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Lipovy B, Hladik M, Vyklicka K, Kocmanova I, Lengerova M, Kren L, Srnik M, Bohm J, Andrla P, Borilova Linhartova P. Rare multi-fungal sepsis: a case of triple-impact immunoparalysis. Folia Microbiol (Praha) 2024:10.1007/s12223-024-01165-0. [PMID: 38647991 DOI: 10.1007/s12223-024-01165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
Patients with burn injury and inhalation injury are highly susceptible to infectious complications, including opportunistic pathogens, due to the loss of skin cover and mucosal damage of respiratory tract as well as the disruption of homeostasis. This case report, a 34-year-old man suffered critical burns, provides the first literature description of triple-impact immunoparalysis (critical burns, inhalation injury, and SARS-CoV-2 infection), leading to a lethal multifocal infection caused by several fungi including very rare environmental representatives Metschnikowia pulcherrima and Wickerhamomyces anomalus. The co-infection by these common environmental yeasts in a human is unique and has not yet been described in the literature. Importantly, our patient developed refractory septic shock and died despite targeted antifungal therapy including the most potent current antifungal agent-isavuconazole. It can be assumed that besides immunoparalysis, effectiveness of therapy by isavuconazole was impaired by the large distribution volume in this case. As this is a common situation in intensive care patients, routine monitoring of plasmatic concentration of isavuconazole can be helpful in personalization of the treatment and dose optimization. Whatmore, many fungal species often remain underdiagnosed during infectious complications, which could be prevented by implementation of new methods, such as next-generation sequencing, into clinical practice.
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Affiliation(s)
- Bretislav Lipovy
- Department of Burns and Plastic Surgery, Faculty of Medicine, Institution Shared With University Hospital Brno, Masaryk University, Jihlavska 20, Brno, Czech Republic
- CEITEC - Central European Institute of Technology, Brno University of Technology, Purkynova 656/123, Brno, Czech Republic
| | - Martin Hladik
- Department of Burns and Plastic Surgery, Faculty of Medicine, Institution Shared With University Hospital Brno, Masaryk University, Jihlavska 20, Brno, Czech Republic
| | - Katerina Vyklicka
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Iva Kocmanova
- Department of Clinical Microbiology and Immunology, University Hospital Brno, Jihlavska 20, Brno, Czech Republic
| | - Martina Lengerova
- Department of Internal Medicine - Haematology and Oncology, Faculty of Medicine, Institution Shared With University Hospital Brno, Masaryk University, Jihlavska 20, Brno, Czech Republic
| | - Leos Kren
- Department of Pathology, Faculty of Medicine, Institution Shared With University Hospital Brno, Masaryk University, Jihlavska 20, Brno, Czech Republic
| | - Michal Srnik
- Department of Forensic Medicine, Institutions Shared With St. Anne's Faculty Hospital, Faculty of Medicine, Masaryk University, Pekarska 664/53, Brno, Czech Republic
| | - Jan Bohm
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
| | - Petr Andrla
- RECETOX, Faculty of Science, Masaryk University, Kotlarska 2, Brno, Czech Republic
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Yang XL, Zhang JY, Ren JM. Successful treatment of Purpureocillium lilacinum pulmonary infection with isavuconazole: A case report. World J Clin Cases 2024; 12:1772-1777. [PMID: 38660073 PMCID: PMC11036475 DOI: 10.12998/wjcc.v12.i10.1772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/05/2024] [Accepted: 03/18/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Purpureocillium lilacinum (P. lilacinum) is a saprophytic fungus widespread in soil and vegetation. As a causative agent, it is very rarely detected in humans, most commonly in the skin. CASE SUMMARY In this article, we reported the case of a 72-year-old patient with chronic lymphocytic leukemia who was admitted with cough and fever. Computed tomography revealed an infection in the right lower lobe. Bronchoalveolar lavage fluid culture and metagenomic next-generation sequencing were ultimately confirmed to have a pulmonary infection with P. lilacinum. She was eventually discharged with good outcomes after treatment with isavuconazole. CONCLUSION Pulmonary infection with P. lilacinum was exceedingly rare. While currently there are no definitive therapeutic agents, there are reports of high resistance to amphotericin B and fluconazole and good sensitivity to second-generation triazoles. The present report is the first known use of isavuconazole for pulmonary P. lilacinum infection. It provides new evidence for the characterization and treatment of clinical P. lilacinum lung infections.
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Affiliation(s)
- Xue-Lin Yang
- Department of Emergency Medicine, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
| | - Jun-Yu Zhang
- Department of Hematology, Lishui Central Hospital, Lishui 323000, Zhejiang Province, China
| | - Jian-Min Ren
- Department of Clinical Laboratory, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui 323000, Zhejiang Province, China
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Russo A, Serraino R, Serapide F, Bruni A, Garofalo E, Longhini F, Trecarichi EM, Torti C. COVID-19-associated pulmonary aspergillosis in intensive care unit: A real-life experience. Heliyon 2024; 10:e24298. [PMID: 38293516 PMCID: PMC10825494 DOI: 10.1016/j.heliyon.2024.e24298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 12/30/2023] [Accepted: 01/05/2024] [Indexed: 02/01/2024] Open
Abstract
Since 2020, cases of COVID-19-associated pulmonary aspergillosis (CAPA) have been frequently described, representing an important cause of mortality, especially among patients admitted to intensive care unit (ICU). A predisposition to invasive infection caused by Aspergillus spp. in SARS-CoV-2 infected patients can be ascribed either to the direct viral-mediated damage of the respiratory epithelium or to the dysregulated immunity associated with COVID-19. In this case series we have collected the clinical, laboratory and radiological data of 10 patients admitted to the ICU with diagnosis of probable CAPA, according to the recent expert consensus statement, from March 2020 to December 2022 in the Teaching Hospital of Catanzaro in Italy. Overall, 249 patients were admitted to the COVID-19-ICU from March 2020 to December 2022; out of these, 4% developed a probable CAPA. Most of patients were male with a mean age of 62 years. Only two patients had an underlying immunocompromising condition. The observed mortality was 70%. In our institution, all COVID-19 patients requiring invasive mechanical ventilation systematically underwent bronchoscopy with bronchoalveolar lavage for an early evaluation of bacterial and/or fungal co- or super-infections, including galactomannan test. Patients were re-evaluated by an infectious diseases consultant team every 24-48 hours and the galactomannan test was systematically repeated based on patient's clinical course. Even though the numbers in this study are very small, we report our experience about the role of early diagnosis and careful choice of antifungal therapy, considering the fragility of these patients, and its relationship with outcomes. Despite a systemic approach allowing early diagnosis and initiation of anti-fungal therapy, the mortality rate turned out to be very high (70%).
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Affiliation(s)
- Alessandro Russo
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, Italy
| | - Riccardo Serraino
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, Italy
| | - Francesca Serapide
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, Italy
| | - Andrea Bruni
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, Italy
| | - Eugenio Garofalo
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, Italy
| | - Federico Longhini
- Anesthesia and Intensive Care Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, Italy
| | - Enrico Maria Trecarichi
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, Italy
| | - Carlo Torti
- Infectious and Tropical Disease Unit, Department of Medical and Surgical Sciences, ‘Magna Graecia’ University of Catanzaro, Italy
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Khatri AM, Natori Y, Anderson A, Jabr R, Shah SA, Natori A, Chandhok NS, Komanduri K, Morris MI, Camargo JF, Raja M. Breakthrough invasive fungal infections on isavuconazole prophylaxis in hematologic malignancy & hematopoietic stem cell transplant patients. Transpl Infect Dis 2023; 25 Suppl 1:e14162. [PMID: 37794708 DOI: 10.1111/tid.14162] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/08/2023] [Accepted: 09/19/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Isavuconazole (ISA) is a newer antifungal used in patients with history of hematologic malignancies and hematopoietic transplant and cellular therapies (HM/TCT). Although it has a more favorable side-effect profile, breakthrough invasive fungal infections (bIFIs) while on ISA have been reported. METHODS In this single-center retrospective study evaluating HM/TCT patients who received prophylactic ISA for ≥7 days, we evaluated the incidence and potential risk factors for bIFIs. RESULTS We evaluated 106 patients who received prophylactic ISA. The patients were predominantly male (60.4%) with median age of 65 (range: 21-91) years. Acute myeloid leukemia (48/106, 45.3%) was the most common HM, with majority having relapsed and/or refractory disease (43/106, 40.6%) or receiving ongoing therapy (38/106, 35.8%). Nineteen patients (17.9%) developed bIFIs-nine proven [Fusarium (3), Candida (2), Mucorales plus Aspergillus (2), Mucorales (1), Colletotrichum (1)], four probable invasive pulmonary Aspergillus, and six possible infections. Twelve patients were neutropenic for a median of 28 (8-253) days prior to bIFI diagnosis. ISA levels checked within 7 days of bIFI diagnosis (median: 3.65 μg/mL) were comparable to industry-sponsored clinical trials. All-cause mortality among the bIFI cases was 47.4% (9/19).We also noted clinically significant cytomegalovirus co-infection in 5.3% (1/19). On univariate analysis, there were no significant differences in baseline comorbidities and potential risk factors between the two groups. CONCLUSION ISA prophylaxis was associated with a significant cumulative incidence of bIFIs. Despite the appealing side-effect and drug-interaction profile of ISA, clinicians must be vigilant about the potential risk for bIFIs.
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Affiliation(s)
- Akshay M Khatri
- Division of Infectious Diseases, Department of Medicine, UnityPoint Health-Des Moines, Des Moines, USA
| | - Yoichiro Natori
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
- Miami Transplant Institute, Jackson Health System, Miami, USA
| | - Anthony Anderson
- Department of Pharmacy, Sylvester Comprehensive Cancer Center, Miami, USA
| | - Ra'ed Jabr
- Department of Medicine, Division of Infectious Diseases, Mayo Clinic Health System-Eau Claire, Miami, USA
| | - Shreya A Shah
- Department of Pharmacy, Sylvester Comprehensive Cancer Center, Miami, USA
| | - Akina Natori
- Division of Medical Oncology, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Namrata S Chandhok
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Krishna Komanduri
- Division of Hematology and Oncology, Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Michele I Morris
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Jose F Camargo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
| | - Mohammed Raja
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, USA
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Tirlangi P, Challa HPR, Keithi-Reddy SR, Koduri VKC, Reddy RS, Arumilli MN, Reddy LSK, Senapathy G. Reversal of uniocular blindness with corticosteroids in a solid organ transplant recipient with cryptococcal meningitis and immune reconstitution syndrome (IRIS): A case report. J Mycol Med 2023; 33:101406. [PMID: 37229913 DOI: 10.1016/j.mycmed.2023.101406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/07/2023] [Accepted: 05/09/2023] [Indexed: 05/27/2023]
Abstract
Cryptococcal meningitis is a life-threatening infection commonly seen in patients with advanced HIV infection and solid organ transplant recipients. We report a case of cryptococcal meningitis with immune reconstitution syndrome (IRIS) who presented to us with a headache and complete loss of vision in the left eye. He was managed with antifungals and a short course of steroids, and he regained vision completely. In the hospital, he developed complications including tacrolimus toxicity, fluconazole-induced QT prolongation, and flucytosine-induced thrombocytopenia. Our case demonstrates the importance of a multidisciplinary approach in the management of complex cases like cryptococcal meningitis in solid organ transplant recipients.
