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陕西医学杂志 2006年第11期35卷 1450-1453页

作者：黄一虹何徐彭李德鹏潘秀英陈令松徐州医学院附属医院血液科徐州221002 徐州医学院第二附属医院

目的：观察静脉用二性霉素B（AmB）及其脂质体（L-AmB）对侵袭性真菌感染（IFI）的临床疗效及安全性。方法：46例IFI的原发基础病包括血液病32例及非血液系统疾病14例。普通AmB用量为0．5～1．0mg／（kg·d），L-AmB用量为0．5～2．... 详细信息

目的：观察静脉用二性霉素B（AmB）及其脂质体（L-AmB）对侵袭性真菌感染（IFI）的临床疗效及安全性。方法：46例IFI的原发基础病包括血液病32例及非血液系统疾病14例。普通AmB用量为0．5～1．0mg／（kg·d），L-AmB用量为0．5～2．0mg／（kg·d），总剂量为215～2950mg，中位数455mg，疗程10～119d，中位数17d。并对进口AmB、L-AmB及国产AmB的抗真菌疗效和副作用进行了比较分析。结果：二性霉素B临床总有效率为73．9％，真菌清除率为71．0％。进口AmB、L-AmB及国产AmB的治疗有效率分别为76．5％、71．5％及73．3％。不良反应发生率中寒颤、发热19．6‰，低血钾21．7％，肝、肾功能损害各为10．9％和15．2％。结论：早期诊断、早期治疗及经验性治疗是提高IFI患者生存率、降低死亡风险的关键。只要预防得当，合理用药，定期监测肝肾功能，二性霉素B仍是一相对较为安全有效的药物。

关键词：真菌病/药物疗法二性霉素B 脂质体/治疗应用

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Curvularia lunata endophthalmitis with secondary keratitis

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AMERICAN JOURNAL OF OPHTHALMOLOGY 2001年第1期131卷 140-142页

作者： Kaushik, S Ram, J Chakrabarty, A Dogra, MR Brar, GS Gupta, A Postgrad Inst Med Educ & Res Dept Ophthalmol & Microbiol Chandigarh 160012 India

PURPOSE: To report a case of pseudophakic endophthalmitis with secondary keratitis caused by Curvularia lunata. METHODS: A 40 year-old man presented with a fluffy mass in the anterior chamber with low-grade delayed postoperative inflammation in the right eye. RESULTS: The anterior chamber and vitreous aspirate demonstrated C. lunata. A large corneal infiltrate developed after aspiration of the mass. Treatment with systemic, topical, and intraocular antifungal agents cleared the vitreous, but the cornea perforated. CONCLUSION: Delayed low-grade infection with a fluffy mass in the anterior chamber after cataract surgery can rarely be a clinical presentation of dematiaceous fungal infection. Secondary keratitis may result after a diagnostic aspiration. (Am J Ophthalmol 2001;131:140-142. (C) 2001 by Elsevier Science Inc. All rights reserved.).

关键词：抗真菌药/治疗应用眼房水/微生物学白内障摘除术眼内炎/药物疗法眼内炎/微生物学眼感染真菌性/药物疗法眼感染真菌性/微生物学角膜炎/药物疗法角膜炎/微生物学晶体植入眼内有丝分裂孢子真菌/分离和提纯真菌病/药物疗法真菌病/微生物学玻璃体/微生物学成年人人类男(雄)性

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Fungal infections of the urinary tract

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WORLD JOURNAL OF UROLOGY 1999年第6期17卷 410-414页

作者： Sobel, JD Vazquez, JA Harper Grace Hosp Detroit MI 48201 USA Wayne State Univ Sch Med Dept Med Div Infect Dis Detroit MI USA

Funguria, fungal urinary tract infections, are most commonly caused by Candida species but may also be caused by Cryptococcus neoformans, Aspergillus species, and the endemic mycoses. Candiduria presents as an increasingly common nosocomial infection, which may involve all anatomic levels of the urinary tract, resulting in a spectrum of disease varying from asymptomatic candiduria to clinical sepsis. Although several successful systemic or local therapeutic options exist for the eradication of candiduria, knowledge of the pathogenesis and natural history of candiduria has lagged. This has resulted in confusion among practitioners as to when antifungal therapy is indicated. Treatment guidelines have recently been formulated and are described herein.

