Micosis cutánea por Curvularia pallescens en un paciente trasplantado pulmonar: primer caso descrito en España

BackgroundCurvularia is a filamentous dematiaceous fungus increasingly recognized as a pathogen in immunocompromised patients. The most common clinical entities associated with this fungus are allergic sinusitis, cutaneous infection and keratitis. In this article, a report on the first clinical case of Curvularia pallescens cutaneous infection in Spain and its treatment is described.Case reportA 68 year-old man with a history of lung transplantation presented to Dermatology Unit due to a skin lesion in the knee that had been evolving for 6 months. A skin biopsy was performed for its study. In the histopathological study, an intense and non-specific inflammatory reaction in the dermis was observed, and with Grocott stain and periodic acid Schiff abundant septate hyphae and spores were found in the dermis. The culture of the sample revealed a filamentous fungus whose microscopic examination allowed to identify the genus as Curvularia. Using MALDI-TOF mass spectrometry and molecular identification, the fungus was finally identified as Curvularia pallescens. The patient underwent surgical resection of the lesion and was treated with posaconazole, evolving favorably.ConclusionsThe species of Curvularia should be considered causal agents of fungal skin infections in immunosuppressed patients. This clinical case, which showed good clinical response after surgical resection and treatment with posaconazole, is the first described in Spain due to this species.     

Cost-effectiveness of posaconazole in private and public Brazilian hospitals

Background

Posaconazole is used for the prophylaxis of invasive fungal disease (IFD). Previous studies have shown it to be cost-effective compared to fluconazole/itraconazole. However, posaconazole has never been economically evaluated in developing countries.

Breakthrough Disseminated Scedosporium prolificans Infection in a Patient with Relapsed Leukaemia on Prolonged Voriconazole Followed by Posaconazole Prophylaxis

A man with acute lymphoblastic leukaemia developed disseminated Scedosporium prolificans infection following chemotherapy for disease relapse while on posaconazole prophylaxis. Scedosporium prolificans infection during posaconazole prophylaxis has not been reported previously. This report is timely as the uptake of posaconazole, the broadest spectrum azole clinically available, is likely to grow with recent evidence supporting its role as prophylaxis against invasive fungal infections in high-risk haematology patients.     

泊沙康唑在预防恶性血液病患者侵袭性真菌病中的应用研究

摘要 目的：研究泊沙康唑在预防恶性血液病患者侵袭性真菌病中的应用效果。方法：选取我院2018年1月~2019年9月收治的50例恶性血液病患者,按照随机数余数分组法分为采取泊沙康唑预防的泊沙康唑组以及采取伊曲康唑预防的伊曲康唑组各25例,对两组预防效果进行对比。结果：泊沙康唑组预防治疗成功率为84.00 % (21/25),显著高于伊曲康唑组的68.00 % ( 17/25),侵袭性真菌病发生率为4.00 % (1/25),显著低于伊曲康唑组的16.00 % (4/25)（P＜0.05）;给药前两组炎性细胞因子差异无统计学意义（P＞0.05）,给药结束后均较本组给药前降低（P＜0.05）,组间比较泊沙康唑组均低于伊曲康唑组（P＜0.05）;泊沙康唑组治疗期间不良反应发生率为8.00 % (2/25),伊曲康唑组治疗期间不良反应发生率为20.00 % (5/25),两组不良反应发生率对比无统计学意义（P＞0.05）。结论：在预防恶性血液病患者侵袭性真菌病中泊沙康唑效果更佳且安全性高,可作为优选用药方案推广使用。     

Aspectos actuales de las enfermedades invasivas por hongos filamentosos

Invasive fungal infections have become a major cause of morbimortality in intensive care patients, persons suffering from cancer or immune deficiencies, and other diseases with impaired immunity. Candida albicans remains the most frequent fungal pathogen, but advances in the diagnosis, prevention and treatment of invasive candidiasis are leading to important etiological changes. Among the emerging invasive mycoses, are those caused by filamentous fungi, such as Aspergillus, Lomentospora/Scedosporium, Fusarium or the Mucorales. Invasive aspergillosis is difficult to diagnose, and although there are diagnostic tools available, their use is not widespread, and their effectiveness vary depending on the group of patients. Clinical suspicion in high-risk patients, radiological diagnosis and the use of biomarkers, such as 1,3-β-D-glucan and galactomannan, can be of great help. However, diagnostic resources are limited in other mycoses, but radiology, pathological studies and the microbiological diagnosis can be useful. The high mortality of these mycoses requires early empirical antifungal treatment in many cases. Voriconazole is the first choice for treatment of the majority of aspergillosis, scedosporiasis, fusariosis and other hyalohyphomycoses. The treatment of mucormycoses, Lomentospora prolificans infections or mycoses by dematiaceous fungi are more complicated. Amphotericin B is active against many mucoralean fungi, but the combination of two or more antifungal agents could be a therapeutic alternative in many amphotericin B-refractory mycoses. Current clinical challenges include improving the diagnosis and the treatment of these mycoses, along with improving the adequate prevention in patients at high risk of suffering from them.     

Successful posaconazole salvage therapy for rhinocerebral mucormycosis in a child with leukemia. Review of the literature

BackgroundMucormycosis is a fungal infection caused by species of the Mucorales order. These microorganisms are angioinvasive, with rapid disease progression and potentially lethal in its rhinocerebral form.Case reportWe present the case of a 12-year-old female with trisomy 21, acute lymphoblastic leukemia and diabetes, with fever and neutropenia who developed rhinocerebral mucormicosis. After treatment with amphotericin B lipid complex and extensive surgery, disease progressed and posaconazole was added as salvage treatment with full remission of the infection. Four years after diagnosis the patient continues without relapse of mucormycosis or leukemia.ConclusionsThis case highlights the use of posaconazole as either monotherapy or combined therapy. Although it is still debated, it can be considered an option for salvage treatment in children with non-responding mucormycosis, despite lack of standard dosage in pediatric patients.