amphotericin-b and Anemia--Refractory

Invasive pulmonary aspergillosis is difficult to diagnose and a critical ill with high mortality. In this paper, the diagnosis and treatment of invasive pulmonary aspergillosis complicated in 3 cases of hematological malignancy (2 acute leukemias and 1 MDS-RA) were retrospectively analysed. All patients had histories of hypoimmunity and were received prophylactic antifungal treatment. Pulmonary aspergillosis infection still occurred and confirmedly diagnosed by sputum examination. After 7 to 14 days of combination treatment of liposomal amphotericin B, itraconazole and flucytosine, 2 cases were cured and another showed effective. In conclusion, early diagnosis and treatment of invasive pulmonary aspergillosis are very critical and the therapeutic effectiveness of combined scheme with liposomal amphotericin B, itraconazole and flucytosine is very effective for pulmonary aspergillosis.

Topics: Adult; Amphotericin B; Anemia, Refractory; Aspergillosis; Female; Humans; Leukemia; Lung Diseases, Fungal; Male; Middle Aged

Voriconazole is a new triazole active orally and parenterally that recently proved effective in the treatment of invasive aspergillosis and in empirical antifungal therapy for persistently febrile neutropenic patients. Limited data are available for pediatric patients. We report our experience with voriconazole in seven children with invasive aspergillosis, i.e., four girls and three boys with a median age of 5 (range 2-13) years affected by acute lymphoblastic leukemia (3), acute myeloid leukemia (2), refractory anemia with excess of blasts (1), and severe aplastic anemia (1). First-line therapy in all patients was liposomal amphotericin B (AmBisome) administered at a dosage of 3-5 mg/kg day. Voriconazole was administered for a median 8 (range 2-15) weeks. Response was complete and partial in two patients, respectively, stable in one, and there was no response (failure) in two. The voriconazole treatment was well tolerated. Four patients died-two of progressive aspergillosis. Three patients are alive and well 6, 5, and 4 months after the diagnosis of aspergillosis. Voriconazole appears to be an effective salvage treatment for invasive aspergillosis in pediatric patients, with good responses in patients who recover from neutropenia or are not relapsing.

Topics: Adolescent; Amphotericin B; Anemia, Aplastic; Anemia, Refractory; Antifungal Agents; Antineoplastic Agents; Aspergillosis; Bone Marrow Transplantation; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Hematologic Neoplasms; Humans; Leukemia, Myelomonocytic, Acute; Male; Neutropenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Time Factors; Treatment Outcome; Triazoles; Voriconazole

Mucormycotic infections caused by fungi of the families Rhizopus, Mucor or Absidia are rare and usually associated with diabetes or immunosuppression. We describe a patient with invasive necrotizing cutaneous mucormycosis caused by Absidia corymbifera shortly after allogeneic BMT. The infection was successfully treated with surgical debridement and liposomal amphotericin B for 6 weeks. Recognition of these rare infections requires a high index of suspicion. These patients should be evaluated with tissue biopsy and cultures and treated without delay.

Topics: Adult; Amphotericin B; Anemia, Refractory; Antifungal Agents; Bone Marrow Transplantation; Combined Modality Therapy; Debridement; Dermatomycoses; Female; Humans; Immunocompromised Host; Mucorales; Mucormycosis