%0 Journal Article
%T Immunological Aspects of Candida and Aspergillus Systemic Fungal Infections
%A Christoph Mueller-Loebnitz
%A Helmut Ostermann
%A Anke Franzke
%A Juergen Loeffler
%A Lutz Uharek
%A Max Topp
%A Hermann Einsele
%J Interdisciplinary Perspectives on Infectious Diseases
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/102934
%X Patients with allogeneic stem cell transplantation (SCT) have a high risk of invasive fungal infections (IFIs) even after neutrophil regeneration. Immunological aspects might play a very important role in the IFI development in these patients. Some data are available supporting the identification of high-risk patients with IFI for example patients receiving stem cells from TLR4 haplotype S4 positive donors. Key defense mechanisms against IFI include the activation of neutrophils, the phagocytosis of germinating conidia by dendritic cells, and the fight of the cells of the innate immunity such as monocytes and natural killer cells against germlings and hyphae. Furthermore, immunosuppressive drugs interact with immune effector cells influencing the specific fungal immune defense and antimycotic drugs might interact with immune response. Based on the current knowledge on immunological mechanism in Aspergillus fumigatus, the first approaches of an immunotherapy using human T cells are in development. This might be an option for the future of aspergillosis patients having a poor prognosis with conventional treatment. 1. Introduction Invasive fungal infections (IFIs) have a great impact on clinical course and outcome. Of 100 patients with acute myeloid leukemia (AML), 7% have proven, 7% probable, and 43% possible IFI. About half of patients developing proven IFI do not survive. Criteria for IFI diagnosis defined by EORTC and MSG include recent history of neutropenia (<0.5 ¡Á 109£¿neutrophils/L for >10 days) temporally related to the onset of fungal disease and receipt of allogeneic stem cell transplantation (SCT), as well as inherited severe immunodeficiency such as chronic granulomatous disease or severe combined immunodeficiency [1]. In addition, EORTC/MSG mentioned diagnostic criteria such as prolonged use of corticosteroids at a mean minimum dose of 0.3£¿mg/kg/day of prednisone equivalent for >3 weeks and treatment with T cell immunosuppressants, for example, cyclosporine or TNF-¦Á blockers, specific monoclonal antibodies (e.g., alemtuzumab), or nucleoside analogues during the past 90 days [1]. The size of the hospital seems to be also associated with the risk of developing a fungal infection, probably due to higher numbers of patients at risk being treated in bigger hospitals [2]. Immunological aspects play an important role in the development of invasive fungal infection, especially in the development of invasive aspergillosis. To discuss the importance of the different cells of the immune system for the development of IFI, a special symposium was held in
%U http://www.hindawi.com/journals/ipid/2013/102934/