Control

Due to the rarity of the disease, no official guidelines exist for the management of human adiaspiromycosis. Many mild infections are asymptomatic or self-limiting and spontaneously resolve.

Patients reportedly receive antifungal treatment even for relatively mild disease (Anstead et al. 2012) and the benefits of therapy may be anecdotal. Only one study of in vitro antifungal susceptibilities of E. crescens exists, with only a single isolate reported (Borman et al. 2009). In vitro, both the adiaspore and mycelial forms of A. crescens appeared susceptible to several conventional antifungal agents, including amphotericin B, itraconazole, voriconazole and caspofungin; there were no discernible differences in susceptibility between the two growth forms (Borman et al. 2009). Similarly, low MICs have been reported for these antifungals with many of the other members of the Ajellomycetaceae, including Blastomyces and Histoplasma spp. (Li et al. 2000). Clinical improvement has been reported in patients treated with itraconazole (de Almeida Barbosa et al. 1997; Dot et al. 2009; Anstead et al. 2012), ketoconazole (Severo et al. 1989; Martins et al. 1997; Santos et al. 2000), voriconazole (Denson et al. 2009) and amphotericin B (Nuorva et al. 1997; Anstead et al. 2012), although in the absence of controls, whether antifungals contributed to recovery is unknown. Since adiaspores are non-replicative structures and pulmonary damage results primarily from the host immune response, some investigators have advocated for the use of corticosteroids, either in combination with antifungals (Anstead et al. 2012; de Almeida Barbosa et al. 1997) or alone (Silva et al. 2010). In severe human disease, a multipronged approach that includes an antifungal agent and corticosteroids to kill the organism and dampen the host inflammatory response that it provokes, respectively, seems reasonable.

Treatment of emergomycosis should follow guidelines for the management of other endemic mycoses in immunocompromised hosts such as progressive disseminated histoplasmosis (Wheat et al. 2007). This should consist of amphotericin B for 10-14 days, followed by itraconazole for a year or longer, pending immune reconstitution.

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Source: Seyedmousavi S. et al. (eds). Emerging and Epizootic Fungal Infections in Animals. Springer International Publishing,2018. - 406 p. 2018

Control

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