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Viñado C, Girón RM, Ibáñez E, García-Ortega A, Pérez I, Polanco D, Pemán J, Solé A. Filamentous fungi in the airway of patients with cystic fibrosis: Just spectators? Rev Iberoam Micol 2021; 38:168-174. [PMID: 34535388 DOI: 10.1016/j.riam.2021.03.005] [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: 11/12/2020] [Revised: 01/17/2021] [Accepted: 03/24/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND There are important advances in the management of bacterial infection in patients with cystic fibrosis (CF), but there are many gaps in the field of fungal infections. AIMS The aim of this study was to analyse whether chronic respiratory filamentous fungal colonization had clinical impact and whether antifungal treatment can change the disease. METHODS The prospective, bicentric and descriptive study was carried out within a 3-year follow-up period, with four-month periodicity medical controls. Adult patients from two CF units of tertiary hospitals were included. Clinical, microbiological, analytical and spirometric variables were collected. Quality of life was evaluated in a subgroup, using the Spanish version of the Revised Cystic Fibrosis Quality of Life Questionnaire (CFQ-R). To statistically analyze the evolution of forced expiratory along time (volume of air blown out in 1 second -FEV1-) and the forced vital capacity (FVC), mixed linear models were carried out. RESULTS From the ninety-eight patients under study, 40 suffered chronic filamentous fungal colonization. The presence of filamentous fungi in airway was associated to an annual fall of FEV1 and FVC of 0.029 and 0.017 litres, respectively (p<0.001). In addition, worse quality of life based on CFQ-R, significant when concerning physical condition and emotional state, was also linked with the fungal colonization. Protocolized antifungal therapy, nebulized or oral, improved FEV1 in 0.023 and 0.024 litres per year, respectively (p<0.001). CONCLUSIONS Chronic filamentous fungal colonization in patients with CF is associated with a significant annual decline of lung function that persists over time. Chronic antifungal therapy slows down this progression, mainly in the patient with more advanced disease.
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Affiliation(s)
- Clara Viñado
- Servicio de Neumología del Hospital de Barbastro, Spain.
| | - Rosa María Girón
- Unidad de Fibrosis Quística del Hospital Universitario de la Princesa de Madrid, Spain
| | - Elisa Ibáñez
- Servicio de Microbiología del Hospital Universitario y Politécnico La Fe de Valencia, Spain
| | - Alberto García-Ortega
- Unidad de Fibrosis Quística y Trasplante Pulmonar del Hospital Universitario y Politécnico La Fe de Valencia, Spain
| | - Inés Pérez
- Unidad de Fibrosis Quística y Trasplante Pulmonar del Hospital Universitario y Politécnico La Fe de Valencia, Spain
| | - Dinora Polanco
- Servicio de Neumología del Hospital Universitario Arnau de Vilanova de Lleida, Spain
| | - Javier Pemán
- Servicio de Microbiología del Hospital Universitario y Politécnico La Fe de Valencia, Spain
| | - Amparo Solé
- Unidad de Fibrosis Quística y Trasplante Pulmonar del Hospital Universitario y Politécnico La Fe de Valencia, Spain
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Ruiz-Gaitán A, Del Pozo JL. [AmBisome, three challenges: Candida auris infection, central nervous system infection, and biofilm-associated infection]. Rev Iberoam Micol 2021; 38:84-90. [PMID: 34144836 DOI: 10.1016/j.riam.2021.03.004] [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: 02/04/2021] [Revised: 03/21/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022] Open
Abstract
The treatment of invasive fungal infections remains a challenge, both for the diagnosis and for the need of providing the appropriate antifungal therapy. Candida auris is a pathogenic yeast that is responsible for hospital outbreaks, especially in intensive care units; it is characterized by a high resistance to the antifungal agents and can become multidrug-resistant. At present, the recommended antifungal agents for the invasive infections with this pathogen are echinocandins, always after carrying out an antifungal susceptibility testing. In case of no clinical response or persistent candidemia, the addition of liposomal amphotericin B or isavuconazole may be considered. Both fungal infection of the central nervous system and that associated with biomedical devices remain rare entities affecting mainly immunocompromised patients. However, an increase in their incidence in recent years, along with high morbidity and mortality, has been shown. The treatment of these infections is conditioned by the limited knowledge of the pharmacokinetic properties of antifungals. A better understanding of the pharmacokinetic and pharmacodynamic parameters of the different antifungals is essential to determine the efficacy of the antifungal agents in the treatment of these infections.
