Patients with neoplastic diseases are predisposed to develop invasive fungal infections as the result of impairment of host defense, due principally to pharmacological immuno-suppression as the resulting from intensive cytotoxic chemotherapy, ablative radiation therapy, and corticosteroids. Candida spp., Aspergillus spp., and emerging opportunistic fungal pathogens comprise the principal etiological agents of opportunistic mycoses in cancer patients. This paper will briefly review the recent progress in management of invasive fungal infections and the current problems of invasive mycosis, which currently confront patients with neoplastic diseases.
Adrenal Cortex Hormones ; Aspergillus ; Candida ; Diagnosis* ; Drug Therapy ; Humans ; Mycoses

Trichosporonosis is a potentially life-threatening infection with Trichosporon beigelii, the causative agent of white piedra. The systemic infection by this fungus has been most frequently described in immunocompromised hosts with neutropenia. Here, we report the first patient with disseminated infection by T. beigelii in Korea, acquired during a period of severe neutropenia after chemo-therapy for myelodysplastic syndrome. The patient recovered from the infection after an early-intensified treatment with amphotericin B and a rapid neutrophil recovery. The disseminated infection by T. beigelii is still rare, however, is an emerging fatal mycosis in immunocompromised patients with severe neutropenia.
Adult ; Amphotericin B/therapeutic use ; Human ; Male ; Mycoses/drug therapy/*etiology ; Myelodysplastic Syndromes/*complications/drug therapy

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

Scopulariopsis brevicaulis is a soil fungus normally associated with onychomycosis. It causes subcutaneous infection in immunocompromised patients and is rarely isolated from blood. A case of systemic Scopulariopsis brevicaulis infection was reported in a patient with acute myeloid leukemia. The patient developed persistent fever that did not respond to wide spectrum antibiotics and amphotericin B. Scopulariopsis brevicaulis was the only pathogen isolated from blood cultures. The fever subsided with itraconazole and there was no recurrence of fungal infection with prolonged maintenance of oral itraconazole.
Acute Disease ; Antifungal Agents/*therapeutic use ; Immunocompromised Host ; Itraconazole/*therapeutic use ; Leukemia, Myeloid/*complications ; Mycoses/*drug therapy ; Mycoses/*microbiology ; Opportunistic Infections/*drug therapy ; Opportunistic Infections/*microbiology

OBJECTIVE: To investigate the clinical characteristics of infection in children with acute myeloid leukemia (AML) after high intensive chemotherapy， so as to provide reference for prevention and control of infection. METHODS: 56 children diagnosed as acute myeloid leukemia in our hospital from January 2016 to August 2019 were enrolled and retrospectively analyzed, the infection rate, pathogens of disease and common location of infection during the induction and consolidation period were analyzed. RESULTS: The total infection rate of the patients was 93.4%－96.4%, the average of serious infection rate was 16.0%(11.3%－19.6%), and the infection related mortality was 10.7%. Fever of unknown cause was the main reason of infection, while blood flow infections were the most common in severe infection, which were mainly caused by Gramnegative bacteria. The rate of fungal infection was 35.7% during chemotherapy. CONCLUSION Children with AML shows a high incidence of infection in each stage of chemotherapy. The serious illness caused by blood flow infection and take antifungal drugs to reduce the occurrence of fungal infection in AML patients should be paid attention.
Antifungal Agents/therapeutic use* ; Child ; Fever/drug therapy* ; Humans ; Leukemia, Myeloid, Acute/drug therapy* ; Mycoses/drug therapy* ; Retrospective Studies

OBJECTIVETo address the features of the fungal infection after burn injury in clinic.

METHODSThree thousand nine hundred and nine burn patients admitted to our institute from Jan. 2003 to Dec. 2006 were involved in this study. Two thousand two hundred and seventy-one samples were harvested for fungal detection by culture from 467 patients suspected to be infected by fungi based on their clinic manifestations. The collected samples included wound tissue, blood, urine, stool, sputum, catheters and others. The antibiotic sensitivity of the identified fungi were determined by routine method. When same kind of fungus was found from different samples taken from one patient, it was recorded as one positive sample. The samples were ranked in an ascending order as wound secretion, stool, urine, sputum and bronchial alveolar lavage fluid, arteriovenous catheter or urinary catheter, blood. Only the positive sample of the highest rank source was recorded as the positive strain of fungus from this particular patient.

