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  • Severe cutaneous and systemic fungal infections are frequent in profoundly immunodepressed patients, i.e., haematological malignancies and organ transplant recipients.

  • Candidiasis and aspergillosis are the most frequent, but emerging ‘new’ fungi are more and more responsible for life-threatening infections.

  • Identification of the responsible agent relies on the study of multiple biologic samples: skin, blood, etc.

  • Histological examination including special stains, culture of tissue, andantibody detection may be necessary to establish a precise diagnostic. The results may be delayed for weeks.

  • The therapeutic armentarium has been enriched with new systemic antifungal, but identification of the responsible organism is necessary to select the appropriate drug.

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References

  1. Warnock DW. Trends in the epidemiology of invasive fungal infections. Nippon Ishinkin Gakkai Zasshi. 2007;48(1):1–12

    Article  PubMed  Google Scholar 

  2. Vento S, Cainelli F. Infections in patients with cancer undergoing chemotherapy: aetiology, prevention, and treatment. Lancet Oncol. 2003;4:595–604.

    Article  PubMed  Google Scholar 

  3. Bodey GP. The emergence of fungi as major hospital pathogens. J Hosp Infect. 1988;11(suppl A):411–426

    Article  PubMed  Google Scholar 

  4. Perlroth J, Choi B, Spellberg B. Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol. 2007;45(4):321–46

    Article  PubMed  Google Scholar 

  5. Paya C V. Prevention of fungal infection in transplantation. Transpl Infect Dis. 2002;4(suppl 3):46–51

    Article  PubMed  Google Scholar 

  6. Silveira FP, Husain S. Fungal infections in solid organ transplantation. Med Mycol. 2007;45(4):305–20

    Article  PubMed  Google Scholar 

  7. Patel R, Paya C V. Infections in solid-organ transplant recipients. Clin Microbiol Rev. 1997;10:86–124.

    PubMed  CAS  Google Scholar 

  8. Hadley S, Karchmer AW. Fungal infections in solid organ transplant recipients. Infect Dis Clin North Am. 1995;9:1045–74

    PubMed  CAS  Google Scholar 

  9. Viscoli C, Girmenia C, Marinus A, et al. Candidemia in cancer patients: a prospective, multicenter surveillance study by the Invasive Fungal Infection Group (IFIG) of the European Organization for Research and Treatment of Cancer (EORTC). Clin Infect Dis. 1999;28:1071–9

    Article  PubMed  CAS  Google Scholar 

  10. Denning DW, Marinus A, Cohen J, et al. An EORTC multi-centre prospective survey of invasive aspergillosis in haematological patients: diagnosis and therapeutic outcome. EORTC Invasive Fungal Infections Cooperative group. J Infect. 1998;37:173–80

    Article  PubMed  CAS  Google Scholar 

  11. Walsh TJ, Groll AH. Emerging fungal pathogens: evolving challenges to immunocompromised patients for the twenty-first century. Transplant Infect Dis. 1999;1:247–61

    Article  CAS  Google Scholar 

  12. Groll AH, Walsh TJ. Uncommon opportunistic fungi: new nosocomial threats. Clin Microbiol Infect. 2001;7:8–24

    Article  PubMed  CAS  Google Scholar 

  13. Venkatesan P, Perfect JR, Myers SA. Evaluation and management of fungal infections in immunocompromised patients. Dermatol Ther. 2005;18(1):44–57

    Article  PubMed  Google Scholar 

  14. Lóránd T, Kocsis B. Recent advances in antifungal agents. Mini Rev Med Chem. 2007;7(9):900–11

    Article  PubMed  Google Scholar 

  15. Metcalf SC, Dockrell DH. Improved outcomes associated with advances in therapy for invasive fungal infections in immunocompromised hosts. J Infect. 2007;55(4):287–99

    Article  PubMed  CAS  Google Scholar 

  16. Singh N, Perfect JR. Immune reconstitution syndrome associated with opportunistic mycoses. Lancet Infect Dis. 2007;7(6):395–401

    Article  PubMed  Google Scholar 

  17. Morgan J. Global trends in candidemia: review of reports from 1995–2005. Curr Infect Dis Rep. 2005;7(6):429–39

    Article  PubMed  Google Scholar 

  18. Singh N. Antifungal prophylaxis in organ transplant recipients: seeking clarity amidst controversy. Clin Infect Dis. 2000;31:545–53

    Article  PubMed  CAS  Google Scholar 

  19. Morgan J, Meltzer MI, Plikaytis BD, Sofair AN, Huie-White S, Wilcox S, Harrison LH, Seaberg EC, Hajjeh RA, Teutsch SM. Excess mortality, hospital stay, and cost due to candidemia: a case-control study using data from population-based candidemia surveillance. Infect Control Hosp Epidemiol. 2005;26(6):540–7

