Opportunistic mycotic infections and malignancies

Techniques have advanced in the management of the biologically defenseless patients, yet these very advances have opened the door for opportunistic mycotic infection. As the ability to contain bacterial infection in these patients becomes more powerful, a rise in systemic mycoses in inevitable. Antifungal therapy is limited, as yeasts can develop resistance to nystatin and 5 fluorocytosine, and neither have a profound effect on the molds. Amphotericin B, a potent antifungal for both yeasts and molds, unfortunately is limited to patients with blood urea nitrogen under 60 mg/ml. Success has been reported with amphotericin B in combination with other antibiotics as well as with the use of new antifungals, such as Clotrimazole or Miconazole. These are purely experimental protocols and not all investigators have reported success with them. The laboratory by providing the physician with prompt and accurate identification of cultured fungi is extremely important in the management of defenseless patients. Thus, the lab should not prejudice itself by thinking of one small group of fungi as pathogenic and the rest as contaminants. Only the physician, on the basis of his clinical judgement, may make that decision, for where opportunistic infections are concerned there are really no non pathogenic fungi. It has been stated by one clinician that a debilitated patient on immunosuppressive and chemotherapy 'has every right to have a fungal infection', and, therefore, good mycological techniques are important assets to the total treatment of the compromised host.