关键词：抗真菌药/治疗应用真菌/分离和提纯真菌/致病力真菌病/药物疗法真菌病/微生物学治疗结果泌尿道/微生物学泌尿道感染/药物疗法泌尿道感染/微生物学人类

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In-vivo therapeutic efficacy in experimental murine mycoses of a new formulation of deoxycholate-amphotericin B obtained by mild heating

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JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY 1998年第6期42卷 779-785页

作者： Petit, C Chéron, M Joly, V Rodrigues, JM Bolard, J Gaboriau, F Univ Paris 06 Lab Physicochim Biomol & Cellulaire CNRS UA 2056 F-75252 Paris 05 France Hop Bichat Claude Bernard INSERM U13 F-75018 Paris France Univ Paris Sud Ctr Etud Pharmaceut CNRS URA 1218 F-92296 Chatenay Malabry France

Heat-induced 'superaggregation' of deoxycholate-amphotericin B (AmB-DOC, Fungizone) was shown previously to reduce the in-vitro toxicity of this antifungal agent. We compared AmB-DOC with the formulation obtained by heating the commercial form (Fungizone, Bristol Myers Squibb, Paris, France) for 20 min at 70 degrees C, in the treatment of murine infections. An improvement of antifungal activity was obtained with heated AmB-DOC formulations due to a lower toxicity which allowed the administration of higher drug doses than those achievable with the commercial preparation. Single Intravenous injections of heated AmB-DOC solutions were demonstrated to be two-fold less toxic than unheated ones to healthy mice. For mice infected with Candida albicans, the maximum tolerated dose was higher with heated than with unheated AmB-DOC solutions. In the model of murine candidiasis, following a single dose of heated AmB-DOC 0.5 mg/kg, 85% of mice survived for 3 weeks, whereas at this dose the immediate toxicity of the standard formulation in infected mice restricted the therapeutic efficacy to 25% survival. Both formulations were equally effective in increasing the survival time for murine cryptococcal pneumonia and meningoencephalitis. Injection of heated AmB-DOC solutions at a dose two-fold higher than the maximal tolerated dose observed with the unheated preparation (1.2 mg/kg) increased the survival time by a factor of 1.4 in cryptococcal meningoencephalitis. These results indicate that mild heat treatment of AmB-DOC solutions could provide a simple and economical method to improve the therapeutic index of this antifungal agent by reducing its toxicity on mammalian cells.

关键词：两性霉素B/治疗应用两性霉素B/毒性抗真菌药/治疗应用抗真菌药/毒性念珠菌白色/药物作用念珠菌白色/致病力念珠菌病/药物疗法化学药物隐球菌病/药物疗法隐球菌新型/药物作用隐球菌新型/致病力脱氧胆酸/治疗应用脱氧胆酸/毒性复方合剂小鼠近交BALBC 小鼠近交DBA 真菌病/药物疗法动物男(雄)性小鼠

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PRINCIPLES IN MANAGEMENT OF OCULOMYCOSIS - XXXI JACKSON,E MEMORIAL LECTURE

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AMERICAN JOURNAL OF OPHTHALMOLOGY 1975年第5期79卷 719-751页

作者： JONES, BR MOORFIELDS EYE HOSP INST OPHTHALMOLDEPT CLIN OPHTHALMOLLONDON EC1V 2PDENGLAND

Effective antifungal therapy must be long term, nondamaging, penetrating to the eye, and highly active against each patient's fungus. Results of antifungal sensitivity testing of 61 collected ocular fungal pathogens, and observations in 25 cases treated with one of the nonpolyene antifungal drugs indicated that infection was rapidly controlled and eradicated with restoration of visual acuity, determined by the degree of disorganization present at the time of commencement of rational specific antifungal therapy. Pimaricin has the widest spectrum, a medium level of activity, and rather poor penetration, but is recommended as an antifungal prophylactic and as first line therapy for ocular fungal disease while awaiting identification and sensitivity testing of the fungus. Flucytosine combined with amphotericin B, or possibly with clotrimazole or miconazole, is recommended for Candida infections. Clotrimazole is the drug of choice for Aspergillus species, although miconazole and econazole are more effective with some isolates. Miconazole and econazole are recommended for miscellaneous filamentous fungi although clotrimazole or thiabendazole are superior in some cases. Each of these drugs may be useful in patients, infected with Fusarium, who do not respond to pimaricin. In these cases, drug use should be guided by the results of antifungal sensitivity testing. In addition to medical antifungal therapy, some eyes may require excisional keratoplasty with lens removal and evacuation of the posterior chamber and anterior vitreous cavity.

