Neonatal cutaneous fungal infections

Smolinski, Kara N.; Shah, Samir S.; Honig, Paul J.; Yan, Albert C.

doi:10.1097/01.mop.0000171320.91677.55

Cited by 60 publications

(46 citation statements)

References 37 publications

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“…Itraconazole infusion appeared to be well tolerated in this population with a single adverse event (stinging at the site of infusion) deemed to be related to study drug administration. Based on the findings of this investigation, it appears that intravenous itraconazole can be administered to infants beyond 6 months, children, and adolescents using a weight-normalized approach to dosing.With both traditional and emerging fungal pathogens contributing to an increasing rate of morbidity, invasive mycoses remain a serious and potentially fatal complication for immunocompromised children (1,16,23,26,27,31). In recent years, a growing number of new therapeutic agents have found their way to market (28).…”

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confidence: 99%

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Single-Dose Pharmacokinetics of Intravenous Itraconazole and Hydroxypropyl-β-Cyclodextrin in Infants, Children, and Adolescents

Abdel‐Rahman

Jacobs

Massarella

et al. 2007

Antimicrob Agents Chemother

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This investigation was designed to evaluate the single-dose pharmacokinetics of itraconazole, hydroxyitraconazole, and hydroxypropyl-␤-cyclodextrin (HP-␤-CD) after intravenous administration to children at risk for fungal infection. Thirty-three children aged 7 months to 17 years received a single dose of itraconazole (2.5 mg/kg in 0.1-g/kg HP-␤-CD) administered over 1 h by intravenous infusion. Plasma samples for the determination of the analytes of interest were drawn over 120 h and analyzed by high-pressure liquid chromatography, and the pharmacokinetics were determined by traditional noncompartmental analysis. Consistent with the role of CYP3A4 in the biotransformation of itraconazole, a substantial degree of variability was observed in the pharmacokinetics of this drug after IV administration. The maximum plasma concentrations (C max ) for itraconazole, hydroxyitraconazole, and HP-␤-CD averaged 1,015 ؎ 692 ng/ml, 293 ؎ 133 ng/ml, and 329 ؎ 200 g/ml, respectively. The total body exposures (area under the concentration-time curve from 0 to 24 h) for itraconazole, hydroxyitraconazole, and HP-␤-CD averaged 4,922 ؎ 6,784 ng ⅐ h/ml, 3,811 ؎ 2,794 ng ⅐ h/ml, and 641.5 ؎ 265.0 g ⅐ h/ml, respectively, with no significant age dependence observed among the children evaluated. Similarly, there was no relationship between age and total body clearance (702.8 ؎ 499.4 ml/h/kg); however, weak associations between age and the itraconazole distribution volume (r 2 ‫؍‬ 0.18, P ‫؍‬ 0.02), C max (r 2 ‫؍‬ 0.14, P ‫؍‬ 0.045), and terminal elimination rate (r 2 ‫؍‬ 0.26, P < 0.01) were noted. Itraconazole infusion appeared to be well tolerated in this population with a single adverse event (stinging at the site of infusion) deemed to be related to study drug administration. Based on the findings of this investigation, it appears that intravenous itraconazole can be administered to infants beyond 6 months, children, and adolescents using a weight-normalized approach to dosing.With both traditional and emerging fungal pathogens contributing to an increasing rate of morbidity, invasive mycoses remain a serious and potentially fatal complication for immunocompromised children (1,16,23,26,27,31). In recent years, a growing number of new therapeutic agents have found their way to market (28). However, the management of systemic fungal infections is still restricted to a relatively small number of drug classes encompassing a limited number of pharmacologic actions (i.e., most are cell wall-acting agents). As such, the spectrum of activity and established efficacy, in combination with the pharmacokinetic and toxicity profiles of each agent, will shape their role in therapy.Itraconazole is a first-generation synthetic triazole antifungal that has been in clinical use for nearly two decades. Although fungistatic against pathogenic yeast, itraconazole retains activity against a portion of fluconazole-resistant isolates and demonstrates fungicidal activity against a number of filamentous organisms that cause severe invasive disease (25). Compa...

