Approach to Patients with Suspected Fungal Infections

Abstract

Fungal infections (mycoses) are increasing in incidence throughout the world as a result of modern medical practice and rise in the population of those at risk. Supporting this increase is the expanding use of immunosuppressive therapies, broad-spectrum antibiotics, and central venous access devices. Technology has led to the improved survival of persons with malignancies, transplanted organs, HIV infection, following trauma, and at the extremes of age. The medical community has met this challenge with the introduction of new antifungal agents, often with less toxicity and improved spectrums of activity. Additionally, newer, more sensitive and specific diagnostic strategies such as improved radiographic imaging and serological tests, have provided clinicians with better tools to detect fungal infections earlier, potentially influencing disease outcomes. Molecular techniques have been introduced in the last decade which can produce a more exact identification of recovered fungal pathogens and have the potential to improve diagnosis of fungal infection. Despite these advances, the approach to the diagnosis and management of fungal infections still relies on recognizing the interaction of the pathogen and the host. Although some fungal diseases have classic presentations, many of these occur so rarely that clinicians may not initially include them in their differential diagnoses. In the setting of immunosuppression, mycoses may produce nonspecific signs and symptoms, making their diagnosis a challenge. Early recognition and treatment is fundamental to modifying disease outcomes in many fungal infections, especially those in immunocompromised individuals. Increased awareness of key risk factors and clinical presentations of the human mycoses may enable clinicians to develop an inclusive approach to the diagnosis of these diseases.