Case 3 Revisited: Finding a diagnostic approach – Part 2
Invasive aspergillosis is a challenging condition to diagnose, treat and manage. Mortality is high, even when the diagnosis is clear and treatment is started early. Much like we saw in …
Course: The Role of Antifungal Stewardship
Case 2 Revisited: When to stop empirical antifungals – Part 2
The ICU team hear back from the Infection Specialist. In the context of his current clinical condition, and the results now available, advice is to stop the intravenous echinocandin. No …
Case 1 Revisited: Avoiding unnecessary Antifungals – Part 2
On further questioning, Mr Daniels gives us more information about his symptoms. He was fully compliant with antifungal treatment but less can be said for his oral hygiene. The problem …
What are the challenges?
There are a number of factors that can hinder developing and establishing antifungal stewardship. One of the most common obstacles is lack of knowledge among clinical staff on fungal diseases, …
What can be done?
What is the answer to the growing problem of antifungal resistance? The solution is multifaceted and antifungal stewardship is in its heart. Antifungal stewardship aims to treat fungal infections effectively …
Benefits of Antifungal Stewardship
As we have seen this week, antifungal stewardship can be a complex and challenging task. Why should we go to the effort of putting these measures in place? There are …
How does Antifungal Resistance occur?
There are many ways a fungus can evade the action of one or more antifungal agents, but the key is exposure to antifungals or related compounds. Some resistance is inherent. …
Antifungal resistance exists
One of the main barriers to successful antifungal stewardship is awareness. Antibiotic stewardship (aimed mainly at common bacterial infections) is now well established in many hospitals. This has led to …
Case Overview- Invasive Aspergilliosis
We have discussed a case of Barbara Bell, a 62-year old woman undergoing chemotherapy for AML. Fever, cough and breathlessness were her presenting symptoms. The differential diagnosis at the time …
How do we treat Invasive Aspergillosis?
The CT scan is reviewed and the medical team take advice from a local Infection specialist. It is felt that, taking into account the patient’s CT findings, neutropenia, symptoms and …
How do we diagnose Invasive Aspergillosis? – Part 2
Following on from the previous article, a combination of radiology, microbiology and clinical diagnostics can be used to aid early diagnosis: Aspergillus PCR Detection of Aspergillus DNA in BAL samples …
How do we diagnose Invasive Aspergillosis? – Part 1
Diagnosing invasive aspergillosis (IA) is a challenging prospect. As a normally innocuous environmental fungus, Aspergillus can contaminate laboratory samples and colonise the oropharynx, sinuses and endotracheal tubes. The more sensitive …
Risk factors of Invasive Aspergillosis
Aspergillus species are environmental moulds which are ubiquitous. We all inhale hundreds of Aspergillus spores daily. Above, Stained microscopy slide showing Aspergillus fumigatus in a lung alveolus Multiple conditions can …
Case 3: Introduction
Barbara Bell, a 62 year old woman is currently an inpatient on the Haematology ward. She was admitted after presenting with a 7 day history of worsening shortness of breath. …
Case Overview – Disseminated Candidosis
This was a case of Richard Wilson, a 54-year old man who attended the Emergency Department with signs and symptoms of urinary sepsis requiring ICU admission, and who deteriorated clinically …