THE EPIDEMIOLOGY AND PREVENTION OF INVASIVE ASPERGILLOSIS

Over the past two decades, the incidence of invasive aspergillosis (IA ) has risen inexorably. This is almost certainly the consequence of th e more widespread use of aggressive cancer chemotherapy regimens, the expansion of organ transplant programmes and the advent of the acquire d immunodeficiency syndrome (AIDS) epidemic. Despite the development o f new approaches to therapy, IA still remains a life-threatening infec tion in immunocompromised patients and is the most important cause of fungal death in cancer patients. It is clear that the prevention of se vere fungal infection by the use of effective infection control measur es should be the priority of the teams involved in managing at-risk pa tients. The evidence from clinical and molecular epidemiological studi es is reviewed and current thinking on sources and routes of transmiss ion of the organism are discussed. Our increasing understanding of the se has led to the development of a variety of environmental and genera l strategies for the prevention of IA. It is anticipated that these, c oupled with the use of prophylactic antifungal agents active against A spergillus spp., will have a significant impact upon the morbidity and mortality associated with this infection.