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Kluge S, Strauß R, Kochanek M, Weigand MA, Rohde H, Lahmer T. Aspergillosis: Emerging risk groups in critically ill patients. Med Mycol 2021; 60:6408468. [PMID: 34677613 DOI: 10.1093/mmy/myab064] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/23/2021] [Accepted: 10/19/2021] [Indexed: 02/06/2023] Open
Abstract
Information on invasive aspergillosis (IA) and other invasive filamentous fungal infections is limited in non-neutropenic patients admitted to the intensive care unit (ICU) and presenting with no classic IA risk factors. This review is based on the critical appraisal of relevant literature, on the authors' own experience and on discussions that took place at a consensus conference. It aims to review risk factors favoring aspergillosis in ICU patients, with a special emphasis on often overlooked or neglected conditions. In the ICU patients, corticosteroid use to treat underlying conditions such as chronic obstructive pulmonary disease (COPD), sepsis, or severe COVID-19, represents a cardinal risk factor for IA. Important additional host risk factors are COPD, decompensated cirrhosis, liver failure, and severe viral pneumonia (influenza, COVID-19). Clinical observations indicate that patients admitted to the ICU because of sepsis or acute respiratory distress syndrome are more likely to develop probable or proven IA, suggesting that sepsis could also be a possible direct risk factor for IA, as could small molecule inhibitors used in oncology. There are no recommendations for prophylaxis in ICU patients; posaconazole mold-active primary prophylaxis is used in some centers according to guidelines for other patient populations and IA treatment in critically ill patients is basically the same as in other patient populations. A combined evaluation of clinical signs and imaging, classical biomarkers such as the GM assay, and fungal cultures examination, remain the best option to assess response to treatment. LAY SUMMARY The use of corticosteroids and the presence of co-morbidities such as chronic obstructive pulmonary disease, acute or chronic advanced liver disease, or severe viral pneumonia caused by influenza or Covid-19, may increase the risk of invasive aspergillosis in intensive care unit patients.
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Affiliation(s)
- Stefan Kluge
- Department of Intensive Care Medicine, University Medical Center Hamburg - Eppendorf, Hamburg, D-20246, Germany
| | - Richard Strauß
- Department of Medicine 1, Medizinische Klinik 1, University Hospital Erlangen, Erlangen, D-91054, Germany
| | - Matthias Kochanek
- Department I of Internal Medicine, Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, D-50937, Germany
| | - Markus A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, D-69120, Germany
| | - Holger Rohde
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, D-20246, Germany
| | - Tobias Lahmer
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universität Munich, Munich, D-81675, Germany
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Lane M, Szymeczek MA, Sherertz R, Meurtos K, Sciarretta JD, Davis JM. Invasive Pulmonary Aspergillosis: Risks for Acquisition and Death in a Community Hospital. Surg Infect (Larchmt) 2018; 19:667-671. [DOI: 10.1089/sur.2018.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Morgan Lane
- Department of Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Mary Anne Szymeczek
- Department of Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Robert Sherertz
- Department of Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Kylie Meurtos
- Department of Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - Jason D. Sciarretta
- Department of Medicine, Grand Strand Regional Medical Center, Myrtle Beach, South Carolina
| | - John M. Davis
- Department of Surgery, Hackensack Meridien Health, Palisades Medical Center, North Bergen, New Jersey
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Borba HHL, Steimbach LM, Riveros BS, Tonin FS, Ferreira VL, Bagatim BADQ, Balan G, Pontarolo R, Wiens A. Cost-effectiveness of amphotericin B formulations in the treatment of systemic fungal infections. Mycoses 2018; 61:754-763. [PMID: 29893450 DOI: 10.1111/myc.12801] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/30/2018] [Accepted: 06/07/2018] [Indexed: 11/27/2022]
Abstract
Amphotericin formulations, indicated for invasive fungal infections (IFIs), vary in effectiveness, safety and costs. In Brazil, only the conventional formulation is provided by the Public Health System. The aim of this study was to perform a cost-effectiveness analysis comparing conventional amphotericin B (CAB), liposomal amphotericin B (LAB) and amphotericin B lipid complex (ABLC). Therefore, a decision tree was developed. The model began with high-risking patients on suspicion or confirmation of IFI. The analysis was conducted under the perspective of the Brazilian Public Health System. Model health states were defined according to medication use and clinical evolution. Clinical efficacy (cure) and transition probabilities were derived from the literature. Resource use was estimated from Brazilian data. Time horizon followed the maximum treatment time determined in the patient information leaflets (3 or 6 weeks). One-way and probabilistic-sensitivity analyses were conducted. The conventional formulation was the most cost-effective. No dominance was observed; however, high incremental cost-effectiveness ratios were obtained for LAB (USD 313 130) and ABLC (USD 1 711 280). Sensitivity analyses demonstrated the robustness of the results. CAB is the most cost-effective treatment, followed by LAB and ABLC. Although CAB presents critical safety aspects, the high acquisition costs of the other formulations prevent their large-scale use in Brazil.
