The authors looked at IgE levels in 53 obital fungal granuloma patients before and after surgery to treat the granuloma. They found high levels of serum IgE prior to surgery which gradually declined post-surgery.
Results showed that IgE was a good diagnostic guide for infection and a good postoperative tool with a high (p<0.001) statistically significance.
4.9% of 12,339 cases in Japan were found to have fungal infections. Aspergillus was the most frequent causative agent among those who were infected with one pathogen. The authors concluded 'this epidemiological analysis of autopsied cases with fungal infection provides a strong incentive to intensify and improve efforts in diagnosing and treating visceral mycosis.'
Bronchial artery embolization (BAE) is an important treatment option for short-term control of hemoptysis in patients with simple aspergilloma (SA). However, there are no data on the outcomes of BAE in patients with chronic pulmonary aspergillosis (CPA).
The authors retrospectively analyzed the clinical data of 55 CPA patients and 9 SA patients. Immediate success was achieved in 64% of patients, complications were observed in 6% with clinical failure in 2%. Reoccurance of hemoptysis was more frequent in CPA patients (55%) compared with SA (33%).
Authors conclusions: BAE is a safe and effective procedure for the management of life-threatening hemoptysis in patients with CPA. However recurrence of hemoptysis is common, especially in patients with CPA. Therefore, definitive treatment for CPA following successful BAE should be considered to ensure the long-term success of the embolization in these patients.
A high-dose 12 mg/kg/day (6 mg/kg twice daily) voriconazole regimen was recommended by the CDC to treat patients injected with contaminated methylprednisolone acetate that caused a multi-state fungal outbreak in 2012-13. Therapeutic drug monitoring results of this unique regimen were unknown, as was the most appropriate dosing weight for obese patients.
Authors observations & conclusions: A high-dose voriconazole regimen produced initial supratherapeutic troughs that required dose adjustment downward by nearly 30%. Adjusted body weight dosing in obese patients resulted in a similar maintenance dose to total body weight dosing in the non-obese and appears to be a sensible dosing strategy for these patients.