Home

M. Mycology, Including Resistance and Mechanisms of Action of Antifungals

 

Meet-the-Experts

 

Fungal Infections Involving the Eye

Fungal infections of the eye are problematic to treat: in that it is an immunologically privileged site, hence there is an increased need for drug efficacy to cure infection; therapeutic concentrations of drugs are relatively difficult to achieve in some compartments especially those that are (relatively) avascular, biopsy (and hence confirmatory) diagnosis may be problematic and clinical experience amongst infectious diseases clinicians is variable. This Meet-the-Experts Session draws together two experts to address the difficult issue of bioavailability, PK/PD of antifungal drugs, diagnostics and their limitations and the perspective of an ophthalmologist with a wealth of clinical experience.

Upon completion of this Meet-the-Experts Session, the participant should be able to:

• Apply the principles of PK/PD to antifungal drug use in eye infections;
• Integrate, and interpret the results of, current diagnostics in the management of eye infections; 
• Discuss the scope and presentations of the problem in a resource poor country; and 
• Apply this experience-based knowledge to clinical practice. 

Experts:
Carol Kauffman, MD; Univ. of Michigan, Ann Arbor, MI.
Grant Comer, MD; Kellogg Eye Ctr., Ann Arbor, MI.

 

Fungal Infections of the Central Nervous System

Late diagnosis of fungal infections involving the brain and/or meninges is characteristic of a number of fungal infections because they are subacute, and/or minimally symptomatic, particularly in immunocompromised hosts. Definitive diagnosis may not be possible if it requires brain biopsy and less invasive methods such as lumbar puncture are contraindicated in the presence of raised intracranial pressure. With increasing travel there is a risk of acquiring infections overseas, with which treating physicians lack familiarity. Antifungal therapy is generally suboptimal due in part to PK/PD issues in the CNS and ancillary treatments may be required. This session will familiarize clinicians with latest clinical, diagnostic and therapeutic issues to be considered in the management of patients with CNS fungal infections.

Upon completion of this Meet-the-Experts Session, the participant should be able to:

• Generate an appropriate differential diagnosis, diagnostic workup and management plan for CNS fungal infections;
• Recognize the importance of travel history and underlying co-morbidities in predicting the likelihood of a fungal cause of CNS infections; and 
• Apply principles of PK/PD and an evidence-based approach to management. 

Experts:
David A. Stevens, MD; Stanford Univ., Palo Alto, CA.
Thomas Walsh, MD; Weill Cornell Med. Coll., Cornell Univ., New York, NY.

 

How Can the Mycology Lab Work for You?

Testing for antifungal susceptibility is not yet routine in clinical practice. This session will examine the evidence for testing antifungal activity in the diagnostic laboratory, its impact on patient outcomes and whether or when it should be done in clinical practice. There has been much debate about the standardization of nucleic acid tests and their implementation into mycology practice, since most assays have been developed in-house and used locally. With the commercial release of multiplexed bacterial and fungal identikits it is time to examine whether their use will impact significantly on clinical outcomes and be cost-effective.

Upon completion of this Meet-the-Experts Session, the participant should be able to:

• Determine when antifungal susceptibility testing is useful in clinical practice and the likely impact of introducing new antifungal susceptibility breakpoints in the diagnostic laboratory;
• Recognize the advantages and pitfalls of in-house nucleic acid testing for fungal identification; and 
• Evaluate the cost-effectiveness and clinical use of multiplexed bacterial and fungal assays. 

Experts:
Maiken C. Arendrup, MD, PhD; Statens Serum Inst., Copenhagen, Denmark.
Sean Zhang, PhD; Johns Hopkins Hosp., Johns Hopkins Sch. of Med., Baltimore, MD.

 

Symposia

 

Controversies in Clinical Mycology

Developed in cooperation with the Mycology Study Group (MSG) and the European Organization for Research and Treatment of Cancer (EORTC-IDG).

In this session there are several basic topics for clinicians who care for patients with invasive fungal infections. The attendee will be able to analyze use of biomarkers and antifungal dosing an individual patient basis. Furthermore, from a general perspective there will be a discussion of guidelines and stewardship. These are critical issues which the clinician must approach on a system basis.

Upon completion of this Symposium Session, the participant should be able to:

• Discuss the use of biomarkers;
• Identify the importance of dosing antifungals; 
• Assess guidelines and their limitations; and 
• Describe issues around antifungal stewardship. 

Conveners:
John Perfect, MD; Duke Univ. Med. Ctr., Durham, NC.
J.P Donnelly, MD; Radboud Univ. Nijmegen Med. Ctr., Nijmegan Inst. for Infection, Nijmegen, Netherlands.

Presentations:
Fungal Biomarkers and How to Use Them
Elias Anaissie, MD; UAMS Med. Ctr., Little Rock, AR.

Do We Really Know How to Dose Antifungals?
William Hope, MBBS, FRACP, FRCPA, PhD; The Univ. of Manchester, Manchester, United Kingdom.

Fungal Infections and Diagnostic Guidelines: What is Right and What is Strong
J.P. Donnelly, MD; Radboud Univ. Nijmegen Med. Ctr., Nijmegan Inst. for Infection, Nijmegen, Netherlands.

