Aims: The exploration of natural products with innovative uses is dynamic and expanding rapidly. Medicinal plants have fascinated many researchers that subsequently lead to research publications highlighting plant extracts with wide range of secondary metabolites such as flavonoids, alkaloids, glycosides, quinones, terpenoids, tannins and saponins that exhibit antimicrobial activities and disease control. The concentration of these bioactive compounds in each plant species varies based on the pathosystem and environmental conditions. This study aims to uncover the various types of phytochemicals with antifungal properties. Methodology and results: Seven categories of plant-based antifungal compounds were reviewed, which are terpenoids, saponins, phenolic compounds, coumarins, alkaloids, essential oils and peptides, with examples and structures of some available compounds. The mechanism of action of each category of phytochemical was discussed. Also, the impact of some compounds was explained and elaborated. Conclusion, significance and impact of study It is of a great importance to explore natural plant fighters against fungal infection. Those active plant components do not only have antifungal properties, but they also help in the healing process and some even exhibit anticancer activities. The development and knowledge of antifungal activities from plant extracts have the potential for applications in antifungal therapy. Since the exact description of how antifungal compounds function in the human body is still unclear more studies are required to unveil phytochemicals’ properties and to elucidate their effects on living cells.
Phytochemicals--therapeutic use ; Antifungal Agents

Antifungal Agents ; therapeutic use ; Child ; Humans ; Pediatrics

Antifungal Agents ; therapeutic use ; Echinocandins ; therapeutic use ; Humans ; Infant, Newborn ; Infant, Premature ; Lipopeptides ; Mycoses ; drug therapy

Antifungal Agents ; therapeutic use ; Child, Preschool ; Cryptococcosis ; drug therapy ; Fluconazole ; therapeutic use ; Humans ; Male

Antifungal Agents ; therapeutic use ; Humans ; Liver Cirrhosis ; complications ; Mucormycosis ; drug therapy ; Triazoles ; therapeutic use

We report a case of mucormycosis induced by Cunninghamella spp. infection in a ten-year-old girl with acute lymphoblastic leukemia, who developed fever and respiratory symptoms after chemotherapy and was diagnosed with invasive fungal disease. Peripheral blood DNA sequences were analyzed using metagenomic next-generation sequencing (mNGS), and by comparison with the Pathogens Metagenomics Database (PMDB), we identified Cunninghamella spp. with sequence number 514 as the pathogen. The patient was treated with amphotericin B combined with posaconazole and showed a favorable response. We searched Pubmed, Embase, CNKI, and Wanfang database for reports of cases of Cunninghamella spp. infection in children and retrieved 22 reported cases (including 12 males) with a median age of 13.5 (3-18) years. In these 22 cases, hematological malignancy was the most common underlying condition (19/22), and most of patients experienced an acute onset and rapid progression with respiratory symptoms (14/20) and fever (16/20) as the most common symptoms. CT imaging often showed unilateral lesions with varying imaging findings, including pulmonary nodules or masses, infiltrative changes, and pleural effusion. Definite diagnoses were established in 18 of the cases, and 4 had probable diagnoses; the lungs and skin were the most frequent organs compromised by the infection. A definite diagnosis of Cunninghamella spp. infection still relied on histopathological examination and fungal culture, but the molecular techniques including PCR and mNGS had shown potentials in the diagnosis. Almost all the cases received antifungal treatment after diagnosis (21/22), and 13 patients also underwent surgeries. Death occurred in 9 (42%) of the cases at a median of 19 (4-54) days after onset of the signs or symptoms. The patients receiving antifungal therapy combined with surgery had a high survival rate (9/13, 69%) than those with antifungal therapy alone (3/8, 37%). Invasive fungal disease is a common complication in immunoco-mpromised patients, but Cunninghamella spp. infection is rare and has a high mortality rate. In cases highly suspected of this disease, active diagnosis and early treatment are critical to improve the survival outcomes of the patients.
Adolescent ; Amphotericin B/therapeutic use* ; Antifungal Agents/therapeutic use* ; Child ; Cunninghamella ; Female ; Humans ; Male ; Mucormycosis/etiology*

