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Invasive Fungal Infections 2021. J Fungi (Basel) 2022; 8:jof8080760. [PMID: 35893128 PMCID: PMC9330019 DOI: 10.3390/jof8080760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 07/19/2022] [Indexed: 11/24/2022] Open
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Prigitano A, Esposto MC, Grancini A, Passera M, Paolucci M, Stanzani M, Sartor A, Candoni A, Pitzurra L, Innocenti P, Micozzi A, Cascio GL, Delia M, Mosca A, Mikulska M, Ossi C, Fontana C, Pizzolante M, Gelmi M, Cavanna C, Lallitto F, Amato G, Vella A, Pagano L, Bandettini R, De Lorenzis G, Cogliati M, Romanò L, Tortorano A. Prospective multicentre study on azole resistance in Aspergillus isolates from surveillance cultures in haematological patients in Italy. J Glob Antimicrob Resist 2020; 22:231-237. [PMID: 32061880 DOI: 10.1016/j.jgar.2020.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/16/2020] [Accepted: 01/25/2020] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVES This study was conducted to assess the prevalence of azole resistance in Aspergillus isolates from patients with haematological malignancies or who were undergoing haematopoietic stem cell transplantation and to identify the molecular mechanism of resistance. METHODS In this 28-month prospective study involving 18 Italian centres, Aspergillus isolates from surveillance cultures were collected and screened for azole resistance, and mutations in the cyp51A gene were identified. Resistant isolates were genotyped by microsatellite analysis, and the allelic profiles were compared with those of resistant environmental and clinical isolates from the same geographical area that had been previously genotyped. RESULTS There were 292 Aspergillus isolates collected from 228 patients. The isolates belonged mainly to the section Fumigati (45.9%), Nigri (20.9%), Flavi (16.8%) and Terrei (4.8%). Three isolates showed itraconazole resistance: Aspergillus fumigatus sensu stricto, Aspergillus lentulus (section Fumigati) and Aspergillus awamori (section Nigri). The itraconazole resistance rates were 1% and 1.48% considering all Aspergillus spp. isolates and the Aspergillus section Fumigati, respectively. The prevalence of azole resistance among all the patients was 1.3%. Among patients harbouring A. fumigatus sensu stricto isolates, the resistance rate was 0.79%. The A. fumigatus isolate, with the TR34/L98H mutation, was genotypically distant from the environmental and clinical strains previously genotyped. CONCLUSIONS In this study, the Aspergillus azole resistance rate was 1% (3/292). In addition to A. fumigatus sensu stricto, A. lentulus and A. awamori azole-resistant isolates were identified. Therefore, it is important have a correct identification at the species level to address a rapid therapy better, quickly understand the shift towards cryptic species and have an updated knowledge of the local epidemiology.
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Affiliation(s)
- A Prigitano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
| | - M C Esposto
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - A Grancini
- I.R.C.C.S. Foundation, Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Passera
- Microbiology and Virology Unit, Asst. Papa Giovanni XXIII, Bergamo, Italy
| | - M Paolucci
- Institute of Hematology, Lorenzo e Ariosto Seràgnoli, Sant'Orsola-Malpighi Hospital Policlinico, University of Bologna, Bologna, Italy
| | - M Stanzani
- Institute of Hematology, Lorenzo e Ariosto Seràgnoli, Sant'Orsola-Malpighi Hospital Policlinico, University of Bologna, Bologna, Italy
| | - A Sartor
- Division of Hematology, ASUIUD, University of Udine, Udine, Italy
| | - A Candoni
- Division of Hematology, ASUIUD, University of Udine, Udine, Italy
| | - L Pitzurra
- Dipartimento di Medicina, Università degli Studi di Perugia, Perugia, Italy
| | - P Innocenti
- Laboratory of Microbiology and Virology, Comprensorio Sanitario di Bolzano-AS Alto Adige, Bolzano, Italy
| | - A Micozzi
- Department of Translational and Precision Medicine, Sapienza Università di Roma, Rome, Italy
| | - G Lo Cascio
- Microbiology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Delia
- Department of Emergency and Organ Transplantation-UO Haematology with transplantation, AO Universitaria Policlinico di Bari, Bari, Italy
| | - A Mosca
- Interdisciplinary Department of Medicine, AO Universitaria Policlinico di Bari, Bari, Italy
| | - M Mikulska
- Università degli Studi di Genova (DISSAL) and Ospedale Policlinico San Martino, Genoa, Italy
| | - C Ossi
- Laboratory of Microbiology and Virology, San Raffaele Scientific Institute, Milan, Italy
| | - C Fontana
- Department of Experimental Medicine, University of Tor Vergata Polyclinic of Tor Vergata, Rome, Italy
| | - M Pizzolante
- Laboratory of Microbiology, Vito Fazzi Regional Hospital Lecce, Lecce, Italy
| | - M Gelmi
- ASST Spedali Civili di Brescia, Brescia, Italy
| | - C Cavanna
- Microbiology and Virology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | - F Lallitto
- Microbiology and Virology Unit, IRCCS Policlinico San Matteo, Pavia, Italy
| | - G Amato
- UOC. Patologia Clinica, AO A. Cardarelli, Naples, Italy
| | - A Vella
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Pagano
