Gosbell I B, Toumasatos V, Yong J, Kuo R S, Ellis D H, Perrie R C
Department of Microbiology and Infectious Diseases, South Western Area Pathology Service, Liverpool.
Mycoses. 2003 Jun;46(5-6):233-6. doi: 10.1046/j.1439-0507.2003.00878.x.
Scedosporium prolificans infections of normal hosts usually require extensive debridement and sometimes amputation to effect cure, due to the intrinsic resistance of this species to available antifungal agents. Newer agents have not tested favourably. Variable results are obtained with voriconazole, and 100% resistance is described with echinocandins. Itraconazole and terbinafine has offered synergy against various moulds including S. prolificans. In vivo success is reported with the azole/terbinafine combination in S. apiospermum pulmonary infection and Pythium insidiosum periorbital cellulitis. We report a case of orthopaedic infection in a non-immunocompromised host with S. prolificans, in which the combinations of itraconazole/terbinafine and voriconazole/terbinafine showed synergy in vitro, and success was achieved without radical surgery, using voriconazole and terbinafine.
由于多育赛多孢菌对现有抗真菌药物具有内在抗性,正常宿主感染该菌通常需要广泛清创,有时还需截肢才能治愈。新型药物的测试效果不佳。伏立康唑的治疗结果不一,而棘白菌素类药物的耐药率达100%。伊曲康唑和特比萘芬对包括多育赛多孢菌在内的各种霉菌具有协同作用。在尖端赛多孢菌肺部感染和隐秘腐霉眼眶周蜂窝织炎中,唑类/特比萘芬联合用药在体内取得了成功。我们报告了1例非免疫功能低下宿主发生的多育赛多孢菌骨科感染病例,其中伊曲康唑/特比萘芬和伏立康唑/特比萘芬联合用药在体外显示出协同作用,使用伏立康唑和特比萘芬治疗后未进行根治性手术即取得了成功。