Fungal Infections

Abstract

Fungal infections remain an important cause of morbidity and mortality in surgical settings, with critically ill patients, transplant patients, and sick neonates all being especially vulnerable. Over the past few decades, technological and scientific advancements have improved physicians’ ability to sustain life in critically ill patients, developments in chemotherapeutics and immune-based therapies have yielded increased survival for many cancer patients, organ transplantation has evolved dramatically, and the use of invasive therapies has increased markedly. With these changes has come an increase in the incidence of serious Candida infections, as well as an increase in the less common but potentially fatal noncandidal infections caused by Aspergillus and the Zygomycetes Mucor and Rhizopus. Antifungal prophylaxis has emerged as a potential means of reducing the occurrence of serious fungal infections. This review covers fungal colonization versus infection, types of fungal infection, epidemiology and risk factors, clinical evaluation, investigative studies, management of acute candidemia and acute disseminated candidiasis, management of nonhematogenous candidiasis, peritonitis and intra-abdominal abscess, management of other fungal infections (Aspergillus, Cryptococcus, Mucor, Rhizopusi), systemic antifungal agents, and the pathogenesis of Candida infection. Tables describe the clinical presentation and diagnostic methods for common fungal infections, antimicrobial agents of choice for candida infections, antifungal chemotherapy, and characteristics of currently available antifungals. Figures show Candida endophthalmitis; superficial candidiasis; biopsy samples of chronic progressive disseminated histoplasmosis and thick-walled, broad-based budding yeasts typical for Blastomyces dermatitidis; and the various forms of Candida. Algorithms demonstrate the approach to the surgical patient at risk for candidiasis, aspergillosis, and other types of fungal infection. This review contains 5 figures, 4 tables, and 189 references.