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Fungi are becoming a serious public health hazard, especially for the growing numbers
of immunocompromised patients in hospitals. These numbers will only increase and cancer
patients will be at greater risk for developing fungal infections as the incidence
of cancer continues to rise and as treatment strategies become more aggressive. Along
with the increased incidence of fungal infections, established fungal pathogens are
beginning to exhibit drug resistance, and new pathogens with reduced susceptibility
to older antifungal drugs are emerging. The mortality rates using amphotericin B in
Candida sepsis and aspergillosis in cancer patients are still high. Therefore, newer antifungal
drugs, such as the triazoles fluconazole and itraconazole, as well as new modalities
to administer amphotericin B (lipid formulations) have been developed in the hope
of diminishing the toxicity and improving the response rates obtained with amphotericin
B. A more thorough study of the epidemiology of fungal infection in cancer patients
can help to determine which patients are most likely to develop infection. Thus, more
intensive monitoring and diagnostic efforts will improve the rapidity and accuracy
of diagnosis of fungal infection and can improve patient outcome by allowing intervention
at an earlier point in the onset of invasive disease. Genetic typing of fungal species
and strains can be used to identify drug resistant organisms. There is an urgent need
for the development of new antifungal agents that attack fungal organisms at different
sites than those targeted by currently available drugs. Finally, the value of large,
well-controlled clinical studies of antifungal agents, as well as the use of growth
factors in certain types of cancers, can greatly increase our understanding of the
most effective means of treating disseminated fungal disease in the immunocompromised
cancer patient.
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References
- The emerging fungal threat.Science. 1994; 266: 1632-1634
- Targeting fungi: a challenge.Am J Med. 1995; 99: 605-675
- Candida and aspergillus infections in immunocompromised patients: an overview.Rev Infect Dis. 1991; 13: 487-492
- Management of the immunocompromised patient: impact of fungal infections.Rev Infect Dis. 1991; 13: 473
- Impact of the changing epidemiology of fungal infections in the 1990s.Eur J Clin Microbiol Infect Dis. 1992; 11: 287-291
- Secular trends in nosocomial primary bloodstream infections in the United States, 1980–1989.Am J Med. 1991; 91: 86S-89S
- Fungal infections in cancer patients: an international autopsy survey.Eur J Clin Microbiol Infect Dis. 1992; 11: 99-109
- Epidemiology of invasive asperillosis in European cancer centres.Eur J Clin Microbiol Infect Dis. 1993; 12 (letter): 392-893
- Fungal infections in bone marrow transplant patients.Semin Oncol. 1990; 17: 10-13
- Etiologic organisms as independent predictors of death and morbidity associated with bloodstream infections.J Infect Dis. 1987; 156: 471-477
- Hospital-acquired candidemia. The attributable mortality and excess length of stay.Arch Intern Med. 1988; 148: 2642-2645
- Fungemia in a cancer hospital: changing frequency, earlier onset, and results of therapy.Rev Infect Dis. 1985; 7: 646-655
- Candida tropicalis: a major pathogen in immunocomproised patients.Ann Intern Med. 1979; 91: 539-543
- Increased incidence of fungemia caused by Candida krusei.J Clin Microbiol. 1986; 24: 581-584
Viscoli C, Girmenia C, Marinus A, et al. Candidemia in cancer patients: factors associated with etiology (albicans vs. non-albicans) and survival. Abstracts of the IDSA 34th Annual Meeting [abstract]. Infectious Diseases Society of America, 196, 40.
- Antifungal and surgical treatment of invasive aspergillosis: review of 2 121 published cases.Rev Infect Dis. 1990; 12: 1147-1201
- ([abstract])Risk factors and outcome from invasive aspergillosis (IA).in: Programs and abstracts of the Thirty-sixth Interscience Conference on Antimicrobial Agents and Chemotherapy. American Society for Microbiology, New York1996: 227
- Future directions of antifungal chemotherapy.Clin Infect Dis. 1992; 14: S170-S181
- Problems in the diagnosis of invasive fungal diseases.Rev Infect Dis. 1991; 13: 493-495
- Detection of circulating candida enolase by immunoassay in patients with cancer and invasive candiasis.N Engl J Med. 1991; 324: 1026-1031
- Serodiagnosis of invasive aspergillosis in patients with hematologic malignancy: validation of the Aspergillus fumigatus antigen radioimmunoassay.J Infect Dis. 1987; 155: 12-27
- The prophylactic use of low-dose amphotericin B in bone marrow transplant patients.Am J Med. 1994; 97: 509-514
- Prophylactic intravenous amphotericin B in neutropenic autologous bone marrow transplant recipients.J Infect Dis. 1992; 165: 891-897
- Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia.Am J Med. 1982; 72: 101-111
- Empiric antifungal therapy in febrile granulocytopenic patients.Am J Med. 1989; 86: 668-672
- Candida lusitaniae: frequency of recovery, colonization, infection, and amphotericin B resistance.J Clin Microbiol. 1984; 20: 1194-1195
- Isolation and characterization of a polyene resistant variant of C. tropicalis.J Clin Microbiol. 1979; 9: 677-680
- Improving treatment of chemotherapy-induced neutropencic fever by administration of colony-stimulating factors.J Natl Cancer Inst. 1995; 87: 803-808
- Colony-stimulating factors and neutropenia: intersection of data and clinical relevance.J Natl Cancer Inst. 1995; 87 (editorial): 781-782
- Critical review of lipid amphotericin B formulations as treatment of invasive aspergillosis in patients with hematologic disorders and bone marrow transplantations.J Mycol Med. 1996; 6: 17-20
- Amphotericin B or ketoconazole therapy of fungal infections in neutropenic patients.Antimicrob Ag Chemother. 1987; 31: 11-15
- Fluconazole. An update of its pharmacodynamic and pharmacokinetic properties and therapeutic use in major superficial and systemic mycoses in immunocompromised patients.Drugs. 1995; 50: 658-690
- Preventing fungal infection in neutropenic patients with acute leukemia: fluconazole compared with oral amphotericin B.Ann Intern Med. 1994; 120: 913-918
- A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation.N Engl J Med. 1992; 326: 845-851
- Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole.N Engl J Med. 1991; 325: 1274-1277
- A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia.N Engl J Med. 1994; 331: 1325-1330
- Antifungal prophylaxis: to prevent or not.Am J Med. 1993; 94 (editorial): 233-234
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© 1997 Published by Elsevier Inc.
