Cofrancesco E, Boschetti C, Viviani M A, Bargiggia C, Tortorano A M, Cortellaro M, Zanussi C
Istituto di Medicina Interna, Università di Milano, Italy.
Haematologica. 1992 May-Jun;77(3):280-3.
We recently succeeded in eradicating a Fusarium infection by treatment with liposomal amphotericin B (L-AmB). The patient, a 22-year-old man with acute lymphoblastic leukaemia (ALL), developed fever and diffuse cutaneous maculopapular necrotising nodules during post-chemotherapy neutropenia. Fusarium verticilloides was isolated from the skin, and hyphae were observed on direct microscopy. Despite increased WBC and amphotericin B (AmB) treatment (0.7 mg/kg/day for 11 days), he remained febrile and a chest X-ray revealed pulmonary lesions. Fusarium infection was confirmed by bronchial aspirate. AmB was increased to 1 mg/kg/day, and continued for 16 days (total dose 1630 mg). A slight improvement was observed at tomography, but nephrotoxicity developed. Treatment was changed to L-AmB (3 mg/kg/day). The patient received this drug for 20 days (total dose of 3850 mg) with complete regression of the pulmonary lesions. No adverse event occurred, and nephrotoxicity resolved. The patient was discharged from hospital cured of the Fusarium infection and in clinical and haematological remission. No relapse of fusariosis occurred, despite additional courses of intensive chemotherapy. Ambisome could represent an important advance in antifungal treatment since it allows aggressive treatment and eradication of mycoses refractory to conventional therapy while avoiding renal toxicity.
我们最近通过脂质体两性霉素B（L-AmB）治疗成功根除了镰刀菌感染。该患者为一名22岁的急性淋巴细胞白血病（ALL）男性，在化疗后中性粒细胞减少期间出现发热和弥漫性皮肤斑丘疹坏死性结节。从皮肤中分离出轮状镰刀菌，直接显微镜检查观察到菌丝。尽管白细胞计数增加且接受了两性霉素B（AmB）治疗（0.7mg/kg/天，共11天），但他仍持续发热，胸部X线显示肺部病变。支气管吸出物证实了镰刀菌感染。AmB剂量增加至1mg/kg/天，并持续16天（总剂量1630mg）。断层扫描显示有轻微改善，但出现了肾毒性。治疗改为L-AmB（3mg/kg/天）。患者接受该药物治疗20天（总剂量3850mg），肺部病变完全消退。未发生不良事件，肾毒性也得到缓解。患者出院时镰刀菌感染已治愈，临床和血液学指标均处于缓解状态。尽管进行了额外的强化化疗疗程，但镰刀菌病未复发。两性霉素脂质体可能代表了抗真菌治疗的一项重要进展，因为它允许积极治疗并根除对传统疗法难治的真菌病，同时避免肾毒性。