RESULTSIt was found 61 fungal positive samples from the 2271 samples collected. Out of 467 patients, 38 strains of fungi were detected from 36 burn patients during the investigated period, the incidence was 0.92% (36/3909). The most three commonest types among the identified 38 strains of fungi were Candida tropicalis (42.1%), Candida albicans (31.6%) and Candida famata (T. Famata, 10.5%). The drug sensitivity tests demonstrated that most of the strains detected in this investigation, with the exception of candida glabrata, were sensitive to most of the routine antimycotics agents such as Amphotericin B, Fluconazole, and Itraconazole etc. Among the 36 fungus positive patients, in 18 patients the burn area exceeded 80% TBSA, 12 patients with 50%-79% TBSA, 4 patients with 30%-49% TBSA, and in 2 patients the burn area was smaller than 30% TBSA. It was found most of the fungal infections (77.78%) occurred 2 weeks after burn injury, and 8 of the 36 fungus-infected patients died (the mortality was 22.22%). Conclusions Further examinations are necessary to confirm the diagnosis in burn patients suspected to have fungal infection. Once fungal infections are confirmed, antimycotic therapy must be started immediately.

Burns ; microbiology ; Candida ; isolation & purification ; Humans ; Incidence ; Microbial Sensitivity Tests ; Mycoses ; drug therapy ; pathology

OBJECTIVETo investigate the clinical features of invasive fungal infections (IFI) in the pediatric intensive care unit (PICU) and, to provide a basis for the effective prevention and treatment of IFI.

METHODSRetrospective analysis was performed on the clinical features and treatment outcomes of 38 children with IFI who were admitted to the PICU of Wuhan Children's Hospital between January 2009 and August 2012.

RESULTSPulmonary fungal infection (89%) was the most common among the 38 cases. Before diagnosis of IFI, all patients had severe underlying diseases and received several broad-spectrum antibiotics, including carbapenems, which were used in 95% of cases; 47% of all cases had been treated with corticosteroids systemically; all patients had received invasive operations, and 47% of them had undergone endotracheal intubation and mechanical ventilation. None of these cases had either typical clinical symptoms and signs or specific imaging findings. Fifty-six strains of fungi were isolated, with Candida albicans (41%), Aspergilli (25%), and Mucor (20%) being the most common ones. All patients received timely antifungal therapies, 15 cases were cured and 16 cases showed improvements, with a response rate of 82%, and the rate of adverse events was 16%.

CONCLUSIONSIn the PICU, the respiratory tract is the most common site of IFI infection, and Candida albicans is the leading pathogen. Severe underlying diseases, use of broad-spectrum antibiotics and corticosteroids, and invasive operations are the main risk factors for IFI in the PICU. Early diagnosis and timely treatment with high-performance antifungal drugs can improve the prognosis in children with IFI.

Female ; Humans ; Infant ; Intensive Care Units, Pediatric ; Male ; Mycoses ; diagnosis ; drug therapy ; etiology ; Retrospective Studies

Fungal infection is one of the serious complications of severely burned patients with high mortality. Application of antifungal agents timely and rationally is very important to control the infection. Antifungal agents including polyenes,triazoles, and echinocandins have been used widely in burned patients and are proved to be effective. Since diagnosis of fungal infection remains difficult, prophylactic and empirical therapies appear to be particularly necessary. In order to improve the efficacy and safety of antifungal agents, the factors of fungal strains, infection sites, hepatic and renal functions, and age, etc. should be considered in selecting antifungal agents.
Antifungal Agents ; therapeutic use ; Burns ; complications ; Humans ; Mycoses ; complications ; drug therapy

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

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