Practice Guidelines for the Treatment of Fungal Infections

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Abstract
During the last decade, the incidence of superficial and deep mycotic infections has continued to increase explosively. Fungal diseases were for many years considered a specialty area, consisting predominantly of endemic mycoses that affected unique subpopulations of individuals. The epidemiology of invasive mycoses has dramatically altered, to a predominantly nosocomial complication or event in an expanding population of at-risk hospitalized subjects. Two factors have had a dominating influence on the changing epidemiology of fungal disease. First, the number of at-risk patients for invasive mycotic infection has increased, as more patients have undergone chemotherapy and transplantation and received a growing array of immunosuppressive agents. The expanding number of patients is further magnified by longer survival, which extends the at-risk period. Patients with AIDS are particularly at risk for virtually all the invasive mycoses from recalcitrant oropharyngeal candidiasis to fulminant systemic mycoses. Second, the increase in fungal disease is in no small way a by-product of the ever-improving technology available to practitioners, including intravascular catheters and the drugs used to suppress the otherwise efficient host defense system.

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