Richardson Malcolm D
Department of Bacteriology and Immunology, University of Helsinki, Helsinki, Finland.
J Antimicrob Chemother. 2005 Sep;56 Suppl 1:i5-i11. doi: 10.1093/jac/dki218.
Invasive mycoses are a significant and growing public health problem. Although bloodstream infections with Candida albicans may be decreasing in frequency, the number of persons at risk for them continues to grow. Moreover, infections with other Candida species, such as Candida glabrata, are increasing in incidence. Invasive mould infections in general, and Aspergillus infections in particular, are becoming more frequent. Fungal opportunistic infections in persons with AIDS are no longer a major problem in developed countries, but are resulting in significant morbidity and mortality in developing countries with AIDS epidemics. Further studies are needed to define populations at very high risk for fungal opportunistic infections who might benefit from targeted antifungal chemoprophylaxis, which remains the most promising of the potential prevention strategies. This review highlights the changing patterns in risk factors, changes in epidemiology, the impact of changes in medical practice in intensive care and organ transplantation on the incidence of systemic fungal infections, and gives an overview of fungal infections in paediatric patients, patients with haematological malignancy, and the emergence of antifungal resistance.
侵袭性真菌病是一个日益严重的重大公共卫生问题。尽管白色念珠菌血症的发生率可能在下降，但感染风险人群的数量仍在持续增加。此外，其他念珠菌属感染，如光滑念珠菌感染的发病率正在上升。侵袭性霉菌感染总体上，尤其是曲霉菌感染，正变得越来越常见。艾滋病患者中的真菌机会性感染在发达国家已不再是主要问题，但在有艾滋病流行的发展中国家却导致了显著的发病率和死亡率。需要进一步研究来确定那些可能从靶向抗真菌化学预防中获益的极高真菌机会性感染风险人群，这仍是最有前景的潜在预防策略。本综述重点介绍了危险因素的变化模式、流行病学的改变、重症监护和器官移植中医疗实践的变化对系统性真菌感染发病率的影响，并概述了儿科患者、血液系统恶性肿瘤患者的真菌感染情况以及抗真菌耐药性的出现。
