Antifungal Agents ; therapeutic use ; Child, Preschool ; Cryptococcosis ; drug therapy ; Fluconazole ; therapeutic use ; Humans ; Male

OBJECTIVEWith the widespread application of peripherally inserted central catheters (PICC) in neonatal intensive care unit (NICU), the incidence of invasive fungal infections increased significantly than ever. The present study aimed to explore the clinical significance of oral fluconazole in premature infants with gestational age ≤ 32 weeks and/or birth weight ≤ 1500 grams who had catheter insertions.

METHODThis study enrolled 118 infants admitted between January 2006 and December 2007 who did not receive fluconazole prophylaxis (control group) and 106 infants admitted between January 2008 and June 2009 who received oral fluconazole prophylaxis (prophylaxis group). Statistical analyses were performed by using SPSS 11.5 software. The clinical characteristics and the risk factors for invasive fungal infection between the two groups were compared. Liver functions (alanine transaminase, ALT and direct bilirubin) were monitored to evaluate the safety of fluconazole prophylaxis.

RESULTExcept for the proportion of infants born via vaginal delivery in the control group (56/118, 47.5%) was significantly lower than that in prophylaxis group (69/106, 65.1%, P = 0.007), there were no significant significant differences in the demographics and other baseline clinical characteristics between the two groups. There were no significant differences in the risk factors for invasive fungal infection between the two groups either. Nine infants developed invasive fungal infection in control group (7.6%), while no invasive fungal infection was found in prophylaxis group (0%, P = 0.01). Compared to infants in control group, those in prophylaxis group showed no significant changes in alanine transaminase ALT and direct bilirubin levels at 2 weeks and 4 weeks after fluconazole prophylaxis: the incidences of abnormal ALT and direct bilirubin levels were 8.5% (10/118) and 6.8% (8/118) in control group compared to 11.3% (12/106) and 8.5% (9/106) in prophylaxis group after 2 weeks (P = 0.47 and 0.63); the incidences of abnormal ALT and direct bilirubin levels were 3.4% (4/118) and 3.4% (4/118) in control group compared to 5.7% (6/106) and 8.5% (9/106) in prophylaxis group after 4 weeks (P = 0.62 and 0.15).

CONCLUSIONFor infants with PICC insertions and gestational ages at birth ≤ 32 weeks and/or low birth weight ≤ 1500 grams, oral fluconazole is effective to prevent invasive fungal infection. Oral fluconazole in premature infants neither affected the liver function, nor increased the incidence of cholestasis.

Antifungal Agents ; therapeutic use ; Catheterization ; Fluconazole ; therapeutic use ; Humans ; Infant, Newborn ; Infant, Premature ; Mycoses ; prevention & control ; Retrospective Studies

OBJECTIVE: To explore the effect of surgery added with antifungal agents in treatment of fungal rhinosinusitis. METHOD: One hundred and two consecutive patients with fungal rhinosinusitis were randomly divided into two groups: the control group (n=48) were treated with surgery alone, the treatment group (n=54) were treated with surgery plus antifungal therapy during operation and postoperation. The patients were followed up for 6 months and the relapse rates between two groups were compared. RESULT: No relapse was observed in the treatment group. The relapse rate of the control group was 20.8% (P < 0.01). CONCLUSION Surgery plus antifungal therapy can prevent the relapse of fungal rhinosinusitis significantly.
Adult ; Antifungal Agents ; therapeutic use ; Female ; Fluconazole ; therapeutic use ; Humans ; Male ; Sinusitis ; drug therapy ; microbiology ; surgery ; Treatment Outcome

Hansenula anomala (H. anomaly) is part of the normal flora in the alimentary tract and throat. It has been reported to be an organism causing opportunistic infections in immunocompromised patients. However, cases of fungal arthritis caused by H. anomala are rare. We encountered a case of H. anomala arthritis in a 70-year-old man who was treated with an empirical antibiotic treatment and surgery under the impression of septic arthritis. However, the patient did not improve after antibiotic therapy and surgery. Consequently, knee joint aspiration was performed again, which identified fungal arthritis caused by H. anomala. It was treated successfully with amphotericin B and fluconazole. When treating arthritis patients with diabetes, it is important to consider the possibility of septic arthritis by H. anomala and provide the appropriate treatment.
Aged ; Amphotericin B/therapeutic use ; Antifungal Agents/therapeutic use ; Arthritis, Infectious/*diagnosis/drug therapy/microbiology ; Fluconazole/therapeutic use ; Humans ; *Knee Joint ; Male ; Mycoses/*diagnosis/drug therapy ; *Pichia

BACKGROUNDLiver transplantation is the most effective treatment for end-stage liver diseases; however, infections after transplantation can seriously affect the patient's health. The aim of this research was to investigate the diagnosis and treatment of fungal infection following liver transplantation.

METHODSClinical data for 232 liver transplant patients at risk of fungal infection were examined for the presence of fungus in the blood, fluid, sputum, urine and stools of patients and by chest or abdominal CT scans. Patients diagnosed with a fungal infection were treated with Fluconazole or, if this was not effective, Voriconazole or Amphotericin B. Immunosuppressive therapy was also reviewed.