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Solano C, Vázquez L. [Invasive aspergillosis in the patient with oncohematologic disease]. Rev Iberoam Micol 2019; 35:198-205. [PMID: 30554673 DOI: 10.1016/j.riam.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 06/04/2018] [Revised: 09/08/2018] [Accepted: 10/05/2018] [Indexed: 12/21/2022] Open
Abstract
Invasive aspergillosis is the most common invasive fungal infection in patients with acute hematological malignancies or treated with hematopoietic stem cell transplantation due to the marked alteration of the physiological mechanisms of antifungal immunity that takes place in these situations. For this reason, antifungal prophylaxis has a relevant role in these patients. The introduction of new antifungal agents has motivated the updating of recommendations for prophylaxis and treatment in different guidelines. The objectives of this chapter are a brief review of the mechanisms of immunity against fungi, the definition of risk for developing an invasive fungal infection and an update of the prophylaxis recommendations and treatment of invasive aspergillosis in the group of patients with hematological diseases.
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Affiliation(s)
- Carlos Solano
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España.
| | - Lourdes Vázquez
- Servicio de Hematología y Hemoterapia, Hospital Clínico Universitario, Universidad de Salamanca, Salamanca, España
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Pérez-Cantero A, Thomson P, Paredes K, Guarro J, Capilla J. Antifungal susceptibility of Saccharomyces cerevisiae and therapy in a murine model of disseminated infection. Rev Iberoam Micol 2019; 36:37-40. [PMID: 30765275 DOI: 10.1016/j.riam.2018.04.004] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 01/31/2018] [Accepted: 04/13/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The incidence of systemic infections by Saccharomyces cerevisiae has increased in recent years, especially among immunocompromised patients. Amphotericin B, voriconazole or echinocandins have been used with favorable outcome against systemic infections by this fungus. However, clinical experience is limited and no in vivo studies have been conducted. AIMS We evaluated the in vitro activity of nine antifungal compounds against S.cerevisiae and the in vivo efficacy of those three antifungals showing the highest in vitro activity by using a murine model of systemic infection. METHODS Minimal inhibitory concentrations (MICs) were determined by the microdilution method against three strains of S. cerevisiae. After intravenous infection with 5×107 CFUs, animals received liposomal amphotericin B (5mg/kg), voriconazole (25mg/kg) or anidulafungin (5mg/kg). Treatment efficacy was assessed by determining of CFUs/g in liver, kidney, brain, lung and spleen. RESULTS 5-Fluorocytosine was the most in vitro active compound followed by amphotericin B, voriconazole and anidulafungin. The in vivo study showed that liposomal amphotericin B was the most effective drug driving highest fungal clearance. CONCLUSIONS All treatments reduced the fungal load in comparison to the control group, being liposomal amphotericin B the most effective drug followed by anidulafungin and finally voriconazole.
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Affiliation(s)
- Alba Pérez-Cantero
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, IISPV Reus, Tarragona, Spain
| | - Pamela Thomson
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, IISPV Reus, Tarragona, Spain
| | - Katihuska Paredes
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, IISPV Reus, Tarragona, Spain
| | - Josep Guarro
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, IISPV Reus, Tarragona, Spain
| | - Javier Capilla
- Unitat de Microbiologia, Facultat de Medicina i Ciències de la Salut, Universitat Rovira i Virgili, IISPV Reus, Tarragona, Spain.
