Opportunistic Fungal Infections, Part 1: Antifungal Treatment and Prophylaxis

Patients with advanced HIV-1 infection, those who are receiving chemotherapy for malignancy, and transplant recipients (both hematopoietic stem cell transplant [HSCT] and solid organ transplant [SOT]) are among the populations of immunosuppressed patients at risk for fungal infections. The fungal infections acquired by these patients are a consequence of immunological deficits associated with the underlying disease or complications of therapy. Diagnosis of fungal infections remains problematic. It is often based on clinical signs and symptoms in an at-risk person, and invasive procedures are frequently required for confirmation. Treatment options have improved with the introduction of newer antifungal classes and medications; however, the optimal treatment for certain infections, such as invasive aspergillosis and infections caused by other invasive moulds (eg, Fusarium species and Zygomycetes) remains controversial. Prevention of fungal disease is dependent on minimizing exposure and having a functioning immune system. Because these conditions may not be possible to achieve in atrisk patients, antifungal prophylaxis has become an important part of care. Development of fungal vaccines remains inherently challenging, given that most vaccine technology relies on host immunity; however, novel approaches are being investigated and may be available in the future.