Fungal Endocarditis: Pathophysiology, Epidemiology, Clinical Presentation, Diagnosis, and Management

Clinical Microbiology Reviews, Journal Year: 2023, Volume and Issue: 36(3)

Published: July 13, 2023

Fungal endocarditis accounts for 1% to 3% of all infective cases, is associated with high morbidity and mortality (>70%), presents numerous challenges during clinical care. Candida spp. are the most common causes fungal endocarditis, implicated in over 50% followed by Aspergillus Histoplasma Important risk factors include prosthetic valves, prior heart surgery, injection drug use.

Language: Английский

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Novel antifungals and treatment approaches to tackle resistance and improve outcomes of invasive fungal disease

Clinical Microbiology Reviews, Journal Year: 2024, Volume and Issue: 37(2)

Published: April 11, 2024

SUMMARYFungal infections are on the rise, driven by a growing population at risk and climate change. Currently available antifungals include only five classes, their utility efficacy in antifungal treatment limited one or more of innate acquired resistance some fungi, poor penetration into "sequestered" sites, agent-specific side effect which require frequent patient reassessment monitoring. Agents with novel mechanisms, favorable pharmacokinetic (PK) profiles including good oral bioavailability, fungicidal mechanism(s) urgently needed. Here, we provide comprehensive review agents, both improved known mechanisms actions new currently clinical development for treating invasive yeast, mold (filamentous fungi),

Language: Английский

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New treatment options for critically important WHO fungal priority pathogens

Clinical Microbiology and Infection, Journal Year: 2024, Volume and Issue: unknown

Published: March 1, 2024

BackgroundYet often overlooked in public health discourse, fungal infections pose a crucialglobal disease burden associated with annual mortality rates approximately equal to tuberculosis and HIV. In response, the World Health Organization (WHO) published its first global priority list of pathogens 2022 assigning Aspergillus fumigatus, Candida albicans, auris, Cryptococcus neoformans critical group.ObjectivesThis review provides succinct insights on novel antifungals development, aiming contribute valuable information perspectives focus recent clinical findings new treatment approaches for members WHO pathogen list.SourcesPubMed literature search using "Aspergillus fumigatus," "Cryptococcus neoformans," "Candida auris," albicans," along names antifungal substances, including "fosmanogepix", "ibrexafungerp", "opelconazole", "oteseconazole", "MAT2203", "olorofim", "rezafungin" was conducted.ContentForeach pathogen, current issues data from trials are covered. The remarkable development three therapeutics recently receiving Food Drug Administration (FDA) approval (ibrexafungerp -June 2021, oteseconazole -April 2022, rezafungin -March 2023) is outlined, two more exciting namely olorofim fosmanogepix expecting within next years. Ibrexafungerp, have additionally been granted orphan drug status by European Medicines Agency (EMA) Europe -November -July -January 2024).ImplicationsWhile limited number targets emergence resistance posed challenges treatment, drugs such as ibrexafungerp, rezafungin, fosmanogepix, or shown promising efficacy. These not only provide alternative options invasive but also alleviate outpatient settings. More data, implementation stewardship programs, surveillance, utilization agriculture necessary prevent ensure safety efficacy these agents.

Language: Английский

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Invasive Aspergillosis in the Intensive Care Unit

Journal of Fungi, Journal Year: 2025, Volume and Issue: 11(1), P. 70 - 70

Published: Jan. 17, 2025

Invasive aspergillosis (IA) is a fungal infection, which has traditionally been associated with neutropenia and immunosuppressive therapies. Our understanding of invasive evolving and, in the past few decades, IA among ICU patients recognized as common infection become more widely recognized. The diagnosis management particularly challenging, due to unstable clinical condition patients, lack diagnostic markers, increased risk further deterioration, multiple comorbidities, need for early assessment treatment. In this article, we will discuss challenges pitfalls an setting, along review current literature that pertinent specific population.

Language: Английский

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A Systematic Review of the Therapeutic Outcome of Mucormycosis

Open Forum Infectious Diseases, Journal Year: 2023, Volume and Issue: 11(1)

Published: Dec. 30, 2023

Mucormycosis is a potentially lethal mycosis. We reviewed peer-reviewed publications on mucormycosis to assess therapeutic outcomes.

Language: Английский

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Therapeutic drug monitoring of antifungal therapies: do we really need it and what are the best practices?

Expert Review of Clinical Pharmacology, Journal Year: 2024, Volume and Issue: 17(4), P. 309 - 321

Published: Feb. 21, 2024

Despite advancements, invasive fungal infections (IFI) still carry high mortality rates, often exceeding 30%. The challenges in diagnosis, coupled with limited effective antifungal options, make managing IFIs complex. Antifungal drugs are essential for IFI management, but their efficacy can be diminished by drug-drug interactions and pharmacokinetic variability. Therapeutic Drug Monitoring (TDM), especially the context of triazole use, has emerged as a valuable strategy to optimize therapy.

