Fungal Infections

2013 ◽  
Author(s):  
Sara Buckman ◽  
Luis A. Fernandez
Keyword(s):  
Fungal Infection ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Antimicrobial Agents ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Diagnostic Methods ◽  
Fungal Colonization ◽  
Surgical Patient ◽  
Candida Infections

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant patients, and sick neonates all being especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients, developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients, organ transplantation has evolved dramatically, and the use of invasive therapies has increased markedly. With these changes has come an increase in the incidence of serious Candida infections, as well as an increase in the less common but potentially fatal noncandidal infections caused by Aspergillus and the Zygomycetes Mucor and Rhizopus. Antifungal prophylaxis has emerged as a potential means of reducing the occurrence of serious fungal infections. This review covers fungal colonization versus infection, types of fungal infection, epidemiology and risk factors, clinical evaluation, investigative studies, management of acute candidemia and acute disseminated candidiasis, management of nonhematogenous candidiasis, peritonitis and intra-abdominal abscess, management of other fungal infections (Aspergillus, Cryptococcus, Mucor, Rhizopusi), systemic antifungal agents, and the pathogenesis of Candida infection. Tables describe the clinical presentation and diagnostic methods for common fungal infections, antimicrobial agents of choice for candida infections, antifungal chemotherapy, and characteristics of currently available antifungals. Figures show Candida endophthalmitis; superficial candidiasis; biopsy samples of chronic progressive disseminated histoplasmosis and thick-walled, broad-based budding yeasts typical for Blastomyces dermatitidis; and the various forms of Candida. Algorithms demonstrate the approach to the surgical patient at risk for candidiasis, aspergillosis, and other types of fungal infection. This review contains 5 figures, 4 tables, and 189 references.

Candidiasis

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antimicrobial Agents ◽  
Fungal Infections ◽  
Diagnostic Methods ◽  
Ventricular Assist Devices ◽  
Transplant Recipients ◽  
Ventricular Assist ◽  
Disseminated Candidiasis ◽  
Candida Infections

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients; developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients; organ transplantation has evolved dramatically; and the use of invasive therapies (eg, ventricular assist devices) has increased markedly. With these changes has come an increase in the incidence of serious Candida infections. This review covers the definition and classification, epidemiology and risk factors, and clinical evaluation of candidiasis, as well as management of candidemia, acute disseminated candidiasis, nonhematogenous candidiasis, and peritonitis and intra-abdominal abscess. Figures show Candida endophthalmitis in patients with persistent fungemia and superficial candidiasis in the gastrointestinal tract. Tables list clinical presentation and diagnostic methods for common fungal infections, antimicrobial agents of choice for candidal infections, and the latest guidelines for candidiasis. This review contains 2 figures, 3 tables and 131 references Key words: acute disseminated candidiasis, candidemia, candidiasis, candiduria, nonhematogenous candidiasis  

Candidiasis

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antimicrobial Agents ◽  
Fungal Infections ◽  
Diagnostic Methods ◽  
Ventricular Assist Devices ◽  
Transplant Recipients ◽  
Ventricular Assist ◽  
Disseminated Candidiasis ◽  
Candida Infections

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients; developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients; organ transplantation has evolved dramatically; and the use of invasive therapies (eg, ventricular assist devices) has increased markedly. With these changes has come an increase in the incidence of serious Candida infections. This review covers the definition and classification, epidemiology and risk factors, and clinical evaluation of candidiasis, as well as management of candidemia, acute disseminated candidiasis, nonhematogenous candidiasis, and peritonitis and intra-abdominal abscess. Figures show Candida endophthalmitis in patients with persistent fungemia and superficial candidiasis in the gastrointestinal tract. Tables list clinical presentation and diagnostic methods for common fungal infections, antimicrobial agents of choice for candidal infections, and the latest guidelines for candidiasis. This review contains 2 figures, 3 tables and 131 references Key words: acute disseminated candidiasis, candidemia, candidiasis, candiduria, nonhematogenous candidiasis  

Noncandidal Fungal Infections

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Fungal Infections ◽  
Ventricular Assist Devices ◽  
Surgical Patient ◽  
Transplant Recipients ◽  
Biopsy Material ◽  
Ventricular Assist ◽  
The Past ◽  
Progressive Disseminated Histoplasmosis

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients; developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients; organ transplantation has evolved dramatically; and the use of invasive therapies (eg, ventricular assist devices) has increased markedly. With these changes has come an increase in the incidence of serious fungal infections, including the less common but potentially fatal noncandidal infections caused by Aspergillus and the Zygomycetes Mucor and Rhizopus. This review outlines an approach to the workup and management of the nonneutropenic surgical patient with a suspected noncandidal infection (aspergillosis and zygomycosis). Figures show biopsy samples from an elderly man with chronic progressive disseminated histoplasmosis and thick-walled, broad-based budding yeasts typical for Blastomyces dermatitidis on biopsy material. This review contains 2 figures and 47 references Key words: aspergillosis, aspergillosis prophylaxis, blastomycosis, Cryptococcus, histoplasmosis, noncandidal fungal infections  

