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Fungal pathogens in cancer patients

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Other Yeasts Trichosporon species, Blastoschizomyces species ... Nosocomial ICU Bloodstream Infections in US (1995-2002) 25.7 (13.8) 34.4 (18.9) 47.1 (29) ... – PowerPoint PPT presentation

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Title: Fungal pathogens in cancer patients


1
Fungal pathogens in cancer patients
  • Opportunistic yeasts
  • Candida spp. C. albicans, non-albicans Candida
    spp.
  • Cryptococcus C. neoformans
  • Other Yeasts Trichosporon species,
    Blastoschizomyces species
  • Opportunistic molds (hyalohyphomycetes)
  • Aspergillus spp. A. fumigatus, A. terreus, A.
    flavus, A. niger, others
  • Fusarium spp. F. solani, F. oxysporum, and
    others
  • Zygomycetes Rhizopus spp., Mucor, Absidia
  • Dematiaceous molds (phaeohyphomycetes)
  • Pseudallescheria boydii,
    Bipolaris, Scedosporum,
  • Alternaria and other
    rare pathogens
  • Endemic dimorphic molds
  • Histoplasma capsulatum,
    Coccidioides immitis
  • Blastomyces
    dermatitidis, Penicillium marneffei

2
Nosocomial ICU Bloodstream Infections in US
(1995-2002)
Wisplinghoff et al CID 200439309
3
Primary Prophylaxis
Colonized (Pre-emptive)
Therapy Induction Maintenance
Symptoms (Empiric)
Secondary Prophylaxis
4
Empirical antifungal therapy in the ICU?
  • In the febrile non-neutropenic patient?
  • - Early treatment is theoretically beneficial
  • IDSA guidelines 2000
  • - Appropriate use has not been defined
  • Here is the Albrecht Rule
  • - Days in critical care (days x number of
    antibiotics)
  • number of risk factors (GI, TPN, steroids,
    lines) gt 25
  • especially if colonized gt think (and treat)
    fungus
  • Apropos colonization
  • - Anywhere works for me
  • - The more sites with fungus the higher the risk
  • (Pittet Ann Surg 94)

5
Fungus Food
  • Anything organic (contains the element carbon)
  • Cardboard
  • Wallpaper glue
  • Soap and body oil
  • Carpet fibers

6
aspergillus from hospital water sites
Warris et al J Hosp Inf 2001 47 143
Anaissee et al Clin Infect Dis 2002 43 780
7
Health Effects of Mold
  • Molds produce three major health effects
  • infection
  • allergic reactions
  • toxicity
  • Many physicians do not believe that the levels of
    mold found in indoor environments can adversely
    effect human health (dose versus response)

8
Guidelines
  • Healthcare Infection Control Practices Advisory
    Committee (HICPAC)
  • Guideline for Preventing Healthcare-Associated
    Pneumonia 2004 CDC
  • Guideline for Environmental Infection Control in
    Health-Care Facilities, 2003 CDC
  • Air Handling Systems
  • Airborne Infectious Isolation (AII) Rooms
  • Protective Environments (PE)
  • Construction, Renovation, Remediation, Repair
    Demolition

9
(No Transcript)
10
Fungi Control
  • You can clean without disinfecting
  • You can NOT disinfect without cleaning

11
Fungicides/Fungistats
  • Sodium Hypochlorite (Bleach)
  • Phenols
  • Quaternary Ammonium Compounds
  • Acids
  • Copper-8-Quinolinate

12
Mold Abatement
  • Address the source of the water incursion before
    beginning clean up of mold
  • Porous surfaces very difficult to clean
  • Removal often the only option for ceiling tiles,
    drywall, carpeting
  • Soap and water is usually sufficient, except for
    sewage incursion, which requires disinfection

13
Large Scale Abatement
  • Abatement of large areas of mold damage requires
    many of the same work practices used for asbestos
    (area isolation, wet cleaning methods,
    directional air flow with HEPA filtration)

14
Infection Control IssuesDuring Construction
  • Relocate high-risk patients, issue
    high-efficiency masks
  • Decrease high-risk admissions
  • Close patient room and unit doors
  • Damp-mop or HEPA-vacuum vicinity
  • Check air filters regularly
  • Monitor air quality

15
Post-Construction Phase
  • Thoroughly clean renovated patient areas
  • Pay special attention to air ducts
  • Obtain cultures, particle counts
  • Verify integrity of ventilation system

16
Final Points to Remember
  • Understand risks for construction projects
  • Educate contractor, workers in infection control
  • Monitor compliance to IC procedures

17
Antifungal Therapy
  • Fungi are
  • Eukaryotes
  • Usually haploid organisms

18
Bug
Drug
Higher inocculum More heteroresistance ?
Drug/target ratio Delayed diagnosis
Infarction Drug delivery ? Penetration Bioavailabi
lity
Steroids Neutropenia Congenital
Immunedeficiency HIV/AIDS Transplant
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