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Abstract:
Fungal infections are seen predominantly in patients with neoplastic diseases. Autopsy studies revealed that 30 to 50% of decreased patients with hematologic neoplasms have histopathologically documented invasive fungal infections. The rationale for fungal chemoprophylaxis is the high incidence of fungal disease in these patients (5), the high mortality (29), the difficulty in diagnosing (28), and the severe side effects of systemic antifungal therapy with amphotericin B (3). Endogenous sources such as oropharyngeal and digestive mucous membranes and exogenous pathways such as air (e.g.aspergilli) or food have to be considered. Therefore, prophylaxis has to comprise both aspects:Prevention of acquisition through nonspecific hygiene measures (5), reduction of colonization (non-absorbable antifungals or systemic chemoprophylaxis) (20). Antifungal prophylaxis of candidosis with both non- and absorbable drugs has not been convincing in terms of reduction of proven fungal infections. Prevention of aspergillosis consists mainly of the control of room air.
Insights
Fungal infections are common and deadly in cancer patients. Prophylaxis strategies must prevent acquisition and reduce colonization, but current methods for candidiasis and aspergillosis are not fully effective.
Area of Science:
- Medical Mycology
- Hematology
- Infectious Diseases
Background:
- Invasive fungal infections (IFIs) are prevalent in patients with neoplastic diseases, with autopsy studies showing 30-50% of hematologic neoplasm patients have documented IFIs.
- High incidence, mortality, diagnostic challenges, and severe side effects of treatments like amphotericin B necessitate effective chemoprophylaxis.
Purpose of the Study:
- To review the rationale and strategies for antifungal chemoprophylaxis in patients with neoplastic diseases.
- To discuss endogenous and exogenous sources of fungal infections and necessary preventive measures.
Main Methods:
- Review of existing literature on fungal infections in cancer patients.
- Analysis of current prophylaxis strategies, including hygiene, non-absorbable, and systemic antifungals.
- Consideration of specific fungal pathogens like Candida and Aspergillus.
Main Results:
- Antifungal prophylaxis for candidiasis using absorbable or non-absorbable drugs has shown limited success in reducing proven infections.
- Prevention of aspergillosis primarily relies on controlling airborne exposure, such as through room air filtration.
Conclusions:
- Comprehensive antifungal prophylaxis requires addressing both acquisition prevention and colonization reduction.
- Current prophylactic approaches for candidiasis and aspergillosis in immunocompromised patients require further optimization and validation.