Candida peritonitis in a patient with necrotising cholecystitis and pancreatitis

An 80-year-old patient in previously excellent state of health presented with septic syndrome for gangrenous cholecystitis and concomitant pancreatitis. Diagnostic paracentesis revealed microbiological evidence of Candida albicans in the abdominal cavity. Laparoscopic cholecystectomy was performed and examination of histological specimens confirmed peritonitis by fungal perforation of the gall bladder. In a complicated postoperative course the patient was finally cured choosing voriconazole (Vfend) for antimycotic therapy.     

Voriconazole for prophylaxis of invasive fungal infections after allogeneic hematopoietic stem cell transplantation

Introduction: Invasive fungal infections (IFIs) following allogeneic hematopoietic stem cell transplantation (alloHSCT) are associated with a high mortality, and accordingly most alloHSCT recipients receive prophylaxis with antifungal agents. Despite some improvement in outcomes of IFIs over time, they continue to represent substantial clinical risk, mortality, and financial burden.

Areas covered: We review the main pathogens responsible for IFIs in recipients of alloHSCT, current treatment recommendations, and discuss clinical and economic considerations associated with voriconazole prophylaxis of IFIs in these patients.

Expert commentary: The clinical efficacy of voriconazole appears to be at least equivalent to other antifungal treatments, and generally well tolerated. Overall, benefit-risk balance is favorable, and findings from cost-effectiveness analyses support the use of voriconazole prophylaxis of IFIs in recipients of alloHSCT.     

Efficacy of voriconazole plus amphotericin B or micafungin in a guinea-pig model of invasive pulmonary aspergillosis

The efficacy of voriconazole in combination with amphotericin B or micafungin was studied in a transiently neutropenic guinea-pig model of invasive pulmonary aspergillosis. Guinea-pigs treated with the antifungal drugs, alone or in two-drug combinations, had an improved survival rate and reduced fungal burden in the lungs compared to untreated control animals. The efficacy of monotherapy and combination therapy was similar; activity was neither enhanced nor reduced with the two-drug combinations. Further studies of efficacy, dosing and optimal regimens for antifungal combinations are warranted.     

Successful treatment of bilateral endogenous Fusarium solani endophthalmitis in a patient with acute lymphocytic leukaemia

Fusarium spp. are an uncommon cause of fungaemia in immunocompromised and neutropenic patients that may hematogenously disseminate to the eyes. Herein, we describe a patient with acute lymphoblastic leukaemia and a prior history of extensive corticosteroid exposure who developed disseminated Fusarium solani infection following chemotherapy despite posaconazole prophylaxis. She was successfully treated with combination liposomal amphotericin B and voriconazole, intraocular injections of voriconazole, topical amphotericin B and bilateral vitrectomy. We also review published literature describing the management of endogenous Fusarium endophthalmitis in immunocompromised hosts.     

伏立康唑对体外培养棘阿米巴增殖和形态表现的影响

目的：探讨伏立康唑对体外培养棘阿米巴的增殖和形态表现的影响,阐明伏立康唑对棘阿米巴滋养体和包囊的抑制和杀伤作用。方法：选取对数生长期的棘阿米巴原虫分为对照组和实验组（2.5 和25.0 mg·L^-1）,分别于药物作用后24、48、72和96 h收集各组虫体,计数虫体数量并绘制增殖曲线;光镜下观察棘阿米巴的形态表现、活力和贴壁情况;电镜下观察其超微结构。结果：与对照组比较,实验组棘阿米巴虫体数量减少（P<0.01）;光镜下实验组棘阿米巴形态变化明显,由不规则带棘状伪足的滋养体转化为圆形包囊,出现大量细胞碎片;电镜下实验组棘阿米巴的超微结构出现不同程度的破坏、坏死。结论：一定浓度伏立康唑能够有效抑制体外培养棘阿米巴的增殖并改变其形态甚至超微结构,对滋养体和包囊均具有明显杀伤作用。     

Fusarium: The Versatile Pathogen

Fusarium is an emerging human opportunistic pathogen of growing importance, especially among immunosuppressed haematology patients due to an increased incidence of disseminated infections over the past two decades. This trend is expected only to continue due to the advances in medical and surgical technologies that will prolong the lives of the severely ill, making these patients susceptible to rare opportunistic infections. Production of mycotoxins, enzymes such as proteases, angio-invasive property and an intrinsically resistant nature, makes this genus very difficult to treat. Fusarium is frequently isolated from the cornea and less commonly from nail, skin, blood, tissue, Continuous Ambulatory Peritoneal Dialysis (CAPD) fluid, urine and pleural fluid. Conventional microscopy establishes the genus, but accurate speciation requires multilocus sequence typing with housekeeping genes such as internal transcribed spacer, translation elongation factor-1α and RPB1 and 2 (largest and second largest subunits of RNA polymerase), for which expansive internet databases exist. Identifying pathogenic species is of epidemiological significance, and the treatment includes immune reconstitution by granulocyte–colony-stimulating factor, granulocyte macrophage–colony-stimulating factor and a combination of the most active species – specific antifungals, typically liposomal amphotericin-B and voriconazole. However, patient outcome is difficult to predict even with in vitro susceptibility with these drugs. Therefore, prevention methods and antifungal prophylaxis have to be taken seriously for these vulnerable patients by vigilant healthcare workers. The current available literature on PubMed and Google Scholar using search terms ‘Fusarium’, ‘opportunistic invasive fungi’ and ‘invasive fusariosis’ was summarised for this review.     

Surviving a recurrent Scedosporium prolificans endocarditis: A case report

Scedosporium prolificans have been reported to be resistant to all antifungals including the newer azoles and echinocandins. We report an unusual case of repeated S. prolificans infection of the heart valves in an immunocompetent patient.