Meeting the challenge of systemic fungal infections in cancer: nursing implications

Several factors have contributed to the increasing incidence of fungal infections over the last 2 decades, including the emergence of Acquired Immune Deficiency Syndrome, increased use of myelotoxic chemotherapy and organ transplantations, prolonged use of broad spectrum antibiotics and aggressive intensive care procedures. The two most common opportunistic fungal infections seen today are caused by Candida spp. and Aspergillus spp. Systemic fungal infections in immunocompromised patients have an extremely high mortality and require aggressive therapy. Skill in identifying early clinical features is therefore crucial and the multifaceted role of the nurse is of major importance in the management of at-risk patients. Nurses are the key resource in the prevention, early detection and treatment of fungal infection. All neutropenic patients should be thoroughly assessed at least twice a day, with special attention given to the most frequent sites of infection-the oral mucosa, lungs, skin, venepuncture sites and perineal area. Although fever is the hallmark of infection, it may be absent in the neutropenic patient who is unable to mount an adequate inflammatory response. It may also be masked by the use of certain drugs, such as steroids or analgesics. When systemic fungal infection is suspected, seriously ill patients require immediate antifungal therapy. Amphotericin B is currently the only agent with a sufficiently broad spectrum of activity to cover all the most common pathogens. Although conventional amphotericin B is effective, however, the required doses often carry significant toxicity, particularly nephrotoxicity. The new, lipid-based forms of amphotericin B, such as Abelcet, are indicated for and have been shown to be effective in patients with severe systemic and/or deep mycoses in whom conventional amphotericin B has proven ineffective or is contraindicated because of renal impairment, and in patients who have failed to respond to other antifungal agents.