title: Fungal pneumonia in patients with hematologic malignancies: current approach and management.
abstract: OBJECTIVE
  Fungal pneumonia is the most frequent presentation of invasive mold infections (IMIs) in patients with hematologic malignancies. In this review, we summarize recent advances in the epidemiology, diagnosis, and treatment of fungal pneumonia and improvement in the outcome of such patients.
  
  
  RESULTS
  The epidemiology of IMIs in hematopoietic stem cell transplant recipients has evolved in response to changes in conditioning regimens, increasing use of alternative sources of stem cells and antifungal prophylaxis, among other factors. PCR analysis and serologic tests, used in combination with imaging findings, have improved the timing and accuracy of diagnosis of these infections.Recent guidelines incorporated evidence-based treatment recommendations; however, application in real world situations is often difficult. A new treatment approach known as preemptive therapy, based on screening with biomarkers combined with early clinical and imaging findings, is being compared with the traditional empirical therapy in neutropenic patients with persistent or recurrent fever. The use of new triazoles and prompt diagnosis has contributed to improved outcomes in these patients. In addition, therapeutic drug monitoring may be useful when administering voriconazole.
  
  
  CONCLUSIONS
  Evidence-based diagnosis and treatment of fungal pneumonia in patients with hematologic malignancies are becoming increasingly institution-specific and patient-specific, integrating host factors, new diagnostic methods, and epidemiologic and pharmacologic considerations.
authors.affiliation: Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas 77030, USA. vmulanov@mdanderson.org
authors.forename: Victor E
authors.initials: VE
authors.lastname: Mulanovich
authors.forename: Dimitrios P
authors.initials: DP
authors.lastname: Kontoyiannis
mesh_terms: D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007938:Leukemia / Q000382:microbiology* / Q000628:therapy; D008172:Lung Diseases, Fungal / Q000150:complications* / Q000628:therapy; D011014:Pneumonia / Q000150:complications* / Q000382:microbiology / Q000628:therapy