Utility of Miconazole Therapy for <i>Trichosporon</i> Fungemia in Patients with Acute Leukemia
- 1 Cancer Center, Mie University Hospital, Tsu, Japan;Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
- 2 Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
- 3 Fourth Department of Internal Medicine, Hiroshima Red Cross and Atomic-Bomb Survivors Hospital, Hiroshima, Japan
- 4 Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
- 5 Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
- 6 Department of Hematology and Oncology, Mie University Graduate School of Medicine, Tsu, Japan
Abstract
Invasive trichosporonosis is an extremely rare mycosis, but Trichosporon fungemia (TF) in patients with hematologic malignancies has been increasingly recognized to be a fulminant and highly lethal infection. Although the utility of azole therapy has been demonstrated in several observations, little is known about the efficacy of one of azoles, miconazole (MCZ). To assess its therapeutic role, we retrospectively investigated 6 cases of TF in patients with acute leukemia receiving MCZ containing regimens. Successful outcome was obtained in 4 patients [MCZ + amphotericin B (AmB) in 2, MCZ only and MCZ + fluconazole (FLCZ) + AmB in one each], but not in 2 (MCZ + FLCZ + AmB and MCZ + FLCZ in one each). Although MCZ and AmB exhibited good in vitro activities against isolates from all patients, FLCZ had such finding from only one patient. Considering the reportedly limited utility of AmB, MCZ seemed to play a critical role even in the combination therapies for TF. Despite the release of newer azoles and other classes of antifungals, the use of MCZ remains a potential therapeutic approach for TF in patients with acute leukemia.
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