[Controversial points in the treatment of patients with haematologic malignancies complicated with systemic fungal infections].
Prophylaxis and treatments for fungal infections differ with the infection type. However, the eradication of risk factors for outbreak of fungal infections, and the usage of appropriate antifungal agents are universally important to prevent these infections. For infections due to intrinsic fungi such as Candida spp., risk factors such as changes in normal flora by aggressive and prolonged broad-spectrum antibiotics therapy should not be permitted to emerge. On the other hand, infections due to extrinsic fungi such as Cryptococcus neoformans and Aspergillus spp. can be prevented by eradication of the colonized fungi using antifungal prophylaxis and the use of air-cleaning machines to combat colonization of patients and contamination in the hospital environment. The most important risk factor of fungal infections in patients suffering from haematologic malignancies is leukopenia. In these cases, it is crucial to reduce the duration of neutropenia and enhance the anti-microbial function using granulocyte-macrophage-colony stimulating factor. When a patient is complicated with a fungal infection, appropriate antifungal agents must be used at appropriate dosages for the appropriate period. However, there are still very few satisfactory antifungals with minimal adverse effects and good potential efficacy for systemic fungal infections. Therefore, combination therapy with amphotericin B and azole antifungals is necessary for patients with severe fungal infections. In patients complicated with fungal infections, the underlying disease is often resistant to aggressive antifungal therapy. Control of this underlying disease is thus a most important therapeutic factor.
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Division of Haematology, Department of Internal Medicine, Juntendo University School of Medicine, 2-1-1, Hongo, Bunkyo-ku, Tokyo, 113-8421.
D000328:Adult; D000935:Antifungal Agents / Q000008:administration & dosage* / Q000009:adverse effects; D016026:Bone Marrow Transplantation; D016207:Cytokines / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D019337:Hematologic Neoplasms / Q000150:complications*; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D009181:Mycoses / Q000150:complications* / Q000188:drug therapy; D009894:Opportunistic Infections / Q000150:complications* / Q000188:drug therapy
D000935:Antifungal Agents; D016207:Cytokines