Wingard J R
Bone Marrow Transplant Program, Emory University School of Medicine, Atlanta, Georgia 30322.
Leuk Lymphoma. 1992 Nov;8(4-5):353-9. doi: 10.3109/10428199209051014.
Systemic Candida infections are a major cause of infectious morbidity and mortality during chemotherapy-induced neutropenia. Because of the unreliability of conventional diagnostic tests to detect systemic infection early in its course, treatment of established disseminated Candida infection has been generally disappointing with mortality rates of 60-80% in leukemia and bone marrow transplant patients and 30-40% in solid tumor patients. The use of empiric amphotericin B in patients with fever not responding to empiric antibacterial agents has been shown to be successful in reducing morbidity and mortality from fungal infections. However, its toxicity has mitigated the success of this approach. Fluconazole given prophylactically at the institution of chemotherapy has been shown to be a safe and effective alternative. It, however, is not active against all fungal species, especially Aspergillus and some of the less virulent Candida species. Some centers have reported break-through infections by these less susceptible organisms. Whether or not these limitations in its spectrum of activity will limit its usefulness in the future remains unanswered at this time and could pose a cloud to an otherwise bright promise.
全身性念珠菌感染是化疗诱导的中性粒细胞减少期间感染性发病和死亡的主要原因。由于传统诊断测试在系统性感染病程早期检测的不可靠性，已确诊的播散性念珠菌感染的治疗通常令人失望，白血病和骨髓移植患者的死亡率为60 - 80%，实体瘤患者的死亡率为30 - 40%。在对经验性抗菌药物无反应的发热患者中使用经验性两性霉素B已被证明能成功降低真菌感染的发病率和死亡率。然而，其毒性降低了这种方法的成功率。在化疗开始时预防性给予氟康唑已被证明是一种安全有效的替代方法。然而，它对所有真菌种类并不都有活性，尤其是曲霉菌和一些毒力较弱的念珠菌种类。一些中心报告了这些较难被感染的生物体引起的突破性感染。目前，其活性谱的这些局限性是否会在未来限制其效用仍未得到解答，并且可能给原本光明的前景蒙上一层阴影。