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Bandettini
- Clinical Pathology and Microbiology Laboratory Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - G De Lorenzis
- Department of Agricultural and Environmental Sciences-Production, Landscape, Agroenergy, Università degli Studi di Milano, Milan, Italy
| | - M Cogliati
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - L Romanò
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - A Tortorano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
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Felice MR, Giuffrè L, El Aamri L, Hafidi M, Criseo G, Romeo O, Scordino F. Looking for New Antifungal Drugs from Flavonoids: Impact of the Genetic Diversity of Candida albicans on the in-vitro Response. Curr Med Chem 2019; 26:5108-5123. [PMID: 29278204 DOI: 10.2174/0929867325666171226102700] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 09/15/2017] [Accepted: 11/06/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND In an era in which antimicrobial resistance is increasing at an alarming pace, it is very important to find new antimicrobial agents effective against pathogenic microrganisms resistant to traditional treatments. Among the notable breakthroughs in the past years of research in natural-drug discovery, there is the identification and testing of flavonoids, a group of plant-derived substances capable of promoting many beneficial effects on humans. These compounds show different biological activities such as inhibition of neuroinflammation and tumor growth as well as antimicrobial activity against many microbial pathogens. METHODS We undertook a review of protocols and standard strains used in studies reporting the inhibitory effects of flavonoids against Candida albicans by focusing our attention on genetic characterization of the strains examined. Moreover, using the C. albicans MLST-database, we performed a phylogenetic analysis showing the genetic variation occurring in this species. RESULTS Today, we have enough information to estimate genetic diversity within microbial species and recent data revealed that most of fungal pathogens show complex population structures in which not a single isolate can be designated as representative of the entire taxon. This is especially true for the highly divergent fungal pathogen C. albicans, in which the assumption that one or few "standard strains" can represent the whole species is overly unrealistic and should be laid to rest. CONCLUSION The goal of this article is to shed light on the extent of genetic variation in C. albicans and how this phenomenon can largely influence the activity of flavonoids against this species.
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Affiliation(s)
- Maria Rosa Felice
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Letterio Giuffrè
- Department of Veterinary Sciences, Division of Animal Production, University of Messina, Messina, Italy
| | - Lamya El Aamri
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy.,Department of Biology, Moulay Ismail University, Faculty of Sciences, Zitoune Meknes, Morocco
| | - Majida Hafidi
- Department of Biology, Moulay Ismail University, Faculty of Sciences, Zitoune Meknes, Morocco
| | - Giuseppe Criseo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy
| | - Orazio Romeo
- Department of Chemical, Biological, Pharmaceutical and Environmental Sciences, University of Messina, Messina, Italy.,Scientific Institute for Research, Hospitalization and Health Care (IRCCS) - Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Fabio Scordino
- Scientific Institute for Research, Hospitalization and Health Care (IRCCS) - Centro Neurolesi "Bonino-Pulejo", Messina, Italy
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Berger AP, Ford BA, Brown-Joel Z, Shields BE, Rosenbach M, Wanat KA. Angioinvasive fungal infections impacting the skin: Diagnosis, management, and complications. J Am Acad Dermatol 2018; 80:883-898.e2. [PMID: 30102950 DOI: 10.1016/j.jaad.2018.04.058] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 04/19/2018] [Accepted: 04/25/2018] [Indexed: 01/05/2023]
Abstract
As discussed in the first article in this continuing medical education series, angioinvasive fungal infections pose a significant risk to immunocompromised and immunocompetent patients alike, with a potential for severe morbidity and high mortality. The first article in this series focused on the epidemiology and clinical presentation of these infections; this article discusses the diagnosis, management, and potential complications of these infections. The mainstay diagnostic tests (positive tissue culture with histologic confirmation) are often supplemented with serum biomarker assays and molecular testing (eg, quantitative polymerase chain reaction analysis and matrix-assisted laser desorption ionization time-of-flight mass spectrometry) to ensure proper speciation. When an angioinvasive fungal infection is suspected or diagnosed, further workup for visceral involvement also is essential and may partially depend on the organism. Different fungal organisms have varied susceptibilities to antifungal agents, and knowledge on optimal treatment regimens is important to avoid the potential complications associated with undertreated or untreated fungal infections.
