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Invasive mould infections: a multi-disciplinary update

Maschmeyer, Georg ; Calandra, Thierry ; Singh, Nina ; Wiley, Joseph ; Perfect, John

In: Medical Mycology, 2009, vol. 47, no. 6, p. 571-583

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    Titel
    • Invasive mould infections: a multi-disciplinary update
    Autor
    • Maschmeyer, Georg. Department of Haematology and Oncology, Center for Haematology, Oncology and Radiotherapy, Klinikum Ernst von Bergmann, Potsdam, Germany
    • Calandra, Thierry. Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
    • Singh, Nina. Veterans Affairs Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
    • Wiley, Joseph. Division of Pediatric Hematology-Oncology, Department of Pediatrics, The Herman and Walter Samuelson Children's Hospital at Sinai, Baltimore, Maryland, USA
    • Perfect, John. Duke Mycology Research Unit, Duke University Medical Center, Durham, North Carolina, USA
    Dokumententyp
    • Postprint
    OAI-PMH-ID
    • oai:doc.rero.ch:301965
    Summary
    Systemic fungal infections remain a significant cause of mortality in neutropenic and immunocompromised patients, despite advances in their diagnosis and treatment. The incidence of such infections is rising due to the use of intensive chemotherapy regimens in patients with solid tumours or haematological cancers, the increasing numbers of allogeneic haematopoietic stem cell and solid organ transplants, and the use of potent immunosuppressive therapy in patients with autoimmune disorders. In addition, the epidemiology of systemic fungal infections is changing, with atypical species such as Aspergillus terreus and zygomycetes becoming more common. Treatment has traditionally focused on empirical therapy, but targeted pre-emptive therapy in high-risk patients and prophylactic antifungal treatment are increasingly being adopted. New treatments, including lipid formulations of amphotericin B, second-generation broad-spectrum azoles, and echinocandins, offer effective antifungal activity with improved tolerability compared with older agents; the potential impact of these treatments is reflected in their inclusion in current treatment and prophylaxis guidelines. New treatment strategies, such as aerosolized lipid formulations of amphotericin B, may also reduce the burden of mortality associated with systemic fungal infections. The challenge is to identify ways of coupling potentially effective treatments with early and reliable identification of patients at highest risk of infection