Preface

Although the means of diagnosing and treating fungal infections have improved greatly over the last decade, fungi still represent a serious threat to the health of immunocompromised and immunodeficient patients. In addition to the more commonly encountered fungi, recent years have also seen the emergence of life-threatening infections due to fungi that had previously been seen only rarely in clinical practice. Many of these fungi are difficult to detect and to treat and their emergence as serious agents of disease among specific patient cohorts presents new challenges to the delivery of safe and effective antifungal therapy.

Recent developments in antifungal drug development have led to the welcome introduction of the Echinocandins and various azole derivatives into routine clinical use. Diagnosis of fungal infections has been improved with the utilization of PCR and immunoassay techniques. Despite these advances in diagnosis and therapy, fungi remain serious threats to the health of susceptible patients and we must strive to fully understand the fungi responsible for these infections and their interactions with the host's immune system if improved means of dealing with these infections are to be developed in the future.

The aim of this book is to give an in-depth assessment of our current understanding of the Biology of the main fungal pathogens and how they interact with the host. Each chapter focuses on a specific fungal pathogen or group of pathogens and examines their biology and the factors that allow the fungus colonize and disseminate within the host. In addition each chapter gives an indication of the challenges that remain to be tackled over the next 5-10 years in increasing our understanding of fungal pathogenicity. Each chapter is written by internationally recognized experts and this has ensured that the book is as comprehensive and authorative a text as is possible to assemble.

Chapter 1 gives a detailed description of the immune response of humans to pathogenic fungi and illustrates how an in-depth understanding of the host immune response can be utilized to better challenge fungal infection. Chapter 2 describes various in vivo models used to study the virulence of fungal pathogens. Chapter 3 presents an examination of the possibility of using 'alternative' animal models and demonstrates how the structural and functional similarities between the innate immune response of mammals and the insect immune response can be utilized to allow insect be used in place of mammals for the routine screening of fungal mutants. Chapter 4 describes recent developments in the antifungal therapy and highlights the possibility of vaccines being used to prevent fungal infections.

Chapter 5 is the first chapter that deals with a specific pathogen and in this case the pathogen is Candida albicans, which has been the subject of much molecular examination in recent years to elucidate its virulence factors and this chapter also describes the current state of our knowledge and highlights the challenges that remain. Chapter 6 describes the biology of Cryptococcus neoformans and examines how this fungus interacts with the immune response. The Zygomycetes have emerged in recent years as serious etiological agents of disease in immunocompromised patients. In Chapter 7 the epidemiology, diagnosis, and treatment of zygomycosis is described. Recent developments in our understanding of the pathogenicity of Aspergillus fumigatus are described in Chapter 8, and Chapter 9 describes the factors affecting the virulence of Pénicillium marneffei, which is a serious cause of disease in Southeast Asia among AIDS patients. Dermatophytic infections are one of the most widely encountered of all fungal infections and Chapter 10 describes how dermatophytes interact with the immune system to colonize areas of the body (skin, hair) that would normally be considered extremely hostile. Chapter 11 describes the biology of Paracoccidioides brasiliensis, which is the agent of the human systemic disease paracoccidioidomycosis that affects individuals in endemic areas extending from Argentina to Central America. Finally, Chapter 12 describes the occurrence and biology of Fusarium spp. and Scedosporium spp., which have recently emerged as important fungal pathogens causing significant morbidity and mortality especially in immunocompromised patients.

As well as providing a comprehensive assessment of our current understanding of the biology and pathogenicity of the principal fungal pathogens, each chapter provides an indication of the main challenges that remain to be tackled over the next 5-10 years in our efforts to improve patient recovery. It is the hope of all the contributors that this book will facilitate increased research into the interaction of pathogenic fungi with the immune response and allow the development of new and improved means of diagnosing and treating fungal infections.

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