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Arechavala A, Negroni R, Messina F, Romero M, Marín E, Depardo R, Walker L, Santiso G. Cryptococcosis in an Infectious Diseases Hospital of Buenos Aires, Argentina. Revision of 2041 cases: Diagnosis, clinical features and therapeutics. Rev Iberoam Micol 2017; 35:1-10. [PMID: 29129578 DOI: 10.1016/j.riam.2017.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 08/05/2016] [Revised: 02/22/2017] [Accepted: 04/21/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cryptococcosis is still a life-threatening mycosis that continues to be of serious concern in Latin American countries, especially among HIV+positive population. However, there is not any reliable information about the prevalence of this disease in this region. AIMS The aim of this study is to report data of 2041 patients with cryptococcosis that were attended at the Infectious Diseases Hospital F. J. Muñiz over a 30 year-period. METHODS Information about demographic and clinical data, survival time and the applied treatment, was taken from the Mycology Unit database. Mycological exams from different clinical samples were performed. Cryptococcal capsular antigen in serum and cerebrospinal fluid was detected through the latex agglutination technique. Cryptococcus isolates were phenotypically identified and the genotype was determined in some of them. Susceptibility tests were carried out following M27-A3 document. RESULTS Seventy five percent of HIV+positive patients and 50% of the HIV-negative population were males. Mean ages were 34.1 in HIV+positive patients and 44.8 in the HIV-negative. Cryptococcosis was associated with AIDS in 98% of the cases. Meningeal compromise was seen in 90% of the patients. Although cerebrospinal fluid rendered more positive results, blood culture was the first diagnostic finding in some cases. Cryptococcal antigen showed positive results in 96.2% of the sera samples and in the 93.1% of the cerebrospinal fluid samples. Most of the isolates were Cryptococcus neoformans and belonged to genotype VNI. Minimal inhibitory concentration values were mostly below the epidemiological cutoff values. CONCLUSIONS We observed that thanks to a high level of clinical suspicion, early diagnosis, combined therapy and intracranial pressure control by daily lumbar punctures, the global mortality rate has markedly decreased through the years in the analyzed period.
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Affiliation(s)
- Alicia Arechavala
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina.
| | - Ricardo Negroni
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Fernando Messina
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Mercedes Romero
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Emmanuel Marín
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Roxana Depardo
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Laura Walker
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
| | - Gabriela Santiso
- Unidad Micología, Hospital de Enfermedades Infecciosas Dr. Francisco J. Muñiz, Uspallata 2272, Buenos Aires City, Argentina
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Ferrer R, Zaragoza R, Rodríguez AH, Maseda E, Llinares P, Grau S, Álvarez-Lerma F, Quindós G, Salavert M, Huarte R. EPICO 3.0. Management of non-neutropenic patients in medical wards. Rev Iberoam Micol 2016; 33:216-223. [PMID: 27769740 DOI: 10.1016/j.riam.2016.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 05/09/2016] [Revised: 06/16/2016] [Accepted: 06/17/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Although the management of invasive fungal infection (IFI) has improved, a number of controversies persist regarding the approach to invasive fungal infection in non-neutropenic medical ward patients. AIMS To identify the essential clinical knowledge to elaborate a set of recommendations with a high level of consensus necessary for the management of IFI in non-neutropenic medical ward patients. METHODS A prospective, Spanish questionnaire, which measures consensus through the Delphi technique, was anonymously answered and e-mailed by 30 multidisciplinary national experts, all specialists (intensivists, anesthesiologists, microbiologists, pharmacologists and specialists in infectious diseases) in IFI and belonging to six scientific national societies. They responded to five questions prepared by the coordination group after a thorough review of the literature published in the last few years. For a category to be selected, the level of agreement among the experts in each category had to be equal to or greater than 70%. In a second round, 73 specialists attended a face-to-face meeting held after extracting the recommendations from the chosen topics, and validated the pre-selected recommendations and derived algorithm. RESULTS The following recommendations were validated and included in the algorithm: 1. several elements were identified as risk factors for invasive candidiasis (IC) in non-hematologic medical patients; 2. no agreement on the use of the colonization index to decide whether prescribing an early antifungal treatment to stable patients (no shock), with sepsis and no other evident focus and IC risk factors; 3. agreement on the use of the Candida Score to decide whether prescribing early antifungal treatment to stable patients (no shock) with sepsis and no other evident focus and IC risk factors; 4. agreement on initiating early antifungal treatment in stable patients (no shock) with a colonization index>0.4, sepsis with no other evident focus and IC risk factors; 5. agreement on the performance of additional procedures in stable patients (no shock) with sepsis and no other evident focus, IC risk factors, without colonization index>0.4, but with a high degree of suspicion. CONCLUSIONS Based on the expert's recommendations, an algorithm for the management of non-neutropenic medical patients was constructed and validated. This algorithm may be useful to support bedside prescription.
