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[Fungal infections].
Internist (Berl) 2019; 60(7):684-689I

Abstract

BACKGROUND

Invasive aspergillosis, mucormycosis, and cryptococcosis are severe opportunistic infections in patients with long phases of neutropenia and also after allogeneic stem cell and organ transplantation. Due to the late appearance of clinical signs and the often poor outcome, these diseases require special attention and proactive interventions.

MATERIAL AND METHODS

Published guidelines and selected current literature were reviewed for this article.

RESULTS

Invasive aspergillosis and mucormycosis are typically observed in the upper and lower airways of severely immunocompromized patients. When invasive fungal diseases are suspected, sectional imaging and, if possible, serological testing should be performed as soon as possible. If imaging or serological tests confirm the suspected diagnosis, pre-emptive antimycotic treatment should be started and further confirmation of the diagnosis sought via microbiological and/or histological investigations. Treatment depends on comedication, comorbidity and risk factors, primarily with voriconazole, isavuconazole and liposomal amphotericin B. With the advent of antiretroviral treatment, a decrease of cryptococcosis cases in people with human immunodeficiency virus was observed; however, increasing cases have been reported in patients with new forms of immunosuppression. Cryptococcus spp. predominantly cause central nervous system infections but also pneumonia and bloodstream infections. Diagnostics include blood and cerebrospinal fluid cultures and antigen tests. First line treatment consists of a combination therapy with amphotericin B and flucytosine.

CONCLUSION

An interdisciplinary approach with microbiologists, infectious diseases specialists and radiologists is needed for diagnostics and treatment of invasive fungal diseases.

Authors+Show Affiliations

Medizinische Fakultät, Klinik I für Innere Medizin, Centrum für Integrierte Onkologie (CIO ABCD), Universität zu Köln, Köln, Deutschland. Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Universität zu Köln, Köln, Deutschland.Medizinische Fakultät, Klinik I für Innere Medizin, Centrum für Integrierte Onkologie (CIO ABCD), Universität zu Köln, Köln, Deutschland. Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Universität zu Köln, Köln, Deutschland. Zentrum für Klinische Studien, ZKS Köln, Köln, Deutschland. Deutsches Zentrum für Infektionsforschung, Standort Bonn-Köln, Köln, Deutschland.Medizinische Fakultät, Klinik I für Innere Medizin, Centrum für Integrierte Onkologie (CIO ABCD), Universität zu Köln, Köln, Deutschland. janne.vehreschild@kgu.de. Deutsches Zentrum für Infektionsforschung, Standort Bonn-Köln, Köln, Deutschland. janne.vehreschild@kgu.de. Medizinische Klinik 2, Hämatologie/Onkologie, Goethe-Universität Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland. janne.vehreschild@kgu.de.

Pub Type(s)

English Abstract
Journal Article
Review

Language

ger

PubMed ID

31119309

Citation

Köhler, P, et al. "[Fungal Infections]." Der Internist, vol. 60, no. 7, 2019, pp. 684-689.
Köhler P, Cornely OA, Vehreschild JJ. [Fungal infections]. Internist (Berl). 2019;60(7):684-689.
Köhler, P., Cornely, O. A., & Vehreschild, J. J. (2019). [Fungal infections]. Der Internist, 60(7), pp. 684-689. doi:10.1007/s00108-019-0618-3.
Köhler P, Cornely OA, Vehreschild JJ. [Fungal Infections]. Internist (Berl). 2019;60(7):684-689. PubMed PMID: 31119309.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - [Fungal infections]. AU - Köhler,P, AU - Cornely,O A, AU - Vehreschild,J J, PY - 2019/5/24/pubmed PY - 2019/5/24/medline PY - 2019/5/24/entrez KW - Cryptococcosis KW - Immunosuppression KW - Invasive aspergillosis KW - Mucormycosis KW - Opportunistic infections SP - 684 EP - 689 JF - Der Internist JO - Internist (Berl) VL - 60 IS - 7 N2 - BACKGROUND: Invasive aspergillosis, mucormycosis, and cryptococcosis are severe opportunistic infections in patients with long phases of neutropenia and also after allogeneic stem cell and organ transplantation. Due to the late appearance of clinical signs and the often poor outcome, these diseases require special attention and proactive interventions. MATERIAL AND METHODS: Published guidelines and selected current literature were reviewed for this article. RESULTS: Invasive aspergillosis and mucormycosis are typically observed in the upper and lower airways of severely immunocompromized patients. When invasive fungal diseases are suspected, sectional imaging and, if possible, serological testing should be performed as soon as possible. If imaging or serological tests confirm the suspected diagnosis, pre-emptive antimycotic treatment should be started and further confirmation of the diagnosis sought via microbiological and/or histological investigations. Treatment depends on comedication, comorbidity and risk factors, primarily with voriconazole, isavuconazole and liposomal amphotericin B. With the advent of antiretroviral treatment, a decrease of cryptococcosis cases in people with human immunodeficiency virus was observed; however, increasing cases have been reported in patients with new forms of immunosuppression. Cryptococcus spp. predominantly cause central nervous system infections but also pneumonia and bloodstream infections. Diagnostics include blood and cerebrospinal fluid cultures and antigen tests. First line treatment consists of a combination therapy with amphotericin B and flucytosine. CONCLUSION: An interdisciplinary approach with microbiologists, infectious diseases specialists and radiologists is needed for diagnostics and treatment of invasive fungal diseases. SN - 1432-1289 UR - https://www.unboundmedicine.com/medline/citation/31119309/[Fungal_infections] L2 - https://dx.doi.org/10.1007/s00108-019-0618-3 DB - PRIME DP - Unbound Medicine ER -