amphotericin-b--deoxycholate-drug-combination and Fusariosis

Fusarium species are the second leading cause of disseminated mold infections in immunocompromised patients. The high mortality caused by such infections is attributed to the high resistance of Fusarium species to current antifungal agents. We report the first case of disseminated fusariosis after the use of alemtuzumab, an anti-CD52 monoclonal antibody, in a patient who presented with striking cutaneous and oral cavity lesions. Case reports of combination antifungal therapy for disseminated fusariosis in immunocompromised patients were reviewed. Among 19 published cases in the last 10 years plus this patient, the patients in 14 cases (70%) responded positively to combination antifungal therapy. A clinical response was achieved in seven cases before resolution of neutropenia.

Topics: Adult; Alemtuzumab; Amphotericin B; Antibodies, Monoclonal, Humanized; Antifungal Agents; Antineoplastic Agents; Combined Modality Therapy; Deoxycholic Acid; Drug Combinations; Drug Therapy, Combination; Fever; Fusariosis; Fusarium; Granulocytes; Humans; Immunocompromised Host; Leukocyte Transfusion; Lymphoma, T-Cell, Cutaneous; Male; Microbial Sensitivity Tests; Neutropenia; Pyrimidines; Skin Neoplasms; Triazoles; Voriconazole

We report a case of a patient with acute lymphoblastic leukemia (ALL), who developed a disseminated infection by Fusarium verticillioides during chemotherapy-induced neutropenia. He was successfully treated only after combination therapy with voriconazole plus amphotericin B deoxycolate was used, but not when these compounds were used in an isolated form.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Deoxycholic Acid; Drug Combinations; Drug Therapy, Combination; Fusariosis; Humans; Male; Neutropenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Voriconazole

Invasive fusariosis (IF) has been associated with a poor prognosis. Although recent series have reported improved outcomes, the definition of optimal treatments remains controversial. The objective of this study was to evaluate changes in the outcome of IF. We retrospectively analysed 233 cases of IF from 11 countries, comparing demographics, clinical findings, treatment and outcome in two periods: 1985-2000 (period 1) and 2001-2011 (period 2). Most patients (92%) had haematological disease. Primary treatment with deoxycholate amphotericin B was more frequent in period 1 (63% vs. 30%, p <0.001), whereas voriconazole (32% vs. 2%, p <0.001) and combination therapies (18% vs. 1%, p <0.001) were more frequent in period 2. The 90-day probabilities of survival in periods 1 and 2 were 22% and 43%, respectively (p <0.001). In period 2, the 90-day probabilities of survival were 60% with voriconazole, 53% with a lipid formulation of amphotericin B, and 28% with deoxycholate amphotericin B (p 0.04). Variables associated with poor prognosis (death 90 days after the diagnosis of fusariosis) by multivariable analysis were: receipt of corticosteroids (hazard ratio (HR) 2.11, 95% CI 1.18-3.76, p 0.01), neutropenia at end of treatment (HR 2.70, 95% CI 1.57-4.65, p <0.001), and receipt of deoxycholate amphotericin B (HR 1.83, 95% CI 1.06-3.16, p 0.03). Treatment practices have changed over the last decade, with an increased use of voriconazole and combination therapies. There has been a 21% increase in survival rate in the last decade.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Child; Child, Preschool; Deoxycholic Acid; Drug Combinations; Drug Therapy, Combination; Female; Fusariosis; Humans; Male; Middle Aged; Retrospective Studies; Survival Analysis; Treatment Outcome; Voriconazole; Young Adult