In the past, even two decades ago, it was not easy for the physicians to diagnose the systemic fungal infection especially in immuno-compromised host. However, as malignant neoplasm and organ transplantation increased, the incidence of fungal infection became heightened. Also the development of newer technique of microbiology and computerized imaging methods made it relatively easy to diagnose the fungal infection. Several new antifungal agents developed recently. It is necessary for us to prescribe the antifungal agents optimally. We summarized amphotericin B lipid formulations, newer triazoles, echinocandins.
Amphotericin B ; Antifungal Agents* ; Echinocandins ; Incidence ; Organ Transplantation ; Transplants ; Triazoles

BACKGROUND: Caspofungin and micafungin are echinochandins with potent activities against Candida species. However, in vitro susceptibility to these agents of clinical Candida isolates in Korea has not been fully surveyed. We determined minimum inhibitory concentrations (MICs) of caspofungin and micafungin against clinical isolates of Candida species. METHODS: A total of 107 blood isolates of Candida species (24 C. albicans, 25 C. tropicalis, 24 C. glabrata, 20 C. parapsilosis, 8 C. krusei, and 6 other Candida species) were tested by using the National Committee for Clinical Laboratory Standards M27-A2 broth microdilution methods. The in vitro antifungal activities and spectrum of caspofungin and micafungin were compared with those of amphotericin B, fluconazole, and itraconazole. RESULTS: Caspofungin and micafungin exhibited a broad-spectrum activity against Candida species: caspofungin MIC ranged from 0.125 to 1 microgram/mL and micafungin MIC from < or =0.03 to 1 microgram/mL. C. albicans, C. tropicalis and C. glabrata showed high susceptibility to caspofungin (MIC90, 0.25 to 0.5 microgram/mL) and micafungin (MIC90 , < or =0.03 microgram/mL), whereas C. parapsilosis was less susceptible to both echinocandins (MIC90, 1 microgram/mL). The MIC50 for caspofungin, micafungin, amphotericin B, fluconazole, and itraconazole were 0.25, < or =0.03, 0.5, 1, and 0.125 microgram/mL, respectively. Caspofungin MIC50 of C. glabrata and C. krusei isolates with decreased susceptibility to azoles were 0.25 and 0.5 microgram/mL, respectively, and micafungin MIC50 were < or =0.03 and 0.125 microgram/mL, respectively. CONCLUSIONS: These data showed an excellent in vitro activity of caspofungin and micafungin against clinical strains of Candida species, including isolates with reduced susceptibility to azoles.
Amphotericin B ; Azoles ; Candida* ; Danazol ; Echinocandins ; Fluconazole ; Itraconazole ; Korea ; Microbial Sensitivity Tests

There is an increasing tendency of systemic fungal infection because of increase in the number of immunocomproised patients such as the patients receiving anticancer chmotherapy or organ transplant. The frequency of systemic fungal infection is problematic, since it is often difficult for clinicians to manage the patients with fungal infection. Amphotericin B was one of the representativ antifungal agent for the systemic antifungal infection even though it has many kinds of advers reactions for instance nephrotoxicity, electrolyte imbalance, etc. Therefore ketoconazole, fluconazole, and itraconazole were develped and prescribed with effect. Because of increase in the number of resistant strains of Candida, Fusarium or Trichosporon nowadays, as for azole antifungal agents there were something to be desired. Other new antifungal agents with fungicidal effect under develpment include polyoxins, echinocandins and pradimicin.
Amphotericin B ; Antifungal Agents* ; Candida ; Danazol ; Echinocandins ; Fluconazole ; Fusarium ; Humans ; Itraconazole ; Ketoconazole ; Transplants ; Trichosporon

Candida orthopsilosis is a recently described Candida species phenotypically indistinguishable from Candida parapsilosis. This new species can be identified only by using molecular methods. We describe here a fatal case of fungemia caused by C. orthopsilosis in a 75-year-old male patient who had panperitonitis after total gastrectomy with Roux-en-Y esophagojejunostomy. All 18 blood cultures obtained from admission day 16 to day 68 yielded the same Candida species. Both Vitek 2 (bioMerieux, Inc., Hazelwood, MO, USA) and API 20C (bioMerieux, Marcy-l'Etoile, France) failed to identify these isolates. However, DNA sequencing analysis of both D1/D2 domain and internal transcribed spacer region of rDNA showed 100% identity with C. orthopsilosis. The fungemia was persistent over 50 days despite of systemic antifungal therapy including fluconazole and caspofungin, and the patient expired on day 73 of his hospital stay. This represents the first reported case of fatal fungemia by C. orthopsilosis in Korea.
Aged ; Candida ; DNA, Ribosomal ; Echinocandins ; Fluconazole ; Fungemia ; Gastrectomy ; Humans ; Korea ; Length of Stay ; Male ; Sequence Analysis, DNA

