Human mycoses and current antifungal therapy.

The Focus on Fungal Infections meeting has become a popular conference for specialists in medical mycology and antifungal chemotherapy. Highlights of the 8th meeting are reported, with a focus on infection and therapy. Although the incidence of mycoses has increased, the identification of these fungal etiologic agents remains difficult. Mucosal candidiasis caused by endogenous Candida albicans and Candida species remains the most common fungal manifestation in HIV-infected patients, while systemic infection by Aspergillus species also has increased in HIV patients. Two presenters at the meeting debated whether fungal infections in AIDS patients are becoming less common and less important. Various strategies for antifungal therapy in AIDS or HIV-positive patients were presented. Most fungal infections in solid organ transplant patients are due to Candida species or Aspergillus species; however, dematiaceous (dark-pigmented) fungi are becoming more common fungal pathogens in these patients. Antifungal therapy remains difficult in this patient group. The meeting included an overview of the current status of diagnosing fungal infections through serodiagnostic techniques. If properly validated, serology can be useful in fungal diagnosis since antigens and antibodies are easier to detect than the invading organism. Premature infants are at high risk for developing invasive fungal infections. Antifungal drugs have not been tested in controlled clinical trials in these patients, thus therapy is accomplished using adult treatment regimens and anecdotal experience. As regards the new lipid-based formulations of amphotericin B, published clinical studies are only now appearing in the literature and these reports suggest that the new formulations have reduced toxicity and comparable efficacy compared to conventional amphotericin B under various clinical conditions. Correlation of minimum inhibitory concentration (MIC) values with clinical response to therapy is beginning to emerge. Two fungal cell wall-active compounds have recently entered clinical trials: an echinocandin and the chitin-synthesis inhibitor nikkomycin Z. Pradimycin and analogues have been studied through experimental animal models with good success; however, phase I clinical trials suggested drug-related toxicities and development was stopped. New molecular targets also are being investigated in antifungal therapy.