Treatment of diseases such as invasive candidiasis and invasive aspergillosis (IA) remains problematic for the clinician. Costs of patient care management are staggering and are most often associated with an increased length of stay in the hospital associated with a delayed- therapeutic intervention and other problems (3,45,54,70,71). But IA and invasive candidiasis are only two of several clinically relevant fungal diseases. A significant number of infections are common among healthy populations, including vulvovaginal candidiasis (61). Also, crypto-coccosis occurs in human immunodeficiency virus/AIDS patients, especially in developing countries, but also has been reported in an outbreak that likely included mostly healthy individuals (33). The dimorphic, endemic fungi are also major pathogens of otherwise healthy individuals. For example, the incidence of coccidioidomycosis alone is about 100,000 cases per year (24). Immunocompromised patients are at risk for these diseases also, and in fact, a 5 to 7 crude mortality rate has been observed in hospitalized patients (20). Further, the endemic mycoses like histoplasmosis can present as common-source or focal epidemics, which can result in disease in a significant number of patients (59). The extensive and expanding list of fungal pathogens and the frequency of their occurrence demand the availability of drugs to counter disease.
展开▼
