FACTORS EXACERBATING IMMUNODEFICIENCY AND ANTIFUNGAL RESISTANCE IN THE TREATMENT OF FUNGAL INFECTIONS
Keyword : Fungal infections, immunodeficiency, antimicrobial treatment, antifungal resistance
Author(s) : Okata-Nwali, Oluchi Divine And Okoli, Ikechukwu
Abstract : Pathogenic fungi with very low inherent virulence are now increasingly causing life-threatening infections in a large number of immunocompromised individuals. Incidence of these infections has paralleled the emergence of acquired immune deficiency syndrome and other macro disruptive procedures that result in lowered resistance of the host to fungal infections. Innate resistance to antifungal agents is becoming a major problem in the management of these diseases. Majority of these fungal infections are caused by Candida species, with Candida albicans mostly implicated in bloodstream infections. Both Candida and Aspergillus infections account for about 90% of all nosocomial fungal infections while Cryptococcus neoformans has become a major opportunistic pathogen in immunocompromised individuals. Zygomycetes, Trichosporon beigelii, Blastoschizomyces capitatus, Dematiaceous fungi and species of Fusarium, Scedosporium, and Acremonium have been recognized as sources of deep fungal infections with intrinsic resistance to available antifungal drugs. Generally, primary antifungal resistance is intrinsic while secondary antifungal resistance can develop in response to drug exposure. Amphotericin B, Flucytosine, Azoles, and Echinocandins are four classes of antifungals now available for treatment of invasive mycoses. Despite marked advances in antifungal therapy, infections caused by opportunistic fungi continue to be associated with high morbidity, mortality, and poor prognosis due to combined effects of drug-resistant strains, lack of robust clinical treatment evaluations, and severe underlying diseases in patients.