Fungal Infections in the Immunocompromised Host

Clinical Syndromes and Diagnosis
  • Herman Chmel
Part of the Infectious Agents and Pathogenesis book series (IAPA)

Abstract

Fungal infections are a major cause of morbidity and mortality in the immunocompromised host. In the last 25 years, the frequency of invasive fungal infections has increased remarkably. Unbiased data concerning the true incidence and prevalence of invasive fungal infections in different patient populations is limited. Hart et al.1 reported 132 invasive fungal infections in normal and immunocompromised patients. Seventy infections occurred in immunocompromised patients, 81% caused by Candida spp., Aspergillus spp., and Zygomycete spp. and 12% by Cryptococcus spp. In contrast, 62 invasive fungal infections occurred in normal patients, and none were caused by Candida, Aspergillus, or Zygomycete spp. Muller et al. 2 reported the following incidence of opportunistic deep-seated mycosis, candidiasis 92.6%; aspergillosis 6.7%; cryptococcosis 0.35%, and zygomycosis 0.35%. Rose and Varkey,3 in a comprehensive review of invasive fungal infections, reported per 10,000 hospital discharges the following rates: Candida spp. 7.08, Aspergillus spp. 1.4, and Zygomycete spp. 0.23. Data from the National Nosocomial Infection Surveillance Program (CDC)4 representing 1984 rates showed Candida spp. accounted for 5.5% of all isolates and was the eighth most common nosocomial pathogen. The category listed as “other fungi” accounted for 1.7% of all isolates and ranked 11th. Although data from autopsies are limited and selective, the relative frequency of invasive fungal infections in transplant and oncologic patients can be inferred by their review. The observed frequency of invasive fungal infections is 20–30% in patients with acute leukemia, 10–15% in patients with lymphoma, and 5% in patients with other malignancies.5 The frequency in organ transplant recipients is 28–42% for liver, 10–35% for heart, 2–30% for bone marrow, and 0–20% for kidneys.6 Overall invasive candidiasis accounted for death in 10–40% of patients and invasive aspergillosis in 5–15%.7

