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Simon M. Fox

, Angela M. Minassian

, Thomas Rawlinson

, and Brian J. Angus

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date: 13 July 2020

Many fungal species considered of low inherent virulence or non-pathogenic in the immunocompetent have the potential to cause serious disease in the immunocompromised. The prevalence and importance of invasive fungal infections is probably greater now than ever before. The expansion of transplantation programmes, the increasingly widespread use of antibiotics, and the many new immunomodulatory drugs have coincided with the HIV epidemic resulting in increasing numbers of susceptible hosts. Patients with end-organ failure and malignancies now live much longer and many treatments and interventions breech protective barriers, disrupt immune function, and alter normal microbiota—all of which predispose to invasive fungal disease. Patient groups less obviously immunocompromised (e.g. patients with diabetes or those undergoing complex surgery) and patients with implanted medical devices or materials are also at increased risk. Neutrophils and macrophages are the principal mediators of innate immunity against fungi, so neutropenic patients are highly susceptible to opportunistic fungal pathogens.

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