Recognition and Management of Angioinvasive Fungal Infections

Purpose of Review To describe the clinical features, diagnosis, and treatment of angioinvasive fungal infections. Recent Findings Candida auris is a recently discovered species with multi- to pan-drug resistance to azoles, amphotericin B, and echinocandins. The SECURE trial showed that isavuconazole was non-inferior to voriconazole for treatment of Aspergillus. Additionally, the VITAL study showed that there was no difference in mortality between those treated with either isavuconazole or amphotericin B. Isavuconazole is now approved by the FDA for the treatment of Aspergillus and Mucor . Summary Invasive fungal infections are a well-known cause of morbidity and mortality, particularly in patients with diabetes or significant immunosuppression related to organ transplantation, chemotherapy, or hematologic malignancy. Angioinvasive fungi have the capacity to enter blood vessels, where they can cause local vascular occlusion, thrombosis, and eventual ischemia and tissue necrosis. The brain, eyes, lungs, liver, spleen, and skin are common sites of fungal infection, although any organ can be affected. Fungi capable of angioinvasion include Candida , Aspergillus , Mucormycetes , Fusarium , and hyaline and dematiaceous molds. Given the severe complications associated with angioinvasive fungi, and that immunosuppression often blunts presenting symptoms such as fever, clinicians must have a high suspicion for these organisms in order to expeditiously diagnose and treat these devastating infections.