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Invasive candidiasis during granulocytopenia
1University of Texas M.D. Anderson Cancer Center, Houston 77030.
Summary
Disseminated candidiasis is a growing fungal infection risk for patients with low white blood cell counts. Combination antifungal therapy may improve outcomes compared to standard treatment alone.
Area of Science:
- Mycology
- Hematology
- Infectious Diseases
Background:
- Candidiasis is the most common fungal infection in patients with profound granulocytopenia.
- Infections are increasing in frequency and occurring earlier during chemotherapy.
- The gastrointestinal tract is the primary source of disseminated candidiasis due to chemotherapy-induced epithelial disruption.
Purpose of the Study:
- To review the current understanding of disseminated candidiasis in patients with profound granulocytopenia.
- To discuss the spectrum of disease, common causative species, and management strategies.
- To evaluate the potential benefits of combination antifungal therapy.
Main Methods:
- Literature review of candidiasis in patients with profound granulocytopenia.
- Analysis of current treatment guidelines and emerging therapeutic options.
- Consideration of animal experimentation for combination therapy efficacy.
Main Results:
- Amphotericin B is the standard empiric therapy, but responses are often poor in this patient group.
- 5-flucytosine and fluconazole show potential utility.
- Animal studies suggest combination therapy (amphotericin B, 5-flucytosine, fluconazole) may yield superior results.
Conclusions:
- Antifungal prophylaxis is recommended due to the high mortality of disseminated candidiasis in hematologic malignancies.
- Further research is needed to define the role of colony-stimulating factors.
- Central venous catheter removal is not indicated in profound granulocytopenia.