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Affiliation(s)
- Praveen Tirlangi
- Department of Infectious Diseases AIG Hospitals, Gachibowli, Hyderabad 500032, India
| | | | - Sai Ram Keithi-Reddy
- Department of Nephrology and Renal Transplant, AIG Hospitals, Tower A, 1st floor, Gachibowli, Hyderabad 500032, India.
| | | | - R Sujith Reddy
- Department of Nephrology and Renal Transplant, AIG Hospitals, Tower A, 1st floor, Gachibowli, Hyderabad 500032, India
| | - Murthy Nln Arumilli
- Department of Critical Care, AIG Hospitals, Gachibowli, Hyderabad 500032, India
| | - L Siva Kumar Reddy
- Department of Critical Care, AIG Hospitals, Gachibowli, Hyderabad 500032, India
| | - Gayatri Senapathy
- Department of Radiology, AIG Hospitals, Gachibowli, Hyderabad 500032, India
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Ortalli G, Oliva E, Lo Cascio G, On Behalf Of The Medical Mycology Committee CoSM-Italian Association Of Clinical Microbiologists Amcli, Farina C. In Vitro Activity of Isavuconazole and Amphotericin B in Association against Mucorales. Pathogens 2023; 12:948. [PMID: 37513795 PMCID: PMC10383810 DOI: 10.3390/pathogens12070948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/06/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Mucormycoses can be treated with the combination of Amphotericin B and Isavuconazole. This study evaluates the effects of these drugs in vitro against 59 strains representing 12 Mucorales. In vitro testing of the two drugs together and alone was performed using the MIC Test strip "Epsilon test synergy-method" (ETSM), which is more standard in clinical practice than microbroth dilution testing. Amphotericin B and Isavuconazole have synergistic/additive effects against L. corymbifera, R. arrhizus and M. circinelloides. Different effects have been shown for other Mucorales. ETSM can help the clinical management of mucormycosis from a practical point of view, due to its feasibility in the laboratory.
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Affiliation(s)
- Gaia Ortalli
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", Piazza OMS 1, 24127 Bergamo, Italy
| | - Ester Oliva
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", Piazza OMS 1, 24127 Bergamo, Italy
| | - Giuliana Lo Cascio
- Microbiology and Virology Laboratory, Ospedale Guglielmo da Saliceto, Via Taverna 49, 29121 Piacenza, Italy
- Medical Mycology Committee (CoSM)-Italian Association of Clinical Microbiologists (AMCLI), Via Carlo Farini 81, 20159 Milano, Italy
| | | | - Claudio Farina
- Microbiology and Virology Laboratory, ASST "Papa Giovanni XXIII", Piazza OMS 1, 24127 Bergamo, Italy
- Medical Mycology Committee (CoSM)-Italian Association of Clinical Microbiologists (AMCLI), Via Carlo Farini 81, 20159 Milano, Italy
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Prayag PS. Author Reply: Therapeutic Drug Monitoring of Isavuconazole: Lessons Learnt from a Real-life Setting in a Tertiary Care Center in India. Indian J Crit Care Med 2023; 27:451. [PMID: 37378360 PMCID: PMC10291673 DOI: 10.5005/jp-journals-10071-24471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
How to cite this article: Prayag PS. Author Reply: Therapeutic Drug Monitoring of Isavuconazole: Lessons Learnt from a Real-life Setting in a Tertiary Care Center in India. Indian J Crit Care Med 2023;27(6):451.
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Affiliation(s)
- Parikshit Shirish Prayag
- Department of Transplant Infectious Diseases, Deenanath Mangeshkar Hospital & Research Center, Pune, Maharashtra, India
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Salhotra R. Therapeutic Drug Monitoring of Isavuconazole-But What about the Critically Ill? Indian J Crit Care Med 2023; 27:454-455. [PMID: 37378375 PMCID: PMC10291658 DOI: 10.5005/jp-journals-10071-24450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023] Open
Abstract
Data on therapeutic drug monitoring of novel, broad-spectrum, and promising antifungal agent Isavuconazole sheds light on factors associated with subtherapeutic drug levels, however, a few other parameters, which characterize the critically ill patients, if included in the analysis, would have improved the understanding of drugs pharmacokinetics in this subset. How to cite this article Salhotra R. Therapeutic Drug Monitoring of Isavuconazole-But What about the Critically Ill? Indian J Crit Care Med 2023;27(6):454-455.
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Affiliation(s)
- Ripenmeet Salhotra
- Department of Critical Care Medicine, Amrita Hospital, Faridabad, Hayana, India
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Kohno S, Izumikawa K, Takazono T, Miyazaki T, Yoshida M, Kamei K, Ogawa K, Taniguchi S, Akashi K, Tateda K, Mukae H, Miyazaki Y, Okada F, Kanda Y, Kakeya H, Suzuki J, Kimura SI, Kishida M, Matsuda M, Niki Y. Efficacy and safety of isavuconazole against deep-seated mycoses: A phase 3, randomized, open-label study in Japan. J Infect Chemother 2023; 29:163-170. [PMID: 36307059 DOI: 10.1016/j.jiac.2022.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 10/08/2022] [Accepted: 10/18/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Isavuconazole is a convenient triazole antifungal agent with a broad antifungal spectrum. A randomized, open-label study (ClinicalTrials.gov, NCT03471988) was conducted to evaluate the efficacy and safety of isavuconazole in Japanese patients with deep-seated mycoses. PATIENTS AND METHODS In Cohort A, patients with aspergillosis (chronic pulmonary aspergillosis and invasive aspergillosis) were randomized in a 2:1 ratio to isavuconazole or voriconazole, and in Cohort B, patients with cryptococcosis and mucormycosis were assigned to isavuconazole for up to 84 days of treatment. The overall outcome was evaluated according to the clinical, radiological, and mycological responses at Days 42 and 84 and at the end of treatment (EOT). RESULTS A total of 103 participants were enrolled and received the study drug. The overall response rate of patients with chronic pulmonary aspergillosis in the isavuconazole (52 patients) and voriconazole (27 patients) groups was 82.7% and 77.8% at EOT, respectively. The response rate in patients with cryptococcosis (10 patients, isavuconazole group only) was 90.0%. One of three participants with invasive aspergillosis and one of three participants with mucormycosis responded in the isavuconazole group. In the safety evaluation, the incidence of adverse events in participants with chronic pulmonary aspergillosis was similar in both groups. Adverse drug reactions were reported in 32 (61.5%) patients receiving isavuconazole and 23 (85.2%) patients receiving voriconazole. CONCLUSIONS Isavuconazole showed efficacy and safety in Japanese patients with chronic pulmonary aspergillosis and cryptococcosis, for which the drug is not currently indicated.
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Affiliation(s)
| | - Koichi Izumikawa
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8501, Japan.
| | - Takahiro Takazono
- Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8501, Japan; Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8501, Japan
| | - Taiga Miyazaki
- Division of Respirology, Rheumatology, Infectious Diseases, and Neurology, Department of Internal Medicine, Faculty of Medicine, University of Miyazaki, Miyazaki, 889-1692, Japan
| | - Minoru Yoshida
- Fourth Department of Internal Medicine, Teikyo University Hospital Mizonokuchi, Kawasaki, 213-8507, Japan
| | - Katsuhiko Kamei
- Department of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, 260-8673, Japan
| | - Kenji Ogawa
- Department of Respiratory Medicine, National Hospital Organization Higashinagoya National Hospital, Nagoya, 465-8620, Japan
| | - Shuichi Taniguchi
- Department of Hematology, Toranomon Hospital, Tokyo, 105-8470, Japan
| | - Koichi Akashi
- Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, 812-8582, Japan
| | - Kazuhiro Tateda
- Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University, Tokyo, 143-8540, Japan
| | - Hiroshi Mukae
- Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, 852-8501, Japan
| | - Yoshitsugu Miyazaki
- Department of Fungal Infection, National Institute of Infectious Diseases, Tokyo, 162-8640, Japan
| | - Fumito Okada
- Department of Radiology, Oita Prefectural Hospital, Oita, 870-8511, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan; Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, 329-0498, Japan
| | - Hiroshi Kakeya
- Department of Infection Control Science, Osaka Metropolitan University Graduate School of Medicine, Osaka, 545-8585, Japan
| | - Junko Suzuki
- Center for Pulmonary Diseases, Department of Respiratory Medicine, National Hospital Organization Tokyo National Hospital, Tokyo, 204-8585, Japan
| | - Shun-Ichi Kimura
- Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, 330-8503, Japan
| | | | | | - Yoshihito Niki
- Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, 142-8555, Japan
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Dvořáčková E, Zajacová A, Havlín J, Klapková E, Lischke R, Slanař O, Šíma M. Demonstration of the Rationale for Therapeutic Drug Monitoring of Isavuconazole: A Case Report with a Lung Transplant Recipient. Prague Med Rep 2023; 124:444-448. [PMID: 38069649 DOI: 10.14712/23362936.2023.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Mucormycosis is a rare invasive fungal disease diagnosed in immunocompromised patients, including those with diabetes or iron overload, and in patients treated for hematological malignancies or after transplantation. Isavuconazole is a triazole antifungal effective against Mucorales with good tolerability, but with potential for relatively high interindividual variability in pharmacokinetics. This report demonstrates the case of a lung transplant recipient treated with isavuconasole that exhibits a very long elimination half-life of 159 hours, and discusses the practical implications of this finding for dosage adjustment and need for therapeutic drug monitoring.
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Affiliation(s)
- Eliška Dvořáčková
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Andrea Zajacová
- Prague Lung Transplant Program, Department of Pneumology, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jan Havlín
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Eva Klapková
- Department of Medical Chemistry and Clinical Biochemistry, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Robert Lischke
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Ondřej Slanař
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Martin Šíma
- Institute of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.
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Wee LE, Tan MG, Tan AL, Tang JZ. Relapsing Aspergillus otomycosis despite prolonged systemic antifungal therapy and resolution after topical voriconazole administration: A case report. Med Mycol Case Rep 2023; 39:23-5. [PMID: 36632528 DOI: 10.1016/j.mmcr.2022.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/29/2022] Open
Abstract
We report a case of intractable Aspergillus otomycosis with multiple relapses despite conventional topical and systemic antifungal treatment, and adjunctive usage of hyperbaric oxygen therapy. Of note, otomycosis relapsed even after six months of continuous systemic antifungal treatment with therapeutic drug levels and without treatment interruption; and only resolved after application of topical voriconazole. (max. 75 words).
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12
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Ramanzini LG, de Medeiros SDP, Lima LMFV, dos Santos MVR, Herbster EA, Araújo GDAS, Araújo VO, Braga JMB, Nones DP, Claudino dos Santos JC. Cerebral cryptococcoma successfully treated by isavuconazole in an immunocompetent patient: A case report. Radiol Case Rep 2022; 18:824-829. [PMID: 36582749 PMCID: PMC9793169 DOI: 10.1016/j.radcr.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/28/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
Cryptococcosis has been recognized as an increasing cause of severe systemic mycosis in immunocompetent patients in the last few years. Cerebral cryptococcomas are a more uncommon manifestation of cryptococcal meningitis, which are not usually included in the differential of brain masses. We report a case of a young, immunocompetent woman that rapidly developed severe neurological deficits. She was ultimately diagnosed with cerebral cryptococcoma caused by both Cryptococcus neoformans and Cryptococcus gattii, and was treated with amphotericin B and isavuconazole. After several complications during hospitalization, including hydrocephalus and cerebellitis, she was discharged home on isavuconazole. On follow-up, she only complained of anosmia. We review the clinical and radiological findings of similar cases. It is the first time that this form of cryptococcal meningitis is favorably treated with isavuconazole and is caused by 2 species of Cryptococcus. We emphasize that cerebral cryptococcomas should be suspected in immunocompetent patients that present with brain masses.
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Affiliation(s)
- Luis Guilherme Ramanzini
- Universidade Federal de Santa Maria, UFSM, Av. Roraima, 1000, 97105-900, Santa Maria, Rio Grande do Sul, Brazil,Corresponding authors.
