Epidemiology of invasive fungal infections. The experience of a teaching hospital in Paris.

The incidence of opportunistic fungal infections have dramatically increased during the past decades. Data from a retrospective study conducted between January 1992 and December 1994 in Necker-Enfants Malades Hospital and a review of the literature were analyzed to assess the main epidemiological features of these infections. Candidiasis remained largely the most frequent: candidemia and invasive candidiasis were diagnosed in respectively 71 and 11 patients. Candida albicans was the agent the most frequently isolated from these infections. However, its percentage was not over 49.35% in our experience. In at least 13 of 27 cases, candidemia could be related to a colonized indwelling catheter. Tough less frequent (24 cases), invasive aspergillosis is of major concern considering its mortality. A wider clinical spectrum was observed with sub-necrotizing aspergillosis reported in non-neutropenic immunocompromised patients (five cases) and invasive aspergillosis in AIDS patients (two cases). Among the 14 cases of cryptococcosis, 11 were diagnosed in AIDS patients whereas the other three were observed in renal transplant recipients. Beside these three major fungal infections, deep immunosuppression, notably induced by bone marrow transplantation, favored the emergence of newly fungal opportunistic agents such as Fusarium sp (two cases), Scedosporium apiospermum (one case) and Trichosporon sp (one case).