Bernard E, Carles M, Toussaint-Gari M, Fournier J P, Dellamonica P
Maladies Infectieuses et Tropicales, Hôpital de l'Archet, Nice.
Pathol Biol (Paris). 1989 Jun;37(5 Pt 2):690-3.
20 patients (18 men, 2 women), 10 of whom were HIV +, were given Fluconazole (F) for either systemic candidiasis (13 cases), histoplasmosis (1), or cryptococcosis (6). The localization of the Candida infections (12 C. albicans, 1 C. tropicalis), were: septicemic (2), urinary (7), bronchial (2), esophageal (5), uveal (1), soft tissue (2), and 1 undetermined localization but a positive serology (1). On day (d) 1, Candidiasis patients were given an initial dose of 400 mg (for septicemia) or 200 mg (other localizations) of FIV or PO, then 200 or 100 mg per d. The length of treatment lasted from 28 to 70 d. Evolution was favorable in all the patients. 4 relapses occurred after the end of treatment: at 10 d, a septicemic candidiasis (C. tropicalis) in 1 patient who had prosthetic endocarditis; and at 1 month, digestive candidiasis in 3 HIV + patients. For the patient, infected by Histoplasma capsulatum, despite a clinical improvement, urine were still positive at day 75. The patients with cryptococcosis (5 meningitidis in the AIDS patients) and renal (1) (kidney transplant) were given on the average 400 mg a d, IV or PO (mean length 8 weeks). Only 5 patients were evaluable. For 2 of the meningitis patients with other localizations, standard treatment was instituted due to the persistence of positive cultures. For the 2 other patients, the cerebrospinal fluid (1) and the urine (1) were sterilized by the 3d week. But they relapsed 1 month after the treatment stopped. For the 18 patients evaluable, clinical and biological tolerance was good except for 1 patient with transaminases rise for which fluconazole was probably the cause.
20名患者（18名男性，2名女性），其中10名HIV呈阳性，因全身性念珠菌病（13例）、组织胞浆菌病（1例）或隐球菌病（6例）接受氟康唑（F）治疗。念珠菌感染的定位（12例白色念珠菌，1例热带念珠菌）为：败血症型（2例）、泌尿系统（7例）、支气管（2例）、食管（5例）、葡萄膜（1例）、软组织（2例），1例定位未确定但血清学呈阳性（1例）。第1天，念珠菌病患者静脉注射或口服给予初始剂量400mg（败血症）或200mg（其他定位）的氟康唑，然后每天200或100mg。治疗持续时间为28至70天。所有患者病情均好转。治疗结束后发生4例复发：10天时，1例患有人工心脏瓣膜心内膜炎的患者发生败血症型念珠菌病（热带念珠菌）；1个月时，3例HIV阳性患者发生消化道念珠菌病。对于感染荚膜组织胞浆菌的患者，尽管临床症状有所改善，但在第75天时尿液仍呈阳性。患有隐球菌病的患者（5例艾滋病患者为脑膜炎型，1例为肾型（肾移植））平均每天静脉注射或口服给予400mg（平均疗程8周）。只有5例患者可评估。对于2例有其他定位的脑膜炎患者，由于培养物持续呈阳性，采用了标准治疗。对于另外2例患者，脑脊液（1例）和尿液（1例）在第3周时除菌。但在治疗停止1个月后复发。对于可评估的18例患者，除1例转氨酶升高的患者外，临床和生物学耐受性良好，氟康唑可能是转氨酶升高的原因。