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13
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Bougioukas L, Noyes CD, Peterson K, Smith LM, Hale AJ. Successful treatment of rhino-cerebral mucormycosis with dual antifungal therapy and minimal surgical debridement. IDCases 2022; 30:e01615. [PMID: 36119757 PMCID: PMC9474854 DOI: 10.1016/j.idcr.2022.e01615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/23/2022] [Accepted: 09/03/2022] [Indexed: 01/09/2023] Open
Abstract
The authors report the case of a 42-year-old female with history of type I diabetes mellitus and recent episode of diabetic ketoacidosis who presented with symptoms of epistaxis, gastrointestinal upset, hyperglycemia, confusion, and a cough. She was found to have rhino-cerebral mucormycosis with associated multi-focal strokes and a left internal carotid artery pseudoaneurysm. Her infection was successfully treated with dual-antifungal therapy consisting of liposomal amphotericin B and isavuconazole, and required only minimal surgical debridement.
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Affiliation(s)
| | - Cindy D. Noyes
- University of Vermont Medical Center, Burlington, VT, USA,Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | | | - Lindsay M. Smith
- University of Vermont Medical Center, Burlington, VT, USA,Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | - Andrew J. Hale
- University of Vermont Medical Center, Burlington, VT, USA,Larner College of Medicine at the University of Vermont, Burlington, VT, USA,Correspondence to: University of Vermont Medical Center, Infectious Disease Unit, 111 Colchester Avenue, Mailstop 115 SM2, Burlington, VT 05401, USA.
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14
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Bauschert L, Sermet K, Fréalle E, Khodr J, Magro L, Yakoub-Agha I, Alfandari S, Beauvais D. A case of subacute bowel obstruction revealing slowly-evolutive gastro-intestinal mucormycosis following allogeneic hematopoietic cell transplantation. J Mycol Med 2022; 32:101312. [PMID: 35914432 DOI: 10.1016/j.mycmed.2022.101312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022]
Abstract
Gastro-intestinal mucormycosis (GIMM) is a highly lethal invasive fungal disease partly because of a challenging diagnosis. An allogeneic hematopoietic cell transplant recipient experienced bowel obstruction caused by slowly-evolutive gastro-intestinal mucormycosis and was successfully treated with surgery and antifungal therapy. Pathological findings revealed a granuloma without angio-invasion, which is unusual in this fungal disease and has incomplete similarities with an immune reconstitution inflammatory syndrome. Mucorales-specific PCR in both serum and resected tissue was positive and helped assessing the diagnosis. GIMM should be considered in front of unexplained granulomatosis or bowel obstruction in immunocompromised patients.
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Affiliation(s)
- Loïc Bauschert
- Department of Hematology, CHU Lille, Univ Lille, Lille, France
| | - Kevin Sermet
- Department of Infectious Disease, CHU Lille, Univ Lille, Lille, France
| | - Emilie Fréalle
- Department of Parasitology-Mycology, CHU Lille, Lille, France
| | - Justine Khodr
- Department of Visceral and Digestive Surgery, CHU Lille, Univ Lille, Lille, France
| | - Léonardo Magro
- Department of Hematology, CHU Lille, Univ Lille, Lille, France
| | - Ibrahim Yakoub-Agha
- Department of Hematology, CHU Lille, Univ Lille, Lille, France; Univ. Lille, CHU Lille, INSERM, Infinite, U1286, Lille, France
| | - Serge Alfandari
- Department of Infectious Diseases, Gustave Dron Hospital, Tourcoing, France
| | - David Beauvais
- Department of Hematology, CHU Lille, Univ Lille, Lille, France; Univ. Lille, CHU Lille, INSERM, Infinite, U1286, Lille, France.
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15
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Ostrosky-Zeichner L, Nguyen MH, Bubalo J, Alexander BD, Miceli MH, Pappas PG, Jiang J, Song Y, Thompson GR 3rd. Multicenter Registry of Patients Receiving Systemic Mold-Active Triazoles for the Management of Invasive Fungal Infections. Infect Dis Ther 2022. [PMID: 35716251 DOI: 10.1007/s40121-022-00661-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/19/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction ‘Real-world’ data for mold-active triazoles (MATs) in the treatment of invasive fungal infections (IFIs) are lacking. This study evaluated usage of MATs in a disease registry for the management of IFIs. Methods Data were collected for this multicenter, observational, prospective study from 55 US centers, between March 2017 and April 2020. Eligible patients received isavuconazole, posaconazole, or voriconazole as MAT monotherapy (one MAT) or multiple/sequenced MAT therapy (more than one MAT) for prophylaxis or treatment. Patients were enrolled within 60 days of MAT initiation. The primary objective was to characterize patients receiving a MAT and their patterns of therapy. The full analysis set (FAS) included eligible patients for the relevant enrollment protocol, and the safety analysis set (SAF) included patients who received ≥ 1 MAT dose. Results Overall, 2009 patients were enrolled in the SAF. The FAS comprised 1993 patients (510 isavuconazole; 540 posaconazole; 491 voriconazole; 452 multiple/sequenced MAT therapies); 816 and 1177 received treatment and prophylaxis at study index/enrollment, respectively. Around half (57.8%) of patients were male, and median age was 59 years. Among patients with IFIs during the study, the most common pathogens were Aspergillus fumigatus in the isavuconazole (18.2% [10/55]) and voriconazole (25.5% [12/47]) groups and Candida glabrata in the posaconazole group (20.9% [9/43]); the lungs were the most common infection site (58.2% [166/285]). Most patients were maintained on MAT monotherapy (77.3% [1541/1993]), and 79.4% (1520/1915) completed their MAT therapies. A complete/partial clinical response was reported in 59.1% (591/1001) of patients with a clinical response assessment. Breakthrough IFIs were reported in 7.1% (73/1030) of prophylaxis patients. Adverse drug reactions (ADRs) were reported in 14.7% (296/2009) of patients (3.9% [20/514] isavuconazole; 11.3% [62/547] posaconazole; 14.2% [70/494] voriconazole). Conclusions In this ‘real-world’ study, most patients remained on their initial therapy and completed their MAT therapy. Over half of patients receiving MATs for IFIs had a successful response, and most receiving prophylaxis did not develop breakthrough IFIs. ADRs were uncommon. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-022-00661-5.
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16
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Soman R, Chakraborty S, Joe G. Posaconazole or isavuconazole as sole or predominant antifungal therapy for COVID-19-associated mucormycosis. A retrospective observational case series. Int J Infect Dis 2022; 120:177-178. [PMID: 35405351 PMCID: PMC8993494 DOI: 10.1016/j.ijid.2022.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 12/03/2022] Open
Abstract
The surge of COVID-19 associated Mucormycosis (CAM) in India during the second wave of COVID-19 led to lack of availability of amphotericin B(AmB). We retrospectively evaluated the outcome in 28 consecutive patients with CAM who received posaconazole (PCZ) or isavuconazole (ISVCZ) as sole or predominant therapy, based on factors like availability, affordability, site of infection or lack of treatment response. Therapeutic drug monitoring was used for PCZ in all cases & for ISVCZ in some cases. Higher trough levels were aimed to ensure therapeutic effect. Overall, 16 patients were cured, 5 patients improved, 6 patients died, of which 2 deaths were attributable to mucormycosis and 1 patient was lost to follow-up. The outcomes and survival were comparable to those reported in the literature. Although wider applicability of these results cannot be assumed, it leads to a speculation that treatment of mucormycosis with PCZ or ISVCZ, without AmB, is possible.
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Affiliation(s)
- Rajeev Soman
- HOD Infectious Disease, Jupiter Hospital, Baner, Pune 411057, India
| | | | - Geethu Joe
- Consultant Microbiologist, Jupiter Hospital, Baner, Pune 411057, India
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17
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Maisons V, Desoubeaux G, Coustillères F, Lemaignen A, Chesnay A, Doman M, Lanternier F, Bernard L, Lacasse M. Intricate isavuconazole therapy of a subcutaneous nodule caused by Alternaria infectoria in a heart transplant recipient. J Mycol Med 2021; 32:101235. [PMID: 34954620 DOI: 10.1016/j.mycmed.2021.101235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 01/09/2023]
Abstract
Invasive fungal infections have appeared to be increasingly emergent in immunocompromised patients, especially in solid organ transplant (SOT) recipients. The Alternaria genus encompasses more than 80 dematiaceus species. Among them, Alternaria alternata and Alternaria infectoria are the most frequent isolated as responsible for infection in humans. To our knowledge, we report the first case of a heart transplant recipient suffering from subcutaneous nodule caused by Alternaria infectoria and who was treated with isavuconazole. Despite all the promises of this new azole drug, one should keep in mind the potential great variability of the inter-individual responses for such complex patients. We demonstrate herein how it can be challenging to manage Alternaria infection in SOT recipients. More comprehensive studies and recommendations are expected in the context of Alternaria infections.
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Affiliation(s)
- Valentin Maisons
- Service de Néphrologie et d'Immunologie Clinique, CHU Bretonneau, CHRU Tours, France.
| | - Guillaume Desoubeaux
- Service de Parasitologie-Mycologie-Médecine tropicale, CHRU Tours, Tours, France
| | | | - Adrien Lemaignen
- Service de Médecine Interne - Maladies Infectieuses, CHRU Tours, Tours, France
| | - Adelaïde Chesnay
- Service de Parasitologie-Mycologie-Médecine tropicale, CHRU Tours, Tours, France
| | - Marc Doman
- Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, APHP, Paris, France
| | - Fanny Lanternier
- Service de Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker Pasteur, APHP, Paris, France
| | - Louis Bernard
- Service de Médecine Interne - Maladies Infectieuses, CHRU Tours, Tours, France
| | - Marion Lacasse
- Service de Médecine Interne - Maladies Infectieuses, CHRU Tours, Tours, France
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Duminuco A, Mauro E, Palumbo GAM, Garibaldi B, Parisi M, Di Raimondo F, Maugeri C, Vetro C. Therapeutic innovation for multi-resistant candidemics: Synergy of isavuconazole and caspofungin association. Hematol Rep 2021; 13:9329. [PMID: 35070221 PMCID: PMC8743983 DOI: 10.4081/hr.2021.9329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/17/2021] [Indexed: 01/16/2023] Open
Abstract
Fungal infections occurring in immunocompromised patients after immunochemotherapy treatment are often difficult to eradicate and capable of even being fatal. Systemic mycoses affecting severely immunocompromised patients often manifest acutely with rapidly progressive pneumonia, fungemia, or manifestations of extrapulmonary dissemination. Opportunistic fungal infections (mycoses) include several pathogens elements, as candidiasis, aspergillosis, mucormycosis (zygomycosis) and fusariosis. Prompt diagnosis and effective therapy are needed to improve the associated morbidity and mortality, especially in cases with non-canonical fungal localizations and not responsive to the available antifungal drugs.
