We report a case of Majocchi's granuloma in a 71-year-old immunocompetent male patient, who presented with a 6-month history of mass with multiple erythematous nodules and indurated plaques with scale on the left cheek. Even though the lesion strongly suggested cutaneous tumor, the histopathologic findings were consistent with the Majocchi's granuloma, showing numerous hyphae, perifolliculitis and granulomatous inflammation with central abscess formation in the dermis. Trichophyton rubrum was isolated from the biopsy specimen fungus culture. The cutaneous lesion was treated with oral administration of itraconazole (200 mg/day) and topical lanoconazole cream for 4 weeks, and successfully treated.
Abscess ; Administration, Oral ; Aged ; Biopsy ; Cheek ; Dermis ; Fungi ; Granuloma* ; Humans ; Hyphae ; Inflammation ; Itraconazole ; Male ; Trichophyton

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

This study was purposed to investigate the efficacy and safety of intravenous injecting itraconazole (ITCZ) as empirical antifungal therapy in the patients with hematological malignancies. According to recommendation in IDSA guidebook, the patients suffered from fever during neutropenia and inefficacy of treatment using broad-spectrum antibiotics for 4 days should receive intravenous injection of ITCZ as empirical antifungal therapy. The results showed that the overall clinical response rate to ITCZ injection was 62.9% (22/35), and the success rate of achieving composite endpoints was 54.3% (19/35). Mild adverse reactions were observed in 6 patients (17.1%). The injection of ITCZ was stopped in 2 patents (5.7%) due to adverse reaction. Further analysis revealed that the response rate was higher in patients with fever prior to the start of ITCZ within five days than beyond five days (P = 0.031). The response rate was higher in patients with possible invasive fungus infection (IFI) than that in patients with probable and confirmed IFI (P = 0.002). The prophylactic antifungal treatment during neutropenia displayed no significant influence on efficacy of empirical antifungal therapy with itraconazole (P = 0.054). It is concluded that the good efficacy and safety of empirical ITCZ injection for hematological malignancies patients is efficient and safe.
Adolescent ; Adult ; Aged ; Antifungal Agents ; administration & dosage ; therapeutic use ; Female ; Hematologic Neoplasms ; drug therapy ; Humans ; Injections, Intravenous ; Itraconazole ; administration & dosage ; therapeutic use ; Male ; Middle Aged ; Treatment Outcome ; Young Adult

Human ; Male ; Adolescent ; Antifungal Agents ; Double-blind Method ; Drug Administration Schedule ; Itraconazole ; Tinea Versicolor

BACKGROUNDInvasive pulmonary mycosis is the most common type of invasive fungal infection. It is often severe and difficult to treat, and is accompanied by high mortality. In this study, we aimed to evaluate the efficacy and safety of intravenous itraconazole followed by oral itraconazole solution in the treatment of invasive pulmonary mycosis and to determine the distribution of different fungi species.

METHODSThis was a multi-center, open-label study which enrolled 71 patients who were diagnosed as invasive pulmonary mycosis between July 2007 and January 2009. All patients received intravenous itraconazole therapy followed by oral itraconazole solution with a total treatment duration of 6 weeks. Intravenous itraconazole was given at a dose of 200 mg bid (intravenous infusion every 12 hours) for the first two days, 200 mg qd for the subsequent 12 days. Sequential oral itraconazole solution was given at a dose of 100 mg bid for 4 weeks. Efficacy and safety were assessed according to clinical as well as microbiological criteria.

RESULTSSeventy one patients participated in this study. Of the 60 patients in the full analysis dataset, the clinical response rate was 61.7% and the mycological eradication rate was 66.7%. The overall response rate was 66.7%. Drug-related adverse events occurred in 18.0% of patients: hypokalemia, liver function impairment and mild gastrointestinal side effects were the most common. One patient suffered from severe adverse event, with limb and facial swelling.

CONCLUSIONThis study showed that in patients with invasive pulmonary mycosis, intravenous itraconazole followed by oral itraconazole solution therapy was safe and effective.

