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Fungal Infections in Immunocompromised Hosts 2.0
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Fungal Infections in Immunocompromised Hosts 2.0

A special issue of Journal of Fungi (ISSN 2309-608X). This special issue belongs to the section "Fungal Pathogenesis and Disease Control".

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 25706

Special Issue Editor

Dr. Marisa H. Miceli

E-Mail Website
Guest Editor
Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
Interests: infections, especially fungal infections in the immunocompromised host with special interest in invasive aspergillosis and endemic fungal infections and in stem cell and solid organ transplant recipients; the clinical application of novel technologies for diagnosis of fungal infections; clinical trials on new agents for treatment of fungal infections
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Invasive fungal infections remain a leading cause of death among immunocompromised patients. Over the last few years, there has been an increase in the number of patients receiving solid organ and stem cell transplantation, as well as novel treatments for the treatment of hematological malignancies and auto-immune diseases. One example is the development of biologic agents and small molecule kinase inhibitors (SMKIs), which have been associated to the occurrence of IFIs.

This Special Issue is designed to provide an update on the specific risks, fungal pathogenesis, clinical presentation, and management of IFIs. Special topics will include endemic infections in immunosuppressed patients, IFIs in patients receiving biological agents, as well as in those receiving SMKs. IFIs in specific populations include patients with chronic liver disease, solid organ transplant recipients, hematological cancer patients, as well as stem cell transplant recipients. In addition to covering the most common pathogens, Aspergillus species, Mucorales, and Candida infections, the emergence of rarer fungi in this special population will also be discussed. Authors are specifically chosen as experts in those subfields, who are actively researching these topics and leading the charge to improve the management of these patients.

Dr. Marisa H. Miceli
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Fungi is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

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Related Special Issue

Published Papers (7 papers)

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Research

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11 pages, 2053 KiB  
Article
Invasive Fungal Disease in Patients with Newly Diagnosed Acute Myeloid Leukemia
by Anastasia I. Wasylyshyn, Kathleen A. Linder, Carol A. Kauffman, Blair J. Richards, Stephen M. Maurer, Virginia M. Sheffield, Lydia Benitez Colon and Marisa H. Miceli
J. Fungi 2021, 7(9), 761; https://doi.org/10.3390/jof7090761 - 15 Sep 2021
Cited by 9 | Viewed by 2994
Abstract
This single-center retrospective study of invasive fungal disease (IFD) enrolled 251 adult patients undergoing induction chemotherapy for newly diagnosed acute myeloid leukemia (AML) from 2014–2019. Patients had primary AML (n = 148, 59%); antecedent myelodysplastic syndrome (n = 76, 30%), or [...] Read more.
This single-center retrospective study of invasive fungal disease (IFD) enrolled 251 adult patients undergoing induction chemotherapy for newly diagnosed acute myeloid leukemia (AML) from 2014–2019. Patients had primary AML (n = 148, 59%); antecedent myelodysplastic syndrome (n = 76, 30%), or secondary AML (n = 27, 11%). Seventy-five patients (30%) received an allogeneic hematopoietic cell transplant within the first year after induction chemotherapy. Proven/probable IFD occurred in 17 patients (7%). Twelve of the 17 (71%) were mold infections, including aspergillosis (n = 6), fusariosis (n = 3), and mucomycosis (n = 3). Eight breakthrough IFD (B-IFD), seven of which were due to molds, occurred in patients taking antifungal prophylaxis. Patients with proven/probable IFD had a significantly greater number of cumulative neutropenic days than those without an IFD, HR = 1.038 (95% CI 1.018–1.059), p = 0.0001. By cause-specific proportional hazards regression, the risk for IFD increased by 3.8% for each day of neutropenia per 100 days of follow up. Relapsed/refractory AML significantly increased the risk for IFD, HR = 7.562 (2.585–22.123), p = 0.0002, and Kaplan-Meier analysis showed significantly higher mortality at 1 year in patients who developed a proven/probable IFD, p = 0.02. IFD remains an important problem among patients with AML despite the use of antifungal prophylaxis, and development of IFD is associated with increased mortality in these patients. Full article
(This article belongs to the Special Issue Fungal Infections in Immunocompromised Hosts 2.0)
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Review

