Fungal Infections

  • Claire Pomeroy
  • Norman L. Goodman
Part of the Infectious Disease book series (ID)


Fungal infections are an increasingly important cause of morbidity and mortality, especially among the growing numbers of immunocompromised patients. Until recently, the armamentarium of drugs available to treat these frequently life-threatening diseases was extremely limited. Although the discovery of the azole drugs has significantly increased therapeutic options, additional approaches are still needed—agents currently under study allow considerable optimism for the future. Unfortunately, as with antibacterial drugs, the expanding use of antifungal therapies has led to the emergence of resistant organisms (1). Selection of mutants resistant to the azole drugs and even to amphotericin B, as well as the emergence of microbes with intrinsic resistance to available antifungal therapies, raise imposing challenges. Clinicians should be aware of the appropriate management of fungal infections, including recommended empiric therapies, indications for susceptibility testing, and options for treatment of resistant pathogens.


Fungal Infection Candida Species Antifungal Therapy Antifungal Drug Human Immunodeficiency Virus Patient 
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  1. 1.
    Alexander B, Perfect JR. Antifungal resistance trends towards the year 2000: implications for therapy and new approaches. Drugs 1997; 54: 657–678.PubMedCrossRefGoogle Scholar
  2. 2.
    Gumbo T, Isada CM, Hall G, et al. Candida glabrata fungemia. Medicine 1999; 78: 220–227.PubMedCrossRefGoogle Scholar
  3. 3.
    Girmenia C, Martino P, DeBemards F, et al. Rising incidence of Candida parapsilosis fungemia in patients with hematologic malignancies. Clin Infect Dis 1996; 23: 506–514.PubMedCrossRefGoogle Scholar
  4. 4.
    White TC, Marr KA, Bowden RA. Clinical cellular, and molecular factors that contribute to anti-fungal drug resistance. Clin Microbiol Rev 1998; 11: 382–402.PubMedGoogle Scholar
  5. 5.
    Wingard JR, Merz WG, Rinaldi MG, et al. Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med 1991; 325: 1274–1277.PubMedCrossRefGoogle Scholar
  6. 6.
    Pfaller MA, Messer SA, Hollis RJ, et al. Trends in species distribution and susceptibility to fluconazole among blood stream isolates of Candida species in the United States. Diagn Microbiol Infect Dis 1999; 33: 217–222.PubMedCrossRefGoogle Scholar
  7. 7.
    Pfaller MA, Messer SA, Houston A, et al. National epidemiology of mycoses survey: a multicenter study of strain variation and antifungal susceptibility among isolates of Candida species. Diagn Microbiol Infect Dis 1998; 31: 289–296.PubMedCrossRefGoogle Scholar
  8. 8.
    Maenza JR, Merz WG, Romagnoli MJ, et al. Risk factors for fluconazole resistant candidiasis in human immunodeficiency virus-infected patients. J Infect Dis 1996; 173: 219–225.PubMedCrossRefGoogle Scholar
  9. 9.
    Maenza JR, Merz WG, Romagnoli MF, et al. Infection due to fluconazole-resistant Candida in patients with AIDS. Clin Infect Dis 1997; 24: 28–34.PubMedCrossRefGoogle Scholar
  10. 10.
    Sobel JD, Vazquez JA. Symptomatic vulvovaginitis due to fluconazole resistant Candida albi-cans in a female who was not infected with human immunodeficiency virus. Clin Infect Dis 1996; 22: 726–727.PubMedCrossRefGoogle Scholar
  11. 11.
    Jandourek A, Brown P, Vazquez JA. Community-acquired fungemia due to a multiple-azoleresistant strain of Candida tropicalis. Clin Infect Dis 1999; 29: 1583–1584.PubMedCrossRefGoogle Scholar
