Diagnosis and prevention of fungal infection in the immunocompromised patient

Profound and prolonged neutropenia following chemotherapy is a major risk f actor for systemic fungal infections. Mortality associated with disseminate d fungal infection is high and treatment with conventional amphotericin B i s complicated by renal toxicity. Candida and Aspergillus are among the majo r pathogens in this patient population. Many patients remaining neutropenic over a prolonged period of time will receive empirical antifungal therapy. The clinical and laboratory diagnosis of these infections are neither sens itive nor specific and are generally limited in the early detection of inva sive fungal infection, However, several new approaches to diagnosis are bei ng developed which should be translated into routine practice. These includ e antigen detection and PCR. It is still unclear how effective the various measures that are currently being used are in preventing serious fungal inf ection. Refinements in the prophylactic use of fluconazole, itraconazole an d aerosolized amphoteric in B, and the introduction of new formulations of existing antifungals may reduce the incidence of systemic fungal infections in some patient groups. Patients with presumed fungal infection require mo re intense and accurate monitoring for signs of disseminated infection. Ear ly diagnosis may guide appropriate treatment and prevent mortality.