Invasive fungal infections in the era of biologics.

With the advent and widespread use of immunomodulating biologic agents, emerging invasive fungal infections are reported increasingly. To date there is no reliable method to screen patients before starting anti-tumor necrosis factor (TNF) therapy to predict their risk for acquiring fungal infections, partly because most of these infections are de novo infections. Patients should be counseled about avoiding high-risk activities that are associated with the endemic mycosis in their geographic areas. Physicians should keep a high level of suspicion for endemic fungal infections when patients receiving anti-TNF therapy or other biologics present with pulmonary or systemic infections. Rapid diagnosis and initiation of antifungal therapy are of utmost importance.