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Chapter 39 : Invasive Aspergillosis in Malignancy and Stem Cell Transplant Recipients
Category: Clinical Microbiology; Fungi and Fungal Pathogenesis
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Invasive mycoses represent a major cause of morbidity and mortality in patients with malignancy or undergoing hematopoietic stem cell transplantation (HSCT). Recently it has been shown that the Toll-like receptor system could play an important role in the development of invasive aspergillosis in patients receiving chemotherapy or after HSCT, and there is evidence suggesting that the involvement of Toll-like receptors during Aspergillus fumigatus infection is influenced by the immunological status of the host. The upper and lower respiratory tracts represent the most frequent locations of A. fumigatus infection in all patient categories and age groups. Among echinocandins, caspofungin has been approved for salvage therapy in patients with invasive aspergillosis, since it has been demonstrated to be well-tolerated and with a 39% response in patients with refractory infections. However, in this study as in other salvage therapy trials, the need for salvage therapy was established in the presence of progression of disease or failure to improve clinically despite receiving at least 7 days of “standard therapy” (mainly amphotericin B deoxycholate, liposomal amphotericin B, or itraconazole). The degree of immunosuppression and the status of the underlying disease could represent very important factors acting upon a patient’s survival. For example, in the voriconazole study, success was observed in 63% of neutropenic patients receiving chemotherapy but in only 32% of recipients of allogeneic HSCT.
Key Concept Ranking
- Tumor Necrosis Factor alpha