Immunocompromised patients fungal infections

Systemic fungal infections are a major cause of morbidity and mortality in the immunocompromised patient. Fungal infections account for 20% to 30% of fatal infections in patients with acute leukemia, 10% to 15% of fatal infections in patients with lymphoma, and 5% of fatal infections in patients with solid tumors. The frequency of fungal infections among transplant recipients ranges from 0% to 20% for kidney and bone marrow transplant recipients to 10% to 35% for heart transplant recipients and 30% to 40% for liver transplant recipients. ... 

Since oropharyngeal and esophageal candidiasis are signs of immunocompromise, the immune status of the patient should be considered in the therapeutic care plan. For HIV-infected patients, this should also include an evaluation of the patient s antiretroviral therapy since fungal infections may represent deterioration in immune status. 

Amphotericin B (AmB) is a broad-spectrum antifungal agent that is the antibiotic of choice for disseminated fungal infections, particularly in immunocompromised patients. AmB is also used for the treatment of Leishmaniasis as a second-line treatment. However, its toxicity toward mammalian cells is often dose limiting, whatever its indication. 

Over the last fifty years, as chemotherapeutics for the treatment of cancer, bacterial infections, and to prevent transplant rejections have improved, there has been a concomitant increase in the number of patients suffering from fungal infections. In the past, most fungal infections were superficial, affecting only the skin, hair, or nails. However, as medical science has progressed in other disease areas, many more patients are immunocompromised, which has resulted in a greater incidence of systemic fungal infections. 

Amphotericin B remains the drug of choice in the treatment of invasive aspergillosis, locally invasive mucormycosis, and many disseminated fungal infections occurring in immunocompromised hosts (the patient population most at risk for serious fungal infections). For example, the febrile neutropenic oncology patient with persistent fever despite empirical antibacterial therapy is best treated with amphotericin B for possible Candida spp. sepsis. 

B. Amphotericin B remains the drug of choice in the treatment of disseminated or invasive fungal infections in immunocompromised hosts bone marrow transplant recipients are the most heavily immunocompromised patients encountered in the hospital setting. 5-Flucytosine has no significant activity against Aspergillus spp., and it has bone marrow toxicity as a common adverse effect it should... 

AIDS is a life-threatening disorder because of the susceptibility of the immunocompromised patient to severe infections and certain forms of cancer.65 73 76 101.113 [n particular, patients with AIDS often suffer from severe viral infections (CMV, various herpesvirus infections), bacterial infections (Mycobacterium tuberculosis), fungal infections (Pneumocystis jiroveri), and infections caused by various other microbes and parasites. Patients with AIDS also develop relatively unusual neoplastic diseases, such as Kaposi sarcoma. 

Sordarin derivatives, (n), prepared by Balkovec (2) were effective in treating fungal infections caused by C. albicans and used in treating infections in immunocompromised patients. 

Daunorabicin (DaunoXome, Gilead Sciences, Inc.) Doxorubicin (Doxil/Caelyx, Ortho Biotech ProductsLP/Sequus Pharmaceuticals) Amphotericin B (Ambisome/Abelcet, Fujisawa Healthcare, Wyeth Pharmaceuticals) Doxorubicin (Myocet/Evacet, Sopherion/ Liposome Company) Hepatitis A virus envelope proteins (Epaxal, Berna Biotech) Influenza virus (Inflexal V, Berna Biotech) Verteporfin (Visudyne, Novartis Ophthalmics) Kaposi s sarcoma Kaposi s sarcoma Fungal infections in immunocompromised patients Metastatic breast cancer Hepatitis A Influenza Age-related macular degeneration... 

Recognition of the role of the GI tract in invasive Candida infections has led to efforts to decrease infections by prophylactic administration of topical or systemically absorbed antifungal agents in immunocompromised patients. The use of systemically absorbable agents such as azole antifungal agents appears to decrease the risk of invasive fungal infections. ... 

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