Fungal infections occur with increasing frequency when neutropenia is prolonged (see below). In the past, most fungal infections were caused by species of Candida or Aspergillus. Candida are frequent colonizers of skin, oropharynx, and the gastrointestinal tract, and may cause localized or disseminated infection. Aspergillus spores are widespread in the environment and can also be nosocomial pathogens, particularly in relation to building construction. Sinus or airway colonization may become an invasive infection in the setting of neutrope-nia. Those with a history of marijuana use, gardening, farming, or construction work are at a higher risk for being colonized.
In recent years, resistance to antifungal agents has increasingly occurred. Fluconazole has been used for therapy or prophylaxis of yeast infections, as it avoids the toxicities of amphotericin B. However, pathogens such as Candida glabrata (frequently fluconazole resistant) and Candida krusei (always resistant) have emerged in the setting of increasing fluconazole usage. In addition, unusual fungi such as Fusarium, Trichosporon, Paecilomyces, and Scedosporium are seen with more frequency. Some of these display resistance to traditional antifungal agents.
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