Keywords

Catheter Pneumonia Meningitis Fusarium Mannose 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Hart, P. D., Russell, E., Jr., and Remington, J. S., 1969, The compromised host and infection, II, Deep fungal infection, J. Infect. Dis. 120: 169–191.PubMedCrossRefGoogle Scholar
  2. 2.
    Miller, J., Kappe, R., Kubitza, D., Fessier, R., and Scheidecker, I., 1988, The incidence of deep seated mycoses in Freiburg, Mycoses 31 (Suppl. 1): 9–28.Google Scholar
  3. 3.
    Rose, H. D., and Varkey, B., 1975, Deep mycotic infection in the hospitalized adult: A study of 123 patients, Medicine 54: 499–507.PubMedCrossRefGoogle Scholar
  4. 4.
    Centers for Disease Control, 1986, Nosocomial infection surveillance, in: CDC Surveillance Summaries, MMWR 35:17–29SS.Google Scholar
  5. 5.
    Bodey, J. P., 1984, Candidiasis in cancer patients, Am. j Med. 77: 13–19.PubMedGoogle Scholar
  6. 6.
    Dummer, J. S., Hardy, A., Poorsatter, A., and Ho, M., 1983, Early infections in kidney, heart and liver transplant recipients on cyclosporin, Transplantation 36: 259–267.PubMedCrossRefGoogle Scholar
  7. 7.
    Weber, D. J., and Rutala, W. A., 1989, Epidemiology of hospital-acquired fungal infections, in: Diagnosis and Therapy of Systemic Fungal Infections ( K. Holmberg and R. D. Meyer, eds.), Raven Press, New York, p. 2.Google Scholar
  8. 8.
    Anonymous, 1988, Orofacial manifestations of HIV infection Lancet 1:976–977.Google Scholar
  9. 9.
    Grant, I. H., and Armstrong, D., 1988, Fungal infections in AIDS: Cryptococcosis, in: Infectious Disease Clinics of North America, Vol. 2 ( M. A. Sande and P. A. Volberding, eds.), W. B. Saunders, Philadelphia, pp. 827–839.Google Scholar
  10. 10.
    Macher, A. M., DeVinatea, M. L., Tuur, S. M., and Angritt, P., AIDS and the mycoses, in: Infectious Disease Clinics of North America, Vol. 2 (D. Drutz, ed.), W. B. Saunders, Philadelphia, pp. 821–839.Google Scholar
  11. 11.
    Armstrong, D., Chmel, H., Singer, C., Tapper, M., and Rosen, P. P., 1975, Nonbacterial infections associated with neoplastic disease, Eur. J. Cancer 11 (Suppl): 79–94.PubMedGoogle Scholar
  12. 12.
    Bodey, G. P., Buckley, M., Sathe, Y. S., and Freireich, E. J., 1966, Quantitative relationships between circulating leukocytes and infections in patients with acute leukocytes and infections in patients with acute leukemia, Ann. Intern. Med. 64: 328–340.PubMedCrossRefGoogle Scholar
  13. 13.
    Kirkpatrick, C. H., 1984, Host factors in defense against fungal infections, Am. J. Med. 77: 1–12.PubMedGoogle Scholar
  14. 14.
    Newman, A. K., and Schimpff, S. C., 1987, Hospital hotel services as risk factors for infection among immunocompromised patients, Rev. Infect. Dis. 9: 206–213.PubMedCrossRefGoogle Scholar
  15. 15.
    Armstrong, D., 1981, Fungal infections in the compromised host, in: Clinical Approach to Infection in the Compromised Host (R. H. Rubin and L. S. Young, eds.), Plenum Publishing, New York, pp. 195–228.Google Scholar
  16. 16.
    Gold, J. W. M., 1984, Opportunistic fungal infections in patients with neoplastic disease, Am. J. Med. 76: 458–463.PubMedCrossRefGoogle Scholar
  17. 17.
    Weber, D. J., and Rutala, W. A., 1989, Epidemiology of hospital-acquired fungal infections, in: Diagnosis and Therapy of Systemic Fungal Infections ( K. Holmberg and R. D. Meyers, eds.), Raven Press, New York, pp. 1–25.Google Scholar
  18. 18.
    Anaissie, E., and Bodey, G. P., 1989, Nosocomial fungal infections, in: Infectious Disease Clinics of North America, Vol. 3 (D. J. Weber and W. A. Rutala, eds.), W. B. Saunders, Philadelphia, pp. 867–882.Google Scholar
  19. 19.
    Edwards, J. E., Jr., Drutz, D. J., Bennett, J. E., and Remington, J. S., 1986, in: Disseminated Candidiasis. A Major Problem in Cancer and Postoperative Patients. Part 1, Academy Professional Information Sources, New York.Google Scholar
  20. 20.
