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Antifungal Treatment (antifungal + treatment)

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Medical Sciences	91%

Selected Abstracts

Epidemiology, treatment and outcome of candidemia: a five-year review at three Canadian hospitals

MYCOSES, Issue 5-6 2002
Behandlung und ausgang von Candidämien: Eine Fünfjahresübersicht an drei kanadischen Hospitälern, Epidemiologie
Candidämie; Epidemiologie; Kanada Summary. To determine treatment regimens and epidemiological patterns in the occurrence of candidemia, a review of cases occurring from 1992 to 1996 in three large Canadian hospitals, University of Alberta Hospital (UAH) and Royal Alexandra Hospital (RAH), Edmonton, and Foothills Medical Center (FMC), Calgary, was carried out. Cases were detected by reviewing microbiology laboratory records. There were 202 cases in all (UAH 104, FMC 70, RAH 28). For the five study years the candidemia rate was 4.5/10 000 discharges (UAH 7.6, FMC 4.9, and RAH 1.7; P < 0.05 for all interhospital comparisons). The rate remained stable between 1992 and 1995 but rose dramatically in 1996 to 7.6/10 000 (P < 0.01 compared to 1995) as a result of increases at UAH and RAH. Of the 208 species identified, Candida albicans accounted for 135 (65%). During hospitalization 93 (46%) patients died. Species did not influence outcome. Antifungal treatment with fluconazole alone was given to 14% of patients, and increased in frequency throughout the study. No antifungal therapy was given to 47 patients (23%). This group had a much higher mortality (68%) than those who received treatment (39% P < 0.01). Twenty of the untreated patients had already died by the time the blood culture had been reported as growing a yeast. Candidemia rates vary significantly between hospitals and increased in some but not all over the five study years. As many patients with candidemia will have died by the time laboratory diagnosis is made, presumptive antifungal therapy in high-risk patients may be necessary if outcome is to be improved. Zusammenfassung. Um epidemiologische Muster zu erkennen und Behandlungsmethoden zu optimieren, wurden die Candidämiefälle in der Zeit von 1992 bis 1996 in drei großen kanadischen Kliniken analysiert: University of Alberta Hospital (UAH) Royal Alexander Hospital (RAH), Edmonton und Foothills Medical Center (FMC), Calgary. Es wurden die archivierten mikrobiologischen Laborbefunde ausgewertet, insgesamt 202 Fälle (UAH 104, FMC 70, RAH 28). Im 5-Jahreszeitraum betrug die Candidämierate 4.5/10 000 Entlassungen (UAH 7.6, FMC 4.9, RAH 1.7, P < 0.05 für den Interklinikvergleich). Die Rate blieb zwischen 1992 und 1995 stabil, stieg aber im Jahr 1996 auf 7.6/10 000 (P < 0.01 im Vergleich zu 1995) infolge der Zunahme im UAH und RAH. Unter den 208 identifizierten Isolaten waren 135 Candida albicans (65%). Während der Hospitalisierung verstarben 93 Patienten (46%). Die Erregerart hatte keinen Einfluß auf den Krankheitsausgang. Fluconazol allein wurde 14% der Patienten verabreicht, die Verordnungshäufigkeit stieg während der Studie an. Keine antimykotische Therapie wurde 47 Patienten verordnet (23%). Diese Gruppe hatte eine wesentlich höhere Mortalität, nämlich 68%, im Vergleich zu der behandelten mit 39% (P < 0.01). 20 der nichtbehandelten Patienten waren schon zu dem Zeitpunkt verstorben, als der Befund ,Hefewachstum' aus der Blutkultur erhoben wurde. Die Candidämieraten unterschieden sich signifikant zwischen den Kliniken und stiegen in einigen, aber nicht allen im 5-Jahreszeitraum an. Da viele Patienten bereits während des Zeitraumes der Labordiagnostik verstarben, erscheint bei Hochrisikopatienten eine empirische Frühtherapie unabdingbar, wenn der Krankheitsausgang optimiert werden soll. [source]

A molecular epidemiological study of sequential oral isolates of Candida albicans from terminally ill patients

JOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 4 2001
M. J. Wilson
Abstract: The pattern of candidal colonisation was studied in a group of terminally ill patients receiving antifungal treatment for oral candidosis. A total of 43 isolates of C. albicans was collected pre- and post-antifungal treatment from patients up to a maximum period of 4 weeks. Isolates were analysed by electrophoretic karyotyping (EK) and by inter-repeat polymerase chain reaction (IR-PCR). Fifteen electrophoretic karyotypes and 17 IR-PCR profiles were identified. Sequential isolates from 10 patients yielded identical profiles in both EKs and IR-PCR analyses. In the case of four patients, minor differences in the profiles were obtained by either EK or IR-PCR. The findings suggest that antifungal treatment in this patient group fails to eradicate the original C. albicans strain, thereby allowing recolonisation of the oral cavity. The present study has also shown that either EK or IR-PCR is a useful typing approach in such epidemiological investigations. [source]

Toenail abnormalities and onychomycosis in chronic venous insufficiency of the legs: should we treat?

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 3 2008
A Shemer
Abstract Background Toenail manifestations of chronic venous insufficiency (CVI) may often mimic the nail changes of onychomycosis. The current study aims to determine the frequency of toenails deformations in patients with CVI, onychomycosis prevalence among deformed toenails and the outcome of itraconazole treatment. Methods Patients with clinical evidence of (CVI) were enrolled. All patients with toenails deformations and proven onychomycosis were treated by itraconazole pulse therapy for 4 months and then followed-up for additional 5 to 6 months. Results Forty-four patients with CVI entered the study. Thirty-seven patients (84%) had nail deformations; 28 of 37 patients (75%) had onychomycosis; and 24 patients completed the follow-up period. Total cure was achieved in 6 of 24 patients (25%), and 14 patients (58%) had no improvement. Patients' age and CVI duration were significantly correlated to onychomycosis cure rate. Conclusions Nail deformations are more prevalent in CVI patients (84%) then in the general elderly population, and 75% of affected nails had also onychomycosis. In these patients, itraconazole achieved only 25% total cure rate compared with the 60% to 70% cure rate commonly cited in the literature, probably due to irreversible nail deformity caused by the CVI and due to the thickened nail that prevented penetrance of itraconazole into the nail plate. Therefore, before antifungal treatment is started for onychomycosis in patients with CVI, especially in older patients, the caregiver must stress out that the final outcome might not be as desirable as in pure onychomycosis patients. [source]

Analysis of the strain relatedness of oral Candida albicans in patients with diabetes mellitus using polymerase chain reaction-fingerprinting

MOLECULAR ORAL MICROBIOLOGY, Issue 6 2006
M. Manfredi
To increase our understanding of Candida pathogenicity, the identification of those strains most frequently associated with infections is of paramount importance. Polymerase chain reaction (PCR)-based methods are extremely effective in differentiating and determining reproducibility, they require minimum starting material and are rapid and simple to perform. In this study, the genetic relatedness of Candida albicans was assessed for two geographically different patient groups (London, UK and Parma, Italy) affected by diabetes mellitus. C. albicans samples from the oral cavities of non-diabetic healthy subjects were also examined by PCR fingerprinting to evaluate the possible genetic differences among endogenous strains in individuals with and without diabetes mellitus. PCR fingerprinting, with subsequent phylogenetic analysis of C. albicans isolates from the diabetic patients from London and Italy and from the non-diabetic subjects, revealed that there were significant differences (P < 0.0001) between C. albicans isolates indicative of the distinct ecological niches that occur in the oral cavities of these patient cohorts. The most diverse group comprised the isolates from the diabetic patients in the UK, possibly reflecting the antifungal treatment that these patients had received. Further studies that include isolates from patient cohorts with systemic diseases other than diabetes mellitus, and from more diverse geographic localities are required to explain the relatedness of C. albicans isolates in the mouth. [source]

Do fungi play a role in psoriatic nails?

