Changing patterns and trends in systemic fungal infections.

Invasive mycoses are a significant and growing public health problem. Although bloodstream infections with Candida albicans may be decreasing in frequency, the number of persons at risk for them continues to grow. Moreover, infections with other Candida species, such as Candida glabrata, are increasing in incidence. Invasive mould infections in general, and Aspergillus infections in particular, are becoming more frequent. Fungal opportunistic infections in persons with AIDS are no longer a major problem in developed countries, but are resulting in significant morbidity and mortality in developing countries with AIDS epidemics. Further studies are needed to define populations at very high risk for fungal opportunistic infections who might benefit from targeted antifungal chemoprophylaxis, which remains the most promising of the potential prevention strategies. This review highlights the changing patterns in risk factors, changes in epidemiology, the impact of changes in medical practice in intensive care and organ transplantation on the incidence of systemic fungal infections, and gives an overview of fungal infections in paediatric patients, patients with haematological malignancy, and the emergence of antifungal resistance.