Assessing responses to treatment of opportunistic mycoses and salvage strategies

Exploring Small Heat Shock Proteins (sHSPs) for Targeting Drug Resistance in Candida albicans and other Pathogenic Fungi

Fungal infections have predominantly increased worldwide that leads to morbidity and mortality in severe cases. Invasive candidiasis and other pathogenic fungal infections are a major problem in immunocompromised individuals and post-operative patients. Increasing resistance to existing antifungal drugs calls for the identification of novel antifungal drug targets for chemotherapeutic interventions. This demand for identification and characterization of novel drug targets leads to the development of effective antifungal therapy against drug resistant fungi. Heat shock proteins (HSPs) are important for various biological processes like protein folding, posttranslational modifications, transcription, translation, and protein aggregation. HSPs are involved in maintaining homeostasis of the cell. A subgroup of HSPs is small heat shock proteins (sHSPs), which functions as cellular chaperones. They are having a significant role in the many cellular functions like development, cytoskeletal organization, apoptosis, membrane lipid polymorphism, differentiation, autophagy, in infection recognition and are major players in various stresses like osmotic stress, pH stress, etc. Studies have shown that fungal cells express increased levels of sHSPs upon antifungal drug induced stress responses. Here we review the important role of small heat shock proteins (sHSPs) in fungal diseases and their potential as antifungal targets.

Diagnosis and treatment of mucormycosis in patients with hematological malignancies: guidelines from the 3rd European Conference on Infections in Leukemia (ECIL 3)

Mucormycosis is an emerging cause of infectious morbidity and mortality in patients with hematologic malignancies. However, there are no recommendations to guide diagnosis and management. The European Conference on Infections in Leukemia assigned experts in hematology and infectious diseases to develop evidence-based recommendations for the diagnosis and treatment of mucormycosis. The guidelines were developed using the evidence criteria set forth by the American Infectious Diseases Society and the key recommendations are summarized here. In the absence of validated biomarkers, the diagnosis of mucormycosis relies on histology and/or detection of the organism by culture from involved sites with identification of the isolate at the species level (no grading). Antifungal chemotherapy, control of the underlying predisposing condition, and surgery are the cornerstones of management (level A II). Options for first-line chemotherapy of mucormycosis include liposomal amphotericin B and amphotericin B lipid complex (level B II). Posaconazole and combination therapy of liposomal amphotericin B or amphotericin B lipid complex with caspofungin are the options for second line-treatment (level B II). Surgery is recommended for rhinocerebral and skin and soft tissue disease (level A II). Reversal of underlying risk factors (diabetes control, reversal of neutropenia, discontinuation/taper of glucocorticosteroids, reduction of immunosuppressants, discontinuation of deferroxamine) is important in the treatment of mucormycosis (level A II). The duration of antifungal chemotherapy is not defined but guided by the resolution of all associated symptoms and findings (no grading). Maintenance therapy/secondary prophylaxis must be considered in persistently immunocompromised patients (no grading).