Invasive aspergillosis in cancer patients

The incidence of invasive aspergillosis is increasing parallel to the inten sity of immunosuppressive and myelosuppressive anticancer treatments. Succe ssful management is linked to an understanding of the pathogenesis and reco gnition of risk factors. Identifying the patients and clinical circumstance s associated with the highest risk for invasive aspergillosis and managing patients in protected environments remain the most effective means of preve ntion. Early accurate diagnosis continues to be a challenge; however, newer non-culture-based methods are encouraging and have been incorporated into standardized case definitions. Unacceptably high mortality rates persist wi th current treatment of established infection. Among the newer potentially less toxic antifungal therapies are the triazoles, and lipid-based polyene- formulations that target the fungal cell membrane and 1,3-beta-D-glitcan sy nthase inhibitors that target the fungal cell wall. These agents are curren tly in clinical trials. Host defense augmentation using hematopoietic growt h factors with or without other cytokines such as interferon-gamma or hemat opoietic growth factor-stimulated neutrophil transfusions remain controvers ial strategies that have yet to be tested in well-designed randomized contr olled trials.