Research Article| Volume 33, SUPPLEMENT 4, S50-S54, May 1997

Fungal infections and the cancer patient

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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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        • Sternberg S
        The emerging fungal threat.
        Science. 1994; 266: 1632-1634
        • Meunier F
        Targeting fungi: a challenge.
        Am J Med. 1995; 99: 605-675
        • Saral R
        Candida and aspergillus infections in immunocompromised patients: an overview.
        Rev Infect Dis. 1991; 13: 487-492
        • Perfect JR
        Management of the immunocompromised patient: impact of fungal infections.
        Rev Infect Dis. 1991; 13: 473
        • Pfaller M
        • Wenzel R
        Impact of the changing epidemiology of fungal infections in the 1990s.
        Eur J Clin Microbiol Infect Dis. 1992; 11: 287-291
        • Banerjee SN
        • Emori TG
        • Culver DH
        • et al.
        Secular trends in nosocomial primary bloodstream infections in the United States, 1980–1989.
        Am J Med. 1991; 91: 86S-89S
        • Bodey G
        • Bueltmann B
        • Duguid W
        • et al.
        Fungal infections in cancer patients: an international autopsy survey.
        Eur J Clin Microbiol Infect Dis. 1992; 11: 99-109
        • Cohen J
        • Denning DW
        • Viviani MA
        • EORTC Invasive Fungal Infections Cooperative Group
        Epidemiology of invasive asperillosis in European cancer centres.
        Eur J Clin Microbiol Infect Dis. 1993; 12 (letter): 392-893
        • Meyers JD
        Fungal infections in bone marrow transplant patients.
        Semin Oncol. 1990; 17: 10-13
        • Miller PJ
        • Wenzel RP
        Etiologic organisms as independent predictors of death and morbidity associated with bloodstream infections.
        J Infect Dis. 1987; 156: 471-477
        • Wey SB
        • Mori M
        • Pfaller MA
        • Woolson RF
        • Wenzel RP
        Hospital-acquired candidemia. The attributable mortality and excess length of stay.
        Arch Intern Med. 1988; 148: 2642-2645
        • Horn R
        • Wong B
        • Kiehn TE
        • Armstrong D
        Fungemia in a cancer hospital: changing frequency, earlier onset, and results of therapy.
        Rev Infect Dis. 1985; 7: 646-655
        • Wingard JR
        • Merz WG
        • Saral R
        Candida tropicalis: a major pathogen in immunocomproised patients.
        Ann Intern Med. 1979; 91: 539-543
        • Merz WG
        • Karp JE
        • Schron D
        • Saral R
        Increased incidence of fungemia caused by Candida krusei.
        J Clin Microbiol. 1986; 24: 581-584
      1. 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.

        • Denning DW
        • Stevens DA
        Antifungal and surgical treatment of invasive aspergillosis: review of 2 121 published cases.
        Rev Infect Dis. 1990; 12: 1147-1201
      2. ([abstract])
        • Denning DW
        • Marinus A
        • Cohen J
        • et al.
        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
        • Graybill JR
        Future directions of antifungal chemotherapy.
        Clin Infect Dis. 1992; 14: S170-S181
        • Rinaldi MG
        Problems in the diagnosis of invasive fungal diseases.
        Rev Infect Dis. 1991; 13: 493-495
        • Walsh TJ
        • Hathorn JW
        • Sobel JD
        • et al.
        Detection of circulating candida enolase by immunoassay in patients with cancer and invasive candiasis.
        N Engl J Med. 1991; 324: 1026-1031
        • Talbot GH
        • Weiner MH
        • Gerson SL
        • Provencher M
        • Hurwitz S
        Serodiagnosis of invasive aspergillosis in patients with hematologic malignancy: validation of the Aspergillus fumigatus antigen radioimmunoassay.
        J Infect Dis. 1987; 155: 12-27
        • Riley DK
        • Pavia AT
        • Beatty PG
        • et al.
        The prophylactic use of low-dose amphotericin B in bone marrow transplant patients.
        Am J Med. 1994; 97: 509-514
        • Perfect JR
        • Klotman ME
        • Gilbert CC
        • et al.
        Prophylactic intravenous amphotericin B in neutropenic autologous bone marrow transplant recipients.
        J Infect Dis. 1992; 165: 891-897
        • Pizzo PA
        • Robichaud KJ
        • Gill FA
        • Witebsky FG
        Empiric antibiotic and antifungal therapy for cancer patients with prolonged fever and granulocytopenia.
        Am J Med. 1982; 72: 101-111
        • EORTC International Antimicrobial Therapy Cooperative Group
        Empiric antifungal therapy in febrile granulocytopenic patients.
        Am J Med. 1989; 86: 668-672
        • Merz WG
        Candida lusitaniae: frequency of recovery, colonization, infection, and amphotericin B resistance.
        J Clin Microbiol. 1984; 20: 1194-1195
        • Merz WG
        • Sandford GR
        Isolation and characterization of a polyene resistant variant of C. tropicalis.
        J Clin Microbiol. 1979; 9: 677-680
        • Mayordomo JI
        • Rivera F
        • Díaz-Puente MT
        • et al.
        Improving treatment of chemotherapy-induced neutropencic fever by administration of colony-stimulating factors.
        J Natl Cancer Inst. 1995; 87: 803-808
        • Freifeld A
        • Pizzo P
        Colony-stimulating factors and neutropenia: intersection of data and clinical relevance.
        J Natl Cancer Inst. 1995; 87 (editorial): 781-782
        • Ribaud P
        • Gluckman E
        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
        • Fainstein V
        • Bodey GP
        • Elting L
        • Maksymiuk A
        • Keating M
        • McCredie KB
        Amphotericin B or ketoconazole therapy of fungal infections in neutropenic patients.
        Antimicrob Ag Chemother. 1987; 31: 11-15
        • Goa KL
        • Barradell LB
        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
        • Menichetti F
        • Del Favero A
        • Martino P
        • et al.
        Preventing fungal infection in neutropenic patients with acute leukemia: fluconazole compared with oral amphotericin B.
        Ann Intern Med. 1994; 120: 913-918
        • Goodman JL
        • Winston DJ
        • Greenfield RA
        • et al.
        A controlled trial of fluconazole to prevent fungal infections in patients undergoing bone marrow transplantation.
        N Engl J Med. 1992; 326: 845-851
        • Wingard JR
        • Merz WG
        • Rinaldi MG
        • Johnson TR
        • Karp JE
        • Saral R
        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
        • Rex JH
        • Bennett JE
        • Sugar AM
        • et al.
        • The Candidemia Study Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group
        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
        • Perfect JR
        Antifungal prophylaxis: to prevent or not.
        Am J Med. 1993; 94 (editorial): 233-234