  12. 12.
    Orni-Wasserlauf R, Izkhakov E, Siegman-Igra Y, et al. Fluconazole-resistant Cryptococcus neoformans isolated from an immunocompetent patient without prior exposure to fluconazole. Clin Infect Dis 1999; 29: 1592–1593.PubMedCrossRefGoogle Scholar
  13. 13.
    Pfaller MA, Rex JH, Rinaldi MG. Antifungal susceptibility testing: technical advances and potential clinical application. Clin Infect Dis 1997; 24: 776–784.PubMedCrossRefGoogle Scholar
  14. 14.
    Klepser ME, Lewis RE, Pfaller MA. Therapy of candida infections: susceptibility testing, resistance, and therapeutic options. Ann Pharmacother 1998; 32: 1353–1361.PubMedCrossRefGoogle Scholar
  15. 15.
    Lewis RE, Klepser ME, Pfaller MA. Update on clinical antifungal susceptibility testing for candida species. Pharmacotherapy 1998; 18 (3): 509–515.PubMedGoogle Scholar
  16. 16.
    Szekely A, Johnson EM, Warnock DW. Comparison of E-test and broth microdilution methods for antifungal drug susceptibility testing of molds. J Clin Microbiol 1999; 37: 1480–1483.PubMedGoogle Scholar
  17. 17.
    Lewis RE, Klepser ME. The changing face of nosocomial candidemia: epidemiology, resistance, and drug therapy. Am J Health Syst Pharmacy 1999; 56: 525–1536.Google Scholar
  18. 18.
    Pfaller MA, Jones RN, Messer SA, et al. SCOPE Participant Group. National surveillance of nosocomial blood stream infection due to species of Candida other than Candida albicans: frequency of occurrence and antifungal susceptibility in the SCOPE program. Diagn Microbiol Infect Dis 1998; 31: 121–129.CrossRefGoogle Scholar
  19. 19.
    Verduyn Lunel FM, Meis JFGM, Voss A. Nosocomial fungal infections: candidemia. Diagn Microbiol Infect Dis 1999; 24: 213–220.CrossRefGoogle Scholar
  20. 20.
    Patterson TF. Cryptococcosis in HIV-infected and non-HIV-infected hosts. Int J Infect Dis 1997; 1: S64–69.Google Scholar
  21. 21.
    Drake LA, Dinehart SM, Farmer ER, et al. Guidelines of care for superficial mycotic infections of the skin. J Am Acad Dermatol 1996; 34: 282–294.PubMedCrossRefGoogle Scholar
  22. 22.
    Groll AH, Piscitelli SC, Walsh TJ. Clinical pharmacology of systemic antifungal agents: a comprehensive review of agents in clinical use, current investigational compounds, and putative targets for antifungal drug development. Adv Pharmacol 1998; 44: 343–501.PubMedCrossRefGoogle Scholar
  23. 23.
    Kauffman CA, Carver PL. Antifungal agents in the 1990’s: current status and future developments. Drugs 1997; 53 (4): 539–549.PubMedCrossRefGoogle Scholar
  24. 24.
    Warnock DW. Fungal infections in neutropenia: current problems and chemotherapeutic control. J Antimicrob Chemother 1998; 41: 595–105.CrossRefGoogle Scholar
  25. 25.
    Georgopapadakou NH, Walsh TJ. Antifungal agents: chemotherapeutic targets and immunologic strategies. Antimicrobial Agents Chemother 1996; 40: 279–291.Google Scholar
  26. 26.
    Dismukes WE. Introduction to antifungal drugs. Clin Infect Dis 2000; 30: 653–657.PubMedCrossRefGoogle Scholar
  27. 27.
    Hiemenz JW, Walsh TJ. Lipid formulations of amphotericin B: recent progress and future directions. Clin Infect Dis 1996; 22: S133–144.PubMedCrossRefGoogle Scholar
  28. 28.
    Walsh TJ, Finberg RW, Arndt C, et al. Liposomal amphotericin B for empirical therapy in patients with persistent fever and neutropenia. N Engl J Med 1999; 340: 747–771.CrossRefGoogle Scholar
  29. 29.
    Sheehan DJ, Hitchcock CA, Sibley CM. Current and emerging azole antifungal agents. Clin Microbiol Rev 1999; 12: 40–79.PubMedGoogle Scholar
