Abstract:
Invasive fungal disease (IFD) due to moulds other than Aspergillus is a significant cause of mortality in patients with malignancies or post haemopoietic stem cell transplantation. The current guidelines focus on the diagnosis and management of the common non-Aspergillus moulds (NAM), such as Mucorales, Scedosporium species (spp.), Lomentospora prolificans and Fusarium spp. Rare but emerging NAM including Paecilomyces variotii, Purpureocillium lilacinum and Scopulariopsis spp. are also reviewed. Culture and histological examination of tissue biopsy specimens remain the mainstay of diagnosis, but molecular methods are increasingly being used. As NAM frequently disseminate, blood cultures and skin examination with biopsy of any suspicious lesions are critically important. Treatment requires a multidisciplinary approach with surgical debridement as a central component. Other management strategies include control of the underlying disease/predisposing factors, augmentation of the host response and the reduction of immunosuppression. Carefully selected antifungal therapy, guided by susceptibility testing, is critical to cure. We also outline novel antifungal agents still in clinical trial which offer substantial potential for improved outcomes in the future. Paediatric recommendations follow those of adults. Ongoing epidemiological research, improvement in diagnostics and the development of new antifungal agents will continue to improve the poor outcomes that have been traditionally associated with IFD due to NAM.
摘要:
由于除曲霉外的霉菌引起的侵袭性真菌病(IFD)是恶性肿瘤或造血干细胞移植后患者死亡的重要原因。当前的指南侧重于常见的非曲霉霉菌(NAM)的诊断和管理,比如Mucorales,Scedosporium物种(spp。),长尾孢菌和镰刀菌。罕见但新兴的NAM,包括变色拟青霉,淡紫色花叶草和短叶草。也进行了审查。组织活检标本的培养和组织学检查仍然是诊断的主要手段,但是越来越多地使用分子方法。由于不结盟运动经常传播,血液培养和皮肤检查以及任何可疑病变的活检至关重要。治疗需要以手术清创为中心的多学科方法。其他管理策略包括控制潜在的疾病/诱发因素,增强宿主反应和减少免疫抑制。精心挑选抗真菌治疗,以敏感性测试为指导,对治愈至关重要。我们还概述了仍在临床试验中的新型抗真菌药物,这些药物为将来改善预后提供了巨大的潜力。儿科建议遵循成年人的建议。正在进行的流行病学研究,诊断方面的改进和新型抗真菌药物的开发将继续改善传统上与NAM引起的IFD相关的不良结局.