An Official American Thoracic Society Statement: Treatment of Fungal Infections in Adult Pulmonary and Critical Care Patients
An Official American Thoracic Society Statement: Treatment of Fungal Infections in Adult Pulmonary and Critical Care Patients
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DOI：
10.1164/rccm.2008-740st
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发表时间：
2011-01-01
影响因子：
24.7
通讯作者：
Stevens, David A.
中科院分区：
文献类型：
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作者：
Limper, Andrew H.;Knox, Kenneth S.;Stevens, David A.
随着越来越多的免疫功能低下的恶性肿瘤患者，血液病，艾滋病毒，以及那些接受免疫抑制药物治疗的器官移植或自身免疫性炎症条件的管理，真菌感染的发病率显着增加，近年来。肺部真菌感染的连续性诊断也得到了较新诊断方法和技术的发展的极大帮助，包括使用抗原检测、聚合酶链反应、血清学、计算机断层扫描和正电子发射断层扫描、支气管镜检查、纵隔镜检查和视频辅助胸腔镜活检。与此同时，新的治疗方式的引入大大拓宽了治疗这些疾病的医生的选择。虽然传统的抗真菌治疗仅限于使用阿替霉素B、氟胞嘧啶和少数临床可用的唑类药物，但目前的药理学。治疗选择包括具有延长的抗真菌活性的有效的新唑类化合物、脂质形式的阿替霉素B和更新的抗真菌药物，包括棘白菌素。鉴于肺部真菌感染的治疗方法不断变化，美国胸科学会召集了一个真菌感染专家工作组，制定了一份简明的临床声明，说明与肺部和重症监护实践特别相关的真菌感染的当前治疗方案。本文件重点关注三个主要领域：地方性真菌病，包括组织胞浆菌病、孢子虫病、芽生菌病和球孢子菌病;免疫功能低下和危重患者特别关注的真菌感染，包括隐球菌病、曲霉病、念珠菌病和肺孢子虫肺炎;以及罕见和新发真菌感染。
With increasing numbers of immune-compromised patients with malignancy, hematologic disease, and HIV, as well as those receiving immunosupressive drug regimens for the management of organ transplantation or autoimmune inflammatory conditions, the incidence of fungal infections has dramatically increased over recent years. Definitive diagnosis of pulmonary fungal infections has also been substantially assisted by the development of newer diagnostic methods and techniques, including the use of antigen detection, polymerase chain reaction, serologies, computed tomography and positron emission tomography scans, bronchoscopy, mediastinoscopy, and video-assisted thorascopic biopsy. At the same time, the introduction of new treatment modalities has significantly broadened options available to physicians who treat these conditions. While traditionally antifungal therapy was limited to the use of amphotericin B, flucytosine, and a handful of clinically available azole agents, current pharmacologic. treatment options include potent new azole compounds with extended antifungal activity, lipid forms of amphotericin B, and newer antifungal drugs, including the echinocandins. In view of the changing treatment of pulmonary fungal infections, the American Thoracic Society convened a working group of experts in fungal infections to develop a concise clinical statement of current therapeutic options for those fungal infections of particular relevance to pulmonary and critical care practice. This document focuses on three primary areas of concern: the endemic mycoses, including histoplasmosis, sporotrichosis, blastomycosis, and coccidioidomycosis; fungal infections of special concern for immune-compromised and critically ill patients, including cryptococcosis, aspergillosis, candidiasis, and Pneumocystis pneumonia; and rare and emerging fungal infections.