scholarly journals Micafungin twice weekly as antifungal prophylaxis in paediatric patients at high risk for invasive fungal disease

2015 ◽  
Vol 70 (5) ◽  
pp. 1527-1530 ◽  
Author(s):  
K. Bochennek ◽  
A. Balan ◽  
L. Müller-Scholden ◽  
M. Becker ◽  
F. Farowski ◽  
...  
Keyword(s):  
High Risk ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Antifungal Prophylaxis ◽  
Paediatric Patients

scholarly journals Somatic GATA2 mutations define a subgroup of myeloid malignancy patients at high risk for invasive fungal disease

2020 ◽  
Vol 5 (1) ◽  
pp. 54-60
Author(s):  
Rahul S. Vedula ◽  
Matthew P. Cheng ◽  
Christine E. Ronayne ◽  
Dimitrios Farmakiotis ◽  
Vincent T. Ho ◽  
...  
Keyword(s):  
High Risk ◽  
Gene Mutations ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Antifungal Prophylaxis ◽  
Cell Transplant ◽  
Myeloid Malignancy ◽  
Somatic Gene ◽  
Treatment Complication ◽  
Gata2 Deficiency

Abstract Invasive fungal disease (IFD) can be a severe treatment complication in patients with myeloid malignancies, but current risk models do not incorporate disease-specific factors, such as somatic gene mutations. Germline GATA2 deficiency is associated with a susceptibility to IFD. To determine whether myeloid gene mutations were associated with IFD risk, we identified 2 complementary cohorts of patients with myeloid malignancy, based on (1) the diagnosis of invasive aspergillosis (IA), or (2) the presence of GATA2 mutations identified during standard clinical sequencing. We found somatic GATA2 mutations in 5 of 27 consecutive patients who had myeloid malignancy and developed IA. Among 51 consecutive patients with GATA2 mutations identified in the evaluation of myeloid malignancy, we found that IFD was diagnosed and treated in 21 (41%), all of whom had received chemotherapy or had undergone an allogeneic stem cell transplant. Pulmonary infections and disseminated candidiasis were most common. The 90-day mortality was 52% among patients with IFD. Our results indicate that patients with somatic GATA2 mutations are a vulnerable subgroup of patients with myeloid malignancy who have high risk for treatment-associated IFD and suggest that a focused approach to antifungal prophylaxis be considered.

scholarly journals A National Strategy to Diagnose Coronavirus Disease 2019–Associated Invasive Fungal Disease in the Intensive Care Unit

2020 ◽  
Author(s):  
P Lewis White ◽  
Rishi Dhillon ◽  
Alan Cordey ◽  
Harriet Hughes ◽  
Federica Faggian ◽  
...  
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Mortality Rate ◽  
Respiratory Distress ◽  
Antifungal Therapy ◽  
Invasive Fungal Disease ◽  
Chronic Respiratory Disease ◽  
Fungal Disease ◽  
Antifungal Prophylaxis ◽  
Severe Respiratory Distress

Abstract Background Fungal coinfection is a recognized complication of respiratory virus infections, increasing morbidity and mortality, but can be readily treated if diagnosed early. An increasing number of small studies describing aspergillosis in coronavirus disease 2019 (COVID-19) patients with severe respiratory distress are being reported, but comprehensive data are lacking. The aim of this study was to determine the incidence, risk factors, and impact of invasive fungal disease in adult COVID-19 patients with severe respiratory distress. Methods An evaluation of a national, multicenter, prospective cohort evaluation of an enhanced testing strategy to diagnose invasive fungal disease in COVID-19 intensive care patients. Results were used to generate a mechanism to define aspergillosis in future COVID-19 patients. Results One-hundred and thirty-five adults (median age: 57, M/F: 2.2/1) were screened. The incidence was 26.7% (14.1% aspergillosis, 12.6% yeast infections). The overall mortality rate was 38%; 53% and 31% in patients with and without fungal disease, respectively (P = .0387). The mortality rate was reduced by the use of antifungal therapy (mortality: 38.5% in patients receiving therapy vs 90% in patients not receiving therapy (P = .008). The use of corticosteroids (P = .007) and history of chronic respiratory disease (P = .05) increased the likelihood of aspergillosis. Conclusions Fungal disease occurs frequently in critically ill, mechanically ventilated COVID-19 patients. The survival benefit observed in patients receiving antifungal therapy implies that the proposed diagnostic and defining criteria are appropriate. Screening using a strategic diagnostic approach and antifungal prophylaxis of patients with risk factors will likely enhance the management of COVID-19 patients.

scholarly journals Invasive Fungal Disease in Patients with Newly Diagnosed Acute Myeloid Leukemia

2021 ◽  
Vol 7 (9) ◽  
pp. 761
Author(s):  
Anastasia I. Wasylyshyn ◽  
Kathleen A. Linder ◽  
Carol A. Kauffman ◽  
Blair J. Richards ◽  
Stephen M. Maurer ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Induction Chemotherapy ◽  
Myeloid Leukemia ◽  
Proportional Hazards ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Antifungal Prophylaxis ◽  
Cell Transplant ◽  
Newly Diagnosed ◽  
Acute Myeloid

