Mycoses
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Invasive fungal infections on the intensive care unit are predominantly caused by Candida spp., most frequently manifesting as candidemia. In spite of increasing treatment options during the last two decades, mortality of invasive candidiasis remains high with 20 to 50%. With the echinocandins, a new class of antifungal drugs with activity against clinically relevant Aspergillus and Candida spp. has become available since the beginning of the new millennium. ⋯ All trials observed non-inferiority of the new drugs against the standard treatment; in the case of anidulafungin, superiority against fluconazole was demonstrated. These results of the trials had resulted in modification of the current guidelines for the treatment of candidemia and invasive candidiasis. Especially in ICU patients frequently showing single- or multi-organ failure and receiving a multitude of drugs with complex interactions, echinocandins have become the treatment of first choice for candidemia.
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Invasive fungus infections caused by aspergillus spp. occur most frequently in immunocompromised patients. A high infection-associated death rate of up to and over 50% is attributed even today to these fungi. The disease in humans is caused mainly by Aspergillus fumigatus, Aspergillus flavus and Aspergillus niger. ⋯ Both the echinocandines and posaconazole have proven effective in daily clinical practise. In refractory cases of invasive aspergillosis a combination therapy has been employed clinically. The results of prospective comparative controlled studies on combination therapy versus monotherapy will not be available until after 2010.
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Letter Case Reports
Cutaneous zygomycosis caused by Saksenaea vasiformis following water-related wound in a 24-year-old immunocompetent woman.
We describe a case of cutaneous zygomycosis caused by Saksenaea vasiformis in an immunocompetent 24-year-old woman. Diagnosis was based on histological and microbiological examination. The patient made a complete recovery with surgical debridement and antifungal therapy (liposomal amphotericin and posaconazole).
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Fonsecaea pedrosoi is the most prevalent aetiological agent of chromoblastomycosis. Fonsecaea monophora is a new species segregated from Fonsecaea pedrosoi. ⋯ Clinical characteristics and mycological parameters are described. Two of the three patients underwent combination therapy with itraconazole and terbinafine during early stages of treatment and were completely healed in a relatively short course of treatment.