Publications by authors named "Peter Pappas"

Background: Infection by Cryptococcus gattii can lead to pulmonary or central nervous system (CNS) disease, or both. Whether site of infection and disease severity are associated with C. gattii species and lineages or with certain underlying medical conditions, or both is unclear.

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Invasive candidiasis (IC) is a term that refers to a group of infectious syndromes caused by a variety of Candida species, 6 of which cause the vast majority of cases globally. Candidemia is probably the most commonly recognized syndrome associated with IC; however, Candida species can cause invasive infection of any organ, especially visceral organs, vasculature, bones and joints, eyes, and central nervous system. The optimal use of these newer diagnostics coupled with a thoughtful clinical assessment of at-risk patients and the judicious use of effective antifungal therapy is a key to achieving good antifungal stewardship and improved patient outcomes.

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Candidemia and invasive candidiasis persist as significant causes of morbidity and mortality. As fluconazole resistance rates rise, alternative means of treatment are necessary, either via mold-active azoles or extended durations of echinocandins. These come with the potential for undesirable side effects for triazoles or choosing between prolonged hospitalization or outpatient parenteral antimicrobial therapy in the case of echinocandins.

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Background: Invasive candidiasis/candidemia (IC/C) is associated with a substantial health economic burden driven primarily by prolonged hospital stay. The once-weekly IV echinocandin, rezafungin acetate, has demonstrated non-inferiority to caspofungin in the treatment of IC/C. This paper reports a post hoc pooled exploratory analysis of length of stay (LoS) for hospital and intensive care unit (ICU) stays in two previously published clinical trials (ReSTORE [NCT03667690] and STRIVE [NCT02734862], that compared rezafungin with daily IV caspofungin (stable patients in the caspofungin group who met relevant criteria could step down to fluconazole after 3 days or more).

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Background: Rezafungin is an echinocandin approved in the US and EU to treat candidaemia and/or invasive candidiasis. This post-hoc, pooled analysis of the Phase 2 STRIVE and Phase 3 ReSTORE trials assessed rezafungin versus caspofungin in patients with candidaemia and/or invasive candidiasis (IC) in the intensive care unit (ICU) at randomisation.

Methods: STRIVE and ReSTORE were randomised double-blind trials in adults with systemic signs and mycological confirmation of candidaemia and/or IC in blood or a normally sterile site ≤ 96 h before randomisation.

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  • A study was conducted to assess the long-term effectiveness of iliac vein stenting for women suffering from pelvic venous insufficiency due to iliac vein stenosis and ovarian vein reflux, finding that 78% experienced complete symptom relief within the first six months.
  • The research included a retrospective review of data from 141 women, with an average age of 44.7 years, who were treated solely with stenting, excluding those with primary dysmenorrhea or leg symptoms.
  • The study analyzed various factors such as pain scores, ultrasound results, and stent types over an average follow-up period of 12 months, highlighting the common stent types used and the specific vein territories covered during the procedures.
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  • The Telecritical Care Collaborative Network aimed to establish best practice recommendations for delivering critical care through telehealth technologies, addressing the variability and lack of evidence in the field.
  • Using a modified Delphi methodology, an oversight panel developed and refined 79 practice statements based on expert feedback across three voting rounds, achieving consensus on 78 statements.
  • The recommendations cover ten core domains, including care delivery models and staffing, emphasizing that effective telecritical care is best provided by specialized care teams and well-structured programs.
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  • * There has been a shift from infections primarily caused by drug-susceptible species to an increase in non-susceptible species, leading to greater treatment difficulties due to rising drug resistance.
  • * With more patients at risk due to advances in cancer treatment and the emergence of resistant strains of Candida, understanding these changes is crucial for developing effective management and prevention strategies.
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  • Iliac vein stenting is a treatment for patients with problems in their pelvic veins caused by blocked iliac veins.
  • The study looked at 409 patients who had this treatment to see if extending the stents into the inferior vena cava (IVC) would increase the risk of blood clots in the other iliac vein.
  • Results showed only 2 patients had clots, and there was no significant difference in clot cases between the different groups of stent types studied.
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The Mycoses Study Group Education and Research Consortium is a collective of clinicians, researchers, and educators with the common goal to advance awareness, diagnosis, and management of invasive fungal diseases. Clinical Mycology Today, the Mycoses Study Group Education and Research Consortium's biennial meeting, is dedicated to discussing the most pressing contemporary issues facing the field of clinical mycology, promoting clinical, translational, and basic science collaborations, and mentoring the next generation of clinical mycologists. Here, we review the current opportunities and challenges facing the field of mycology that arose from discussions at the 2022 meeting, with emphasis on novel host risk factors, emerging resistant fungal pathogens, the evolving antifungal pipeline, and critical issues affecting the advancement of mycology research.

