THE ROLE OF IMMUNORECONSTITUTION IN THE MANAGEMENT OF REFRACTORY OPPORTUNISTIC FUNGAL-INFECTIONS

Systemic fungal infections are an increasingly important threat to imm unocompromised patients. In particular, invasive disease due to Candid a spp., Aspergillus spp. and other moulds is associated with high mort ality rates in these patients, despite the many recent advances in ant ifungal chemotherapy. Recent studies examining the immunopathogenesis of these infections have provided increased insights into the relative importance of the different compartments of host immune defences for these fungi. In parallel, a number of cytokines have been discovered a nd studies of their involvement in antifungal host defences both in vi tro and in experimental animal models of fungal infections have become possible. Due to their ability to upregulate phagocyte number and/or function, the cytokines of greatest interest are granulocyte colony-st imulating factor, granulocyte-macrophage colony-stimulating factor, ma crophage colony-stimulating factor, interferon-gamma, interleukin-l an d tumour necrosis factor-alpha. Adjuvant use of these cytokines may be of value for some refractory fungal infections, as may reconstitution of immune response by transfusion of allogeneic phagocytes. Further e valuation of the safety and efficacy of these modalities of immunother apy is a new and promising area for research.