    Body, B. A., Pfaller, M. A., Durrer, J., Koontz, E, and Groschel, D. H., 1988, Comparison of the lysis centrifugation and radiometric blood culture systems for recovery of yeasts, Eur. J. Clin. Microbiol. Infect. Dis. 7: 417–420.Google Scholar
  21. 21.
    Kiehn, T. E., Wong, B., Edwards, E E, and Armstrong, D., 1983, Comparative recovery of bacteria and yeasts from lysis-centrifugation and a conventional blood culture system, J. Clin. Microbiol. 18: 300–304.Google Scholar
  22. 22.
    Bennett, J. E., 1987, Rapid diagnosis of candidiasis and aspergillosis, Rev. Infect. Dis. 9: 398–402.PubMedCrossRefGoogle Scholar
  23. 23.
    DeRepentigny, L., and Reiss, E., 1984, Current trends in immunodiagnosis of candidiasis and aspergillosis, Rev. Infect. Dis. 6: 301–312.CrossRefGoogle Scholar
  24. 24.
    Barnes, R. A., 1990, Immunological diagnosis of fungal infection in the immunocompromised host, Rev. Med. Microbiol. 1: 58–65.Google Scholar
  25. 25.
    Rinaldi, M. G., 1989, Emerging Opportunists, in: Infectious Disease Clinics of North America, Vol. 3 ( D. Drutz, ed.), W. B. Saunders, Philadelphia, pp. 65–76.Google Scholar
  26. 26.
    Odds, E C., 1984, Ecology and epidemiology of Candida species, Zentralbl. Bakteriol. Parasitenkd. Infektionskr. Hyg. Abt. I Reihe A 257: 207–212.Google Scholar
  27. 27.
    Anonymous, 1989, Oral candidosis in HIV infection, Lancet 2: 1491–1492.Google Scholar
  28. 28.
    Klein, R. S., Harris, C. A., Small, C. B., Moll, B., Lasser, M., and Friedland, G., 1984, Oral candidiasis in high risk patients as the initial manifestation of the acquired immunodeficiency syndrome, N. Engl. J. Med. 311: 354–357.PubMedCrossRefGoogle Scholar
  29. 29.
    Syrjanen, S., Valle, S. L., and Antonen, J., 1988, Oral candidal infections as a sign of HIV infection in homosexual men, Oral Surg. 65: 36–40.CrossRefGoogle Scholar
  30. 30.
    Schiodt, M., and Pindborg, J. J., 1987, Epidemiology and clinical oral manifestations of human immune deficiency virus infection: A review, Int. J. Oral Maxillofac. Surg. 16: 1–19.PubMedCrossRefGoogle Scholar
  31. 31.
    Coleman, M. E, 1986, Epiglottitis in immunocompromised patients, Head Neck Surg. 8: 466–468.CrossRefGoogle Scholar
  32. 32.
    Walsh, T. J., and Gray, W. C., 1987, Candida epilottitis in immunocompromised patients, Chest 91: 482–485.PubMedCrossRefGoogle Scholar
  33. 33.
    Cole, S., Zawin, M., Lungberg, B., Hoffman, J., Bailey, L., and Ernstoff, M. S., 1987, Candida epiglottitis in an adult with acute non-lymphocytic leukemia, Am. J. Med. 82: 662–664.PubMedCrossRefGoogle Scholar
  34. 34.
    Nathieson, R., and Dutta, S. K., 1983, Candida esophagitis, Digest. Dis. Sci. 28: 365–371.CrossRefGoogle Scholar
  35. 35.
    Welik, R. M., Starcher, E. T., and Curran, J. W, 1987, Opportunistic diseases reported in AIDS patients: Frequencies, associations, and trends, AIDS 1: 175–182.Google Scholar
  36. 36.
    Holt, H., 1986, Candida infections of the esophagus, Gut 9: 227–238.CrossRefGoogle Scholar
  37. 37.
    Walsh, T. S., Hamilton, S. R., and Belitos, N., 1988, Esophageal candidiasis. Diagnoses and treatment of an increasingly recognized fungal infection, Postgrad. Med. 84: 193–205.PubMedGoogle Scholar
  38. 38.
    Tashjian, L. S., Abramson, J. S., and Peacock, J. E., Jr., 1983, Focal hepatic candidiasis: A distinct clinical variant of candidiasis in immunocompromised patients, Rev. Infect. Dis. 6: 689–703.CrossRefGoogle Scholar
  39. 39.
    Haron, E., Feld, R., Tuffnell, P., Patterson, B., Hasselback, R., and Matlow, A., 1987, Hepatic candidiasis: An increasing problem in immunocompromised patients, Am. J. Med. 83: 17–26.PubMedCrossRefGoogle Scholar
  40. 40.
    Thaler, M., Pastakia, B., Shawker, T. H., O’Leary, T. O., and Pizzo, P. A., 1988, Hepatic candidiasis in immunocompromised patients: A new or evolving syndrome, Ann. Intern. Med. 108: 88–100.PubMedCrossRefGoogle Scholar
  41. 41.
    Odds, E C., 1988, Candida and Candidiosis, 2nd ed., W. B. Saunders, Philadelphia, pp. 169–174.Google Scholar
  42. 42.
    Bodey, G. P., and Fainstein, V, 1985, Candidemia, Raven Press, New York, pp. 135–154.Google Scholar
