Mycoses and anti-fungals – an update
Fungi normally originate from the environment that surrounds us, and appear to be harmless until inhaled or ingestion of spores occur. For many years fungal infections were thought of as superficial diseases or infections such as athlete’s foot, or vulvovaginal candidiasis. Subsequently, when invasive fungal infections were first encountered, amphotericin B was the only treatment for systemic mycoses. However, with the advances in medical technology such as bone marrow transplants, cytotoxic chemotherapy, indwelling catheters as well as with the increased use of broad spectrum antimicrobials in antimicrobial resistance, there has been a marked increase of fungal infections worldwide.
Populations at risk of acquiring fungal infections are those living with human immunodeficiency virus (HIV), cancer, patients receiving immunosuppressant therapy, neonates and those of advanced age.
The management of superficial fungal infections is mainly topical, with agents including terbinafine, miconazole and ketoconazole. Oral treatment includes griseofulvin and fluconazole.
Historically the management of invasive fungal infections involved the use of amphotericin B, however newer agents include the azoles and the echinocandins. This paper provides a general overview of the management of fungus infections.