From the Guidelines
Mold poisoning in immunocompromised individuals is a serious condition that requires prompt treatment, and the most effective approach is to remove the patient from the mold exposure source and administer antifungal medications, with voriconazole being the first-line therapy for invasive aspergillosis, as recommended by the 2018 guidelines for the use of antifungal agents in patients with invasive fungal diseases in Taiwan 1.
Clinical Manifestations
Mold poisoning in immunocompromised individuals can present with diverse clinical manifestations, including:
- Respiratory issues such as cough, wheezing, and shortness of breath
- Fever, fatigue, and headaches
- Skin rashes
- Invasive infections affecting the lungs, sinuses, brain, or other organs These symptoms can be severe and life-threatening, and prompt treatment is essential to prevent morbidity and mortality.
Treatment
Treatment of mold poisoning in immunocompromised individuals typically involves:
- Removing the patient from the mold exposure source
- Administering antifungal medications, with voriconazole being the first-line therapy for invasive aspergillosis, as recommended by the 2018 guidelines for the use of antifungal agents in patients with invasive fungal diseases in Taiwan 1
- Alternative options include isavuconazole, posaconazole, or liposomal amphotericin B for patients who cannot tolerate voriconazole
- For mucormycosis, liposomal amphotericin B (5-10 mg/kg/day) is the primary treatment, with surgical debridement often necessary
- Treatment duration typically ranges from 6-12 weeks depending on infection severity and clinical response
Prevention Strategies
Prevention strategies are crucial in preventing mold poisoning in immunocompromised individuals, including:
- HEPA air filtration
- Avoiding areas with visible mold
- Prophylactic antifungals for high-risk patients
- Environmental control, including elimination of environmental fungal exposures to plants, new construction, and mold in areas where patients are at greatest risk of developing aspergillosis, as recommended by the 2016 practice guidelines for the diagnosis and management of aspergillosis 1
Supportive Care
Supportive care is essential in the management of mold poisoning in immunocompromised individuals, including:
- Oxygen therapy
- Corticosteroids for inflammatory reactions
- Management of underlying immunosuppression when possible These measures can help reduce the severity of symptoms and prevent complications, and should be tailored to the individual patient's needs and medical history.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Clinical Manifestations of Mold Poisoning in Immunocompromised Individuals
- Symptoms of mold exposure in immunocompromised individuals can include respiratory symptoms, such as cough and rhinitis, as well as central nervous system symptoms, fatigue, and headache 2
- Physical examination may reveal pale nasal mucosa, pharyngeal "cobblestoning," and rhinorrhea 2
- Immunocompromised hosts are at risk for dermatologic and systemic infections from various fungi, which can be associated with significant morbidity or mortality 3
Treatment of Mold Poisoning in Immunocompromised Individuals
- Voriconazole is an important agent in the antifungal armamentarium and is the treatment of choice for invasive aspergillosis, other hyaline molds, and many brown-black molds 4
- Other antifungal agents, such as caspofungin, posaconazole, and amphotericin B, also have activity against various molds and may be used in treatment 4, 5
- Therapeutic drug monitoring is essential when using voriconazole due to its unpredictable pharmacokinetics and potential for adverse effects 4
Immune Response to Mold in Immunocompromised Individuals
- Pathogenic fungi can cause a wide range of syndromes in immune-competent and immune-compromised individuals, with life-threatening disease primarily seen in humans with HIV/AIDS and in patients receiving immunosuppressive therapies 6
- The discovery of specific primary immune deficiencies that manifest with fungal infections has facilitated insight into fungus-specific recognition, signaling, effector pathways, and adaptive immune responses 6
- Progress in deciphering the molecular and cellular basis of immunity against fungi is guiding preclinical studies into vaccine and immune reconstitution strategies for vulnerable patient groups 6