The frequency and diversity of serious fungal infections does increase and severely immunocompromised patients are particularly vulnerable to infection from moulds and yeasts. Candida and Aspergillus species are the predominant pathogens. Candida bloodstream infections are associated with high morbidity and mortality in both neutropenic and non-neutropenic critically ill patients. Risk factors associated are diverse and include exposure to broad spectrum antimicrobial agents, mucosal colonization, indwelling vascular catheters, surgery and cancer chemotherapy. Differences in geographical epidemiology are emerging, in particular regarding a shift towards non-albicans species. This shift has been correlated with routine fluconazole administration. Aspergillus spp. can cause a wide spectrum of diseases in humans, including allergy, superficial infection, and invasive disease. Invasive aspergillosis has emerged as a leading cause of morbidity and mortality in immunocompromised patients. The most important species are Aspergillus fumigatus followed by Aspergillus flavus. Contemporaneously, infections with rare molds are on rise. Zygomyzetes, Trichosporon, Fusarium, Alternaria, Pseudallescheria and dematiaceous fungi are recognized more frequently. The emergence of these organisms is multifactorial and can be related to more intense immunosuppression, the prolonged survival of patients, and the selective pressure of broad spectrum antifungal agents used for prophylaxis or therapy. Among these rare mould infections, the zygomycetes are the most commonly encountered, and appear to be associated with the use of voriconazole. Aspergillus terreus, a species that is resistant to amphotericin B, and less frequently, A. ustus and A. lentulus, have been noted increasingly as causes of invasive aspergillosis in some tertiary care centres. Scedosporium with innate resistance to many antifungal agents have emerged as major causes of disseminated infections, followed by infections due to Fusarium species. Dematiaceous, or brown-black, fungi, most often associated with chronic localised infections, are now increasingly reported as a cause of disseminated infection in immunosuppressed hosts. Watchful surveillance, rapid detection of disease, adequate treatment and effective control measures are highly warranted in the optimal management of these difficult to treat fungal infections.
Full conference title:
20th European Congress of Clinical Microbiology and Infectious Diseases
- ECCMID 20th (2010)