The changing face of invasive fungal infections in hematopoietic cell transplant recipients.

PURPOSE OF REVIEW: To review recent observations that describe changes in the likelihood of invasive fungal infections, shifts in types of fungal pathogens, and altered manifestations of fungal syndromes after hematopoietic cell transplantation and explore how changes in transplant practices are influencing these epidemiologic shifts.

RECENT FINDINGS: Shifts in invasive fungal infections are occurring as a consequence of changes in transplant practices, including the intensity of conditioning regimens, new immunosuppressive therapies, new antineoplastic therapies administered before hematopoietic cell transplantation, and possibly use of mold-active agents as prophylaxis. Non-fumigatus Aspergillus species and other mold pathogens, such as Fusarium and zygomycosis, are assuming greater prominence and may be increasing.

SUMMARY: Epidemiologic shifts in invasive fungal infections are likely co-travelers with advances in transplant practices. Thus, ongoing studies of epidemiologic shifts in invasive fungal infections are important.