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Affiliation(s)
- Andrea Duminuco
- Post Graduation School of Hematology, University of Catania, A.O.U. 'Policlinico-San Marco', Catania
| | - Elisa Mauro
- Division of Hematology, A.O.U. 'Policlinico-San Marco', Catania, Italy
| | | | - Bruno Garibaldi
- Post Graduation School of Hematology, University of Catania, A.O.U. 'Policlinico-San Marco', Catania
| | - Marina Parisi
- Division of Hematology, A.O.U. 'Policlinico-San Marco', Catania, Italy
| | | | - Cinzia Maugeri
- Division of Hematology, A.O.U. 'Policlinico-San Marco', Catania, Italy
| | - Calogero Vetro
- Division of Hematology, A.O.U. 'Policlinico-San Marco', Catania, Italy
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Odysseos G, Mayr U, Bozsaki G, Seidensticker C, Ehmer U, Schmid RM, Lahmer T, Dill V. Isavuconazole and Liposomal Amphotericin B as Successful Combination Therapy of Refractory Invasive Candidiasis in a Liver Transplant Recipient: A Case Report and Literature Review. Mycopathologia 2021; 187:113-120. [PMID: 34718931 PMCID: PMC8807427 DOI: 10.1007/s11046-021-00599-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/15/2021] [Indexed: 11/30/2022]
Abstract
Invasive fungal infections in liver transplant recipients are associated with elevated morbidity and mortality and pose a challenge to the treating physicians. Despite of lacking clinical data, the use of antifungal combination therapy is often considered to improve response rates in an immunocompromised patient population. We herein report a case of refractory invasive candidiasis in a liver transplant recipient treated successfully with a combination of isavuconazole und high-dose liposomal amphotericin B. The antimycotic combination treatment was able to clear a bloodstream infection with C. glabrata and led to regression of bilomas among tolerable side effects. The use of the above-mentioned antifungal combination therapy in a liver transplant recipient has not been reported previously. This case highlights the efficacy and safety of antifungal combination therapy in immunocompromised patients with refractory invasive candidiasis.
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Affiliation(s)
- Georgios Odysseos
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Ulrich Mayr
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Gabor Bozsaki
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Christian Seidensticker
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Ursula Ehmer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Roland M Schmid
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Tobias Lahmer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität München, Munich, Germany
| | - Veronika Dill
- Klinik und Poliklinik für Innere Medizin III, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675, Munich, Germany.
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Bogler Y, Stern A, Su Y, Lee YJ, Seo SK, Shaffer B, Perales MA, Papanicolaou GA, Neofytos D. Efficacy and safety of isavuconazole compared with voriconazole as primary antifungal prophylaxis in allogeneic hematopoietic cell transplant recipients. Med Mycol 2021; 59:970-979. [PMID: 34036319 PMCID: PMC8487767 DOI: 10.1093/mmy/myab025] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/10/2021] [Accepted: 05/15/2021] [Indexed: 12/17/2022] Open
Abstract
Voriconazole is frequently discontinued prematurely as primary antifungal prophylaxis (AFP) in allogeneic hematopoietic cell transplant (HCT) recipients due to adverse events. Limited data exists for isavuconazole as AFP. We analyzed adult HCT recipients who received voriconazole or isavuconazole AFP to estimate rate of premature AFP discontinuation, identify risk factors for premature AFP discontinuation, and compare incidence of invasive fungal infection (IFI) and survival at day + 180 post-HCT between patients who received voriconazole/isavuconazole-AFP. This was a propensity score matched cohort analysis of 210 HCT-recipients who received voriconazole-AFP (9/1/2014-12/31/2016; voriconazole-cohort), and 95 HCT-recipients who received isavuconazole-AFP (5/1/2017-10/31/2018; isavuconazole-cohort). AFP discontinuation for any reason prior to completion was defined as "premature". Median (interquartile range, IQR) duration of AFP was longer in the isavuconazole-cohort (94 days, 87-100) vs. the voriconazole-cohort (76 days, 23-94; P-value < 0.0001). Premature AFP discontinuation was more frequent in the voriconazole-cohort (92/210, 43.8%) vs. the isavuconazole-cohort (14/95, 14.7%; P-value < 0.0001). The most common reason for premature discontinuation was biochemical hepatotoxicity (voriconazole-cohort: 48/210, 22.8% vs. isavuconazole-cohort: 5/95, 5.26%; P-value = 0.0002). Transaminase values between baseline and end-of-treatment (EOT) and up to 14 days post-EOT significantly increased in the voriconazole-cohort, but remained unchanged in the isavuconazole-cohort. The incidence of IFI at day + 180 was 2.9% (6/210) and 3.2% (3/95) in the voriconazole-cohort and isavuconazole-cohort, respectively (P-value = 0.881). All-cause mortality at day + 180 was 2.4% (5/210) and 6.3% (6/95) in the voriconazole-cohort and isavuconazole-cohort, respectively (P-value = 0.089). When compared to voriconazole, isavuconazole was a safer and as effective primary AFP during the first 3 months after HCT. LAY SUMMARY When compared to voriconazole, isavuconazole is a safer and as effective primary antifungal prophylaxis during the first 3 months after allogeneic hematopoietic cell transplant, with lower rates of hepatotoxicity, and similar rates of fungal infections and all-cause mortality.
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Affiliation(s)
- Yael Bogler
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anat Stern
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yiqi Su
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yeon Joo Lee
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Susan K Seo
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Brian Shaffer
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Miguel-Angel Perales
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
- Adult Bone Marrow Transplantation Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Genovefa A Papanicolaou
- Infectious Diseases Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Dionysios Neofytos
- Infectious Disease Service, Geneva University Hospital, Geneva, Switzerland
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Vangheluwe T, Van Hoecke F, Dumoulin A, Vogelaers D. Broad-spectrum azoles and flucloxacillin: a dangerous match. Eur J Clin Microbiol Infect Dis 2021. [PMID: 34494173 DOI: 10.1007/s10096-021-04333-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 08/04/2021] [Indexed: 11/16/2022]
Abstract
Both invasive fungal infection with Aspergillus fumigatus and blood stream infection with methicillin-susceptible Staphylococcus aureus (MSSA) have a significant incidence in the critically ill. Voriconazole and, more recently, isavuconazole and high dose flucloxacillin are the standard first line treatments for these respective serious infections. However, an underestimated risk of a significant interaction needs to be taken into consideration, when both co-occur. We wish to highlight this important issue in the management of these patients through two case reports and to point to the inconsistency between different validated databases regarding this significant interaction as well the importance of a strict protocol for readily available therapeutic drug monitoring.
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22
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Kronig I, Masouridi-Levrat S, Chalandon Y, Glampedakis E, Vernaz N, Van Delden C, Neofytos D. Clinical Considerations of Isavuconazole Administration in High-Risk Hematological Patients: A Single-Center 5-Year Experience. Mycopathologia 2021; 186:775-788. [PMID: 34432216 PMCID: PMC8602163 DOI: 10.1007/s11046-021-00583-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 08/03/2021] [Indexed: 11/25/2022]
Abstract
Background There are limited real-life data on isavuconazole prophylaxis and treatment of invasive mold infections (IMI) in hematological patients and allogeneic hematopoietic cell transplant (HCT) recipients. Objectives Primary objective was to describe the indications of real-life isavuconazole administration at a university hospital. Secondary objectives included the description of liver function tests and QTc interval between baseline and end of treatment (EOT), clinical outcomes and breakthrough IMI by the EOT. Patients/Methods This was a 5-year single-center retrospective study of all adult patients with acute myeloid leukemia and/or allogeneic HCT recipients who received isavuconazole as prophylaxis and/or treatment between June 1, 2016, and July 31, 2020. Results Among 30 identified patients, the indications for isavuconazole administration were adverse events associated with prior antifungal treatment (N: 18, 60%: hepatotoxicity, renal insufficiency, long QTc interval, neurotoxicity, and potential drug–drug interactions in 6, 4, 3, 1 and 4 patients, respectively), clinical efficacy (N: 5, 16.6%), and other reasons (N: 10, 33.3%; 5/10 patients treated with isavuconazole to facilitate hospital discharge with orally administered appropriate treatment). Alanine aminotransferase significantly decreased from baseline (mean: 129 IU/L, range: 73, 202) to a mean of 48 IU/L (range: 20, 80) by day 14 (P-value: 0.02), 23.5 IU/L (range: 20, 27) by day 28 (P-value: 0.03) and 16.5 IU/L (range: 16, 17) by day 42 (P-value: 0.009). The QTc interval decreased from baseline (mean: 456.8 ms, range: 390, 533) to EOT (mean: 433.8 ms, range: 400, 472; P-value: 0.03). The mean isavuconazole plasma concentration was 2.9 mg/L (range: 0.9, 6.7). There was no breakthrough IMI observed. Conclusion Isavuconazole is a safe and reliable antifungal agent in complex hematological patients, with relatively low hepatotoxicity and QTc interval shortening properties.
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Affiliation(s)
- Ilona Kronig
- Division of Infectious Diseases, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Stavroula Masouridi-Levrat
- Bone Marrow Transplant Unit, Division of Hematology, Faculty of Medicine, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Yves Chalandon
- Bone Marrow Transplant Unit, Division of Hematology, Faculty of Medicine, University Hospital of Geneva, University of Geneva, Geneva, Switzerland
| | - Emmanouil Glampedakis
- Division of Infectious Diseases, University Hospital of Lausanne, Lausanne, Switzerland
| | - Nathalie Vernaz
- Geneva University Hospitals, University of Geneva, Geneva, Switzerland
| | - Christian Van Delden
- Division of Infectious Diseases, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland
| | - Dionysios Neofytos
- Division of Infectious Diseases, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211, Geneva, Switzerland.
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Rothe K, Braitsch K, Okrojek R, Heim M, Rasch S, Verbeek M, Schmid RM, Busch DH, Lahmer T. Clinical and microbiological features and outcomes of mucormycosis in critically ill patients. Int J Infect Dis 2021; 109:142-147. [PMID: 34229089 DOI: 10.1016/j.ijid.2021.06.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/18/2021] [Accepted: 06/30/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Mucormycosis is a rare invasive fungal infection with high mortality in patients with severe underlying predisposing factors causing immunosuppression. The exact incidence of mucormycosis and the optimal therapeutic approach is difficult to determine, especially in severe cases, due to the rarity of the disease. The new second-generation triazole isavuconazole provides an alternative treatment option which may represent a potential benefit in severe cases. MATERIALS AND METHODS A retrospective case series was conducted of patients with a positive laboratory culture for Mucorales and consistent clinical findings who required intensive care treatment. Patient characteristics including demographics, comorbidities, microbiological analysis, specific antifungal therapy and clinical outcome were analysed. RESULTS Fifteen critically ill patients with Mucorales detected between 2016 and 2019 were included in this study; the crude mortality rate was 100%. At the time of diagnosis of mucormycosis, 80% of subjects had relevant medical immunosuppression and 53.3% of subjects had neutropenia. Manifestation of mucormycosis was pulmonary in 53.3% of subjects, rhino-orbital in 20% of subjects and disseminated in 26.7% of subjects. Notably, 40% of all patients had received antifungal prophylaxis prior to mucormycosis, mainly with posaconazole due to underlying haematological malignancy, thus possibly representing break-through infections. Antifungal therapy for invasive mucormycosis was administered in 80% of subjects for a median duration of 16 days. CONCLUSION In this retrospective cohort analysis of intensive care patients, the prognosis of mucormycosis was extremely poor. An aggressive strategy for diagnosis and treatment is essential for intensive care patients with mucormycosis. There is a need for further research to determine if combination therapy in higher dosages or prompt surgery is beneficial in severe critically ill patients.
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Affiliation(s)
- Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Munich, Germany
| | - Krischan Braitsch
- Department of Internal Medicine III, Technical University of Munich, School of Medicine, Munich, Germany
| | - Rainer Okrojek
- Department of Internal Medicine I, Technical University of Munich, School of Medicine, Munich, Germany
| | - Markus Heim
- Department of Anaesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sebastian Rasch
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich, Germany
| | - Mareike Verbeek
- Department of Internal Medicine III, Technical University of Munich, School of Medicine, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich, Germany
| | - Dirk H Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Munich, Germany; German Centre for Infection Research, Partner Site Munich, Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich, Germany.
