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Management of osteoarticular fungal infections in the setting of immunodeficiency.
Expert Review of Anti-infective Therapy ( IF 4.2 ) Pub Date : 2020-04-02 , DOI: 10.1080/14787210.2020.1748499
Savvas G Papachristou 1 , Elias Iosifidis 1 , Nikolaos V Sipsas 2 , Maria N Gamaletsou 2 , Thomas J Walsh 3 , Emmanuel Roilides 1
Affiliation  

Introduction: Osteoarticular fungal infections (OAFIs) complicate the clinical course of high-risk patients, including immunosuppressed individuals. Their management, however, despite being intricate, is governed by evidence arising from sub-optimal quality research, such as case series. Guidelines are scarce and when present result in recommendations based on low quality evidence. Furthermore, the differences between the management of immunocompromised and immunocompetent patients are not distinct. This is a narrative review after a literature search in PubMed, up to November 2019.Areas covered: The major fungal groups causing osteomyelitis and/or arthritis are Candida spp., Aspergillus spp., non-Aspergillus filamentous fungi, non-Candida yeasts and endemic dimorphic fungi. Their epidemiology is briefly analyzed with emphasis on immunodeficiency and other risk factors. Management of OAFIs includes appropriate antifungal drug therapy (liposomal amphotericin B, triazoles or echinocandins), local surgery and immunotherapy for primary immunodeficiencies. Cessation of immunosuppressive drugs is also mandated.Expert opinion: Management of OAFIs includes affordable and available options and approaches. However, research on therapeutic practices is urgently required to be further improved, due to the rarity of affected patients. Evolution is expected to translate into novel antifungal drugs, less invasive and precise surgical approaches and targeted enhancement of immunoregulatory pathways in defense of challenging fungal pathogens.

中文翻译:

在免疫缺陷的情况下处理骨关节真菌感染。

简介:骨关节真菌感染(OAFI)使高危患者(包括免疫抑制的个体)的临床过程复杂化。然而,尽管如此,他们的管理还是受到来自次优质量研究(例如案例系列)的证据的支配。指南很少,如果存在,则会导致基于低质量证据的建议。此外,免疫功能低下和免疫功能正常的患者之间的区别也不明显。这是一篇叙事性评论,截至2019年11月在PubMed上进行了文献检索。研究范围包括:引起骨髓炎和/或关节炎的主要真菌群是念珠菌属,曲霉属,非曲霉丝状真菌,非念珠菌和地方性双态真菌。对他们的流行病学进行了简要分析,重点是免疫缺陷和其他危险因素。OAFI的管理包括适当的抗真菌药物治疗(脂质体两性霉素B,三唑或棘球e素),局部手术和针对原发性免疫缺陷的免疫疗法。还必须停止使用免疫抑制剂。专家意见:OAFI的管理包括负担得起的可用方法和途径。然而,由于受影响患者的稀有性,迫切需要进一步改进治疗方法的研究。进化有望转化为新型抗真菌药,侵入性更强和更精确的手术方法以及免疫调节途径的靶向增强,以防御具有挑战性的真菌病原体。OAFI的管理包括适当的抗真菌药物治疗(脂质体两性霉素B,三唑或棘球e素),局部手术和针对原发性免疫缺陷的免疫疗法。还必须停止使用免疫抑制剂。专家意见:OAFI的管理包括负担得起的可用方法和途径。然而,由于受影响患者的稀有性,迫切需要进一步改进治疗方法的研究。进化有望转化为新型抗真菌药,侵入性更强和更精确的手术方法以及免疫调节途径的靶向增强,以防御具有挑战性的真菌病原体。OAFI的管理包括适当的抗真菌药物治疗(脂质体两性霉素B,三唑或棘球e素),局部手术和针对原发性免疫缺陷的免疫疗法。还必须停止使用免疫抑制剂。专家意见:OAFI的管理包括负担得起的可用方法和途径。然而,由于受影响患者的稀有性,迫切需要进一步改进治疗方法的研究。预计进化将转化为新型抗真菌药,侵入性较小且精确的手术方法以及针对性强的真菌病原体防御的免疫调节途径的靶向增强。OAFI的管理包括负担得起的可用选项和方法。然而,由于受影响患者的稀有性,迫切需要进一步改进治疗方法的研究。预计进化将转化为新型抗真菌药,侵入性较小且精确的手术方法以及针对性强的真菌病原体防御的免疫调节途径的靶向增强。OAFI的管理包括负担得起的可用选项和方法。然而,由于受影响患者的稀有性,迫切需要进一步改进治疗方法的研究。预计进化将转化为新型抗真菌药,侵入性较小且精确的手术方法以及针对性强的真菌病原体防御的免疫调节途径的靶向增强。
更新日期:2020-04-20
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