Changes in C-Reactive Protein Forecast Infection Risk Following Treatment with Chimeric Antigen Receptor T Cells.

BACKGROUND: Immunosuppressive conditioning regimens for chimeric antigen receptor-modified T cell immunotherapy (CARTx) and subsequent T cell dysfunction increase risk for infection. However, it is difficult to discern infection from CRS in the early (up to Day 30) and late (Days 31-180) periods after CARTx due to overlapping signs and symptoms. METHODS: We analyzed infectious complications and predictors of infection during the early and late periods after CARTx in 213 adult patients with malignancies over a 5-year period. RESULTS: Overall, 75 patients (35%) had at least one infection, most

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… Prophylaxis | | | | Fungal | 127 (60) | 36 (48) | 91 (66) | 0.01 None | 73 (34) | 20 (27) | 53 (38) | 0.09 Fluconazole | 112 (53) | 42 (56) | 70 (51) | 0.48 Voriconazole | 5 (2.4) | 5 (6.7) | 0 (0) | 0.01 Posaconazole | 43 (20) | 21 (28) | 22 (16) | 0.05 Isavuconazole | 9 (4.2) | 3 (4.0) | 6 (4.4) | 1.0 Micafungin … Use of antifungal prophylaxis with micafungin, voriconazole or posaconazole antifungal prophylaxis significantly differed between the groups with and without infection. …

Machine learning-based prognostic model for bloodstream infections in hematological malignancies using Th1/Th2 cytokines.

OBJECTIVE: Bloodstream infection (BSI) is a significant cause of mortality in patients with hematologic malignancies(HMs), particularly amid rising antibiotic resistance. This study aimed to analyze pathogen distribution, drug-resistance patterns and develop a novel predictive model for 30-day mortality in HM patients with BSIs. METHODS: A retrospective analysis of 231 HM patients with positive blood cultures was conducted. Logistic regression identified risk factors for 30-day mortality. Th1/Th2 cytokines were collected at BSI onset, with LASSO regression and restricted cubic spline analysis

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… Meanwhile, no fungus resistant to amphotericin B, caspofungin and micafungin was found in this study. … Resistance to voriconazole in fungal infections exceeded 50%, suggesting that alternatives such as amphotericin B, caspofungin, or micafungin should be considered for antifungal treatment. …

Атипичные презентации Acolovir-Resistant Herpes Simplex Virus в иммунокомпромиссированных пациентах: Серия дел.

Инфекции, связанные с вирусом герпеса (HSV), у иммунокомпромиссированных пациентов могут иметь атипичные представления - от грануломатных до линейных эрозийных повреждений - и превращаться в рефракторную и стандартную терапию. Мы сообщаем three :: случаи некротизации категорической инфекции HSV у иммунокомпромиссированных пациентов с гематологическими малигнациями или предшествующими химиотерапиями, все из которых имеют нетипичные и рефракторные проявления заболевания. One дело касалось 53-year-old :: пациентка с реанимацией/рефрактом острой миэлоидной лейкемией (АМЛ), разработавшая некротизир

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… consulted; central line removed | Zosyn maintained 26 | HSV PCR positive; valacyclovir resumed | Valacyclovir resumed 29 | EBV PCR 14,500 copies/mL | Supportive care, monitoring 33 | Blood cultures: Candida glabrata | Meropenem + antifungal coverage 34 | Escalation to IV acyclovir, then foscarnet; micafungin … started | Acyclovir → foscarnet; micafungin 35 | Goals-of-care discussion; transition to comfort care | Comfort care measures 37 | Discharged to hospice | Hospice Case 2 A 72-year-old woman with a history of chronic diarrhea and anal squamous cell carcinoma, previously treated with 5-fluorouracil, …

Epidemiology and Factors Associated with Treatment Success of Invasive Fungal Infections Among Newly Hematologic Malignancy Patients Receiving Chemotherapy or Hematopoietic Stem Cell Transplant in Thailand.

