Emerging fungal pathogens: evolving challenges to immunocompromised patients for

[Guest guest]

http://www.blackwell-synergy.com/servlet/useragent?

func=synergy & synergyAction=showAbstract & doi=10.1034/j.1399-

3062.1999.010404.x & area=production & prevSearch=allfield%3A%

28mycotoxin+fungus%29

Transplant Infectious Disease

Volume 1 Issue 4 Page 247 - December 1999

doi:10.1034/j.1399-3062.1999.010404.x

Emerging fungal pathogens: evolving challenges to immunocompromised

patients for the twenty-first century

Authors\' affiliations:T.J. Walsh, A.H. Groll

Abstract:

Opportunistic fungi have emerged during the past decade as important

causes of morbidity and mortality in immunocompromised patients.

Candida species constitute the third to fourth most common causes of

nosocomial blood stream infections, and Aspergillus species have

emerged as the most common infectious cause of pneumonic mortality

in bone marrow/stem cell transplant recipients. Among HIV-infected

patients, meningoencephalitis due to Cryptococcus neoformans ranks

among the most common AIDS-defining infections. Hyaline septated

filamentous fungi, such as Fusarium species, Acremonium species,

Paecilomyces species, and Trichoderma species, are increasingly

reported as causing invasive mycoses refractory to conventional

therapy. Dematiaceous septated filamentous fungi, such as

Pseudallescheria boydii, Bipolaris species, and Cladophialophora

bantiana cause pneumonia, sinusitis, and CNS infection unresponsive

to current therapy. An increasing number of different members of the

class of Zygomycetes are reported as causing lethal infections,

despite aggressive medical and surgical interventions. Yet the

treatment for zygomycosis has not changed in approximately 40 years.

The prevalence of the endemic mycoses, such as those due to

Penicillium marneffei, Coccidioides immitis, and Histoplasma

capsulatum, has been reported to expand rapidly in response to

environmental exposures and increased numbers of vulnerable hosts in

endemic regions of the world. Dermatophytoses are occurring with

increasing prevalence and morbidity in elderly and immunocompromised

patients. As we enter the next millennium, we may anticipate that

emergent fungal infections will continue to develop in the settings

of permissive environmental conditions, selective antifungal

pressure, and an expanding population of immunocompromised hosts.

Note