Invasive fungal infections (IFIs) are an important cause of morbidity and mortality, particularly in patients with underlying risk factors (e.g., neutropenia, cancer chemotherapy, transplantation, AIDS). Candida species and Aspergillus species remain the relevant causes of IFI but other organisms become increasingly important with mucormycosis (formerly zygomycosis), Trichosporon, Fusarium and Scedosporium species being on rise. The incidence, severity and outcome of IFIs, is largely influenced by the causative organism, underlying condition, state of immunosuppression, and the geographic location. IFD-related mortality rates range from 38 to 90%. Non-Aspergillus invasive infections are of particular concern because of the following factors: the difficulty in distinguishing them clinically from Aspergillus spp. infections and from each other; their progressive and aggressive course; and the intrinsic resistance of many of these fungi to several antimicrobial agents, including voriconazole and echinocandins. IFD may occur as breakthrough fungal infections during treatment with the latter antifungal drugs. These trends are worrisome, given that these emerging molds are often refractory to conventional antifungal agents. Innate resistance or erratic susceptibility to amphotericin B is characteristic of certain fungi (e.g. Scedosporium apiospermum and Scedosporium prolificans). Clinical manifestations range from colonization to chronic localized lesions to acute invasive and/or disseminated diseases. Diagnosis usually requires isolation and identification of the infecting pathogen and early therapy is important to prevent progression to a more aggressive or disseminated infection. Management may consist of surgery and antifungal treatment, depending on the clinical presentation.
Full conference title:
- ISHAM 19th (2015)