Two cases of disseminated hyalohyphomycosis due to Fusarium solani in patients with acute nonlymphocytic leukemia were studied. The clinical features in both patients included fever, fungemia, severe myalgias, disseminated ecthyma gangrenosum-like skin lesions, ocular symptoms, and a fatal outcome despite systemic administration of amphotericin B in the setting of profound, persistent granulocytopenia. In vitro studies showed the resistance of both F. solani isolates to amphotericin B, 5-fluorocytosine, and imidazoles. This investigation confirmed the emergence of F. solani infection in immunosuppressed hosts.

Adolescent↗

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Blastoschizomyces capitatus: an emerging cause of invasive fungal disease in leukemia patients.

Blastoschizomyces capitatus (formerly named Trichosporon capitatum or Geotrichum capitatum) is a rare cause of invasive fungal disease in immunocompromised hosts. We retrospectively studied epidemiologic, clinical, pathologic, and microbiologic features of this infection during a 68-month period at the Division of Hematology of the University La Sapienza in Rome. Twenty patients with evidence of B. capitatus were identified: 12 were infected, four were possibly infected, and four had evidence of B. capitatus colonization but were not infected by this fungus. Pulmonary infiltrates were seen in seven infected patients; four of these patients eventually developed mycetomalike cavitations. Eight infected patients presented clinical and radiologic features of focal hepatitis compatible with hepatosplenic candidiasis. Of the 12 infected patients, two did not receive any antifungal treatment and died, five did not show any response to systemic antifungal therapy, and five received prolonged amphotericin B plus 5-fluorocytosine therapy. Of the last group, three patients achieved stable remission of their acute leukemia and were cured, and two improved but had an apparent relapse of B. capitatus infection after their acute leukemia recurred.

Adolescent↗

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Rhinocerebral zygomycosis in acute lymphoblastic leukaemia.

We describe a patient with acute lymphoblastic leukaemia who developed rhinocerebral zygomycosis during the aplastic phase induced by antineoplastic chemotherapy. The patient was treated with fluconazole intravenously (400 mg daily) for 30 days and underwent surgical debridement. As a result of this treatment a complete remission of the zygomycosis-associated symptoms was observed. The possibility of treating zygomycosis with fluconazole is discussed.

Adult↗

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In vitro susceptibility of Candida species isolated from patients with haematological malignancies.

Candida spp. (83 isolates including C. (Torulopsis) glabrata) were tested in vitro for their susceptibility to 5-fluorocytosine, amphotericin B, ketoconazole, itraconazole, fluconazole, and miconazole. The yeasts were isolated from clinical specimens, mostly from the lower respiratory tract, of 30 oncologic patients, 27/30 with haematological malignancies, during a 6-month period (December 1991-May 1992). Minimal inhibitory concentration (MIC) and minimal fungicidal concentration (MFC) values of the 6 drugs were obtained for each yeast using a microdilution broth method developed in our laboratory. Amphotericin B, and 5-fluorocytosine were active against the majority of the yeasts with MIC90/MFC90 values within achievable serum concentrations (3.12/6.25 micrograms ml(-1) and 0.625/0.625 micrograms ml(-1) respectively). Azole derivatives showed a species-specific activity. MFC values were two to four times higher than those of the MICs, confirming the fungistatic rather than fungicidal activity of azole derivatives. An interesting correlation was found when the in vitro susceptibility values of the isolates were compared with data of patients with or without antifungal prophylaxis or therapy during that period. In general, with respect to fluconazole, C. albicans strains isolated from patients who received no treatment showed MIC and MFC values lower than those obtained from patients who were under prophylaxis or treatment with this drug. Fluconazole administration appears to influence in vitro susceptibility testing.

Antifungal Agents↗

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[Invasive nasosinusal aspergillosis in an immunocompetent patient].

The authors describe a case of invasive nasosinusal aspergillosis in an immunocompetent patient. After a careful bibliographic review, they emphasize that in the present case the diagnosis was made by means of fungal culture as the clinical picture, imaging techniques and histopathological findings were aspecific. The pathogenetic agent resulted Aspergillus tamarii which belongs to the Aspergillus flavus group and is one of the most unusual agents in literature. The treatment of choice, in the invasive form, is surgery that should be as radical as possible followed by a medical therapy. In the present case, after two-phase radical surgery on all the paranasal sinuses, medical treatment with traconazole was employed with excellent local results at a follow-up of one year.

Adult↗

PubMedDate not supplied