Consensus guidelines for the diagnosis and management of invasive fungal disease due to moulds other than Aspergillus in the haematology/oncology setting, 2021

被引:45
作者
Bupha-Intr, Olivia [1 ]
Butters, Coen [2 ,8 ,9 ]
Reynolds, Gemma [10 ]
Kennedy, Karina [16 ,17 ]
Meyer, Wieland [3 ,4 ,5 ,6 ,7 ]
Patil, Sushrut [11 ]
Bryant, Penelope [8 ,13 ,14 ]
Morrissey, Catherine O. [12 ,15 ]
机构
[1] Wellington Reg Hosp, Dept Infect Serv, Wellington, New Zealand
[2] John Hunter Childrens Hosp, Dept Gen Paediat & Adolescent Med, Newcastle, NSW, Australia
[3] Univ Sydney, Mol Mycol Res Lab, Ctr Infect Dis & Microbiol, Westmead Clin Sch,Fac Med & Hlth, Sydney, NSW, Australia
[4] Univ Sydney, Sydney Med Sch, Fac Med & Hlth, Sydney, NSW, Australia
[5] Univ Sydney, Marie Bashir Inst Infect Dis & Biosecur, Sydney, NSW, Australia
[6] Westmead Hosp, Res & Educ Network, Westmead, NSW, Australia
[7] Westmead Inst Med Res, Sydney, NSW, Australia
[8] Univ Melbourne, Dept Paediat, Melbourne, Vic, Australia
[9] Royal Childrens Hosp, Murdoch Childrens Res Inst, Melbourne, Vic, Australia
[10] Austin Hlth, Dept Infect Dis, Heidelberg, Vic, Australia
[11] Alfred Hosp, Malignant Haematol & Stem Cell Transplantat Serv, Dept Clin Haematol, Melbourne, Vic, Australia
[12] Alfred Hosp, Dept Infect Dis, Level 2,Burnet Bldg,85 Commercial Rd, Melbourne, Vic 3004, Australia
[13] Royal Childrens Hosp, Dept Infect Dis, Melbourne, Vic, Australia
[14] Monash Univ, Infect & Immun, Murdoch Childrens Res Inst, Melbourne, Vic, Australia
[15] Monash Univ, Dept Infect Dis, Cent Clin Sch, Melbourne, Vic, Australia
[16] Australian Natl Univ, Dept Infect Dis & Microbiol, Canberra Hosp & Hlth Serv, Canberra, ACT, Australia
[17] Australian Natl Univ, ANU Med Sch, Canberra, ACT, Australia
关键词
non-Aspergillus mould; mucormycosis; scedosporiosis; Lomentospora prolificans; fusariosis; invasive mould disease; LIPOSOMAL AMPHOTERICIN-B; REAL-TIME PCR; DESORPTION IONIZATION-TIME; ACUTE MYELOID-LEUKEMIA; IN-VITRO ACTIVITY; CELL TRANSPLANT RECIPIENTS; FLIGHT MASS-SPECTROMETRY; SCOPULARIOPSIS-BREVICAULIS INFECTION; SCEDOSPORIUM-PROLIFICANS INFECTION; IMMUNOCOMPROMISED PATIENTS;
D O I
10.1111/imj.15592
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Invasive fungal disease (IFD) due to moulds other than Aspergillus is a significant cause of mortality in patients with malignancies or post haemopoietic stem cell transplantation. The current guidelines focus on the diagnosis and management of the common non-Aspergillus moulds (NAM), such as Mucorales, Scedosporium species (spp.), Lomentospora prolificans and Fusarium spp. Rare but emerging NAM including Paecilomyces variotii, Purpureocillium lilacinum and Scopulariopsis spp. are also reviewed. Culture and histological examination of tissue biopsy specimens remain the mainstay of diagnosis, but molecular methods are increasingly being used. As NAM frequently disseminate, blood cultures and skin examination with biopsy of any suspicious lesions are critically important. Treatment requires a multidisciplinary approach with surgical debridement as a central component. Other management strategies include control of the underlying disease/predisposing factors, augmentation of the host response and the reduction of immunosuppression. Carefully selected antifungal therapy, guided by susceptibility testing, is critical to cure. We also outline novel antifungal agents still in clinical trial which offer substantial potential for improved outcomes in the future. Paediatric recommendations follow those of adults. Ongoing epidemiological research, improvement in diagnostics and the development of new antifungal agents will continue to improve the poor outcomes that have been traditionally associated with IFD due to NAM.
引用
收藏
页码:177 / 219
页数:43
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