Division of Infectious Diseases, Department of Internal Medicine, Wayne State University School of Medicine, Karmanos Cancer Institute, Detroit, MI 48201, USA.
Eur J Haematol. 2010 Apr;84(4):281-90. doi: 10.1111/j.1600-0609.2009.01391.x. Epub 2009 Nov 30.
During the past 20 yr, the population of immunocompromized patients at risk of developing invasive fungal infections (IFIs) has increased, and there has been a shift in fungal epidemiology, with more infections caused by non-Aspergillus molds and yeasts, which are often resistant to one or more antifungal drugs. Traditional diagnostic methods, such as culture and the histopathology of infected tissue, often fail to detect IFIs until the later stages. Furthermore, invasive diagnostic methods to obtain tissue may be contraindicated in severely ill patients; even when tissue is available, the morphology of several filamentous fungi is identical, or the cultures may fail to grow the pathogen. Recently developed non-invasive diagnostic techniques, such as tests for serum markers and polymerase chain reaction assays, may allow for earlier and more accurate diagnoses - crucial in the effort to reduce morbidity and the risk of mortality. This article reviews current approaches to diagnosis and treatment, focusing on how an early and accurate diagnosis can guide treatment and improve outcomes. Strategies for improving the management of IFIs also are discussed.
在过去的 20 年中，有发生侵袭性真菌感染（IFI）风险的免疫功能低下患者人群增加，真菌感染的流行病学也发生了变化，由非曲霉属霉菌和酵母菌引起的感染越来越多，这些真菌通常对一种或多种抗真菌药物具有耐药性。传统的诊断方法，如培养和感染组织的组织病理学检查，往往无法在后期阶段之前检测到 IFI。此外，获得组织的侵袭性诊断方法在重病患者中可能是禁忌的；即使有组织可用，几种丝状真菌的形态是相同的，或者培养物可能无法生长病原体。最近开发的非侵入性诊断技术，如血清标志物检测和聚合酶链反应检测，可能可以更早、更准确地诊断——这对于降低发病率和死亡率的风险至关重要。本文综述了目前的诊断和治疗方法，重点介绍了早期和准确的诊断如何指导治疗和改善预后。还讨论了改善 IFI 管理的策略。
