Chandrasekar Pranatharthi
Division of Infectious Diseases, Department of Internal Medicine, Karmanos Cancer Institute, Wayne State University School of Medicine, Detroit, MI, USA.
Leuk Lymphoma. 2009 May;50(5):703-15. doi: 10.1080/10428190902777434.
An increasing number of patients are undergoing transplantation procedures or receiving aggressive immunosuppression and chemotherapy. The growing population of immunocompromised hosts has led to a rise in the prevalence of invasive fungal infections (IFIs) due to yeasts and molds. Recent trends suggest that patients are acquiring infections with non-Candida albicans species, non-Aspergillus fumigatus species and non-Aspergillus molds such as Fusarium species, Scedosporium species and Zygomycetes. There are also a few reports of resistance to standard azole and echinocandin therapy, and some Aspergillus (A. ustus, A. terreus) and Scedosporium species are inherently resistant to polyenes. Early diagnosis and appropriate treatment of mold infections are important to improve outcomes. The use of high-resolution computed tomography scanning and new diagnostic tools such as the galactomannan and beta-glucan tests help early detection of IFIs. With the changing epidemiology of fungal infections and emergence of rare pathogens, and with the availability of a larger number of antifungal drugs, new management strategies are evolving to effectively treat invasive mold infections.
越来越多的患者正在接受移植手术或接受强化免疫抑制及化疗。免疫功能低下宿主群体的不断增加导致了由酵母和霉菌引起的侵袭性真菌感染（IFI）患病率上升。最近的趋势表明，患者正在感染非白色念珠菌、非烟曲霉以及镰刀菌属、赛多孢菌属和接合菌等非烟曲霉霉菌。也有一些关于对标准唑类和棘白菌素治疗耐药的报道，并且一些曲霉（土曲霉、黑曲霉）和赛多孢菌属对多烯类天然耐药。霉菌感染的早期诊断和恰当治疗对于改善预后很重要。使用高分辨率计算机断层扫描以及半乳甘露聚糖和β-葡聚糖检测等新诊断工具有助于IFI的早期检测。随着真菌感染流行病学的变化和罕见病原体的出现，以及更多抗真菌药物的可获得性，新的管理策略正在不断发展以有效治疗侵袭性霉菌感染。
