Abstract
Invasive fungal infections (IFIs) are serious infections that develop in conjunction with neutropenia after chemotherapy for acute leukemia or with hematopoietic stem cell transplantation. Conventionally, empirical antifungal therapy was recommended to treat IFIs for patient safety despite a lack of evidence of fungal infections. However, many studies have indicated that antifungals were not necessary for over half of patients, and several detriments of empirical therapy were noted, e.g., antifungals caused adverse reactions, an increase in drug-resistant fungi was a possibility, and medical costs soared. β-D-glucan (BDG) is a component of clinically important fungi such as Aspergillus and Candida. The G-test was developed in Japan as a way to measure BDG in serum using a coagulation factor from the blood of the horseshoe crab. Pre-emptive antifungal therapy based upon serodiagnosis with a BDG or galactomannan assay and CT imaging has been introduced. With pre-emptive antifungal therapy, the prognosis is equivalent to that with empirical therapy, and the dose of the antifungal has been successfully reduced. Measurement of BDG has been adopted widely as a method of diagnosing IFIs and is listed in the key guidelines for fungal infections and febrile neutropenia.
Highlights
Fourth Department of Internal Medicine, Teikyo University School of Medicine, Mizonokuchi Hospital, Citation: Yoshida, M
Invasive fungal infections (IFIs) are serious infections that develop in conjunction with neutropenia after chemotherapy for acute leukemia or with hematopoietic stem cell transplantation (HSCT)
Empirical antifungal therapy (EAT) is a strategy of administering an antifungal automatically in cases of refractory febrile neutropenia (FN). This therapy is based on research into empirical therapy with an antifungal conducted by the European Organization for Research and Treatment of Cancer (EORTC) over 30 years ago
Summary
Invasive fungal infections (IFIs) are serious infections that develop in conjunction with neutropenia after chemotherapy for acute leukemia or with hematopoietic stem cell transplantation (HSCT). Candida species and Aspergillus species are the major fungi that cause IFIs, with candidemia and invasive pulmonary aspergillosis (IPA) being the predominant mycoses Both conditions lack characteristic clinical manifestations and there is no method of diagnosing either early, so definitive diagnosis of those conditions was often delayed and their subsequent therapeutic outcomes were poor. 6 of the control patients; 4 of the patients in the control group died, while none of the patients receiving Am-B did Because this strategy allowed aggressive chemotherapy and HSCT and improved patient prognosis, the FN guidelines of the Infectious Diseases Society of America (IDSA) recommended empirical therapy with an antifungal [2]. As various new antifungals have subsequently been developed, several detriments of EAT have been noted, e.g., patients often received an antifungal unnecessarily, antifungals caused adverse reactions, an increase in drug-resistant fungi was a possibility, and medical costs soared. The current work explains the significance of BDG in the management of IFIs
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