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Roberto Luzzati SC Malattie Infettive, Ospedale Maggiore

Terapia delle Micosi Invasive Trieste, PneumoTrieste 2017. Roberto Luzzati SC Malattie Infettive, Ospedale Maggiore Azienda Ospedale/Università ASUITS, Trieste. Emerg Infect Dis 2014. Emerg Infect Dis 2014. EJCMID 2017. Principali antifungini disponibili per uso clinico o in sviluppo.

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Roberto Luzzati SC Malattie Infettive, Ospedale Maggiore

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  1. Terapia delle Micosi Invasive Trieste, PneumoTrieste 2017 Roberto Luzzati SC Malattie Infettive, Ospedale Maggiore Azienda Ospedale/Università ASUITS, Trieste

  2. Emerg Infect Dis 2014

  3. Emerg Infect Dis 2014

  4. EJCMID 2017

  5. Principali antifungini disponibili per uso clinico o in sviluppo • Polieni • Amfotericina B (AMB) desossicolato (D-AMB) • AMB liposomiale (L-AMB) • AMB complessi lipidici (ABLC) • Azolici • Fluconazolo • Itraconazolo • Voriconazolo • Posaconazolo • Flucitosina • Echinocandine • Caspofungin • Anidulafungin • Micafungin • Novità approvate o in fase II/IIIa • -Isavuconazolo (Basilea) • -Posaconazolo e.v (MSD) • -echinocandina long-acting • (Cidara, US)

  6. Yeasts AMB FCZ ITZ VCZ PCZ IVZ CF MF AFCandida albicans Candida tropicalis Candida parapsilosis Candida krusei Candida glabrata* Cryptococcus neoformans Aspergillus fumigatus Mucor spp Rhizopus spp Fusarium spp Moulds ANTIFUNGAL AGENTSRange of Activity for Selected Pathogens * Strains with reduced susceptibility to azoles AMB, Amphotericin B Azole: FCZ, Fluconazole; ITZ, Itraconazole; VCZ, Voriconazole; PCZ, Posaconazole; IVZ, Isavuconazolo Echinocandin: CF, Caspofungin; MF, Micafungin; AF, Anidulafungin Adapted from JP Donnelly, by Malcolm Richardson.

  7. Pathogenesis of Invasive Candidiasis. Kullberg BJ, Arendrup MC. N Engl J Med 2015;373:1445-1456

  8. Infect Control Hosp Epid, 2016 CoNS, coagulase-negative stafilococci; CLABSI, central line associated bloodstream infection; CAUTI, catheter-associated urinary tract infection; VAP, ventilator associated pneumonia; SSI, surgical site inf.

  9. EJIM 2017

  10. EJIM 2017

  11. 21% 54% 25% Infection, 2016 2011-2013: 686 adult patients (52% males); mean age 70 + 15 yrs

  12. Table 4. Comparison of treatment and outcome according to ward admission Surgery/ICUs, surgery and intensive care units; OR, odds ratio (misure quantitative OR per unit); CI, confidence interval; NA, not available Infection, 2016

  13. Recommendations on Targeted Treatment of Candidemia and Invasive Candidiasis (ESCMID, 2012)

  14. Interaction of Aspergillus with the hostA unique microbial-host interaction Acute IA ABPA Allergic sinusitis Frequency of aspergillosis Frequency of aspergillosis CNPA Aspergilloma Immune dysfunction Immune hyperactivity . www.aspergillus.man.ac.uk www.aspergillus.man.ac.uk

  15. Clin Infect Dis 2015

  16. Clin Infect Dis 2015

  17. Lancet 2016

  18. Lancet 2016

  19. Lancet 2016 Lancet 2016

  20. Lancet 2016

  21. Lancet 2016

  22. CCPA Chronic cavitary pulmonary aspergillosis CFPA Chronic fibrosing pulmonary aspergillosis CNPA Chronic necrotizing pulmonary aspergillosis

  23. 63%

  24. Effetti Avversi al Voriconazolo (28,5%) 2 casi di EPATITE 2 casi di REAZIONE PEMFIGOIDE 2 casi di ALLUCINAZIONI SOSPENSIONE del FARMACO a 3 e 4 mesi 1 caso lievi e transitorie 1 caso grave CHIRURGIA Continua terapia POSACONAZOLO Sospensione temporanea ripresa a diverso dosaggio 150 mg x3 volte al giorno Infection 2015

  25. Clin Infect Dis 2016

  26. Clin Infect Dis 2016

  27. AAC 2016

  28. Clin Infect Dis 2016

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