Fungal infections in transplant recipients

Fungi are ubiquitous and the respiratory tract is exposed to aerosolized sp ores of both fungi that are "pathogenic" even in the normal host, such as C ryptococus neoformans, and those that are "opportunistic", such as Candida and Aspergillus species, among others. Although these latter species may oc casionally form fungal balls or induce allergic phenomena in the normal hos t, they produce more invasive diseases in immunosuppressed patients. Among these diseases, pseudomembranous aspergillosis has recently been described. The diagnostic approach to these entities, and, in particular, the thin div iding line between colonization and infection are addressed, along with the diagnostic value of the various procedures. New prophylactic regimens are reviewed such as the possibility of using amp hotericin aerosols in combination with systemic azole administration. The authors would emphasize the importance of restoring lung defences by no t only decreasing immunosuppressive regimens but also considering the use o f newly available recombinant cytokines such as growth factors, to reduce n eutropenia, for instance, in addition to antifungal drugs when infection is diagnosed. However, immunomodulation procedures are far from being well es tablished.