When we take a look at the 10 most significant invasive fungal infections worldwide, over 2 million cases are reported each year, with a startlingly high average mortality rate of 45%. This war against invasive mycoses demands an urgent need for efficient diagnostic tests and safe and effective new drugs and vaccines.
In this CME offering from IDCARELIVE, “The War Against Invasive Mycoses: Critical Thinking in High-Risk Patients,” a panel of four clinicians discuss various causes, complications, treatment options, and likely outcomes in our fight against fungal infections.
Thomas Patterson, MD, from the University of Texas School of Medicine explains that between 1989 and 2003 there were 1,017 autopsies performed at MD Anderson Hospital. Of those cases, 319 (31%) showed clinical signs of invasive mycoses. During the 20-year study, it was noted:
- autopsy rates declined
- there was a recent increased prevalence of Candida
- an increase in the antemortem diagnosis (from 16% to 51%)
A study published in 2014, showed reasons for underestimating the diseases include diagnostic deficiencies and differences in diagnostic utilization.
Mycoses and Transplants
Infections in transplant patients is covered in depth in the early part of the presentation, showing that despite Candida being more opportunistic in the immediate post-op period, it can be rapidly treated. There is a short overlap period, however, where the longer lasting (but later emerging) infections from Aspergillus have been show to occur at the same time as the Candida infections. While the Candida infections have an overall mortality rate of approximately 30%, those caused by Aspergillus range from 50-80%.
Antibiotics Aren’t the Biggest Risk Factor
Prolonged use of antibiotics has long been known as a risk factor for developing an opportunistic mycoses, but it isn’t the biggest risk factor. Dr. George R. Thompson, III from the University of California, Davis, School of Medicine describes surgeries, particularly those that transect the bowel wall, carry the highest risk.
The presence of central venous catheters, a prolonged ICU course, and hyperalimentation are other risk factors. The panel stressed the importance of obtaining a thorough travel history during patient and family interviewing, as Aspergillus and other molds can be resistant to treatment in some areas of the world but susceptible to treatment in others. Some locations have noted up to 12 percent of Candida glabrata isolates are resistant to echinocandins.
You can watch our full online on-demand CME session at IDCareLive.
Disclaimer: All IDCareLive articles, reports, summaries, and recaps of events are for informational purposes. The quotes and opinions of the speakers covered are not to be taken as direct advice for individual patients. Patients should always seek care from qualified, properly accredited healthcare professionals.
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