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# Opportunistic Fungi in Cancer and Hematopoietic Stem-Cell Transplant Patients: Diagnosis and Management Strategies
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– Patients and Procedures
 
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Introduction


Medical progress in treating cancer with antineoplastic therapy and hematopoietic stem-cell transplantation (HSCT) has itself given rise to further challenges to successful patient outcome. The profound immunosuppression and invasive therapies needed to support the patient during a course of treatment provide the substrate for opportunistic infection. It may come as a surprise to many physicians that invasive fungal infections (IFI) are now the leading cause of death from infection in this patient population. Mortality rates for the 2 major fungal pathogens are in the range of 20% to 50% for candidal infections and 68% to 95% for aspergillosis.

Factors responsible for the increased risk of death from IFI include:
  • Effective antibacterial strategies: more patients survive to develop IFI
  • Reduced incidence of cytomegalovirus (CMV) infection due to recent success of antiviral strategies
  • IFI goes undetected or is diagnosed too late for effective therapy
  • Progress in antifungal therapy lags behind that for bacteria
Successful prevention, diagnosis, and treatment of fungal infection require the clinician to understand how the vast array of procedures used to treat hematologic malignancies impact patients' immune systems and thus their ability to resist infection (Fig 1). This monograph will review the suppression and subsequent recovery of host defenses caused by chemotherapy-induced myelosuppression and the HSCT procedure, and use this knowledge to provide guidelines for the clinical management of IFI in these patients. It will become apparent to the reader that there is no such thing as a standard patient or a standard therapy. Each patient presents with different risk factors for infection, and these should dictate decisions on prophylaxis, assessment, and treatment. The monograph will review HSCT as a model for understanding treatment-induced immunosuppression in patients with neoplastic diseases.

fig1

figure 1






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Introduction
   Hematopoietic Stem-Cell Transplantation – Patients and Procedures
      The Patient – Factors Relevant to Fungal Infections
      The Procedure – Factors Relevant to Fungal Infections

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Course Number: V035D

This CME Expires on July 1, 2005; no tests will be accepted after this date.

This course is accredited by The University of Pittsburgh School of Medicine, Center for Continuing Education and The International Immunocompromised Host Society




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