Seminars in respiratory and critical care medicine
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Blastomyces dermatitidis is acquired in almost all cases via inhalation, and pulmonary disease is the most frequent clinical manifestation of blastomycosis. Pulmonary disease can range from asymptomatic infection to rapidly severe and fatal disease. Most cases will present as pneumonia, either acute or chronic, or as a lung mass. ⋯ Detection of urinary Blastomyces antigen is a recent addition to diagnostic options. Itraconazole is the drug of choice for most forms of the disease; amphotericin B is reserved for the more severe forms. Newer azoles such as voriconazole and posaconazole have a limited role in the treatment of pulmonary blastomycosis.
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Semin Respir Crit Care Med · Dec 2011
ReviewAntifungal PK/PD considerations in fungal pulmonary infections.
Pharmacokinetic/pharmacodynamic (PK/PD) studies examine the relationships of drug pharmacokinetic properties, in vitro drug potency, and treatment efficacy. Study results are integral to the design of optimal dosing strategies, prevention of toxicity, development and interpretation of susceptibility break points, and prevention and recognition of drug resistance. These principles are increasingly utilized to optimize therapy for pulmonary fungal pathogens such as ASPERGILLUS species, although they have been underutilized for other difficult-to-treat fungal pathogens. Understanding the design and implementation of PK/PD studies facilitates more effective utilization of the available antifungal agents to improve outcomes for many of these life-threatening infections.
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Fungal infections are among the most serious complications of lung transplantation. The 1-year cumulative incidence of invasive fungal infections in lung transplant recipients is 6 to 10%, which is higher than most other solid organ transplant recipients. ⋯ Most centers employ either universal or targeted antifungal prophylaxis in some form, but the agents, doses, durations, and monitoring strategies vary widely from one center to another. This review discusses the salient fungal organisms responsible for infection in lung transplant recipients and management strategies for prevention.
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Pneumocystis (carinii) jiroveci pneumonia can occur in immunocompromised individuals, especially hematopoietic stem and solid organ transplant recipients and those receiving immunosuppressive agents, and is the most common opportunistic infection in persons with advanced human immunodeficiency virus (HIV) infection. The Pneumocystis genus was initially mistaken as a trypanosome and later as a protozoan. Genetic analysis identified the organism as a unicellular fungus. ⋯ Fulminant respiratory failure associated with fever and dry cough is typical in non-HIV-infected patients. Definitive diagnosis relies on histopathological testing of sputum, induced or sampled by fiberoptic bronchoscopy with bronchoalveolar lavage. The first-line drug for treatment and prevention is trimethoprim-sulfamethoxazole.