关键词：肾上腺皮质激素类/治疗应用两性霉素B/治疗应用抗生素类抗真菌/治疗应用抗真菌药/治疗应用曲霉菌病/药物疗法曲霉菌属/药物作用盲/病因学念珠菌属/药物作用念珠菌病/药物疗法克霉唑/治疗应用角膜眼疾病/并发症眼疾病/药物疗法眼疾病/病因学镰刀菌属/药物作用青光眼/病因学青光眼/微生物学咪唑类/治疗应用真菌病/并发症真菌病/药物疗法纳他霉素/治疗应用聚烯类/治疗应用成年人老年人动物女(雌)性人类男(雄)性中年人

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Keratomycosis: Clinical and microbiologic experience with dematiaceous fungi

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OPHTHALMOLOGY 2000年第3期107卷 574-580页

作者： Garg, P Gopinathan, U Choudhary, K Rao, GN L V Prasad Eye Inst Sight Savers Corneal Trainig Ctr Hyderabad 500034 Andhra Pradesh India L V Prasad Eye Inst Devchand Nagardas Jhaveri Microbiol Ctr Hyderabad 500034 Andhra Pradesh India

Objective: To assess the significance of dematiaceous fungi in the causation of keratomycosis, Design: Retrospective, noncomparative case series. Participants: Eighty-eight cases of dematiaceous fungal keratitis seen at the L. V. Prasad Eye Institute, Hyderabad, India from January 1991 through December 1996. Intervention: Only culture-proven cases were analyzed. Main Outcome Measures: Predisposing factors, clinical characteristics, microbiology, treatment methods, and outcome. Results: Of 557 cases of fungal keratitis seen during the study period, dematiaceous fungi were the etiologic agents in 88 (15.7%), after Fusarium in 210 (37.6%) and Aspergillus species in 170 cases (30.4%), respectively. Trauma was the most common predisposing factor (47.7%). Fifty-three eyes (61.3%) had the classical clinical picture of yellow-white, dry raised infiltrate with feathery hyphate edges at initial examination. The characteristic macroscopic pigmentation was seen in only 24 eyes (27.27%). Septate branching fungal filaments were identified in 78 smears (88.63%) on light microscopy, of which 5 (5.7%) also showed the presence of bacteria. Curvularia species dominated the spectrum (22.7%). Treatment was started in 48 eyes with topical antifungal agents, whereas 37 received both oral and topical antifungal agents. Outcome data were available for 68 cases. Forty-nine (72%) responded to medical therapy, whereas 13 eyes required therapeutic penetrating keratoplasty and 6 eyes had to be eviscerated. Conclusions: This is the largest series of keratitis caused by dematiaceous fungi reported to date. It clearly brings out the clinical importance of this group of corneal infections. (C) 2000 by the American Academy of Ophthalmology.

关键词：抗真菌药/治疗应用角膜/微生物学角膜/病理学眼感染真菌性/诊断眼感染真菌性/药物疗法眼感染真菌性/微生物学角膜炎/诊断角膜炎/药物疗法角膜炎/微生物学有丝分裂孢子真菌/分离和提纯真菌病/诊断真菌病/药物疗法真菌病/微生物学回顾性研究青少年成年人老年人儿童儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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Ophthalmic manifestations of allergic fungal sinusitis

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AMERICAN JOURNAL OF OPHTHALMOLOGY 1999年第2期127卷 189-195页

