[Successful treatment of azole-refractory Candida guilliermondii fungemia with a combination therapy of micafungin and liposomal amphotericin B].
Candida guilliermondii (C. guilliermondii) are uncommon, representing approximately 1% of all Candida infections, but have been reported to show a higher rate of drug-resistance and mortality rate than C. albicans. Current guidelines for treatment of non-albicans candidemia in neutropenic patients now recommend the use of amphotericin B or voriconazole (VRCZ). We describe here the successful treatment for a 58-year-old male with azole-refractory C. guilliermondii fungemia by combination with liposomal (L-AmB) and micafungin (MCFG) therapy. He was diagnosed as having mantle cell lymphoma, and treatment with HyperCVAD (Rituximab, cyclophosphamide, vincristine, doxorubicin, dexamethasone) was started. Despite prophylactic treatment with fluconazole, he developed fungemia due to C. guilliermondii 41 days after the start of chemotherapy. Positive blood culture and high levels of (1-->3)-beta-D-glucan persisted despite changing the treatment from fluconazole to voriconazole. Although L-AmB was also added to VRCZ, the clinical symptoms worsened. When MCFG was combined with L-AmB, the symptoms and data dramatically improved. Thus, combination therapy consisting of MCFG and L-AmB might be more effective against candidemia that is refractory to azole than combination therapy with VRCZ and L-AmB.
Saitoh
Takayuki
T
Department of Medicine and Clinical Science, Gunma University Graduate School of Medicine.
Matsushima
Takafumi
T
Shimizu
Hiroyuki
H
Osaki
Yohei
Y
Yamane
Arito
A
Irisawa
Hiroyuki
H
Yokohama
Akihiko
A
Uchiumi
Hideki
H
Handa
Hiroshi
H
Tsukamoto
Norifumi
N
Karasawa
Masamitsu
M
Nojima
Yoshihisa
Y
Murakami
Hirokazu
H
D000666:Amphotericin B / Q000627:therapeutic use*; D000935:Antifungal Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects; D001393:Azoles; D002177:Candidiasis / Q000188:drug therapy* / Q000209:etiology; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D004317:Doxorubicin / Q000008:administration & dosage / Q000009:adverse effects; D025141:Drug Resistance, Fungal; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000627:therapeutic use*; D016469:Fungemia / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D016867:Immunocompromised Host; D055666:Lipopeptides; D008074:Lipoproteins / Q000627:therapeutic use*; D020522:Lymphoma, Mantle-Cell / Q000150:complications / Q000188:drug therapy; D008297:Male; D000077551:Micafungin; D008875:Middle Aged; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage / Q000009:adverse effects
D000935:Antifungal Agents; D001393:Azoles; D054714:Echinocandins; D055666:Lipopeptides; D008074:Lipoproteins; C068538:liposomal amphotericin B; D014750:Vincristine; D003907:Dexamethasone; D000666:Amphotericin B; D004317:Doxorubicin; D003520:Cyclophosphamide; D000077551:Micafungin