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Affiliation(s)
| | - Laiza Maria Steimbach
- Pharmaceutical Sciences Postgraduate Research Programme, Federal University of Paraná, Curitiba, Brazil
| | - Bruno Salgado Riveros
- Pharmaceutical Sciences Postgraduate Research Programme, Federal University of Paraná, Curitiba, Brazil
| | - Fernanda Stumpf Tonin
- Pharmaceutical Sciences Postgraduate Research Programme, Federal University of Paraná, Curitiba, Brazil
| | - Vinicius Lins Ferreira
- Pharmaceutical Sciences Postgraduate Research Programme, Federal University of Paraná, Curitiba, Brazil
| | | | - Gisele Balan
- Pharmaceutical Sciences Postgraduate Research Programme, Federal University of Paraná, Curitiba, Brazil
| | - Roberto Pontarolo
- Pharmaceutical Sciences Postgraduate Research Programme, Federal University of Paraná, Curitiba, Brazil
| | - Astrid Wiens
- Pharmaceutical Sciences Postgraduate Research Programme, Federal University of Paraná, Curitiba, Brazil
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van Paassen J, Russcher A, In 't Veld-van Wingerden AW, Verweij PE, Kuijper EJ. Emerging aspergillosis by azole-resistant Aspergillus fumigatus at an intensive care unit in the Netherlands, 2010 to 2013. ACTA ACUST UNITED AC 2017; 21:30300. [PMID: 27541498 DOI: 10.2807/1560-7917.es.2016.21.30.30300] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 05/27/2016] [Indexed: 12/17/2022]
Abstract
The prevalence of invasive aspergillosis (IA) at the intensive care unit (ICU) is unknown and difficult to assess since IA also develops in patients lacking specific host factors. In the Netherlands, increasing azole-resistance in Aspergillus fumigatus complicates treatment of patients with IA. The aim of this study was to determine the prevalence of IA by azole-resistant A. fumigatus at the ICU among patients receiving antifungal treatment and to follow their clinical outcome and prognosis. A retrospective cohort study was conducted in a university hospital ICU from January 2010 to December 2013. From all patients who received antifungal treatment for suspected IA, relevant clinical and microbiological data were collected using a standardised questionnaire. Of 9,121 admitted ICU-patients, 136 had received antifungal treatment for suspected IA, of which 38 had a positive A. fumigatus culture. Ten of the 38 patients harboured at least one azole-resistant isolate. Resistance mechanisms consisted of alterations in the cyp51A gene, more specific TR34/L98H and TR46/T289A/Y121F. Microsatellite typing did not show clonal relatedness, though isolates from two patients were genetically related. The overall 90-day mortality of patients with IA by azole-resistant A. fumigatus and patients with suspicion of IA by azole-susceptible isolates in the ICU was 100% (10/10) vs 82% (23/28) respectively. We conclude that the changing pattern of IA in ICU patients requires appropriate criteria for recognition, diagnosis and rapid resistance tests. The increase in azole resistance rates also challenges a reconsideration of empirical antifungal therapy.
