Department of Internal Medicine, Hematology, and Oncology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany; Department I for Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research, partner site Bonn-Cologne, University of Cologne, Cologne, Germany.
University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Excellence Center for Medical Mycology (ECMM), Cologne, Germany.
Med Mycol. 2021 Jan 4;59(1):93-101. doi: 10.1093/mmy/myaa079.
Diagnosis, treatment, and management of invasive mould infections (IMI) are challenged by several risk factors, including local epidemiological characteristics, the emergence of fungal resistance and the innate resistance of emerging pathogens, the use of new immunosuppressants, as well as off-target effects of new oncological drugs. The presence of specific host genetic variants and the patient's immune system status may also influence the establishment of an IMI and the outcome of its therapy. Immunological components can thus be expected to play a pivotal role not only in the risk assessment and diagnosis, but also in the treatment of IMI. Cytokines could improve the reliability of an invasive aspergillosis diagnosis by serving as biomarkers as do serological and molecular assays, since they can be easily measured, and the turnaround time is short. The use of immunological markers in the assessment of treatment response could be helpful to reduce overtreatment in high risk patients and allow prompt escalation of antifungal treatment. Mould-active prophylaxis could be better targeted to individual host needs, leading to a targeted prophylaxis in patients with known immunological profiles associated with high susceptibility for IMI, in particular invasive aspergillosis. The alteration of cellular antifungal immune response through oncological drugs and immunosuppressants heavily influences the outcome and may be even more important than the choice of the antifungal treatment. There is a need for the development of new antifungal strategies, including individualized approaches for prevention and treatment of IMI that consider genetic traits of the patients.
Anticancer and immunosuppressive drugs may alter the ability of the immune system to fight invasive mould infections and may be more important than the choice of the antifungal treatment. Individualized approaches for prevention and treatment of invasive mold infections are needed.
侵袭性霉菌感染（IMI）的诊断、治疗和管理受到多种风险因素的挑战，包括局部流行病学特征、真菌耐药性和新兴病原体的固有耐药性的出现、新型免疫抑制剂的使用，以及新型肿瘤药物的脱靶效应。特定宿主遗传变异和患者免疫系统状态的存在也可能影响 IMI 的建立及其治疗结果。因此，免疫成分不仅有望在风险评估和诊断中发挥关键作用，而且在 IMI 的治疗中也发挥关键作用。细胞因子可以作为生物标志物，与血清学和分子检测一样，提高侵袭性曲霉病诊断的可靠性，因为它们易于测量，且周转时间短。免疫标志物在评估治疗反应中的应用有助于减少高危患者的过度治疗，并允许及时升级抗真菌治疗。针对个体宿主需求的霉菌活性预防措施可以更好地靶向个体，从而针对具有高易感性的 IMI（特别是侵袭性曲霉病）的已知免疫特征的患者进行针对性预防。细胞性抗真菌免疫反应的改变通过肿瘤药物和免疫抑制剂产生影响，这可能比选择抗真菌治疗更重要。需要开发新的抗真菌策略，包括预防和治疗 IMI 的个体化方法，同时考虑患者的遗传特征。
抗癌和免疫抑制药物可能会改变免疫系统对抗侵袭性霉菌感染的能力，其重要性甚至超过抗真菌治疗的选择。需要针对侵袭性霉菌感染采取个体化的预防和治疗方法。
