ESCMID and ECMM joint clinical guidelines for the diagnosis and management of systemic phaeohyphomycosis: Diseases caused by black fungi

A. Chowdhary, J. F. Meis, J. Guarro, G. S. de Hoog, S. Kathuria, M. C. Arendrup, S. Arikan-Akdagli, M. Akova, T. Boekhout, M. Caira, J. Guinea, A. Chakrabarti, E. Dannaoui, A. van Diepeningen, T. Freiberger, A. H. Groll, W. W. Hope, E. Johnson, M. Lackner, K. LagrouF. Lanternier, C. Lass-Flörl, O. Lortholary, J. Meletiadis, P. Muñoz, L. Pagano, G. Petrikkos, M. D. Richardson, E. Roilides, A. Skiada, A. M. Tortorano, A. J. Ullmann, P. E. Verweij, O. A. Cornely, M. Cuenca-Estrella*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

201 Citations (Scopus)

Abstract

The aetiological agents of many invasive fungal infections are saprobes and opportunistic pathogens. Some of these fungi are darkly pigmented due to melanin production and traditionally have been named 'dematiaceous'. The melanized fungi cause a wide array of clinical syndromes ranging from superficial to deep-seated infections. Diagnosis relies on histopathological examination of clinical specimens and on examination of cultures. Sequencing is recommended for accurate species identification, especially for unusual or newly described pathogens. In cases of mycetoma and chromoblastomycosis, pathognomonic histological findings are useful and the Fontana-Masson stain, specific for melanin, usually confirms the diagnosis. There are no standardized therapies but voriconazole, posaconazole and itraconazole demonstrate the most consistent in vitro activity against this group of fungi. Oral itraconazole has been considered the drug of choice, given the extensive clinical experience with this drug. However, voriconazole may presumably be superior for central nervous system infections because of its ability to achieve good levels in the cerebrospinal fluid. Posaconazole is a well-tolerated alternative drug, backed by less clinical experience but with excellent salvage treatment results after failure of other antifungals. Amphotericin B has been useful as alternative therapy in some cases. Combination antifungal therapy is recommended for cerebral abscesses when surgery is not possible and for disseminated infections in immunocompromised patients.

Original languageEnglish
Pages (from-to)47-75
Number of pages29
JournalClinical Microbiology and Infection
Volume20
Issue numberS3
DOIs
Publication statusPublished - 2014

