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Marx J, Reinstadler V, Gasperetti T, Welte R, Oberacher H, Moser P, Joannidis M, Bellmann R. Human Tissue Distribution of Caspofungin. Int J Antimicrob Agents 2022; 59:106553. [PMID: 35176477 DOI: 10.1016/j.ijantimicag.2022.106553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/24/2022] [Accepted: 02/07/2022] [Indexed: 11/26/2022]
Abstract
Tissue concentrations of caspofungin were determined in nine different tissues taken during autopsy of twenty patients who had deceased during treatment or within 23 days after cessation. The highest levels were achieved in liver with concentrations ranging from ≤0.50 to 91.5 µg/g (0.60 µg/g 21 days after the last administration), followed by spleen (<0.25 to 46.3 µg/g), kidney (<0.25 to 33.6 µg/g), and lung (<0.25 to 31.0 µg/g). Intermediate concentrations were found in pancreas, skeletal muscle, thyroid, and myocardium. The smallest amounts were recovered from brain where caspofungin could be measured in six out of seventeen samples only. Caspofungin concentrations exceeded the MIC values of pathogenic Candida species in most of the tissue samples taken from patients who had deceased during treatment, except in brain samples. Our findings warrant clinical outcome studies for establishment of optimal treatment of deep-seated candidiasis and support the current recommendations against echinocandins for treatment of fungal meningoencephalitis.
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Affiliation(s)
- Jana Marx
- Clinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Vera Reinstadler
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | - Tiziana Gasperetti
- Clinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - René Welte
- Clinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Herbert Oberacher
- Institute of Legal Medicine and Core Facility Metabolomics, Medical University of Innsbruck, Innsbruck, Austria
| | - Patrizia Moser
- Department of Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Romuald Bellmann
- Clinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria.
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Phelps RRL, Lu AY, Lee AT, Yue JK, Winkler EA, Raygor KP, Oh T, Barkovich MJ, Hollander H. Cerebrovascular complications of coccidioidomycosis meningitis: Case report and systematic review. J Clin Neurosci 2020; 80:282-289. [PMID: 33099362 DOI: 10.1016/j.jocn.2020.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/03/2020] [Indexed: 11/25/2022]
Abstract
Coccidioidomycosis exposure is common in the southwest United States and northern Mexico. Dissemination to the meninges is the most severe form of progression. Although ischemic strokes are well-reported in these patients, other cerebrovascular complications of coccidioidomycosis meningitis (CM), as well as their treatment options and outcomes, have not been systematically studied. We present a uniquely severe case of CM with several cerebrovascular complications. We also systematically queried PubMed and EMBASE databases, including articles published before April 2020 reporting human patients with CM-induced cerebrovascular pathology other than ischemic infarcts. Sixteen articles met inclusion criteria, which describe 6 patients with aneurysmal hemorrhage, 10 with non-aneurysmal hemorrhage, one with vasospasm, and one with transient ischemic attacks. CM-associated aneurysms invariably presented with hemorrhage. These were universally fatal until the past decade, when advances in surgical clipping and/or combined surgical and endovascular treatment have improved outcomes. We found that non-aneurysmal intracranial hemorrhages were limited to male patients, involved a diverse set of intracranial vasculature, and had a mortality rate surpassing 80%. Vasospasm was reported once, and was treated with percutaneous transluminal angioplasty. Transient ischemic attacks were reported once, and were successfully treated with fluconazole and dexamethasone. This review suggests that CM can present with a wide array of cerebrovascular complications, including ischemic infarcts, aneurysmogenesis, non-aneurysmal intracranial hemorrhage, vasospasm, and transient ischemic attacks. Mortality has improved over time due to advances in surgical and endovascular treatment modalities. The exception is non-aneurysmal intracranial hemorrhage, which remains associated with high mortality rates and few targeted therapeutic options.
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Affiliation(s)
- Ryan R L Phelps
- Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, Room M779, Box 0112, San Francisco, CA 94143, USA.
