K R Stover1, S T King, J D Cleary. 1. Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, MS, USA; Division of Infectious Diseases, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
Abstract
WHAT IS KNOWN AND OBJECTIVE: Fungal infections pose a constant risk to critically ill and immunosuppressed patients. The echinocandin antifungals give practitioners an arsenal of agents with apparently lower toxicity relative to older agents. The objective of this commentary is to review the cardiac toxicity of the echinocandin antifungals in the light of recent evidence and published case reports. COMMENT: Three case reports detail cardiac decompensation following the initiation of anidulafungin and caspofungin and corroborate ex vivo laboratory results, in which rat hearts exposed to anidulafungin and caspofungin had significantly decreased cardiac contractility. Our hypothesized mechanism of toxicity of anidulafungin and caspofungin is mitochondrial toxicity. WHAT IS NEW AND CONCLUSION: The clinical corroboration of the ex vivo work presented above highly suggests that the cardiac toxicity seen with some of the echinocandin antifungals is a cause and effect pattern, not a chance finding.
WHAT IS KNOWN AND OBJECTIVE:Fungal infections pose a constant risk to critically ill and immunosuppressed patients. The echinocandin antifungals give practitioners an arsenal of agents with apparently lower toxicity relative to older agents. The objective of this commentary is to review the cardiac toxicity of the echinocandin antifungals in the light of recent evidence and published case reports. COMMENT: Three case reports detail cardiac decompensation following the initiation of anidulafungin and caspofungin and corroborate ex vivo laboratory results, in which rat hearts exposed to anidulafungin and caspofungin had significantly decreased cardiac contractility. Our hypothesized mechanism of toxicity of anidulafungin and caspofungin is mitochondrial toxicity. WHAT IS NEW AND CONCLUSION: The clinical corroboration of the ex vivo work presented above highly suggests that the cardiac toxicity seen with some of the echinocandin antifungals is a cause and effect pattern, not a chance finding.
Authors: Christian Koch; Jennifer Jersch; Emmanuel Schneck; Fabian Edinger; Hagen Maxeiner; Florian Uhle; Markus A Weigand; Melanie Markmann; Michael Sander; Michael Henrich Journal: Antimicrob Agents Chemother Date: 2018-10-24 Impact factor: 5.191
Authors: Christian Koch; Florian Uhle; Matthias Wolff; Christoph Arens; Astrid Schulte; Ling Li; Bernd Niemann; Michael Henrich; Susanne Rohrbach; Markus A Weigand; Christoph Lichtenstern Journal: Antimicrob Agents Chemother Date: 2014-12-29 Impact factor: 5.191
Authors: Tobias Lahmer; Christopher Schnappauf; Marlena Messer; Sebastian Rasch; Lisa Fekecs; Analena Beitz; Stefan Eser; Roland M Schmid; Wolfgang Huber Journal: Infection Date: 2015-08-11 Impact factor: 3.553
Authors: Christian Koch; Matthias Wolff; Michael Henrich; Markus A Weigand; Christoph Lichtenstern; Florian Uhle Journal: Antimicrob Agents Chemother Date: 2015-10-26 Impact factor: 5.191