Fungal Infections in the Immunocompromised Patient

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ISBN: 9780824754280 | 082475428X
Cover: Hardcover
Copyright: 8/5/2005

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Unlike any other source on the subject, this reference provides an up-to-date account of fungal syndromes in immunocompromised patients and provides expert descriptions of their clinical manifestations and settings in which they cause illness-covering the pros and cons of current and emerging diagnostic measures, techniques to incorporate new diagnostic tools and treatments into established clinical practices, and the most recent therapeutic strategies in patient care.

Preface

iii

Contributors

Overview of Host Defenses: Innate and Acquired Immunity

(44)

Monica Grazziutti

Elias J. Anaissie

John R. Wingard

Introduction

(1)

Innate Immunity

(17)

Acquired Immunity

(8)

Host Defenses Against the Most Common Fungi in Immunocompromised Hosts

(8)

Conclusion

(11)

References

(11)

Impact of Invasive Fungal Infection on Patients Undergoing Solid Organ Transplantation

(30)

Francisco M. Marty

Lindsey R. Baden

Robert H. Rubin

Introduction

(2)

Invasive Fungal Infection in Solid Organ-Transplant Patients

(1)

Risk of Invasive Fungal Infection in the Solid Organ-Transplant Recipient

(4)

Temporal Aspects of Fungal Infection in the Solid Organ-Transplant Recipient

(3)

Fungal Infections of Importance in the Organ-Transplant Recipient

(10)

Principles of Antifungal Therapy in Solid Organ-Transplant Recipients

(6)

Summary and Conclusions

(4)

References

(4)

Fungal Infections in Blood and Marrow Transplant Recipients

(22)

Kieren A. Marr

Introduction

(1)

Fungal Infections: Overall Incidence and Risks

(11)

Conclusion

(11)

References

(10)

Assessment of the Risk for Invasive Fungal Infection Among Oncology Patients

(32)

E. J. Bow

Introduction

(1)

Epidemiology of Invasive Fungal Infection Observed at Autopsy

(4)

Superficial and Invasive Candidiasis

101

(4)

Invasive Filamentous Fungal Infection

105

(2)

Colonization

107

(1)

Myelosuppression and Immunosuppression

108

(5)

Cytotoxic Therapy-Induced Mucosal Injury and Invasive Fungal Infection

113

(16)

References

114

(15)

Epidemiology of Fungal Infection in Patients with Human Immunodeficiency Virus

129

(20)

Anucha Apisarnthanarak

William G. Powderly

Introduction

129

(1)

Specific Fungal Infections

129

(9)

Special Considerations in HIV-Infected Patients

138

(2)

Conclusion

140

(9)

References

140

(9)

Candida Infections in the Intensive Care Unit

149

(36)

Joseph S. Solomkin

Introduction

149

(1)

Pathogenicity and Virulence Factors for Candida

149

(1)

The Microbiology, Incidence, Morbidity, and Mortality of Candida Infection

150

(3)

Clinical Aspects of Candida Infection

153

(4)

Who Should Receive Antifungal Prophylaxis in the ICU?

157

(3)

Special Populations at Risk of Candida Infections and Possibly Meriting Prophylaxis

160

(2)

Management of Specific Infections

162

(2)

Catheter Management in Candidemic Patients

164

(1)

Descriptions of Specific Agents

165

(5)

Recommendations for Therapy---A Care Path

170

(1)

Other Sites of Candida Infections

171

(3)

Conclusions

174

(11)

References

174

(11)

Fungal Infections in Immunocompromised Hosts: Host Defenses, Risks, and Epidemiology in Special Patient Groups---Pediatrics

185

(14)

Charles B. Foster

Stephen J. Chanock

Introduction

185

(2)

Specific Fungal Infections

187

(12)

References

193

(6)

Clinical Manifestations of Invasive Fungal Infections

199

(16)

Ben E. de Pauw

Jacques F.G.M. Meis

Unexplained Fever

199

(2)

Bronchopneumonia

201

(4)

Skin Lesions

205

(2)

Sinusitis and Central Nervous System Disease

207

(2)

Disseminated Disease and Miscellaneous Issues

209

(6)

References

210

(5)

Clinical Syndromes by Candida Species

215

(42)

Maria Cecilia Dignani

Introduction

215

(1)

The Pathogen

215

(1)

Epidemiology

216

(2)

Pathogenesis

218

(1)

Syndromes

218

(13)

Diagnosis

231

(2)

Therapy

233

(6)

Prevention

239

(18)

References

242

(15)

Aspergillosis

257

(38)

William J. Steinbach

Juergen Loeffler

David A. Stevens

Etiology and Epidemiology

257

(1)

Syndromes

258

(4)

Diagnosis

262

(7)

Therapy

269

(26)

References

278

(17)

Endemic Mycoses Fungal Infections in Immunocompromised Patients

295

(16)

Robert W. Bradsher

Introduction

295

(11)

Summary

306

(5)

References

307

(4)

Emerging Fungal Infections

311

(30)

Rhonda V. Fleming

Elias J. Anaissie

Introduction

311

(1)

Emerging Yeasts

311

(5)

Emerging Filamentous Fungi

316

(9)

Dematiaceous Molds

325

(2)

Cryptococcus spp

327

(2)

Conclusion

329

(12)

References

330

(11)

Conventional Methods for the Laboratory Diagnosis of Fungal Infections in the Immunocompromised Host

341

(42)

