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Invasive fungal infections in hematology: new trends
1Division of Clinical Hematology, Hospital de la Sant Creu i Sant Pau, Av. Sant Antoni Ma Claret, 167, 08025 Barcelona, Spain. rmartino@hsp.santpau.es
Abstract:
Invasive fungal infections (IFI) are among the most feared complications of patients being treated for a hematological malignancy. Currently, most serious IFI occur in patients with acute leukemia and after allogeneic hematopoietic stem cell transplantation. Although Candida albicans and Aspergillusspp. continue to be the main pathogens, the proportion of patients infected by non-albicans species of Candida and other yeasts and by other filamentous fungi is rising in most institutions. Risk factors for the various IFI differ, and it is thus of utmost importance to realize that not all patients are the same with respect to the risk for developing the various IFI. Recent advances in diagnosis now allow the use of very sensitive imaging techniques with an extremely low negative predictive value. Among the novel microbiologic methods, the galactomannan antigen test is now commercially available for routine use in the diagnosis of aspergillosis, while DNA fungal detection is still experimental. For the first time, clinicians now have a broad range of antifungals to chose from, with special emphasis on amphotericin B preparations, novel broad-spectrum azoles, and the echinocandins. However, the exact place of these agents in treating different IFI will need to be found in the near future.
Insights
Invasive fungal infections (IFIs) are a serious risk for patients with blood cancers and stem cell transplants. New diagnostic tools and antifungal treatments offer hope, but their optimal use requires further study.
Area of Science:
- Hematology
- Mycology
- Infectious Diseases
Background:
- Invasive fungal infections (IFIs) are a significant complication in patients undergoing treatment for hematological malignancies.
- While Candida and Aspergillus remain primary pathogens, there's a rising incidence of infections caused by non-albicans Candida species and other fungi.
- Patient risk factors for IFIs vary significantly, necessitating individualized risk assessment.
Purpose of the Study:
- To review the current landscape of invasive fungal infections in immunocompromised patients.
- To highlight advancements in diagnostic techniques and therapeutic options for IFIs.
- To emphasize the need for personalized approaches to managing IFIs in hematology patients.
Main Methods:
- Review of recent literature on invasive fungal infections in hematological malignancies.
- Discussion of emerging diagnostic modalities, including imaging and novel microbiologic tests.
- Overview of the current and emerging antifungal armamentarium.
Main Results:
- Invasive fungal infections pose a major threat, particularly in acute leukemia and post-allogeneic stem cell transplantation.
- Diagnostic advancements include sensitive imaging and the galactomannan antigen test for aspergillosis.
- A wider array of antifungal agents, including amphotericin B, azoles, and echinocandins, are now available.
Conclusions:
- The spectrum of pathogens causing IFIs is evolving, with an increase in non-albicans yeasts and other fungi.
- Novel diagnostic tools improve early detection, though DNA fungal detection is still experimental.
- The optimal clinical application of new antifungal agents for various IFIs requires further investigation.