MYCOSES, Issue 6 2007
Jacek C. Szepietowski
Summary Onychomycosis is the most common disease of the nails and constitutes about a half of all nail abnormalities. Some factors like increasing age, male sex, repeated nail damage, genetic predispositions and underlying conditions, such as diabetes, immunodeficiency or peripheral arterial disease may predispose to develop onychomycosis. It is also suggested that abnormalities in nail morphology are the predisposing factors to onychomycosis. Psoriasis is one of the most common reasons of disturbed nail morphology and the spectrum of nail changes in psoriasis is very wide. Thus, there were suggestions that dystrophic nails in psoriatic patients lose their natural preventing barrier and therefore are more predisposed to fungal infection. This paper summarizes the knowledge about prevalence of onychomycosis among psoriatic patients and contains a literature review concerning this problem. Most authors report that the prevalence of onychomycosis in psoriatic patients is not higher than that in control population. However, especially yeasts and maybe moulds, probably as concomitant pathogens, are more often isolated from psoriatic patients than from non-psoriatic population. In reasonable cases, the mycological examination is required, especially when the clinical picture of the nails suggests the presence of fungal infection. In these cases, antifungal treatment may be beneficial for psoriatic patients. [source]

Influence of topical antifungal drugs on ciliary beat frequency of human nasal mucosa,

THE LARYNGOSCOPE, Issue 7 2010
An In Vitro Study
Abstract Objectives/Hypothesis: Topical antifungal treatment is a subject of discussion in the treatment of chronic rhinosinusitis. The aim of this research was to study the effects of antifungal drugs on ciliary beat frequency (CBF) of human nasal mucosa under in vitro conditions. Study Design: Case series of in vitro experiments and in vitro study of cultured ciliated cells of human nasal mucosa. Methods: Human nasal mucosa was acquired during routine endoscopic sinus surgery. Cells were cultivated on object slides and exposed to different antifungal drugs in a newly developed test system. This system allowed continuous and reproducible exposure to different drugs at constant temperature, pH value, and osmolarity. The drugs were amphotericin B in two different concentrations and itraconazole. Results: Rinsing with higher concentrations of amphotericin B led to an immediate decrease of CBF, with a total stop after 15 minutes. A different result was seen in the group with lower concentrations; CBF decreased again quickly after rinsing with the test drug, but all of them recovered after rinsing with neutral solution. When using itraconazole a decline in CBF was observed again; one half of the samples returned to activity. Conclusions: Our in vitro results demonstrate a dose-dependent effect of the antifungal drugs amphotericin B and itraconazole on ciliary beat frequency of human nose epithelium. Laryngoscope, 2010 [source]

Artificial incubation of noble crayfish (Astacus astacus) eggs in a partially recirculating system using formaldehyde as an antifungal treatment

AQUACULTURE RESEARCH, Issue 10 2010
Antonín Kouba
Abstract There is little information on the long-term artificial incubation of noble crayfish eggs. The present study evaluated artificial incubation in a partially recirculating system using formaldehyde baths as antifungal prophylaxis. Crayfish eggs were treated three times a week in a formaldehyde bath of 3000 ppm for 15 and 20 min and in 2500 ppm for 15, 20 and 25 min. In all treated groups, high final survival rates (87.8,92.0%) to stage 2 juveniles were obtained after 83 days. Significantly lower survival was observed in the control group (45.4%). It was concluded that recirculating systems can be used successfully for artificial incubation of crayfish eggs in order to conserve water. Formalin was found as an effective fungicide but its use should be carefully considered because of its safety issues for farm staff and environmental pollution. [source]

Isolated invasive Aspergillus tracheobronchitis: a clinical study of 19 cases

CLINICAL MICROBIOLOGY AND INFECTION, Issue 6 2010
N. Wu
Clin Microbiol Infect 2010; 16: 689,695 Abstract Isolated invasive Aspergillus tracheobronchitis (iIATB) is an uncommon clinical form of invasive Aspergillosis in which Aspergillus infection is limited entirely or predominantly to the tracheobronchial tree. In the present study, we retrospectively analyzed the medical records of 19 patients who had histological documented iIATB in the Department of Respiratory Medicine of Changhai Hospital between October 2000 and February 2008. Malignancy was the most common underlying disease, which existed in 14 patients (73.7%) in our series. Most patients had impaired airway structures or defence functions, whereas the systemic immune status was relatively normal. Only three patients (15.8%) had neutropenia. The clinical manifestations and chest radiograph were nonspecific. We classified iIATB into four different forms according to the bronchoscopic features of intraluminal lesions: superficial infiltration type (Type I, n = 4), full-layer involvement type (Type II, n = 2), occlusion type (Type III, n = 6) and mixed type (Type IV, n = 7). Type IV was the largest group in our study, followed by Type III. All patients with iIATB of Type IV had definite airway occlusion. Fourteen patients (73.7%) had a good response to antifungal treatments and five (26.3%) died as a result of the progression of Aspergillosis, all of whom had full-layer invasion of the involved bronchi. In conclusion, we found that iIATB could occur in moderately or non-immunocompromised patients with impaired airway structures or defence functions and may be an early period of invasive pulmonary Aspergillosis. Most of the iIATB patients had a favourable prognosis with early diagnosis and effective antifungal treatment. The morphological features of intraluminal lesions might be of prognostic value. [source]