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24
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Cuetara MS, Jusdado Ruiz-Capillas JJ, Nuñez-Valentin MP, Rodríguez Garcia E, Garcia-Benayas E, Rojo-Amigo R, Rodriguez-Gallego JC, Hagen F, Colom MF. Successful Isavuconazole Salvage Therapy for a Cryptococcus deuterogattii (AFLP6/VGII) Disseminated Infection in a European Immunocompetent Patient. Mycopathologia 2021; 186:507-518. [PMID: 34115285 DOI: 10.1007/s11046-021-00566-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/24/2021] [Indexed: 12/29/2022]
Abstract
Members of the Cryptococcus gattii species complex are notorious causes of cryptococcosis as they often cause severe, life-threatening infections. Here we describe a case of a severe disseminated C. deuterogattii infection in a previously healthy patient who was initially treated with amphotericin B, 5-fluorocytosine and fluconazole, which led to a good neurological response, but the infection in the lungs remained unaltered and was not completely resolved until switching the antifungal therapy to isavuconazole. The infection was likely acquired during a one-month stay at the Azores Islands, Portugal. Environmental sampling did not yield any cryptococcal isolate; therefore, the source of this apparent autochthonous case could not be determined. Molecular typing showed that the cultured C. deuterogattii isolates were closely related to the Vancouver Island outbreak-genotype.
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Affiliation(s)
- Maria Soledad Cuetara
- Department of Microbiology, Hospital Universitario Severo Ochoa, Avda. de Orellana S/N. 28914, Leganés, Madrid, Spain.
| | | | | | | | - Elena Garcia-Benayas
- Department of Pharmacy, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - Ricardo Rojo-Amigo
- Department of Immunology, Hospital Materno-Infantil-CHUAC, La Coruña, Spain
| | | | - Ferry Hagen
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Laboratory of Medical Mycology, Jining No. 1 People's Hospital, Jining, Shandong, People's Republic of China
| | - María Francisca Colom
- Medical Mycology Laboratory, Department of Plant Production and Microbiology, University Miguel Hernández, Campus of Sant Joan D'Alacant, 03550, Alicante, Spain. .,Institute for Healthcare and Biomedical Research of Alicante, Isabial, Spain.
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25
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Miller RP, Farrugia L, Leask J, Khalsa K, Khanna N, Melia L. Successful treatment of Rhizopus arrhizus rhino-orbital-cerebral mucormycosis with isavuconazole salvage therapy following extensive debridement. Med Mycol Case Rep 2021; 32:39-42. [PMID: 33816097 PMCID: PMC8010354 DOI: 10.1016/j.mmcr.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 12/29/2022] Open
Abstract
A 61-year old lady with poorly-controlled type 2 diabetes mellitus was diagnosed with rhino-orbital-cerebral mucormycosis following presentation with sinusitis, ophthalmoplegia, proptosis and facial numbness. She was treated successfully with aggressive surgical intervention including orbital exenteration, accompanied by anti-fungal therapy with liposomal amphotericin B and posaconazole, followed by isavuconazole as salvage therapy. We discuss the challenges around optimising antifungal therapy of this lethal infection in the context of hepatic and renal toxicity.
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Affiliation(s)
- R P Miller
- Department of Ear, Nose & Throat (ENT) Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - L Farrugia
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - J Leask
- Depatment of Urology, Queen Elizabeth University Hospital, Glasgow, UK
| | - K Khalsa
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - N Khanna
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - L Melia
- Department of Ear, Nose & Throat (ENT) Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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26
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Mercorelli B, Celegato M, Luganini A, Gribaudo G, Lepesheva GI, Loregian A. The antifungal drug isavuconazole inhibits the replication of human cytomegalovirus (HCMV) and acts synergistically with anti-HCMV drugs. Antiviral Res 2021; 189:105062. [PMID: 33722615 DOI: 10.1016/j.antiviral.2021.105062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/29/2021] [Accepted: 03/05/2021] [Indexed: 02/07/2023]
Abstract
We recently reported that some clinically approved antifungal drugs are potent inhibitors of human cytomegalovirus (HCMV). Here, we report the broad-spectrum activity against HCMV of isavuconazole (ICZ), a new extended-spectrum triazolic antifungal drug. ICZ inhibited the replication of clinical isolates of HCMV as well as strains resistant to the currently available DNA polymerase inhibitors. The antiviral activity of ICZ against HCMV could be linked to the inhibition of human cytochrome P450 51 (hCYP51), an enzyme whose activity we previously demonstrated to be required for productive HCMV infection. Moreover, time-of-addition studies indicated that ICZ might have additional inhibitory effects during the first phase of HCMV replication. Importantly, ICZ showed synergistic antiviral activity in vitro when administered in combination with different approved anti-HCMV drugs at clinically relevant doses. Together, these results pave the way to possible future clinical studies aimed at evaluating the repurposing potential of ICZ in the treatment of HCMV-associated diseases.
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Affiliation(s)
| | - Marta Celegato
- Department of Molecular Medicine, University of Padua, Padua, Italy
| | - Anna Luganini
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy
| | - Giorgio Gribaudo
- Department of Life Sciences and Systems Biology, University of Turin, 10123, Turin, Italy
| | - Galina I Lepesheva
- Department of Biochemistry, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Arianna Loregian
- Department of Molecular Medicine, University of Padua, Padua, Italy.
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27
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Cultrera R, Torelli R, Sarnicola C, Segala D, Mengoli A, Chiaretto G, Perri P, Sanguinetti M. Identification and molecular characterization of Subramaniula asteroides causing human fungal keratitis: a case report. BMC Infect Dis 2021; 21:82. [PMID: 33461505 PMCID: PMC7814578 DOI: 10.1186/s12879-021-05768-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Keratitis due to by filamentous fungi are not easy to diagnose thus causing a delay in correct therapy. There are many descriptions of keratitis due to Candida, Fusarium and Aspergillus genera. Subramaniula genus has only recently been reported to cause human infections and there are few descriptions of eye infections due to this filamentous fungus. Diagnosis of fungal keratitis is usually based on microscopic and cultural techniques of samples obtained by corneal swabbing or scraping. Considering the amount of time required to obtain culture results it is wise to use other diagnostic methods, such as molecular analyses. Therapeutic options against these fungi are limited by low tissue penetration in the eye due to ocular barriers. We describe the first case of S. asteroides human keratitis treated with isavuconazole. Case presentation We describe a rare case of fungal keratitis unresponsive to antimicrobial treatment in a 65-year-old male patient without a history of diabetes or immunological diseases. He reported that the onset of symptoms occurred during a long holiday in Cape Verde Island. Initial treatment with topical antibiotics associated to steroids were ineffective, allowing a slow clinical progression of disease to corneal perforation. On admission in our Hospital, slit-lamp examination of the left eye showed conjunctival congestion and hyperemia, a large inferior corneal ulceration with brown pigment, corneal edema, about 3 mm of hypopyon and irido-lenticular synechiae. The slow clinical progression of the disease to corneal perforation and the aspect of the ulcer were consistent with a mycotic etiology. Molecular methods used on fungal colonies isolated by Sabouraud’s dextrose agar cultures allowed the identification of Subramaniula asteroids from corneal scraping. Antimicrobial test showed a good susceptibility of this filamentous fungus to voriconazole and isavuconazole. Moreover, this fungal keratitis was successfully treated with isavuconazole, without side effects, observing a progressive clinical improvement. Conclusions Molecular methods may be useful for the identification of filamentous fungal keratitis on scraping samples thus shortening the time of diagnosis. Systemic therapy by isavuconazole could be useful to treat the filamentous fungal keratitis, reducing the possible adverse effects due to the use of voriconazole by systemic administration.
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Affiliation(s)
- Rosario Cultrera
- Department of Morphology, Surgery and Experimental Medicine, Infectious Diseases Unit, University 'S. Anna' Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy.
| | - Riccardo Torelli
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Caterina Sarnicola
- Department of Biomedical and Surgical Sciences, Ophthalmology Unit, 'S. Anna' University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Daniela Segala
- Department of Morphology, Surgery and Experimental Medicine, Infectious Diseases Unit, University 'S. Anna' Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Andrea Mengoli
- Department of Biomedical and Surgical Sciences, Ophthalmology Unit, 'S. Anna' University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Giuseppina Chiaretto
- Clinical Microbiology, 'S. Anna' University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Paolo Perri
- Department of Biomedical and Surgical Sciences, Ophthalmology Unit, 'S. Anna' University Hospital of Ferrara, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Maurizio Sanguinetti
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Largo Agostino Gemelli 8, 00168, Rome, Italy.,Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
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28
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Miller MA, Molina KC, Gutman JA, Scherger S, Lum JM, Mossad SB, Burgess M, Cheng MP, Chuang ST, Jacobs SE, Melendez DP, Shah DP, Zimmer A, Sohail MR, Syed S, Walker RC, Poeschla EM, Abidi MZ. Mucormycosis in Hematopoietic Cell Transplant Recipients and in Patients With Hematological Malignancies in the Era of New Antifungal Agents. Open Forum Infect Dis 2020; 8:ofaa646. [PMID: 33575424 PMCID: PMC7863870 DOI: 10.1093/ofid/ofaa646] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/23/2020] [Indexed: 01/28/2023] Open
Abstract
Background The survival benefit of combination antifungal therapy for invasive mucormycosis (IM) in patients with hematologic malignancy (HM) and hematopoietic cell transplant (HCT) is not well defined. Methods This multicenter, retrospective study included HM and HCT recipients with proven or probable IM between January 1, 2007 and December 31, 2017 from 10 transplant centers across North America. Results Sixty-four patients with proven (n = 47) or probable (n = 17) IM defined by 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) consensus definitions were included. Thirty-nine (61%) were HCT recipients (95% allogeneic). Sites of infection included rhino-orbital-cerebral (33), pulmonary (30%), disseminated (19%), gastrointestinal (3%), and cutaneous (3%). Surgical debridement was performed in 66%. Initial antifungal treatment consisted of the following: lipid formulation of amphotericin B (AmB) alone (44%), AmB + posaconazole (25%), AmB + echinocandin (13%), AmB + isavuconazole (8%), posaconazole alone (5%), and isavuconazole alone (3%). All-cause mortality at 30 days and 1 year were 38% and 66%, respectively. Initial treatment with AmB plus posaconazole or isavuconazole (n = 28) was associated with a trend toward lower treatment failure compared with AmB (n = 21) (42% vs 64%, P = .136). Conclusions Long-term survival with IM among HM and HCT populations remains poor. However, initial use of AmB + azole in conjunction with surgery may result in less treatment failure. More evidence from prospective controlled studies is needed to confirm this observation.
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Affiliation(s)
- Matthew A Miller
- Department of Pharmacy-Infectious Diseases, University of Colorado Hospital, Denver, Colorado, USA
| | - Kyle C Molina
- Department of Pharmacy-Infectious Diseases, University of Colorado Hospital, Denver, Colorado, USA
| | - Jonathan A Gutman
- Division of Hematology and Oncology, University of Colorado Denver, Denver, Colorado, USA
| | - Sias Scherger
- Division of Infectious Diseases, University of Colorado Denver, Denver, Colorado, USA
| | - Jessica M Lum
- Department of Infectious Diseases, Respiratory Institute and Transplant Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Sherif B Mossad
- Department of Infectious Diseases, Respiratory Institute and Transplant Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Mary Burgess
- Division of Infectious Diseases, University of Arkansas, Fayetteville, Arkansas, USA
| | - Matthew P Cheng
- Division of Infectious Diseases, McGill University Health Centre, Montreal, Canada.,Division of Medical Microbiology, McGill University Health Centre, Montreal, Canada
| | - Sally T Chuang
- Division of Infectious Diseases, University of Rochester, Rochester, New York, USA
| | - Samantha E Jacobs
- Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Dante P Melendez
- Division of Infectious Diseases, University of Utah, Salt Lake City, Utah, USA
| | - Dimpy P Shah
- Division of Infectious Diseases, University of San Antonio, San Antonio, Texas, USA
| | - Andrea Zimmer
- Division of Infectious Diseases, University of Nebraska, Lincoln, Nebraska, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Baylor College of Medicine, Houston, Texas, USA
| | - Sadia Syed
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Randall C Walker
- Division of Infectious Diseases, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Eric M Poeschla
- Division of Infectious Diseases, University of Colorado Denver, Denver, Colorado, USA
| | - Maheen Z Abidi
- Division of Infectious Diseases, University of Colorado Denver, Denver, Colorado, USA
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29
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Durà-Miralles X, Escolà-Vergé L, Moreno D, Martínez-Ricarte F, Lung M, Fernández-Hidalgo N, Auger C, Martín-Gómez MT. Isolated cerebral mucormycosis associated with intravenous drug use. J Mycol Med 2020; 30:101046. [PMID: 33067115 DOI: 10.1016/j.mycmed.2020.101046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/20/2020] [Accepted: 09/28/2020] [Indexed: 11/20/2022]
Abstract
We present an uncommon case of isolated basal ganglia mucormycosis in a patient without any known cause of immunosuppression, but with a history of drug injection. The patient presented a good clinical and radiological response to antifungal treatment without aggressive surgical debridement (liposomal amphotericin B combined with isavuconazole for 4 weeks followed by isavuconazole as maintenance therapy for 10 months).