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  • Rezafungin, a new once-weekly echinocandin, showed similar effectiveness to caspofungin in treating candidemia and invasive candidiasis in the ReSTORE trial, particularly in terms of day 30 all-cause mortality and day 14 global cure rates.
  • The study involved patients aged 18 and older, comparing the outcomes of those receiving rezafungin to those on caspofungin, with specific focus on patients who had a positive culture close to the time of treatment randomization.
  • Results indicated comparable safety and efficacy between the two treatments, with rezafungin showing potential advantages in early mycological response, suggesting it could be an effective option for treatment.
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Background: Recently, increasing focus on patient input into research and healthcare improvements has fostered expanded patient-centered advocacy efforts. This first pan-fungal disease summit, part of the MYCology Advocacy, Research, & Education effort, brought together patients, caregivers, and mycology experts to better document patient experiences with invasive fungal disease (IFD) and establish priorities for mycology education, advocacy, and research.

Methods: Patients who had suffered from IFD, their caregivers, clinicians, industry representatives, government officials, and patient advocacy professionals were invited.

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  • In 2021, a multi-disciplinary group developed the Symptoms-Varices-Pathophysiology (SVP) classification system to effectively categorize patients with pelvic venous disorders (PeVD) due to limited data on existing tools.
  • A study conducted from January 2018 to January 2019 reviewed the medical records of 70 female patients treated for PeVD, assessing factors like age, race, intervention types, and their categorization under the SVP system.
  • Results showed the average patient age was 47.4, with a significant proportion exhibiting symptoms related to S2 disease, such as dyspareunia, and lower extremity varicosities were present in 35% of patients at the time of
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  • Rezafungin, a long-acting echinocandin, is effective for treating candidemia and invasive candidiasis, showing non-inferiority to caspofungin in a Phase 3 study.
  • The study included 93 patients on rezafungin and 94 on caspofungin, with similar baseline species distribution across groups and comparable cure rates and mortality outcomes.
  • Efficacy was not affected by minimum inhibitory concentration values, and two patients with non-susceptible isolates had successful outcomes with rezafungin treatment.
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Crowdsourced registries have been used to quickly gather information, especially during emerging public health concerns. Registries that began during the COVID-19 pandemic were used to rapidly answer key questions on coinfections, experimental treatments, and morbidity and mortality outcomes. Registries are also used more frequently to support clinical trials and track long-term outcomes in patient populations.

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Background: Invasive fungal disease caused by dimorphic fungi is associated with significant morbidity and mortality. Super-bioavailability itraconazole (SUBA-itra) is a novel antifungal agent with pharmacokinetic advantages over currently available formulations. In this prospective comparative study, we report the outcomes of patients with endemic fungal infections (histoplasmosis, blastomycosis, coccidioidomycosis, and sporotrichosis).

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Cryptococcosis is a major worldwide disseminated invasive fungal infection. Cryptococcosis, particularly in its most lethal manifestation of cryptococcal meningitis, accounts for substantial mortality and morbidity. The breadth of the clinical cryptococcosis syndromes, the different patient types at-risk and affected, and the vastly disparate resource settings where clinicians practice pose a complex array of challenges.

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  • Rezafungin is a newly approved drug for treating candidaemia and invasive candidiasis, showing effectiveness and safety comparable to caspofungin in clinical trials.
  • The analysis combined data from two trials (STRIVE and ReSTORE) involving 294 patients worldwide, where both drugs were evaluated for their efficacy and safety profiles.
  • Results indicated similar 30-day mortality rates for both treatments (around 19%), and a higher rate of mycological response by day 5 in the rezafungin group, with both medications exhibiting comparable safety.
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Cryptococcosis is an invasive fungal infection found worldwide that causes significant morbidity and mortality among a broad range of hosts. There are approximately 223,000 new cases of cryptococcosis annually throughout the world, and at least 180,000 deaths are attributed to this infection each year. Most of these are due to complications of cryptococcal meningoencephalitis among HIV-infected patients in resource-limited environments.

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