Table 2.
Factors that may affect risk stratification for antifungal prophylaxis
| Factor | Comments |
|---|---|
| Genetic markers86-91 | • SNPs in Toll-like receptor genes |
| • SNPs in plasminogen genes | |
| • IL-1 gene polymorphisms and haplotype | |
| • Polymorphisms in the chemotactic cytokine CXC10 | |
| • Dectin-1 deficiency | |
| • Mannose-binding lectin deficiency | |
| Geographic factors92 | • US Ohio/Mississippi River Valley: Histoplasma capsulatum |
| • US Midwest and South Central: Blastomyces dermatitidis; Southwest: Coccidioides immitis | |
| • South America: Paracoccidioides brasiliensis | |
| • Southeast Asia: Penicillium marneffei | |
| Climate92 | • Incidence of IA associated with climate/season |
| Environmental exposure93-95 | • Soil contact, food safety, water safety |
| • Construction increases risk IFIs, especially IA | |
| • Increased in-hospital transfers out of hematology ward increased risk for filamentous IFIs | |
| Metabolic factors96,97 | • Increased bone marrow and peripheral markers of iron stores associated with an increased risk of fungal infections, including mucormycosis |
| Viral and bacterial coinfections98,99 | • CMV and respiratory virus coinfections increase risk of IA |
| • Bacteremia increases risk of IFIs | |
| Mycobiome98,100-104 | • Baseline colonization important risk for invasive candidiasis and predictive of subsequent infection |
| • More than 1 site of colonization/heavy colonization at single site increases risk IFIs | |
| • Rectal fungal colonization increases IFI risk | |
| • Nasal cultures for Aspergillus spp predict increased risk of IA | |
| • PCR and sequencing showed that the majority of fungi from lung infections in patients matched fungi from mouth and throat |
CMV, cytomegalovirus; IL, interleukin; PCR, polymerase chain reaction; SNP, single nucleotide polymorphism.