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Prevention and early treatment of invasive fungal infection in patients with cancer and neutropenia and in stem cell transplant recipients in the era of newer broad-spectrum antifungal agents and diagnostic adjuncts.

Publication ,  Journal Article
Segal, BH; Almyroudis, NG; Battiwalla, M; Herbrecht, R; Perfect, JR; Walsh, TJ; Wingard, JR
Published in: Clin Infect Dis
February 1, 2007

Invasive fungal infection (IFI) is a leading cause of infection-related mortality among patients with cancer and prolonged neutropenia and among allogeneic hematopoietic stem cell transplant recipients with graft-versus-host disease. Invasive candidiasis was the principal IFI in the period predating fluconazole prophylaxis, whereas today, invasive aspergillosis and other mold infections cause the majority of deaths from fungal infection in this patient population. The changing epidemiology of IFI, in addition to advances made in antifungal therapeutics and early diagnosis of IFI, warrant a reevaluation of earlier strategies aimed at prevention and early treatment of IFI that were developed several years ago. Here, we propose that persistent neutropenic fever is nonspecific for an IFI and should not be used as the sole criterion for empirical modification in the antifungal regimen in a patient receiving mold-active prophylaxis. We explore the potential benefits and gaps in knowledge associated with employing chest CT scans and laboratory markers as diagnostic adjuncts for IFI. Finally, we discuss the implications of newer antifungal agents and diagnostic adjuncts in the design of future clinical trials to evaluate prophylaxis and early prevention strategies.

Duke Scholars

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

February 1, 2007

Volume

44

Issue

3

Start / End Page

402 / 409

Location

United States

Related Subject Headings

  • beta-Glucans
  • Yeasts
  • Tomography, X-Ray Computed
  • Randomized Controlled Trials as Topic
  • Practice Guidelines as Topic
  • Neutropenia
  • Neoplasms
  • Mycoses
  • Microbiology
  • Mannans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Segal, B. H., Almyroudis, N. G., Battiwalla, M., Herbrecht, R., Perfect, J. R., Walsh, T. J., & Wingard, J. R. (2007). Prevention and early treatment of invasive fungal infection in patients with cancer and neutropenia and in stem cell transplant recipients in the era of newer broad-spectrum antifungal agents and diagnostic adjuncts. Clin Infect Dis, 44(3), 402–409. https://doi.org/10.1086/510677
Segal, Brahm H., Nikolaos G. Almyroudis, Minoo Battiwalla, Raoul Herbrecht, John R. Perfect, Thomas J. Walsh, and John R. Wingard. “Prevention and early treatment of invasive fungal infection in patients with cancer and neutropenia and in stem cell transplant recipients in the era of newer broad-spectrum antifungal agents and diagnostic adjuncts.Clin Infect Dis 44, no. 3 (February 1, 2007): 402–9. https://doi.org/10.1086/510677.
Journal cover image

Published In

Clin Infect Dis

DOI

EISSN

1537-6591

Publication Date

February 1, 2007

Volume

44

Issue

3

Start / End Page

402 / 409

Location

United States

Related Subject Headings

  • beta-Glucans
  • Yeasts
  • Tomography, X-Ray Computed
  • Randomized Controlled Trials as Topic
  • Practice Guidelines as Topic
  • Neutropenia
  • Neoplasms
  • Mycoses
  • Microbiology
  • Mannans