Risk Factors
Risk Factors that Predispose to Invasive Fungal Infections*
Invasive fungal infections (IFIs) occur predominantly in immunocompromised individuals but can also be seen in previously well persons. The human innate immune system recognizes key components of the fungal cell wall as foreign resulting in a myriad of signaling cascades. This triggers release of antifungal molecules as well as adaptive immune responses, which kill or at least contain the invading fungi. However, these defenses may fail in hosts with primary or secondary immunodeficiencies resulting in IFIs. A number of risk factors can predispose a patient to Invasive Fungal Infections (IFIs).
*Source: Christina C Chang, Stuart M Levitz, Fungal immunology in clinical practice: Magical realism or practical reality?, Medical Mycology, Volume 57, Issue Supplement_3, June 2019, Pages S294–S306, https://doi.org/10.1093/mmy/myy165

Epidemiological Trends of Invasive Aspergillosis
Patients at Risk for Infection Rising Rapidly

New Biologic Agents and Fungal Infections*
There has been a proliferation of new biologic agents in clinical practice many of which have been associated with susceptibility to specific and in some cases unusual fungal infections. Keeping pace with these novel agents, particularly their cellular and humoral impact, is challenging. Examples of these agents and their respective fungal susceptibility are reviewed in the table* below:
Inhibitor Mechanism | Biologic Agent Example(s) | Fungal Susceptibility |
---|---|---|
IL-17A | Secukinumab, Ixekizumab, Brodalumab | Candidiasis |
IL-23/IL-17 blockers | Ustekinumab | Mucosal Candidiasis |
Janus kinase inhibitors - JAK1/2 and 1/3 inhibitors | Tofacitinib, Ruxolitinib, Baricitinib | Cryptococcosis, Talaromycosis, Candidiasis |
Bruton's tyrosine kinase (BTK) inhibitor | Ibrutinib | Cryptococcosis, Aspergillosis, Mucormycosis |
Vascular endothelial growth factor (VEGF) | Bevacizumab | Aspergillosis, Fusariosis |
α-4/β-7 integrin | Natalizumab, Vedolizumab | Cryptococcosis, Candidiasis |
BCR-ABL, c-Kyt, other off-target kinases | Imatinib, Dasatinib, Sorafenib | Candidiasis, PJP, Rhodoturulosis |
B cell lymphoma (BCL)-2 | Venetoclax | Aspergillosis, Candidiasis, PJP |
*Source: Christina C Chang, Stuart M Levitz, Fungal immunology in clinical practice: Magical realism or practical reality?, Medical Mycology, Volume 57, Issue Supplement_3, June 2019, Pages S294–S306, https://doi.org/10.1093/mmy/myy165