Seminars in respiratory and critical care medicine
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Semin Respir Crit Care Med · Oct 2015
ReviewHistoplasmosis: Up-to-Date Evidence-Based Approach to Diagnosis and Management.
Histoplasmosis is the most common endemic mycosis in the North America, Central America, and many countries of South America and also occurs in China, India, Southeast Asia, Africa, Australia, and Europe. Clinical syndromes are not specific and histoplasmosis often is overlooked in the evaluation of patients with community-acquired pneumonia, chronic cavitary pneumonia resembling tuberculosis or anaerobic infection, granulomatous inflammatory diseases such as sarcoidosis or Crohn disease, and malignancy. ⋯ Treatment is appropriate in most patients with acute pulmonary disease but rarely in those with other pulmonary or mediastinal manifestations. The preferred agents include liposomal amphotericin B for more severe cases and itraconazole for milder cases and "step-down" therapy following response to amphotericin B.
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Coccidioidomycosis manifests as a variety of clinical manifestations and ranges in severity from asymptomatic exposure with resultant immunity to reinfection, to fulminant, and life-threatening disseminated disease. Primary coccidioidal pneumonia represents the most common clinical form of infection, and the incidence continues to increase. ⋯ Chronic infection develops in 3 to 5% of patients, and almost all morbidity and mortality observed in coccidioidomycosis occur in these forms (e.g., chronic pulmonary disease, extrapulmonary manifestations). This review summarizes the ecology, epidemiology, manifestations of disease, and treatment options currently available for coccidioidomycosis.
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Semin Respir Crit Care Med · Oct 2015
ReviewPosaconazole: Use in the Prophylaxis and Treatment of Fungal Infections.
Posaconazole, a fluorinated triazole antifungal drug, is approved by the U. S. Food and Drug Administration (FDA) for (1) prophylaxis against Aspergillus and Candida infections in immunocompromised patients at high risk for these infections and (2) oropharyngeal candidiasis (OPC), including cases refractory to fluconazole and/or itraconazole. ⋯ However, newer posaconazole formulations achieve higher blood levels and it remains to be seen whether this may lead to an increase in the rate of adverse effects. Currently, posaconazole is used predominantly for prophylaxis and salvage therapy of fungal infections in adults. Indications for use as initial therapy of fungal infections and for broader use in children will depend on the accrual of additional clinical data.
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Fusarium species are frequent agents of onychomycosis and fungal keratitis, and occasional agents of invasive disease. The clinical spectrum of fusariosis in the lungs includes allergic disease (allergic bronchopulmonary fusariosis), hypersensitivity pneumonitis, colonization of a preexisting cavity, and pneumonia. Fusarial pneumonia occurs almost exclusively in severely immunocompromised patients, especially acute leukemia patients and recipients of allogeneic cell transplantation. ⋯ Different from aspergillosis is the frequent occurrence of disseminated nodular and papular skin lesions and positive blood cultures. The drug of choice for the treatment of invasive fusariosis is either voriconazole or liposomal amphotericin B. The outcome is usually poor, and largely dependent on the recovery of the immune status of the host, particularly neutropenia.
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Blastomyces dermatitidis, the etiologic agent of blastomycosis, is a thermally dimorphic fungus that grows as a filamentous mold in the environment and as budding yeast in human tissue. This pathogen is endemic to North America, particularly in the states bordering the Mississippi and Ohio rivers, the Great Lakes, and the St. Lawrence Seaway. ⋯ B. dermatitidis can infect almost any organ in the body, but has a predilection for lungs and skin. There have been recent advances in the understanding of the pathogenesis, diagnosis, and treatment of this fungus. The Infectious Diseases Society of America published updated guidelines in 2008 to guide clinicians in the treatment of this important pathogen.