Skip to main content
Public Health Reports logoLink to Public Health Reports
. 1996 May-Jun;111(3):226–235.

Fungal infections: a growing threat.

D M Dixon 1, M M McNeil 1, M L Cohen 1, B G Gellin 1, J R La Montagne 1
PMCID: PMC1381764  PMID: 8643813

Abstract

THE EMERGENCE OF newly identified fungal pathogens and the reemergence of previously uncommon fungal diseases is primarily related to increases in the numbers of susceptible persons: people with HIV infection, bone marrow and organ transplant recipients, cancer patients being treated with chemotherapy, critically ill persons, and very low birth weight ( < or = 1500 g) infants. These immunocompromised populations are at risk for infection not only with opportunistic pathogens (for example, Pneumocystis, Candida, Cryptococcus, Trichosporon, Malassezia, Aspergillus, Penicillium marneffei, and numerous other moulds or yeasts) but also with fungal pathogens that usually infect otherwise healthy persons not previously exposed to endemic fungi (for example, Coccidioides immitis, Histoplasma capsulatum, and Blastomyces dermatitidis) and Sporothrix schenckii. Morbidity, mortality, and health care costs associated with fungal infections are high. Addressing the emergence of fungal diseases will require increased surveillance coupled with the availability of rapid, noninvasive diagnostic tests; monitoring the development of resistance to antifungal agents; and research focused on the understanding, prevention, and control of fungal infections.

