New perspectives in the diagnosis of systemic fungal infections

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 is complicated by renal toxicity. Candida and Aspergillus are among the maj or pathogens in these patients. Many patients remaining neutropenic over a prolonged period of time will receive empirical antifungal therapy. The cli nical and laboratory diagnoses of these infections are neither sensitive no r specific and are generally limited in the early detection of invasive fun gal infection. However, several new approaches to diagnosis are being devel oped, which should be translated into routine practice, based on a greater understanding of the pathogenesis of systemic fungal infection and virulenc e determinants of fungal pathogens. These include antigen detection and pol ymerase chain reaction. Patients with presumed fungal infection require mor e intense and accurate monitoring for signs of disseminated infection. Earl y diagnosis may guide appropriate treatment and prevent mortality. Continue d development of commercial tests should help achieve the objective of defi nitive diagnostic tests for systemic fungal infections.