NDLI: Breakthrough Invasive Fungal Infections in Allogeneic Hematopoietic Stem Cell Transplantation

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Breakthrough Invasive Fungal Infections in Allogeneic Hematopoietic Stem Cell Transplantation

Content Provider	MDPI
Author	Liberatore, Carmine Farina, Francesca Greco, Raffaella Giglio, Fabio Clerici, Daniela Oltolini, Chiara Stanghellini, Maria Lupo Barzaghi, Federica Vezzulli, Paolo Orsenigo, Elena Corti, Consuelo Ciceri, Fabio Peccatori, Jacopo
Copyright Year	2021
Description	Despite the recent introduction of mold-active antifungal prophylaxis (MAP), breakthrough invasive fungal infections (b-IFI) still represent a possible complication and a cause of morbidity and mortality in hematological patients and allogeneic hematopoietic stem-cell transplantation recipients (HSCT). Data on incidence and type of b-IFI are limited, although they are mainly caused by non-fumigatus Aspergillus and non-Aspergillus molds and seem to depend on specific antifungal prophylaxis and patients’ characteristics. Herein, we described the clinical presentation and management of two cases of rare b-IFI which recently occurred at our institution in patients undergoing HSCT and receiving MAP. The management of b-IFI is challenging due to the lack of data from prospective trials and high mortality rates. A thorough analysis of risk factors, ongoing antifungal prophylaxis, predisposing conditions and local epidemiology should drive the choice of antifungal treatments. Early broad-spectrum preemptive therapy with a lipid formulation of amphotericin-B, in combination with a different mold-active azole plus/minus terbinafine, is advisable. The therapy would cover against rare azole-susceptible and -resistant fungal strains, as well as atypical sites of infections. An aggressive diagnostic work-up is recommended for species identification and subsequent targeted therapy.
Starting Page	347
e-ISSN	2309608X
DOI	10.3390/jof7050347
Journal	Journal of Fungi
Issue Number	5
Volume Number	7
Language	English
Publisher	MDPI
Publisher Date	2021-04-28
Access Restriction	Open
Subject Keyword	Journal of Fungi Mycology Invasive Fungal Infections Breakthrough Invasive Fungal Infections Transplantation Chemotherapy Hematology Prophylaxis Antifungal Therapy New Risks Diagnosis Resistance
Content Type	Text
Resource Type	Article

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