Universität zu Köln

Koehler, P., Cornely, O. A. and Vehreschild, J. J. (2019). Fungal infections. Internist, 60 (7). S. 684 - 690. HEIDELBERG: SPRINGER HEIDELBERG. ISSN 1432-1289

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Abstract

Background. Invasive aspergillosis, mucormycosis, and cryptococcosis are severe opportunistic infections in patients with long phases of neutropenia and also after allogeneic stem cell and organ transplantation. Due to the late appearance of clinical signs and the often poor outcome, these diseases require special attention and proactive interventions. Material and methods. Published guidelines and selected current literature were reviewed for this article. Results. Invasive aspergillosis and mucormycosis are typically observed in the upper and lower airways of severely immunocompromized patients. When invasive fungal diseases are suspected, sectional imaging and, if possible, serological testing should be performed as soon as possible. If imaging or serological tests confirm the suspected diagnosis, pre-emptive antimycotic treatment should be started and further confirmation of the diagnosis sought via microbiological and/or histological investigations. Treatment depends on comedication, comorbidity and risk factors, primarily with voriconazole, isavuconazole and liposomal amphotericin B. With the advent of antiretroviral treatment, a decrease of cryptococcosis cases in people with human immunodeficiency virus was observed; however, increasing cases have been reported in patients with new forms of immunosuppression. Cryptococcus spp. predominantly cause central nervous system infections but also pneumonia and bloodstream infections. Diagnostics include blood and cerebrospinal fluid cultures and antigen tests. First line treatment consists of a combination therapy with amphotericin B and flucytosine. Conclusion. An interdisciplinary approach with microbiologists, infectious diseases specialists and radiologists is needed for diagnostics and treatment of invasive fungal diseases.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Koehler, P. UNSPECIFIED UNSPECIFIED UNSPECIFIED Cornely, O. A. UNSPECIFIED UNSPECIFIED UNSPECIFIED Vehreschild, J. J. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-136688
DOI:	10.1007/s00108-019-0618-3
Journal or Publication Title:	Internist
Volume:	60
Number:	7
Page Range:	S. 684 - 690
Date:	2019
Publisher:	SPRINGER HEIDELBERG
Place of Publication:	HEIDELBERG
ISSN:	1432-1289
Language:	German
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language RESISTANT INVASIVE ASPERGILLOSIS; PRACTICE GUIDELINES; DISEASES SOCIETY; MANAGEMENT; DIAGNOSIS; EPIDEMIOLOGY; VORICONAZOLE; LEUKEMIA; UPDATE; VOLUME Multiple languages Medicine, General & Internal Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/13668