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脂质体两性霉素B成功治疗耐氟康唑茄病镰刀菌角膜炎

[Successful treatment of resistant Fusarium solani keratitis with liposomal amphotericin B].

作者信息

Touvron G, Denis D, Doat M, Girard A, Brandely M-L, Chast F, Renard G

机构信息

Service d'ophtalmologie, CHU Marseille, Hôpital Nord, Chemin Bourrely, Marseille, France. gwen

出版信息

J Fr Ophtalmol. 2009 Dec;32(10):721-6. doi: 10.1016/j.jfo.2009.10.011.

Abstract

INTRODUCTION

The prognosis for Fusarium keratitis is poor. Effective drugs to treat this infection are therefore needed.

CASE REPORT

A patient presented Fusarium solani keratitis. The infection regressed with topical amphotericin B and intravenous voriconazole. Topical steroids were introduced. There was reactivation and extension of the infection, invading the anterior chamber. Steroids were discontinued and the antifungal treatment was restarted but there was continued deterioration. Recovery was achieved without surgery, with topical voriconazole, topical liposomal amphotericin B, topical natamycin, intravenous liposomal amphotericin B, and intravenous voriconazole.

CONCLUSION

Combined orally and topically administered voriconazole is a promising therapy when the minimum inhibitory concentration is approximately 2 microg/ml. Liposomal amphotericin B seems to be the most effective drug for the different infection stages. Posaconazole is a useful alternative but further investigations must be pursued.

摘要

引言

镰刀菌角膜炎预后不佳。因此,需要有效的药物来治疗这种感染。

病例报告

一名患者出现茄病镰刀菌角膜炎。局部使用两性霉素B和静脉注射伏立康唑后感染消退。开始使用局部类固醇。感染复发并扩散,侵入前房。停用类固醇并重新开始抗真菌治疗,但病情仍持续恶化。通过局部使用伏立康唑、局部使用脂质体两性霉素B、局部使用那他霉素、静脉注射脂质体两性霉素B和静脉注射伏立康唑,在未进行手术的情况下实现了康复。

结论

当最低抑菌浓度约为2微克/毫升时,联合口服和局部使用伏立康唑是一种有前景的治疗方法。脂质体两性霉素B似乎是针对不同感染阶段最有效的药物。泊沙康唑是一种有用的替代药物,但必须进行进一步研究。

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