overview of changing trends in systemic fungal infections

ABSTRACT

Invasive mycoses are a significant and growing public health problem. The increasing use of invasive monitoring and aggressive therapeutic technologies in intensive care units has resulted in improved survival of individuals with life-threatening illnesses, but has also contributed to an increase in number of persons at risk for fungal infections. Today, invasive fungal infections pose the chief infectious challenge in hematology, oncology and intensive care practice. This review discusses the changing patterns in the risk factors, epidemiology, the impact of changes in medical practice on the incidence of systemic fungal infection and the emergence of antifungal resistance. Relevant English-language articles were identified through search of four databases [PubMed, ProQuest, Medline and Embase [all, 2005-2011]] conducted in June 2011 using Keywords "systemic fungal infection", "aspergillosis", "candidosis" and "antifungal". Original research and review articles related to patients with systemic fungal infection were considered for the review. Despite marked reduction in the rates of invasive fungal infections in developed countries, the burden is increasing largely in developing countries. Infections with Candida albicans may be decreasing in frequency, yet the number of persons at risk for them continues to grow. Prolonged and deep neutropenia and treatments neutralizing macrophage inflammatory cytokines have increased the likelihood of opportunistic infections. Extensive use of fluconazole in neutropenic patients has resulted in marked decrease in the incidence of invasive candidosis but it has also resulted in a shift from highly susceptible to less susceptible Candida spp. Candida glabrata. Along with Aspergillus app., Fusarium spp., Scedosporium spp., Penicillium spp. and Zygomycetes are gaining importance. Although there is improvement in the survival rates of patients with invasive fungal infection in recent years, continued research is required to meet the challenges associated with changes in epidemiology and resistance development