National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne, Australia.
Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia.
Clin Microbiol Rev. 2024 Jun 13;37(2):e0000423. doi: 10.1128/cmr.00004-23. Epub 2024 Mar 29.
SUMMARYAlthough species and are uncommon causes of invasive fungal diseases (IFDs), these infections are associated with high mortality and are costly to treat with a limited armamentarium of antifungal drugs. In light of recent advances, including in the area of new antifungals, the present review provides a timely and updated overview of these IFDs, with a focus on the taxonomy, clinical epidemiology, pathogenesis and host immune response, disease manifestations, diagnosis, antifungal susceptibility, and treatment. An expansion of hosts at risk for these difficult-to-treat infections has emerged over the last two decades given the increased use of, and broader population treated with, immunomodulatory and targeted molecular agents as well as wider adoption of antifungal prophylaxis. Clinical presentations differ not only between genera but also across the different species. is intrinsically resistant to most currently available antifungal agents, and the prognosis of immunocompromised patients with lomentosporiosis is poor. Development of, and improved access to, diagnostic modalities for early detection of these rare mold infections is paramount for timely targeted antifungal therapy and surgery if indicated. New antifungal agents (e.g., olorofim, fosmanogepix) with novel mechanisms of action and less cross-resistance to existing classes, availability of formulations for oral administration, and fewer drug-drug interactions are now in late-stage clinical trials, and soon, could extend options to treat scedosporiosis/lomentosporiosis. Much work remains to increase our understanding of these infections, especially in the pediatric setting. Knowledge gaps for future research are highlighted in the review.
摘要 虽然 和 是侵袭性真菌病(IFD)的罕见病因,但这些感染与高死亡率相关,并且由于抗真菌药物的有限选择,治疗成本很高。鉴于最近的进展,包括新抗真菌药物领域的进展,本综述及时提供了对这些 IFD 的更新概述,重点介绍了分类学、临床流行病学、发病机制和宿主免疫反应、疾病表现、诊断、抗真菌药敏性和治疗。在过去的二十年中,由于免疫调节剂和靶向分子药物的使用增加,以及抗真菌预防措施的广泛采用,这些难以治疗的感染的高危宿主范围扩大。不仅在不同属之间,而且在不同的 种之间,临床表现也不同。 对大多数现有的抗真菌药物具有内在耐药性,免疫功能低下的患者患有节孢子菌病的预后较差。开发和更好地获得用于早期检测这些罕见霉菌感染的诊断方法对于及时进行靶向抗真菌治疗和手术至关重要。新型抗真菌药物(例如,olorofim、fosmanogepix)具有新的作用机制,与现有类别交叉耐药性较低,可提供口服制剂,药物相互作用较少,目前处于后期临床试验阶段,很快将为治疗拟青霉病/节孢子菌病提供更多选择。仍有许多工作需要提高我们对这些感染的认识,特别是在儿科环境中。该综述强调了未来研究的知识空白。
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