Administration, Oral ; Adult ; Aged ; Antifungal Agents ; administration & dosage ; therapeutic use ; Female ; Humans ; Itraconazole ; administration & dosage ; therapeutic use ; Lung Diseases, Fungal ; diagnosis ; drug therapy ; Male ; Middle Aged ; Mycoses ; diagnosis ; drug therapy

Candidaemia associated with intravascular catheter-associated infections is of great concern due to the resulting high morbidity and mortality. The antibiotic lock technique (ALT) was previously introduced to treat catheter-associated bacterial infections without removal of catheter. So far, the efficacy of ALT against Candida infections has not been rigorously evaluated. We investigated in vitro activity of ALT against Candida biofilms formed by C. albicans, C. glabrata, and C. tropicalis using five antifungal agents (caspofungin, amphotericin B, itraconazole, fluconazole, and voriconazole). The effectiveness of antifungal treatment was assayed by monitoring viable cell counts after exposure to 1 mg/mL solutions of each antibiotic. Fluconazole, itraconazole, and voriconazole eliminated detectable viability in the biofilms of all Candida species within 7, 10, and 14 days, respectively, while caspofungin and amphotericin B did not completely kill fungi in C. albicans and C. glabrata biofilms within 14 days. For C. tropicalis biofilm, caspofungin lock achieved eradication more rapidly than amphotericin B and three azoles. Our study suggests that azoles may be useful ALT agents in the treatment of catheter-related candidemia.
Amphotericin B/administration & dosage/pharmacology ; Antifungal Agents/*administration & dosage/pharmacology/therapeutic use ; Biofilms/*drug effects ; Candida albicans/*drug effects/physiology ; Candida glabrata/*drug effects/physiology ; Candida tropicalis/*drug effects/physiology ; Candidiasis/drug therapy ; Catheter-Related Infections/drug therapy ; Catheterization, Central Venous ; Drug Administration Routes ; Echinocandins/administration & dosage/pharmacology ; Fluconazole/administration & dosage/pharmacology ; Humans ; Itraconazole/administration & dosage/pharmacology ; Microbial Sensitivity Tests ; Pyrimidines/administration & dosage/pharmacology ; Triazoles/administration & dosage/pharmacology

Systemic infection with Aspergillus is an opportunistic disease that affects mainly immunocompromised hosts, and is associated with a high mortality rate. It typically occurs in patients with several predisposing factors, but Aspergillus endocarditis of native valves is rare and experience in diagnosis and treatment is limited. We report a case of native valve endocarditis caused by Aspergillus. A 35-yr-old male patient who underwent pericardiocentesis four months previously for pericardial effusion of unknown etiology presented with right leg pain and absence of the right femoral artery pulse. Cardiac echocardiography revealed severe mitral insufficiency with large mobile vegetations, and computed tomographic angiography showed embolic occlusion of both common iliac arteries. We performed mitral valve replacement and thromoembolectomy, and Aspergillus was identified as the vegetation. We started intravenous amphotericin B and oral itraconazole, but systemic complications developed including superior mesenteric artery aneurysm and gastrointestinal bleeding. After aggressive management, the patient was discharged 78 days post surgery on oral itraconazole. He was well at 12 months post discharge but died in a traffic accident 13 months after discharge.
Administration, Oral ; Adult ; Amphotericin B/administration & dosage ; Antifungal Agents/administration & dosage ; Aspergillosis/complications/*diagnosis/drug therapy ; Aspergillus/isolation & purification ; Endocarditis/*diagnosis/surgery/ultrasonography ; Heart Valve Diseases/*diagnosis/microbiology/surgery ; Humans ; Itraconazole/administration & dosage ; Male ; Postoperative Complications/microbiology ; Tomography, X-Ray Computed