Language: Английский

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Use of isavuconazole in mucormycosis: a systematic review

BMC Infectious Diseases, Journal Year: 2025, Volume and Issue: 25(1)

Published: Jan. 6, 2025

Mucormycosis is an opportunistic fungal infection which associated with poor prognosis. Only a few antifungals are available in the arsenal against mucormycosis. The global guidelines for diagnosing and managing mucormycosis recommend high doses of liposomal amphotericin B (LAmB) as first-line treatment. Isavuconazole another potential treatment option This systematic review aims to consolidate analyse existing evidence concerning efficacy safety isavuconazole treating alone or combination LAmB. For data aggregation, comprehensive searches were conducted across various electronic databases, such PubMed, Science Direct, Trip, Google Scholar, Cochrane Library, Open-Gray. Furthermore, we explored gray literature, employing tailored keywords. reference lists selected articles scrutinized identify additional pertinent publications. Articles reporting any studies, case series, reports on form exclusively involving human subjects published English included. There no time restrictions involved. We extracted crucial data, publication year, country, disease form, dosage, frequency, duration, overall outcomes, reported adverse effects. A total 31 articles, included four 24 reports, one open-label trial, randomized controlled non-interventional registry study, final analysis. 135 adult patients 14 children treated primary monotherapy, therapy, nonprimary therapy. mortality rate following LAmB plus azole, followed posaconazole only was 32%, 6.6%, 13.7%, 17.2% 24.6%, respectively. heterogeneity studies did not allow comparison different strategies (primary mono- vs. combination, etc.). use therapies during acute phase via intravenous administration alongside other triazoles, by long-term monotherapy oral route, has yielded promising recovery rates. Adverse events infrequently reported.

Language: Английский

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Metagenomic next-generation sequencing could play a pivotal role in validating the diagnosis of invasive mold disease of the central nervous system

Frontiers in Cellular and Infection Microbiology, Journal Year: 2024, Volume and Issue: 14

Published: June 7, 2024

Background Invasive mold diseases of the central nervous (CNS IMD) system are exceedingly rare disorders, characterized by nonspecific clinical symptoms. This results in significant diagnostic challenges, often leading to delayed diagnosis and risk misdiagnosis for patients. Metagenomic Next-Generation Sequencing (mNGS) holds importance infectious diseases, especially rapid accurate identification difficult-to-culture pathogens. Therefore, this study aims explore characteristics invasive disease CNS IMD children assess effectiveness mNGS technology diagnosing IMD. Methods Three pediatric patients diagnosed with brain abscess treated Pediatric Intensive Care Unit (PICU) First Affiliated Hospital Zhengzhou University from January 2020 December 2023 were selected study. Results Case 1, a 6-year-old girl, was admitted hospital “acute liver failure.” During her stay, she developed fever, irritability, seizures. CSF testing resulted negative outcome. Multiple abscesses drained, Aspergillus fumigatus detected pus culture mNGS. The condition gradually improved after treatment voriconazole combined caspofungin. 2, 3-year-old B-lymphoblastic leukemia.” induction chemotherapy, fever intracranial fluid mNGS, caspofungin, followed “right-sided drainage surgery.” 3, 7-year-old showed lethargy, right-sided limb weakness during pending chemotherapy period acute leukemia. Rhizomucor miehei pusillus cerebrospinal amphotericin B posaconazole. After six-month follow-up post-discharge, three without residual neurological sequelae, primary complete remission. Conclusion manifestations lack specificity. Early can assist identifying pathogen, providing basis definitive diagnosis. Combined surgical when necessary help improve prognosis.

Language: Английский

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Mortality in ICU Patients with COVID-19-Associated Pulmonary Aspergillosis

Journal of Fungi, Journal Year: 2023, Volume and Issue: 9(6), P. 689 - 689

Published: June 20, 2023

A review of 38 studies involving 1437 COVID-19 patients admitted to intensive care units (ICUs) with pulmonary aspergillosis (CAPA) was conducted investigate whether mortality has improved since the pandemic’s onset. The study found that median ICU 56.8%, ranging from 30% 91.8%. These rates were higher for during 2020–2021 (61.4%) compared 2020 (52.3%), and prospective (64.7%) than retrospective ones (56.4%). in various countries used different criteria define CAPA. percentage who received antifungal therapy varied across studies. results indicate rate among CAPA is a growing concern, mainly there been an overall reduction patients. Urgent action needed improve prevention management strategies CAPA, additional research identify optimal treatment reduce these This serves as call healthcare professionals policymakers prioritize serious potentially life-threatening complication COVID-19.

Language: Английский

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Green Chemistry and In silico Techniques for Synthesis of Novel Pyranopyrazole and Pyrazolo-pyrano-pyrimidine Derivatives as Promising Antifungal Agents

Recent Advances in Anti-Infective Drug Discovery, Journal Year: 2024, Volume and Issue: 19(3), P. 216 - 231

Published: Feb. 3, 2024

Every year Invasive Fungal Infections (IFI) are globally affecting millions of people.

Language: Английский

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