ABSTRACT
With the increasing proportion of Candida glabrata in patients with candidiasis, C. glabrata has become one of the most common pathogenic Candida in clinical practice. There are limited types of antifungal drugs, and the consequent problem of drug resistance is severely increasing, which brings difficulties to clinical treatment. The resistance mechanisms of C. glabrata to azoles, echinocandins and polyenes were reviewed in this paper.
ABSTRACT
With the application of echinocandin antifungals, more and more resistant Candida albicans strains have been detected. It has been reported that mechanisms underlying the resistance of Candida albicans to echinocandin antifungals mainly involve FKS, MSH2 and ERG3 gene mutations, biofilm formation, cellular stress response, compensatory increases in chitin, sphingolipid synthesis, etc. This review focuses on echinocandin resistance-related genes and underlying mechanisms in Candida albicans, which will help to overcome and prevent echinocandin resistance in clinical practice, and explore new therapeutic targets and drugs for Candida albicans infection.
ABSTRACT
Over nearly 70-year development, organ transplantation has become an effective treatment for multiple end-stage diseases. However, postoperative administration of immunosuppressants should be given for the recipients, which leads to low immune function and high incidence rate of infection, including viral, bacterial and fungal infections. Among them, the occurrence of fungal infection is hidden, and it is difficult to deliver prompt diagnosis. Candida, Aspergillus, Cryptococcus and Pneumocystis infection are common fungal infections in solid organ transplantation. High-risk factors of fungal infection after solid organ transplantation should be identified and prevented in advance, and prompt diagnosis and treatment should be carried out by combining the results of (1, 3)-β-D-glucan assay (fungal G-test), imaging examination and related body fluid culture. These interventions are of clinical significance to reduce the incidence of fungal infection and fatality after solid organ transplantation. In this article, common fungal infections after organ transplantation were reviewed, aiming to provide reference for the prevention and treatment of fungal infections after organ transplantation.
ABSTRACT
OBJECTIVE: To review systematically the efficacy and safety of echinocandins to invasive candidiasis in pediatric patients. METHODS: Databases including multiple databases were searched electronically for randomized controlled trials (RCTs) of echinocandins to invasive candidiasis in pediatric patients up to September 2018. Two reviewers independently screened literatures according to the inclusion and exclusion criteria, extracted data, and assessed the methodological quality of the included studies. Then Meta-analysis was performed using Rev Man 5.3 software. RESULTS: A total of 5 RCTs involving 1 190 patients were included. There were 598 patients in the echinocandins group and 592 patients in the control group. Micafungin and caspofungin were retrieved. Fluconazole, and amphotericin B liposome and amphotericin B deoxycholate were used to treat the patient in control group. The RESULTS: of Meta-analysis showed that there was significant difference between experimental group and control group on the overall effectiveness. Subgroup analysis showed that there were significant difference between caspofungin and control group, also between micafungin and control group. There was significant difference between echinocandins and control group on the subgroup analysis of empiric therapy. There were significant difference between experimental group and control group on the discontinuation due to adverse events. Subgroup analysis showed that there was significant difference between caspofungin and control group. CONCLUSION: According to recent analysis, the efficacy and safety of echinocandins in children with invasive candidiasis infections is superior to fluconazole and/or amphotericin B.
ABSTRACT
The fungi of the order Mucorales cause mucormycosis, which usually presents as an invasive fungal disease with rapid angioinvasion in immunocompromised patients. Rhinocerebral is the most common presentation. The lipid formulations of amphotericin B are used as primary treatment in invasive mucormycosis; the combined use of posaconazole could allow a reduction in the dose of amphotericin B improving tolerance and adherence to treatment. Caspofungin and amphotericin B association has been shown to be synergistic in vitro and effective in murine models. We present the case of a preschool patient that during the debut of acute lymphoblastic leukemia developed a rhinocerebral mucormycosis successfully responding to antifungal treatment with the combination of liposomal amphotericin and caspofungin.
Los hongos del orden Mucorales causan la mucormicosis, que se presenta habitualmente como una enfermedad fúngica invasora con rápida angioinvasión en pacientes inmunocomprometidos. La presentación rino-cerebral es la más frecuente. Las formulaciones lipídicas de anfotericina B se usan como tratamiento primario en las mucormicosis invasoras; el uso combinado de posaconazol podría permitir reducir la dosis de anfotericina B generando una mejor tolerancia y adherencia al tratamiento. La asociación de caspofungina con anfotericina ha demostrado acción sinérgica in vitro y eficacia en modelos murinos. Se presenta el caso de una niña preescolar que durante el debut de una leucemia linfoblástica aguda evolucionó con una mucormicosis rino-cerebral persistente, que respondió en forma exitosa al tratamiento antifúngico combinado de anfotericina liposomal y caspofungina.