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Affiliation(s)
- Anthony P Berger
- Department of Dermatology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, Iowa
| | - Bradley A Ford
- Department of Pathology and Clinical Microbiology, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, Iowa
| | - Zoe Brown-Joel
- University of Iowa Carver College of Medicine, University of Iowa Hospitals and Clinics, University of Iowa, Iowa City, Iowa
| | - Bridget E Shields
- Department of Dermatology, University of Wisconsin, Madison, Wisconsin
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Karolyn A Wanat
- Department of Dermatology and Pathology, University of Iowa, Iowa City, Iowa.
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Ludwig DB, de Camargo LEA, Khalil NM, Auler ME, Mainardes RM. Antifungal Activity of Chitosan-Coated Poly(lactic-co-glycolic) Acid Nanoparticles Containing Amphotericin B. Mycopathologia 2018; 183:659-668. [PMID: 29497926 DOI: 10.1007/s11046-018-0253-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
Amphotericin B (AmB) is one of the most used drugs for the treatment of systemic fungal infections; however, the treatment causes several toxic manifestations, including nephrotoxicity and hemolytic anemia. Chitosan-coated poly(lactide-co-glycolide) (PLGA) nanoparticles containing AmB were developed with the aim to decrease AmB toxicity and propose the oral route for AmB delivery. In this work, the antifungal efficacy of chitosan-coated PLGA nanoparticles containing AmB was evaluated in 20 strains of fungus isolates from patients with vulvovaginal candidiasis (01 Candida glabrata and 03 Candida albicans), bloodstream infections (04 C. albicans and 01 C. tropicalis) and patients with urinary tract infection (04 Candida albicans, 02 Trichosporon asahii, 01 C. guilhermondii, 03 C. glabrata) and 01 Candida albicans ATCC 90028. Moreover, the cytotoxicity over erythrocytes was evaluated. The single-emulsion solvent evaporation method was suitable for obtaining chitosan-coated PGLA nanoparticles containing AmB. Nanoparticles were spherical in shape, presented mean particle size about 460 nm, positive zeta potential and encapsulation efficiency of 42%. Moreover, nanoparticles prolonged the AmB release. All the strains were susceptible to plain AmB and nanostructured AmB, according to EUCAST breakpoint version 8.1 (resistant > 1 μg/mL), using broth microdilution method. In C. albicans (urine, blood, and vulvovaginal secretion isolates, and 1 ATCC), the MIC value of AmB-loaded nanoparticles varied from 0.25 to 0.5 μg/mL and EUCAST varied from 0.03 to 0.5 μg/mL. In urine and vulvovaginal secretion isolates of C. glabrata, the MIC value of AmB-loaded nanoparticles varied from 0.25 to 0.5 μg/mL and EUCAST varied from 0.03 to 0.015 μg/mL. In urine isolates of C. guilhermondii, the MIC value of AmB-loaded nanoparticles was 0.12 μg/mL and EUCAST was 0.06 μg/mL. In blood isolates of C. tropicalis, the MIC value of AmB-loaded nanoparticles was 0.5 μg/mL and EUCAST was 0.25 μg/mL. Finally, in urine isolates of T asahii, the MIC value of AmB-loaded nanoparticles was 1 μg/mL and EUCAST varied from 0.5 to 1 μg/mL. In the cytotoxicity assay, plain AmB was highly hemolytic (100% in 24 h) while AmB-loaded chitosan/PLGA nanoparticles presented negligible hemolysis.
