INVASIVE CANDIDA INFECTIONS IN PATIENTS WITH HAEMATOLOGICAL MALIGNANCIES AND HEMATOPOIETIC STEM CELL TRANSPLANT RECIPIENTS: CURRENT EPIDEMIOLOGY AND THERAPEUTIC OPTIONS.

Abstract

<p class="MsoNormal" style="text-indent: 35.4pt; line-height: 200%; mso-layout-grid-align: none; text-autospace: none;"><span style="mso-ansi-language: EN-GB;" lang="EN-GB">In the last decades, the global epidemiological impact of invasive candidiasis (IC) in patients with hematologic malignancies (HM) and in hematopoietic stem cell transplant (HSCT) recipients has decreased and the incidence of invasive aspergillosis <span style="mso-spacerun: yes;"> </span>exceeded that of Candida infections. The use of prevention strategies, first of all antifungal prophylaxis with triazoles,<span style="mso-spacerun: yes;"> </span>contributed to the reduction of IC in these populations as demonstrated by several<span style="mso-spacerun: yes;"> </span>epidemiological studies. However, r<span style="color: #231f20;">elatively little is known about the current epidemiological patterns of IC in HM and HSCT populations, because recent epidemiological data almost exclusively derive from retrospective experiences and few prospective data are available. Several prospective, controlled studies in the prophylaxis of invasive fungal diseases have been conducted in both the HM and HSCT setting. On the contrary, </span>most of the prospective controlled trials that demonstrated the efficacy of the antifungal drugs echinocandins and voriconazole in the treatment of candidemia and invasive candidiasis mainly involved <span style="mso-spacerun: yes;"> </span>patients with underlying conditions other than HM or<span style="mso-spacerun: yes;"> </span>HSCT. <span style="color: #231f20;"><span style="mso-spacerun: yes;"> </span>For these reasons, i</span>nternational guidelines provided specific indications for the prophylaxis strategies in HM and HSCT patients, whereas the<span style="mso-spacerun: yes;"> </span>recommendations on therapy of documented Candida infections are based on the results observed in the general population and should be considered with caution.</span></p>

Keywords

• Infection, Fungal Infection, Candida, Innunocompromised Host