Invasive fungal infections: a review of epidemiology and management options

Abstract

Fungi are increasingly recognised as major pathogens in critically ill patients. Candida spp. and Cryptococcus spp. are the yeasts most frequently isolated in clinical practice. The most frequent filamentous fungi (moulds) isolated are Aspergillus spp., but Fusarium spp., Scedosporium spp., Penicillium spp., and Zygomycetes are increasingly seen. Several reasons have been proposed for the increase in invasive fungal infections, including the use of antineoplastic and immunosuppressive agents, broad-spectrum antibiotics, and prosthetic devices and grafts, and more aggressive surgery. Patients with burns, neutropenia, HIV infection and pancreatitis are also predisposed to fungal infection. The epidemiology and clinical features of fungal infections are reviewed, together with antifungal agents currently or soon to be available. IntroductionFungi are increasingly recognized as major pathogens in critically ill patients. Candida spp. and Cryptococcus spp. are the yeasts most frequently isolated in clinical practice. The most frequent filamentous fungi (moulds) isolated are Aspergillus spp., but Fusarium spp., Scedosporium spp., Penicillium spp. and Zygomycetes are increasingly seen (Marr et al., 2002;Husain et al., 2003). Several reasons have been proposed for the increase in invasive fungal infections, including the use of antineoplastic and immunosuppressive agents, broad-spectrum antibiotics, and prosthetic devices and grafts, and more aggressive surgery. Patients with burns, neutropenia, HIV infection and pancreatitis are also predisposed to fungal infection (Eggimann et al., 2003).The epidemiology and clinical features of fungal infections are reviewed, together with antifungal agents currently or soon to be available. OrganismsCandida spp.Disseminated candidiasis is associated with a mortality in excess of 25 % . Candida is a normal commensal of the skin, and gastrointestinal and genitourinary tracts. Candida albicans is the most frequent species isolated from clinical specimens, but other species (nonalbicans Candida, NAC) are increasingly seen. NAC are of special concern, since some are highly virulent and are associated with treatment failure due to reduced susceptibility to antifungal agents. Although identification to species level and susceptibility testing are technically demanding, it is recommended that they should be performed on all fungi obtained from sterile sites and urine of intensive-care and transplant patients .Candidaemia rates increased rapidly in the 1980s, so that Candida spp. became the fourth-commonest cause of bloodstream infection (BSI) in the USA (Edmond et al., 1999). It has been noted, however, that this increasing trend changed in the late 1990s as a result of a significant decrease in the incidence of C. albicans BSI (Trick et al., 2002). The incidence of NAC BSI remained stable, apart from that due to Candida glabrata, which increased significantly. This rise in C. glabrata also occurred in two prospective studies from Italy (Tortorano et al., 2002(Tortorano et al., , 2004a. Pro...

Diagnosis of invasive fungal infections by a real-time panfungal PCR assay in immunocompromised pediatric patients

“…Whenever possible, specimens were collected at first onset of fever, within 48 h thereafter, and at subsequent time points in the course of the febrile episode, upon availability. On average, four peripheral blood samples were investigated during each episode (range [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15]. In selected instances, depending on availability, additional types of specimens derived from primarily sterile sites of suspected infection were collected and subjected to molecular analysis.…”

“…The vast majority of IFD events are still caused by Candida and Aspergillus species; however, changes in the epidemiology have occurred over the past decades. [1][2][3][4][5] Recent studies from North American and European centers indicate an increasing incidence of previously uncommon fungal genera, such as Cryptococcus, Trichosporon, Malassezia, 6,7 Fusarium, 8,9 Scedosporium, Pseudallescheria, 10,11 and, very importantly, different members of the class Zygomycetes, such as Rhizopus and Mucor. 12 Timely detection of the fungal pathogens is a prerequisite for successful therapy and the clinical outcome in patients with IFD.…”

Micosis pulmonares en pacientes de la Quinta Región: Período 2007-2010

“…En los últimos años hemos asistido a un incremento de las aspergilosis invasoras, debido al aumento de los trasplantes, tratamientos inmunodepresores, citotóxicos y pacientes con SIDA 5,6 , además de una mayor sospecha y mejores herramientas diagnósticas 7,8 .…”

A rare, fatal case of invasive spinal aspergillosis in an antiretroviral-naïve, HIV-infected man with pre-existing lung colonization

“…Aspergillus species are the most frequently isolated moulds among human immunodeficiency virus (HIV)-infected patients (Enoch et al, 2006), but invasive aspergillosis is very uncommon in this population (,1 %) (Cornet et al, 2002). Despite this low incidence, it is of particular importance because the case-fatality rate associated with disseminated infection or central nervous system (CNS) involvement is reported to be 88 % (Lin et al, 2001).…”