title: ESCMID* guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT).
abstract: Fungal diseases still play a major role in morbidity and mortality in patients with haematological malignancies, including those undergoing haematopoietic stem cell transplantation. Although Aspergillus and other filamentous fungal diseases remain a major concern, Candida infections are still a major cause of mortality. This part of the ESCMID guidelines focuses on this patient population and reviews pertaining to prophylaxis, empirical/pre-emptive and targeted therapy of Candida diseases. Anti-Candida prophylaxis is only recommended for patients receiving allogeneic stem cell transplantation. The authors recognize that the recommendations would have most likely been different if the purpose would have been prevention of all fungal infections (e.g. aspergillosis). In targeted treatment of candidaemia, recommendations for treatment are available for all echinocandins, that is anidulafungin (AI), caspofungin (AI) and micafungin (AI), although a warning for resistance is expressed. Liposomal amphotericin B received a BI recommendation due to higher number of reported adverse events in the trials. Amphotericin B deoxycholate should not be used (DII); and fluconazole was rated CI because of a change in epidemiology in some areas in Europe. Removal of central venous catheters is recommended during candidaemia but if catheter retention is a clinical necessity, treatment with an echinocandin is an option (CII(t) ). In chronic disseminated candidiasis therapy, recommendations are liposomal amphotericin B for 8 weeks (AIII), fluconazole for >3 months or other azoles (BIII). Granulocyte transfusions are only an option in desperate cases of patients with Candida disease and neutropenia (CIII).
authors.affiliation: Department of Internal Medicine II, Julius-Maximilians-University, Würzburg, Germany. andrew.ullmann@uni-wuerzburg.de
authors.forename: A J
authors.initials: AJ
authors.lastname: Ullmann
authors.forename: M
authors.initials: M
authors.lastname: Akova
authors.forename: R
authors.initials: R
authors.lastname: Herbrecht
authors.forename: C
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authors.lastname: Viscoli
authors.forename: M C
authors.initials: MC
authors.lastname: Arendrup
authors.forename: S
authors.initials: S
authors.lastname: Arikan-Akdagli
authors.forename: M
authors.initials: M
authors.lastname: Bassetti
authors.forename: J
authors.initials: J
authors.lastname: Bille
authors.forename: T
authors.initials: T
authors.lastname: Calandra
authors.forename: E
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authors.lastname: Castagnola
authors.forename: O A
authors.initials: OA
authors.lastname: Cornely
authors.forename: J P
authors.initials: JP
authors.lastname: Donnelly
authors.forename: J
authors.initials: J
authors.lastname: Garbino
authors.forename: A H
authors.initials: AH
authors.lastname: Groll
authors.forename: W W
authors.initials: WW
authors.lastname: Hope
authors.forename: H E
authors.initials: HE
authors.lastname: Jensen
authors.forename: B J
authors.initials: BJ
authors.lastname: Kullberg
authors.forename: C
authors.initials: C
authors.lastname: Lass-Flörl
authors.forename: O
authors.initials: O
authors.lastname: Lortholary
authors.forename: W
authors.initials: W
authors.lastname: Meersseman
authors.forename: G
authors.initials: G
authors.lastname: Petrikkos
authors.forename: M D
authors.initials: MD
authors.lastname: Richardson
authors.forename: E
authors.initials: E
authors.lastname: Roilides
authors.forename: P E
authors.initials: PE
authors.lastname: Verweij
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authors.initials: M
authors.lastname: Cuenca-Estrella
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use*; D002177:Candidiasis / Q000150:complications / Q000175:diagnosis / Q000517:prevention & control* / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects; D019317:Evidence-Based Medicine / Q000592:standards; D019337:Hematologic Neoplasms / Q000150:complications*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D009503:Neutropenia / Q000150:complications
chemical_list: D000935:Antifungal Agents