This single-center retrospective study of invasive fungal disease (IFD) enrolled 251 adult patients undergoing induction chemotherapy for newly diagnosed acute myeloid leukemia (AML) from 2014–2019. Patients had primary AML (n = 148, 59%); antecedent myelodysplastic syndrome (n = 76, 30%), or secondary AML (n = 27, 11%). Seventy-five patients (30%) received an allogeneic hematopoietic cell transplant within the first year after induction chemotherapy. Proven/probable IFD occurred in 17 patients (7%). Twelve of the 17 (71%) were mold infections, including aspergillosis (n = 6), fusariosis (n = 3), and mucomycosis (n = 3). Eight breakthrough IFD (B-IFD), seven of which were due to molds, occurred in patients taking antifungal prophylaxis. Patients with proven/probable IFD had a significantly greater number of cumulative neutropenic days than those without an IFD, HR = 1.038 (95% CI 1.018–1.059), p = 0.0001. By cause-specific proportional hazards regression, the risk for IFD increased by 3.8% for each day of neutropenia per 100 days of follow up. Relapsed/refractory AML significantly increased the risk for IFD, HR = 7.562 (2.585–22.123), p = 0.0002, and Kaplan-Meier analysis showed significantly higher mortality at 1 year in patients who developed a proven/probable IFD, p = 0.02. IFD remains an important problem among patients with AML despite the use of antifungal prophylaxis, and development of IFD is associated with increased mortality in these patients.

Prevention and diagnosis of invasive fungal disease in high-risk patients within an integrative care pathway

2013 ◽  
Vol 67 (3) ◽  
pp. 206-214 ◽  
Author(s):  
Rosemary A. Barnes ◽  
Kate Stocking ◽  
Sarah Bowden ◽  
Matthew H. Poynton ◽  
P. Lewis White
Keyword(s):  
High Risk ◽  
Care Pathway ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Integrative Care ◽  
High Risk Patients ◽  
Risk Patients

scholarly journals Secondary Antifungal Prophylaxis in Hematological Malignancy Patients with Previous Invasive Fungal Disease: A Retrospective Analysis

PLoS ONE ◽  
2014 ◽  
Vol 9 (12) ◽  
pp. e115461 ◽  
Author(s):  
Mingjuan Liu ◽  
Yan Li ◽  
Yongqing Zhang ◽  
Xiaoli Zhao ◽  
Bing Zhai ◽  
...  
Keyword(s):  
Retrospective Analysis ◽  
Hematological Malignancy ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Antifungal Prophylaxis

Incidence and outcome of invasive fungal disease after front-line intensive chemotherapy in patients with acute myeloid leukemia: impact of antifungal prophylaxis

2019 ◽  
Vol 98 (9) ◽  
pp. 2081-2088 ◽  
Author(s):  
Rebeca Rodríguez-Veiga ◽  
Pau Montesinos ◽  
Blanca Boluda ◽  
Ignacio Lorenzo ◽  
David Martínez-Cuadrón ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Antifungal Prophylaxis ◽  
Intensive Chemotherapy ◽  
Front Line ◽  
Acute Myeloid

scholarly journals Efficacy of Rezafungin in Prophylactic Mouse Models of Invasive Candidiasis, Aspergillosis, and Pneumocystis Pneumonia

2020 ◽  
pp. AAC.01992-20
Author(s):  
Lynn Miesel ◽  
Melanie T. Cushion ◽  
Alan Ashbaugh ◽  
Santiago R. Lopez ◽  
Voon Ong
Keyword(s):  
Mouse Models ◽  
Invasive Candidiasis ◽  
Opportunistic Infections ◽  
Single Agent ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Antifungal Prophylaxis ◽  
Pneumocystis Jirovecii ◽  
Drug Concentrations

Antifungal prophylaxis is recommended to prevent invasive fungal disease caused by Candida spp., Aspergillus spp., and Pneumocystis jirovecii in patients at risk for opportunistic infections, such as allogeneic blood or marrow transplant recipients, patients with hematological disease undergoing chemotherapy, or patients on immunosuppressive therapies. Current approaches to antifungal prophylaxis require multiple agents to cover these key fungi. Rezafungin, a novel echinocandin designed for next-generation properties (e.g., greater stability and long-acting pharmacokinetics for once-weekly dosing), has demonstrated in vitro activity against Candida and Aspergillus spp. and efficacy against Pneumocystis spp. biofilms. Rezafungin was evaluated in in vivo studies of prophylactic efficacy using immunosuppressed mouse models of invasive candidiasis, aspergillosis, and Pneumocystis pneumonia. Rezafungin reduction of Candida CFU burden was generally greater with increasing drug concentrations (5, 10, or 20 mg/kg) and when rezafungin was administered closer to the time of fungal challenge (Days –1,–3, or–5). Similarly, in the aspergillosis model, survival rates increased with drug concentrations and when rezafungin was administered closer to the time of fungal challenge. Against P. murina, rezafungin significantly reduced trophic nuclei and asci counts at all doses tested. Rezafungin prevented infection at the 2 higher doses when compared with vehicle and had comparable activity to the active control trimethoprim-sulfamethoxazole at human equivalent doses for prevention. These findings support Phase 3 development of rezafungin and the potential for single-agent prophylaxis against invasive fungal disease caused by Candida spp., Aspergillus spp., and Pneumocystis jirovecii.

