Abstract

Diagnosis, treatment, and management of invasive mould infections (IMI) are challenged by several risk factors, including local epidemiological characteristics, the emergence of fungal resistance and the innate resistance of emerging pathogens, the use of new immunosuppressants, as well as off-target effects of new oncological drugs. The presence of specific host genetic variants and the patient's immune system status may also influence the establishment of an IMI and the outcome of its therapy. Immunological components can thus be expected to play a pivotal role not only in the risk assessment and diagnosis, but also in the treatment of IMI. Cytokines could improve the reliability of an invasive aspergillosis diagnosis by serving as biomarkers as do serological and molecular assays, since they can be easily measured, and the turnaround time is short. The use of immunological markers in the assessment of treatment response could be helpful to reduce overtreatment in high risk patients and allow prompt escalation of antifungal treatment. Mould-active prophylaxis could be better targeted to individual host needs, leading to a targeted prophylaxis in patients with known immunological profiles associated with high susceptibility for IMI, in particular invasive aspergillosis. The alteration of cellular antifungal immune response through oncological drugs and immunosuppressants heavily influences the outcome and may be even more important than the choice of the antifungal treatment. There is a need for the development of new antifungal strategies, including individualized approaches for prevention and treatment of IMI that consider genetic traits of the patients.

Lay Abstract

Anticancer and immunosuppressive drugs may alter the ability of the immune system to fight invasive mould infections and may be more important than the choice of the antifungal treatment. Individualized approaches for prevention and treatment of invasive mold infections are needed.

中文翻译：

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在癌症患者的侵袭性霉菌感染的诊断和管理中，未来的挑战和机遇。

摘要

侵袭性霉菌感染（IMI）的诊断，治疗和管理面临多种风险因素的挑战，包括局部流行病学特征，真菌耐药性和新兴病原体的固有耐药性的出现，使用新的免疫抑制剂以及脱靶新抗肿瘤药的作用。特定宿主遗传变异的存在和患者的免疫系统状态也可能影响IMI的建立及其治疗的结果。因此，免疫学成分不仅有望在风险评估和诊断中发挥重要作用，而且在IMI的治疗中也将发挥关键作用。细胞因子可以像血清学和分子分析一样用作生物标记物，因此可以很容易地进行测量，因此可以提高侵袭性曲霉病诊断的可靠性，而且周转时间很短。在评估治疗反应中使用免疫学标记可能有助于减少高危患者的过度治疗，并迅速提高抗真菌治疗的水平。模具主动预防可以更好地针对个体宿主需求，从而导致具有已知免疫学特征且与IMI尤其是侵袭性曲霉病高度敏感相关的患者进行靶向预防。通过肿瘤药物和免疫抑制剂引起的细胞抗真菌免疫反应的改变会严重影响治疗效果，甚至可能比抗真菌治疗的选择更为重要。需要开发新的抗真菌策略，包括考虑患者遗传特征的个体化IMI预防和治疗方法。

放置摘要

抗癌和免疫抑制药物可能会改变免疫系统抵抗侵袭性霉菌感染的能力，可能比选择抗真菌治疗更重要。需要用于预防和治疗侵袭性霉菌感染的个体化方法。