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Affiliation(s)
- Judith van Paassen
- Leiden University Medical Centre, intensive care department, Leiden, the Netherlands
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Steimbach LM, Tonin FS, Virtuoso S, Borba HHL, Sanches ACC, Wiens A, Fernandez-Llimós F, Pontarolo R. Efficacy and safety of amphotericin B lipid-based formulations-A systematic review and meta-analysis. Mycoses 2016; 60:146-154. [DOI: 10.1111/myc.12585] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 09/05/2016] [Accepted: 10/22/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Laiza M. Steimbach
- Department of Pharmacy; Pharmaceutical Sciences Postgraduate Research Program; Federal University of Paraná; Curitiba Brazil
| | - Fernanda S. Tonin
- Department of Pharmacy; Pharmaceutical Sciences Postgraduate Research Program; Federal University of Paraná; Curitiba Brazil
| | - Suzane Virtuoso
- Department of Pharmacy; Pharmaceutical Sciences Postgraduate Research Program; Federal University of Paraná; Curitiba Brazil
- Department of Medical and Pharmaceutical Sciences; West-Stadual University of Parana (UNIOESTE); Cascavel Brazil
| | - Helena H. L. Borba
- Department of Pharmacy; Pharmaceutical Sciences Postgraduate Research Program; Federal University of Paraná; Curitiba Brazil
| | - Andréia C. C. Sanches
- Department of Medical and Pharmaceutical Sciences; West-Stadual University of Parana (UNIOESTE); Cascavel Brazil
| | - Astrid Wiens
- Department of Pharmacy; Pharmaceutical Sciences Postgraduate Research Program; Federal University of Paraná; Curitiba Brazil
| | - Fernando Fernandez-Llimós
- Department of Social Pharmacy; Research Institute for Medicines (iMed. ULisboa); Faculty of Pharmacy; University of Lisboa; Lisbon Portugal
| | - Roberto Pontarolo
- Department of Pharmacy; Pharmaceutical Sciences Postgraduate Research Program; Federal University of Paraná; Curitiba Brazil
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Salci TP, Batilana AP, Pietrobon R, Caparroz-Assef SM. Problems related to antifungal prescription: a qualitative study of the views of intensivists. J Eval Clin Pract 2014; 20:460-6. [PMID: 24840772 DOI: 10.1111/jep.12181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 12/29/2022]
Abstract
RATIONALE AND OBJECTIVE The choice of the appropriate antifungal medication is essential for therapeutic success. Although guidelines are available in the literature that regulate the consistent use of antifungal, no previous qualitative studies have addressed the difficulties related to the use of antifungal medication, especially in the intensive care unit (ICU). Our objective was to qualitatively investigate how intensivists consider antifungal prescriptions in an adult ICU. METHODS The Grounded Theory analytical method was used for the data analysis. Physicians who worked in the adult ICU and prescribed antifungal medications were individually interviewed. A semi-structured interview was used to ask core questions, followed by follow-up questions at the discretion of the interviewer. RESULTS Our analysis generated eight main emerging themes that were classified into three related groups. The main insights were that various interconnected reasons were given for the lack of conformity with regard to prescription patterns for antifungals. A negative cycle was perceived based on issues related to prescriptions and the search for knowledge. If problems related to individual actions and multidisciplinary team integration are resolved and local protocols are implemented based on local epidemiology, then barriers to proper prescriptions can be overcome when intensivists are faced with the unusual practice of prescribing antifungals. CONCLUSIONS Our investigation indicates the need for prescription assistance with support from a well-trained multidisciplinary team and consensus among its members and the importance of well-designed protocols.
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Affiliation(s)
- Tânia Pereira Salci
- Post Graduate Program in Biosciences Applied to Pharmacy, Universidade Estadual de Maringá, Maringá, Paraná, Brazil
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Synthesis and antifungal activity of ASP9726, a novel echinocandin with potent Aspergillus hyphal growth inhibition. Bioorg Med Chem Lett 2014; 24:1172-5. [PMID: 24468413 DOI: 10.1016/j.bmcl.2013.12.116] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Revised: 12/24/2013] [Accepted: 12/28/2013] [Indexed: 11/21/2022]
Abstract
The synthesis and antifungal activity of ASP9726, a novel echinocandin with potent Aspergillus hyphal growth inhibition and significantly improved MIC against Candida parapsilosis and echinocandin resistant-Candida is described.
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Hamad M, Kazandji N, Awadallah S, Allam H. Prevalence and epidemiological characteristics of vaginal candidiasis in the UAE. Mycoses 2013; 57:184-90. [PMID: 24102778 DOI: 10.1111/myc.12141] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 08/09/2013] [Accepted: 08/22/2013] [Indexed: 11/27/2022]
Abstract
Vaginal candidiasis (VC) continues to be a health problem to women worldwide. Although the majority of VC cases are caused by Candida albicans (C. albicans), non-albicans Candida spp. like C. glabrata and C. tropicalis are emerging as important and potentially resistant opportunistic agents of VC. The objective of this study was to evaluate the prevalence and epidemiology of VC in the UAE through retrospective analysis of pertinent data compiled by the microbiology and infection control unit at Latifa Hospital, Dubai between 2005 and 2011. The incidence of VC significantly increased from 10.76% in 2005 to 17.61% in 2011; average prevalence was 13.88%. C. albicans occurred at a frequency of 83.02%, C. glabrata at 16.5% and C. tropicalis at 1.2%. A single C. dubliniensis isolate was identified in the sample population. The percentage of C. albicans significantly decreased from 83.02% in the sample population as a whole to 60.8% in subjects over 45 years of age (P < 0.01) and that of C. glabrata, C. tropicalis and C. krusei significantly increased from 13.88%, 0.9% and 0.03% to 29.7%, 6.7% and 1.4% (P < 0.05) respectively. The incidence of VC in the UAE is on the rise and the frequency of non-albicans Candida spp. is noticeably increasing especially in postmenopausal women.