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30
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Pagano L, Cattaneo C, Quattrone M, Oberti M, Mazzitelli M, Trecarichi EM. Isavuconazole-Animal Data and Clinical Data. J Fungi (Basel) 2020; 6:E209. [PMID: 33036295 DOI: 10.3390/jof6040209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 12/14/2022] Open
Abstract
The treatment of invasive fungal infections has deeply evolved in the last years with the inclusion of new antifungals, mainly new azoles (i.e., posaconazole, isavuconazole), to the therapeutic armamentarium. This review focuses on the role of isavuconazole for treating the most important invasive fungal infections both in animals and humans (hematological and non-hematological patients).
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31
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Escribano P, Rodríguez-Sánchez B, Díaz-García J, Martín-Gómez MT, Ibáñez-Martínez E, Rodríguez-Mayo M, Peláez T, García-Gómez de la Pedrosa E, Tejero-García R, Marimón JM, Reigadas E, Rezusta A, Labayru-Echeverría C, Pérez-Ayala A, Ayats J, Cobo F, Pazos C, López-Soria L, Alastruey-Izquierdo A, Muñoz P, Guinea J. Azole resistance survey on clinical Aspergillus fumigatus isolates in Spain. Clin Microbiol Infect 2020; 27:1170.e1-1170.e7. [PMID: 33010446 DOI: 10.1016/j.cmi.2020.09.042] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/11/2020] [Accepted: 09/22/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We aimed to assess the percentage of azole resistance in Aspergillus fumigatus in Spain. METHODS Thirty participating Spanish hospitals stored all morphologically identified A. fumigatus sensu lato clinical isolates-regardless their clinical significance-from 15 February to 14 May 2019. Isolates showing azole resistance according to the EUCAST 9.3.2 methodology were molecularly identified and the cyp51A gene was studied in A. fumigatus sensu stricto isolates. RESULTS Eight hundred and forty-seven isolates from 725 patients were collected in 29 hospitals (A. fumigatus sensu stricto (n = 828) and cryptic species (n = 19)). Isolates were mostly from the lower respiratory tract (94.0%; 797/847). Only cryptic species were amphotericin B resistant. Sixty-three (7.4%) out of the 847 isolates were resistant to ≥1 azole(s). Azole resistance was higher in cryptic species than in A. fumigatus sensu stricto (95%, 18/19 vs. 5.5%, 45/828); isavuconazole was associated to the lowest number of non-wild type isolates. The dominant mechanism of resistance was the presence of TR34-L98H substitutions (n = 24 out of 63). Out of the 725 patients, 48 (6.6%) carried either cryptic species (n = 14) or A. fumigatus sensu stricto (n = 34; 4.7%) resistant isolates. Aspergillus fumigatus sensu stricto harbouring either the TR34-L98H (n = 19) or TR46/Y121F/T289A (n = 1) mutations were detected in patients in hospitals located at 7/24 studied cities. DISCUSSION Of the patients, 6.6% carry azole-resistant A. fumigatus sensu lato isolates in Spain. TR34-L98H is the dominant cyp51A gene substitutions, although its presence is not widespread.
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Affiliation(s)
- Pilar Escribano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Belén Rodríguez-Sánchez
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Judith Díaz-García
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | - María Rodríguez-Mayo
- Servicio de Microbiología Clínica, Complejo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - Teresa Peláez
- Servicio de Microbiología, Hospital Universitario Central de Asturias, Oviedo, Spain; Fundacion para la Investigación y la Innovación Biosanitaria del Principado de Asturias, Oviedo, Spain
| | - Elia García-Gómez de la Pedrosa
- Servicio de Microbiología, Hospital Ramón y Cajal, Madrid, Spain; Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain; Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Rocío Tejero-García
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Servicio de Microbiología Clínica del Hospital Universitario Reina Sofía, Córdoba, Spain; Instituto Maimónides de Investigación Biomédica, Córdoba, Spain
| | - José María Marimón
- Biodonostia, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group; Donostialdea Integrated Health Organisation, Microbiology Department, Donostia, Spain
| | - Elena Reigadas
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Antonio Rezusta
- Servicio de Microbiología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | | | - Ana Pérez-Ayala
- Servicio de Microbiología, Hospital 12 de Octubre, Madrid, Spain; Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain
| | - Josefina Ayats
- CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Microbiology Department, Hospital Universitari de Bellvitge-Universitat de Barcelona-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Fernando Cobo
- Instituto de Investigación Biosanitaria IBS, Granada, Spain; Department of Microbiology, University Hospital Virgen de las Nieves, Granada, Spain
| | - Carmen Pazos
- Servicio de Microbiología Clínica, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain
| | - Leyre López-Soria
- Servicio de Microbiología, Hospital Universitario Cruces, Barakaldo, Spain; Instituto de Investigación Sanitaria Biocruces Bizkaia, Barakaldo, Spain
| | - Ana Alastruey-Izquierdo
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain; Mycology Reference Laboratory, National Centre for Microbiology (ISCIII), Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain; Medicine Department, Faculty of Medicine, Universidad Complutense de Madrid, Spain
| | - Jesús Guinea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain.
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32
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Marcos-Zambrano LJ, Gómez A, Sánchez-Carrillo C, Bouza E, Muñoz P, Escribano P, Guinea J. Isavuconazole is highly active in vitro against Candida species isolates but shows trailing effect. Clin Microbiol Infect 2020; 26:1589-1592. [PMID: 32712246 DOI: 10.1016/j.cmi.2020.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Isavuconazole is a triazole previously shown to have potent in vitro activity against Aspergillus spp., Mucorales, and Candida spp. Unlike for other azoles, it is unclear if isavuconazole may induce a trailing effect. We studied isavuconazole MICs for a large collection of Candida isolates from blood samples and determined the extent of the trailing effect when using the EUCAST Edef 7.3.1 method. METHODS 761 molecularly identified Candida isolates from blood samples of 742 patients admitted to the hospital (January 2007 to September 2017) were evaluated and further tested for in vitro susceptibility to isavuconazole following the EUCAST E.Def 7.3.1 test method. RESULTS C. albicans showed the highest susceptibility, followed by C. parapsilosis and C. tropicalis (geometric mean MIC 0.003 vs 0.005/0.006, respectively; P < 0.001). In contrast, C. glabrata, and C. krusei had significantly higher MIC values (geometric mean MIC 0.094 vs 0.093, respectively). Isavuconazole MIC distributions were not truncated at the lowest concentration tested, except for C. albicans. Overall, the mean percentage of trailing was 12.9% but differences among species were observed: C. glabrata, C. albicans, and C. tropicalis exhibited higher trailing in comparison to C. parapsilosis and non-Candida yeasts (P < 0.001). The percentage of non-wild-type C. albicans (considering the heavy trailer isolates as wild-type), C. parapsilosis and C. glabrata isolates were 0.56% (2/355), 1.5% (3/200), and 4.65% (4/86), respectively. CONCLUSIONS Isavuconazole showed high in vitro activity against Candida spp., particularly against C. albicans. Trailing effect is commonly observed with isavuconazole, particularly with C. glabrata.
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Affiliation(s)
- Laura Judith Marcos-Zambrano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Gómez
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Carlos Sánchez-Carrillo
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CD06/06/0058), Madrid, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CD06/06/0058), Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CD06/06/0058), Madrid, Spain
| | - Pilar Escribano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CD06/06/0058), Madrid, Spain
| | - Jesús Guinea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain; CIBER Enfermedades Respiratorias-CIBERES (CD06/06/0058), Madrid, Spain.
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Prabhudas-Strycker KK, Butt S, Reddy MT. Candida tropicalis endocarditis successfully treated with AngioVac and micafungin followed by long-term isavuconazole suppression. IDCases 2020; 21:e00889. [PMID: 32642436 PMCID: PMC7332520 DOI: 10.1016/j.idcr.2020.e00889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/24/2020] [Accepted: 06/24/2020] [Indexed: 11/15/2022] Open
Abstract
We provide a review of current literature of native valve Candida tropicalis endocarditis. A 41-year old man presented with C. tropicalis candidemia complicated by superior vena cava mass and right main pulmonary artery thrombus. The patient achieved clinical and microbiologic cure with AngioVac of the mass and echinocandin for six weeks. Long-term suppression was challenging given the C. tropicalis strain was resistant to fluconazole, voriconazole and posaconazole. Additional susceptibilities were obtained and he remained relapse-free at 12 months with isavuconazole.
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Affiliation(s)
| | - Saira Butt
- Department of Internal Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Madhukanth T Reddy
- Infectious Diseases Consultants, Texas Health Harris Methodist Hospital, Fort Worth, TX, USA
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Mercier V, Bastides F, Bailly É, Garcia-Hermoso D, Miquelestorena-Standley E, El Baz Z, Marteau E, Vermes E, De Muret A, Bernard L, Desoubeaux G. Successful Terbinafine Treatment for Cutaneous Phaeohyphomycosis Caused by Trematosphaeria grisea in a Heart Transplanted Man: Case Report and Literature Review. Mycopathologia 2020; 185:709-716. [PMID: 32562177 DOI: 10.1007/s11046-020-00467-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 06/06/2020] [Indexed: 01/19/2023]
Abstract
Phaeohyphomycosis is a chronic infectious disease caused by dematiaceous fungi. It is characterized by the presence of pigmented septate mycelia within tissues. In the case of superficial infection, the lesion(s) chronically evolve(s) toward painless pseudo-tumor(s) of the soft parts. We report herein the original case of a heart transplanted man who exhibited phaeohyphomycosis of the left hand, with no mention of travels in endemic areas. Trematosphaeria grisea was identified as the causative agent, which is quite innovative since this species has been rather described in mycetoma. The antifungal treatment initially based on isavuconazole alone was not sufficient to cure the patient. In contrast, its association with local terbinafine ointment allowed total clinical improvement. This finding is unusual as diagnosis of phaeohyphomycosis caused by T. grisea is uncommon in nontropical countries, and as the outcome appeared successful by the means of add-on therapeutic strategy with terbinafine.
