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[Evaluation of antimycotics in the elderly].
1Department of Internal Medicine, Tokyo Metropolitan Geriatric Hospital, Japan.
Summary
This study identified risk factors for deep-seated mycosis in elderly patients, including candidiasis and aspergillosis. Amphotericin B (AMPH) showed effectiveness but its use is limited by nephrotoxicity in elderly patients.
Area of Science:
- Medical Mycology
- Geriatric Medicine
- Infectious Diseases
Context:
- Deep-seated mycosis presents a significant challenge in elderly patients.
- Autopsy studies are crucial for understanding the incidence of invasive fungal infections.
- Identifying specific risk factors is essential for targeted prevention strategies.
Purpose:
- To analyze the incidence and risk factors of deep-seated mycosis (candidiasis and aspergillosis) in elderly individuals.
- To evaluate the efficacy and limitations of antifungal treatments, specifically Amphotericin B (AMPH).
- To provide recommendations for the safe and effective use of antimycotics in geriatric populations.
Summary:
- A review of 1,663 autopsy cases revealed 20 instances of deep-seated mycosis.
- Prominent risk factors for candidiasis included intravascular catheters, antibiotic use, and steroid therapy.
- Leukocytopenia induced by anti-cancer drugs was linked to aspergillosis.
- Preventive Amphotericin B (AMPH) was effective for mycosis in patients with hematological malignancies or on steroid therapy.
- Nephrotoxicity limits AMPH use in the elderly, necessitating careful dosing and sensitivity testing for safe antimycotic administration.
Impact:
- Highlights the importance of monitoring for invasive fungal infections in elderly patients.
- Informs clinical practice regarding the management of mycosis in vulnerable populations.
- Emphasizes the need for individualized treatment approaches considering renal function and drug toxicity.