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woensdag 2 augustus 2017

The Lancet: [Series] Improvement of fungal disease identification and management: combined health systems and public ...

[Series] Improvement of fungal disease identification and management: combined health systems and public health approaches
More than 1·6 million people are estimated to die of fungal diseases each year, and about a billion people have cutaneous fungal infections. Fungal disease diagnosis requires a high level of clinical suspicion and specialised laboratory testing, in addition to culture, histopathology, and imaging expertise. Physicians with varied specialist training might see patients with fungal disease, yet it might remain unrecognised. Antifungal treatment is more complex than treatment for bacterial or most viral infections, and drug interactions are particularly problematic.
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[Series] Immunotherapeutic approaches to treatment of fungal diseases
Fungal infections cause morbidity worldwide and are associated with an unacceptably high mortality despite the availability of antifungal drugs. The incidence of mycoses is rising because of the HIV pandemic and because immunomodulatory drugs are increasingly used to treat autoimmune diseases and cancer. New classes of antifungal drugs have only been partly successful in improving the prognosis for patients with fungal infection. Adjunctive host-directed therapy is therefore believed to be the only option to further improve patient outcomes.
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[Series] Emerging issues, challenges, and changing epidemiology of fungal disease outbreaks
Several high-profile outbreaks have drawn attention to invasive fungal infections (IFIs) as an increasingly important public health problem. IFI outbreaks are caused by many different fungal pathogens and are associated with numerous settings and sources. In the community, IFI outbreaks often occur among people without predisposing medical conditions and are frequently precipitated by environmental disruption. Health-care-associated IFI outbreaks have been linked to suboptimal hospital environmental conditions, transmission via health-care workers' hands, contaminated medical products, and transplantation of infected organs.
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[Comment] Recovery from serious fungal infections should be realisable for everyone
Fungal infections are neglected by social and political communities. However, they affect more than a billion people, resulting in approximately 11·5 million life-threatening infections and more than 1·5 million deaths annually.1,2 There have been enormous advances in fungal diagnostics and antifungal drug development over the past 20 years, but most of the world's population has not yet benefited from these advances. The Lancet Infectious Diseases Fungal Infections Series brings readers up to date on fungal infections and addresses how fungal infection management can be integrated into health systems in low-income and middle-income countries (LMICs).
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[Personal View] Urgent challenges in implementing live attenuated influenza vaccine
Conflicting reports have emerged about the effectiveness of the live attenuated influenza vaccine. The live attenuated influenza vaccine appears to protect particularly poorly against currently circulating H1N1 viruses that are derived from the 2009 pandemic H1N1 viruses. During the 2015–16 influenza season, when pandemic H1N1 was the predominant virus, studies from the USA reported a complete lack of effectiveness of the live vaccine in children. This finding led to a crucial decision in the USA to recommend that the live vaccine not be used in 2016–17 and to switch to the inactivated influenza vaccine.
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