    Article  PubMed  Google Scholar 

  20. Petrovic J, Ngai A, Bradshaw S, Williams-Diaz A, Taylor A, Sable C, Vuocolo S, Kartsonis N. Efficacy and safety of caspofungin in solid organ transplant recipients. Transplant Proc. 2007;39(10):3117–20

    Article  PubMed  CAS  Google Scholar 

  21. Aperis G, Myriounis N, Spanakis EK, Mylonakis E. Developments in the treatment of candidiasis: more choices and new challenges. Expert Opin Investig Drugs. 2006; 15(11):1319–36

    Article  PubMed  CAS  Google Scholar 

  22. Walsh TJ. Primary cutaneous aspergillosis: an emerging infection among immunocompromised patients. Clin Infect Dis. 1998;27:453–457

    Article  PubMed  CAS  Google Scholar 

  23. Segal BH, Walsh TJ. Current approaches to diagnosis and treatment of invasive aspergillosis. Am J Respir Crit Care Med. 2006;173:707–17

    Article  PubMed  CAS  Google Scholar 

  24. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al; Invasive Fungal Infections Group of the European Organisation for Research and Treatment of Cancer and the Global Aspergillus Study Group. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med. 2002;347(6):408–15

    Article  PubMed  CAS  Google Scholar 

  25. Maertens J, Raad I, Petrikkos G, Boogaerts M, Selleslag D, Petersen FB, et al. Caspofungin Salvage Aspergillosis Study Group. Efficacy and safety of caspofungin for treatment of invasive aspergillosis in patients refractory to or intolerant of conventional antifungal therapy. Clin Infect Dis. 2004; 39(11):1563–71

    PubMed  CAS  Google Scholar 

  26. Raad II, Hanna HA, Boktour M, Jiang Y, Torres H, Afif C, et al. Novel antifungal agents as salvage therapy for invasive aspergillosis in patients with hematologic malignancies: posaconazole compared with high-dose lipid formulations of amphotericin B alone or in combination with caspofungin. Leukemia. 2008;22:496–503

    Article  PubMed  CAS  Google Scholar 

  27. Saha DC, Goldman DL, Shao X, Casadevall A, Husain S, Limaye AP, Lyon M, Somani J, Pursell K, Pruett TL, Singh N. Serologic evidence for reactivation of cryptococcosis in solid-organ transplant recipients. Clin Vaccine Immunol. 2007;14(12):1550–4

    Article  PubMed  CAS  Google Scholar 

  28. Van Grieken SA, Dupont LJ, Van Raemdonck DE, Van Bleyenbergh P, Verleden GM. Primary cryptococcal cellulitis in a lung transplant recipient. J Heart Lung Transplant. 2007;26(3):285–9

    Article  PubMed  Google Scholar 

  29. Husain S, Wagener MM, Singh N. Cryptococcus neoformans infection in organ transplant recipients: variables influencing clinical characteristics and outcome. Emerg Infect Dis. 2001;7(3):375–81

    PubMed  CAS  Google Scholar 

  30. Dimino-Emme L, Gurevitch AW. Cutaneous manifestations of disseminated cryptococcosis. J Am Acad Dermatol. 1995;32:844–50

    Article  PubMed  CAS  Google Scholar 

  31. Neuville S, Dromer F, Morin O, Dupont B, Ronin O, Lortholary O; French Cryptococcosis Study Group. Primary cutaneous cryptococcosis: a distinct clinical entity. Clin Infect Dis. 2003;36(3):337–47

    Article  PubMed  Google Scholar 

  32. Hajjeh RA, Pappas PG, Henderson H, et al. Multicenter case control study of risk factors for histoplasmosis in huma immunodeficiency virus-infected persons. Clin Infect Dis. 2001;32:1215–20

    Article  PubMed  CAS  Google Scholar 

  33. Kauffman CA. Histoplasmosis: a clinical and laboratory update. Clin Microbiol Rev. 2007;20(1):115–32

    Article  PubMed  CAS  Google Scholar 

  34. Goldman M, Zackin R, Fichtenbaum CJ, Skiest DJ, Koletar SL, Hafner R, et al; AIDS Clinical Trials Group A5038 Study Group. Safety of discontinuation of maintenance therapy for disseminated histoplasmosis after immunologic response to antiretroviral therapy. Clin Infect Dis. 2004;38(10):1485–9

    Article  PubMed  Google Scholar 

  35. Duong TA. Infection due to Penicillium marneffei, an emerging pathogen: review of 155 reported cases. Clin Infect Dis. 1996;23(1):125–30

