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Antea Worldwide Palliative Care Conference

Rome, 12-14 November 2008


Presenting author TITLE: Treatment of mycotic infections in the terminally ill patient
Michele Cianciulli
Authors: Michele Cianciulli
Email: Mycotic infections represent an important cause of morbidity and mortality in the terminally ill
patients, especially in those affected with hemolymphopoietic neoplasias and who received bone
Phone marrow transplant. In the last thirty years, the incidence is increased because of the diffusion of
fungal species generally endemic, HIV infections and migratory flows. Principal defence
mechanisms are phagocytes, cell-mediated immunity and mucocutaneous epithelial barriers. Risk
Mobile phone factors are intensive chemotherapy, total body irradiation, administration of corticosteroids,
venous catheters and contaminated enviroments. Etiologic agents may be subdivided in two
339 2114094 different groups: Candida, Aspergillus and Ficomycetes cause infections in immunocompromised
patients; Cryptococcus, Histoplasma and Coccidioides cause systemic infections in hematologic
Please underline the most patients. Diffusion of infections may be superficial, visceral or generalized. Diagnosis is often
appropriate category for your difficult.
abstract Candida infections (C. albicans and C. tropicalis) may involve superficial or visceral sites or may
be generalized. Oropharyngeal candidiasis is very common with a prevalence of 80-90% in
• Pain and other symptoms
patients with advanced neoplasias. There is a correlation with prothesis, xerostomia and poor
• Palliative care for cancer patients
performance status. Symptoms are pain and/or burning, with odynophagia and dysphagia. The
• Palliative care for non cancer role of prophylaxis is unclear. Elective drugs for this clinical presentation are Fluconazole and
patients Itraconazole. For more severe forms of candidiasis involving endocardium, brain or for
• Paediatric palliative care generalized presentation, the association of B Aphfotericine and other antimycotic drugs is
• Palliative care for the elderly effective.
• The actors of palliative care Aspergillus infections (A. fumigatus) are frequent in case of heavy deficit of macrophages activity
• Latest on drugs and usually involve the lungs. Symptoms are severe hypoxia, fever, cough, severe dyspnea,
• Bureaucratic pain thoracic pain; in presence of generalized form, central nervous system, kidneys, liver, heart are
• Illness and suffering through involved, too. Elective drugs are B Amphotericine, Itraconazole and Voriconazole.
Cryptococcus infections (C. neoformans) are frequent in case of deficit of cell-mediated immunity
• Marginalisation and social stigma
and usually involve the lungs; moreover, they may cause a generalized dissemination with the
at the end of life
involvement of skin, bones, central nervous system, kidneys and liver. Elective therapy is the
association of B Amphotericine and Flucitosine.
• Palliative care advocacy projects
Histoplasma infections (H. Capsulatum) are very diffused in Caribbean regions and frequent in
• Prognosis and diagnosis
case of deficit of T-lymphocites, low production of γ-interferon, poor macrophagic activity. They
communication in
may involve only the lungs or develop as a fulminant form characterized by a multi-organ
different cultures
infection. Elective drugs are B Amphotericine and Itraconazole.
• Communication between doctor-
The majority of mycotic infections are due to Candida (the prevalence of candidiasis in the
patient and patient-
patients admitted to hospice is 83-85%) and usually localize to lungs, brain and skin; it’s
important to identify the mycotic agent in order to administer the specific antimycotic
• Religions and cultures versus
suffering, death and
• Public institution in the world:
palliative care policies
and law
• Palliative care: from villages to
• Space, light and gardens for the
terminally ill patient
• End-of-life ethics
• Complementary therapies
• Education, training and research
• Fund-raising and no-profit
• Bereavement support Session: Symptoms
• Volunteering in palliative care
Chair: Dott. Francesca Giorgi
• Symptoms