title: [State of the art in invasive diseases by filamentous fungi].
abstract: Invasive fungal infections have become a major cause of morbimortality in intensive care patients, persons suffering from cancer or immune deficiencies, and other diseases with impaired immunity. Candida albicans remains the most frequent fungal pathogen, but advances in the diagnosis, prevention and treatment of invasive candidiasis are leading to important etiological changes. Among the emerging invasive mycoses, are those caused by filamentous fungi, such as Aspergillus, Lomentospora/Scedosporium, Fusarium or the Mucorales. Invasive aspergillosis is difficult to diagnose, and although there are diagnostic tools available, their use is not widespread, and their effectiveness vary depending on the group of patients. Clinical suspicion in high-risk patients, radiological diagnosis and the use of biomarkers, such as 1,3-β-D-glucan and galactomannan, can be of great help. However, diagnostic resources are limited in other mycoses, but radiology, pathological studies and the microbiological diagnosis can be useful. The high mortality of these mycoses requires early empirical antifungal treatment in many cases. Voriconazole is the first choice for treatment of the majority of aspergillosis, scedosporiasis, fusariosis and other hyalohyphomycoses. The treatment of mucormycoses, Lomentospora prolificans infections or mycoses by dematiaceous fungi are more complicated. Amphotericin B is active against many mucoralean fungi, but the combination of two or more antifungal agents could be a therapeutic alternative in many amphotericin B-refractory mycoses. Current clinical challenges include improving the diagnosis and the treatment of these mycoses, along with improving the adequate prevention in patients at high risk of suffering from them.
authors.affiliation: Servicio de Microbiología, Hospital Universitario y Politécnico La Fe, Valencia, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Pemán
authors.affiliation: Unidad de formación e investigación multidisciplinar Microbios y Salud (UFI 11/25), Departamento de Inmunología, Microbiología y Parasitología, Facultad de Medicina y Odontología, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Bilbao, Vizcaya, España. Electronic address: guillermo.quindos@ehu.es.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Quindós
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D042241:Early Diagnosis; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D060585:Fusariosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D016867:Immunocompromised Host; D009091:Mucormycosis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D009172:Mycology / Q000379:methods; D021681:Scedosporium / Q000302:isolation & purification
chemical_list: D000935:Antifungal Agents
keywords: Amphotericin B; Anfotericina B; Aspergillus; Candinas; Candins; Fusarium; Invasive mycoses; Lomentospora; Micosis invasivas; Posaconazol; Posaconazole; Scedosporium; Voriconazol; Voriconazole