Systemische Mykosen

Zusammenfassung

Hauptsächlich Candida- und Aspergillus-Spezies sind die Erreger, die in Deutschland systemische Pilzinfektionen verursachen. Beide Infektionen sind mit einer unbefriedigend hohen Morbidität und Mortalität belastet. Eine sensitive und spezifische Diagnostik, die eine frühzeitige, effektive Therapie ermöglicht, könnte den Verlauf der Erkrankungen entscheidend beeinflussen. Hierzu wurden in der jüngsten Vergangenheit zahlreiche neue Ansätze, zum Beispiel in der serologischen und molekularen Diagnostik invasiver Mykosen, etabliert. Heute steht - neben den wirkungsvolleren Triazolen und nebenwirkungsärmeren Polyen-Lipid-Formulierungen - mit den Candinen eine neue Wirkstoffklasse zur Therapie zur Verfügung, deren Zielstruktur die Zellwand der Pilze ist. Damit bieten sich für den klinischen Einsatz deutlich mehr Optionen, die eine differenziertere und effektivere Therapie erlauben. Der Fortschritt in der molekularen pilzlichen Pathogenitätsforschung sowie die Entwicklung neuer zellwandwirksamer Antimykotika und Peptidantibiotika versprechen weitere therapeutische Verbesserungen.

Summary

In Germany invasive fungal infections are caused predominantly by Candida and Aspergillus spp. The morbidity and mortality rates of these infections are still very high. The outcome of systemic mycoses might be improved using sensitive and specific diagnostic methods that lead to an early and effective therapy. Indeed, useful and promising serological and molecular diagnostic tools have been developed in the recent past. In addition, new drugs are now available that allow a more differentiated and effective therapy. Beside the development of more potent azoles and polyene-lipid-formulations with less side effects, the candins, a novel group of antimycotic drugs targeting the fungal cell wall, are now available for clinical use. New molecular data on fungal pathogenesis as well as the design of new drugs (i.e. peptide antibiotics or cell wall active substances) will improve the therapy of systemic mycoses in the future.

Key Words

systemic mycosis - serology - galactomannan - mitogillin - molecular diagnosis - echinocandin - voriconazol

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