RESULTSThirty-seven of 232 (15.9%) patients were diagnosed with a fungal infection, which occurred 4 to 34 days post-transplantation. Candida infections were diagnosed in 23 cases (62.2%) and Aspergillus infections in 12 cases (32.4%). Twenty-one cases were effectively treated with Fluconazole, 11 cases with Voriconazole, and two cases with Amphotericin B; however, three cases were not effectively treated with any of the antifungal agents. Overall, treatment was effective in 91.9% of patients.

CONCLUSIONSFungal infection has a significant influence on survival rate after liver transplantation. Imaging studies, and pathogenic and biopsy examinations can diagnose fungal infections, which can be effectively treated with antifungal agents such as Fluconazole, Voriconazole or Amphotericin B.

Adult ; Amphotericin B ; therapeutic use ; Antifungal Agents ; therapeutic use ; Female ; Fluconazole ; therapeutic use ; Humans ; Liver Transplantation ; adverse effects ; Male ; Mycoses ; diagnosis ; drug therapy ; etiology ; Pyrimidines ; therapeutic use ; Triazoles ; therapeutic use ; Voriconazole

OBJECTIVETo evaluate the effect of fluconazole in prophylaxis of fungal infection in very low birth weight infants.

METHODSPubMed, EMBASE, Ovid, China National Knowledge Infrastructure, Vip Chinese Periodical Database, Wanfang Chinese Periodical Database and Chinese Bio-medicine Database were searched for the case-control study on the effect of fluconazole in prophylaxis of fungal infection in very low birth weight infants from Jan. 1994 to Jan. 2009. Articles were evaluated according to inclusion criteria. Poor-quality studies were excluded, and RevMan 4.22 software was applied for investigating the heterogeneity among individual studies and calculating the pooled risk ratio (RR) and 95% confidence interval (CI).

RESULTSFive eligible randomized clinical trials were included. Four studies were graded as "A" and one study was graded "B". Meta-analysis based on the included studies showed that the prophylactic fluconazole could significantly reduce the fungal colonization (RR: 0.32 and 95% CI: 0.23 to 0.44, P < 0.00001); and infections (RR: 0.44 and 95% CI: 0.29 to 0.65, P < 0.0001) in very low birth weight neonates. However, there was no statistically significant difference between the infants treated and not treated with prophylactic fluconazole in the neonatal mortality (RR: 0.68 and 95% CI: 0.43 to 1.07, P = 0.09) and the prophylactic use of fluconazole did not show any side-effects on the liver and bilirubin. None of the studies found any significant changes in the minimal inhibitory concentration of fluconazole in fungal isolates during the study period. There were different results about the emergence of resistance to fluconazole.

CONCLUSIONSMeta-analysis of five randomized controlled trials suggest that prophylactic fluconazole reduces the incidence of fungal colonization and invasive fungal infection in very low birth weight infants. Further trials are needed to provide more precise evaluation on efficacy, and to assess the effect on mortality, neurodevelopment and the emergence of resistance to antifungal agents. Different NICU should have different policy on prophylactic fluconazole and also adjust the policy at different time according to the incidence of fungal infection and antifungal drug resistance.

Antifungal Agents ; adverse effects ; therapeutic use ; Fluconazole ; adverse effects ; therapeutic use ; Humans ; Infant, Newborn ; Infant, Very Low Birth Weight ; Mycoses ; prevention & control ; Randomized Controlled Trials as Topic ; Safety

Candida haemulonii, one of the non-albicans Candida species, is an emerging yeast pathogen that is known to be resistant to amphotericin B and other antifungal agents such as azoles. These anti-fungal agents have often been associated with clinical treatment failure, so no treatment regimen has been clearly established for invasive C. haemulonii infections. We investigated a catheter-related infection of C. haemulonii candidemia in an adult patient in long-term hospital care. In the early stages, the candidemia remained persistent despite treatment with fluconazole. However, after changing the antifungal agent to caspofungin, the candidemia was resolved. Fluconazole and amphotericin B are not reliable empirical antifungal agents for invasive C. haemulonii infections, as shown in previous case reports. An echinocandin such as caspofungin may be an appropriate empirical choice of antifungal agent for an invasive C. haemulonii infection.
Aged ; Amphotericin B/therapeutic use ; Antifungal Agents/therapeutic use ; Candida/classification/isolation & purification/*pathogenicity ; Candidiasis/drug therapy/*microbiology ; Catheter-Related Infections/drug therapy/*microbiology ; Echinocandins/therapeutic use ; Fluconazole/therapeutic use ; *Hospitals ; Humans ; *Long-Term Care ; Male ; Phylogeny

BACKGROUNDIn recent years, superficial and deep mycoses caused by trichosporon were occasionally reported. In 2001, we reported the first case of disseminated trichosporonosis caused by Trichosporon asahii (T. asahii) in China. In this study, the pathogenicity of T. asahii was investigated in a murine model of disseminated trichosporonosis.