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Affiliation(s)
- Daniel Brustolin Ludwig
- Department of Pharmacy, Universidade Estadual do Centro-Oeste/UNICENTRO, Rua Simeão Camargo Varela de Sá 03, Guarapuava, PR, 85040-080, Brazil.,Faculdade Guairacá, Rua XV de Novembro, 7050, Guarapuava, PR, 85010-000, Brazil
| | - Luciana Erzinger Alves de Camargo
- Department of Pharmacy, Universidade Estadual do Centro-Oeste/UNICENTRO, Rua Simeão Camargo Varela de Sá 03, Guarapuava, PR, 85040-080, Brazil.,Faculdade Guairacá, Rua XV de Novembro, 7050, Guarapuava, PR, 85010-000, Brazil
| | - Najeh Maissar Khalil
- Department of Pharmacy, Universidade Estadual do Centro-Oeste/UNICENTRO, Rua Simeão Camargo Varela de Sá 03, Guarapuava, PR, 85040-080, Brazil
| | - Marcos Ereno Auler
- Department of Pharmacy, Universidade Estadual do Centro-Oeste/UNICENTRO, Rua Simeão Camargo Varela de Sá 03, Guarapuava, PR, 85040-080, Brazil
| | - Rubiana Mara Mainardes
- Department of Pharmacy, Universidade Estadual do Centro-Oeste/UNICENTRO, Rua Simeão Camargo Varela de Sá 03, Guarapuava, PR, 85040-080, Brazil.
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Carradori S, Bizzarri B, D'Ascenzio M, De Monte C, Grande R, Rivanera D, Zicari A, Mari E, Sabatino M, Patsilinakos A, Ragno R, Secci D. Synthesis, biological evaluation and quantitative structure-active relationships of 1,3-thiazolidin-4-one derivatives. A promising chemical scaffold endowed with high antifungal potency and low cytotoxicity. Eur J Med Chem 2017; 140:274-292. [PMID: 28963991 DOI: 10.1016/j.ejmech.2017.09.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/15/2017] [Accepted: 09/15/2017] [Indexed: 01/04/2023]
Abstract
With reference to recent studies reporting on the various biological properties of the thiazolidinone scaffold, we synthesized more than a hundred compounds characterized by a 1,3-thiazolidin-4-one nucleus derivatised at the C2 with a hydrazine bridge linked to (cyclo)aliphatic or hetero(aryl) moieties, and their N-benzylated derivatives. These molecules were assayed as potential anti-Candida agents and they were shown to possess comparable, and in some cases higher biological activity than well-established topical and systemic antimycotic drugs (i.e. clotrimazole, fluconazole, ketoconazole, miconazole, tioconazole, amphotericin B). Compounds endowed with the lowest MICs underwent further testing in order to assess their cytotoxic effect (CC50) on Hep2 cells, which demonstrated their relative safety. Finally, QSAR and 3-D QSAR models were used to predict putative chemical modifications of the 1,3-thiazolidin-4-one scaffold in order to design new and potential more active compounds against Candida spp.
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Affiliation(s)
- Simone Carradori
- Department of Pharmacy, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy.
| | - Bruna Bizzarri
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy
| | - Melissa D'Ascenzio
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy
| | - Celeste De Monte
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy
| | - Rossella Grande
- Department of Pharmacy, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy; Center for Aging Science and Translational Medicine (CeSI-MeT), Via dei Vestini 31, 66100 Chieti, Italy
| | - Daniela Rivanera
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy
| | - Alessanda Zicari
- Dipartimento di Medicina Sperimentale, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy
| | - Emanuela Mari
- Dipartimento di Medicina Sperimentale, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy
| | - Manuela Sabatino
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy; Rome Center for Molecular Design, Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy
| | - Alexandros Patsilinakos
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy; Rome Center for Molecular Design, Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy; Alchemical Dynamics s.r.l., 00125 Rome, Italy
| | - Rino Ragno
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy; Rome Center for Molecular Design, Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy; Alchemical Dynamics s.r.l., 00125 Rome, Italy
| | - Daniela Secci
- Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza University of Rome, P.le A. Moro 5, 00185 Rome, Italy.
