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Refractory fungal infection: Three case reports highlighting good practice

Summary

This case series examines three patients with serious fungal infections that did not respond well to standard antifungal treatments. The cases demonstrate how fungi can develop resistance to common antifungal drugs like azoles, making infections harder to treat. The authors emphasize that accurate identification of the fungus, testing its sensitivity to drugs, monitoring drug levels in the blood, and careful use of antifungal medications are essential for successfully treating these difficult infections.

Background

Refractory invasive fungal disease is a significant clinical problem with high morbidity, mortality and costs. Complex causes include breakthrough infection due to antifungal resistance, suboptimal therapy, and impaired immune responses in critically ill or immunocompromised patients.

Objective

To detail three case reports demonstrating identification and management of refractory fungal infections, including two cases of azole resistance and one case of resistant candidiasis, highlighting the importance of accurate diagnosis and antifungal stewardship.

Results

Case 1: Aspergillus fumigatus with TR34/L98H mutation responded to caspofungin after azole failure. Case 2: Chronic disseminated candidiasis required prolonged dual antifungal therapy with resolution post-transplant. Case 3: Azole-resistant A. fumigatus responded to liposomal amphotericin B followed by posaconazole prophylaxis without recurrence during 2-year follow-up.

Conclusion

These cases demonstrate the growing problem of azole-resistant fungi and emphasize the critical need for accurate diagnosis, antifungal susceptibility testing, therapeutic drug monitoring, fungal biomarkers, and antifungal stewardship to optimize management and minimize resistance emergence.
  • Published in:Medical Mycology Case Reports,
  • Study Type:Case Report,
  • Source: PMID: 39759765, DOI: 10.1016/j.mmcr.2024.100688
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