作者： Carter, KD Graham, SM Carpenter, KM Univ Iowa Coll Med Dept Ophthalmol & Visual Sci Oculoplast Orbit & Oncol Serv Iowa City IA 52242 USA Univ Iowa Coll Med Dept Otolaryngol Head & Neck Surg Div Head & Neck Surg Iowa City IA 52242 USA Univ Iowa Hosp & Clin Iowa City IA 52242 USA Duluth Clin Otolaryngol Sect Duluth MN USA

PURPOSE: To highlight allergic fungal sinusitis as a cause of ophthalmic and sinus problems by identifying the profile of the patient with allergic fungal sinusitis and presenting a successful treatment approach. METHODS: Six consecutive cases of patients with ophthalmic manifestations of allergic fungal sinusitis were reviewed. Ophthalmic findings, sinus involvement, mycology, immune response, imaging studies, and treatment were examined, The characteristics of this patient group with ophthalmic manifestations of allergic fungal sinusitis were compared with those of the general group of patients with allergic fungal sinusitis. RESULTS: All six patients had proptosis, One had symptomatic diplopia and one had visual loss. Imaging studies, fungal characterization, and immune profiles were similar to the reported allergic fungal sinusitis population, After treatment there was no recurrence of ophthalmic or sinus symptoms at a mean follow up of 34 months (range, 8 to 48 months). There were no complications of treatment. CONCLUSIONS: Initial diagnosis of allergic fungal sinusitis requires suspicion on the part of the ophthalmologist, Proptosis is the most common ophthalmic sign. Differentiation from invasive forms of fungal sinus dis ease is crucial, because systemic antifungal medication and extensive surgical tissue debridement are not required in allergic fungal sinusitis. Treatment consists of extirpation of the allergic mucin and fungus, sinus aeration, and systemic and topical corticosteroids. (Am J Ophthalmol 1999;127:189-195. (C) 1999 by Elsevier Science Inc. All rights reserved,)

关键词：抗生素类抗真菌/治疗应用药物疗法联合突眼/药物疗法突眼/微生物学突眼/放射摄影术眼感染真菌性/药物疗法眼感染真菌性/病因学眼感染真菌性/放射摄影术真菌/分离和提纯糖皮质激素类/治疗应用超敏反应速发型/诊断超敏反应速发型/药物疗法超敏反应速发型/微生物学免疫球蛋白E/分析灌洗真菌病/药物疗法真菌病/微生物学真菌病/放射摄影术鼻窦/微生物学鼻窦/放射摄影术鼻窦炎/药物疗法鼻窦炎/微生物学鼻窦炎/放射摄影术体层摄影术 X线计算机青少年成年人老年人女(雌)性人类男(雄)性

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Disseminated Saccharomyces cerevisiae infection following polymicrobial hepatobiliary sepsis

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AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 2000年第4期30卷 521-522页

作者： Heath, CH Jaksic, A McKerracher, D Clarke, GM Royal Perth Hosp Dept Microbiol & Infect Dis Perth WA 6000 Australia Royal Perth Hosp Intens Care Unit Perth WA 6000 Australia

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CLOTRIMAZOLE - REVIEW OF ITS ANTIFUNGAL ACTIVITY AND THERAPEUTIC EFFICACY

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DRUGS 1975年第6期9卷 424-447页

作者： SAWYER, PR BROGDEN, RN PINDER, RM SPEIGHT, TM AVERY, GS AUSTRALASIAN DRUG INFORMATION SERV POB 34 030AUCKLAND 10NEW ZEALAND

Clotrimazole 2, a synthetic imidazole derivative, is primarily used locally in the treatment of vaginal and skin infections due to yeasts and dermatophytes. In vitro, it is most active against Candida spp., Trichophyton spp., Microsporum spp. and Malazzesia fuffur (Pityrosporon orbiculare). In addition, it has some in vitro activity against certain Gram-positive bacteria, and at very high concentrations has activity against Trichomonas spp. In the treatment of vaginal candidiasis, clotrimazole vaginal tablets have produced cure rates comparable with those of conventional nystatin vaginal tablets. There have been no published comparisons with nystatin vaginal cream or foaming vaginal tablets - nystatin dosage forms preferred by some clinicians. Cootrimazole has also been successful in patients who had failed to respond to other antifungal agents such as nystatin and amphotericin B. Results in trichomonal vaginitis are not impressive. Skin infections caused by Candida or dermatophytes have been effectively treated with topical application of clotrimazole. In comparative trials, clotrimazole cream has been as effective as Whitfield's ointment and tolnaftate in the treatment of dermatophytoses, and as effective as nystatin in cutaneous candidiasis. Clotrimazole topical preparations are generally well tolerated, but local irritation has necessitated withdrawal of therapy in a few cases. Candidal septicemia and urinary and pulmonary candidiasis have been cured with oral clotrimazole therapy. Results in other types of serious fungal infections, including pulmonary aspergillosis, have been disappointing. A limiting factor in oral clotrimazole therapy is the high incidence of gastro-intestinal disturbances and neurological reactions.