    PubMed  CAS  Google Scholar 

  36. Cristofaro P, Mileno MD. Penicillium marneffei infection in HIV-infected travelers. AIDS Alert. 2006;21(12):140–2

    PubMed  Google Scholar 

  37. Chan YH, Wong KM, Lee KC, Kwok PC, Chak WL, Choi KS, et al. Pneumonia and mesenteric lymphadenopathy caused by disseminated Penicillium marneffei infection in a cadaveric renal transplant recipient. Transpl Infect Dis. 2004;6(1):28–32

    Article  PubMed  Google Scholar 

  38. Wong SS, Wong KH, Hui WT, Lee SS, Lo JY, Cao L, Yuen KY. Differences in clinical and laboratory diagnostic characteristics of penicilliosis marneffei in human immunodeficiency virus (HIV)- and non-HIV-infected patients. J Clin Microbiol. 2001;39(12):4535–40

    Article  PubMed  CAS  Google Scholar 

  39. Ruhnke M. Mucosal and systemic fungal infections in patients with AIDS: prophylaxis and treatment. Drugs. 2004;64(11):1163–80

    Article  PubMed  CAS  Google Scholar 

  40. Roden MM, Zaoutis TE, Buchanan WL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis. 2005;41:634–653

    Article  PubMed  Google Scholar 

  41. Jimenez C, Lumbreras C, Aguado JM, et al. Successful treatment of mucor infection after liver or pancreas-kidney transplantation. Transplantation. 2002;73:476–80

    Article  PubMed  Google Scholar 

  42. Spellberg B, Edwards J Jr, Ibrahim A. Novel perspectives on mucormycosis: pathophysiology, presentation, and management. Clin Microbiol Rev. 2005;18:556–569

    Article  PubMed  CAS  Google Scholar 

  43. Greenberg RN, Scott LJ, Vaughn HH, Ribes JA. Zygomycosis (mucormycosis): emerging clinical importance and new treatments. Curr Opin Infect Dis. 2004;17:517–525

    Article  PubMed  CAS  Google Scholar 

  44. Cohen-Ludmann C, Kerob D, Feuilhade M, et al. Zygomycosis of the penis due to Rhizopus oryzae successfully treated with surgical debridement and a combination of high-dose liposomal and topical amphotericin B. Arch Dermatol. 2006;142:1657–8

    Article  PubMed  Google Scholar 

  45. Sampathkumar P, Paya CV. Fusarium infection after solid-organ transplantation. Clin Infect Dis. 2001;32(8):1237–40

    Article  PubMed  CAS  Google Scholar 

  46. Nucci M, Anaissie E. Cutaneous infection by Fusarium species in healthy and immunocompromised hosts: implications for diagnosis and management. Clin Infect Dis. 2002;35:909–20

    Article  PubMed  Google Scholar 

  47. Ho DY, Lee JD, Rosso F, Montoya JG. Treating disseminated fusariosis: amphotericin B, voriconazole or both? Mycoses. 2007;50(3):227–31

    Article  PubMed  CAS  Google Scholar 

  48. Spanakis E, Aperis G, Mylonakis E. New agents for the treatment of fungal infections: clinical efficacy and gaps in coverage. Clin Infect Dis. 2006;43:1060–1068

    Article  PubMed  CAS  Google Scholar 

  49. Espinel-Ingroff A. In vitro fungicidal activities of voriconazole, itraconazole, and amphotericin B against opportunistic moniliaceous and dematiaceous fungi. J Clin Microbiol. 2001;39:954–958

    Article  PubMed  CAS  Google Scholar 

  50. Pfaller MA, Marco F, Messer SA, Jones RN. In vitro activity of two echinocandin derivates, LY303366 and MK-0991 (L-743792), against clinical isolates of Aspergillus, Fusarium, Rhizopus, and other filamentous fungi. Diagn Microbiol Infect Dis. 1998;30:251–255

    Article  PubMed  CAS  Google Scholar 

  51. Deresinski S. Coccidioides immitis as a potential bioweapon. Semin Respir Infect. 2003;18:216–219

    PubMed  Google Scholar 

  52. DiCaudo DJ. Coccidioidomycosis: a review and update. J Am Acad Dermatol. 2006;55:929–42

    Article  PubMed  Google Scholar 

  53. Assaly RA, Hammersley JR, Olson DE, Farrouk A, Zaher A, Amurao GV, et al. Disseminated blastomycosis. J Am Acad Dermatol. 2003;48(1):123–7