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Affiliation(s)
- Victor Mercier
- Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France.
| | - Frédéric Bastides
- Médecine Interne Et Maladies Infectieuses, CHU de Tours, Tours, France
| | - Éric Bailly
- Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France
| | - Dea Garcia-Hermoso
- CNRS, National Reference Center for Invasive Mycoses and Antifungals (NRCMA), Molecular Mycology Unit, UMR2000, Institut Pasteur, Paris, France
| | | | - Zaki El Baz
- Radiologie, CHU de Tours, Chambray-les-Tours, France
| | - Emilie Marteau
- Chirurgie orthopédique Et Traumatologie, CHU de Tours, Chambray-les-Tours, France
| | | | - Anne De Muret
- Anatomie Et Cytologie Pathologiques, CHU de Tours, Chambray-les-Tours, France
| | - Louis Bernard
- Médecine Interne Et Maladies Infectieuses, CHU de Tours, Tours, France
| | - Guillaume Desoubeaux
- Parasitologie - Mycologie et Médecine Tropicale, Hôpital Bretonneau, CHU de Tours, 2 Boulevard Tonnellé, 37044, Tours, France
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Hoang K, Abdo T, Reinersman JM, Lu R, Higuita NIA. A case of invasive pulmonary mucormycosis resulting from short courses of corticosteroids in a well-controlled diabetic patient. Med Mycol Case Rep 2020; 29:22-4. [PMID: 32547914 DOI: 10.1016/j.mmcr.2020.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/23/2020] [Accepted: 05/25/2020] [Indexed: 12/15/2022] Open
Abstract
A patient with well-controlled type 2 diabetes mellitus developed a severe pulmonary infection secondary to Rhizopus spp. after receiving short courses of corticosteroids for a respiratory tract infection. He recovered after an aggressive surgical intervention and treatment with isavuconazole. Patients on chronic corticosteroid therapy have a higher risk for pulmonary mucormycosis, but there are much fewer reports of mucormycosis occurring in patients after only short courses of steroid therapy.
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Castagnola E, Mesini A, Saffioti C, Barco S, Bandettini R, Dallorso S, Carrega G, Miano M, Palmisani E, Dufour C. Intravenous isavuconazole can be administered 5 days-a-week. A possibility suggested by a real-life observation. J Chemother 2020; 32:217-218. [PMID: 32364049 DOI: 10.1080/1120009x.2020.1755591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In this report it is shown that intravenous formulation of isavuconazole could be administered 5/7 days a week in patients who can not swallow capsules, once the steady state has been stably reached and maintained, thanks to its very long half-life. In this case TDM should be highly recommended.
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Affiliation(s)
- Elio Castagnola
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Alessio Mesini
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Carolina Saffioti
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Sebastiano Barco
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Roberto Bandettini
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Sandro Dallorso
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Giuliana Carrega
- Infectious Diseases Unit, Ospedale Santa Maria di Misericordia, Albenga, Italy
| | - Maurizio Miano
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Elena Palmisani
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Carlo Dufour
- Infectious Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Perrone S, Lisi C, La Barbera EO, Luise C, Lichtner M, Girmenia C, Cimino G. Isavuconazole Therapy of Disseminated and Encephalic Saprochaete Capitata Infection in an Acute Myeloid Leukemia Patient Treated with Midostaurin. Mediterr J Hematol Infect Dis 2020; 12:e2020026. [PMID: 32395215 DOI: 10.4084/MJHID.2020.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/05/2020] [Indexed: 12/24/2022] Open
Abstract
Background Saprochaete capitata is a rare and emerging opportunistic fungus, involving immunocompromised hosts, in particular, neutropenic patients after chemotherapy. Case Report: We report a case of disseminated and cerebral infection by Saprochaete capitata, in a 68-year-old woman affected by acute myeloid leukemia that was successfully managed with liposomal amphotericin B and isavuconazole. Conclusions This case illustrates the feasibility of isavuconazole therapy in the treatment of a S. capitata infection when co-administered with midostaurin.
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Novak AR, Bradley ME, Kiser TH, Mueller SW. Azole-resistant Aspergillus and Echinocandin-resistant Candida - What are the treatment options? Curr Fungal Infect Rep 2020; 14:141-152. [PMID: 32699568 DOI: 10.1007/s12281-020-00379-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose of Review This review summarizes current treatment options for echinocandin-resistant Candida spp. (ERC) and azole-resistant Aspergillus fumigatus (ARAF), emphasizing recent in vitro/in vivo data, clinical reports, and consensus statements. Recent Findings Advances in ERC and ARAF treatment are limited to specific antifungal combinations and dose optimization but remain reliant on amphotericin products. Although novel antifungals may provide breakthroughs in the treatment of resistant fungi, these agents are not yet available. Early identification and appropriate treatment remain a paramount, albeit elusive, task. Summary When either ERC or ARAF are suspected or proven, amphotericin products remain the cornerstone of initial therapy. For ERC, azoles are de-escalation options for susceptible isolates in stable patients to avoid amphotericin toxicities. Although combination echinocandin with high-dose salvage posaconazole or isavuconazole may be attempted in ARAF, it requires careful consideration following patient stabilization. Future research defining optimal therapies and early identification of ERC and ARAF is of extreme importance.
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Affiliation(s)
- Alison R Novak
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
| | - Mary E Bradley
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
| | - Tyree H Kiser
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
| | - Scott W Mueller
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
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Abstract
PURPOSE OF REVIEW This article aimed to review animal models of antifungals and identifies human literature to assess if the extrapolation of results is reliable. RECENT FINDINGS Animal studies have helped identify AUC/MIC targets for new drugs and formulations such as isavuconazole and delayed release posaconazole that have translated to successful outcomes in humans. Models have also been influential in the identification of possible combination therapies for the treatment of aspergillosis, such as voriconazole and echinocandins. However, challenges are endured with animal models when it comes to replicating the pharmacokinetics of humans which has been exemplified with the newest itraconazole formulation. Additionally, animal models have displayed a survival benefit with the use of iron chelators and amphotericin for mucormycosis which was not demonstrated in humans. SUMMARY Animal models have been a staple in the development and optimization of antifungal agents. They afford the ability to investigate uncommon diseases, such as invasive fungal infections, that would otherwise take years and many resources to complete. Although there are many benefits of animal models there are also shortcomings. This is why the reliability of extrapolating data from animal models to humans is often scrutinized.
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Affiliation(s)
- Victoria M Stevens
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
| | - Scott W Mueller
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
| | - Paul M Reynolds
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
| | - Robert MacLaren
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
| | - Tyree H Kiser
- Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, 12850 East Montview Boulevard, Mail Stop C238, Aurora, CO 80045, USA
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Abreu I, Guedes M, Duro R, Lopes S, Maciel J, Santos L. Pleural aspergillosis in a patient with recurrent spontaneous pneumothorax: The challenge of an optimal therapeutic approach. Med Mycol Case Rep 2020; 28:4-7. [PMID: 32181124 PMCID: PMC7063088 DOI: 10.1016/j.mmcr.2020.02.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 11/29/2022] Open
Abstract
Pleural aspergillosis (PA) is a rare but potentially fatal disease. Most cases are secondary to bronchopleural fistulae or pleural intervention and can occur in the absence of immunosuppression. We report a case of PA in a young patient after pleurodesis for recurrent pneumothorax. Clinical resolution was achieved with systemic and local antifungal therapy combined with surgical debridement. Hepatotoxicity led to a switch from voriconazole to isavuconazole, with a successful outcome.
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Affiliation(s)
- Isabel Abreu
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - Mariana Guedes
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - Raquel Duro
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - Sara Lopes
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - João Maciel
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
| | - Lurdes Santos
- Infectious Diseases Department, Centro Hospitalar Universitário de São João, Alameda Prof. Hernâni Monteiro, Oporto, 4200-319, Portugal
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Stern A, Su Y, Lee YJ, Seo S, Shaffer B, Tamari R, Gyurkocza B, Barker J, Bogler Y, Giralt S, Perales MA, Papanicolaou GA. A Single-Center, Open-Label Trial of Isavuconazole Prophylaxis against Invasive Fungal Infection in Patients Undergoing Allogeneic Hematopoietic Cell Transplantation. Biol Blood Marrow Transplant 2020; 26:1195-1202. [PMID: 32088367 DOI: 10.1016/j.bbmt.2020.02.009] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 12/13/2022]
Abstract
Isavuconazole is a broad-spectrum triazole approved for treatment of invasive fungal infections (IFIs). In this open-label, single-arm study, we evaluated isavuconazole for antifungal prophylaxis after allogeneic hematopoietic cell transplantation (HCT). Adult patients admitted for first HCT received micafungin 150 mg i.v. daily from admission through day +7 (D+7) post-transplantation (±2 days) followed by isavuconazole prophylaxis (i.v./p.o. 372 mg every 8 hours for 6 doses and then 372 mg daily) through maximum D+98 post-HCT. Patients were followed through D+182. The primary endpoint was prophylaxis failure, defined as discontinuation of prophylaxis for proven/probable IFI; systemic antifungal therapy for >14 days for suspected IFI; toxicity leading to discontinuation; or an adverse event. Between June 2017 and October 2018, 99 patients were enrolled in the study, of whom 95 were included in our analysis. The median patient age was 57 years (interquartile range [IQR], 50 to 66 years). Sixty-four (67%) patients received peripheral blood, 17(18%) received bone marrow, and 14 (15%) received a cord blood allograft for acute leukemia (55%), lymphoma (17%), myelodysplastic syndrome (16%), or another hematologic disease (14%). One-third (n = 31; 33%) of patients underwent CD34+-selected HCT. Isavuconazole prophylaxis was given for a median of 90 days (IQR, 87 to 91 days). Ten patients (10.7%) met the primary endpoint. Candidemia occurred in 3 patients (3.1%), 1 of whom had grade III skin acute graft-versus-host disease (GVHD). Toxicity leading to discontinuation occurred in 7 patients (7.4%). The most common toxicity was liver function abnormalities in 5 patients, including grade 1 transaminitis in 2 patients and grade 3 hyperbilirubinemia in 3 patients. Four patients (4.2%) had early discontinuation of isavuconazole for reasons not meeting the primary study endpoint. Six patients died during the study period, including 3 during prophylaxis and 3 during follow-up. No deaths were attributed to isavuconazole. The majority (85%) of allogeneic HCT recipients completed isavuconazole prophylaxis according to protocol. The rate of breakthrough candidemia was 3.1%, and there were no invasive mold infections. Our data support the utility of isavuconazole for antifungal prophylaxis after HCT.
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Affiliation(s)
- Anat Stern
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yiqi Su
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yeon Joo Lee
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Susan Seo
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Brian Shaffer
- Weill Cornell Medical College, New York, New York; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Roni Tamari
- Weill Cornell Medical College, New York, New York; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Boglarka Gyurkocza
- Weill Cornell Medical College, New York, New York; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Juliet Barker
- Weill Cornell Medical College, New York, New York; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yael Bogler
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sergio Giralt
- Weill Cornell Medical College, New York, New York; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Miguel-Angel Perales
- Weill Cornell Medical College, New York, New York; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Genovefa A Papanicolaou
- Infectious Disease Service, Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
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Mendoza MA, Anderson A, Morris MI, Lekakis L, Simkins J, Prado CE, Martinez OV, Komanduri KV, Camargo JF. Successful Treatment of Invasive Fungal Infection Due to Highly Resistant Aspergillus calidoustus in an Allogeneic Hematopoietic Cell Transplant Recipient. Mycopathologia 2020; 185:399-403. [PMID: 31925638 DOI: 10.1007/s11046-019-00423-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 12/20/2019] [Indexed: 12/13/2022]
Abstract
Invasive aspergillosis (IA) is the most common invasive fungal infection following a hematopoietic cell transplant, with emerging cryptic species exhibiting resistance to commonly used antifungals such as azoles. These species have been increasingly found after the introduction of anti-mold prophylaxis. We report a case of a 56-year-old female with primary myelofibrosis whose allogeneic hematopoietic cell transplant was complicated by disseminated fungal infection (skin, lung) due to Aspergillus calidoustus, a cryptic specie. Treatment of Aspergillus species remains challenging as these cryptic species are usually resistant to azoles including voriconazole which is the first line of treatment of IA. Infection was successfully treated with surgical excision and combination antifungal therapy based on in vitro susceptibility and synergy testing. Therapy included isavuconazole, a drug that has been shown to be non-inferior to voriconazole in the treatment of invasive mold infections.