Full text

PDF
226

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ampel N. M., Dols C. L., Galgiani J. N. Coccidioidomycosis during human immunodeficiency virus infection: results of a prospective study in a coccidioidal endemic area. Am J Med. 1993 Mar;94(3):235–240. doi: 10.1016/0002-9343(93)90054-s. [DOI] [PubMed] [Google Scholar]
  2. Anaissie E., Kantarjian H., Ro J., Hopfer R., Rolston K., Fainstein V., Bodey G. The emerging role of Fusarium infections in patients with cancer. Medicine (Baltimore) 1988 Mar;67(2):77–83. doi: 10.1097/00005792-198803000-00001. [DOI] [PubMed] [Google Scholar]
  3. Beck-Sagué C., Jarvis W. R. Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. National Nosocomial Infections Surveillance System. J Infect Dis. 1993 May;167(5):1247–1251. doi: 10.1093/infdis/167.5.1247. [DOI] [PubMed] [Google Scholar]
  4. Chugh K. S., Sakhuja V., Jain S., Talwar P., Minz M., Joshi K., Indudhara R. High mortality in systemic fungal infections following renal transplantation in third-world countries. Nephrol Dial Transplant. 1993;8(2):168–172. [PubMed] [Google Scholar]
  5. Coles F. B., Schuchat A., Hibbs J. R., Kondracki S. F., Salkin I. F., Dixon D. M., Chang H. G., Duncan R. A., Hurd N. J., Morse D. L. A multistate outbreak of sporotrichosis associated with sphagnum moss. Am J Epidemiol. 1992 Aug 15;136(4):475–487. doi: 10.1093/oxfordjournals.aje.a116521. [DOI] [PubMed] [Google Scholar]
  6. Collins L. A., Samore M. H., Roberts M. S., Luzzati R., Jenkins R. L., Lewis W. D., Karchmer A. W. Risk factors for invasive fungal infections complicating orthotopic liver transplantation. J Infect Dis. 1994 Sep;170(3):644–652. [PubMed] [Google Scholar]
  7. Crawford S. W. Bone-marrow transplantation and related infections. Semin Respir Infect. 1993 Sep;8(3):183–190. [PubMed] [Google Scholar]
  8. DE LA BARREDA P., ALCALA R., RIOS V., ORTEGA R. Sobre la forma pulmonar de la enfermedad de Schauman Boeck. Rev Clin Esp. 1956 Feb 29;60(4):248–250. [PubMed] [Google Scholar]
  9. Denning D. W., Follansbee S. E., Scolaro M., Norris S., Edelstein H., Stevens D. A. Pulmonary aspergillosis in the acquired immunodeficiency syndrome. N Engl J Med. 1991 Mar 7;324(10):654–662. doi: 10.1056/NEJM199103073241003. [DOI] [PubMed] [Google Scholar]
  10. Denning D. W., Stevens D. A. Antifungal and surgical treatment of invasive aspergillosis: review of 2,121 published cases. Rev Infect Dis. 1990 Nov-Dec;12(6):1147–1201. doi: 10.1093/clinids/12.6.1147. [DOI] [PubMed] [Google Scholar]
  11. Devi S. J., Schneerson R., Egan W., Ulrich T. J., Bryla D., Robbins J. B., Bennett J. E. Cryptococcus neoformans serotype A glucuronoxylomannan-protein conjugate vaccines: synthesis, characterization, and immunogenicity. Infect Immun. 1991 Oct;59(10):3700–3707. doi: 10.1128/iai.59.10.3700-3707.1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Diamond R. D. The growing problem of mycoses in patients infected with the human immunodeficiency virus. Rev Infect Dis. 1991 May-Jun;13(3):480–486. doi: 10.1093/clinids/13.3.480. [DOI] [PubMed] [Google Scholar]
  13. Edman J. C., Kovacs J. A., Masur H., Santi D. V., Elwood H. J., Sogin M. L. Ribosomal RNA sequence shows Pneumocystis carinii to be a member of the fungi. Nature. 1988 Aug 11;334(6182):519–522. doi: 10.1038/334519a0. [DOI] [PubMed] [Google Scholar]
  14. Edwards J. E., Jr, Filler S. G. Current strategies for treating invasive candidiasis: emphasis on infections in nonneutropenic patients. Clin Infect Dis. 1992 Mar;14 (Suppl 1):S106–S113. doi: 10.1093/clinids/14.supplement_1.s106. [DOI] [PubMed] [Google Scholar]
  15. Fish D. G., Ampel N. M., Galgiani J. N., Dols C. L., Kelly P. C., Johnson C. H., Pappagianis D., Edwards J. E., Wasserman R. B., Clark R. J. Coccidioidomycosis during human immunodeficiency virus infection. A review of 77 patients. Medicine (Baltimore) 1990 Nov;69(6):384–391. doi: 10.1097/00005792-199011000-00006. [DOI] [PubMed] [Google Scholar]
  16. Galgiani J. N. Coccidioidomycosis. West J Med. 1993 Aug;159(2):153–171. [PMC free article] [PubMed] [Google Scholar]
  17. Galgiani J. N. Coccidioidomycosis. West J Med. 1993 Aug;159(2):153–171. [PMC free article] [PubMed] [Google Scholar]
  18. Georgopapadakou N. H., Walsh T. J. Human mycoses: drugs and targets for emerging pathogens. Science. 1994 Apr 15;264(5157):371–373. doi: 10.1126/science.8153622. [DOI] [PubMed] [Google Scholar]