Systemic Antifungal Agents

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Morbidity And Mortality ◽  
Transplant Recipients ◽  
Therapeutic Approaches ◽  
Timely Fashion ◽  
Antifungal Chemotherapy

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Despite the development of a number of new and useful antifungal agents in the past decade and the noteworthy improvements in therapeutic approaches to fungal infections, physicians’ ability to diagnose these infections in a timely fashion remains limited, and patient outcomes remain poor. Antifungal prophylaxis has emerged as a potential means of reducing the occurrence of serious fungal infections. In patient populations estimated to be at high risk for acquiring a fungal infection, antifungal prophylaxis has reduced infection rates by about 50%; however, it has not been shown to significantly improve mortality. This review discusses both established and newly approved systemic antifungal agents. Tables list characteristics of currently available antifungals and antifungal chemotherapy. This review contains 2 tables and 32 references Key words: antifungal chemotherapy, antifungal prophylaxis, antifungals, Candida prophylaxis, systemic antifungal medications

Management of Candidiasis in Critically Ill Patients

2002 ◽  
Vol 15 (2) ◽  
pp. 106-113
Author(s):  
Manjunath P. Pai ◽  
Larry H. Danziger ◽  
Susan L. Pendland
Keyword(s):  
Amphotericin B ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Susceptibility ◽  
Economic Consequences ◽  
Drug Selection ◽  
Testing Method ◽  
Candida Infections

Fungal infections have been increasing at an alarming rate in critically ill patients. Candida is now the fourth most common pathogen isolated from the bloodstream and is associated with significant morbidity, mortality, and economic consequences. Novel antifungals have been developed in recent years to provide alternatives to amphotericin B, which continues to be the standard therapy for most invasive fungal infections. These alternatives include lipid-based amphotericin B, ketoconazole, fluconazole, itraconazole, caspofungin, and potentially voriconazole. Optimal therapy for the various forms of candidiasis remains controversial. A standardized antifungal susceptibility testing method for Candida isolates has been developed to assist drug selection, but its clinical relevance remains to be determined. The relative susceptibility of Candida isolates can be estimated by the species. Specifically, C krusei is resistant to azoles, C glabrata may be resistant to azoles, and C lusitaniae may be resistant to amphotericin B Candida infections can affect any organ system, and the diagnosis of such infections remains difficult. The Infectious Diseases Society of America recently developed guidelines for the management of candidiasis. This review includes a brief discussion of systemically administered antifungal agents and provides a synopsis of the practice guidelines for the management of candidiasis.

scholarly journals 1170. Invasive Fungal Infections and Colonization in Critically Ill Patients: Impact of Diagnosis and Management on Outcomes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S610-S610
Author(s):  
Anthony Siudela ◽  
Afshin Khan ◽  
Marjorie E Bateman
Keyword(s):  
Hospital Mortality ◽  
Critically Ill ◽  
High Mortality ◽  
Critically Ill Patients ◽  
Hospital Admissions ◽  
Fungal Infections ◽  
Invasive Fungal Infections ◽  
Fungal Colonization ◽  
Post Discharge ◽  
The Impact

Abstract Background Invasive fungal infections (IFIs), though uncommon, are on the rise and have a high mortality rate. Fungal colonization is common, but its clinical significance is unclear. Our study aims to characterize the impact of these diagnoses and their management on outcomes in a large ICU population. Methods We utilized the Multiparameter Intelligent Monitoring in Intensive Care III database for this retrospective cohort study. Adults with positive fungal cultures were classified as colonized or infected using definitions from the EORTC/MSG guidelines and the Blot protocol for Aspergillus. Outcomes were compared between groups matched by age, SOFA score, admission diagnosis, culture results, and comorbidities. Results There were 595 hospital admissions with IFI (11.7/1000 admissions) and 5789 with colonization (114/1000 admissions). In-hospital mortality was 52% in patients with IFIs and 36% in colonized patients. Mortality post-discharge remained high and was not significantly different in the two groups. 67% of patients with IFIs had the diagnosis documented. 24% of patients with IFIs and 8% of colonized patients received antifungal therapy. Treatment did not significantly impact mortality in infected or colonized patients but was associated with increased length of hospital and ICU stay. Infectious disease (ID) consultation was performed in 39.8% of patients with IFIs and 20% of patients with colonization. In the group of IFI patients with ID consultation, in-hospital mortality was higher, but survival post-discharge increased significantly. There was a significant increase in diagnosis of IFI in the ID group and a trend toward increased treatment. In colonized patients with ID consultation, in-hospital mortality and survival post-discharge improved. Hospital and ICU length of stay were longer for patients with ID consultation. Conclusion Critically ill patients with IFIs have high mortality rates, which were not reduced by treatment. The prevalence of colonization was high, and colonized patients experienced significant in-hospital and post-discharge mortality. This study supports the need for additional investigation into ID consultation, which may improve outcomes in critically ill patients with fungal infection and colonization. Disclosures All Authors: No reported disclosures