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Affiliation(s)
- Ricardo Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital. Shock, organ dysfunction and Resuscitation Research Group (SODIR), VHIR, Barcelona, Spain.
| | - Rafael Zaragoza
- Intensive Care Medicine Service, Dr. Peset University Hospital, Valencia, Spain
| | | | - Emilio Maseda
- Anesthesiology Service, La Paz University Hospital, Madrid, Spain
| | - Pedro Llinares
- Infectious Diseases Service, A Coruña University Complex Hospital, A Coruña, Spain
| | - Santiago Grau
- Pharmacy Service, Hospital del Mar, Barcelona, Spain
| | | | - Guillermo Quindós
- Microbiology Service, Faculty of Medicine and Dentistry, Basque Country University, Spain
| | - Miguel Salavert
- Infectious Diseases Service, Hospital La Fe, Valencia, Spain
| | - Rafael Huarte
- Pharmacy Service, Miguel Servet University Hospital, Zaragoza, Spain
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Gómez-Moyano E, Hiraldo Gamero A, Vera Casaño Á, Crespo Erchiga V, González Enseñat MA, Vicente Villa MA, Zsolt Fradera I, Moreno Giménez JC. [Phase III study of the efficacy and safety of ciclopirox olamine cream in small children with dermatomycosis]. Rev Iberoam Micol 2015; 32:164-9. [PMID: 25728876 DOI: 10.1016/j.riam.2014.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 02/13/2014] [Accepted: 04/07/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND There is scarce information on the use of ciclopirox olamine in children. AIMS The aim of this study was to evaluate the efficacy and safety of ciclopirox olamine cream 1% for the treatment of dermatomycosis in pediatric patients. METHODS A multicenter, non-randomized, open-label, phase iii study was conducted on patients aged 3 months to 9 years diagnosed with dermatomycosis confirmed by direct microscopy and culture, and treated with ciclopirox olamine cream 1% for 28 days. Clinical and microbiological evaluations were performed before starting the treatment therapy, at 7, 14 and 28 days after starting the treatment, and 28 days after its completion. RESULTS Twenty-one patients with a median age of 2.7 years (range 3 months-9 years) were included. The most frequent mycosis location was the inguinal region (72%). The most frequently isolated etiological agent was Candida spp. (71%). No adverse events were reported in 62% of the patients. Among the mild and moderate reported adverse events, only one, irritative dermatitis, was considered as possibly related to the treatment. Safety evaluation was excellent in 95% of the patients, and good in 5%. After the first week of treatment, 12 patients out of 13 (92%) showed a clinical improvement, and 5 out of 7 (71%) had both clinical and mycological improvements. At the end of the treatment, clinical cure was observed in 7 out of 9 patients (78%). No relapses occurred. CONCLUSIONS Ciclopirox olamine cream 1% is a safe and feasible treatment for superficial cutaneous mycotic infections, especially Candida spp. infection, in children aged between 3 months and 10 years.
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