| | - Alex Y Lu
- Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, Room M779, Box 0112, San Francisco, CA 94143, USA
| | - Anthony T Lee
- Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, Room M779, Box 0112, San Francisco, CA 94143, USA
| | - John K Yue
- Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, Room M779, Box 0112, San Francisco, CA 94143, USA
| | - Ethan A Winkler
- Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, Room M779, Box 0112, San Francisco, CA 94143, USA
| | - Kunal P Raygor
- Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, Room M779, Box 0112, San Francisco, CA 94143, USA
| | - Taemin Oh
- Department of Neurosurgery, University of California San Francisco, 505 Parnassus Avenue, Room M779, Box 0112, San Francisco, CA 94143, USA
| | - Matthew J Barkovich
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Avenue, Room M391, San Francisco, CA 94143, USA
| | - Harry Hollander
- Department of Medicine, University of California San Francisco, 505 Parnassus Avenue, Room M1498, Box 0119, San Francisco, CA 94117, USA
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Anidulafungin and Micafungin Concentrations in Cerebrospinal Fluid and in Cerebral Cortex. Antimicrob Agents Chemother 2020; 64:AAC.00275-20. [PMID: 32340985 PMCID: PMC7318006 DOI: 10.1128/aac.00275-20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/17/2020] [Indexed: 11/20/2022] Open
Abstract
Anidulafungin and micafungin were quantified in cerebrospinal fluid (CSF) of critically ill adults and in cerebral cortex of deceased patients. In CSF, anidulafungin levels (<0.01 to 0.66 μg/ml) and micafungin levels (<0.01 to 0.16 μg/ml) were lower than those in plasma concentrations (0.77 to 5.07 and 1.21 to 8.70 μg/ml, respectively) drawn simultaneously. In cerebral cortex, anidulafungin and micafungin levels were 0.21 to 2.34 and 0.18 to 2.88 μg/g, respectively. Thus, MIC values of several pathogenic Candida strains exceed concentrations in CSF and in brain.
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Miller R, Assi M. Endemic fungal infections in solid organ transplant recipients-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13553. [PMID: 30924967 DOI: 10.1111/ctr.13553] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/22/2019] [Indexed: 02/07/2023]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention and management of blastomycosis, histoplasmosis, and coccidioidomycosis in the pre- and post-transplant period. Though each of these endemic fungal infections has unique epidemiology and clinical manifestations, they all share a predilection for primary pulmonary infection and may cause disseminated infection, particularly in immunocompromised hosts. Culture remains the gold standard for definitive diagnosis, but more rapid diagnosis may be achieved with direct visualization of organisms from clinical specimens and antigen-based enzyme immunoassay assays. Serology is of limited utility in transplant recipients. The mainstay of treatment for severe infections remains liposomal amphotericin followed by a step-down azole therapy. Cases of mild to moderate severity with no CNS involvement may be treated with azole therapy alone. The newer generation azoles provide additional treatment options, but supported currently with limited clinical efficacy data. Azole therapy in transplant recipients presents a unique challenge owing to the drug-drug interactions with immunosuppressant agents. Therapeutic drug monitoring of azole levels is an essential component of effective and safe therapy. Infection prevention centers around minimizing epidemiological exposures, early clinical recognition, and azole prophylaxis in selected individuals.
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Affiliation(s)
- Rachel Miller
- Department of Internal Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina
| | - Maha Assi
- Department of Internal Medicine, University of Kansas School of Medicine Wichita, Wichita, Kansas
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Low penetration of caspofungin into cerebrospinal fluid following intravenous administration of standard doses. Int J Antimicrob Agents 2017; 50:272-275. [DOI: 10.1016/j.ijantimicag.2017.02.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 02/07/2017] [Accepted: 02/22/2017] [Indexed: 01/05/2023]
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Bajema KL, Dalesandro MF, Fredricks DN, Ramchandani M. Disseminated coccidioidomycosis presenting with intramedullary spinal cord abscesses: Management challenges. Med Mycol Case Rep 2016; 15:1-4. [PMID: 28053850 PMCID: PMC5198726 DOI: 10.1016/j.mmcr.2016.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 11/29/2016] [Accepted: 12/01/2016] [Indexed: 01/05/2023] Open
Abstract
Coccidioides species are endemic to the southwestern United States and typically cause a mild or asymptomatic primary infection. In some instances, infection can disseminate and involve the central nervous system with meningitis being the most common manifestation. Non-osseous spinal cord involvement is exceedingly rare. We report a case of disseminated coccidioidomycosis in an otherwise healthy 20 year old man with diffuse leptomeningeal enhancement, cerebrospinal fluid findings suggestive of meningitis, and intramedullary spinal cord abscesses. Response to treatment occurred with prolonged systemic liposomal amphotericin B and voriconazole. An extended course of steroids was needed to blunt inflammation.
