[Current status and future perspectives of invasive fungal infections after hematopoietic stem cell transplantation].

Invasive fungal infections (IFI) are associated with considerable morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Recently, the epidemiology of IFI has changed notably by evolution in transplantation procedures as well as preventative strategies. Invasive Aspergillosis is the major fungal infection in the patients undergoing HSCT, which mainly occurred during later period of post-HSCT. With the risk factors, such as prolonged neutropenia, graft-versus-host disease and adopted immunosuppressants and so on in HSCT patients, moreover there are the difficult requirement of histopathological specimen and time consuming, few positive blood culture, the attributable mortality still remains high. Hence high-resolution computed tomography, PET/CT and non-culture based adjunctive diagnostic tests, such as enzyme-linked immunosorbent assay for galactomannan (GM) and (1, 3)-β-D-glucan have been incorporated into clinical practice, while the molecular detection, like fungal PCR assays have been developed and will bring the earlier, specific diagnosis for IFI. Newer agents with higher efficacy and lower toxicity, such as voriconazole, caspofungin and micafungin are currently being introduced as prophylaxis, while the combination of these agents and immunotherapy are evaluated to be more prospective strategies. This review summarizes the changed epidemiology, risk factors and recent advances in the diagnosis and management of IFI in HSCT recipients.