Invasive aspergillosis in cancer patients

The incidence of invasive aspergillosis is increasing parallel to the intensity of immunosuppressive and myelosuppressive anticancer treatments. Successful management is linked to an understanding of the pathogenesis and recognition of risk factors. Identifying the patients and clinical circumstances associated with the highest risk for invasive aspergillosis and managing patients in protected environments remain the most effective means of prevention. Early accurate diagnosis continues to be a challenge; however, newer non-culture-based methods are encouraging and have been incorporated into standardized case definitions. Unacceptably high mortality rates persist with current treatment of established infection. Among the newer potentially less toxic antifungal therapies are the triazoles, and lipid-based polyene-formulations that target the fungal cell membrane and 1,3-beta-D-glucan synthase inhibitors that target the fungal cell wall. These agents are currently in clinical trials. Host defense augmentation using hematopoietic growth factors with or without other cytokines such as interferon-gamma or hematopoietic growth factor-stimulated neutrophil transfusions remain controversial strategies that have yet to be tested in well-designed randomized controlled trials.