  30. 30.
    Kauffman CA. Role of azoles in antifungal therapy. Clin Infect Dis 1996; 22: S148–153.PubMedCrossRefGoogle Scholar
  31. 31.
    Sobel JD. Practice guidelines for the treatment of fungal infections Clin Infect Dis 2000; 30: 652.Google Scholar
  32. 32.
    Quereda C, Polanco AM, Giner C, et al. Correlation between in vitro resistance to fluconazole and clinical outcome of oropharyngeal candidiasis in HIV-infected patients. Eur J Clin Microbiol Infect Dis 1996; 15: 30–37.PubMedCrossRefGoogle Scholar
  33. 33.
    Edwards JE, Bodey GP, Bowden RA, et al. International conference for the development of a consensus on the management and prevention of severe candidal infections. Clin Infect Dis 1997; 25: 43–59.PubMedCrossRefGoogle Scholar
  34. 34.
    Rex JH, Walsh TJ, Sobel JD et al. Practice guidelines for the treatment of candidiasis. Clin Infect Dis 2000; 30: 662–678.PubMedCrossRefGoogle Scholar
  35. 35.
    Rex JH, Bennett JE, Sugar AM, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. N Engl J Med 1994; 331: 1325–1330.PubMedCrossRefGoogle Scholar
  36. 36.
    Van Burik JH, Leisenring W, Myerson D, et al. The effect of prophylactic fluconazole on the clinical spectrum of fungal diseases in bone marrow transplant recipients with special attention to hepatic candidiasis. Medicine 1998; 77: 246–254.PubMedCrossRefGoogle Scholar
  37. 37.
    Vazquez JA, Sobel JD, Peng G, et al. Evolution of vaginal Candida species recovered from human immunodeficiency virus infected women receiving fluconazole prophylaxis. The emergence of Candida glabrata? Clin Infect Dis 1999; 28: 1025–1031.PubMedCrossRefGoogle Scholar
  38. 38.
    Stevens DA, Kan VL, Judson MA, et al. Practice guidelines for diseases caused by Aspergillus. Clin Infect Dis 2000; 30: 696–709.PubMedCrossRefGoogle Scholar
  39. 39.
    Saag MS, Groybill RJ, Larsen RA. Practice guidelines for the management of cryptococeal disease. Clin Infect Dis 2000; 30: 710–718.PubMedCrossRefGoogle Scholar
  40. 40.
    Chopman SW, Bradsher RW, Campbell GD, et al. Practice guidelines for the management of patients with blastomycosis. Clin Infect Dis 2000; 30: 679–683.CrossRefGoogle Scholar
  41. 41.
    Wheat J, Sarosi G, McKinsey D, et al. Practice guidelines for the management of patients with histoplasmosis. Clin Infect Dis 2000; 30: 688–695.PubMedCrossRefGoogle Scholar
  42. 42.
    Galgiani JN, Ampel NM, Catanzoro A, et al. Practice guidelines for the treatment of coccidioidomycosis. Clin Infect Dis 2000; 30: 658–661.PubMedCrossRefGoogle Scholar
  43. 43.
    Kauffman CA, Hajjeh R, Chopman SW. Practice guidelines for the management of patients with sporotrichosis. Clin Infect Dis 2000; 30: 684–687.PubMedCrossRefGoogle Scholar
  44. 44.
    Gubbins PO, Bowman JL, Penzak SR. Antifungal prophylaxis to prevent invasive mycoses among bone marrow transplant recipients. Pharmacotherapy 1998; 18: 549–564.PubMedGoogle Scholar
  45. 45.
    Lortholary 0, Dupont B. Antifungal prophylaxis during neutropenia and immunodeficiency. Clin Microbiol Rev 1997; 10: 477–504.PubMedGoogle Scholar
  46. 46.
    McKinsey DS, Wheat LJ, Cloud GA, et al. Itraconazole prophylaxis for fungal infections in patients with advanced human immunodeficiency virus infection. Clin Infect Dis 1999; 28: 1049–1056.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2001

Authors and Affiliations

  • Claire Pomeroy
  • Norman L. Goodman

There are no affiliations available

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