Related Experiment Videos
Association therapy as a prognostic factor in deep fungal infection complicating oncohaematological diseases
1Internal Medicine Department, University of Milan, S. Gerardo Hospital, Monza, Italy.
Abstract:
A group of 31 oncohaemopathic patients (17 male, mean age 44 +/- 6 years), diagnosed as having primary deep fungal infection involving the lungs, were retrospectively evaluated. When infection was suspected on a clinical basis the major associated risks for death were the duration of bone marrow aplasia (12 +/- 7 versus 21 +/- 6 days, P < 0.001), increase in white blood cells and, in particular, prolonged granulocytopenia (11 +/- 5 versus 24 +/- 8 days, P < 0.001) when survivors were compared with patients, who died. Our therapeutic empirical approach was based on the association of i.v. amphotericin B, 1 mg kg-1 day-1, with oral 5-fluorocytosine (5-FC) 150 mg kg-1 day-1. Only 9 subjects received combination therapy for more than 7 days. For majority of them, oral 5-FC was interrupted because of altered compliance or sustained liver damage. A chi 2 test for independent parameters showed (P = 0.0021) a concentration of deaths among patients who received amphotericin B alone (15/22); none of the patients treated with amphotericin B + 5-FC (9 cases) died. Results generally suggest that a more favourable outcome was statistically associated with empirical antifungal combination therapy in deep fungal infection, although both treatment regimens showed effectiveness in terms of survival. Nevertheless the low 5-FC compliance and the small sample do not indicate the safe use of this drug in a large population.
Insights
Empirical combination antifungal therapy, including amphotericin B and 5-fluorocytosine (5-FC), showed improved survival in oncohaematologic patients with deep fungal lung infections. However, 5-FC
Area of Science:
- Medical Mycology
- Oncology
- Infectious Diseases
Background:
- Deep fungal infections pose a significant risk to oncohaematologic patients.
- Clinical suspicion of fungal infection necessitates prompt and effective therapeutic strategies.
- Risk factors for mortality include prolonged bone marrow aplasia and granulocytopenia.
Purpose of the Study:
- To evaluate the efficacy of empirical antifungal combination therapy in oncohaematologic patients with deep fungal lung infections.
- To compare outcomes between patients treated with amphotericin B alone versus combination therapy with 5-fluorocytosine (5-FC).
Main Methods:
- Retrospective evaluation of 31 oncohaematologic patients with primary deep fungal lung infections.
- Therapeutic regimens included intravenous amphotericin B alone or in combination with oral 5-FC.
- Statistical analysis using chi-squared test to assess treatment outcomes.
Main Results:
- Patients receiving amphotericin B alone had a higher mortality rate (15/22) compared to those receiving combination therapy (0/9).
- Prolonged granulocytopenia was a significant risk factor for death.
- Combination therapy was statistically associated with a more favorable outcome.
Conclusions:
- Empirical antifungal combination therapy appears to improve survival in this patient group.
- Low compliance and potential liver damage associated with 5-FC limit its widespread use.
- Further research with larger sample sizes is needed to confirm the safety and efficacy of 5-FC in combination therapy.