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. 2018 Oct 30;67(10):1621-1630.
doi: 10.1093/cid/ciy473.

Breakthrough Invasive Mold Infections in the Hematology Patient: Current Concepts and Future Directions

Michail S Lionakis  1 , Russell E Lewis  2 , Dimitrios P Kontoyiannis  3
Affiliations

Breakthrough Invasive Mold Infections in the Hematology Patient: Current Concepts and Future Directions

Michail S Lionakis et al. Clin Infect Dis. .

Abstract

Although the widespread use of mold-active agents (especially the new generation of triazoles) has resulted in reductions of documented invasive mold infections (IMIs) in patients with hematological malignancies and allogeneic hematopoietic stem cell transplantation (HSCT), a subset of such patients still develop breakthrough IMIs (bIMIs). There are no data from prospective randomized clinical trials to guide therapeutic decisions in the different scenarios of bIMIs. In this viewpoint, we present the current status of our understanding of the clinical, diagnostic, and treatment challenges of bIMIs in high-risk adult patients with hematological cancer and/or HSCT receiving mold-active antifungals and outline common clinical scenarios. As a rule, managing bIMIs demands an individualized treatment plan that takes into account the host, including comorbidities, certainty of diagnosis and site of bIMIs, local epidemiology, considerations for fungal resistance, and antifungal pharmacological properties. Finally, we highlight areas that require future investigation in this complex area of clinical mycology.

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Figures

Figure 1.
Figure 1.
Flowchart for assessment and management of breakthrough invasive mold infections in patients receiving mold-active antifungal agents. Abbreviations: bIMI, breakthrough invasive mold infection; L-AMB, liposomal formulation of AMB.
Figure 2.
Figure 2.
Limited specificity of chest CT imaging findings for invasive mold disease. Images are courtesty of Claudia Sassi, MD, Department of Radiology, S. Orsola-Malpighi Hospital, University of Bologna, Italy. Abbreviation: CT, computed tomography.
See this image and copyright information in PMC

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