Systemic Antifungal Agents

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Antifungal Agents ◽  
Fungal Infections ◽  
Antifungal Prophylaxis ◽  
Morbidity And Mortality ◽  
Transplant Recipients ◽  
Therapeutic Approaches ◽  
Timely Fashion ◽  
Antifungal Chemotherapy

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Despite the development of a number of new and useful antifungal agents in the past decade and the noteworthy improvements in therapeutic approaches to fungal infections, physicians’ ability to diagnose these infections in a timely fashion remains limited, and patient outcomes remain poor. Antifungal prophylaxis has emerged as a potential means of reducing the occurrence of serious fungal infections. In patient populations estimated to be at high risk for acquiring a fungal infection, antifungal prophylaxis has reduced infection rates by about 50%; however, it has not been shown to significantly improve mortality. This review discusses both established and newly approved systemic antifungal agents. Tables list characteristics of currently available antifungals and antifungal chemotherapy. This review contains 2 tables and 32 references Key words: antifungal chemotherapy, antifungal prophylaxis, antifungals, Candida prophylaxis, systemic antifungal medications

scholarly journals Tocilizumab is Associated with Increased Risk of Fungal Infections Among Critically Ill Patients with COVID-19 and Acute Renal Failure: An Observational Cohort Study.

2021 ◽  
Author(s):  
Barrett J Burger ◽  
Sarenthia M. Epps ◽  
Victor M. Cardenas ◽  
Rajani Jagana ◽  
Nikhil K. Meena ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Length Of Stay ◽  
Fungal Infection ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fungal Infections ◽  
Unit Length ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Increased Risk

Abstract Research QuestionDoes treatment with tocilizumab increase the risk of a fungal infection in critically ill patients with coronavirus-19?BackgroundNumerous therapies have been re-evaluated as possible treatment options for coronavirus-2019 caused by severe acute respiratory syndrome coronavirus-2. Tocilizumab is a humanized monoclonal antibody directed against the interleukin-6 receptor that has been proposed as a therapy for patients with severe coronavirus-19 pneumonia. The immunomodulatory effects of tocilizumab may have the unintended consequence of predisposing recipients to secondary infections. We sought to assess the risk of invasive fungal disease and the therapeutic impact of tocilizumab on hospital length of stay, duration of mechanical ventilation, and intensive care unit length of stay in critically ill patients with severe coronavirus-19.MethodsRecords of critically ill patients with coronavirus-2019 admitted from March to September 2020 at our institution were reviewed. The risk for fungal infections, intensive care unit length of stay, hospital length of stay, and duration of mechanical ventilation in those that received tocilizumab in addition to standard coronavirus-2019 treatments was assessed. ResultsFifty-six critically ill patients treated with dexamethasone and remdesivir for coronavirus-2019 were included, of which 16 patients also received tocilizumab. The majority of the cohort was African American, Asian, or other ethnic minorities (53.6%). Invasive fungal infections occurred in 10.7% of all patients and infection rates were significantly higher in the tocilizumab group than in the control group (31.2% vs 2.5%, Risk Difference [RD]= 28.8%, p<0.01). The increased risk in the tocilizumab group was strongly associated with renal replacement therapy. There was a dose-response relation between the risk of fungal infection and doses of tocilizumab, with 2.5% of infections occurring with zero doses, 20% with a single dose (RD=17.5%), and 50% with two doses (RD=47.5%) (trend test p<0.001). In addition, ICU LOS (23.4 days v 9.0 days, p <0.01), duration of mechanical ventilation (18.9 v. 3.5 days, p=0.01), and hospital LOS (29.1 v. 15.5, p <0.01) were increased in patients that received tocilizumab. ConclusionsRepurposed therapies, such as tocilizumab, may have a role in the treatment of severe coronavirus-2019 pneumonia but safety concerns remain. In this cohort, tocilizumab treatment was associated with an increased risk of fungal infection in those that were critically ill and received renal replacement therapy. Tocilizumab was also associated with increased ICU and hospital LOS and duration of mechanical ventilation.

Noncandidal Fungal Infections

2018 ◽  
Author(s):  
Brett A Melnikoff ◽  
René P Myers
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Fungal Infections ◽  
Ventricular Assist Devices ◽  
Surgical Patient ◽  
Transplant Recipients ◽  
Biopsy Material ◽  
Ventricular Assist ◽  
The Past ◽  
Progressive Disseminated Histoplasmosis

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant recipients, and sick neonates all especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients; developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients; organ transplantation has evolved dramatically; and the use of invasive therapies (eg, ventricular assist devices) has increased markedly. With these changes has come an increase in the incidence of serious fungal infections, including the less common but potentially fatal noncandidal infections caused by Aspergillus and the Zygomycetes Mucor and Rhizopus. This review outlines an approach to the workup and management of the nonneutropenic surgical patient with a suspected noncandidal infection (aspergillosis and zygomycosis). Figures show biopsy samples from an elderly man with chronic progressive disseminated histoplasmosis and thick-walled, broad-based budding yeasts typical for Blastomyces dermatitidis on biopsy material. This review contains 2 figures and 47 references Key words: aspergillosis, aspergillosis prophylaxis, blastomycosis, Cryptococcus, histoplasmosis, noncandidal fungal infections  

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