Abstract
Fungal infections are increasing in frequency and complexity. The number of reported candidaemia cases has been rising in the UK from 1398 cases in 2003 to 1873 cases in 2006. Invasive aspergillosis has increased in incidence so that in Europe it is found at autopsy in 4% of all patients dying in European teaching hospitals. Other figures from Japan and USA support this upward trend. There is a high frequency (∼4%) in medical ICU patients, of whom > 40% are COPD patients. More than 500 cases of IA have been described postoperatively in non-immunocompromised patients. Overall risk estimates by underlying condition are shown in the table below, assuming no prophylaxis. Poor diagnostic performance of current methods accounts for some underdiagnosis
AmBisome (liposomal amphotericin B) is useful for the management of candidaemia, cryptococcal meningitis invasive aspergillosis and zygomycosis. The dose of 3mg/Kg appears to be the optimal dose for all or almost all cases, with the possible exception of zygomycosis in which higher doses are often used. While voriconazole remains the drug of first choice for invasive aspergillosis, drug interactions, organ dysfunction, azole resistance and breakthrough infection are reasons to consider AmBisome. The echinocandins have no useful activity for cryptococcal infection or zygomycosis, and so amphotericin B is first-line therapy in almost all these cases.
