amphotericin-b and Myeloproliferative-Disorders

Invasive fungal rhinosinusitis (IFR) is a life-threatening infection. Its onset is subtle and a late diagnosis leads to severe complications. Death may occur within a few weeks notwithstanding treatment. We describe a comprehensive pre- and post-operative approach to care for haematological patients with IFR. Five haematological patients with IFR were treated with systemic antifungal therapy and endoscopic surgical debridement of infected tissues, followed by amphotericin-B directly instilled in the sinuses by a new type of ethmoidal drainage. The IFR remitted in all cases; after 32 months of follow-up, three patients are still alive, and two have died of other causes. Two of the patients who experienced IFR progression to the brain at the IFR onset are still alive. The pharmacological and surgical approach with the post-operative local therapy by a new ethmoidal drainage system could support radical antifungal sinus treatment, thus improving the overall survival.

Topics: Acute Disease; Adult; Aged; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Chronic Disease; Female; Humans; Immunocompromised Host; Leukemia, Myeloid; Male; Middle Aged; Myeloproliferative Disorders; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sinusitis; Stem Cell Transplantation

Topics: Amphotericin B; Child; Drug Combinations; Humans; Immunosuppression Therapy; Leukemia; Mycoses; Myeloproliferative Disorders; Phosphatidylcholines; Phosphatidylglycerols

Between July 1973 and June 1981 systemic fungal infections were found in 27 of 270 autopsies of patients with hematologic malignancies: in 16 aspergillosis, in 6 candidiasis, in one aspergillosis and candidiasis, and in 4 mucormycosis. The frequency increased from 6% during the first 6 years to 25% during the last 2 years (p = 0.025). Fever despite antibiotics and new pulmonary infiltrates were the major symptoms. In only 6 of 16 patients did microbiological findings support the clinically suspected diagnosis. Systemic fungal infections were the principal cause of death in 12 patients. Because of the difficulty of establishing the diagnosis, empiric antimycotic therapy should be started promptly on clinical suspicion in patients with neutropenia and fever despite antibiotics.

Topics: Amphotericin B; Aspergillosis; Candidiasis; Humans; Leukemia; Lymphoma; Mucormycosis; Mycoses; Myeloproliferative Disorders; Retrospective Studies