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Recent progress and current problems in treatment of invasive fungal infections in neutropenic patients
T J Walsh1, J W Hiemenz, E Anaissie
1Infectious Diseases Section, National Cancer Institute, Bethesda, Maryland, USA.
Abstract:
Invasive fungal infections, including disseminated candidiasis and invasive pulmonary aspergillosis, are important causes of morbidity and mortality in neutropenic patients. The recent development of fluconazole, itraconazole, lipid formulations of amphotericin B, and recombinant cytokines have expanded our therapeutic armamentarium. Clinical trials have elucidated new strategies for utilizing these compounds in the prevention and treatment of opportunistic mycoses. The population of more severely immunocompromised patients, however, continues to expand and the spectrum of drug-resistant fungi, including but not limited to Candida spp, Fusarium spp, Zygomycetes, and dematiaceous moulds, continues to evolve, thus presenting new challenges to recent therapeutic advances. Development of new antifungal chemotherapeutic agents and novel approaches for augmentation of host response will be required to meet these new mycologic challenges.
Insights
New antifungal drugs and host response strategies are needed to combat evolving drug-resistant fungi in immunocompromised patients, addressing rising invasive fungal infections like candidiasis and aspergillosis.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pharmacology
Background:
- Invasive fungal infections (IFIs) significantly contribute to morbidity and mortality in neutropenic patients.
- Disseminated candidiasis and invasive pulmonary aspergillosis are critical IFIs.
- Advances in antifungal therapies have improved treatment options.
Purpose of the Study:
- To review current therapeutic strategies for opportunistic mycoses in immunocompromised patients.
- To highlight the challenges posed by emerging drug-resistant fungi.
- To emphasize the need for novel antifungal agents and host-response augmentation.
Main Methods:
- Review of clinical trials and therapeutic advancements in antifungal treatment.
- Analysis of the evolving spectrum of drug-resistant fungi.
- Discussion of challenges in managing IFIs in expanding immunocompromised populations.
Main Results:
- Newer agents like fluconazole, itraconazole, and lipid formulations of amphotericin B have expanded treatment options.
- Despite advances, increasing numbers of severely immunocompromised patients face evolving drug-resistant fungi.
- Emerging resistant fungi include Candida spp., Fusarium spp., Zygomycetes, and dematiaceous moulds.
Conclusions:
- Current therapeutic advances face challenges from drug-resistant fungi and expanding immunocompromised populations.
- Novel antifungal chemotherapeutic agents are essential for future treatment.
- Augmenting host response presents a promising avenue for combating challenging mycologic infections.