Hyperbaric oxygen as an adjunctive treatment for zygomycosis

CLINICAL MICROBIOLOGY AND INFECTION, Issue 7 2005
B. V. John
Abstract Zygomycosis is a rare but emerging mycosis. Because of the sub-optimal efficacy of the standard antifungal treatment for this disease, hyperbaric oxygen (HBO) has been used occasionally as an adjunctive therapeutic modality. A review of 28 published cases of zygomycosis indicates that adjunctive HBO may be beneficial in diabetic patients (94% survival), whereas its benefit in the small group of patients with haematological malignancies or bone marrow transplants is doubtful (33% survival; p 0.02). Prolonged courses of HBO were associated with a higher survival (100% survival; p 0.003). Additional studies are required to assess the optimal timing and dose for HBO treatment. [source]

Fusarium fungaemia in immunocompromised patients

CLINICAL MICROBIOLOGY AND INFECTION, Issue 6 2004
T. G. Jensen
Abstract Fusarium spp. cause infections only rarely in immunologically competent hosts, but disseminated infection may occur in severely immunocompromised patients. Symptoms of disseminated infection are persistent fever, despite broad-spectrum antibacterial and antifungal treatment, associated with skin lesions, most commonly on the extremities, in 60,80% of patients. A mortality rate of 50,75% has been reported for patients with disseminated fusariosis. Despite treatment failures, amphotericin B remains the preferred drug, in part because of lack of alternatives. Voriconazole is a promising new agent, but more clinical experience is required. [source]

Comparison of the efficacy and safety of miconazole 50-mg mucoadhesive buccal tablets with miconazole 500-mg gel in the treatment of oropharyngeal candidiasis,

CANCER, Issue 1 2008
A prospective, comparative, multicenter, neck cancer, phase III trial in patients treated with radiotherapy for head, randomized, single-blind
Abstract BACKGROUND. Topical antifungal treatments are recommended but rarely used as first-line therapy for oropharyngeal candidiasis (OPC) in patients with cancer. Miconazole Lauriad 50-mg mucoadhesive buccal tablet (MBT) Loramyc reportedly delivered rapid and prolonged, effective concentrations of miconazole in the mouth. The objective of the current study was to compare MBT with miconazole 500-mg oral gel (MOG) in patients with head and neck cancer. METHODS. Two hundred eighty-two patients with head and neck cancer received a 14-day treatment of either single-dose MBT or MOG administered in 4 divided doses. The primary endpoint was clinical success at Day 14, and secondary endpoints included clinical success at Day 7, clinical cure, improvement in clinical symptoms, mycologic cure, recurrence rate, and safety. RESULTS. The success rate was statistically not inferior (P < .0001) in the MBT population to the rate observed in the MOG group (56% vs 49%, respectively; P < .0001). After adjustment for the extent of lesions and salivary secretions, a trend toward superiority was observed in favor of MBT (P = .13), particularly among patients with multiple lesions (P = .013). Results for secondary endpoints were comparable to those observed for the primary endpoint. Compliance with MBT was excellent, and >80% of patients completed treatment. Both treatments were safe. CONCLUSIONS. The success rate of MBT Loramyc was significantly not inferior to that of MOG in the treatment of cancer patients with OPC; and, after adjusting for prognostic variables, it was more effective than MOG. MBT was well tolerated and, thus, may be recommended as first-line treatment in cancer patients who have OPC as an alternative to systemic antifungal agents. Cancer 2008. © 2007 American Cancer Society. [source]