Inhoudsopgave
An introduction into clinical mycology .................................................................................................. 2
1. Background ................................................................................................................................... 2
1.1 Immune defenses .................................................................................................................... 3
2. Pathogenesis and risk of invasive fungal disease/strategies .......................................................... 3
2.1 Candida/aspergillosis .............................................................................................................. 3
3. Diagnosis (aspergillosis)................................................................................................................ 5
3.1 Diagnosis of invasive fungal diseases ...................................................................................... 5
3.2 Galactomannan ....................................................................................................................... 6
3.2 Other tests ............................................................................................................................... 7
3.3 Determination of antifungal resistance .................................................................................... 8
3.4 Non-enhanced chest compute tomography............................................................................. 8
3.5 Diagnostic flowchart IPA .......................................................................................................... 8
3.6 CAPA versus IAPA in critically ill ............................................................................................... 9
4. Treatment strategies of invasive fungal diseases ........................................................................... 9
5. Antifungal drugs and indications ................................................................................................. 10
6. Summary..................................................................................................................................... 12
1
, An introduction into clinical mycology
1. Background
Introduction fungi
• Eukaryotes
• Mainly opportunistic pathogens causing infections in immunocompromised patients.
• Cell membrane with ergosterol
• Cell wall primarily composed of chitin, glucans, mannans and glycoproteins
- The cell walls consists of components that are used for diagnostics.
Candida is a part of the flora of the gastro-intestinal tract however, overgrowth of these organisms can cause
symptoms to develop (superficial and invasive infections).
Aspergillus is ubiquitously present in the environment (air, soil, compost, water …)
Superficial infections of skin and nails:
• Most common fungal diseases in humans, affect ~ 25% of the general population worldwide
• Caused primarily by dermatophytes
• Athlete’s foot: 1 in 5 adults
• Ringworm of the scalp: affect 200 million individuals worldwide
• Onychomycosis: 10% of the general population worldwide (incidence increases with age to ~ 50% in
adults 70 years).
Mucosal infections:
• 50-75% of women in their childbearing years suffer from at least one episode of vulvovaginitis; 5 -8%
have at least four episodes annually.
• Nearly 10 million cases of oral thrush and 2 million cases of esophageal fungal infections annually in
HIV/AIDS patients.
Invasive infections:
• Incidence much lower than superficial infections but
unacceptably high mortality rates.
• Kill about 1.5 million people every year
• >90% of all reported fungal-related deaths results from
species that belong to these four genera: Candida,
Aspergillus, Pneumocystis (Mucorales, endemic) and
Cryptococcus
For a long time, the WHO has no program on fungal infection.
WHO fungal priority pathogens list to guide research, development and
public health action.
• Fungal infections are on the rise, especially among
immunocompromised patients.
• Diagnosis and treatment are difficult
• Public health burden: invasive fungal diseases cause high
mortality and disability worldwide.
2
An introduction into clinical mycology .................................................................................................. 2
1. Background ................................................................................................................................... 2
1.1 Immune defenses .................................................................................................................... 3
2. Pathogenesis and risk of invasive fungal disease/strategies .......................................................... 3
2.1 Candida/aspergillosis .............................................................................................................. 3
3. Diagnosis (aspergillosis)................................................................................................................ 5
3.1 Diagnosis of invasive fungal diseases ...................................................................................... 5
3.2 Galactomannan ....................................................................................................................... 6
3.2 Other tests ............................................................................................................................... 7
3.3 Determination of antifungal resistance .................................................................................... 8
3.4 Non-enhanced chest compute tomography............................................................................. 8
3.5 Diagnostic flowchart IPA .......................................................................................................... 8
3.6 CAPA versus IAPA in critically ill ............................................................................................... 9
4. Treatment strategies of invasive fungal diseases ........................................................................... 9
5. Antifungal drugs and indications ................................................................................................. 10
6. Summary..................................................................................................................................... 12
1
, An introduction into clinical mycology
1. Background
Introduction fungi
• Eukaryotes
• Mainly opportunistic pathogens causing infections in immunocompromised patients.
• Cell membrane with ergosterol
• Cell wall primarily composed of chitin, glucans, mannans and glycoproteins
- The cell walls consists of components that are used for diagnostics.
Candida is a part of the flora of the gastro-intestinal tract however, overgrowth of these organisms can cause
symptoms to develop (superficial and invasive infections).
Aspergillus is ubiquitously present in the environment (air, soil, compost, water …)
Superficial infections of skin and nails:
• Most common fungal diseases in humans, affect ~ 25% of the general population worldwide
• Caused primarily by dermatophytes
• Athlete’s foot: 1 in 5 adults
• Ringworm of the scalp: affect 200 million individuals worldwide
• Onychomycosis: 10% of the general population worldwide (incidence increases with age to ~ 50% in
adults 70 years).
Mucosal infections:
• 50-75% of women in their childbearing years suffer from at least one episode of vulvovaginitis; 5 -8%
have at least four episodes annually.
• Nearly 10 million cases of oral thrush and 2 million cases of esophageal fungal infections annually in
HIV/AIDS patients.
Invasive infections:
• Incidence much lower than superficial infections but
unacceptably high mortality rates.
• Kill about 1.5 million people every year
• >90% of all reported fungal-related deaths results from
species that belong to these four genera: Candida,
Aspergillus, Pneumocystis (Mucorales, endemic) and
Cryptococcus
For a long time, the WHO has no program on fungal infection.
WHO fungal priority pathogens list to guide research, development and
public health action.
• Fungal infections are on the rise, especially among
immunocompromised patients.
• Diagnosis and treatment are difficult
• Public health burden: invasive fungal diseases cause high
mortality and disability worldwide.
2