    Article  PubMed  Google Scholar 

  54. Husain S, Munoz P, Forrest G, et al. Infections due to Scedosporium apiospermum and Scedosporium prolificans in transplant recipients: clinical characteristics and impact of antifungal agent therapy on outcome. Clin Infect Dis. 2005;40:89–99

    Article  PubMed  Google Scholar 

  55. Chaveiro MA, Vieira R, Cardoso J, Afonso A. Cutaneous infection due to Scedosporium apiospermum in an immunosuppressed patient. J Eur Acad Dermatol Venereol. 2003;17(1): 47–9

    Article  PubMed  CAS  Google Scholar 

  56. Pastor FJ, Guarro J. Clinical manifestations, treatment and outcome of Paecilomyces lilacinus infections. Clin Microbiol Infect. 2006;12:948–60

    Article  PubMed  CAS  Google Scholar 

  57. Espinel-Ingroff A, Chturvedi V, Fothergill A, et al. Optimal testing conditions for determining MICs and minimum fungicidal agents for uncommon moulds: NCCLS collaborative study. J Clin Microbiol. 2002;40:3776–81

    Article  PubMed  CAS  Google Scholar 

  58. Sellier P, Monsuez JJ, Lacroix C, et al. Recurrent subcutaneous infection due to Scopulariosis brevicaulis in a liver transplant recipient. Clin Infect Dis. 2000;30:820–3

    Article  PubMed  CAS  Google Scholar 

  59. Blotta MH, Mamoni RL, Oliveira SJ, Nouér SA, Papaiordanou PM, Goveia A, Camargo ZP. Endemic regions of paracoccidioidomycosis in Brazil: a clinical and epidemiologic study of 584 cases in the southeast region. Am J Trop Med Hyg. 1999;61(3):390–4

    PubMed  CAS  Google Scholar 

  60. Paniago AM, de Freitas AC, Aguiar ES, Aguiar JI, da Cunha RV, Castro AR, Wanke B. Paracoccidioidomycosis in patients with human immunodeficiency virus: review of 12 cases. J Infect. 2005;51(3):248–52

    Article  PubMed  Google Scholar 

  61. Guarro J, Gams W, Pujol I, Gene J. Acremonium species: new emerging fungal opportunistsin vitro antifungal susceptibilities and review. Clin Infect Dis. 1997;25: 1222–9

    Article  PubMed  CAS  Google Scholar 

  62. Geyer AS, Fox LP, Husain S, et al. Acremonium mycetoma in a heart transplant recipient. J Am Acad Dermatol. 2006;55: 1095–100

    Article  PubMed  Google Scholar 

  63. Herbrecht R, Letscher-Bru V, Fohrer C, et al. Acremonium strictum pulmonary infection in a leukemic patient successfully treated with posaconazole after failure of amphotericin B. Eur J Clin Microbiol Infect Dis. 2002;21(11):814–7

    Article  PubMed  CAS  Google Scholar 

  64. Saldarreaga A, Garcia Martos P, Ruiz Aragón J. Antifungal susceptibility of Acremonium species using E-test and Sensititre. Rev Esp Quimioter. 2004;17(1):44–7

    PubMed  CAS  Google Scholar 

  65. Husain S, Alexander B, Munoz P, et al. Opportunistic mycelia fungi in organ transplant recipients: emerging importance of non-Aspergillus mycelial infections. Clin Infect Dis. 2003; 37:221–9

    Article  PubMed  Google Scholar 

  66. Revankar SG. Phaeohyphomycosis. Infect Dis Clin N Am. 2006;20(3):609–20

    Article  Google Scholar 

  67. Rivard RG, McCall S, Griffith ME, Hawley JS, Ressner RA, Borra H, et al. Efficacy of caspofungin and posaconazole in a murine model of disseminated Exophiala infection. Med Mycol. 2007;18:1–5

    Google Scholar 

  68. Kauffman CA, Bustamante B, Chapman SW, Pappas PG, Infectious Diseases Society of America. Clinical practice guidelines for the management of sporotrichosis: 2007 update by the Infectious Diseases Society of America. Clin Infect Dis. 2007;45(10):1255–65

    Article  PubMed  CAS  Google Scholar 

  69. Rinaldi MG. Dermatophytosis: epidemiological and mirobiological update. J Am Acad Dermatol. 2000;43: S120–S124

    Article  PubMed  CAS  Google Scholar 

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Kerob, D., Feuillhade-de-Chauvin, M., Lebbe, C. (2009). Severe Mycoses in Immunodepressed Patients. In: Revuz, J., Roujeau, JC., Kerdel, F.A., Valeyrie-Allanore, L. (eds) Life-Threatening Dermatoses and Emergencies in Dermatology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-79339-7_14

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