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Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease.

Publication ,  Journal Article
Salzer, HJF; Burchard, G; Cornely, OA; Lange, C; Rolling, T; Schmiedel, S; Libman, M; Capone, D; Le, T; Dalcolmo, MP; Heyckendorf, J
Published in: Respiration
2018

Systemic endemic mycoses cause high rates of morbidity and mortality in certain regions of the world and the real impact on global health is not well understood. Diagnosis and management remain challenging, especially in low-prevalence settings, where disease awareness is lacking. The main challenges include the variability of clinical presentation, the fastidious and slow-growing nature of the fungal pathogens, the paucity of diagnostic tests, and the lack of options and toxicity of antifungal drugs. Coccidioidomycosis and paracoccidioidomycosis are restricted to the Americas only, and while histoplasmosis and blastomycosis also occur predominantly in the Americas, these mycoses have also been reported on other continents, especially in sub-Saharan Africa. Talaromycosis is endemic in tropical and subtropical regions in South-East Asia and southern China. Systemic endemic mycoses causing pulmonary disease are usually acquired via the airborne route by inhalation of fungal spores. Infections can range from asymptomatic or mild with flu-like illnesses to severe pulmonary or disseminated diseases. Skin involvement is frequent in patients with paracoccidioidomycosis, blastomycosis, sporotrichosis, and talaromycosis and manifests as localized lesions or diffuse nodules in disseminated disease, but can also occur with other endemic mycoses. Culture and/or characteristic histopathology from clinical samples is the diagnostic standard for endemic mycoses. Immunological assays are often not available for the diagnosis of most endemic mycoses and molecular amplification methods for the detection of fungal nucleic acids are not standardized at present. The first-line treatment for mild to moderate histoplasmosis, paracoccidioidomycosis, blastomycosis, sporotrichosis, and talaromycosis is itraconazole. Severe illness is treated with amphotericin B. Patients with severe coccidioidomycosis should receive fluconazole. Treatment duration depends on the specific endemic mycosis, the severity of disease, and the immune status of the patient, ranging between 6 weeks and lifelong treatment.

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Published In

Respiration

DOI

EISSN

1423-0356

Publication Date

2018

Volume

96

Issue

3

Start / End Page

283 / 301

Location

Switzerland

Related Subject Headings

  • Respiratory System
  • Radiography, Thoracic
  • Middle Aged
  • Male
  • Lung Diseases, Fungal
  • Itraconazole
  • Humans
  • Female
  • Endemic Diseases
  • Antifungal Agents
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Salzer, H. J. F., Burchard, G., Cornely, O. A., Lange, C., Rolling, T., Schmiedel, S., … Heyckendorf, J. (2018). Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease. Respiration, 96(3), 283–301. https://doi.org/10.1159/000489501
Salzer, Helmut J. F., Gerd Burchard, Oliver A. Cornely, Christoph Lange, Thierry Rolling, Stefan Schmiedel, Michael Libman, et al. “Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease.Respiration 96, no. 3 (2018): 283–301. https://doi.org/10.1159/000489501.
Salzer HJF, Burchard G, Cornely OA, Lange C, Rolling T, Schmiedel S, et al. Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease. Respiration. 2018;96(3):283–301.
Salzer, Helmut J. F., et al. “Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease.Respiration, vol. 96, no. 3, 2018, pp. 283–301. Pubmed, doi:10.1159/000489501.
Salzer HJF, Burchard G, Cornely OA, Lange C, Rolling T, Schmiedel S, Libman M, Capone D, Le T, Dalcolmo MP, Heyckendorf J. Diagnosis and Management of Systemic Endemic Mycoses Causing Pulmonary Disease. Respiration. 2018;96(3):283–301.
Journal cover image

Published In

Respiration

DOI

EISSN

1423-0356

Publication Date

2018

Volume

96

Issue

3

Start / End Page

283 / 301

Location

Switzerland

Related Subject Headings

  • Respiratory System
  • Radiography, Thoracic
  • Middle Aged
  • Male
  • Lung Diseases, Fungal
  • Itraconazole
  • Humans
  • Female
  • Endemic Diseases
  • Antifungal Agents