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15 pages, 338 KiB  
Review
Fungal Infections in Liver Transplant Recipients
by Michael Scolarici, Margaret Jorgenson, Christopher Saddler and Jeannina Smith
J. Fungi 2021, 7(7), 524; https://doi.org/10.3390/jof7070524 - 29 Jun 2021
Cited by 27 | Viewed by 3230
Abstract
Invasive fungal infections (IFIs) are one of the most feared complications associated with liver transplantation, with high rates of morbidity and mortality. We discuss the most common invasive fungal infections in the setting of liver transplant, including Candida, Aspergillus, and Cryptococcal [...] Read more.
Invasive fungal infections (IFIs) are one of the most feared complications associated with liver transplantation, with high rates of morbidity and mortality. We discuss the most common invasive fungal infections in the setting of liver transplant, including Candida, Aspergillus, and Cryptococcal infections, and some less frequent but devastating mold infections. Further, we evaluate the use of prophylaxis to prevent invasive fungal infection in this population as a promising mechanism to reduce risks to patients after liver transplant. Full article
(This article belongs to the Special Issue Fungal Infections in Immunocompromised Hosts 2.0)
13 pages, 405 KiB  
Review
Invasive Fungal Infections after Anti-CD19 Chimeric Antigen Receptor-Modified T-Cell Therapy: State of the Evidence and Future Directions
by Will Garner, Palash Samanta and Ghady Haidar
J. Fungi 2021, 7(2), 156; https://doi.org/10.3390/jof7020156 - 23 Feb 2021
Cited by 34 | Viewed by 3673
Abstract
Studies describing invasive fungal infections (IFIs) after chimeric antigen receptor-modified T-cell (CAR-T-cell) therapy are limited. Although post-CAR-T-cell IFIs appear to be uncommon, they are associated with significant morbidity and mortality. Specific risk factors for IFIs in CAR-T-cell recipients have not been fully characterized [...] Read more.
Studies describing invasive fungal infections (IFIs) after chimeric antigen receptor-modified T-cell (CAR-T-cell) therapy are limited. Although post-CAR-T-cell IFIs appear to be uncommon, they are associated with significant morbidity and mortality. Specific risk factors for IFIs in CAR-T-cell recipients have not been fully characterized and are often extrapolated from variables contributing to IFIs in patients with other hematologic malignancies or those undergoing hematopoietic cell transplant. Optimal prophylaxis strategies, including the use of yeast versus mold-active azoles, also remain ill-defined. Further research should investigate key risk factors for IFIs and establish an evidence-based approach to antifungal prophylaxis in these patients in order to improve clinical outcomes. Full article
(This article belongs to the Special Issue Fungal Infections in Immunocompromised Hosts 2.0)
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14 pages, 1447 KiB  
Review
Strategies for the Prevention of Invasive Fungal Infections after Lung Transplant
by Roni Bitterman, Tina Marinelli and Shahid Husain
J. Fungi 2021, 7(2), 122; https://doi.org/10.3390/jof7020122 - 7 Feb 2021
Cited by 14 | Viewed by 3592
Abstract
Long-term survival after lung transplantation is lower than that associated with other transplanted organs. Infectious complications, most importantly invasive fungal infections, have detrimental effects and are a major cause of morbidity and mortality in this population. Candida infections predominate in the early post-transplant [...] Read more.
Long-term survival after lung transplantation is lower than that associated with other transplanted organs. Infectious complications, most importantly invasive fungal infections, have detrimental effects and are a major cause of morbidity and mortality in this population. Candida infections predominate in the early post-transplant period, whereas invasive mold infections, usually those related to Aspergillus, are most common later on. This review summarizes the epidemiology and risk factors for invasive fungal diseases in lung transplant recipients, as well as the current evidence on preventive measures. These measures include universal prophylaxis, targeted prophylaxis, and preemptive treatment. Although there is consensus that a preventive strategy should be implemented, current data show no superiority of one preventive measure over another. Data are also lacking regarding the optimal antifungal regimen and the duration of treatment. As all current recommendations are based on observational, single-center, single-arm studies, it is necessary that this longstanding debate is settled with a multicenter randomized controlled trial. Full article
(This article belongs to the Special Issue Fungal Infections in Immunocompromised Hosts 2.0)
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16 pages, 500 KiB  
Review
Review of Pharmacologic Considerations in the Use of Azole Antifungals in Lung Transplant Recipients
by Megan E. Klatt and Gregory A. Eschenauer
J. Fungi 2021, 7(2), 76; https://doi.org/10.3390/jof7020076 - 22 Jan 2021
Cited by 17 | Viewed by 3832
Abstract
Mold-active azole antifungals are commonly prescribed for the prevention of invasive fungal infections in lung transplant recipients. Each agent exhibits a unique pharmacologic profile, an understanding of which is crucial for therapy selection and optimization. This article reviews pharmacologic considerations for three frequently-used [...] Read more.
Mold-active azole antifungals are commonly prescribed for the prevention of invasive fungal infections in lung transplant recipients. Each agent exhibits a unique pharmacologic profile, an understanding of which is crucial for therapy selection and optimization. This article reviews pharmacologic considerations for three frequently-used azole antifungals in lung transplant recipients: voriconazole, posaconazole, and isavuconazole. Focus is drawn to analysis of drug-interactions, adverse drug reactions, pharmacokinetic considerations, and the role of therapeutic drug monitoring with special emphasis on data from the post-lung transplant population. Full article
(This article belongs to the Special Issue Fungal Infections in Immunocompromised Hosts 2.0)
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Other