  43. 43.
    Wey, S. B., Mori, M., Pfaller, M. A., Woolson, R. E, and Wenzel, R. P., 1989, Risk factors for hospital-acquired candidemia, Arch. Intern. Med. 149: 2349–2353.PubMedCrossRefGoogle Scholar
  44. 44.
    Collignon, P. J., Soni, N., and Pearson, I. Y., 1986, Is semi-quantitative culture of central vein catheter tips useful in the diagnosis of catheter-associated bacteremia, J. Clin. Microbiol. 24: 532–535.PubMedGoogle Scholar
  45. 45.
    Torres-Rojas, J. R., Stratton, C. W, Sanders, C. V, Horsman, T. A., Hawley, H. B., Dascomb, H. E., and Vial, L. J., 1982, Candidal suppurative peripheral thrombophlebitis, Ann. Intern. Med. 96: 431–435.PubMedCrossRefGoogle Scholar
  46. 46.
    Prager, R. L., and Silva, J., Jr., 1984, Colonization of central venous catheters, South. Med. J. 77: 458–461.PubMedCrossRefGoogle Scholar
  47. 47.
    Odds, E C., 1988, Candida and Candidiosis, 2nd ed., W B. Saunders, Philadelphia, pp. 206–230.Google Scholar
  48. 48.
    Musial, C. E., Cockerill, F. R., and Roberts, G. D., 1988, Fungal infections of the immunocompromised host: Clinical and laboratory aspects, Clin. Microbiol. Rev. 1: 349–364.PubMedGoogle Scholar
  49. 49.
    Sarubbi, E. A., Jr., Kopf, H. B., Wilson, M. B., McGinnis, M. R., and Rutala, W. A., 1982, Increased recovery of Aspergillus flavus from respiratory specimens during hospital construction, Am. Rev. Resp. Dis. 125: 33–38.PubMedGoogle Scholar
  50. 50.
    Opal, S. M., Asp, A. A., Cannady, P. B., Jr., Morse, P. L., Burton, L. J., and Hammer, P. G., 1986, Efficacy of infection control measures during a nosocomial outbreak of disseminated aspergillosis associated with hospital construction, J. Infect. Dis. 153: 634–637.PubMedCrossRefGoogle Scholar
  51. 51.
    Aisner, J., Murillo, J., Schimpff, S. C., and Steere, A. C., 1979, Invasive aspergillosis in acute leukemia: Correlation with nose cultures and antibiotic use, Ann. Intern. Med. 90: 4–9.PubMedCrossRefGoogle Scholar
  52. 52.
    Rinaldi, M. G., 1983, Invasive aspergillosis, Rev. Infect. Dis. 5: 1061–1077.PubMedCrossRefGoogle Scholar
  53. 53.
    Young, R. C., Bennett, J. E., Vogel, C. L., Carbone, P. P., and DeVita, V. T., 1970, Aspergillosis: The spectrum of the disease in 98 patients, Medicine 49: 147–173.PubMedCrossRefGoogle Scholar
  54. 54.
    Levity, S. M., 1989, Aspergillosis, in: Infectious Disease Clinics of North America, Vol. 3 ( D. J. Drutz, ed.), W. B. Saunders, Philadelphia, pp. 1–18.Google Scholar
  55. 55.
    McCarty, J. M., Flam, M. S., Pullen, G., 1986, Outbreak of primary cutaneous aspergillosis related to intravenous arm boards, J. Pediatr. 108: 721–724.PubMedCrossRefGoogle Scholar
  56. 56.
    Gerson, S. L., Talbot, G. H., Hurwitz, S., Strom, B. L., Lusk, E. J., and Cassileth, P. A., 1984, Prolonged granulocytopenia: The major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia, Ann. Intern. Med. 100: 345–351.PubMedCrossRefGoogle Scholar
  57. 57.
    Rinaldi; M. G., 1989, Zygomycosis, in: Infectious Disease Clinics of North America, Vol. 3 ( D. J. Drutz, ed.), W. B. Saunders, Philadelphia, pp. 19–41.Google Scholar
  58. 58.
    Cho, S. Y., and Choi, H. Y., 1979, Opportunistic fungal infection among cancer patients, Am. J. Clin. Pathol. 72: 617–621.PubMedGoogle Scholar
  59. 59.
    Ingram, C. W, Sennesh, J., Cooper, J. N., and Perfect, J. R., 1989, Disseminated zygomycosis: Report of four cases and review, Rev. Infect. Dis. 11: 741–754.PubMedCrossRefGoogle Scholar
  60. 60.
    Karam, E, and Chmel, H., 1990, Rhino-orbito cerebral mucormycosis, Ear, Nose Throat J. 69: 187–193.Google Scholar
  61. 61.
    Perfect, J. R., 1989, Cryptococcosis, in: Infectious Disease Clinics of North America, Vol. 3 ( D. J. Drutz, ed.), W. B. Saunders, Philadelphia, pp. 77–102.Google Scholar
  62. 62.
    Bennett, J. E., Kwon-Chung, K. J., and Howard, D. H., 1977, Epidemiology differences among serotypes of Cryptococcus neoformans, Am. J Epidemiol. 105: 582–590.PubMedGoogle Scholar
