Abstract

In the expanding population of immunocompromised patients and those treated in intensive care units, rare fungal infectious agents have emerged as important pathogens, causing invasive infections associated with high morbidity and mortality. These infections may present either as de novo or as breakthrough invasive infections in high-risk patients with hematologic malignancies receiving prophylactic or empirical antifungal therapy or in patients with central venous catheters. Diagnosis and treatment are challenging. Physicians should have a high index of suspicion because early diagnosis is of paramount importance. Conventional diagnostic methods such as cultures and histopathology are still essential, but rapid and more specific molecular techniques for both detection and identification of the infecting pathogens are being developed and hopefully will lead to early targeted treatment. The management of invasive fungal infections is multimodal. Reversal of risk factors, if feasible, should be attempted. Surgical debridement is recommended in localized mold infections. The efficacy of various antifungal drugs is not uniform. Amphotericin B is active against most yeasts, except Trichosporon, as well as against Mucorales, Fusarium, and some species of Paecilomyces and dimorphic fungi. The use of voriconazole is suggested for the treatment of trichosporonosis and scedosporiosis. Combination treatment, though recommended as salvage therapy in some infections, is controversial in most cases. Despite the use of available antifungals, mortality remains high. The optimization of molecular-based techniques, with expansion of reference libraries and the possibility for direct detection of resistance mechanisms, is awaited with great interest in the near future. Further research is necessary, however, in order to find the best ways to confront and destroy these lurking enemies.

Highlights

  • The quest for the early diagnosis and effective treatment of invasive fungal infections is ongoing, and there are still many obstacles to overcome

  • The aim of this review is to present an update on invasive infections due to these rare and emerging fungi, focusing on new developments in diagnostic methodologies and therapeutic modules

  • In recent years, improved treatment of HIV infection with highly active antiretroviral therapy and control of HIV/AIDS because of improvement in the healthcare systems of developing countries in that region, such as mainland China, Thailand, and Vietnam, have led to a change in the epidemiology of T. marneffei infection, and there is an increasing number in immunocompromised non-HIV-infected patients[234]. These are usually patients receiving immunosuppressive therapies associated with transplantation or autoimmune diseases and hematology patients treated with novel targeted therapies, including anti-CD20 monoclonal antibodies and kinase inhibitors[234,235,236], and patients with primary adult-onset immunodeficiency due to anti-interferon-gamma auto-antibodies[237]

Read more

Summary

Introduction

The quest for the early diagnosis and effective treatment of invasive fungal infections is ongoing, and there are still many obstacles to overcome. In recent years, improved treatment of HIV infection with highly active antiretroviral therapy and control of HIV/AIDS because of improvement in the healthcare systems of developing countries in that region, such as mainland China, Thailand, and Vietnam, have led to a change in the epidemiology of T. marneffei infection, and there is an increasing number in immunocompromised non-HIV-infected patients[234] These are usually patients receiving immunosuppressive therapies associated with transplantation or autoimmune diseases and hematology patients treated with novel targeted therapies, including anti-CD20 monoclonal antibodies and kinase inhibitors[234,235,236], and patients with primary adult-onset immunodeficiency due to anti-interferon-gamma auto-antibodies[237].

Conclusions
26. European Centre for Disease Prevention and Control
Findings
PubMed Abstract
Full Text
Published version (Free)

Talk to us

Join us for a 30 min session where you can share your feedback and ask us any queries you have

Schedule a call