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4 pages, 231 KiB  
Case Report
First Case of Candida auris Colonization in a Preterm, Extremely Low-Birth-Weight Newborn after Vaginal Delivery
by Alessio Mesini, Carolina Saffioti, Marcello Mariani, Angelo Florio, Chiara Medici, Andrea Moscatelli and Elio Castagnola
J. Fungi 2021, 7(8), 649; https://doi.org/10.3390/jof7080649 - 10 Aug 2021
Cited by 13 | Viewed by 2743
Abstract
Candida auris is a multidrug-resistant, difficult-to-eradicate pathogen that can colonize patients and health-care environments and cause severe infections and nosocomial outbreaks, especially in intensive care units. We observed an extremely low-birth-weight (800 g), preterm neonate born from vaginal delivery from a C. auris [...] Read more.
Candida auris is a multidrug-resistant, difficult-to-eradicate pathogen that can colonize patients and health-care environments and cause severe infections and nosocomial outbreaks, especially in intensive care units. We observed an extremely low-birth-weight (800 g), preterm neonate born from vaginal delivery from a C. auris colonized mother, who was colonized by C. auris within a few hours after birth. We could not discriminate whether the colonization route was the birth canal or the intensive care unit environment. The infant died on her third day of life because of complications related to prematurity, without signs or symptoms of infections. In contexts with high rates of C.auris colonization, antifungal prophylaxis in low-birth-weight, preterm neonates with micafungin should be considered over fluconazole due to the C. auris resistance profile, at least until its presence is excluded. Full article
(This article belongs to the Special Issue Fungal Infections in Immunocompromised Hosts 2.0)
11 pages, 683 KiB  
Commentary
The Current State of Antifungal Stewardship in Immunocompromised Populations
by William Alegria and Payal K. Patel
J. Fungi 2021, 7(5), 352; https://doi.org/10.3390/jof7050352 - 30 Apr 2021
Cited by 9 | Viewed by 4181
Abstract
Inappropriate antifungal use is prevalent and can lead to drug-resistant fungi, expose patients to adverse drug events, and increase healthcare costs. While antimicrobial stewardship programs have traditionally focused on antibiotic use, the need for targeted antifungal stewardship (AFS) intervention has garnered interest in [...] Read more.
Inappropriate antifungal use is prevalent and can lead to drug-resistant fungi, expose patients to adverse drug events, and increase healthcare costs. While antimicrobial stewardship programs have traditionally focused on antibiotic use, the need for targeted antifungal stewardship (AFS) intervention has garnered interest in recent years. Despite this, data on AFS in immunocompromised patient populations is limited. This paper will review the current state of AFS in this complex population and explore opportunities for multidisciplinary collaboration. Full article
(This article belongs to the Special Issue Fungal Infections in Immunocompromised Hosts 2.0)
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