Common Antifungal Drugs in Pregnancy: Risks and Precautions

Blastomycosis

Blastomycosis is caused primarily by Blastomyces dermatitidis. The fungus is a mold in the environment, causing infection when conidia are dispersed and inhaled. In the lungs, the organism transforms into the yeast phase. Pneumonia is most common, but dissemination to skin, bones, and other organs also occurs. Diagnosis is established by growth in culture, identifying large thick-walled yeast with a single broad-based bud in tissue, and testing for cell wall antigens in urine and serum. Antifungal treatment and duration depend on severity. Mild-to-moderate disease is treated with itraconazole; severe blastomycosis is initially treated with amphotericin B, followed by itraconazole.

Mycetoma managment: Therapeutic challenges and the role of pharmacovigilance

Mycetoma presents numerous therapeutic challenges, particularly due to delays in diagnosis, the toxic nature of existing antifungals and antibiotics treatments, and the lack of robust clinical evidence to guide care. This neglected tropical disease, which primarily affects low-resource regions, is further complicated by socio-economic barriers that limit access to healthcare and treatment. These challenges underscore the urgent need for better treatment options, more comprehensive research, and strengthened pharmacovigilance systems to monitor treatment safety and efficacy. Pharmacovigilance plays a critical role in managing mycetoma due to the prolonged and often toxic treatment regimens required. Adverse drug reactions, drug interactions, and treatment side effects need continuous monitoring to ensure patient safety. Effective pharmacovigilance systems should be adapted to the resource-limited settings where mycetoma is most prevalent, integrating into broader public health efforts to improve both the safety and efficacy of treatments. Such systems could greatly enhance patient outcomes by preventing unnecessary harm from toxic therapies and ensuring proper drug use. However, several barriers remain in endemic regions, including inadequate healthcare infrastructure, a lack of trained healthcare professionals, and limited access to pharmacovigilance tools. Addressing these issues requires building stronger national systems, offering more training for healthcare workers, and leveraging innovative technologies such as mobile health tools. Additionally, involving patients in reporting adverse effects could enhance the accuracy and reliability of pharmacovigilance data. Global collaboration and increased clinical research are also essential in improving mycetoma treatment. Investment in these areas, alongside the development of infrastructure and education in endemic countries, will help ensure safer long-term medical therapies and better outcomes for mycetoma patients. Furthermore, improving pharmacovigilance practices is critical to ensuring that vulnerable populations receive the most effective and safe care possible for this neglected disease.

Clinical treatment of cryptococcal meningitis: an evidence-based review on the emerging clinical data

Cryptococcal meningitis (CM) is a fatal fungal central nervous system (CNS) infection caused by Cryptococcus infecting the meninges and/or brain parenchyma, with fever, headache, neck stiffness, and visual disturbances as the primary clinical manifestations. Immunocompromised individuals with human immunodeficiency virus (HIV) infection or who have undergone organ transplantation, as well as immunocompetent people can both be susceptible to CM. Without treatment, patients with CM may have a mortality rate of up to 100% after hospital admission. Even after receiving therapy, CM patients may still suffer from problems such as difficulty to cure, poor prognosis, and high mortality. Therefore, timely and effective treatment is essential to improve the mortality and prognosis of CM patients. Currently, the clinical outcomes of CM are frequently unsatisfactory due to limited drug choices, severe adverse reactions, drug resistance, etc. Here, we review the research progress of CM treatment strategies and discuss the suitable options for managing CM, hoping to provide a reference for physicians to select the most appropriate treatment regimens for CM patients.

Paracoccidioidomycosis and pregnancy: A 40-year single-center cohort study in the endemic area of Rio de Janeiro, Brazil

The occurrence of acute paracoccidioidomycosis (PCM) in urban areas of the Rio de Janeiro state, Brazil, has emerged in recent years. Therefore, young populations, including pregnant women, are at a higher risk of infection. Furthermore, young women undergoing itraconazole treatment for PCM have increased chances to get pregnant because this medication may reduce the effectiveness of contraceptives. Acute PCM is invasive, reaching abdominal organs, posing a maternal-fetal risk. PCM treatment in pregnant women is also challenging due to the teratogenicity associated with the currently available oral drugs. There are scarce studies on PCM and pregnancy, mainly consisting of case reports and experimental murine models that highlight the severity of this association. We conducted a database research at a PCM reference center in Rio de Janeiro state from 1980 to 2020. We included patients diagnosed with PCM who were pregnant shortly before, at admission, or at any moment of their PCM follow-up care. Data related to pregnancy, childbirth, and the newborn were obtained from the Brazilian official public databases. We also reviewed the epidemiological and clinical features of these patients. During the study period, we identified 18 pregnant patients, with a median age of 26 years (range: 16-38). Among these cases, six (33.3%) were detected in the last 5 years, and 14 (77.8%) presented acute PCM, supporting the recent shift in the epidemiological profile towards acute PCM. Most pregnancies occurred during PCM treatment (n = 11, 61.1%), which led to challenges in the therapeutic management. Maternal-fetal complications occurred in some of these cases, including vaginal bleeding (n = 1), preeclampsia (n = 1), prematurity (n = 2), low birth weight (n = 4), and fetal deaths (n = 2). PCM during pregnancy presents a significant public health concern in the context of the emergence of acute PCM in urban areas.

Vulvovaginal candidiasis: An overview of mycological, clinical, and immunological aspects

AIM

To provide an overview of clinical, immunological, and mycological aspects of vulvovaginal candidiasis (VVC).

METHODS

A literature search was conducted to find relevant articles about different aspects of VVC. Related data from retrieved articles were summarized in different headings.

RESULTS

VVC has a global distribution and Candida albicans is the leading cause of infection except for specific patient groups like postmenopausal, diabetic, or immunocompromised women. VVC has a range of clinical presentations, accordingly, its diagnosis should be based on clinical examination coupled with laboratory investigations. The best therapeutic regimen depends on the patient's conditions and the causative agent. Moreover, factors like drug resistance of the causative agents and different mutations in the immunity-related genes could affect the treatment outcome.

CONCLUSION

As a globally distributed disease, VVC needs further attention, especially in areas related to the treatment failure and recurrence of the disease.