PurposeInvasive fungal infection (IFI) causes disability/death in patients with hematologic malignancy (HM) receiving chemotherapy or hematopoietic stem cell transplant (HSCT). There is limited epidemiological data, treatment outcomes, and factors associated with IFI treatment success in Thailand. This study aimed to identify factors associated with IFI treatment success among new HM patients receiving chemotherapy or HSCT, determine IFI incidence among HM patients receiving chemotherapy or HSCT, and the IFI incidence of a breakthrough in patients receiving primary antifungal prophylaxis, and

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… Table 4 The Data of Antifungal Susceptibility Testing (N = 12) Fungal Species (N) Test Minimum Inhibitory Concentration (mg/L) Amphotericin B Fluconazole Itraconazole Voriconazole Posaconazole Caspofungin Micafungin Anidulafungin 5-FU C. tropicalis (7) A 1 (S) A 0.38 (S) A 24 (R) 1.5 (R) 0.25 (S) A 0.25 … Fungal Species (N) | Test | Minimum Inhibitory Concentration (mg/L) Amphotericin B | Fluconazole | Itraconazole | Voriconazole | Posaconazole | Caspofungin | Micafungin | Anidulafungin | 5-FU C. tropicalis (7) | A | | 1 (S) | | | | | | | A | | 0.38 (S) | | | | | | | A | | 24 (R) | | …

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 … 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 ongoing studies and four new studies await …

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 …

Infectious diseases in allogeneic haematopoietic stem cell transplantation: prevention and prophylaxis strategy guidelines 2016.

Infectious complications after allogeneic haematopoietic stem cell transplantation (allo-HCT) remain a clinical challenge. This is a guideline provided by the AGIHO (Infectious Diseases Working Group) of the DGHO (German Society for Hematology and Medical Oncology). A core group of experts prepared a preliminary guideline, which was discussed, reviewed, and approved by the entire working group. The guideline provides clinical recommendations for the preventive management including prophylactic treatment of viral, bacterial, parasitic, and fungal diseases. The guideline focuses on antimicrobial

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… iv b | C | I | No difference seen in the trial in comparison to fluconazole | [ 114 ] Posaconazole (suspension) 200 mg tid b | B | II t | Improved overall survival in AML/MDS induction during neutropenia, new formulations (tablet and iv, 300 mg qid) provide a better bioavailability | [ 115 – 117 ] Micafungin … Micafungin versus fluconazole for prophylaxis against invasive fungal infections during neutropenia in patients undergoing hematopoietic stem cell transplantation. Clin Infect Dis. 2004;39(10):1407–1416. doi: 10.1086/422312. 119. Marr KA, et al. …

Prevention and management of adverse events of novel agents in multiple myeloma: a consensus of the European Myeloma Network.

During the last few years, several new drugs have been introduced for treatment of patients with multiple myeloma, which have significantly improved the treatment outcome. All of these novel substances differ at least in part in their mode of action from similar drugs of the same drug class, or are representatives of new drug classes, and as such present with very specific side effect profiles. In this review, we summarize these adverse events, provide information on their prevention, and give practical guidance for monitoring of patients and for management of adverse events.

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… additional prophylactic measures have been recommended [ 93 ] c Itraconazole, voriconazole, and posaconazole are more potent inhibitors of cytochrome P450 3A4 isoenzymes than fluconazole and may significantly decrease the clearance of several agents used to treat cancer d All three agents in the class (micafungin … prophylaxis | Trimethoprim–sulfamethoxazole, amoxicillin, quinolone | Parasites | Consider prophylaxis | Trimethorpim–sulfamethoxazole, pentamidine-inhalation in allogeneic transplantation | Fungal | Consider prophylaxis during neutropenia; consider pneumocystis pneumonia prophylaxis | Fluconazole c or micafungin …

Oral complications and management strategies for patients undergoing cancer therapy.

With cancer survival rate climbing up over the past three decades, quality of life for cancer patients has become an issue of major concern. Oral health plays an important part in one's overall quality of life. However, oral health status can be severely hampered by side effects of cancer therapies including surgery, chemotherapy, radiotherapy, and hematopoietic stem cell transplantation. Moreover, prevention and treatment of these complications are often overlooked in clinical practice. The present paper aims at drawing health care professionals' attention to oral complications associated wit

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… A number of studies have demonstrated the efficacy of prophylactic use of fluconazole, itraconazole, posaconazole, and intravenous micafungin (Mycamine; Astellas Pharma US, Inc., Deerfield, IL, USA) in reducing the prevalence of all clinical fungal infections during cancer therapy [ 128 , 133 – 137 ] … Rijnders B Economic evaluation of posaconazole vs. standard azole prophylaxis in high risk neutropenic patients in the Netherlands European Journal of Haematology 2008 81 6 467 474 2-s2.0-56649109482 18754857 10.1111/j.1600-0609.2008.01141.x 136 Sohn HS Lee T-J Kim J Kim D Cost-effectiveness analysis of micafungin …

Busulfan plus melphalan versus melphalan alone conditioning regimen after bortezomib based triplet induction chemotherapy for patients with newly diagnosed multiple myeloma.

