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Uncommon opportunistic fungi: new nosocomial threats
1Immunocompromised Host Section, Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA. grolla@mail.nih.gov
Abstract:
During the past two decades opportunistic fungal infections have emerged as important causes of morbidity and mortality in patients with severe underlying illnesses and compromised host defenses. While Aspergillus and Candida spp. collectively account for the majority of these infections, recent epidemiological trends indicate a shift towards infections by Aspergillus spp., nonalbicans Candida spp., as well as previously uncommon opportunistic fungi. Apart from an expanding number of different Zygomycetes, previously uncommon hyaline filamentous fungi (such as Fusarium species, Acremonium species, Paecilomyces species, Pseudallescheria boydii, and Scedosporium prolificans), dematiaceous filamentous fungi (such as Bipolaris species, Cladophialophora bantiana, Dactylaria gallopava, Exophiala species, and Alternaria species) and yeast-like pathogens (such as Trichosporon species, Blastoschizomyces capitatus, Malassezia species, Rhodotorula rubra and others) are increasingly encountered as causing life threatening invasive infections that are often refractory to conventional therapies. On the basis of past and current trends, the spectrum of fungal pathogens will continue to evolve in the settings of an expanding population of immunocompromised hosts, selective antifungal pressures, and shifting conditions in hospitals and the environment. An expanded and refined drug arsenal, further elucidation of pathogenesis and resistance mechanisms, establishment of in vitro/in vivo correlations, incorporation of pharmacodynamics, combination- and immunotherapies offer hope for substantial progress in prevention and treatment.
Insights
Opportunistic fungal infections are increasing, with a rise in uncommon fungi affecting immunocompromised patients. New treatments are needed to combat these evolving, often drug-resistant, infections.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Immunocompromised Host Research
Background:
- Opportunistic fungal infections pose significant morbidity and mortality risks in immunocompromised individuals.
- Epidemiological trends show a shift from common fungi like Aspergillus and Candida spp. towards less common species.
- Previously rare fungi, including Zygomycetes, hyaline and dematiaceous molds, and yeast-like pathogens, are increasingly causing life-threatening infections.
Purpose of the Study:
- To highlight the evolving spectrum of opportunistic fungal pathogens.
- To underscore the challenges posed by infections refractory to conventional therapies.
- To discuss future directions in combating these infections.
Main Methods:
- Review of epidemiological trends in opportunistic fungal infections.
- Analysis of emerging fungal pathogens and their clinical significance.
- Discussion of current and future therapeutic strategies.
Main Results:
- A notable increase in infections caused by non-albicans Candida, Aspergillus spp., and previously uncommon fungi.
- Identification of various hyaline and dematiaceous filamentous fungi and yeast-like pathogens as emerging threats.
- Recognition that many of these infections are resistant to standard antifungal treatments.
Conclusions:
- The landscape of fungal pathogens is continuously changing due to factors like increased immunocompromised populations and antifungal drug pressure.
- Advancements in antifungal drugs, understanding pathogenesis and resistance, and novel therapies like combination and immunotherapy are crucial.
- Further research and development are essential for improved prevention and treatment of invasive fungal infections.