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Affiliation(s)
- Kristina L Bajema
- Department of Medicine, Divison of Allergy and Infectious Diseases, University of Washington, 1959 NE Pacific Street Box 356423, Seattle, WA 98195, USA
| | | | - David N Fredricks
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Meena Ramchandani
- Department of Medicine, Divison of Allergy and Infectious Diseases, Harborview Medical Center, Seattle, WA, USA
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7
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Hartmann CA, Aye WT, Blair JE. Treatment considerations in pulmonary coccidioidomycosis. Expert Rev Respir Med 2016; 10:1079-91. [PMID: 27635942 DOI: 10.1080/17476348.2017.1234378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Coccidioidomycosis is an endemic fungal infection caused by the soil-dwelling fungi, Coccidioides species. Coccidioidal infections may be asymptomatic in up to two-thirds of infected persons. Pulmonary coccidioidomycosis is the most common form of symptomatic infection. Fluconazole is the antifungal agent typically used to treat pulmonary coccidioidomycosis. Other azoles and amphotericin B products may be prescribed to treat nuanced aspects of coccidioidomycosis. AREAS COVERED This review discusses current literature regarding medical treatment options, including the various triazoles and amphotericin B products. In addition, we discuss uncomplicated and complicated pulmonary infections and their sequelae and the approach to managing coccidioidomycosis in certain populations of patients, such as pregnant women, transplant recipients, individuals infected with human immunodeficiency virus, and recipients of tumor necrosis factor-α inhibitors. Expert commentary: Symptomatic coccidioidomycosis can present physicians with a number of challenges, including the lack of sensitivity and specificity of diagnostic tests and lack of a standard treatment approach for all patients with the infection. Ongoing and future clinical trials will determine the optimal diagnostic, therapeutic, and prophylactic approaches, particularly for patients with comorbid conditions.
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Affiliation(s)
- Carlos A Hartmann
- a Division of Infectious Diseases , Mayo Clinic Hospital , Phoenix , AZ , USA
| | - Wint T Aye
- b Department of Internal Medicine , Mayo Clinic , Scottsdale , AZ , USA
| | - Janis E Blair
- a Division of Infectious Diseases , Mayo Clinic Hospital , Phoenix , AZ , USA
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Abstract
Central nervous system (CNS) infections are frequently encountered in the intensive care unit setting and are a significant source of morbidity and mortality. The constantly changing trends in microbial resistance, as well as the pharmacokinetic difficulties in providing effective concentrations of antimicrobials at the site of infection represent a unique challenge to clinicians. Achievement of a successful outcome in patientswith CNS infections is reliant on eradication of the offending pathogen and management of any neurologic complications. This requires an anatomic and physiologic understanding of the different types of CNS infection, diagnostic strategies, associated complications, causative organisms, and the principles that govern drug distribution into the CNS. This article serves as a review of the epidemiology, pathophysiology, diagnosis, and treatment options for a variety of CNS infections, with a focus on those commonly encountered in an intensive care setting.
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Affiliation(s)
- John J. Lewin
- The Johns Hopkins Hospital, 600 North Wolfe St., Carnegie 180, Baltimore, MD 21287-6180
| | - Marc Lapointe
- College of Pharmacy, Department of Pharmacy and Clinical Sciences, College of Medicine, Department of Neurological Surgery, Medical University of South Carolina, Charleston
| | - Wendy C. Ziai
- Division of Neurosciences Critical Care, The Johns Hopkins Hospital, Baltimore
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Abstract
Understanding the tissue penetration of systemically administered antifungal agents is critical for a proper appreciation of their antifungal efficacy in animals and humans. Both the time course of an antifungal drug and its absolute concentrations within tissues may differ significantly from those observed in the bloodstream. In addition, tissue concentrations must also be interpreted within the context of the pathogenesis of the various invasive fungal infections, which differ significantly. There are major technical obstacles to the estimation of concentrations of antifungal agents in various tissue subcompartments, yet these agents, even those within the same class, may exhibit markedly different tissue distributions. This review explores these issues and provides a summary of tissue concentrations of 11 currently licensed systemic antifungal agents. It also explores the therapeutic implications of their distribution at various sites of infection.
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Levy ER, McCarty JM, Shane AL, Weintrub PS. Treatment of Pediatric Refractory Coccidioidomycosis With Combination Voriconazole and Caspofungin: A Retrospective Case Series. Clin Infect Dis 2013; 56:1573-8. [DOI: 10.1093/cid/cit113] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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11
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Miller R, Assi M. Endemic fungal infections in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:250-61. [PMID: 23465018 DOI: 10.1111/ajt.12117] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- R Miller
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
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Favorable outcome of neonatal cerebrospinal fluid shunt-associated Candida meningitis with caspofungin. Antimicrob Agents Chemother 2013; 57:2391-3. [PMID: 23439643 DOI: 10.1128/aac.02085-12] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Invasive Candida infections associated with medical devices are very difficult to cure without device removal. We present a case of neonatal cerebrospinal fluid shunt-associated Candida meningitis, in which removal of the device was precluded, that was successfully treated with caspofungin. Pharmacokinetic assessment of caspofungin concentrations in cerebrospinal fluid showed that exposure was adequate in the presence of a high systemic exposure. In complex cases of neonatal Candida infections involving medical devices, the addition of caspofungin might be beneficial.
