ZYGOMYCOSIS: current approaches to management of patients with haematological malignancies.
Zygomycosis is an invasive infection that can occur particularly in patients with haematological malignancy. The causative fungi are members of the order Mucorales, and individual species within this group require a high level of laboratory skill to be identified. Zygomycosis can present as rhinocerebral, pulmonary, or disseminated disease, with a rapid clinical course. The optimal management of these cases requires early diagnosis, aggressive antifungal therapy and, when possible, surgical debridement. Founded on clinical experience, but without the benefit of comparative studies, liposomal amphotericin B has become the therapeutic agent of choice. Posaconazole is an orally administered triazole with a demonstrated in vitro and in vivo activity against most Zygomycetes that is comparable to that of amphotericin B. Studies on salvage therapy with posaconazole have yielded promising results, and successful case reports are also available. As an adjuvant approach, iron chelation with deferasirox has shown promising results, although clinical experience is still limited.
Pagano
Livio
L
Istituto di Ematologia, Università Cattolica S. Cuore, Roma, Italia. lpagano@rm.unicatt.it
Valentini
Caterina G
CG
Caira
Morena
M
Fianchi
Luana
L
D000666:Amphotericin B / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D000935:Antifungal Agents / Q000627:therapeutic use*; D006098:Granulocytes / Q000637:transplantation; D019337:Hematologic Neoplasms / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006931:Hyperbaric Oxygenation; D007502:Iron Chelating Agents / Q000627:therapeutic use; D009504:Neutrophils / Q000637:transplantation; D012307:Risk Factors; D014230:Triazoles / Q000627:therapeutic use*; D020096:Zygomycosis / Q000175:diagnosis / Q000628:therapy*
D000935:Antifungal Agents; D007502:Iron Chelating Agents; D014230:Triazoles; C101425:posaconazole; D000666:Amphotericin B