Clinical microbiology and infectious diseases. Management of fungal infections.
Invasive fungal infections are a major cause of morbidity and mortality in immunocompromised patients. Despite remarkable progress in mycology, many uncertainties and difficulties remain. Invasive fungal infections are difficult to diagnose. Noninvasive, rapid diagnostic tools, such as the detection of Aspergillus galactomannan antigen in serum or of fungal nucleic acids by molecular methods are promising, but are still under investigation. The other difficulty in diagnosis is the lack of standard, consistent criteria. Very recently, diagnostic criteria based on host factors, as well as clinical features and microbiological results, have been proposed. Treatment of invasive fungal infections is also problematic. The development of novel antifungal compounds constitutes a major advance in antifungal therapy. These include novel azoles such as voriconazole (Pfizer), posaconazole (Schering- Plough), and ravuconazole (Eisai/Bristol-Myers Squibb), and novel echinocandins such as caspofungin (Merck), anidulafungin (Eli Lilly), and micafungin (Fujisawa Pharmaceutical). These agents appear more efficacious and less toxic than currently available antifungal drugs. However, immune status of the host remains one of the major determinants of clinical outcome. This property limits the efficiency of in vitro antifungal susceptibility tests in predicting in vivo outcome. Using immune system modifiers such as cytokines in combination with antifungal agents is beneficial in the improvement of immune status, and thus clinical outcome.
Arikan
S
S
Hacettepe University School of Medicine, Infectious Diseases and Clinical Microbiology Department, School of Medicine, Ankara 06100, Turkey. sarikan@rorqual.cc.metu.edu.tr