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Epidemiology of fungal infections: What, where, and when
Published in Mahmoud A. Ghannoum, John R. Perfect, Antifungal Therapy, 2019
Frederic Lamoth, Sylvia F. Costa, Barbara D. Alexander
Purpureocillium lilacinum has been isolated from many sites of infection. In a large study from Spain, 119 cases were reported from 1964 to 2004 [105]. Most cases of P. lilacinum were onychomycosis (51.3%) followed by cutaneous and subcutaneous infection (35.3%). For cutaneous infections, risk factors included SOT, HSCT, surgery, primary immunodeficiency, and AIDS. Lesions presented as painful red nodules that sometimes progressed to excoriated nodules and draining pustules. Severe onychomycosis, as with Fusarium spp., may constitute a risk factor for invasive disease since the toenail may serve as a portal of entry and provide contiguous or lymphangitic spread [106]. Cases of oculomycosis presenting as scleritis, keratitis, and endophthalmitis have also been reported, with lens implantation, diabetes, prior scleritis, surgery, and immunosuppression constituting risk factors [105,107,108].
The antifungal pipeline for invasive fungal diseases: what does the future hold?
Published in Expert Review of Anti-infective Therapy, 2023
Chin Fen Neoh, Wirawan Jeong, David CM Kong, Monica A Slavin
Ibrexafungerp also displayed enhanced in vitro activity against the majority of Aspergillus spp. studied [49] (Figure 1). It has potent in vitro activity against both azole susceptible and azole resistant A. fumigatus sensu stricto strains [50]. Likewise, ibrexafungerp is active against most of the cryptic Aspergillus species tested, except for A. ustus complex species (i.e. A. insuetus and A. keveii - marginal activity) and A. alliaceus (least activity) [50]. In combination with amphotericin B, isavuconazole or voriconazole, ibrexafungerp was reported to have synergistic activity against most azole-susceptible Aspergillus strains (i.e. A. fumigatus, A. flavus, A. terreus), Cunninghamella bertholettiae, Fusarium spp. (i.e. F. oxysporum, F. solani species complexes), and Scedosporium apiospermum [51]; this synergistic activity is also demonstrated in the neutropenic rabbit model of invasive pulmonary aspergillosis [52]. Similar synergistic effect against resistant cyp51A mutants was noted in the combined therapy of ibrexafungerp and amphotericin B as well [53], indicating that ibrexafungerp could potentially be used in combination therapy for invasive aspergillosis that is difficult to treat. For non-Aspergillus molds, ibrexafungerp has potent activity against Alternaria spp., Cladosporium spp., Paecilomyces variotii and Penicillium citrinum with marginal activity against L. prolificans, Scedosporium spp. and Scopulariopsis spp., but it is inactive against Purpureocillium lilacinum, Fusarium spp. and Mucorales [54,55] (Figure 2).