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Emerging fungal pathogens
E J Anaissie1, G P Bodey, M G Rinaldi
1Department of Medical Specialities, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Abstract:
Fungi such as Fusarium spp., Curvularia spp., Alternaria spp. or Trichosporon beigelii, had been thought to represent contamination or harmless colonization when isolated from humans. More recently, the role of these and other newly recognized fungi as serious pathogens has been clearly established. Three diverse groups of fungi are responsible for these infections: the agents of phaeohyphomycosis and hyalohyphomycosis and certain yeasts. These infections, which have been encountered in both presumably healthy and immuno-compromised individuals, tend to be localized in the former, and disseminated and frequently fatal in the latter group of patients. A major concern is that these organisms are not uniformly susceptible to amphotericin B. Standardization of antifungal susceptibility testing may, therefore, be helpful in determining the antifungal drug of choice for each infection. It is also hoped that the advent of newer antifungals and biologic response modifiers will have a significant impact on the morbidity and mortality of these emerging infections.
Insights
Emerging fungal infections caused by Fusarium, Curvularia, and other fungi are increasingly recognized as serious threats. Antifungal susceptibility testing is crucial for treating these potentially fatal infections, especially in immunocompromised patients.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Clinical Microbiology
Background:
- Fungi previously considered contaminants, such as Fusarium spp. and Trichosporon beigelii, are now recognized as significant human pathogens.
- Infections caused by these fungi fall into three main groups: phaeohyphomycosis, hyalohyphomycosis, and yeast infections.
- These infections affect both healthy and immunocompromised individuals, with disseminated and fatal outcomes more common in the latter group.
Purpose of the Study:
- To highlight the emerging role of fungi as serious human pathogens.
- To emphasize the importance of antifungal susceptibility testing for guiding treatment decisions.
- To discuss the potential impact of new antifungals and biologic response modifiers on managing these infections.
Main Methods:
- Review of current literature on emerging fungal infections.
- Categorization of fungal pathogens into distinct groups responsible for human infections.
- Discussion of clinical presentations and outcomes in different patient populations.
Main Results:
- Previously overlooked fungi are now established as causative agents of significant human mycoses.
- Fungal infections present with varying severity, from localized to disseminated and life-threatening disease.
- A significant challenge is the variable susceptibility of these fungi to standard antifungal agents like amphotericin B.
Conclusions:
- Standardization of antifungal susceptibility testing is essential for selecting effective treatments.
- Emerging fungal infections pose a growing threat, necessitating improved diagnostic and therapeutic strategies.
- Newer antifungal agents and immunomodulatory therapies hold promise for improving patient outcomes.