74,75,77In vitro studies of superficial and invasive selleck products clinical Malassezia isolates consistently demonstrate susceptibility to amphotericin B and antifungal triazoles, whereas flucytosine and echinocandins appear to be inactive.11,65,71,90–92 Thus, in the absence of experimental and comparative clinical data and the large clinical experience with invasive Candida infections, fluconazole or voriconazole may be rational

first-line options for antifungal chemotherapy with an amphotericin B product as back-up for refractory or life-threatening infections (Table 1). While the duration of treatment has not been defined, we would advocate a course of 14 days of effective antifungal MK-1775 concentration therapy after the last positive blood culture and catheter removal as recommended for invasive Candida infections and optional switch from initial intravenous to oral therapy depending on the individual patient’s clinical response.79 Very little is known about the detailed morbidity

and mortality of invasive Malassezia infections. While Malassezia can cause severe disease and fatal cases have been reported in untreated patients, available series of catheter-associated fungaemia in premature neonates and in immunocompromised non-neonatal patients suggest low attributable mortality with appropriate management.12,21,56,80,93,94 Oxalosuccinic acid “
“The amino acid derivative 2-hydroxyisocaproic

acid (HICA) is a nutritional additive used to increase muscle mass. Low levels can be detected in human plasma as a result of leucine metabolism. It has broad antibacterial activity but its efficacy against pathogenic fungi is not known. The aim was to test the efficacy of HICA against Candida and Aspergillus species. Efficacy of HICA against 19 clinical and reference isolates representing five Candida and three Aspergillus species with variable azole antifungal sensitivity profiles was tested using a microdilution method. The concentrations were 18, 36 and 72 mg ml−1. Growth was determined spectrophotometrically for Candida isolates and by visual inspection for Aspergillus isolates, viability was tested by culture and impact on morphology by microscopy. HICA of 72 mg ml−1 was fungicidal against all Candida and Aspergillus fumigatus and Aspergillus terreus isolates. Lower concentrations were fungistatic. Aspergillus flavus was not inhibited by HICA. HICA inhibited hyphal formation in susceptible Candida albicans and A. fumigatus isolates and affected cell wall integrity. In conclusion, HICA has broad antifungal activity against Candida and Aspergillus at concentrations relevant for topical therapy.