Refractory fungal infection: Three case reports highlighting good practice

Area of Science:

• Medical Mycology
• Infectious Diseases
• Clinical Microbiology

Background:

• Refractory invasive fungal disease presents a major clinical challenge with substantial morbidity, mortality, and healthcare costs.
• Complex etiologies include antifungal resistance (innate and acquired), inadequate treatment, and compromised immune responses in vulnerable patients.
• Antifungal resistance is a growing concern, necessitating improved diagnostic and therapeutic strategies.

Purpose of the Study:

• To present a case series detailing the identification and management of refractory fungal infections.
• To highlight challenges posed by azole resistance and resistant candidiasis.
• To underscore the importance of integrated approaches in managing difficult-to-treat fungal infections.

Main Methods:

• Case series reporting on three patients with refractory fungal infections.
• Inclusion of diagnostic methods such as serological markers and polymerase chain reaction (PCR).
• Emphasis on antifungal susceptibility testing and antifungal stewardship protocols.

Main Results:

• Two cases demonstrated azole resistance, while one case involved resistant candidiasis.
• Successful management strategies were implemented based on accurate diagnosis and tailored therapy.
• The series illustrates the clinical impact of emerging drug resistance in fungal pathogens.

Conclusions:

• Accurate diagnosis, including the use of biomarkers and susceptibility testing, is crucial for refractory fungal infections.
• Antifungal stewardship is essential to optimize treatment and mitigate the emergence of drug resistance.
• Integrated management strategies are vital for improving outcomes in patients with complex fungal diseases.