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mentioning

confidence: 99%

“…With both traditional and emerging fungal pathogens contributing to an increasing rate of morbidity, invasive mycoses remain a serious and potentially fatal complication for immunocompromised children (1,16,23,26,27,31). In recent years, a growing number of new therapeutic agents have found their way to market (28).…”

mentioning

confidence: 99%

Single-Dose Pharmacokinetics of Intravenous Itraconazole and Hydroxypropyl-β-Cyclodextrin in Infants, Children, and Adolescents

Abdel‐Rahman

Jacobs

Massarella

et al. 2007

Antimicrob Agents Chemother

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“…The maturation (i.e., keratinization) of fetal skin is functionally incomplete at birth and continues over the first few weeks of life [11]. Thus, all neonates are at an increased risk for cutaneous infections that may present as pustules, blisters and/or erosions.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Pitfalls in Newborns and Babies with Blisters and Erosions

Nischler

Klausegger

Hüttner

et al. 2009

Dermatology Research and Practice

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Establishing the correct diagnosis in newborns presenting with blisters and erosions is not always a straightforward process. Many different disease entities including acquired (i.e., infectious, immunobullous, traumatic) and inherited disorders have to be taken into consideration. Similarities in clinical appearance, colonization and/or superinfections of preexisting skin lesions, as well as the absence of late changes in the neonate often pose significant diagnostic challenges. In this paper we discuss by giving examples the process of making an accurate diagnosis of blistering skin diseases in the neonatal period on the basis of a diagnostic algorithm. In addition, we provide an overview of the rational use and the limitations of laboratory procedures such as microbial testing, routine light microscopy, immunofluorescence antigen mapping, transmission electron microscopy, and molecular genetic analysis.

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“…Aspergillosis is the second-most frequent opportunistic infection, surpassed only by candidiasis (1, 3, 4). There are more than 1,000 species of Aspergillus , but A. fumigatus is the most common cause of colonization and invasive aspergillosis (2, 3).…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, this is the first report of flap reconstruction of cutaneous aspergillosis. Therefore, we report our clinical experience with a review of the relevant literature (1, 4). …”

Section: Introductionmentioning

confidence: 99%

Free Flap Coverage of Extensive Soft Tissue Defect in Cutaneous Aspergillosis: A Case Report

et al. 2008

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Isolated fungal soft-tissue infections are uncommon, but may cause severe morbidity or mortality. Aspergillosis infection is rare, but the frequency in increasing over the last two decades. Here, we present a patient with cutaneous aspergillosis of his right elbow with unusual clinical and radiological features suggestive of a malignant disease, which remained undiagnosed for an extended period of time. The patient presented with necrotic, black-colored skin ulcerations. We completely removed the skin ulcer with the surrounding erythematous skin lesion, and then we reconstructed the area with thoracodorsal perforator free flap. The biopsy specimen contained septate hyphae with dichotomous branching, which is morphologically consistent with a finding of Aspergillus. After surgery, we initiated antifungal medication therapy with amphotericin B and itraconazole. At the time of follow-up, the elbow with the reconstructed flap had fully healed, and no recurrent disease was found.

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Neonatal cutaneous fungal infections

Cited by 60 publications

References 37 publications

Single-Dose Pharmacokinetics of Intravenous Itraconazole and Hydroxypropyl-β-Cyclodextrin in Infants, Children, and Adolescents

Single-Dose Pharmacokinetics of Intravenous Itraconazole and Hydroxypropyl-β-Cyclodextrin in Infants, Children, and Adolescents

Diagnostic Pitfalls in Newborns and Babies with Blisters and Erosions

Free Flap Coverage of Extensive Soft Tissue Defect in Cutaneous Aspergillosis: A Case Report

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