Impact for the clinician

Ref ID: 19459

Author:

O.I. Lortholary

Author address:

Institut Pasteur and H^opital Necker Enfants Malades, Paris,
France

Full conference title:

6th Trends in Medical Mycology 2013

Date: 11 October 2014

Abstract:

Optimal management of invasive fungal infections relies on an
appropriate fungal identification at the genus and more ideally at the
species level for most of the clinical situations particularly those
occurring in immunocompromised hosts. The first useful step for the
clinician is the accurate microscopic examination. For example the
presence of broad, marginally septate hyphae in a broncho-alveolar
lavage (BAL) of a febrile allogeneic stem cell transplant recipient with
pulmonary nodules should first suggest the presence of a Mucorale
and thus avoid the use of any echinocandin or voriconazole. In addi-
tion, growing Aspergillus spp. in the appropriate host makes at least
the diagnosis of probable aspergillosis while culturing Penicillium
spp. from a BAL even from an at risk host strongly suggests a con-
tamination (except the peculiar diagnosis of P. marneffei, mostly in
the HIV setting). When dealing with probable aspergillosis, knowing
the causative species also impacts the therapeutic strategy as illus-
trated by the identification of A. terreus which should prompt the
choice of a non polyene-based therapy. Finally, with the extent of
triazole resistance in A. fumigatus, separating ’true’ fumigatus iso-
lates from recently recognized new species may also impact epidemi-
ology and therapeutic recommendations. When dealing with invasive
Candida infections, knowing as fast as it can be, thanks to the mod-
ern mycological tools, that C. glabrata or C. krusei is the causative
pathogen impacts the first line therapy by avoiding the prolonged
use of fluconazole.
On the other hand, sophisticated taxonomy with fungal names
changing quite a lot of time (Lichtheimia spp..; Magnusiomyces capit-
atum; etc”¦.) may lead to confusion in the clinical setting and such
changes should be ideally motivated by a clear impact on the clinical
picture, therapeutic choice or outcome.
During the lecture, we will thus illustrate how important for the
clinician is the precise fungal name through examples of emerging
invasive filamentous or yeast infections, sometimes responsible for
deadly nosocomial outbreaks. We will also emphasize some situations
(ex: fusariosis) for which trying to speciate and perform susceptibility
testing for all isolates may not provide any pertinence for the immediate therapeutic management.

Abstract Number: w10.4

Conference Year: 2013

Link to conference website: NULL

New link: NULL

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