Approach to Patients with Suspected Fungal Diseases

Abstract

Fungal infections (mycoses) are increasing in incidence throughout the world as a result of modern medical practice and rise in the population of those at risk. Supporting this increase is the expanding use of immunosuppressive therapies, broad-spectrum antibiotics, central venous access, other medical devices, and emergence of resistance to licensed antifungal agents. Technology has led to the improved survival of persons with malignancies, with transplanted organs, with HIV infection, following trauma, and at the extremes of age. The medical scientific community has met this challenge with the introduction of new antifungal agents, often with less toxicity and improved spectrums of activity. Additionally, newer, more sensitive, and specific diagnostic strategies such as improved radiographic imaging and biomarkers have provided clinicians with better tools for detection of fungal infections earlier and potentially influencing disease outcomes. Modern molecular techniques can now allow more precise identification of recovered and unrecovered fungal pathogens with the potential to rapidly improve diagnosis of fungal infections. Despite these advances, the approach to the diagnosis and management of fungal infections often still relies on recognizing the interaction between the pathogen and host. Although some fungal diseases have classic presentations, many of these occur so rarely that clinicians may not initially include them in their differential diagnoses. In the setting of immunosuppression, mycoses may produce nonspecific signs and symptoms, making their diagnosis a challenge. Early recognition and treatment are fundamental to modifying disease outcomes in many fungal infections, especially those in immunocompromised individuals. Increased awareness of key risk factors and clinical presentations of the human mycoses may enable clinicians to develop an inclusive approach to the diagnosis of these diseases.