Aspergillus peritonitis is a rare but serious cause of peritonitis in continuous ambulatory peritoneal dialysis (CAPD) patients. We report 2 cases of peritonitis caused by Aspergillus niger in CAPD which were treated successfully with voriconazole and caspofungin, respectively, and catheter removal. Both patients initially received amphotericin B; however, they were not cured with the agent. We briefly discuss the proper selection of antifungal agent and the treatment duration. Previously reported cases of the CAPD peritonitis caused by A. Niger are also reviewed in this article.
Amphotericin B ; Aspergillus ; Aspergillus niger ; Catheters ; Echinocandins ; Humans ; Niger ; Peritoneal Dialysis, Continuous Ambulatory ; Peritonitis ; Pyrimidines ; Triazoles

Anidulafungin is an effective antifungal medicine, which can inhibit activities of candida in vitro and in vivo. Echinocandin B (ECB) is the key precursor of Anidulafungin, thus the price and market prospect of Anidulafungin is directly due to the fermentation titer of ECB. In this study, Aspergillus nidulans was used for ECB fermentation, and the influence of adding microparticles on ECB fermentation was studied, such as talcum powder, Al2O3, and glass beads. The particle size and concentration were the key factors for mycelium morphology and ECB production, and ECB production could reach 1 262.9 mg/L and 1 344.1 mg/L by adding talcum powder of 20 g/L (d50 = 14.2 μm) and 7 glass beads (6 mm), an increase by 33.2% and 41.7%, respectively. The results indicated that the mycelium morphology of filamentous microorganisms and the product yield of fermentation could be improved by adding microparticles remarkably, and it provide an important method for the fermentative optimization of filamentous microorganisms.
Antifungal Agents ; metabolism ; Aspergillus nidulans ; metabolism ; Echinocandins ; biosynthesis ; Fermentation ; Fungal Proteins ; biosynthesis ; Industrial Microbiology ; methods

Echinocandins ; therapeutic use ; Humans ; Infant, Newborn ; Infant, Premature ; Lipopeptides ; Mycoses ; drug therapy ; Sepsis ; drug therapy ; microbiology

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

The incidence of invasive fungal infection has increased worldwide along with the increasing population of high risk patients. Recently developed antifungal agents, such as second-generation triazoles and echinocandins, provide the potential to improve therapeutic options against invasive fungal infections. However, treatment of invasive fungal infections has been hampered by both intrinsic and acquired resistance to antifungal agents among many fungal pathogens. A better understanding of the clinical impact of antifungal resistance is important for selecting the proper antifungal agent in patients with systemic fungal infections. This article reviews the current situation with regard to intrinsic and acquired resistance of clinically significant yeasts and filamentous fungi against currently available antifungal agents.
Amphotericin B ; Antifungal Agents ; Azoles ; Drug Resistance, Fungal ; Echinocandins ; Fungi ; Humans ; Incidence ; Triazoles ; Yeasts

The incidence of invasive fungal infections has been increased worldwide along with the increasing population at high risk for fungal infection. However, no data is available for the current status of usage of antifungal agents in Korea. We described the usage of antifungal agents including second-generation triazole and echinocandins that have been recently introduced. Data from Health Insurance Review and Assessment Service were analyzed. Estimated total DDDs (daily defined doses)/1,000 patient-day of parenteral antifungal agents were 187.6 in 2008 and 143.2 in 2007 and annual rates of increase was 20% to 30% since 2004. Indeed, increased percentage of newer agents were observed. Changes of the treatment guidelines and the regulations for insurance coverage are considered to influence the trend of antifungal usage.
Antifungal Agents ; Dichlorodiphenyldichloroethane ; Echinocandins ; Incidence ; Insurance Coverage ; Insurance, Health ; Korea ; Social Control, Formal