Fungal infections in the organ transplant recipient

Fungal infections constitute some of the most difficult clinical management problems encountered after solid organ transplantation. Although the predominant pathogens continue to be Candida species followed by Aspergillus species, emerging fungal pathogens including azole-resistant yeast, Fusarium, and dematiaceous fungi are becoming more significant. Identification of novel risk factors has expanded traditional concepts of the epidemiology of these infections. Optimal prophylaxis of fungal infections constitutes an area of active research. Diagnosis continues to be a challenge, but newer methods including antigen assays and panfungal or specific fungal polymerase chain reaction methodology are promising. Advances in therapy include lipid amphotericin formulations, newer azoles such as voriconazole, ravuconazole, and posaconazole, and echinocandins such as the recently approved drug caspofungin, as well as immunomodulatory therapy.