METHODSSeventy-five mice were randomly divided into 7 groups. Each group was inoculated with T. asahii, through intradermal, gastrointestinal tract or intravenous injection. The mice in the experimental groups were given an intraperitoneal injection of cyclophosphamide (CY) to induce granulocytopenia. Mice in the therapeutic group were given both liposomal amphotericin B and fluconazole. The main viscera of the mice were examined by means of tissue culture and pathologic sections.

RESULTSIn the two intravenous inoculation groups, T. asahii was isolated from at least one organ in 10 of the 12 granulocytopenic mice and 2 of the 14 immunocompetent mice. Two of the 7 mice in the granulocytopenia group presented with lesions in the inoculation position, but none of the 30 mice in the granulocytopenia and the control group which were inoculated intradermally or through the gastrointestinal tract had viscera infection. In the therapeutic group, the ratio of consequently dead mice, the number of involved viscera, and the incidence of systemic infection were significantly less than the untreated group. Acute purulent inflammation and granulomatous inflammation were the main pathological changes in the course of the infection. Arthrospores and filaments were found in the focus.

CONCLUSIONST. asahii is an opportunistic pathogen that causes cutaneous and visceral infections in immunologically impaired hosts. An immunocompetent host was to be infected by the invading T. asahii. Several organs, namely the liver, lungs, kidneys, spleen and heart, were predisposed. The therapy of combining liposomal amphotericin B with fluconazole can prevent the host from an infection and inhibit the diffusion of the infection.

Amphotericin B ; therapeutic use ; Animals ; Antifungal Agents ; therapeutic use ; Cyclophosphamide ; therapeutic use ; Disease Models, Animal ; Fluconazole ; therapeutic use ; Male ; Mice ; Mycoses ; drug therapy ; microbiology ; Random Allocation ; Trichosporon ; isolation & purification ; pathogenicity

OBJECTIVE: To summarize the clinical datas of thepatients with invasive laryngeal fungal infections in, discuss pathogenesis and treatment methods. METHOD: Eleven cases of invasive laryngeal fmycosis who were collected from September 2006 to February 2010 with electronic laryngoscopy, aspirate smear and culture and tissue biopsy for pathological diagnosis, were restrospectively analyzed. Those patients were received iv fluconazole, treatment of Oxygen Atomization of amphotericin B solution and taking itraconazole orally. The hepatic and renal functions of the patients were monitored in the course of treatment. RESULT: All the cases were diagnosed of invasive laryngeal mycosis. 1 patient showed liver dysfunction in the second week during treatment. And continuing the treatment after using liver protection drugs. All symptoms of the patients were improved and no recurrence happened during the 1-6 years of follow-up. CONCLUSION Invasive laryngeal fmycosis was correlated with occupation exposure, abusing of antibiotics and low immunity. Laryngeal mycosis was Diagnosised mainly depended on the pathological examination. The positive rates of the secretion smear was low. The effects of iv fluconazole, Oxygen Atomization of amphotericin B 2-4 weeks, and 4 weeks of taking itraconazole orally were safety and reliable.
Administration, Oral ; Amphotericin B ; therapeutic use ; Antifungal Agents ; therapeutic use ; Chemical and Drug Induced Liver Injury ; prevention & control ; Fluconazole ; therapeutic use ; Humans ; Itraconazole ; therapeutic use ; Laryngeal Diseases ; drug therapy ; etiology ; pathology ; Mycoses ; drug therapy ; etiology ; pathology

We experienced a rare case of colonic cryptococcosis in an apparently immunocompetent individual. A 27-year- old woman admitted our hospital for intermittent melena. Initial abdominal CT scan revealed a mass lesion obstructing most of the lumen in ascending colon. Colonoscopy showed huge ulcerofungating mass in proximal ascending colon. Colonoscopic biopsy was performed and pathologic diagnosis was made as colonic cryptococcosis with positive PAS stain. Laboratory test evaluating immune status and bone marrow examination was normal. The patient was treated with intravenous amphotericin B for four weeks and six months of oral fluconazole afterwards. Follow-up abdominal CT scan and colonoscopy were taken at four weeks and seven months after the beginning of treatment. On completion of intravenous amphotericin B treatment, the mass lesion was decreased in abdominal CT and colonoscopy. After seven months, abdominal CT and colonoscopy showed near-complete resolution of the colonic lesion so the treatment ended. Cryptococcosis in a healthy individual is a rare disease and there have been only several sporadic case reports on pulmonary or central nervous system involvement. Hence, we report a case of colonic cryptococcosis in an apparently immunocompetent individual.
Adult ; Amphotericin B/therapeutic use ; Antifungal Agents/therapeutic use ; Colonic Diseases/*diagnosis/drug therapy/pathology ; Colonoscopy ; Cryptococcosis/*diagnosis/drug therapy ; *Cryptococcus neoformans ; Female ; Fluconazole/therapeutic use ; Humans ; Injections, Intravenous ; Tomography, X-Ray Computed