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Affiliation(s)
- Mawieh Hamad
- Department of Medical Laboratory Sciences, University of Sharjah, Sharjah, UAE
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Farina C, Perin S, Andreoni S, Conte M, Fazii P, Lombardi G, Manso E, Morazzoni C, Sanna S. Evaluation of the peptide nucleic acid fluorescence in situ hybridisation technology for yeast identification directly from positive blood cultures: an Italian experience. Mycoses 2012; 55:388-92. [PMID: 22233292 DOI: 10.1111/j.1439-0507.2011.02166.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Fungaemia is an increasing nosocomial pathology. The 'gold standard' for detection of fungaemia is blood culture, but it is time-consuming and its sensitivity for early detection is low. On the other hand, yeasts present different antifungal sensitivity patterns to be quickly detected to allow an effective treatment. The aim of this study was to evaluate the diagnostic performances of PNA-FISH to directly identify yeasts from blood cultures and to compare results with those obtained by culture. A total of 176 blood cultures positive for yeasts at direct Gram stain and 24 negative blood cultures as control collected from 15 Italian hospitals, included in a network coordinated by the Medical Mycology Committee, Italian Society of Clinical Microbiology (AMCLI), were examined both by culture and PNA-FISH technology. Sensitivity of the PNA-FISH technique evaluated for five Candida species was 99.3% and specificity, 100%. Distinguishing which yeast is implicated in fungaemia and whether the infection is caused by multiple species are important for the selection of antifungal therapy. The PNA-FISH technique is a very useful approach because the test discriminates between groups of Candida species with different susceptibility pattern, particularly against azoles and echinocandins, with only a 90-minute turn-around time after the Gram-stain reading.
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Affiliation(s)
- Claudio Farina
- Microbiology Institute, AO, Ospedale San Carlo Borromeo, Milano, Italy.
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Fortún J, Carratalá J, Gavaldá J, Lizasoain M, Salavert M, de la Cámara R, Borges M, Cervera C, Garnacho J, Lassaleta Á, Lumbreras C, Sanz MÁ, Ramos JT, Torre-Cisneros J, Aguado JM, Cuenca-Estrella M. [Guidelines for the treatment of invasive fungal disease by Aspergillus spp. and other fungi issued by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC). 2011 Update]. Enferm Infecc Microbiol Clin 2011; 29:435-54. [PMID: 21474210 DOI: 10.1016/j.eimc.2011.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Revised: 01/20/2011] [Accepted: 01/24/2011] [Indexed: 01/17/2023]
Abstract
The guidelines on the treatment of invasive fungal disease by Aspergillus spp. and other fungi issued by the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) are presented. These recommendations are focused on four clinical categories: oncology-haematology patients, solid organ transplant recipients, patients admitted to intensive care units, and children. An extensive review is made of therapeutical advances and scientific evidence in these settings. These guidelines have been prepared according the SEIMC consensus rules by a working group composed of specialists in infectious diseases, clinical microbiology, critical care medicine, paediatrics and oncology-haematology. Specific recommendations on the prevention of fungal infections in these patients are included.
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Affiliation(s)
- Jesús Fortún
- Servicio de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain.
