Jarque Isidro, Sanz Miguel A
Servicio de Hematología, Hospital Universitario La Fe, Valencia, Spain.
Rev Iberoam Micol. 2007 Sep 30;24(3):213-6. doi: 10.1016/s1130-1406(07)70045-1.
Invasive fungal infections (IFI) are the main cause of infectious death in cancer patients, especially in hematological malignancies and hematopoietic transplant recipients. Current epidemiology is characterized by a predominance of IFI caused by molds, mainly aspergillosis, along with a emergence of hard-to-treat fungi such are Zygomicetes, Fusarium and Scedosporium. Voriconazole is a broad spectrum antifungal agent with oral and intravenous formulations, approved by the EMEA for the treatment of invasive aspergillosis, candidemia in non-neutropenic patients, IFI caused by fluconazole-resistant species of Candida as well as Scedosporium and Fusarium infections. However, its use in clinical practice is broader, as empirical antifungal treatment and as secondary prophylaxis. It should be kept in mind the possibility of breakthrough IFI, particularly zygomycosis, in patients treated with voriconazole for long periods.
侵袭性真菌感染(IFI)是癌症患者,尤其是血液系统恶性肿瘤患者和造血干细胞移植受者感染性死亡的主要原因。当前的流行病学特征是由霉菌引起的IFI占主导地位,主要是曲霉病,同时出现了难以治疗的真菌,如接合菌、镰刀菌和赛多孢菌。伏立康唑是一种具有口服和静脉制剂的广谱抗真菌药物,已被欧洲药品管理局批准用于治疗侵袭性曲霉病、非中性粒细胞减少患者的念珠菌血症、由耐氟康唑念珠菌以及赛多孢菌和镰刀菌感染引起的IFI。然而,它在临床实践中的应用更为广泛,可作为经验性抗真菌治疗和二级预防。应牢记,长期接受伏立康唑治疗的患者可能会发生IFI突破,尤其是接合菌病。