Current Fungal Infection Reports最新文献

Purpose of review: Eumycetoma, chromoblastomycosis, and sporotrichosis are three of only four fungal infections recognized as Neglected Tropical Diseases (NTDs) by the World Health Organization. They are a significant source of morbidity in subtropical and tropical regions of the Americas, Africa, and Asia. There are very few treatments approved for these diseases. Clinicians often use drug repurposing, off-label use of existing drugs, for their treatment. This article is a systematic review of the published literature on the treatment of fungal NTDs from the last five years (2019-2024). It will provide an overview for each fungal NTD, their current treatment landscape, and the challenges associated with their treatment.

Recent findings: Itraconazole remains the most widely used antifungal for the treatment of these fungal NTDs. Newer antifungals such as fosravuconazole have matched the efficacy of currently available drugs while reducing adverse events and pill burden. Other promising treatment strategies involve the use of immunomodulators (e.g., imiquimod), steroids (e.g., prednisolone), or non-steroidal anti-inflammatory agents in combination with traditional antifungal agents.

Summary: Frequently repurposed drugs include itraconazole, posaconazole, voriconazole, amphotericin B, terbinafine, potassium iodide, and 5-flucytosine. Most of these drugs have significant side effects, unsatisfactory cure rates, and significant cost that restricts their use. Systematic collection of this drug repurposing data and analyzing it in aggregate using platforms such as CURE ID has the potential to generate efficacy signals for drugs. These promising candidates can then be studied comprehensively in clinical trials for drug approval.

Purpose of review: This review summarizes current literature about the disability burden of the fungal neglected tropical diseases (NTDs) sporotrichosis, chromoblastomycosis, eumycetoma, and paracoccidioidomycosis. The review highlights current knowledge gaps in global settings and describes available tools that could be adopted to fill these gaps.

Recent findings: Sporotrichosis, chromoblastomycosis, and eumycetoma often present initially as skin lesions that can become progressively disfiguring, lead to stigmatization, and cause various sequalae affecting health and function. Chronic paracoccidioidomycosis can have systemic involvement and commonly results in impaired pulmonary function, which can limit activities of daily living and employment capacity. Use of standardized tools to quantify disability with fungal NTDs has been limited to date. Standardized tools to measure the impacts on quality of life and mental health are available and have been used for similar patient populations, including persons with other fungal diseases and persons with non-fungal skin NTDs.

Summary: Fungal NTDs can be disabling. Improved understanding of the quality of life and mental health consequences might lead to greater awareness of the burden of fungal NTDs and enhance health planning to address the health and rehabilitation needs of persons affected by these diseases.

Introduction: The outbreak of coronavirus disease 2019 (COVID-19) had affected clinical practice in several ways, including the restriction of nonessential endoscopic procedures. Therefore, our aim was to evaluate how colorectal cancer (CRC) diagnosis and management was affected during the first year of pandemics in Portugal.

Methods: This is a Portuguese substudy of the French retrospective multicentric study ETICC (Etude de l'Impact de la pandémie COVID-19 sur le diagnostic et la prise en charge du Cancer Colorectal). We compared patients' characteristics, clinical manifestations, CRC staging at diagnosis, delay to first medical appointment, histological diagnosis, surgical and medical treatments between the year previous to the pandemics (control) and the first year of pandemics.

Results: We included 766 patients: 496 in the control group and 270 in the COVID group. There was no significant difference in CRC staging at diagnosis between both groups, with 21% being diagnosed as metastatic in the control group and 22% in the first year of pandemics (p = 0.770). Contrary to what happened in France, there was a significant decrease in CRC diagnosis in asymptomatic patients (25-8.4%; p < 0.001) and after a positive fecal immunochemical test (20.8-11.3%; p = 0.002) during the pandemics. Although the increase in the overall complication rate at diagnosis was nonsignificant, in Portugal, there was a significant increase in diagnosis of abdominal occlusion (12.1-18.1%; p = 0.033). In Portugal, time between the beginning of symptoms and the first medical appointment significantly increased from a median of 50 days to 64 days during COVID (p < 0.001). On the contrary, time between histological diagnosis and tumor resection had significantly decreased from a median of 65 to 39 days (p < 0.001). Time between histological diagnosis and neoadjuvant treatment was not statistically different (median of 64-67 days; p = 0.590), as was time between histological diagnosis and palliative chemotherapy (median of 50-51 days; p = 1.000). Time from CRC resection and adjuvant treatment has significantly decreased from a median of 54 to 43 days (p = 0.001).

Discussion: We found a significant impact in CRC diagnosis in the first year of pandemics, more pronounced than what was found in France. These are likely related not only with the closing of endoscopy units but also with the difficulties patients had in finding an appointment with their general practitioners. On the other hand, both in France and Portugal, the first year of pandemics did not worsen CRC staging at diagnosis and did not significantly affect medical and surgical treatments once the diagnosis was made.