[A multi-institutional study for prevalence, diagnosis and treatment of deep fungal infection in gastrointestinal surgery].
A multi-institutional study was conducted for prevalence, diagnosis and treatment of deep fungal infection in gastrointestinal surgery. Forty five cases including thirty six complete cases were entered basing on the diagnostic criteria and the mortality of complete cases was 17%. By the administration of miconazole (MCZ), clinical response rate was obtained in 87%, mycological radiation rate in 82% and valuable rate in 71%, with occurrence of side effects in 20%. Fungal endophthalmitis was found in 41% (12/29 cases). beta-glucan [the toxinometer method (T), the Seikagaku-Kogyo method (S)] and candida antigen [the C and-Tec method (C)] were monitored as sero-diagnostic methods, the positive rates for all cases, fungemia, and mycosis of which were 63, 83, 62% (T), 88, 100, 92% (S) and 52, 83, 50% (C), respectively. After mycological re-classification, the positive rates of the T method and endophthalmitis, and the mortality rates were 86, 60, 38% in fungemia, 63, 43, 23% in urinary tract infection, 64, 80, 7% in TPN infection, and 33, 17, 33% in drain infection, respectively. High association of endophthalmitis was found in TPN infection. The beta-glucan assay and a prospective ophthalmoscopic examination are useful for the early diagnosis of deep fungal infection and it is reasonable to treat patients in gastrointestinal surgery by MCZ when mycosis is confirmed or suspected.
Tsujinaka
T
T
Department of Surgery II, Osaka University Medical School, Japan.
Kambayashi
J
J
Imaoka
M
M
Iwanaga
T
T
Mori
T
T
D013505:Digestive System Surgical Procedures; D009877:Endophthalmitis / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008825:Miconazole / Q000627:therapeutic use; D009181:Mycoses / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D010289:Parenteral Nutrition, Total / Q000009:adverse effects; D015995:Prevalence; D012698:Serologic Tests
D008825:Miconazole