Author
Anna Skiada
Bio: Anna Skiada is an academic researcher from National and Kapodistrian University of Athens. The author has contributed to research in topics: Mucormycosis & Colistin. The author has an hindex of 27, co-authored 44 publications receiving 5312 citations.
Topics: Mucormycosis, Colistin, Zygomycosis, Posaconazole, Voriconazole
Papers
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TL;DR: The emerging epidemiology and the clinical manifestations of mucormycosis are described and this disease is increasingly recognized in recently developed countries, such as India, mainly in patients with uncontrolled diabetes or trauma.
Abstract: Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Mucorales order of the class of Zygomycetes. Mucormycosis has emerged as the third most common invasive mycosis in order of importance after candidiasis and aspergillosis in patients with hematological and allogeneic stem cell transplantation. Mucormycosis also remains a threat in patients with diabetes mellitus in the Western world. Furthermore, this disease is increasingly recognized in recently developed countries, such as India, mainly in patients with uncontrolled diabetes or trauma. Epidemiological data on this type of mycosis are scant. Therefore, our ability to determine the burden of disease is limited. Based on anatomic localization, mucormycosis can be classified as one of 6 forms: (1) rhinocerebral, (2) pulmonary, (3) cutaneous, (4) gastrointestinal, (5) disseminated, and (6) uncommon presentations. The underlying conditions can influence clinical presentation and outcome. This review describes the emerging epidemiology and the clinical manifestations of mucormycosis.
1,015 citations
Hacettepe University1, Boston Children's Hospital2, Katholieke Universiteit Leuven3, University of Bologna4, Radboud University Nijmegen5, University of Aberdeen6, Claude Bernard University Lyon 17, European Respiratory Society8, Cardiff University9, University Hospital of Lausanne10, University of Queensland11, Ghent University12, University of Paris13, Istituto Giannina Gaslini14, Post Graduate Institute of Medical Education and Research15, Carlos III Health Institute16, National and Kapodistrian University of Athens17, University of Rennes18, University Hospital Heidelberg19, University College London20, Goethe University Frankfurt21, Catholic University of the Sacred Heart22, McGill University23
TL;DR: Treatment duration for aspergillosis is strongly recommended based on clinical improvement, degree of immunosuppression and response on imaging, and in refractory disease, where a personalized approach considering reversal of predisposing factors, switching drug class and surgical intervention is also strongly recommended.
848 citations
Carlos III Health Institute1, University of Cologne2, University of Sydney3, Paris Descartes University4, Universidade Federal de Ciências da Saúde de Porto Alegre5, Pontifícia Universidade Católica do Rio Grande do Sul6, University of California, San Diego7, Medical University of Graz8, University of Copenhagen9, Katholieke Universiteit Leuven10, University of Bologna11, University of the Witwatersrand12, RMIT University13, McGill University14, Hacettepe University15, University of Paris16, Utrecht University17, Mazandaran University of Medical Sciences18, Tel Aviv University19, Hospital General de México20, Istituto Giannina Gaslini21, Mahidol University22, Federal University of São Paulo23, King's College, Aberdeen24, Comenius University in Bratislava25, Boston Children's Hospital26, Hospital General Universitario Gregorio Marañón27, Complutense University of Madrid28, University Hospital Heidelberg29, University of California, Los Angeles30, American University of Beirut31, Innsbruck Medical University32, University of Lausanne33, Catholic University of Korea34, Goethe University Frankfurt35, Erasmus University Rotterdam36, National and Kapodistrian University of Athens37, Monash University38, Federal University of Rio de Janeiro39, Catholic University of the Sacred Heart40, University of Health Sciences Antigua41, National Institutes of Health42, Amrita Institute of Medical Sciences and Research Centre43, University of Pittsburgh44, Peter MacCallum Cancer Centre45, University of Melbourne46, P. D. Hinduja Hospital and Medical Research Centre47, University of Southern California48, Duke University49, Singapore General Hospital50, NewYork–Presbyterian Hospital51, Cardiff University52, University of Texas Health Science Center at San Antonio53, Children's Hospital of Philadelphia54, Post Graduate Institute of Medical Education and Research55
TL;DR: Management of mucormycosis depends on recognising disease patterns and on early diagnosis, and limited availability of contemporary treatments burdens patients in low and middle income settings.
Abstract: Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the "One World One Guideline" initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.
