Category: Antifungals

Cryptococcus Meningitis – Making Amphotericin Float Like a Crashing Seagull and Sting Like a Scorpion

Am I going there? Am I going to look into a topic that one of my attendings literally wrote the guidelines for? I guess I am. Cryptococcus is a yeast that is typically found everywhere there is bat/pigeon droppings or contaminated soil, as well as in certain tree species throughout the world. The most common

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MIC, PK/PD Indices, and Antibiotic Breakpoints

I discussed C. auris in my last post and pointed out that, due to the relative novelty of the organism, there are no “defined” breakpoints when it comes to drug-bug combinations. While I did say that fluconazole, in many instances, was considered “resistant”, the truth is I cannot say that with 100% confidence as there

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Emergence of the New Menace! Candida Auris and the Rise of MDR Yeasts.

Ear yeast! That is the translation of Candida auris. It was discovered by isolation from an ear infection in an elderly patient in Japan in 2009 and since then it has been isolated in places such as India, southeast Asia and several parts of south America (1-4):  One of the defining characteristics is its resistance

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PJP in AIDS-Patients vs non-AIDS Patients

Consider this post a continuation of the prior one on prophylaxis. I mention a bit on the pathophysiology, where adaptive immunity seems to play a key role in the way the body deals with the fungus, with mice with SCID infected with pneumocystis not being able to mount an inflammatory response. As a result of

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PJP Prophylaxis in Rheumatological Disease – Do You Need it? Probably

First identified by Carlos Chagas (yes, that Chagas) back in 1909, pneumocystis was identified as a cause of plasma cell pneumonia in debilitated infants following WWII (1). Since then, it has been identified as a unicellular fungus that is of low virulence and unique amongst the other fungi in that it lacks ergosterol in its

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Candidal Endocarditis – Looking for Sasquash

Infective endocarditis is a rare enough disease in and of itself that many folks won’t see much of in their lifetimes, though the rise in IV drug abuse means this may not be the case in the future. Staphylococcus aureus and streptococci, as well as enterococci, tend to be the most common organisms associated with

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Bad Bug, Bad Bug – Or Mould? Meet Your Demise

Last week I talked about invasive pulmonary aspergillosis in influenza and COVID patients. This is not the first time I have talked about this topic. I have mentioned how the halo sign is not terribly specific for IPA, especially in hematological patients and the testing characteristics of galactomannan. I have also spoken about the other

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Influenza, COVID-19, Pulmonary Aspergillosis, Lions, Tigers, And Bears – Oh My!

Influenza season is right around the corner, and given the current circumstances, it is a terrifying thought to have both COVID and flu running around. Besides causing significant respiratory distress and subsequent ARDS, severe influenza leads to bacterial superinfection with organisms such as Staph aureus and Streptococcal pneumonia. This usually happens in 10-35% of cases

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The Terrifying Threat of Mucormycosis

If I had to name an infection that gives people nightmares, besides COVID as of the time of writing this, would be Mucormycosis. These are moulds of the order Mucorales, which are comprised of multiple species, including Rhizopus spp, Mucor spp, and Lichtheimia spp (formerly of the genera Absidia and Mycocladus). Others include Rhizomucor spp,

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Types of Amphotericin B – What I Didn’t Know

I’ve been reading quite a bit about antifungals lately and one of the things I realized is the many formulations of amphotericin. Actually, the realization I had was I didn’t know the differences between them. It is a polyene antifungal that has broad spectrum antifungal activity (including Leshmania spp) but it is limited by its

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