Systemic fungal infections

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• 作者：Tihana A. Bicanic ; Thomas S. Harrison
• 关键词：amphotericin ; aspergillosis ; candidaemia ; candidiasis ; caspofungin ; cryptococcal meningitis ; cryptococcosis ; fluconazole ; histoplasmosis ; mucormycosis ; posaconazole ; voriconazole
• 刊名：Medicine
• 出版年：January, 2014
• 年：2014
• 卷：42
• 期：1
• 页码：26-30
• 全文大小：279 K

文摘

Systemic fungal infections have increased in incidence and are associated with significant mortality. The challenges they pose are further compounded by difficulties with early diagnosis and the high cost of the newer antifungal drugs. These include voriconazole, a broad-spectrum triazole. In treatment of invasive aspergillosis, voriconazole was associated with improved survival compared with amphotericin. Posaconazole is similar but with a slightly different spectrum of activity and side effect profile. Caspofungin was the first of a new class of intravenous antifungals, the echinocandins, which have largely superseded amphotericin in treatment of invasive candidiasis.

The management of candidiasis and aspergillosis is discussed in the light of these new agents and advances in susceptibility testing for Candida sp. and of diagnostic tests for aspergillosis. Cryptococcal meningitis remains a leading cause of death in HIV-infected patients in Africa and Asia. Initial treatment is with amphotericin plus flucytosine. Patients with high cerebrospinal fluid opening pressure may need serial therapeutic lumbar punctures. Rhinocerebral mucormycosis is a rare but devastating infection in diabetic and neutropenic patients, presenting with orbital swelling, fever and facial pain. The endemic dimorphic fungal infections include histoplasmosis, which is widespread but most common in the Ohio and Mississippi valleys, and penicilliosis in South-East Asia.