BackgroundHigh dose melphalan (HDMEL) is considered the standard conditioning regimen for autologous stem cell transplantation (ASCT) in multiple myeloma (MM) patients. Recent studies showed superiority of busulfan plus melphalan (BUMEL) compared to HDMEL as a conditioning regimen. We compared the efficacy of HDMEL and BUMEL in newly diagnosed Asian MM patients, who are often underrepresented.MethodsThis is a single-center, retrospective study including MM patients who underwent ASCT after bortezomib-thalidomide-dexamethasone (VTD) triplet induction chemotherapy between January 2015 and August

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… Micafungin was used as an prophylactic antifungal and ciprofloxacin as an prophylactic antibiotic, and these were administered from the day of the chemotherapy initiation to absolute neutrophil count (ANC) recovery. Intravenous immunoglobulin was administered as CMV prophylaxis. …

Практические рекомендации в отношении инфекционных профилактических мероприятий и вакцинации нескольких пациентов, страдающих миэломой.

Инфекции по-прежнему являются одной из основных причин заболеваемости и смертности во множестве миеломы (ММ), обусловленной взаимосвязью между иммунной дисфункцией, вызванной болезнями, и иммунодепрессией, связанной с лечением. Внедрение протеазных ингибиторов, иммуномодуляционных препаратов, моноклонных антител, биконкретных антител и химеорической антигенной рецепторной терапии Т (CAR-T) заметно улучшило выживание при одновременном изменении ландшафта инфекционных рисков. Различные стратегии обращения ставят под угрозу иммунитет в рамках различных механизмов. Обычная химиотерапия и некоторые

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… Micafungin 50 mg daily is recommended for azole-intolerant patients undergoing ASCT due to oral mucositis ( 16 , 23 ). Antimold therapy (e.g., Aspergillus spp.) may be considered for selected high-risk patients, particularly when the risk of invasive aspergillosis exceeds 6%. … Micafungin 50 mg daily can be considered as an alternative to fluconazole if it is contraindicated ( 64 , 87 , 95 , 108 ). PJP is a life-threatening opportunistic fungal infection that can affect patients with MM. …

Infectious Diseases

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Delayed Presentation of Thymoma-Related Aplastic Anemia: An Unusual Presentation of a Rare Complication.

A 68-year-old Caucasian man presented with gross hematuria and oral mucosal bleeding. The patient was known to have an anterior mediastinal mass, highly suspicious for thymoma, which was incidentally identified on imaging, 8 years prior. The patient then declined treatment and was lost to follow-up. On presentation, imaging re-demonstrated the anterior mediastinal mass and the patient was found to have profound pancytopenia. Bone marrow biopsy confirmed the diagnosis of aplastic anemia (AA). Despite optimal treatment, the patient expired on day 9 of admission. In this case we report an unusual

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… Cefepime and micafungin were started. Patient developed multiorgan failure and made do not resuscitate (DNR) at family’s request. Cardiopulmonary arrest occurred later that day and the patient expired. No post-mortem examination was done due to family’s refusal. …

Case report: Clinical course and treatment of SARS-CoV-2 in a pediatric CAR-T cell recipient with persistent hypogammaglobulinemia.

This report describes a pediatric patient who underwent chimeric antigen receptor (CAR) T-cell therapy for refractory B-cell acute lymphoblastic leukemia (B-ALL) four years prior, with resultant hypogammaglobulinemia for which he was receiving weekly subcutaneous immune globulin. He presented with persistent fever, dry cough, and a tingling sensation in his toes following a confirmed COVID-19 infection 3 weeks prior. His initial nasopharyngeal SARS-CoV-2 PCR was negative, leading to an extensive workup for other infections. He was ultimately diagnosed with persistent lower respiratory tract CO

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… Antimicrobial coverage was broadened from ceftriaxone (50 mg/kg every 24 h) to vancomycin (15 mg/kg every 8 h, increased to every 6 h following the fourth dose based on trough level), cefepime (50 mg/kg every 8 h), and micafungin (150 mg every 24 h). …