CHAPTER 25. Management of Aspergillosis, Zygomycosis, and Other Clinically Relevant Mold Infections by Konstantinos Leventakos, Dimitrios P. Kontoyiannis  

ABSTRACT

Invasive mold infections (IMIs) are a major cause of morbidity and mortality in severely immunocompromised hematologic malignancy patients and hematopoietic stem cell transplantations recipients. Invasive aspergillosis caused by Aspergillus fumigatus is the most common cause of IMI, but recent advances in the pharmacotherapy of fungal infections and an increase in the number of patients at risk has caused an epidemiologic shift towards infections with resistant non-fumigatus Aspergillus species and non-Aspergillus molds such as Zygomycetes. Patient outcome is a function of immune function recovery, early diagnosis, and multiple interventions, such as with broad-spectrum antifungal therapy and adjunct immunotherapy and surgery in select patients. In this chapter, we review the utility of new diagnostic modalities such as the galactomannan test, the 1,3-beta-D-glucan test, and fungal DNA tests in diagnosing IMIs early. We focus on modern antifungal agents (the lipid formulations of amphotericin B, the broad-spectrum azoles, and the echinocandins) and evaluate them in the context of evolving prophylactic, pre-emptive, and targeted therapies for IMIs.