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14
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Kamei K. [Clinical problems that come with mycoses brought in from foreign countries]. Med Mycol J 2012; 53:103-108. [PMID: 22728592 DOI: 10.3314/mmj.53.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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16
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The role of azoles in the treatment of invasive mycoses: review of the Infectious Diseases Society of America guidelines. Curr Opin Infect Dis 2011. [DOI: 10.1097/01.qco.0000399602.83515.ac] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Abstract
The endemic mycoses are a diverse group of diseases caused by thermally dimorphic fungi. While they share many characteristics, each has unique aspects with regards to their clinical course, diagnosis and management. Diagnosis may be difficult and delayed owing to the varied manifestations and wide differential diagnosis. Historically, treatment has been with amphotericin B, which has been limited by its significant toxicity. The advent of the azole class of medications has allowed for safer alternatives to amphotericin B. The azoles have become the mainstay of treatment for many, if not most, forms of these diseases. Guidelines have been released for the management of each of the North American endemic mycoses; however, many questions remain as to the best strategies for the diagnosis and management of various manifestations of these diseases.
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Affiliation(s)
- Keyur S Vyas
- Division of Infectious Diseases, University of Arkansas for Medical Sciences, 4301 W Markham, Mail Slot #639, Little Rock, AR 72205, USA.
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18
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Proia L, Miller R. Endemic fungal infections in solid organ transplant recipients. Am J Transplant 2009; 9 Suppl 4:S199-207. [PMID: 20070682 DOI: 10.1111/j.1600-6143.2009.02912.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- L Proia
- Section of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center Chicago, IL, USA.
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Blair JE. Coccidioidal meningitis: Update on epidemiology, clinical features, diagnosis, and management. Curr Infect Dis Rep 2009; 11:289-95. [DOI: 10.1007/s11908-009-0043-1] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
Central nervous system (CNS) infections presenting to the emergency room include meningitis, encephalitis, brain and spinal epidural abscess, subdural empyema, and ventriculitis. These conditions often require admission to an intensive care unit (ICU) and are complications of ICU patients with neurologic injury, contributing significantly to morbidity and mortality. Reducing morbidity and mortality is critically dependent on rapid diagnosis and, perhaps more importantly, on the timely initiation of appropriate antimicrobial therapy. New insights into the role of inflammation and the immune response in CNS infections have contributed to development of new diagnostic strategies using markers of inflammation, and to the study of agents with focused immunomodulatory activity, which may lead to further adjunctive therapy in human disease.
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Voriconazole in Combination With Amphotericin B for Salvage Therapy of Coccidioidomycosis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2007. [DOI: 10.1097/ipc.0b013e31802b415a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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23
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Ziai WC, Lewin JJ. Advances in the management of central nervous system infections in the ICU. Crit Care Clin 2007; 22:661-94; abstract viii-ix. [PMID: 17239749 DOI: 10.1016/j.ccc.2006.11.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This chapter focuses on early aggressive management of common infections of the central nervous system that require monitoring in an ICU setting. These include meningitis, encephalitis, brain and epidural abscess, subdural empyema and ventriculitis. It emphasizes priorities in evaluation and management due to increasing morbidity and mortality as a result of failure to appreciate non-specific symptoms or administer timely therapy. The emergence of organisms resistant to penicillin and cephalosporins has also further complicated the early management of bacterial meningitis. Current antimicrobial guidelines are provided along with discussion of new diagnostic and therapeutic strategies and controversial aspects of management.
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Affiliation(s)
- Wendy C Ziai
- Division of Neurosciences Critical Care, Department of Neurology, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
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DiCaudo DJ. Coccidioidomycosis: a review and update. J Am Acad Dermatol 2006; 55:929-42; quiz 943-5. [PMID: 17110216 DOI: 10.1016/j.jaad.2006.04.039] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2005] [Revised: 04/05/2006] [Accepted: 04/11/2006] [Indexed: 11/25/2022]
Abstract
Coccidioidomycosis occurs in arid and semi-arid regions of the New World from the western United States to Argentina. Highly endemic areas are present in the southwest United States. Coccidioides species live in the soil and produce pulmonary infection via airborne arthroconidia. The skin may be involved by dissemination of the infection, or by reactive eruptions, such as a generalized exanthem or erythema nodosum. Interstitial granulomatous dermatitis and Sweet's syndrome have recently been recognized as additional reactive signs of the infection. Coccidioidomycosis is a "great imitator" with protean manifestations. Cutaneous findings may be helpful clues in the diagnosis of this increasingly important disease.