842 citations
University of Cologne1, Hacettepe University2, Boston Children's Hospital3, Katholieke Universiteit Leuven4, Post Graduate Institute of Medical Education and Research5, Necker-Enfants Malades Hospital6, Pasteur Institute7, Catholic University of the Sacred Heart8, National and Kapodistrian University of Athens9, Statens Serum Institut10, Second Military Medical University11, University Medical Center Utrecht12, University of Delhi13, Carlos III Health Institute14, Central European Institute of Technology15, Hospital General Universitario Gregorio Marañón16, University of Liverpool17, Innsbruck Medical University18, Radboud University Nijmegen Medical Centre19, Manchester Academic Health Science Centre20, University of Milan21, University of Würzburg22
TL;DR: These European Society for Clinical Microbiology and Infectious Diseases and European Confederation of Medical Mycology Joint Clinical Guidelines focus on the diagnosis and management of mucormycosis and strongly recommend continuing treatment until complete response demonstrated on imaging and permanent reversal of predisposing factors.
725 citations
National and Kapodistrian University of Athens1, The Catholic University of America2, Boston Children's Hospital3, University of Bern4, Necker-Enfants Malades Hospital5, Katholieke Universiteit Leuven6, Innsbruck Medical University7, Manchester Academic Health Science Centre8, Palacký University, Olomouc9, Hacettepe University10, Carlos III Health Institute11
TL;DR: Administration of amphotericin B and surgery, where feasible, significantly improve survival and the most common manifestations of zygomycosis were pulmonary, rhinocerebral and soft tissue.
561 citations
Cited by
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University of Alabama at Birmingham1, University of Michigan2, University of Wisconsin-Madison3, Duke University4, University of Lausanne5, University of California, Los Angeles6, Georgia Regents University7, Radboud University Nijmegen8, University of Texas at Austin9, Rowan University10, AstraZeneca11, National Institutes of Health12, Wayne State University13
TL;DR: These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections.
Abstract: Guidelines for the management of patients with invasive candidiasis and mucosal candidiasis were prepared by an Expert Panel of the Infectious Diseases Society of America. These updated guidelines replace the previous guidelines published in the 15 January 2004 issue of Clinical Infectious Diseases and are intended for use by health care providers who care for patients who either have or are at risk of these infections. Since 2004, several new antifungal agents have become available, and several new studies have been published relating to the treatment of candidemia, other forms of invasive candidiasis, and mucosal disease, including oropharyngeal and esophageal candidiasis. There are also recent prospective data on the prevention of invasive candidiasis in high-risk neonates and adults and on the empiric treatment of suspected invasive candidiasis in adults. This new information is incorporated into this revised document.
3,016 citations
University of Alabama at Birmingham1, University of Michigan2, University of Wisconsin-Madison3, University of Pittsburgh4, Johns Hopkins University School of Medicine5, University of Texas Health Science Center at Houston6, Rowan University7, University of Pennsylvania8, Georgia Regents University9, Cornell University10, Boston Children's Hospital11, Wayne State University12
TL;DR: IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
Abstract: It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
2,367 citations
TL;DR: This guideline addresses the wide array of SSTIs that occur in this population and emphasizes the importance of clinical skills in promptly diagnosing SSTI, identifying the pathogen, and administering effective treatments in a timely fashion.
Abstract: A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.
1,856 citations
TL;DR: This research presents a novel, scalable, and scalable approaches that can be applied to the rapidly changing and rapidly changing environment of drug discovery and development.
Abstract: Fraser F. Fleming,* Lihua Yao, P. C. Ravikumar, Lee Funk, and Brian C. Shook Department of Chemistry and Biochemistry, Duquesne University, Pittsburgh, Pennsylvania 15282-1530, Mylan Pharmaceuticals Inc., 781 Chestnut Ridge Road, Morgantown, West Virginia 26505, and Johnson & Johnson Pharmaceutical Research and Development, L.L.C., Welsh and McKean Roads, P.O. Box 776, Spring House, Pennsylvania 19477
1,058 citations
TL;DR: This guideline addresses the wide array of SSTIs that occur in this population and emphasizes the importance of clinical skills in promptly diagnosing SSTI, identifying the pathogen, and administering effective treatments in a timely fashion.
Abstract: A panel of national experts was convened by the Infectious Diseases Society of America (IDSA) to update the 2005 guidelines for the treatment of skin and soft tissue infections (SSTIs). The panel's recommendations were developed to be concordant with the recently published IDSA guidelines for the treatment of methicillin-resistant Staphylococcus aureus infections. The focus of this guideline is the diagnosis and appropriate treatment of diverse SSTIs ranging from minor superficial infections to life-threatening infections such as necrotizing fasciitis. In addition, because of an increasing number of immunocompromised hosts worldwide, the guideline addresses the wide array of SSTIs that occur in this population. These guidelines emphasize the importance of clinical skills in promptly diagnosing SSTIs, identifying the pathogen, and administering effective treatments in a timely fashion.
1,041 citations