Opportunistic fungi

Systemic mycoses are caused either by true pathogenic fungi (endemic in distinct areas of USA/South America) or by opportunistic fungi that induce severe infections in immunosuppressed patients. The arsenal for the treatment of deep organ mycoses is relatively small Amph B, 5FC, azoles (FLU, ITRA, voriconazole (NBA filing)) and CAS. 

One compound that has been associated with distal tubular injury is amphotericin B, a polyene antifungal agent used in the treatment of systemic mycoses caused by opportunistic fungi. Clinical utility of amphotericin B is limited by its nephrotoxicity, characterized functionally by polyuria resistant to antidiuretic hormone administration, hyposthenuria, hypokalemia, and mild renal tubular acidosis. 

Systemic (Deep) Mycoses Caused by Opportunistic Fungi... 

Systemic mycoses may be caused by pathogenic fungi and include histoplasmosis, coccidioidomycosis, cryptococcosis, blastomycosis, paracoccidioidmycosis, and sporotrichosis, or infections by opportunistic fungi such as Candida albicans, Aspergillus spp., Trichosporon, C. glabrata, Fusarium, Alternarla, and Mucor. 

Groll AH, Walsh TJ. Uncommon opportunistic fungi New nosocomial threats. Clin Microbiol Infect 2001 7(suppl 2) 8-24. 

It is often stated that resistance to polyene antibiotics does not occur [103, 299—301). It is perhaps more true to say that although yeasts and other fungi are capable of giving rise to polyene-resistant strains, polyene resistance has not become a clinical problem, even after twenty years of therapeutic use. This is fortunate, for an increase in resistance of twenty-fold would be sufficient to render many strains of pathogenic and opportunistic fungi resistant to antibiotic concentrations that can be achieved in clinical lesions by conventional polyene therapy. 

Infectious complications persist as a major cause of death, especially within the first year of heart transplantation (Hosenpud et al. 2000). Within the first month of transplantation, infections are usually of nosocomial bacterial origin, including Pseudomonas aeruginosa. Staphylococcus aureus. Enterococci, and Enterobacteriaceae. These organisms can cause pneumonia, urinary tract and wound infections. Later infections are commonly caused by viruses and opportunistic fungi (e.g., Pneumocystis, Candida, and Aspergillus) (Miniati and Robbin 2002). 

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