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Opportunistic mycoses in the immunocompromised host: experience at a cancer center and review
1Department of Medical Specialties, University of Texas M. D. Anderson Cancer Center, Houston 77030.
Abstract:
The field of opportunistic mycoses in the patient with cancer is rapidly changing. Not only are fungal infections increasing in frequency in this patient population, but these infections are occurring earlier during the course of cytotoxic chemotherapy, and newer fungi are increasingly recognized as potentially lethal pathogens. Candidiasis remains the most commonly encountered infection. The spectrum of disease includes candidemia and acute and chronic disseminated candidiasis. Pulmonary aspergillosis and disseminated aspergillosis are common and remain relatively resistant to therapy. Disseminated fusariosis and trichosporosis are almost always fatal in the setting of persistent profound neutropenia. Therapy for these mycoses relies on the use of amphotericin B and 5-fluorocytosine. Newer antifungal agents, such as fluconazole and itraconazole, appear to exhibit good activity against a variety of fungi. Newer approaches need to be tested for the treatment of the more-resistant mycoses and may include the use of maximally tolerated doses of antifungal agents, colony-stimulating factors, and combination therapy.
Insights
Opportunistic fungal infections are increasing in cancer patients, often occurring earlier during chemotherapy. Newer antifungal agents show promise, but resistant mycoses require novel treatment strategies.
Area of Science:
- Oncology
- Mycology
- Infectious Diseases
Background:
- Opportunistic mycoses are a growing concern in cancer patients.
- Fungal infections are occurring earlier in chemotherapy and involve new pathogens.
- Candidiasis, aspergillosis, fusariosis, and trichosporosis are significant threats.
Purpose of the Study:
- To review the changing landscape of opportunistic mycoses in cancer patients.
- To discuss current and emerging treatment strategies for these infections.
Main Methods:
- Literature review of opportunistic mycoses in cancer patients.
- Analysis of current therapeutic approaches and newer antifungal agents.
Main Results:
- Candidiasis is the most common fungal infection.
- Pulmonary and disseminated aspergillosis are common and treatment-resistant.
- Disseminated fusariosis and trichosporosis are often fatal in neutropenic patients.
- Newer agents like fluconazole and itraconazole show activity against various fungi.
Conclusions:
- Effective management of opportunistic mycoses in cancer patients is critical.
- Novel therapeutic approaches, including combination therapy and supportive measures, are needed for resistant infections.