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Epidemiology of opportunistic invasive mycoses
B J Kullberg1, A M L Oude Lashof
1Nijmegen Center for Infectious Diseases and Department of Medicine (541), Nijmegen University Medical Center St Radboud, Geert Grooteplein 8, 6525 GA Nijmegen, The Netherlands. bj@kullberg.com
Abstract:
Invasive aspergillosis and disseminated candidiasis are the two major manifestations of opportunistic invasive mycoses. Their incidence has risen considerably during the past decades, due to more intensive anticancer chemotherapy, organ transplantations, intensive care, and aggressive surgical interventions. Especially bone marrow transplant recipients are at risk for developing invasive aspergillosis. Whether the infection is acquired through contaminated water or through airborne spores is a matter of much debate. Candidemia and disseminated candidiasis commonly originate from the gastrointestinal tract. Abdominal surgery and mucosal damage due to anticancer chemotherapy are the majors factor through which gut colonization may lead to invasive disease. A shift in the epidemiology of disseminated candidiasis has been noted, with an increasing incidence of Candida glabrata, C. tropicalis and C. krusei strains.
Insights
Invasive fungal infections like aspergillosis and candidiasis are increasing, particularly in transplant patients. Understanding infection sources and evolving fungal strains is crucial for managing these opportunistic mycoses.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Immunocompromised Host
Background:
- Opportunistic invasive mycoses, specifically invasive aspergillosis and disseminated candidiasis, represent significant threats.
- Increased incidence is linked to intensive anticancer chemotherapy, organ transplantation, critical care, and major surgery.
- Bone marrow transplant recipients are particularly vulnerable to invasive aspergillosis.
Purpose of the Study:
- To review the epidemiology and risk factors associated with invasive aspergillosis and disseminated candidiasis.
- To discuss the debated sources of invasive aspergillosis (waterborne vs. airborne).
- To highlight the gastrointestinal tract as the common origin for candidemia and disseminated candidiasis.
Main Methods:
- Review of current literature on opportunistic invasive mycoses.
- Analysis of epidemiological trends and risk factors.
- Discussion of potential infection pathways and emerging fungal pathogens.
Main Results:
- Invasive aspergillosis and disseminated candidiasis incidence has risen significantly.
- Gastrointestinal tract is a primary source for candidiasis, with abdominal surgery and chemotherapy-induced mucosal damage as key factors.
- A notable shift in candidiasis epidemiology shows increased prevalence of Candida glabrata, C. tropicalis, and C. krusei.
Conclusions:
- Intensified medical interventions have led to a rise in life-threatening invasive fungal infections.
- Further research is needed to clarify the transmission routes of invasive aspergillosis.
- Awareness of changing candidiasis epidemiology is essential for effective treatment and prevention strategies.