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Mazzella A, Stone NRH, Pool ERM, García Mingo A, Bolache S, Wood C. HIV-associated disseminated histoplasmosis successfully treated with isavuconazole consolidation therapy. Med Mycol Case Rep 2019; 27:42-43. [PMID: 31908913 PMCID: PMC6940692 DOI: 10.1016/j.mmcr.2019.12.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 01/16/2023] Open
Abstract
A 30-year-old man with advanced HIV and disseminated histoplasmosis deteriorated after stepping down from intravenous liposomal amphotericin B to itraconazole. Therapeutic levels of itraconazole and posaconazole were not achieved, therefore liposomal amphotericin B was reintroduced. Stepdown treatment was switched to oral isavuconazole; since then the patient has remained well. Isavuconazole was effective in disseminated histoplasmosis as consolidation therapy. Lower plasma isavuconazole levels (1.6–2 μg/mL) were associated with a good outcome. With low plasma itraconazole levels, isavuconazole was a viable alternative.
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Affiliation(s)
- Andrea Mazzella
- Alexander Pringle Centre, North Middlesex University Hospital, Sterling Way, N18 1QX, London, UK
| | - Neil R H Stone
- Alexander Pringle Centre, North Middlesex University Hospital, Sterling Way, N18 1QX, London, UK
| | - Erica R M Pool
- Alexander Pringle Centre, North Middlesex University Hospital, Sterling Way, N18 1QX, London, UK.,University College London, Gower Street, WC1E 6BT, London, UK
| | - Ana García Mingo
- Alexander Pringle Centre, North Middlesex University Hospital, Sterling Way, N18 1QX, London, UK
| | - Sorina Bolache
- Alexander Pringle Centre, North Middlesex University Hospital, Sterling Way, N18 1QX, London, UK
| | - Chris Wood
- Alexander Pringle Centre, North Middlesex University Hospital, Sterling Way, N18 1QX, London, UK
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Scabini S, Lupia T, Angilletta R, De Rosa FG, Corcione S. Real-life use of isavuconazole outside the hematological wards. Eur J Intern Med 2019; 70:e10-e12. [PMID: 31526649 DOI: 10.1016/j.ejim.2019.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/09/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Silvia Scabini
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy.
| | - Roberto Angilletta
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
| | | | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
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45
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Andreani G, Fadda G, Gned D, Dragani M, Cavallo G, Monticone V, Morotti A, De Gobbi M, Guerrasio A, Barbui AM, D'Avolio A, Cilloni D. Rhino-Orbital-Cerebral Mucormycosis after Allogeneic Hematopoietic Stem Cell Transplantation and Isavuconazole Therapeutic Drug Monitoring during Intestinal Graft versus Host Disease. Mediterr J Hematol Infect Dis 2019; 11:e2019061. [PMID: 31700586 DOI: 10.4084/MJHID.2019.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022] Open
Abstract
A diagnosis of rhino-orbital-cerebral mucormycosis was made in a 59-year-old man with a secondary acute myeloid leukemia a few days after hematopoietic stem cell transplantation. Prompt treatment with combined antifungal therapy (liposomal amphotericin B and isavuconazole) followed by a procedure of endoscopic sinus surgery resulted in the resolution of the infection. Therapeutic drug monitoring of isavuconazole was performed during the year of treatment showing an increment of plasma concentrations in correspondence with the improvement of intestinal GvHD, thus suggesting that in this or similar conditions TDM for isavuconazole can be of value. A literature review of cases of rhino-orbital-cerebral and rhino-cerebral mucormycosis in allogeneic hematopoietic stem cell transplant recipients was carried out.
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Zuglian G, Ripamonti D, Tebaldi A, Rizzi M. Cutaneous mucormycosis by Rhizopus arrhizus treated with isavuconazole as first line therapy: A case report. Med Mycol Case Rep 2019; 26:42-43. [PMID: 31667060 PMCID: PMC6812037 DOI: 10.1016/j.mmcr.2019.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/22/2019] [Accepted: 10/02/2019] [Indexed: 11/17/2022] Open
Abstract
Mucormycosis are a group of infections that affect principally immunocompromised host and have a high mortality. Liposomal amphotericin B is the first-line treatment with combined surgical removal of the infectious focus. We report the case of 67-year-old man with idiopathic granulocytic aplasia and a cutaneous lesion caused by Rhizopus arrhizus treated with isavuconazole. Its safety profile and spectrum of activity make it an important therapeutic option.
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Affiliation(s)
- G. Zuglian
- University Department of Infectious and Tropical Diseases, University of Brescia and Spedali Civili General Hospital, Brescia, 25123, Italy
- Corresponding author.
| | - D. Ripamonti
- Unit of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, 24129, Italy
| | - A. Tebaldi
- Unit of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, 24129, Italy
| | - M. Rizzi
- Unit of Infectious Diseases, ASST Papa Giovanni XXIII, Piazza OMS 1, Bergamo, 24129, Italy
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47
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Oarbeascoa G, Dorado N, Bailén R, Serrano D, Balsalobre P, Pradillo V, Guinea J, Padilla B, Sancho M, Machado M, Buño I, Anguita J, Diez-Martin JL, Kwon M. Successful Treatment of Severe Aspergillosis with Isavuconazole Therapy after Allogeneic Stem Cell Transplantation. Chemotherapy 2019; 64:57-61. [PMID: 31484176 DOI: 10.1159/000502279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/22/2019] [Indexed: 11/19/2022]
Abstract
Invasive fungal infections are one of the main infectious complications in allogeneic stem cell transplantation (SCT). Triazoles (voriconazole, posaconazole) are the main prophylactic and therapeutic options for the treatment of invasive aspergillosis. However, pharmacological interactions and hepatotoxicity limit its use. Isavuconazole (ISV) is a recently approved azole with a promising interaction and safety profile. We present a case with invasive aspergillosis in the post-allogeneic SCT setting in a critically ill patient with severe multiorgan failure due to veno-occlusive disease. The patient was treated with ISV and B amphotericin during severe kidney and liver failure and multiple immunosuppressants, without significant drug-related toxicity and with favorable outcome. The interaction and safety profile of ISV is discussed along the reported experience. ISV can be an effective salvage therapy even in complex clinical situations with multiple potential interactions.
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Affiliation(s)
- Gillen Oarbeascoa
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain, .,Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain,
| | - Nieves Dorado
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain
| | - Rebeca Bailén
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain
| | - David Serrano
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain
| | - Pascual Balsalobre
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain
| | - Virginia Pradillo
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Jesus Guinea
- Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain.,Clinical Microbiology and Infectious Diseases - HIV Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain.,CIBER Enfermedades Respiratorias-CIBERES (CB06/06/0058), Madrid, Spain
| | - Belen Padilla
- Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain.,Clinical Microbiology and Infectious Diseases - HIV Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Milagros Sancho
- Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain.,Intensive Care Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Marina Machado
- Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain.,Clinical Microbiology and Infectious Diseases - HIV Department, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Ismael Buño
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain.,Genomics Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | - Javier Anguita
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain
| | - Jose Luis Diez-Martin
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain.,Universidad Complutense de Madrid, Madrid, Spain
| | - Mi Kwon
- Department of Hematology, Hospital General Universitario Gregorio Marañon, Madrid, Spain.,Instituto de Investigación Sanitaria Gregorio Marañon, Madrid, Spain
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48
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Finniss M, Lewis P, Myers J, Ibrahim L, Patel P. A case of gastrointestinal histoplasmosis with esophageal involvement. Clin J Gastroenterol 2020; 13:173-7. [PMID: 31486020 DOI: 10.1007/s12328-019-01036-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 08/13/2019] [Indexed: 12/29/2022]
Abstract
Histoplasmosis is a common infection endemic to the Ohio and Mississippi River Valleys caused by the inhalation of Histoplasma capsulatum spores from contaminated soil. Most infections are asymptomatic; however, patients with impaired cellular immunity (HIV infection, hematologic malignancy, solid organ transplant, hematopoietic stem cell transplant or TNF-⍺ inhibitor use) are at risk for disseminated disease. Disseminated histoplasmosis commonly affects the lungs, liver, spleen, bone marrow and gastrointestinal tract. Esophageal involvement is rare and usually due to extrinsic compression from affected mediastinal/hilar lymph nodes. Herein, we report a case of disseminated histoplasmosis in an AIDs patient involving the esophagus, without evidence of mediastinal involvement.
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Abstract
PURPOSE OF REVIEW The incidence of invasive aspergillosis has increased substantially over the past few decades, accompanied by a change in susceptibility patterns of Aspergillus fumigatus with increasing resistance observed against triazole antifungals, including voriconazole and isavuconazole, the most commonly used antifungal agents for the disease. Culture-based methods for determining triazole resistance are still the gold standard but are time consuming and lack sensitivity. We sought to provide an update on non-culture-based methods for detecting resistance patterns to Aspergillus. RECENT FINDINGS New molecular-based approaches for detecting triazole resistance to Aspergillus, real-time polymerase chain reaction (PCR) to detect mutations to the Cyp51A protein, have been developed which are able to detect most triazole-resistant A. fumigatus strains in patients with invasive aspergillosis. SUMMARY Over the last few years, a number of non-culture-based methods for molecular detection of Aspergillus triazole resistance have been developed that may overcome some of the limitations of culture. These molecular methods are therefore of high epidemiological and clinical relevance, mainly in immunocompromised patients with hematological malignancies, where culture has particularly limited sensitivity. These assays are now able to detect most triazole-resistant Aspergillus fumigatus strains. Given that resistance rates vary, clinical utility for these assays still depends on regional resistance patterns.
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Affiliation(s)
- Jeffrey D. Jenks
- Department of Medicine, University of California San Diego, San Diego, CA 92103, USA
| | - Birgit Spiess
- Department of Hematology and Oncology, Scientific Laboratory, University Hospital Mannheim, Heidelberg University, Pettenkoferstraße 22, 68169 Mannheim, Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology, Scientific Laboratory, University Hospital Mannheim, Heidelberg University, Pettenkoferstraße 22, 68169 Mannheim, Germany
| | - Martin Hoenigl
- Department of Medicine, University of California San Diego, San Diego, CA 92103, USA
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
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50
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Linder KA, Gandhi TN, Miceli MH. Treatment Failure of Isavuconazole in a Patient with Cryptococcosis. Mycopathologia 2019; 184:667-670. [PMID: 31451965 DOI: 10.1007/s11046-019-00374-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/16/2019] [Indexed: 12/13/2022]
Abstract
Isavuconazole is a broad-spectrum azole that is FDA-approved for the treatment of aspergillosis and mucormycosis; data on the use of isavuconazole for the treatment and prevention of other invasive fungal infections are limited. Here, we report a patient with pulmonary cryptococcosis treated with isavuconazole who experienced progression to disseminated infection with Cryptococcus while on isavuconazole. Caution is advised when using isavuconazole in situations where there is a paucity of data to recommend its use.
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Affiliation(s)
- Kathleen A Linder
- Division of Infectious Diseases, University of Michigan Medical School, 1500 E. Medical Dr., South University Hospital F4005, Ann Arbor, MI, 48109-5378, USA.,Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Tejal N Gandhi
- Division of Infectious Diseases, University of Michigan Medical School, 1500 E. Medical Dr., South University Hospital F4005, Ann Arbor, MI, 48109-5378, USA
| | - Marisa H Miceli
- Division of Infectious Diseases, University of Michigan Medical School, 1500 E. Medical Dr., South University Hospital F4005, Ann Arbor, MI, 48109-5378, USA.
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