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Fungal infections in nontransplant patients with hematologic malignancies
Brahm H Segal1, Eric J Bow, Francisco Menichetti
1Division of Infectious Diseases, SUNY at Buffalo, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA. brahm.segal@roswellpark.org
Abstract:
Fungal infections are a major cause of morbidity and mortality in patients with hematologic malignancies. Candida and Aspergillus species are the most important opportunistic fungal pathogens in this patient population. Dimorphic fungi can cause serious infection in immunocompetent persons, but infection is more likely to be disseminated in patients with compromised cell-mediated immunity. Cryptococcus neoformans and Pneumosystis carinii typically cause infections in persons with severe T-cell suppression. The frequency of rare pathogenic fungi commonly resistant to amphotericin B has significantly increased over the past 20 years among patients with hematologic malignancies. Examples of such emerging pathogens include Trichosporon, Fusarium, and Scedosporium species, and dark-walled molds. This article reviews the epidemiology, clinical manifestations, diagnostic evaluation, and treatment of the major fungal pathogens in nontransplant patients with hematologic malignancies.
Insights
Hematologic malignancy patients face significant risks from fungal infections, particularly from Candida and Aspergillus species. Emerging resistant fungal pathogens pose an increasing threat, necessitating a review of their epidemiology, diagnosis, and treatment.
Area of Science:
- Mycology
- Hematology
- Infectious Diseases
Background:
- Fungal infections are a significant cause of illness and death in patients with hematologic malignancies.
- Candida and Aspergillus species are the primary opportunistic fungal pathogens in this vulnerable group.
- Rare fungal pathogens resistant to standard treatments are increasingly prevalent.
Purpose of the Study:
- To review the epidemiology of fungal infections in non-transplant hematologic malignancy patients.
- To discuss the clinical manifestations, diagnostic approaches, and treatment strategies for major fungal pathogens.
- To highlight the rising incidence of emerging fungal pathogens resistant to amphotericin B.
Main Methods:
- Review of epidemiological data on fungal infections in hematologic malignancy patients.
- Analysis of clinical presentations and diagnostic methods for common and emerging fungal pathogens.
- Evaluation of current treatment guidelines and therapeutic options for fungal infections.
Main Results:
- Candida and Aspergillus species are the most common fungal pathogens.
- Dimorphic fungi and encapsulated yeasts like Cryptococcus neoformans cause disseminated infections in immunocompromised hosts.
- Emerging pathogens such as Trichosporon, Fusarium, Scedosporium, and dark-walled molds are increasingly identified and often resistant to amphotericin B.
Conclusions:
- Fungal infections remain a critical concern for patients with hematologic malignancies.
- Early diagnosis and appropriate treatment are crucial for improving outcomes.
- The rise of antifungal resistance necessitates ongoing surveillance and development of new therapeutic strategies.