Advances against Aspergillosis

As contemporary medicine advances treatment of life-threatening diseases with the addition of newer, aggressive chemotherapeutic regimens and the frequent use of bone marrow and organ transplantation, the rising incidence of invasive aspergillosis has paralleled the marked increase in immunocompromised patients. The incidence of invasive mold infections following hematopoietic stem cell transplantation has tripled in some series [1], with Aspergillus species the most common pathogen. Unfortunately, the overall survival rate among patients treated with the historical standard of amphotericin B is dismal, and until recently there were only 2 antifungals with inherent activity against Aspergillus, amphotericin B deoxycholate and itraconazole. Treatment of invasive aspergillosis is now at a critical junction. More than a decade ago, Clinical Infectious Diseases published an exhaustive review of old and new treatments for aspergillosis, compiling the results of reports on 2121 patients [2]. This landmark analysis had an unprecedented scope and has served as a reference point for many subsequent analyses. In the interval, there have been several comprehensive reviews of the area, including reviews of treatment results [3], analysis of the significance and consequences of a positive culture result [4], synthesis of current approaches to therapy by an Infectious Diseases Society of America committee [5], update of the biology of the organism [6], study of the epidemiology and costs of the diseases [7], new consensus definitions of disease for future clinical trials [8], and some updating of the earlier analysis [9, 10]. This journal, designed for the busy infectious diseases clinician, has provided a forum for many of these articles and opinions, as well as reviews of individual antifungals.