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Angioinvasive fungal infections impacting the skin
Journal of the American Academy of Dermatology ( IF 13.8 ) Pub Date : 2018-08-10 , DOI: 10.1016/j.jaad.2018.04.059
Bridget E. Shields , Misha Rosenbach , Zoe Brown-Joel , Anthony P. Berger , Bradley A. Ford , Karolyn A. Wanat

Angioinvasive fungal infections cause significant morbidity and mortality because of their propensity to invade blood vessel walls, resulting in catastrophic tissue ischemia, infarct, and necrosis. While occasionally seen in immunocompetent hosts, opportunistic fungi are emerging in immunosuppressed hosts, including patients with hematologic malignancy, AIDS, organ transplant, and poorly controlled diabetes mellitus. The widespread use of antifungal prophylaxis has led to an “arms race” of emerging fungal resistance patterns. As the at-risk population expands and new antifungal resistance patterns develop, it is critical for dermatologists to understand and recognize angioinvasive fungal pathogens, because they are often the first to encounter the cutaneous manifestations of these diseases. Rapid clinical recognition, histopathologic, and culture confirmation can help render a timely, accurate diagnosis to ensure immediate medical and surgical intervention. Superficial dermatophyte infections and deep fungal infections, such as blastomycosis and histoplasmosis, have been well characterized within the dermatologic literature, and therefore this article will focus on the severe infections acquired by angioinvasive fungal species, including an update on new and emerging pathogens. In the first article in this continuing medical education series, we review the epidemiology and cutaneous manifestations. The second article in the series focuses on diagnosis, treatment, and complications of these infections.



中文翻译:

血管感染性真菌感染影响皮肤

血管侵入性真菌感染由于其倾向于侵入血管壁而导致严重的发病率和死亡率,从而导致灾难性的组织缺血,梗塞和坏死。尽管偶尔出现在有免疫能力的宿主中,但机会免疫真菌却出现在免疫抑制的宿主中,包括血液系统恶性肿瘤,艾滋病,器官移植和控制不佳的糖尿病患者。抗真菌药物的广泛使用已导致出现新的真菌抗药性模式的“军备竞赛”。随着高危人群的增加和新的抗真菌耐药性模式的发展,对于皮肤科医生来说,了解和识别血管浸润性真菌病原体至关重要,因为它们通常是最先遇到这些疾病的皮肤病表现。快速临床识别,组织病理学,文化确认可以帮助您进行及时,准确的诊断,以确保立即进行医学和外科手术干预。在皮肤病学文献中,浅表皮肤真菌感染和深层真菌感染(如胚芽胞菌病和组织胞浆菌病)已得到很好的表征,因此,本文将重点探讨由血管侵入性真菌引起的严重感染,包括新出现的病原体的更新。在这个继续医学教育系列的第一篇文章中,我们回顾了流行病学和皮肤表现。该系列的第二篇文章重点介绍这些感染的诊断,治疗和并发症。在皮肤病学文献中,如芽孢杆菌病和组织胞浆菌病已得到很好的鉴定,因此,本文将重点讨论由血管侵入性真菌引起的严重感染,包括新出现的病原体的更新。在这个继续医学教育系列的第一篇文章中,我们回顾了流行病学和皮肤表现。该系列的第二篇文章重点介绍这些感染的诊断,治疗和并发症。在皮肤病学文献中,如芽孢杆菌病和组织胞浆菌病已得到很好的鉴定,因此,本文将重点讨论由血管侵入性真菌引起的严重感染,包括新出现的病原体的更新。在这个继续医学教育系列的第一篇文章中,我们回顾了流行病学和皮肤表现。该系列的第二篇文章重点介绍这些感染的诊断,治疗和并发症。我们回顾了流行病学和皮肤表现。该系列的第二篇文章重点介绍这些感染的诊断,治疗和并发症。我们回顾了流行病学和皮肤表现。该系列的第二篇文章重点介绍这些感染的诊断,治疗和并发症。

更新日期:2018-08-10
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