Presterl E, Graninger W
Klinische Abteilung für Infektionen, Allgemeines Krankenhaus, Wien, Osterreich.
Wien Klin Wochenschr. 1998 Nov 13;110(21):740-50.
The incidence of systemic fungal infection has been increasing during the last two decades. Candida and Aspergillus spp. are the classical opportunistic pathogens. Rare fungi, such as Mucor, Rhizopus, Fusarium, Trichosporon, Paecilomyces, Alternaria, Cladosporium and Pseudoallescheria, are emerging as cause of systemic fungal infection in the immunocompromised host. For more than 40 years Amphotericin B has been the gold standard of antifungal treatment because of its broad spectrum comprising yeasts, dimorphic fungi and moulds. Its nephrotoxicity has led to the development of lipid-associated preparations of amphotericin B: liposomal amphotericin B, amphotericin B colloidal dispersion and amphotericin B lipid complex. These preparations are less nephrotoxic, but higher doses than those of conventional amphotericin B are needed to achieve the same effect. The triazole fluconazole is the treatment of choice in infections caused by Candida albicans. New antifungal compounds are voriconazole and the candins, the pradimicin/benanomycin family, nikkomycin Z and a liposomal preparation of nystatin.
在过去二十年中，系统性真菌感染的发病率一直在上升。念珠菌和曲霉菌是典型的机会性病原体。毛霉、根霉、镰刀菌、丝孢酵母、拟青霉、链格孢、枝孢霉和伪阿利什霉等罕见真菌正逐渐成为免疫功能低下宿主系统性真菌感染的病因。四十多年来，两性霉素B一直是抗真菌治疗的金标准，因为它对酵母、双相真菌和霉菌具有广谱抗菌活性。其肾毒性促使了两性霉素B脂质体制剂的研发：脂质体两性霉素B、两性霉素B胶体分散体和两性霉素B脂质复合物。这些制剂的肾毒性较小，但要达到与传统两性霉素B相同的效果，所需剂量更高。三唑类氟康唑是白色念珠菌感染的首选治疗药物。新型抗真菌化合物有伏立康唑、棘白菌素类、普拉地米星/贝那霉素家族、多氧霉素Z和制霉菌素脂质体制剂。
