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Emergence of Nonalbicans Candida Species in Immunocompromised Leukemia Patients during Fluconazole Treatment

Kunio Yano1, Shinya Fujisawa1, Hirotaka Matsui1

  • 1Department of Hematology, Hamamatsu Medical Center, Hamamatsu, Japan.

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|April 24, 2018
PubMed

Insights

In severely immunocompromised leukemia patients, non-albicans Candida species resistant to fluconazole emerged in 21.2% of cases. Routine surveillance for fluconazole-resistant yeast is crucial during treatment.

Area of Science:

  • Medical Mycology
  • Infectious Diseases
  • Hematology

Background:

  • Patients with leukemia undergoing intensive chemotherapy or bone marrow transplantation are severely immunocompromised.
  • Antifungal prophylaxis and treatment are critical in managing invasive fungal infections in these vulnerable populations.

Purpose of the Study:

  • To survey the incidence of non-albicans Candida species emergence during fluconazole treatment in leukemia patients.
  • To identify specific non-albicans Candida species that emerge and assess their susceptibility to fluconazole.

Main Methods:

  • A 3-year prospective study (April 1993-March 1996) involving 33 leukemia patients receiving fluconazole.
  • Monitoring for the emergence of non-albicans Candida species during or immediately after fluconazole administration.

Main Results:

  • Non-albicans Candida species emerged in 7 out of 33 patients (21.2%).
  • Candida inconspicua was the most prevalent emerging species, alongside C. krusei, C. glabrata, and C. maris.
  • The emerged yeast strains demonstrated resistance to fluconazole, suggesting selection pressure.

Conclusions:

  • Fluconazole treatment can select for resistant non-albicans Candida species in immunocompromised leukemia patients.
  • Routine surveillance for fluconazole-resistant yeast strains is recommended during treatment.
  • Alternative effective antifungal agents should be administered in cases of resistance.
Keywords:
fluconazoleleukemianonalbicans Candida species

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