Pustaka Ilmiah Universitas Padjadjaran

Abstrak

New Parameters In Fungal Testing In Relation To The Appropriate Anti-fungal Treatment

Invasive fungal infections are a major health problem in immunocompromised or critically ill patients. The clinical manifestations vary and can range from colonization to active infection. Patient with neutropenia, HIV infection, bone marrow and solid organ transplantation, cancer, diabetes mellitus, severe burn, the use of antineoplastic and immunosuppressive agents, broad-spectrum antibiotics are among many others predisposing factor for invasive fungal infections. In the absence of these factors, fungi cause mild, self-limited infections that typically involve mucocutaneous surfaces. If invasive fungal infections develop in an immunocompetent host, indicated a genetic defects causing innate or adaptive immune dysfunction. Candida spp. and Cryptococcus spp. are the yeasts most frequently isolated in clinical practice. While the most frequent filamentous fungi isolated are Aspergillus spp. Just like some bacterial infections are resistant to antibiotics, some fungi develops resistance to the antifungal medications. The antifungal antibiotics target various stages of metabolic pathways and are placed in different groups including azoles, polyenes, fluoropyrirnidine analogs, echinocandins, morpholines, allylamines and thiocarbainates. The most antifungal resistance occurs in Candida species. Diagnosis of fungal infection remains a problem because signs and symptoms are non-specific and colonization is difficult to distinguish from invasive disease. Direct smears of samples with KOH is the most rapid, cost-effective and sensitive method for the diagnosis of fungal infections. Culture of clinical specimens is the gold standard. Other methods such as histopathology may also be used. There were fungal serologic detection such as antibodies (Histoplasniosis, Coccidioidomycosis) and antigen (Cryptococcosis, Aspergillus, Candidosis, Histoplasmosis). In some country Galactomannan antigen testing of blood is routinely done. Molecular or fungal nucleic acids amplification, currently is being applied for identification and antifungal resistance test.