关键词：变形虫属/药物作用念珠菌病/药物疗法克霉唑/代谢克霉唑/药理学克霉唑/治疗应用抗药性微生物真菌/药物作用咪唑类/药理学动力学半数致死量真菌病/药物疗法生殖/药物作用皮肤疾病传染性/药物疗法致畸剂/药理学毛滴虫属/药物作用阴道疾病/药物疗法动物狗女(雌)性人类小鼠妊娠兔大鼠

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A multicenter, randomized trial of fluconazole versus amphotericin B for empiric antifungal therapy of febrile neutropenic patients with cancer

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AMERICAN JOURNAL OF MEDICINE 2000年第4期108卷 282-289页

作者： Winston, DJ Hathorn, JW Schuster, MG Schiller, GJ Territo, MC Univ Calif Los Angeles Ctr Hlth Sci Dept Med Div Hematol Oncol Los Angeles CA 90024 USA Duke Univ Med Ctr Dept Med Div Hematol Oncol Durham NC 27710 USA Duke Univ Med Ctr Dept Med Div Infect Dis Durham NC 27710 USA Hosp Univ Penn Dept Med Div Infect Dis Philadelphia PA 19104 USA

PURPOSE: To compare the efficacy and safety of fluconazole and amphotericin B as empiric antifungal therapy of febrile neutropenic patients with cancer. PATIENTS AND METHODS: A total of 317 neutropenic patients (<500 cells/mm(3)) with persistent or recrudescent fever despite 4 or more days of antibacterial therapy were randomly assigned to receive either fluconazole (400 mg intravenously once daily) or amphotericin B (0.5 mg/kg once daily). Patients were evaluated for the efficacy and safety of each drug by clinical criteria, frequent cultures and radiological procedures, and laboratory values. A response was classified as satisfactory at the end of therapy if the patient was afebrile, had no clinical or microbiological evidence of fungal infection, and did not require study termination due to lack of efficacy, drug toxicity, or death. RESULTS: A satisfactory response occurred in 68% of the patients treated with fluconazole (107 of 158 patients) and in 67% of patients treated with amphotericin B (106 of 159 patients). Progressive or new fungal infections during therapy occurred in 13 (8%) patients treated with fluconazole (8 with Candida, 5 with Aspergillus) and in 10 (6%) patients treated with amphotericin B (5 with Candida, 3 with Aspergillus, 2 with other fungi). Adverse events related to study drug (especially fryer, chills, renal insufficiency, electrolyte disturbances, and respiratory distress) occurred more often in patients treated with amphotericin B (128 [81%] of 159 patients) than patients treated with fluconazole (20 [13%] of 158 patients, P = 0.001). Eleven (7%) patients treated with amphotericin B but only 1 (1%) patient treated with fluconazole were terminated from the study owing to an adverse event (P = 0.005). Overall mortality (27 [17%] patients treated with fluconazole versus 34 [21%] patients treated with amphotericin B) and mortality from fungal infection (7 [4%] patients treated with fluconazole versus 5 [3%] patients treated with amphotericin

关键词：两性霉素B/治疗应用抗真菌药/治疗应用死亡原因发热/药物疗法发热/病因学氟康唑/治疗应用输注静脉内真菌病/药物疗法真菌病/病因学真菌病/死亡率真菌病/预防和控制肿瘤/并发症中性粒细胞减少/并发症治疗结果女(雌)性人类男(雄)性中年人

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