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Ozment-Skelton TR, deFluiter EA, Ha T, Li C, Graves BM, Ferguson DA, Schweitzer JB, Preizsner J, Brown GD, Gordon S, Kalbfleisch JH, Williams DL. Leukocyte Dectin-1 expression is differentially regulated in fungal versus polymicrobial sepsis. Crit Care Med 2009; 37:1038-45. [PMID: 19237915 PMCID: PMC2730197 DOI: 10.1097/ccm.0b013e3181968fa0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine peripheral leukocyte Dectin-1 regulation in clinically relevant models of fungal and polymicrobial sepsis. DESIGN Prospective animal study. SETTING University medical school research laboratory. SUBJECTS Age, weight, and sex matched ICR/HSD mice. INTERVENTIONS Mice were infected with Candida albicans (1 x 10, intravenously) or were subjected to cecal ligation and puncture to induce polymicrobial sepsis. MEASUREMENTS Blood, spleen, and peritoneal exudate were harvested and leukocytes were isolated. Leukocytes were evaluated for membrane-associated Dectin-1 expression and cell phenotype by flow cytometry. MAIN RESULTS In C. albicans infection, Dectin-1-positive blood and splenic leukocytes were increased from 23.5% to 58.9% over the course of infection. The increased percentage of Dectin-1-expressing cells was primarily attributable to neutrophilia. However, the amount of Dectin-1 expressed by blood and splenic neutrophils in C. albicans-infected mice was decreased by a range of 49.0% to 53.3%. C. albicans infection also resulted in an infiltration of Dectin-1-positive macrophages and neutrophils into the kidney. In contrast, polymicrobial sepsis decreased blood leukocyte Dectin-1-expressing cells by up to 51.4%. This reduction was due to a decrease in Dectin-1-positive neutrophils in the periphery. However, the percentage of Dectin-1-expressing cells in the peritoneal cavity increased by 774% with cecal ligation and puncture. Treatment of isolated neutrophils with three soluble glucans, mannan, lipopolysaccharide, or a variety of cytokines revealed that glucans, alone or in combination, were the only treatment that resulted in a decrease in Dectin-1-positive neutrophils. CONCLUSIONS We conclude that peripheral leukocyte Dectin-1 expression is differentially regulated in fungal vs. polymicrobial sepsis. These data demonstrate that leukocyte Dectin-1 levels are modulated in response to infections of fungal and nonfungal origin.
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Affiliation(s)
- Tammy R Ozment-Skelton
- Departments of Surgery, Microbiology, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
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Al-Sadeq A, Hamad M, Abu-Elteen K. Patterns of Expression of Vaginal T-Cell Activation Markers during Estrogen-Maintained Vaginal Candidiasis. ALLERGY, ASTHMA, AND CLINICAL IMMUNOLOGY : OFFICIAL JOURNAL OF THE CANADIAN SOCIETY OF ALLERGY AND CLINICAL IMMUNOLOGY 2008; 4:157-63. [PMID: 20525139 PMCID: PMC2868890 DOI: 10.1186/1710-1492-4-4-157] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
: The immunosuppressive activity of estrogen was further investigated by assessing the pattern of expression of CD25, CD28, CD69, and CD152 on vaginal T cells during estrogen-maintained vaginal candidiasis. A precipitous and significant decrease in vaginal fungal burden toward the end of week 3 postinfection was concurrent with a significant increase in vaginal lymphocyte numbers. During this period, the percentage of CD3+, CD3+CD4+, CD152+, and CD28+ vaginal T cells gradually and significantly increased. The percentage of CD3+ and CD3+CD4+ cells increased from 43% and 15% at day 0 to 77% and 40% at day 28 postinfection. Compared with 29% CD152+ vaginal T cells in naive mice, > 70% of vaginal T cells were CD152+ at day 28 postinfection. In conclusion, estrogen-maintained vaginal candidiasis results in postinfection time-dependent changes in the pattern of expression of CD152, CD28, and other T-cell markers, suggesting that T cells are subject to mixed suppression and activation signals.
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Affiliation(s)
- Ameera Al-Sadeq
- Department of Biology and Biotechnology, Hashemite University, Zarqa, Jordan
| | - Mawieh Hamad
- Department of Biology and Biotechnology, Hashemite University, Zarqa, Jordan
- Department of Biology and Biotechnology, Hashemite University, Zarqa, Jordan, and Taif University School of Medicine, Taif, Saudi Arabia
| | - Khaled Abu-Elteen
- Department of Biology and Biotechnology, Hashemite University, Zarqa, Jordan
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Tomishima M, Ohki H, Yamada A, Maki K, Ikeda F. Novel echinocandin antifungals. Part 2: Optimization of the side chain of the natural product FR901379. Discovery of micafungin. Bioorg Med Chem Lett 2008; 18:2886-90. [DOI: 10.1016/j.bmcl.2008.03.093] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 03/25/2008] [Accepted: 03/29/2008] [Indexed: 11/17/2022]
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Tomishima M, Ohki H, Yamada A, Maki K, Ikeda F. Novel echinocandin antifungals. Part 1: Novel side-chain analogs of the natural product FR901379. Bioorg Med Chem Lett 2008; 18:1474-7. [DOI: 10.1016/j.bmcl.2007.12.062] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2007] [Revised: 12/20/2007] [Accepted: 12/22/2007] [Indexed: 11/26/2022]
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