  19. Gradon J. D., Timpone J. G., Schnittman S. M. Emergence of unusual opportunistic pathogens in AIDS: a review. Clin Infect Dis. 1992 Jul;15(1):134–157. doi: 10.1093/clinids/15.1.134. [DOI] [PubMed] [Google Scholar]
  20. Guiot H. F., Fibbe W. E., van 't Wout J. W. Risk factors for fungal infection in patients with malignant hematologic disorders: implications for empirical therapy and prophylaxis. Clin Infect Dis. 1994 Apr;18(4):525–532. doi: 10.1093/clinids/18.4.525. [DOI] [PubMed] [Google Scholar]
  21. Gustafson T. L., Schaffner W., Lavely G. B., Stratton C. W., Johnson H. K., Hutcheson R. H., Jr Invasive aspergillosis in renal transplant recipients: correlation with corticosteroid therapy. J Infect Dis. 1983 Aug;148(2):230–238. doi: 10.1093/infdis/148.2.230. [DOI] [PubMed] [Google Scholar]
  22. Hall K. A., Sethi G. K., Rosado L. J., Martinez J. D., Huston C. L., Copeland J. G. Coccidioidomycosis and heart transplantation. J Heart Lung Transplant. 1993 May-Jun;12(3):525–526. [PubMed] [Google Scholar]
  23. He X., Tiballi R. N., Zarins L. T., Bradley S. F., Sangeorzan J. A., Kauffman C. A. Azole resistance in oropharyngeal Candida albicans strains isolated from patients infected with human immunodeficiency virus. Antimicrob Agents Chemother. 1994 Oct;38(10):2495–2497. doi: 10.1128/aac.38.10.2495. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Heller H. M., Fuhrer J. Disseminated sporotrichosis in patients with AIDS: case report and review of the literature. AIDS. 1991 Oct;5(10):1243–1246. [PubMed] [Google Scholar]
  25. Horowitz B. J. Mycotic vulvovaginitis: a broad overview. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 2):1188–1192. doi: 10.1016/s0002-9378(12)90725-5. [DOI] [PubMed] [Google Scholar]
  26. Iwata K. Drug resistance in human pathogenic fungi. Eur J Epidemiol. 1992 May;8(3):407–421. doi: 10.1007/BF00158576. [DOI] [PubMed] [Google Scholar]
  27. Iwen P. C., Kelly D. M., Reed E. C., Hinrichs S. H. Invasive infection due to Candida krusei in immunocompromised patients not treated with fluconazole. Clin Infect Dis. 1995 Feb;20(2):342–347. doi: 10.1093/clinids/20.2.342. [DOI] [PubMed] [Google Scholar]
  28. Kent H. L. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 2):1168–1176. doi: 10.1016/s0002-9378(12)90722-x. [DOI] [PubMed] [Google Scholar]
  29. Marcon M. J., Powell D. A. Human infections due to Malassezia spp. Clin Microbiol Rev. 1992 Apr;5(2):101–119. doi: 10.1128/cmr.5.2.101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Matsumoto T., Ajello L., Matsuda T., Szaniszlo P. J., Walsh T. J. Developments in hyalohyphomycosis and phaeohyphomycosis. J Med Vet Mycol. 1994;32 (Suppl 1):329–349. doi: 10.1080/02681219480000951. [DOI] [PubMed] [Google Scholar]
  31. Miller L. W., Naftel D. C., Bourge R. C., Kirklin J. K., Brozena S. C., Jarcho J., Hobbs R. E., Mills R. M. Infection after heart transplantation: a multiinstitutional study. Cardiac Transplant Research Database Group. J Heart Lung Transplant. 1994 May-Jun;13(3):381–393. [PubMed] [Google Scholar]
  32. Morse D. L., Gordon M. A., Matte T., Eadie G. An outbreak of histoplasmosis in a prison. Am J Epidemiol. 1985 Aug;122(2):253–261. doi: 10.1093/oxfordjournals.aje.a114096. [DOI] [PubMed] [Google Scholar]
  33. Nelson P. E., Dignani M. C., Anaissie E. J. Taxonomy, biology, and clinical aspects of Fusarium species. Clin Microbiol Rev. 1994 Oct;7(4):479–504. doi: 10.1128/cmr.7.4.479. [DOI] [PMC free article] [PubMed] [Google Scholar]
  34. Pfaller M. A., Rhine-Chalberg J., Redding S. W., Smith J., Farinacci G., Fothergill A. W., Rinaldi M. G. Variations in fluconazole susceptibility and electrophoretic karyotype among oral isolates of Candida albicans from patients with AIDS and oral candidiasis. J Clin Microbiol. 1994 Jan;32(1):59–64. doi: 10.1128/jcm.32.1.59-64.1994. [DOI] [PMC free article] [PubMed] [Google Scholar]
  35. Phair J., Muñoz A., Detels R., Kaslow R., Rinaldo C., Saah A. The risk of Pneumocystis carinii pneumonia among men infected with human immunodeficiency virus type 1. Multicenter AIDS Cohort Study Group. N Engl J Med. 1990 Jan 18;322(3):161–165. doi: 10.1056/NEJM199001183220304. [DOI] [PubMed] [Google Scholar]
  36. Rex J. H., Rinaldi M. G., Pfaller M. A. Resistance of Candida species to fluconazole. Antimicrob Agents Chemother. 1995 Jan;39(1):1–8. doi: 10.1128/aac.39.1.1. [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Rowlings P. A., Passweg J. R., Armitage J. O., Gale R. P., Sobocinski K. A., Klein J. P., Zhang M. J., Horowitz M. M. Report from the International Bone Marrow Transplant Registry and the Autologous Blood and Marrow Transplant Registry--North America. Clin Transpl. 1994:87–98. [PubMed] [Google Scholar]
