Interactions of Yeasts, Moulds, and Antifungal Agents: How to Detect Resistance

183 Pages·2012·1.17 MB·English

by  Gerri S. Hall Ph.D. (auth.)

Interactions of Yeasts, Moulds,
and Antifungal Agents

Gerri S. Hall
Editor
Interactions of Yeasts,
Moulds, and Antifungal
Agents
How to Detect Resistance
Editor
Gerri S. Hall, Ph.D., D(ABMM), F(AAM)
Section of Clinical Microbiology
Department of Clinical Pathology
Cleveland Clinic
Cleveland, OH 44195, USA
[email protected]
ISBN 978-1-58829-847-8 e-ISBN 978-1-59745-134-5
DOI 10.1007/978-1-59745-134-5
Springer New York Dordrecht Heidelberg London
Library of Congress Control Number: 2011941443
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I would like to dedicate this to my husband,
James O. Hall, DPM and my son
James Joseph (JJ) Hall, and my secretary
and dear friend Faith Cumberledge.
Thanks for your support
and encouragement.

Preface
The incidence of fungal infections continues to increase in hospitalized patients.
Candida spp. have become a signifi cant cause of bloodstream infections (BSIs) in
immunocompromised and immunocompetent patients. Candida albicans no longer
is the cause of all of these fungemia cases, but rather only about 50% of BSIs are
caused by C . albicans ; the remainder are caused by other species of C andida to
include C . glabrata, C. tropicalis, C. parapsilosis , and others. Not all of these yeast
responsible for fungemia have a 100% predictable response to antifungal agents.
Candida spp. in addition can be involved in a wide spectrum of infections from
candidal vulvovaginitis to postsurgical wound infections, endophthalmitis, kerati-
tis, endocarditis, and a host of other infections. Molds like A spergillus spp.,
Fusarium spp., and Pseudallescheria boydii are responsible for pulmonary infec-
tions in immunocompromised hosts, including transplant patients, diabetics, and
patients on long-term steroids. Dermatophyte infections remain one of the most
communicable infectious diseases in the world.
The number of antifungal agents has increased so that there are choices and one
drug does not have to be used for all fungal infections. There is a variable response
of each yeast or mold to the antifungal agents. Some are always susceptible; others
are intrinsically resistant. As more of these newer agents are used, resistance has
begun to emerge just as it has for bacteria. To accommodate these changes, in vitro
fungal susceptibility testing is being requested more and more. The manufacturing
of manual and automated methods for performing an in vitro susceptibility test has
increased, and more laboratories are performing yeast susceptibilities in house,
rather than sending these out to reference laboratories. Even performance of in vitro
mold susceptibilities are not as uncommonly done as was once the case.
This text has been designed to cover the topic of antifungal agents and resistance
detection in fungal organisms, both yeasts and molds. One chapter is devoted to a
description of the most used antifungal agents, including those that are given sys-
temically, orally, and topically. Three chapters give information on the methods that
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viii Preface
can be used for performing in vitro susceptibility tests for yeasts and molds, and the
dermatophytes. The clinical utility of these in vitro tests is well described in one
chapter of this text. A chapter on the usual patterns of susceptibility for common
yeasts and molds is included as a reference tool for the laboratorian and the clini-
cian. The authors hope that you will fi nd this text useful in determining when and
how in vitro testing might be done and instances where it need not be performed due
to intrinsic resistances among the fungi.
Cleveland, OH, USA Gerri S. Hall
Acknowledgments
I would like to acknowledge all of the authors who have contributed to this textbook.
They are the experts in the area of laboratory and clinical diagnosis of fungi and
have taught me so much throughout the years I have known them.
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