Fungal infections during neutropenia: the role of prophylaxis.

Fungal infections are seen predominantly in patients with neoplastic diseases. Autopsy studies revealed that 30 to 50% of decreased patients with hematologic neoplasms have histopathologically documented invasive fungal infections. The rationale for fungal chemoprophylaxis is the high incidence of fungal disease in these patients (5), the high mortality (29), the difficulty in diagnosing (28), and the severe side effects of systemic antifungal therapy with amphotericin B (3). Endogenous sources such as oropharyngeal and digestive mucous membranes and exogenous pathways such as air (e.g.aspergilli) or food have to be considered. Therefore, prophylaxis has to comprise both aspects:Prevention of acquisition through nonspecific hygiene measures (5), reduction of colonization (non-absorbable antifungals or systemic chemoprophylaxis) (20). Antifungal prophylaxis of candidosis with both non- and absorbable drugs has not been convincing in terms of reduction of proven fungal infections. Prevention of aspergillosis consists mainly of the control of room air.