Dying with or Because of Invasive Fungal Infection? The Role of Immunity Exhaustion on Patient Outcome

Cortegiani, Andrea; Russotto, Vincenzo; Raineri, Santi Maurizio; Gregoretti, Cesare

doi:10.5152/tjar.2016.0013

Cited by 8 publications

(5 citation statements)

References 14 publications

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“…Another interesting aspect would be the impact of CRRT in the trend of PCT values in these patients, since almost all the included studies reported the values at the beginning of the diagnostic process [1]. However, the pathophysiology of the immune response and inflammatory response seems to be different in patients with candidemia, with signs of immune cell exhaustion, suppressive immunophenotype of T cells, and concomitant downregulation of positive co-stimulatory molecules [7][8][9]. These findings may be considered the main potential mechanisms for the different PCT level at the moment of the diagnostic process even in the ICU patients.…”

Section: Andrea Cortegiani Mariachiara Ippolito and Antonino Giarratanomentioning

confidence: 99%

Biomarkers to delineate bacteremia from candidemia remain a challenging issue

et al. 2020

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Section: Andrea Cortegiani Mariachiara Ippolito and Antonino Giarratanomentioning

confidence: 99%

Biomarkers to delineate bacteremia from candidemia remain a challenging issue

et al. 2020

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“…The majority of invasive fungal infections occur in immunocompromised hosts, such as those with advanced HIV disease, neutropaenia, haematological and solid organ transplant and chronic respiratory diseases 4,50,51 . A key determinant of outcome from infection is whether or not the host immune response can be reconstituted during antifungal therapy, either by treating the underlying disease, modification of immunosuppressant therapies or through immunotherapeutic approaches 52,53 . A key principle is to direct the immunotherapy according to the particular immune defect that is thought to be leading to susceptibility to fungal infection 53 .…”

Section: Current and Emerging Immunotherapeutic Options For Fungal Di...mentioning

confidence: 99%

“… 4 , 50 , 51 A key determinant of outcome from infection is whether or not the host immune response can be reconstituted during antifungal therapy, either by treating the underlying disease, modification of immunosuppressant therapies or through immunotherapeutic approaches. 52 , 53 A key principle is to direct the immunotherapy according to the particular immune defect that is thought to be leading to susceptibility to fungal infection. 53 Therefore, the development of better clinical immunological assays to define fungal immunotherapies in our at‐risk patient groups is a key priority.…”

Section: Current and Emerging Immunotherapeutic Options For Fungal Di...mentioning

confidence: 99%

Antifungal chemotherapies and immunotherapies for the future

Armstrong‐James

2022

Parasite Immunology

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Human fungal pathogens cause a broad plethora of infections, spanning cutaneous dermatophytoses to invasive infections in immunocompromised hosts. As eukaryotic pathogens are capable of morphotype switching, they present unique challenges both for drug development and the immunological response. Whilst current antifungal therapies are limited to the orally available triazoles, intravenous echonocandins and polyenes, and flucytosine and terbinafine, there has been recent significant progress in the antifungal armamentorium with ibrexafungerp, a novel orally available terpanoid that inhibits 1,3‐beta‐D‐glucan‐approved by Food and Drug Administration in 2021, and fosmanogepix, an orally available pro‐drug of manogepix, which targets glycosylphosphatidylinositol‐anchored protein maturation entering Phase 3 studies for candidaemia. A number of further candidates are in development. There has been significant use of existing immunotherapies such as recombinant interferon‐γ and G‐CSF for fungal disease in immunocompromised patients, and there are emerging opportunities for monoclonal antibodies targeting TH2 inflammation. Omalizumab, an anti‐IgE monoclonal antibody in asthma, is now used routinely for the treatment of allergic bronchopulmonary aspergillosis, and further agents targeting IL‐4 and IL‐5 are being evaluated. In addition, T‐cell CAR therapy is showing early promise for fungal disease. Thus, we are likely to see rapid advances to our approach to the management of fungal disease in the near future.

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“…An effective pharmacological intervention, which aims at eradicating fungi from deep body sites, may not be adequate for reverting the patients' outcomes (27,28). Moreover, the positive results from early RCTs may be attributed to the 'small trial effect' and potentially biased by the low methodological quality and/or low sample size.…”

Section: Paradoxical Evidencementioning

confidence: 99%

What Is the Most Recent Evidence on the Prevention and Early Treatment of Invasive Fungal Infections in Nonneutropenic Critically Ill Patients?

Cortegiani

Russotto

Iozzo

et al. 2017

Arch Clin Infect Dis

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Invasive fungal infections (IFIs) are associated with high morbidity and mortality in intensive care units. Candida species are the most important fungal pathogens and among the most frequent causes of infection in critically ill patients. Studies have evaluated the correlation between the onset of antifungal treatment and survival. However, definitive diagnosis of IFI is time-consuming in clinical practice. Antifungal prophylaxis and preemptive or empirical treatments are among therapeutic strategies to prevent or treat early fungal infections in selected patients. Recently, new evidence from randomized controlled trials and systematic reviews has been published. Moreover, new clinical practice guidelines from international communities are available. The aim of this review was to present updated evidence on this topic.

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Dying with or Because of Invasive Fungal Infection? The Role of Immunity Exhaustion on Patient Outcome

Cited by 8 publications

References 14 publications

Biomarkers to delineate bacteremia from candidemia remain a challenging issue

Biomarkers to delineate bacteremia from candidemia remain a challenging issue

Antifungal chemotherapies and immunotherapies for the future

What Is the Most Recent Evidence on the Prevention and Early Treatment of Invasive Fungal Infections in Nonneutropenic Critically Ill Patients?

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