Onkológia 1/2008

THERAPY OF INVASIVE FUNGAL INFECTION IN IMMUNOSUPPRESSED PATIENTS

Invasive fungal infection (IFI) remains to be a serious complication in patients with significant primary or secondary immunodeficiency. High-dose chemotherapy and/or therapy with potent immunosuppressants, allogeneic stem cell transplantation with increasing proportion of alternative donors are responsible for increasing number of patients suffering such life-threatening complication. Despite infections caused by yeasts in general population predominate, in heavily immunosuppressed patients we observe increase of invasive mold infections. One of important factors negatively influencing the efficiency of therapy is difficult diagnostics. Therefore clinicians should think early about the possibility of IFI in patients in higher risk. In case of suspicion based on clinical signs and/or imaging or laboratory methods it is crucial to immediately start efficient therapy. Such therapy is often long-lasting, costly and usually accompanied by different adverse side effects. The therapy could be insufficient if not indicated based on evaluation of all available information and diagnostic tools, because than the selection of antifungal drug may not be optimal in terms of bio-availability and/or sensitivity. Treatment failure might be caused by severe and persistent defect of cellular immunity.

Keywords: invasive fungal infection, risk factors, therapy, antifungal agents, yeasts, molds