Bibliographical note

Funding Information:
AnC has no conflicts of interest to declare. JaM has received research grants from Astellas, Merck and MSD, is a consultant to Astellas, Basilea, Merck and MSD, received travel support from Astellas, and received lecture honoraria from Merck. JoG has no conflicts of interest to declare. SdH has no conflicts of interest to declare. SK has no conflicts of interest to declare. MCA has received research grants from Astellas, Gilead, Merck/Schering and Pfizer, is a consultant to Merck, Gilead, Pfizer, received travel support from Astellas, Merck/Schering and Pfizer and received lecture honoraria from Astellas, Gilead, Merck/Schering, and Pfizer. SAA has received research grants from Pfizer, is a consultant to Pfizer, and received lecture honoraria from Merck, and Pfizer. MA has received research grants from Gilead, Merck and Pfizer, is a consultant to Gilead, Merck and Pfizer, has received travel support from Merck, Gilead, and Pfizer, and received lecture honoraria from Gilead, Merck, and Pfizer. TB has received royalties from Elsevier. MoC has no conflicts of interest to declare. JeG has received research grants from Basilea, BioMerieux, Astellas, Pfizer, Fundacion Mutua Madrilena, Fondo de Investigacion Sanitaria (FIS), and received lecture honoraria from Astellas, Pfizer, Gilead, MSD, and Hickma Pharma. ArC has no conflict of interest to declare. ED has received research grants from BioRad, Gilead and Pfizer, is a consultant to Astellas and Innothera, received travel support from Merck/Schering, Astellas and Gilead, and received lecture honoraria from Gilead and Merck/Schering. AvD has no conflict of interest to declare. TF is a consultant to Hutman AG. AHG has received research grants from Gilead and Merck Sharp & Dohme, is a consultant to Astellas, Gilead, Merck Sharp & Dohme and Schering-Plough, and received lecture honoraria from Astellas, Gilead, Merck Sharp & Dohme, Schering-Plough, and Zeneus/Cephalon. WH has received research grants from Pfizer, Astellas, Gilead and F2G, is a consultant to Pfizer, Astellas, Gilead and F2G, and received lecture honoraria from Astellas, Gilead, Merck/Schering, and Pfizer. EJ is a consultant to Astellas, Gilead, Merck/Schering and Pfizer, received travel support from Astellas, Merck/Schering and Pfizer, received payment for development of educational presentations from Astellas, Merck/Schering and Pfizer, and received lecture honoraria from Astellas, Gilead, Merck/Schering, and Pfizer. ML has no conflicts of interest to declare. KL has received research grants from Gilead, MSD and Pfizer, has given expert testimony for Merck/Schering and Pfizer, is a consultant to Gilead, Merck/Schering and Pfizer, received travel support from MSD, Pfizer and Gilead and received lecture honoraria from Gilead, Merck/Schering, and Pfizer. FL has received research grants from Gilead, received travel support from Gilead, MSD and Schering, and received lecture honoraria from Gilead. CLF has received research grants from Astellas, Gilead, Pfizer, Schering-Plough and MSD, is a consultant to Gilead, MSD, Pfizer and Schering-Plough, received payment for development of educational presentations from Pfizer, received travel support from Gilead, MSD, Pfizer, Astellas and Schering-Plough, and received lecture honoraria from Astellas, Gilead, Merck/Schering, and Pfizer. OL is a consultant to Astellas and Gilead, and received lecture honoraria from Astellas, Gilead, Merck/Schering, and Pfizer. JoM has received research grants from Gilead, Merck/Schering and Pfizer, and received lecture honoraria from Gilead, Pfizer, and Liofilchem. PM is a consultant to Astellas, Gilead, Merck/Schering and Pfizer, received payment for development of educational presentations from Merck, and received lecture honoraria from Astellas, Gilead, Merck/Schering, and Pfizer. LP is a board member of Gilead and Merck is a consultant to Gilead, Merck and Pfizer, and received lecture honoraria from Astellas, Gilead, Merck, and Pfizer. GP has received research grants from Pfizer, Gilead, AstraZeneca, Novartis, Astellas, GSK, is a consultant to MSD, received travel support from Gilead, Astellas and Pfizer and received lecture honoraria from MSD, and Astellas. MR has received payment for development of educational presentations from Pfizer, received royalties from Blackwell Publishing, received travel support from Astellas, is a consultant to Gilead and MSD, and received lecture honoraria from Astellas, and Pfizer. ER has received research grants from Enzon, Gilead, Pfizer and Schering, is a consultant to Astellas, Gilead, Merck, Pfizer and Schering, and received lecture honoraria from Astellas, Aventis, Cephalon, Gilead, Merck, Pfizer, Schering, and Wyeth. AS has received travel support from Merck, Gilead, Astellas, and Pfizer. AT has received research grants from Astellas and MSD, and received lecture honoraria from Astellas, Gilead, and MSD. AJU has received research grants from Astellas, Gilead, Merck/Schering and Pfizer, is a consultant to Astellas, Basilea, Gilead, Merck/Schering and Pfizer, received payment for development of educational presentations from Gilead, and received lecture honoraria from Astellas, Gilead, Merck/Schering, and Pfizer. PV has received research grants from Astellas, Gilead, Merck/Schering and Pfizer, is a consultant to Astellas, Gilead, Merck and Pfizer, received payment for development of educational presentations from Merck and Pfizer, and received lecture honoraria from Astellas, Gilead, Merck/Schering, and Pfizer. OAC is supported by the German Federal Ministry of Research and Education (BMBF 01KN1106), has received research grants from 3M, Actelion, Astellas, Basilea, Bayer, Celgene, Cubist, F2G, Genzyme, Gilead, GSK, Merck/MSD, Miltenyi, Optimer, Pfizer, Quintiles, and Viropharma, is a consultant to 3M, Astellas, Basilea, Cubist, F2G, Gilead, GSK, Merck/MSD, Optimer, Pfizer and Sanofi Pasteur, and received lecture honoraria from Astellas, Gilead, Merck/MSD, and Pfizer. MCE has received research grants from MSD, Astellas, Pfizer, Gilead and Ferrer, is a consultant to MSD, Astellas, Pfizer, Gilead and Ferrer, has provided expert testimony for MSD, Astellas, Pfizer, Gilead and Ferrer and received lecture honoraria from MSD, Astellas, Pfizer, Gilead, and Ferrer.

Keywords

  • Clinical presentation
  • Diagnosis
  • Guideline
  • Mycosis
  • Phaeohyphomycosis
  • Prophylaxis
  • Treatment

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