  38. Sangeorzan J. A., Bradley S. F., He X., Zarins L. T., Ridenour G. L., Tiballi R. N., Kauffman C. A. Epidemiology of oral candidiasis in HIV-infected patients: colonization, infection, treatment, and emergence of fluconazole resistance. Am J Med. 1994 Oct;97(4):339–346. doi: 10.1016/0002-9343(94)90300-x. [DOI] [PubMed] [Google Scholar]
  39. Schoenberger C. I., Weiner J. H., Mayo F. J., Spellman J., Waltersdorff R. G. Acute pulmonary histoplasmosis outbreak following home renovation. Md Med J. 1988 Jun;37(6):457–460. [PubMed] [Google Scholar]
  40. Shaw J. C., Levinson W., Montanaro A. Sporotrichosis in the acquired immunodeficiency syndrome. J Am Acad Dermatol. 1989 Nov;21(5 Pt 2):1145–1147. doi: 10.1016/s0190-9622(89)70318-2. [DOI] [PubMed] [Google Scholar]
  41. Sobel J. D. Epidemiology and pathogenesis of recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 1985 Aug 1;152(7 Pt 2):924–935. doi: 10.1016/s0002-9378(85)80003-x. [DOI] [PubMed] [Google Scholar]
  42. Standaert S. M., Schaffner W., Galgiani J. N., Pinner R. W., Kaufman L., Durry E., Hutcheson R. H. Coccidioidomycosis among visitors to a Coccidioides immitis-endemic area: an outbreak in a military reserve unit. J Infect Dis. 1995 Jun;171(6):1672–1675. doi: 10.1093/infdis/171.6.1672. [DOI] [PubMed] [Google Scholar]
  43. States B., Segal S. Levels of gamma-glutamyltranspeptidase in cultured skin fibroblasts from cystinotics and normals. Life Sci. 1980 Nov 24;27(21):1985–1990. doi: 10.1016/0024-3205(80)90419-1. [DOI] [PubMed] [Google Scholar]
  44. Vanden Bossche H., Marichal P., Odds F. C. Molecular mechanisms of drug resistance in fungi. Trends Microbiol. 1994 Oct;2(10):393–400. doi: 10.1016/0966-842x(94)90618-1. [DOI] [PubMed] [Google Scholar]
  45. Vartivarian S. E., Anaissie E. J., Bodey G. P. Emerging fungal pathogens in immunocompromised patients: classification, diagnosis, and management. Clin Infect Dis. 1993 Nov;17 (Suppl 2):S487–S491. doi: 10.1093/clinids/17.supplement_2.s487. [DOI] [PubMed] [Google Scholar]
  46. Vuffray A., Durussel C., Boerlin P., Boerlin-Petzold F., Bille J., Glauser M. P., Chave J. P. Oropharyngeal candidiasis resistant to single-dose therapy with fluconazole in HIV-infected patients. AIDS. 1994 May;8(5):708–709. doi: 10.1097/00002030-199405000-00023. [DOI] [PubMed] [Google Scholar]
  47. Walsh T. J., Melcher G. P., Lee J. W., Pizzo P. A. Infections due to Trichosporon species: new concepts in mycology, pathogenesis, diagnosis and treatment. Curr Top Med Mycol. 1993;5:79–113. [PubMed] [Google Scholar]
  48. Walsh T. J., Melcher G. P., Rinaldi M. G., Lecciones J., McGough D. A., Kelly P., Lee J., Callender D., Rubin M., Pizzo P. A. Trichosporon beigelii, an emerging pathogen resistant to amphotericin B. J Clin Microbiol. 1990 Jul;28(7):1616–1622. doi: 10.1128/jcm.28.7.1616-1622.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Wenzel R. P., Pfaller M. A. Candida species: emerging hospital bloodstream pathogens. Infect Control Hosp Epidemiol. 1991 Sep;12(9):523–524. doi: 10.1086/646403. [DOI] [PubMed] [Google Scholar]
  50. Wey S. B., Mori M., Pfaller M. A., Woolson R. F., Wenzel R. P. Hospital-acquired candidemia. The attributable mortality and excess length of stay. Arch Intern Med. 1988 Dec;148(12):2642–2645. doi: 10.1001/archinte.148.12.2642. [DOI] [PubMed] [Google Scholar]
  51. Wheat L. J., Connolly-Stringfield P. A., Baker R. L., Curfman M. F., Eads M. E., Israel K. S., Norris S. A., Webb D. H., Zeckel M. L. Disseminated histoplasmosis in the acquired immune deficiency syndrome: clinical findings, diagnosis and treatment, and review of the literature. Medicine (Baltimore) 1990 Nov;69(6):361–374. doi: 10.1097/00005792-199011000-00004. [DOI] [PubMed] [Google Scholar]
  52. Wheat L. J., Wass J., Norton J., Kohler R. B., French M. L. Cavitary histoplasmosis occurring during two large urban outbreaks. Analysis of clinical, epidemiologic, roentgenographic, and laboratory features. Medicine (Baltimore) 1984 Jul;63(4):201–209. doi: 10.1097/00005792-198407000-00002. [DOI] [PubMed] [Google Scholar]
  53. Wingard J. R., Merz W. G., Rinaldi M. G., Johnson T. R., Karp J. E., Saral R. Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med. 1991 Oct 31;325(18):1274–1277. doi: 10.1056/NEJM199110313251803. [DOI] [PubMed] [Google Scholar]

Articles from Public Health Reports are provided here courtesy of SAGE Publications

RESOURCES