Abstract
Despite the medical advances and interventions to improve the quality of life of those in intensive care, people with cancer or severely immunocompromised or other susceptible hosts, invasive fungal diseases (IFD) remain severe and underappreciated causes of illness and death worldwide. Therefore, IFD continue to be a public health threat and a major hindrance to the success of otherwise life-saving treatments and procedures. Globally, hundreds of thousands of people are affected every year with Candida albicans, Aspergillus fumigatus, Cryptococcus neoformans, Pneumocystis jirovecii, endemic dimorphic fungi and Mucormycetes, the most common fungal species causing invasive diseases in humans. These infections result in morbidity and mortality rates that are unacceptable and represent a considerable socioeconomic burden. Raising the general awareness of the significance and impact of IFD in human health, in both the hospital and the community, is hence critical to understand the scale of the problem and to raise interest to help fighting these devastating diseases.
Highlights
In this perspective article, the main risk factors of people to develop invasive fungal diseases (IFD) are summarised, to aid recognising the impact of fungi on human health, an issue often underestimated and underappreciated
Recent studies have estimated that globally, fungal infections kill more than 1.5 million people per year, which is similar to the mortality due to tuberculosis and about three-times more than malaria.[6] the true burden of IFD is probably miscalculated because of the absence or availability of reliable, sensitive and universal diagnostic methods and because fungal infections are usually hindered by other diseases
Among at-risk and immunocompromised patients, Candida albicans, Aspergillus fumigatus, Cryptococcus neoformans, Pneumocystis jirovecii, endemic dimorphic fungi and Mucormycetes remain the main fungal pathogens responsible for most cases of serious fungal diseases in the world (Tables I, II, Figure).(5,6,9,10) While the ability of these fungi to cause disease depends on their virulence factors and pathogenic capacity, as well as on the interactions with the host and adaptation to different environments, the outcome of the infections is influenced by various others factors
Summary
An invasive or systemic fungal disease is proven when tissue damage due to fungal elements is observed by histopathologic examination and/or when the aetiologic agent is isolated by culture from clinical sterile samples such as blood, tissue or cerebrospinal fluid.[7]. As clinical manifestations of IFD are not specific and the severity of the disease depends on the host’s defences and immune response, a high degree of suspicion is needed for the early diagnosis and optimal management of these infections.[8]. The patients’ underlying medical condition, the time for diagnosis, the choice of therapy, especially when fighting strains or species that are resistant to antifungal drugs, the capacity to achieve prompt and effective source control, and the adverse effects of antifungal drugs alone or concomitantly administered with other drugs, are factors that significantly contribute to IFD prognosis.[5] identifying susceptible patients or those who are clinically suspected of having a fungal infection, along with an early empiric therapy or prophylaxis, are of paramount importance to decrease mortality and morbidity associated to IFD
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