2,25–27 The selection of appropriate, targeted antimicrobial therapy must accommodate the fact that a variety of Candida species ranging from C. albicans to C. parapsilosis have been recovered from cases of CRMD-related Candida endocarditis. Accordingly, current treatment guidelines15 include the use
of an amphotericin B formulation (e.g. liposomal formulation amphotericin B – 3 to 5 mg kg day−1) with or without 5-flucytosine 25 mg kg−1 qid or an echinocandin agent such as micafungin 100 mg day−1 as primary therapy. With regard to the echinocandins, it is noteworthy that two recent publications19,24 Decitabine ic50 describe the use of these agents in the treatment of Candida endocarditis. Alternative step-down therapy can include fluconazole 400–800 mg daily for stable patients with a susceptible organism and negative blood culture results. Treatment is continued for 4–6 weeks after device removal. In summary, CRMD-associated Candida endocarditis is a rare but potentially life-threatening event, the microbiology can include both common and uncommon Candida mTOR inhibitor species and treatment involves both device removal and well-targeted antifungal therapy. “
“Invasive fungal infections (IFI) lead to morbidity and mortality in neutropenic patients and in allogenic stem
cell transplantation. Serum-based fungal detection assays have limitation of specificity or sensitivity. Studies on fungal DNA detection using real-time PCR in childhood leukaemia are lacking. The aim of this study was to develop sensitive and specific diagnostic tools for IFI in paediatric acute leukaemia patients 3-mercaptopyruvate sulfurtransferase using real-time PCR.
Of 100 randomised paediatric acute leukaemia patients receiving antifungal prophylaxis with voriconazole/amphotericin B, single peripheral whole blood sample in EDTA was used for Pan-AC real-time PCR assay (detects nine Candida and six Aspergillus species) in patients who failed prophylaxis due to proven, probable, possible or suspected fungal infections. PCR results were retrospectively correlated with clinical profile. Real-time PCR test was positive in 18/29 (62%) patients who failed prophylaxis. The only patient with proven IFI (mucormycosis), real-time PCR assay was negative. Real-time PCR was positive in 2/4 (50%) patients with possible and 16/24 (66.6%) suspected IFI and 5/10 (50%) patients with pneumonia. By applying method A/B, sensitivity and positive predictive value could not be commented due to unproven Aspergillus or Candida infections; specificity and negative predictive values (NPV) were 41% and 100% respectively; by method C (included episodes of possible IFI as true positive), sensitivity, specificity, PPV and NPV were 50%, 36%, 11% and 81% respectively. In those with suspected IFI, 8/24 (33.