How Does the Clinical Mycologist Fit into Antimicrobial Stewardship
Graeme Forrest, MD; Portland VA Med. Ctr., Portland, OR.

 

Fungal Infections in High-Risk Groups: Current and Future Strategies for Control

Developed in cooperation with the mycikigy study group (MSG)

This symposium is highly focused on clinical insights into the care of patients with specific high risk underlying diseases. It has brought together both unique patient populations and created a multiple, diverse clinical practices to examine similarities and differences. It focuses on epidemiology, prevention and treatment.

Upon completion of this Symposium Session, the participant should be able to:

• Identify risk groups for invasive fungal infection;
• Assess variability in resources for antifungal management; and 
• Provide guidelines for success in care of invasive fungal infections. 

Conveners:
Tania Sorrell, MD; Sydney Med. Sch., Univ. of Sydney, Sydney, Australia.
John Edwards Jr., MD; Harbor UCLA Med. Ctr., Torrance, CA.

Presentations:
ICU Patients
Philippe Eggimann, MD; The Ctr. Hosp. Univ. Vaudois, Lausanne, Switzerland.

Candidemia in Neonates: Focus on an Indian Neonatal ICU
Arunaloke Chakrabarti; PGIMER, Chandigarh, India.

Candida Vaccination as a Therapeutic Strategy
John Edwards, Jr., MD; Harbor UCLA Med. Ctr., Torrance, CA.

HIV-Treatment Issues in Cryptococcal Meningitis
Jeremy Day, MD; Hosp. of Tropical Diseases, Ho Chi Minh City, Viet Nam.

 

Mycology 2012: Top Papers

This symposium will provide a critical analysis of some of the major research papers in the last year. The presenters will critique the manuscripts and offer the authors or audience to participate. The learner or attendee has the ability to be educated on state-of-the-art information in the field of mycology. It will be recent data and relevant data.

Upon completion of this Symposium Session, the participant should be able to analyze major findings in fungal diseases.

Conveners:
Thomas F. Patterson, MD, FACP; Univ. of Texas Hlth. Sci. Ctr., San Antonio, TX.
David W. Denning, MD; Univ. Hosp. of Manchester, Manchester, United Kingdom.

Presentation:
Dimitrios P. Kontoyiannis, MD; MD Anderson Cancer Ctr., Houston, TX.

 

Research in Mycology: Hot Topics

This session will interest those wishing to understand the complex issues involved in multicentre collaborative translational/clinical research and how to achieve successful outcomes. Complementing this are presentations on two novel therapeutic approaches - cell based immuno-therapeutics involving adoptive transfer of ex vivo expanded fungus specific T cells in hematological malignancies and radioimmunotherapy in invasive fungal infections, their promise and pitfalls. This session will be completed with a topic of contemporary clinical importance, the relationship between the site of a given fungal infection and outcome.

Upon completion of this Symposium Session, the participant should be able to:

• Debate issues and participate constructively in planning and execution of multicentre collaborative studies;
• Discuss the status and potential of two non-drug experimental approaches to therapy of invasive fungal infections; and 
• Translate information on the relationship between site of a fungal infection and outcome into clinical practice. 

Conveners:
Tania Sorrell, MB, BS, MD, FRACP; Univ. of Sydney, Westmead, Australia.
John Perfect, MD; Duke Univ. Med. Ctr., Durham, NC.

Presentations:
Multicentre Collaborative Studies: How Do They Work and Why?
Peter G. Pappas, MD; Univ. of Alabama, Birmingham, AL.

Cell-Based Therapies for IFIs in Haematology Patients
David Gottlieb, MD; Univ. of Sydney, Westmead, Australia.

What the Site of a Fungal Infection Means for Outcome
Michail Lionakis, MD, ScD; NIAID, Bethesda, MD.

What are the Possibilities for Use of Radioimmunotherapy for Fungal Infections: The Data and the Reality
Joshua Nosanchuk, MD; Albert Einstein Coll. of Med., Bronx, NY.

 

Interactive Symposium

 

Challenging Cases in Mycology

With the use of clinical cases these clinicians will provide insights into some of the major issues around management of certain invasive fungal infections. With the use of guidelines, clinical experience and specific cases the principles in care of fungal infections will be revealed and the audience will be able to participate in the teaching.

Upon completion of this Interactive Symposium Session, the participant should be able to:

• Manage complex cases;
• Discuss the boundaries of diagnosis and treatment; and 
• Identify principles for the epidemiology and care of patients. 

Conveners:
Andrew Ullmann, MD; Klinikum der Johannes, Mainz, Germany.
Jack D. Sobel, MD; Wayne State Univ. Sch. of Med., Detroit, MI.

Presentations:
Management Guidelines and Real Life Situations
Andrew J. Ullmann, MD; Julius-Maximilians Univ., Wuerzburg, Germany.

Conudrums in Management
Jack D. Sobel, MD; Wayne State Univ. Sch. of Med., Detroit, MI.

A Difficult Case
Patricia Muñoz, MD; Hosp. G.U. Gregorio Maranon, Madrid, Spain.

Australia: When the Human Petri Dish Serves an Unusual Guest
Deborah E. Marriott, MD; St. Vincent's Hosp., Sydney, Australia.