  63. 63.
    Sabetta, J. R., and Andriole, V. T., 1985, Cryptococcal infections of the central nervous system, Med. Clin. North Am. 69: 333–342.Google Scholar
  64. 64.
    Salaki, J. S., Louria, D. B., and Chmel, H., 1984, Fungal and yeast infections of the central nervous system. A clinical review, Medicine 63: 108–131.PubMedCrossRefGoogle Scholar
  65. 65.
    Zuger, A., Louie, E., Holzman, R. S., Simberkoff, M. S., and Rahal, J. J., 1986, Cryptococcal disease in patients with the acquired immunodeficiency syndrome, Ann. Intern. Med. 104: 234–240.PubMedCrossRefGoogle Scholar
  66. 66.
    Kaufman, L., and Reiss, E., 1985, Serodiagnosis of fungal diseases, in: Manual of Clinical Microbiology ( E. H. Lennette, A. Balows, W. J. Hausler, Jr., and H. J. Shadomy, eds.), American Society of Microbiology, Washington, D.C., pp. 924–944.Google Scholar
  67. 67.
    Kerkering, T. M., Duma, R. J., and Shadomy, S., 1981, The evolution of pulmonary cryptococcosis, Ann. Intern. Med. 94: 611–616.PubMedCrossRefGoogle Scholar
  68. 68.
    Hoy, J., Hsu, K. C., Rolston, K., Hopfer, R. L., Lura, M., and Bodey, G. P., 1986, Trichosporon beigelli infection: A review, Rev. Infect. Dis. 8: 959–967.CrossRefGoogle Scholar
  69. 69.
    Walsh, T. J., Newman, K. R., Moody, M., Wharton, R. C., and Wade, J. C., 1986, Trichosporonosis in patients with neoplastic disease, Medicine 65: 268–279.PubMedCrossRefGoogle Scholar
  70. 70.
    Walsh, T. J., 1989, Trichosporonosis, in: Infectious Disease Clinics of North America, Vol. 3 ( D. J. Drutz, ed.), W. B. Saunders, Philadelphia, pp. 43–52.Google Scholar
  71. 71.
    Anaissie, E., Kantarjian, H., Ro, J., Jones, P., and Bodey, G. P., 1988, The emerging role of Fusarium infections in patients with cancer, Medicine 67: 77–83.PubMedCrossRefGoogle Scholar
  72. 72.
    Travis, L. B., Roberts, G. D., and Wilson, W. R., 1985, Clinical significance of Pseudoallescheria boydii: A review of 10 years experience, Mayo Clin. Proc. 60: 531–537.PubMedCrossRefGoogle Scholar
  73. 73.
    Wheat, L. J., Slama, T. G., and Norton, J. A., 1982, Risk factors for disseminated or fatal histoplasmosis, Ann. Intern. Med. 96: 159–163.PubMedCrossRefGoogle Scholar
  74. 74.
    Kaufman, C. A., Israel, K. S., and Smith, J. W, 1978, Histoplasmosis in immunosuppressed patients, Am. J. Med. 64: 923–932.CrossRefGoogle Scholar
  75. 75.
    Wheat, L. J., Histoplasmosis, in: Infectious Disease Clinics of North America, Vol. 2 (D. J. Drutz, ed.), W. B. Saunders, Philadelphia, pp. 841–859.Google Scholar
  76. 76.
    Wheat, L. J., Kohler, R. B., and Tewari, R. P., Diagnosis of disseminated histoplasmosis by detection of histoplasma capsulation antigen in serum and urine specimens, N. Engl. J. Med. 314: 83–88.Google Scholar
  77. 77.
    Rutala, P. J., and Smith, J. W, 1978, Coccidioidomycosis in potentially compromised hosts: The effects of immunosuppressive therapy in dissemination, Am. J. Med. Sci. 275: 283–295.PubMedCrossRefGoogle Scholar
  78. 78.
    Deresinski, S. C., and Stevens, D. A., 1975, Coccidioidomycosis in compromised hosts, Medicine 54: 377–395.Google Scholar
  79. 79.
    Ampel, N. M., Ryan, K. J., Carry, P. J., and Schifman, R. B., 1986, Fungemia due to Coccidioides immitis: An analysis of 16 episodes in 15 patients and a review of the literature, Medicine 65: 312–321.Google Scholar
  80. 80.
    Meyers, R. D., and Holmberg, K., 1989, Fungal infections in HIV patients, in: Diagnosis and Therapy of Systemic Fungal Infections (K. Holmberg and R. D. Meyers, eds.), Raven Press, New York, pp. 93–94.Google Scholar
  81. 81.
    Pappagianis, D., and Zimmer, B. L., 1990, Serology of coccidioidomycosis, Clin. Microbiol. Rev. 3: 247–268.Google Scholar

Copyright information

© Springer Science+Business Media New York 1993

Authors and Affiliations

  • Herman Chmel
    • 1
  1. 1.Division of Infectious and Tropical Diseases, Department of Internal Medicine, College of MedicineUniversity of South FloridaTampaUSA

Personalised recommendations