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Żesławska E, Korona-Głowniak I, Szczesio M, Olczak A, Żylewska A, Tejchman W, Malm A. Structural analysis and antimicrobial activity of 2[1H]-pyrimidinethione/selenone derivatives. J Mol Struct 2017. [DOI: 10.1016/j.molstruc.2017.04.067] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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8
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Khan H, Khan Z, Amin S, Mabkhot YN, Mubarak MS, Hadda TB, Maione F. Plant bioactive molecules bearing glycosides as lead compounds for the treatment of fungal infection: A review. Biomed Pharmacother 2017; 93:498-509. [PMID: 28675856 DOI: 10.1016/j.biopha.2017.06.077] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 06/16/2017] [Accepted: 06/20/2017] [Indexed: 12/20/2022] Open
Abstract
Despite therapeutic advancement in the treatment of fungal infections, morbidity and mortality caused by these infections are still very high. There are approximately 300 fungal species that are infectious and can cause a variety of diseases. At present, several synthetic antifungal drugs are in clinical practice, many of them, however, are vulnerable to multidrug-resistant strains of microbes, and thus compromising the overall treatment outcomes. Glycosides are naturally occurring plant secondary metabolites with important therapeutic potential and clinical utility. The aim of this review was to focus on the antifungal effects of glycosides in preclinical studies with possible mechanism(s) wherein described. Published research show significant susceptibility of different fungi towards phytoglycosides, mediated through multiple mechanisms. Further detailed studies are needed to explain the clinical applications and limitations of these glycosides.
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Affiliation(s)
- Haroon Khan
- Department of Pharmacy, Abdul Wali Khan University Mardan, 23200, Pakistan.
| | - Ziyad Khan
- Department of Pharmacy, Abdul Wali Khan University Mardan, 23200, Pakistan
| | - Surriya Amin
- Department of Botany, Islamia College University Peshawar, Pakistan
| | - Yahia Nasser Mabkhot
- Department of Chemistry, College of Science, King Saud University, P. O. Box 2455, Riyadh-11451, Saudi Arabia
| | | | - Taibi Ben Hadda
- LCM Laboratory, University of Mohammed 1st, Faculty of Sciences, Oujda 60000, Morocco
| | - Francesco Maione
- Department of Pharmacy, University of Naples Federico II, Via Domenico Montesano 49, 80031, Naples, Italy
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van de Peppel RJ, von dem Borne PA, le Cessie S, de Boer MGJ. A new time-dependent approach for assessment of the impact of invasive aspergillosis shows effect on short- but not on long-term survival of patients with AML or high-risk MDS. Bone Marrow Transplant 2017; 52:883-888. [PMID: 28504663 DOI: 10.1038/bmt.2017.71] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/21/2017] [Accepted: 03/03/2017] [Indexed: 12/13/2022]
Abstract
Invasive aspergillosis (IA) has been reported to yield high mortality rates. Patients with an unfavourable prognostic haematological disease not only have a higher probability of developing IA but are also more likely to die due to causes directly related to the underlying disease. This complexity of risk mechanisms confounds the causal interpretation of IA occurrence and mortality. Full consideration of the changing patient characteristics over time is necessary to obtain reliable estimates of the correlation of IA with mortality. We studied the effect of IA on mortality in 167 consecutive patients starting with remission-induction therapy for AML or of whom most patients continued to haematopoietic stem cell transplantation (HSCT). No standard antifungal prophylaxis was administered in the period before HSCT. Survival analyses were performed to determine risk estimates of IA for different phases of treatment before and after HSCT. Time-dependent adjustment for confounding variables was performed using Cox proportional hazards models. In 55 of 167 enroled patients, IA was diagnosed. Before HSCT, adjusted hazard ratios and 95% confidence intervals on mortality after the diagnosis of IA were 3.5 (1.7-7.5), 2.0 (0.69-5.9), 2.3 (0.79-6.8) and 0.80 (0.49-1.4) within 30 days, between 30 and 60 days, between 60 and 90 days or more than 90 days, respectively. A similar pattern was observed after HSCT. The occurrence of IA did not significantly influence the decision to follow through with HSCT. The results provide new insights in short- and long-term survival of patients diagnosed with IA. A significantly increased mortality risk was only observed in the first month after diagnosis of IA. No unfavourable association with mortality was observed in the later course of treatment. The occurrence of IA did not affect the probability of attaining HSCT in our population.
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Affiliation(s)
- R J van de Peppel
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - P A von dem Borne
- Department of Haematology, Leiden University Medical Center, Leiden, The Netherlands
| | - S le Cessie
- Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
| | - M G J de Boer
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
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Affiliation(s)
- M J Day
- School of Veterinary Sciences, University of Bristol, UK.
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