Liposomal amphotericin B for invasive fungal infections : an experimental study in the leukopenic host

Advances in medical treatment have improved the prognosis for patients with cancer. While significant progression has been made in eradicating certain malignant diseases, a growing concern for patients who receive cytotoxic chemotherapy is the development of fungal infections. Candidiasis is the most common nosocomial mycosis. There are several predisposing factors for hematogenously disseminated candidal infections in patients with cancer. These factors include granulocytopenia, the use of extended~spectrum antibiotics, and the breakdown of anatomic barriers against infection caused by catheterization or the use of cytotoxic chemotherapy. Invasive aspergillosis is now the second most common mycosis encountered in patients with cancer, particularly in those with hematological malignancies. Patients are at high risk when their absolute neutrophil count is < 500/mL and the duration of neutropenia exceeds 1 week. The diagnosis during life of both invasive candidiasis as well as invasive aspergillosis still remains a significant problem. Invasive fungal infections are also a serious threat in non-granulocytopenic patients. Cryptococcosis, that is caused by Cryptococcus neoformans, is a life threatening infection in patients with acquired immunodeficiency syndrome (AIDS). Histoplasmosis, blastomycosis, or coccidioidomycosis are serious infections in AIDS patients who have resided in, or travelled through endemic regions for Histoplasma capsuJatum, Blastomyces dermatitidis, and Coccidioides immitis, respectively.