Lai Chih-Cheng, Tan Che-Kim, Huang Yu-Tsung, Shao Pei-Lan, Hsueh Po-Ren
Department of Internal Medicine, Yi-Min Hospital, Taipei, Taiwan.
J Infect Chemother. 2008 Apr;14(2):77-85. doi: 10.1007/s10156-007-0595-7. Epub 2008 Apr 30.
The incidence of invasive fungal infections (IFIs) has increased over the past two decades, as the populations of patients at risk have continued to rise. Early and accurate diagnosis and the subsequent usage of appropriate antifungal therapy are difficult, which leads to a high mortality rate in patients with IFI. Along with the widespread use of antifungal prophylaxis, the epidemiology of invasive fungal pathogens has changed. Non-albicans Candida, Non-fumigatus Aspergillus, and molds other than Aspergillus have become more common pathogens causing invasive diseases, and most of these emerging fungi are resistant to or less susceptible than others to standard antifungal agents. Therefore, invasive infections due to these previously rare fungi are more difficult to treat. Advances in more potent and less toxic antifungal agents, such as second-generation triazoles and echinocandins, may potentially improve the outcomes of these infections. Recent advances in detecting fungal cell-wall components and genomic DNA also allow earlier diagnosis. This article reviews the changing spectrum of invasive fungal infections and the introduction of recent advances in diagnostic tools and antifungal agents.
在过去二十年中，侵袭性真菌感染（IFI）的发病率有所上升，因为高危患者群体持续增加。早期准确诊断以及随后使用适当的抗真菌治疗存在困难，这导致IFI患者的死亡率很高。随着抗真菌预防措施的广泛应用，侵袭性真菌病原体的流行病学发生了变化。非白色念珠菌、非烟曲霉以及曲霉属以外的霉菌已成为引起侵袭性疾病的更常见病原体，并且这些新出现的真菌大多对标准抗真菌药物耐药或敏感性较低。因此，由这些以前罕见的真菌引起的侵袭性感染更难治疗。更有效且毒性更低的抗真菌药物（如第二代三唑类和棘白菌素类）的进展可能会改善这些感染的治疗效果。检测真菌细胞壁成分和基因组DNA的最新进展也有助于早期诊断。本文综述了侵袭性真菌感染不断变化的范围以及诊断工具和抗真菌药物的最新进展。
