[Fungal and parasitic infections during immunosupressive treatment (author's transl)]

Deep visceral fungus infections, induced by occasional pathogens, have caused a new class of diseases, and occupy a more and more important place among the complications due to immunosuppressive agents. The experience of the Mycology Unit of the Pasteur Institute, where recent techniques of mycological and immunological diagnosis of these fungus infections are used, is reported here. 24 patients submitted to corticosteroids and other immunosuppressive treatments, including 6 renal transplants and one liver transplant, developed deep visceral infection with septicemia due to Candida, in a series of 106 cases of deep candidiasis due to massive antibiotic treatment diagnosed over the last few years. The mycological, immunological and therapeutic data obtained after treatment with amphotericin B and 5-fluorocytosine are reported here. 8 cases of meningeal, pulmonary and bony and cutaneous cryptococcosis, occurring after corticotherapy (6 cases), radiotherapy (1 case) and renal transplantation (one case), are presented together with the favourable results (6 cures out of 8) obtained with amphotericin B and 5-fluorocytosine, eight alone or in association. The authors also report 2 cases of aspergillosis, one in the lung, occurring in a case of renal transplantation who was given, at an early stage, amphotericin B and 5-fluorocytosine, thanks to rapid laboratory diagnosis, and another case in a heart transplant with pulmonary and cerebral localisations from which the patient died. The literature on these fungus infections, together with the mucormycoses, nocardioses and other fungus and antinomycosal complications are reported, together with parasitic infections the severity of which is emphasized in renal transplants, in particular P. carinii pneumonia, toxoplasmosis, strongyloidiasis and other parasitic diseases.