• Abdul Wahab, David Sanborn, Paschalis Vergidis, Raymund Razonable, Hemang Yadav, and Kelly M Pennington.
• Department of Medicine, Mayo Clinic Health Systems, Mankato, MN.
• Chest. 2024 Sep 7.

Topic ImportanceThe prevalence of invasive fungal infections (IFIs) has risen in the past 3 decades, attributed to advancements in immune-modulatory therapies used in transplantation, rheumatology, and oncology.Review FindingsOrganisms that cause IFI evade the host's natural defenses or at opportunities of immunologic weakness. Infections occur from inhalation of potentially pathogenic organisms, translocation of commensal organisms, or reactivation of latent infection. Organisms that cause IFI in immunocompromised populations include Candida species, Cryptococcus species, environmental molds, and endemic fungi. Diagnosis of these infections is challenging due to slow organism growth and fastidious culture requirements. Moreover, fungal biomarkers tend to be nonspecific and can be negatively impacted by prophylactic antifungals. Antibody-based tests are not sensitive in immunocompromised hosts making antigen-based testing necessary. Prevention of IFI is guided by pathogen avoidance, removal or minimization of immune-suppressing factors, and pharmacologic prophylaxis in select hosts.SummaryUnderstanding the complex interplay between the immune system and opportunistic fungal pathogens plays a key role in early diagnosis and prevention.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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