PURPOSE: To investigate the clinical efficacy of intracameral amphotericin injection and to evaluate risk factors affecting primary treatment success in fungal infection invading the anterior segment of the eye. METHODS: Twenty-six eyes of 26 patients diagnosed with fungal infection in the anterior segment were studied. The initial treatment regimen was a topical 0.15% amphotericin application and itraconazole oral administration after culture. Amphotericin (5 ug/0.1 ml, 0.1 cc) was repeatedly injected intracamerally when the infection intensified. Penetrating keratoplasty was conducted for eyes unresponsive to intracameral amphotericin injection. The relative risk ratios of ulcer size, infiltration depth, culture positivity, and hypopyon were compared in each treatment group to evaluate the treatment response. RESULTS: Of patients with fungal infection, 30.7% were cured with intracameral amphotericin injection, while 30.7% needed penetrating keratoplasty. Intracameral amphotericin injection was needed in the presence of large corneal ulcers (>14 mm2), hypopyon, positive fungal culture, use of steroid eye drops, and deep infiltration at initial examination. Large ulcer size (>14 mm2) was the main risk factor for needing penetrating keratoplasty. Of the eyes Candida infection, 66.5% needed evisceration. CONCLUSIONS: Large ulcer size and the isolation of Candida were poor prognostic factors related to the efficacy of intracameral amphotericin injection.
Administration, Oral ; Amphotericin B* ; Candida ; Humans ; Itraconazole ; Keratoplasty, Penetrating ; Odds Ratio ; Ophthalmic Solutions ; Risk Factors* ; Ulcer

Sporotrichosis is a chronic infectious disease caused by Sporothrix(S.) schenckii. Regional lymphatic sporotrichosis is common type, accounting for 75% of the cases. But fixed cutaneous sporotrichosis is seen in 20% of cases. We report two cases of fixed cutaneous sporotrichosis in a 48-year-old man and 8-year-old boy. The lesions were manifested by erythematous plaques on right arm and left cheek, respectively. The fungal culture from biopsy specimen on Sabouraud's dextrose agar showed dark brown to black, moist and wrinkled colonies of S. schenckii. Histopathologically, pseudoepitheliomatous hyperplasia and chronic granulomatous inflammation were observed on H & E stain. The patients were treated with surgical excision of lesion & oral administration of 30 drops of saturated solution of potassium iodide three times a day and 100 mg of itraconazole daily for 3 months, respectively. Skin lesions were completely cured and recurrence is not observed to date.
Administration, Oral ; Agar ; Arm ; Biopsy ; Cheek ; Child ; Communicable Diseases ; Glucose ; Humans ; Hyperplasia ; Inflammation ; Itraconazole ; Male ; Middle Aged ; Potassium Iodide ; Recurrence ; Skin ; Sporotrichosis*

This study was aimed to investigate the clinical features and therapy of Ph(+) acute lymphoblastic leukemia (Ph(+)ALL) combined with invasive aspergillosis. A series of examination, including routine blood and bone marrow picture analysis, chest roentgenography, cranial computerized tomography and detection of cell genetics etc were carried out for a Ph(+)ALL patient combined with invasive aspergillosis. This patient received chemotherapy with DVCP, idarubicin and imatinib mesylate and was treated with sporanox and amphotericin B (Amb; including Amb-L) and cerebrotomy for drainage because the invasive aspergillosis occurred during myelosuppression. The results showed that patient gained complete remission and the invasive aspergillosis was controlled successfully. It is concluded that patient with Ph(+)ALL has poor prognosis despite intensive conventional chemotherapy, imatinib mesylate may prove to be an effective treatment for Ph(+)ALL. Because detection rate of the fungus is very low, itraconazole in combination with surgical excision of focus is the best treatment of lung and brain invasive aspergillosis.
Antifungal Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Aspergillosis ; diagnosis ; drug therapy ; Benzamides ; Brain Diseases ; complications ; microbiology ; Humans ; Imatinib Mesylate ; Itraconazole ; therapeutic use ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; complications ; Lung Diseases, Fungal ; drug therapy ; etiology ; Piperazines ; administration & dosage ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; genetics ; microbiology ; Pyrimidines ; administration & dosage