[The problem of pulmonary mycoses].
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The cellular and molecular mechanisms of host defenses to histoplasmosis, a prototype of respiratory fungal infections are described. Although, cell-mediated acquired immunity is considered as a hallmark of protective immunity to histoplasmosis, the recent findings provide mounting evidence on the importance of natural cellular immunity in host resistance to fungal infections. The natural immunity to Histoplasma capsulatum infection is primarily mediated by natural killer cells, endothelial cells and platelets but mechanisms of intercellular communication and their interactions with the pathogen are not clearly defined.
Candidiasis and aspergillosis are the most common fungal infections in hematopoietic stem cell transplant recipients and other hematology/oncology patients. Strategies for reducing the morbidity and mortality associated with these infections include antifungal prophylaxis, empiric therapy in patients with persistent fever and neutropenia, and preemptive therapy. Antifungal therapies include amphotericin B deoxycholate, lipid formulations of amphotericin B, the triazoles (fluconazole, itraconazole, and voriconazole), and the echinocandins (caspofungin and the investigational agents micafungin and anidulafungin). Fluconazole is a reasonable choice for the treatment of invasive candidiasis if the patient has not previously received a triazole and the institution has a low incidence of triazole resistance. If resistance is a concern, an echinocandin, such as caspofungin, is an appropriate option. Voriconazole may be the initial choice in most patients with invasive aspergillosis. If patients are intolerant of or refractory to conventional therapy, effective alternatives include a lipid formulation of amphotericin B or an echinocandin.
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Human beings today living in high industrialized areas suffer more frequently from fungal diseases than before. This is due to the management in animal production, but also to the use of cosmetics and contraceptives, smoking cigarettes, wearing clothes of synthetic polymers and application of new drugs, like antibiotics, cytostatics, immunosuppressives and others, which favours the growth of certain fungi in and on the skin and inside the human body. Some mechanisms are known from the macroorganism which are able to protect man from fungal invasion. Effective in this way are the normal flora of the skin, gut and the mucous membranes, the enzymes digestive and the natural low pH of the healthy skin. The fungal growths are favoured when primary diseases of not-infectious genesis due to disorders in metabolism or endocrinium, vitamin deficiency, malabsorption, maldigestion, false and malnutrition, and diseases of the haemopoetic system exist. But also viral and bacterial infections stimulate the development of secondary fungal diseases. The pathogens belong to three groups, dermatophytes, yeasts and molds, which can be differentiated according to their behaviour in culture and in tissue.