| Abstract: |
The susceptibility of immunocompromised patients to opportunistic fungi has been recognized for at least 40 years. These infections are difficult to diagnose and are usually treated empirically or presumptively. There have been modest advances, but amphotericin B remains the mainstay of therapy. Liposomal or lipid-associated formulations of amphotericin B appear to have reduced toxicity and to permit administration of higher doses. The comparative toxicities, efficacies, and costs of these new formulations need to be considered. New oral azoles can be used for completion or maintenance therapy of some fungal infections; they may also be indicated in milder cases or in patients with less severe immunosuppression. New broader spectrum azoles are undergoing clinical evaluation. Other new classes of drugs, such as the echinocandins and pneumocandins are in advanced stages of testing. The gains in diagnosis, treatment, and prevention of fungal infections have not matched those achieved in the control of bacterial and viral infections in the immunocompromised host. The problem of opportunistic fungal infections is the focus of an expanded research effort, and there are potentially significant improvements on the horizon. |
