Nosocomial fungal infections: epidemiology, diagnosis, and treatment

Abstract

Invasive fungal infections are increasingly common in the nosocomial setting. Furthermore, because risk factors for these infections continue to increase in frequency, it is likely that nosocomial fungal infections will continue to increase in frequency in the coming decades. The predominant nosocomial fungal pathogens include Candida spp., Aspergillus spp., Mucorales, Fusarium spp., and other molds, including Scedosporium spp. These infections are difficult to diagnose and cause high morbidity and mortality despite antifungal therapy. Early initiation of effective antifungal therapy and reversal of underlying host defects remain the cornerstones of treatment for nosocomial fungal infections. In recent years, new antifungal agents have become available, resulting in a change in standard of care for many of these infections. Nevertheless, the mortality of nosocomial fungal infections remains high, and new therapeutic and preventative strategies are needed.

A simple and reproducible 96-well plate-based method for the formation of fungal biofilms and its application to antifungal susceptibility testing

“…and Cryptococcus neoformans are among the most common etiologic agents of fungal infections 1,2 . Fungi being eukaryotic cells and more complex than bacteria cause infections that are often difficult to diagnose and treat, and carry unacceptably high mortality rates 3 .…”

Candida albicansdimorphism as a therapeutic target

“…Furthermore, such a therapeutic strategy may not be attractive to large pharmaceutical companies, who may prefer to create a universal antifungal. Moreover, non-albicans species (including non-hyphae-producing species) now account for approximately half the cases of disseminated candidiasis [11]. Therefore, inhibition of hypha formation as a prophylactic strategy or as empirical antifungal therapy for disseminated candidiasis (even upon positive diagnosis of candidiasis), would currently be undesirable.…”

“…The presence of a central venous catheter, parenteral nutrition, burns and gastrointestinal surgery list among the leading risk factors for disseminated candidiasis [11]. As C. albicans can grow as yeast in the gastrointestinal tract [20] or on the skin [21], these risk factors could certainly lead to hematogenous seeding with yeast cells.…”

“…In contrast, vaginal infections often occur in individuals without any clear sign of immune defects. Hospitalized patients with certain risk factors are predisposed to life-threatening systemic candidiasis [11], characterized by dissemination via the bloodstream and infection of internal organs.…”

Overview of Aspergillus Allergens

“…However, fungal infections rarely affect immunocompetent hosts, and patients at high risk to be affected by fungal mycoses are those with significant reduction in the number or function of granulocytes such as leukaemia patients undergoing chemotherapy [4], patients on long-term treatment with immunosuppressive drugs (e.g. organ transplant patients) [5], or patients under high dosed steroid treatment [6]. The fatality rate of invasive mycoses is high and the majority of the patients die despite of anti-mycotic treatment [7].…”