scholarly journals Invasive Fungal Disease Following Myeloablative Cord Blood Transplantation for Patients with Hematological Malignancies

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 5653-5653
Author(s):  
Duihong Li ◽  
Huang Jiafu ◽  
Xiaofan Li ◽  
Zheng Jing ◽  
Haiying Fu ◽  
...  
Keyword(s):  
Cord Blood ◽  
Incidence Rate ◽  
Hematological Malignancies ◽  
Conflicts Of Interest ◽  
Cord Blood Transplantation ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Antifungal Prophylaxis ◽  
Hematopoietic Stem ◽  
Blood Transplantation

Objective: Invasive fungal disease (IFD) is a serious complication after allogeneic hematopoietic stem cell transplantation (HSCT). However, limited data is available on its clinical features after cord blood transplantation (CBT) for patients with hematological malignancies. Method: We retrospectively reviewed 63 patients who underwent myeloablative CBT at our institution between July 2013 and June 2019 with a median follow-up of 14 months. Micafungin, Voriconzole or Posaconazole was used for IFD prophylaxis. Results: Eight patients were identified as having an IFD, including 2 with proven IFD, 1 with probable IFD, and 5 with possible IFD. The most common prophylaxis regimen is micafungin (68.2%, 43/63). The incidence rate of IFD in the primary antifungal prophylaxis (PAP) and secondary antifungal prophylaxis (SAP) groups were 11.3% and 25% (P=0.488). The OS of day at +100, six months and +200 in the IFD and No IFD groups were 62.5% vs. 86.9% (P=0.1), 50 % vs.78.2% (P=0.07), and 50% vs.75.9% (P=0.094), respectively. The 3-year probabilities of overall survival (OS) in the IFD and No IFD groups were 50% and 60.5%, respectively (p=0.316). The incidence rate of Non-relapse Mortality in the IFD and No IFD groups were 42.9% and 30%, respectively (p=0.319). Conclusion: Antifungal prophylaxis could help to reduce the incidence of IFD after CBT for patients with hematological malignancies. Figure Disclosures No relevant conflicts of interest to declare.

scholarly journals Recipient And Donor PTX3 rs2305619 Polymorphisms Increase The Susceptibility To Invasive Fungal Disease Following Haploidentical Stem Cell Transplantation: A Prospective Study

2021 ◽  
Author(s):  
Chen Zhao ◽  
Xiao-Su Zhao ◽  
Lan-Ping Xu ◽  
Xiao-Hui Zhang ◽  
Xiao-Jun Huang ◽  
...  
Keyword(s):  
Stem Cell ◽  
High Risk ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Scoring System ◽  
Invasive Fungal Disease ◽  
Fungal Disease ◽  
Chinese Han ◽  
Haploidentical Stem Cell Transplantation ◽  
Increased Risk

Abstract Background Invasive fungal disease (IFD) is a severe complication after haploidentical stem cell transplantation (haplo-HSCT) and has a poor prognosis. It has been shown that genetic polymorphism may be one possible reason for the increased risk of IFD. This study aimed to assess the role of genetic polymorphisms in the level of susceptibility to IFD in after haplo-HSCT. Methods In this study, we prospectively enrolled 251 patients who received haplo-HSCT at the Peking University Institute of Hematology from to 2016-2018. Forty-three single nucleotide polymorphisms (SNPs) of the genomic DNA were genotyped in blood samples from both recipient and donor. Results Twenty-two patients (8.8%) were diagnosed with proven or probable IFD. The independent risk factors for IFD were grades 3-4 acute graft-versus-host disease, cytomegalovirus reactivation, and recipient and donor rs2305619 (PTX3) (P<0.05) in multivariate analysis. Meanwhile, we combined the variables to develop the IFD risk scoring system and stratified patients into low- (0), intermediate- (1-2), and high-risk (3-4) groups. The 30-day and 100-day cumulative incidence of IFD in the low-, intermediate-, and high-risk groups were 0.1%, 2.4%, 10.2% and 4.5%, 4.1%, 20.3%, respectively (P=0.015). Conclusions PTX3 rs2305619 polymorphisms increase the susceptibility of IFD after haplo-HSCT in the Chinese Han population, and the IFD scoring system could be considered as a new standard for risk stratification for IFD after HSCT.

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