Currently, the first-line drugs for invasive fungal infections (IFI), such as amphotericin B, fluconazole and itraconazole, have drawbacks including poor water solubility, low bioavailability, and severe side effects. Using drug delivery systems is a promising strategy to improve the efficacy and safety of traditional antifungal therapy. Synthetic and biomimetic carriers have greatly facilitated the development of targeted delivery systems for antifungal drugs. Synthetic carrier drug delivery systems, such as liposomes, nanoparticles, polymer micelles, and microspheres, can improve the physicochemical properties of antifungal drugs, prolong their circulation time, enhance targeting capabilities, and reduce toxic side effects. Cell membrane biomimetic drug delivery systems, such as macrophage or red blood cell membrane-coated drug delivery systems, retain the membrane structure of somatic cells and confer various biological functions and specific targeting abilities to the loaded antifungal drugs, exhibiting better biocompatibility and lower toxicity. This article reviews the development of antifungal drug delivery systems and their application in the treatment of IFI, and also discusses the prospects of novel biomimetic carriers in antifungal drug delivery.
Antifungal Agents/therapeutic use* ; Drug Delivery Systems ; Amphotericin B/therapeutic use* ; Liposomes/chemistry* ; Nanoparticles ; Drug Carriers

BACKGROUNDNowadays, there are published trials in regards to the comparison of caspofungin with liposomal amphotericin B (L-AmB). However, these studies have a modest sample size and convey inconclusive results. The aim of this study was to review the efficacy and safety of caspofungin for the treatment of invasive fungal infections (IFIs), compared with L-AmB.

METHODSElectronic databases (up to July 31, 2013) PubMed and Embase databases, the Cochrane Library, and Google Scholar were searched to identify relevant trials of caspofungin and L-AmB. Analyses of efficacy and adverse outcomes were performed by relative risks (RRs) and 95% confidence intervals (CIs). Heterogeneity was assessed by χ(2)-test and the I(2)-statistic.

RESULTSThree trials were included in this meta-analysis with 1249 modified intention-to-treat (MITT) patients. The results showed that caspofungin produced equal efficacy in favorable overall response (RR = 1.02, 95% CI 0.88-1.18; P = 0.81) and mortality rate (RR = 1.53, 95% CI 0.38-6.27, P = 0.55), safer in clinical adverse events (RR = 0.20, 95% CI 0.08-0.54; P = 0.001), laboratory adverse events (RR = 0.69, 95% CI 0. 57-0.84; P = 0.0002), and discontinuation rate (RR = 0.26, 95% CI 0.08-0.83, P = 0.02), compared with L-AmB in the treatment of patients with IFIs.

CONCLUSIONBased on the results of this meta-analysis, it would appear that caspofungin was measured to have equal efficacy in clinical outcomes and safer in terms of adverse events.

Amphotericin B ; therapeutic use ; Antifungal Agents ; therapeutic use ; Echinocandins ; therapeutic use ; Febrile Neutropenia ; drug therapy ; Humans ; Lipopeptides ; Mycoses ; drug therapy

Antifungal Agents ; therapeutic use ; Humans ; Male ; Mycoses ; diagnosis ; drug therapy ; Near Drowning ; microbiology ; Scedosporium ; pathogenicity

Invasive fungal infections (IFI) are a kind of the most severe complications after hematopoietic stem cell transplantation (HSCT), Candida and Aspergillus are common causes. Because of immunosuppressive therapy, ablative conditioning regimen, acute or chronic graft-versus-host disease, long-term treatment of broad-spectrum antibiotics and cytomegalovirus infection, IFI has increased in the past few years. Invasive mould infection is a major cause of morbidity and mortality in HSCT recipients. Methods for early diagnosis of IFI include clinical and laboratory examinations, as well as characteristic radiography. Voriconazole is the first-line antifungal agent for prevention of IFI. Combination therapy of two antifungal compounds such as azoles or amphotericin B with echinocandins have shown a good effectiveness and may be a promising future strategy for antifungal treatment. In this review, the early diagnosis and treatment of IFI in HSCT recipients are summarized. As for early diagnosis of IFI, the laboratory diagnosis techniques such as GM test, G test and PCR techniques are discussed. As for prophylaxis and treatment of IFI, the prophylaxis treatment, empirical treatment, preemptive treatment, targeted treatment, combined treatment and immunologic treatment are discussed.
Antifungal Agents ; therapeutic use ; Hematopoietic Stem Cell Transplantation ; adverse effects ; Humans ; Mycoses ; diagnosis ; drug therapy