New therapies for fungal pneumonia.
OBJECTIVE
This review summarizes recent developments in the diagnosis and treatment of fungal pneumonia, with an emphasis on invasive pulmonary aspergillosis.


RESULTS
Improvements in nonculture-based fungal diagnostics, early implementation of pulmonary high resolution, or spiral computed tomography scanning and a recent expansion of the antifungal armamentarium have greatly improved the outcome of immunocompromised patients with invasive aspergillosis. However, the field is changing: new pathogens (such as Zygomycetes) are emerging, and novel risk groups (ICU patients in particular) are being identified.


CONCLUSIONS
Galactomannan antigen detection is a valuable tool for evaluating patients at risk for invasive aspergillosis (as a screening assay on serum samples from neutropenic patients or as a confirmatory assay on bronchoalveolar lavage fluid samples, in general), but should be used in conjunction with modern imaging techniques. beta-D-Glucan and PCR assays are still investigational. Voriconazole is the drug of choice for invasive aspergillosis, whereas liposomal amphotericin B at 3 mg/kg per day is the preferred alternative in case of contraindication, drug-related side-effects, or intolerance. Whenever possible, optimal antifungal therapy should be complemented by surgical debridement of necrotic tissue. The added value of combination therapy is still unproven. Therapeutic drug monitoring of mold-active azoles should be implemented in order to minimize toxicity and maximize efficacy. Lipid-based formulations of amphotericin B, and to a lesser extent voriconazole, are the drugs of choice for non-Aspergillus related fungal pneumonia. Although active in prophylaxis, the efficacy of posaconazole in confirmed infections remains controversial.
Maertens
Johan
J
Department of Hematology, Acute Leukemia and Stem Cell Transplantation Unit, University Hospitals Leuven, Campus Gasthuisberg, Herestraat 49, Leuven, Belgium. johan.maertens@uz.kuleuven.ac.be
Meersseman
Wouter
W
Van Bleyenbergh
Pascal
P
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D005658:Fungi / Q000302:isolation & purification; D005690:Galactose / Q000031:analogs & derivatives; D006801:Humans; D008351:Mannans / Q000097:blood; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy*; D011014:Pneumonia / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D055732:Pulmonary Aspergillosis / Q000175:diagnosis / Q000188:drug therapy; D011743:Pyrimidines / Q000627:therapeutic use; D013902:Radiography, Thoracic / Q000379:methods; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
D000935:Antifungal Agents; D008351:Mannans; D011743:Pyrimidines; D014230:Triazoles; C012990:galactomannan; D000666:Amphotericin B; D065819:Voriconazole; D005690:Galactose