Michael A. Pfaller

Sandra S. Richter

Daniel J. Diekema

Introduction

341

(2)

Clinical Recognition of Fungal Infection

343

(1)

Spectrum of Opportunistic Fungal Pathogens

344

(1)

Conventional Methods for the Laboratory Diagnosis of Fungal Infections

344

(29)

Antifungal Susceptibility Testing

373

(3)

Summary and Conclusions

376

(7)

References

376

(7)

Serological and Molecular Approaches to the Diagnosis of Invasive Fungal Infections in Immunocompromised Patients

383

(24)

Jose L. Lopez-Ribot

Thomas F. Patterson

Introduction

383

(1)

Serodiagnosis of Invasive Candidiasis

384

(4)

Serodiagnosis of Invasive Aspergillosis

388

(3)

Detection of Fungal Metabolites and Other Nonantigenic Components

391

(1)

PCR-Based Diagnosis

392

(3)

Nonculture Based Diagnosis of Pathogenic and Endemic Mycoses

395

(1)

Summary

396

(11)

References

397

(10)

Radiology of Fungal Infections in the Immunocompromised Patient

407

(22)

Reginald Greene

Overview

407

(1)

Clinical-Etiologic Constellations

408

(1)

Imaging Techniques

409

(1)

Imaging in Specific Invasive Mycoses

410

(14)

Summary

424

(5)

References

425

(4)

Polyenes

429

(28)

John Hiemenz

Thomas J. Walsh

Introduction

429

(1)

Amphotericin B Deoxycholate

430

(3)

Lipid Formulations of Amphotericin B

433

(24)

References

448

(9)

The Systemically Acting Azoles

457

(28)

Paul O. Gubbins

Introduction

457

(1)

Mechanism of Action

458

(9)

In Vitro Activity

467

(5)

Mechanisms of Resistance to Azoles

472

(1)

In Vivo Experimental Activity

473

(2)

Clinical Efficacy of the Azoles

475

(3)

Drug Interactions

478

(1)

Conclusion

478

(7)

References

479

(6)

Echinocandin Antifungal Drugs

485

(24)

John R. Graybill

Gregory M. Anstead

A New Antifungal Target

485

(1)

Mechanism of Action

486

(2)

Correlating In Vitro and In Vivo Activity

488

(3)

Clinical Evaluation: How Are These Drugs Handled?

491

(3)

Clinical Efficacy

494

(5)

Combination Therapy of Mycoses

499

(2)

A Footnote on Pneumocystis

501

(8)

References

501

(8)

Antifungal Agents: Other Classes and Compounds

509

(20)

Andreas H. Groll

Thomas J. Walsh

Agents for Systemic Treatment of Invasive Mycoses

509

(5)

Cell Wall Active Agents

514

(1)

Cell Membrane Active Agents

515

(2)

Agents for Systemic Treatment of Mycoses of the Skin and Its Appendages

517

(3)

Topical Antifungal Agents

520

(9)

References

521

(8)

Clinically Relevant Drug Interactions with Systemic Antifungal Therapy

529

(38)

Helen L. Leather

Introduction

529

(3)

Drug-Drug Interactions

532

(22)

Conclusion

554

(13)

References

554

(13)

Adjunctive Immunotherapy Against Opportunistic Fungal Infections

567

(34)

Emmanuel Roilides

John Dotis

Thomas J. Walsh

Introduction

567

(1)

Overview of Antifungal Host Defenses

568

(1)

Rationale of Adjunctive Immunotherapy

569

(1)

Preclinical Basis of Immunotherapy

570

(10)

Recommendations for the Use of HGFs and Cytokines in the Prevention and Treatment of IFIs in Immunocompromised Patients

580

(3)

White Blood Cell Transfusions (WBCTx)

583

(3)

Other Modes of Adjunctive Immunotherapy

586

(1)

Future Directions

587

(1)

Conclusions

588

(13)

References

588

(13)

Antifungal Prophylaxis

601

(20)

John R. Wingard

Elias J. Anaissie

Rationale

601

(1)

Types of Prophylaxis

602

(1)

Candida

603

(4)

Aspergillus

607

(2)

Cryptococcus

609

(1)

Histoplasmosis

610

(1)

Coccidioides

610

(1)

Pneumocystis jiroveci

611

(1)

Duration of Prophylaxis

611

(1)

Infection Control

612

(1)

Conclusions

613

(8)

References

613

(8)

Empirical Therapy of Suspected Infections

621

(16)

J. A. Maertens

K. Theunissen

M. A. Boogaerts

Introduction

621

(1)

Rationale and Goal of Empirical Therapy

622

(1)

Historical Perspective of Empirical Antifungal Therapy

623

(1)

The Evolving Empirical Arsenal

624

(4)

Towards Preemptive or Early-Therapy Strategies

628

(1)

Future Perspectives

629

(1)

Conclusion

630

(7)

References

630

(7)

Treatment of Invasive Fungal Infections

637

(30)

John R. Wingard

Elias J. Anaissie

Introduction

637

(1)

Candidiasis

637

(5)

Aspergillosis

642

(4)

Cryptococcus

646

(5)

Histoplasmosis

651

(2)

Coccidiodomycosis

653

(1)

Other Fungi

653

(2)

Pneumocystis jiroveci (Formerly Pneumocystis carinii)

655

(1)

Conclusion

656

(11)

References

656

(11)

Index

667

(8)

About the Editors

675

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Fungal Infections in the Immunocompromised Patient

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