title: Identification and management of invasive mycoses in internal medicine: a road-map for physicians.
abstract: Invasive mycoses are a rising problem, not only in traditional categories of patients like hematologic or neutropenic ones, but also in elderly non-neutropenic patients admitted to internal medicine wards. Patients being admitted to medical wards are usually older, have multiple comorbidities, e.g., liver cirrhosis or chronic obstructive respiratory disease, may be malnourished or receive peripheral or total parenteral nutrition, and frequently are undergoing chronic corticosteroid therapy, chemotherapy for cancer or monoclonal antibodies for autoimmune diseases. Such risk factors may be contemporarily present in a single patient increasing the risk for the development of invasive mycoses. Diagnosis of candidemia and invasive aspergillosis is particularly difficult in patients hospitalized on medical wards, since symptoms and signs have low specificity, and most diagnostic tests have been only validated in neutropenic hematologic patients, but not in those without neutropenia. Both candidemia and invasive aspergillosis carry significant morbidity and mortality. The aim of this paper is to provide a simple guide to physicians for a prompt identification and treatment of patients with possible or suspected invasive mycoses.
authors.affiliation: Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy, marcofalc@libero.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Falcone
authors.forename: Ercole
authors.initials: E
authors.lastname: Concia
authors.forename: Ido
authors.initials: I
authors.lastname: Iori
authors.forename: Giuliana
authors.initials: G
authors.lastname: Lo Cascio
authors.forename: Antonino
authors.initials: A
authors.lastname: Mazzone
authors.forename: Federico
authors.initials: F
authors.lastname: Pea
authors.forename: Francesco
authors.initials: F
authors.lastname: Violi
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
mesh_terms: D058365:Candidiasis, Invasive / Q000175:diagnosis* / Q000188:drug therapy*; D003663:Decision Trees; D006801:Humans; D007388:Internal Medicine; D055744:Invasive Pulmonary Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy*; D010347:Patient Care Planning