Association therapy as a prognostic factor in deep fungal infection complicating oncohaematological diseases.
A group of 31 oncohaemopathic patients (17 male, mean age 44 +/- 6 years), diagnosed as having primary deep fungal infection involving the lungs, were retrospectively evaluated. When infection was suspected on a clinical basis the major associated risks for death were the duration of bone marrow aplasia (12 +/- 7 versus 21 +/- 6 days, P < 0.001), increase in white blood cells and, in particular, prolonged granulocytopenia (11 +/- 5 versus 24 +/- 8 days, P < 0.001) when survivors were compared with patients, who died. Our therapeutic empirical approach was based on the association of i.v. amphotericin B, 1 mg kg-1 day-1, with oral 5-fluorocytosine (5-FC) 150 mg kg-1 day-1. Only 9 subjects received combination therapy for more than 7 days. For majority of them, oral 5-FC was interrupted because of altered compliance or sustained liver damage. A chi 2 test for independent parameters showed (P = 0.0021) a concentration of deaths among patients who received amphotericin B alone (15/22); none of the patients treated with amphotericin B + 5-FC (9 cases) died. Results generally suggest that a more favourable outcome was statistically associated with empirical antifungal combination therapy in deep fungal infection, although both treatment regimens showed effectiveness in terms of survival. Nevertheless the low 5-FC compliance and the small sample do not indicate the safe use of this drug in a large population.
Internal Medicine Department, University of Milan, S. Gerardo Hospital, Monza, Italy.
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Pogliani
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Clini
D000293:Adolescent; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy; D001230:Aspergillus / Q000302:isolation & purification; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D003454:Cryptococcus / Q000302:isolation & purification; D004359:Drug Therapy, Combination; D005260:Female; D005437:Flucytosine / Q000627:therapeutic use*; D006801:Humans; D008172:Lung Diseases, Fungal / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology / Q000401:mortality; D008232:Lymphoproliferative Disorders / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000188:drug therapy / Q000209:etiology / Q000382:microbiology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
D000666:Amphotericin B; D005437:Flucytosine