Efficacy and Safety Assessment of Antifungal Sequential Therapy from Micafungin to Liposomal Amphotericin B for Antibiotics-Refractory Febrile Neutropenia in Patients with Hematologic Malignancies

Invasive fungal infections are a major challenging problem in the management of febrile neutropenia (FN) in patients with hematologic malignancies. Liposomal amphotericin B (L-AmB) or micafungin (MCFG) has been widely used as a first-line empirical antifungal therapy for suspected fungal infection in such patients. However, there are several issues in patients receiving these agents: drug related toxicities for L-AmB and breakthrough fungal infections for MCFG. In order to make the best use of these 2 agents, we conducted a prospective study of sequential therapy from MCFG to L-AmB, and evaluated the efficacy and safety of this strategy in FN patients with hematologic malignancies. A total of 18 patients were enrolled, and 11 patients who fulfilled the protocol defined criteria were evaluated. Underlying diseases consisted of acute leukemia (n = 9), non-Hodgkin lymphoma (n = 1), and myelodysplastic syndrome (n = 1). Treatment success was achieved in 8 patients (72.7%). Drug-related adverse events occurred in 8 patients (72.7%). All of those adverse events except one case were below grade 2. Three patients required discontinuation of L-AmB. Although our empirical antifungal sequential therapy seems to be encouraging for antibiotics-refractory FN in patients with hematologic malignancies, further investigation in large-scale studies is warranted.

The first report of treatment of liver abscess due to Candida albicans with intra-abscess and intravenous administration of liposomal amphotericin B (Amphotec)

Increasing reports on application and safety of liposomal amphotericin B (Amphotec) in the treatment of deep fungal infections have been described recently. This is the first report that a case of liver abscess due to Candida albicans was completely cured with intra-abscess and intravenous administration of liposomal amphotericin B without recurrence in three-year follow-up period.

Disseminated Fusarium bloodstream infection in a child with acute myeloid leukemia:A case report

BACKGROUND Disseminated Fusarium is rare in healthy children.Children with hematological tumors may have secondary fungal infections,including Fusarium infections,which are due to tumor bone marrow infiltration or prolonged bone marrow suppression after chemotherapy.Because of the lack of typical clinical manifestations and effective antifungal drugs,early diagnosis and treatment of the disease are difficult,and the prognosis is poor.CASE SUMMARY The patient in this case was a 13-year-old female child with rash and fever as the first symptoms.She had the characteristics of the four stages of skin that are typical of Fusarium infection.She was diagnosed with disseminated Fusarium infection through skin biopsy and blood culture and diagnosed with Fusarium solani infection based on the morphological characteristics of the blood culture.After treatment with liposome amphotericin B combined with voriconazole,the child recovered.CONCLUSION This case highlights that for children with secondary agranulocytosis after receiving chemotherapy for hematological malignancies,once typical abnormal skin damage is found,the possibility of Fusarium infection should be considered,and voriconazole alone or in combination with polyenes may be the most effective anti-Fusarium drugs.Amphotericin B,the traditional drug of disseminated Fusarium disease,has a high mortality rate,and it is not recommended to use it alone.Adequate neutrophil counts are essential for the treatment of disseminated Fusarium bloodstream infection.

Use of bronchoscopy-guided treatment and oral posaconazole to treat pulmonary mucormycosis:a case report and literature review

Background:Pulmonary mucormycosis(PM)is rare condition,which is difficult to diagnose and has a high mortality rate.Currently,there is a lack of effective drugs,with few side effects,to treat PM.There have been a few reports on the use of bronchoscopy and posaconazole for the treatment of adult PM.Methods:A man with diabetes mellitus developed diabetic ketoacidosis and subsequently developed repeated cough,hemoptysis,and fever.He was diagnosed with pneumonia and was treated with antibiotics in a local hospital.However,his condition worsened.After admission to our hospital,chest computed tomography(CT)showed bilateral pneumonia and cavities in the left upper lobe that were significantly worse than those seen previously.Bronchoscopy revealed swelling of the left bronchial mucosa and yellow necrosis adhering to the wall.Histology of transbronchial lung biopsy specimens revealed PM pneumonia,characterized by numerous mucormycelia,spores,and neutrophils between necrotic debris.Results:Following diagnosis,liposomal amphotericin B was administered intravenously,and although the symptoms improved significantly,side effects caused the patient to discontinue taking the drug.An alternative regimen,including oral posaconazole and local injection of amphotericin B was administered via bronchoscopy.Finally,the patient did not experience any discomfort and chest CT showed complete resolution of the consolidation and the lung cavity.Conclusion:Bronchoscopy can play an important role in the diagnosis and treatment of PM.The combination of oral posaconazole and bronchoscopy-guided anti-infective therapy is a novel and effective way to treat PM for patient cannot tolerate liposomal amphotericin B.

Caspofungin versus liposomal amphotericin B for treatment of invasive fungal infections or febrile neutropenia

Background Nowadays,there are published trials in regards to the comparison of caspofungin with liposomal amphotericin B （L-AmB）.However,these studies have a modest sample size and convey inconclusive results.The aim of this study was to review the efficacy and safety of caspofungin for the treatment of invasive fungal infections （IFIs）,compared with L-AmB.Methods Electronic databases （up to July 31,2013） PubMed and Embase databases,the Cochrane Library,and Google Scholar were searched to identify relevant trials of caspofungin and L-AmB.Analyses of efficacy and adverse outcomes were performed by relative risks （RRs） and 95% confidence intervals （C/s）.Heterogeneity was assessed by x2-test and the/2-statistic.Results Three trials were included in this meta-analysis with 1249 modified intention-to-treat （MITT） patients.The results showed that caspofungin produced equal efficacy in favorable overall response （RR=1.02,95% Cl 0.88-1.18; P=0.81） and mortality rate （RR=1.53,95% Cl 0.38-6.27,P=0.55）,safer in clinical adverse events （RR=0.20,95% Cl 0.08-0.54; P=0.001）,laboratory adverse events （RR=0.69,95% Cl 0.57-0.84; P=0.0002）,and discontinuation rate （RR=0.26,95% Cl 0.08-0.83,P=0.02）,compared with L-AmB in the treatment of patients with IFls.Conclusion Based on the results of this meta-analysis,it would appear that caspofungin was measured to have equal efficacy in clinical outcomes and safer in terms of adverse events.