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Identification and management of invasive mycoses in internal medicine: a road-map for physicians
Marco Falcone1, Ercole Concia, Ido Iori
1Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy, marcofalc@libero.it.
Abstract:
Invasive mycoses are a rising problem, not only in traditional categories of patients like hematologic or neutropenic ones, but also in elderly non-neutropenic patients admitted to internal medicine wards. Patients being admitted to medical wards are usually older, have multiple comorbidities, e.g., liver cirrhosis or chronic obstructive respiratory disease, may be malnourished or receive peripheral or total parenteral nutrition, and frequently are undergoing chronic corticosteroid therapy, chemotherapy for cancer or monoclonal antibodies for autoimmune diseases. Such risk factors may be contemporarily present in a single patient increasing the risk for the development of invasive mycoses. Diagnosis of candidemia and invasive aspergillosis is particularly difficult in patients hospitalized on medical wards, since symptoms and signs have low specificity, and most diagnostic tests have been only validated in neutropenic hematologic patients, but not in those without neutropenia. Both candidemia and invasive aspergillosis carry significant morbidity and mortality. The aim of this paper is to provide a simple guide to physicians for a prompt identification and treatment of patients with possible or suspected invasive mycoses.
Insights
Invasive mycoses, including candidemia and invasive aspergillosis, are increasing in elderly patients on internal medicine wards. This guide aids physicians in early identification and treatment of these serious fungal infections.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Mycology
Background:
- Invasive mycoses are increasingly prevalent in non-neutropenic elderly patients on internal medicine wards.
- Risk factors include advanced age, comorbidities, malnutrition, parenteral nutrition, and immunosuppressive therapies.
- Traditional diagnostic methods are often inadequate for this patient population.
Purpose of the Study:
- To provide a practical guide for physicians on the prompt identification of invasive mycoses.
- To outline strategies for the early treatment of suspected invasive fungal infections in internal medicine patients.
Main Methods:
- Review of current literature on invasive mycoses in non-neutropenic patients.
- Synthesis of diagnostic challenges and treatment considerations for internal medicine settings.
- Development of a simplified approach for clinical decision-making.
Main Results:
- Invasive fungal infections pose a significant threat with high morbidity and mortality in this demographic.
- Early recognition is hampered by non-specific symptoms and limitations of existing diagnostic tools.
- A proactive approach to diagnosis and treatment is crucial.
Conclusions:
- Prompt identification and management of invasive mycoses are essential for improving outcomes in elderly non-neutropenic patients.
- Physicians require updated guidance tailored to the complexities of internal medicine wards.
- Further research is needed to refine diagnostic and therapeutic strategies for this growing patient group.
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