Lymphocyte depletion during treatment with intensive chemotherapy for cancer.

The field of opportunistic mycoses in the patient with cancer is rapidly changing Not only are fungal infections increasing in frequency in this patient population, but these infections are occurring earlier during the course of cytotoxic chemotherapy, and newer fungi are increasingly recognized as potentially lethal pathogens Candidiasis remains the most commonly encountered infection The spectrum of disease includes candidemia and acute and chronic disseminated candidiasis Pulmonary aspergillosis and disseminated aspergillosis are common and remain relatively resistant to therapy Disseminated fusariosis and trichosporosis are almost always fatal in the setting of persistent profound neutropenia Therapy for these mycoses relies on the use of amphotericin B and 5-fluorocytosine Newer antifungal agents, such as fluconazole and itraconazole, appear to exhibit good activity against a variety of fungi Newer approaches need to be tested for the treatment of the more-resistant mycoses and may include the use of maximally tolerated doses of antifungal agents, colony-stimulating factors, and combination therapy

Opportunistic Mycoses in the Immunocompromised Host: Experience at a Cancer Center and Review

The taxonomy of yeasts is continually evolving, and currently yeasts that are of medical importance belong to two classes: the Saccharomycetes (previously Hemiascomycetes or Endomycetes), which contains Candida species, and the Tremellomycetes (previously Heterobasidiomycetes), which contains the basidiomycetous fungi Trichosporon and Cryptococcus. A number of species have been merged into Candida albicans, including Candida claussenii and Candida langeronii. There is evidence that C. albicans var. africana may be a new cause of vaginitis that is often misidentified as C. albicans on the Vitek 2 ID-YST system. Candida species are ubiquitous yeasts, being found on many plants and as the normal biota of the alimentary tract of mammals and mucocutaneous membranes of humans. In nearly 45% of AIDS patients, cryptococcosis was reported as the first AIDS-defining illness. Because none of the presenting signs or symptoms of cryptococcal meningitis (such as headache, fever, and malaise) are sufficiently characteristic to distinguish it from other infections that occur in patients with AIDS, determining cryptococcal antigen titers and culturing blood and cerebrospinal fluid (CSF) are useful in making a diagnosis. Not surprisingly, little effort has been undertaken to develop serologic tests for detection of invasive infections caused by yeasts other than Candida and Cryptococcus species. In order to develop a universal genetic identification system for yeasts, the most reproducible, specific, and sensitive sequence for comparison must be identified, and the majority of research has focused on the rDNA regions.

Candida, Cryptococcus, and other yeasts of medical importance.

The last decade has witnessed remarkable advances in the therapy for cutaneous fungal diseases. These will have a major impact on the choice of antifungal therapy. To understand these advances traditional therapies for fungal diseases, the polyenes, griseofulvin, older topical agents and the older azoles, will be reviewed first. Part II will focus on recent advances.

https://www.jaad.org/article/S0190-9622(08)81495-8/pdf

Antifungal agents: An overview. Part II

• Forty-six patients with systemic fungal infections were treated with liposomal amphotericin B. Twenty-one patients had disseminated candidiasis, 19 had aspergillosis, and the rest had a variety of other fungal infections. Forty patients failed to respond to conventional amphotericin B therapy, and 6 patients were given liposomal amphotericin B because conventional amphotericin B caused severe side effects. Twenty-four patients had a complete response, and 22 patients failed to respond. No short- or long-term toxic reactions were observed. The acute side effects such as fever, chills, and potassium loss were infrequent and milder than those commonly observed with conventional amphotericin B. No chronic renal, hematologic, or central nervous system side effects were observed. Liposomal amphotericin B therapy was effective and less toxic than conventional amphotericin B therapy. ( Arch Intern Med . 1989;149:2533-2536)

Treatment of Systemic Fungal Infections With Liposomal Amphotericin B

Systemic mycoses continue to emerge as life-threatening infections. Considerable progress in treating these infections is being achieved through better application of established available antifungal agents (amphotericin B, flucytosine, miconazole and ketoconazole), and through development of promising investigational agents (fluconazole, itraconazole). Systemic fungal infections, however, continue to present major problems, including clinical resistance, microbiological resistance, emergence of new pathogens, and involvement of more immunocompromised patients. The purpose of this paper, therefore, is to review the recent progress and current problems in treatment of systemic fungal infections.

Treatment of systemic fungal infections: Recent progress and current problems

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Treatment of systemic fungal infections: Recent progress and current problems