Immunomodulators: What is the Evidence for Use in Mycoses?

INTRODUCTION Because alterations in immunity are the major risk factor for developing invasive mycoses, strategies to augment immune function are being explored as adjunctive therapy in these infections. In neutropenic patients, efforts to increase neutrophil number and function include the use of granulocyte infusions and colony-stimulating factors (CSFs). Investigators have also studied the role of cytokines, such as interleukin-12 and interferon-gamma, in enhancing immunity in immunocompromised patients. The administration of nonspecific immunoglobulin has been used for decades in the treatment of infections; however, recent advances in this technology include the passive administration of specific antibodies directed against fungal pathogens. As the immune status of the patient improves, clinicians must be aware of the immune reconstitution syndrome. Although a sign of clinical improvement, this syndrome may mimic worsening infection.