Büchner T, Roos N
Department of Medicine-Hematology/Oncology, University of Münster, Federal Republic of Germany.
Ann Hematol. 1992 Oct;65(4):153-61. doi: 10.1007/BF01703108.
Among the opportunistic infections in patients with leukemias systemic fungal infections contribute a major part if not the majority. This results from autopsy data and is supported clinically when using new criteria by imaging techniques, while microbiological documentation shows a low sensitivity in this situation. Those lessons require a change in strategy toward an earlier and empiric use of systemic antifungal drugs in the frequent infections appearing as fever of unknown origin. By its high systemic activity and low toxicity Fluconazole facilitates this approach. Amphotericin B with 5-Flucytosine remain as the most established standard. Liposomal Amphotericin B allowing higher dosage by lower toxicity appears effective as salvage treatment especially in aspergillosis which also responds to Itraconazole available as oral formulation so far.
在白血病患者的机会性感染中，全身性真菌感染即便不是占大多数，也占了很大一部分。这是根据尸检数据得出的结果，在使用影像学技术的新标准时也得到了临床支持，而微生物学记录在这种情况下显示出较低的敏感性。这些经验教训要求改变策略，在不明原因发热这种常见感染中更早且经验性地使用全身性抗真菌药物。氟康唑因其高全身性活性和低毒性，便于采用这种方法。两性霉素B与5-氟胞嘧啶仍是最成熟的标准治疗药物。脂质体两性霉素B毒性较低，允许更高剂量使用，作为挽救治疗似乎有效，尤其是在曲霉病中，曲霉病对目前可作为口服制剂的伊曲康唑也有反应。
