Fungal Molecular Pathogenesis: What Can It Do and Why Do We Need It?
As molecular studies are applied to study the pathogenesis of invasive mycoses, it is essential that the parameters of the host-parasite interactions are known. The issue of clinical antifungal drug resistance and the impact of molecular studies on these invasive mycoses can be discussed under several categories: (i) diagnosis, (ii) immunomodulation, (iii) drug prescription, (iv) surgery, (v) prevention, (vi) new antifungal agents, and (vii) drug combinations. This chapter talks about how molecular studies of medically relevant fungi have begun to find uses in the clinical arena and discusses their potential to make a major impact on the outcome of human mycoses. There are two major issues in clinical diagnosis in which molecular biology is likely to lead to significant advances. First, despite the availability of several new diagnostic tests for invasive candidiasis and aspergillosis, there remain, from a clinical standpoint, opportunities to make an earlier specific fungal diagnosis or prevent the use of empirical antifungal therapies. The second area in which molecular biology is poised to make a major diagnostic contribution in the clinical mycology laboratory is in strain or isolate identification. The use of antifungal combinations to treat invasive mycoses has been a controversial topic because there are few evidence-based studies that support their widespread clinical use. In today's environment of constant fungal threat, it is both exciting and helpful that fungal molecular pathogenesis is maturing into a science with practical applications.