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Affiliation(s)
- David J DiCaudo
- Department of Dermatology and Pathology, Mayo Clinic, Scottsdale, Arizona 85259, USA.
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25
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Park DW, Sohn JW, Cheong HJ, Kim WJ, Ja Kim M, Kim JH, Shin C. Combination therapy of disseminated coccidioidomycosis with caspofungin and fluconazole. BMC Infect Dis 2006; 6:26. [PMID: 16480497 PMCID: PMC1386678 DOI: 10.1186/1471-2334-6-26] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2005] [Accepted: 02/15/2006] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The current recommended therapy for diffuse coccidioidal pneumonia involves initial treatment with amphotericin B deoxycholate or high-dose fluconazole, followed by an azole after clinical improvement. Amphotericin B is more frequently used as initial therapy if the patient's deterioration is rapid. CASE PRESENTATION A 31-year-old Korean male with coccidioidomycosis presented to the hospital with miliary infiltrates on chest X-ray (CXR) and skin rash on the face and trunk. Initially, the patient did not respond to amphotericin B deoxycholate therapy. However, following caspofungin and fluconazole combination therapy, the patient showed favourable radiological, serological, and clinical response. CONCLUSION This appears to be the first case of diffuse coccidioidal pneumonia with skin involvement in an immunocompetent patient who was treated successfully with caspofungin and fluconazole. Combination therapy with caspofungin and fluconazole may, therefore, be an alternative treatment for diffuse coccidioidal pneumonia that does not respond to amphotericin B deoxycholate therapy.
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Affiliation(s)
- Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, 126-1, Anam-dong 5th Str., Seongbuk-gu, Seoul 136–705, Republic of Korea
| | - Jang Wook Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, 126-1, Anam-dong 5th Str., Seongbuk-gu, Seoul 136–705, Republic of Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, 126-1, Anam-dong 5th Str., Seongbuk-gu, Seoul 136–705, Republic of Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, 126-1, Anam-dong 5th Str., Seongbuk-gu, Seoul 136–705, Republic of Korea
| | - Min Ja Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, 126-1, Anam-dong 5th Str., Seongbuk-gu, Seoul 136–705, Republic of Korea
| | - Je Hyeong Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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Abstract
Coccidioidomycosis is an endemic fungal infection in the southwestern United States. It causes morbidity and mortality among solid organ transplant recipients who reside in or visit the endemic area or who receive organs from donors infected with the fungus. This paper reviews current literature addressing these infections in liver transplantation programs, including risk factors, clinical manifestations in persons with cirrhosis or who have had a liver transplantation, prophylaxis, treatment, and outcomes.
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Affiliation(s)
- Janis E Blair
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, AZ 85259, USA.
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Mattiuzzi G, Giles FJ. Management of intracranial fungal infections in patients with haematological malignancies. Br J Haematol 2005; 131:287-300. [PMID: 16225648 DOI: 10.1111/j.1365-2141.2005.05749.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The incidence of, and mortality associated with, invasive fungal infections remains far higher than hoped. As a consequence of the overall increase in the incidence of such infections over time, the incidence of central nervous system (CNS) fungal infections is also increasing and, despite improvements in diagnostic techniques and the introduction of novel antifungal agents, therapy for CNS infections is still associated with discouragingly poor results. In patients with haematological malignancies, opportunistic infections with Candida or Aspergillus remain the most common infections affecting the CNS; however, opportunistic infections with less well-known fungi are becoming more common and must be considered in the differential diagnosis. New techniques for the early diagnosis of invasive fungal infections are emerging. Pharmacologic options for treating invasive fungal infections have also improved during the past few years, with new drugs becoming available that have broader antifungal spectra and better safety profiles. Other novel treatment approaches, such as combination therapy, are also being explored. Early investigations have produced encouraging results; however, large, prospective studies involving many patients are necessary to validate the widespread use of these approaches. This review analyses the existing guidelines for treatment of CNS fungal infections and the literature available on the use of new drugs to generate sets of recommendations for treatment of these life-threatening infections in patients with haematological malignancies.
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Affiliation(s)
- Gloria Mattiuzzi
- Department of Leukemia, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
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