Winn R E, Anderson J, Piper J, Aronson N E, Pluss J
Department of Medicine, Fitzsimons Army Medical Center, Aurora, Colorado 80045.
Clin Infect Dis. 1993 Aug;17(2):210-7. doi: 10.1093/clinids/17.2.210.
Amphotericin B is recommended for the treatment of systemic infection caused by Sporothrix schenckii. However, this agent is toxic, its use is frequently followed by relapse, and some isolates of S. schenckii are resistant. Recent studies suggest that newer azole compounds, such as itraconazole, are effective in cutaneous and lymphocutaneous sporotrichosis, but data on their efficacy in systemic infections are scarce. We used itraconazole in the sequential treatment of six patients with systemic sporotrichosis: three with bone and joint disease and three with disseminated infection manifested by subcutaneous nodules. In all six cases, symptoms and signs of infection improved, with resolution of subcutaneous nodules, normalization of imaging studies, cessation of wound drainage, and return of joint mobility and function. No toxicity was noted. One patient with disseminated infection had a relapse while receiving 100 mg of itraconazole daily. The average duration of follow-up was 18 months. Thus itraconazole appears promising for the treatment of systemic sporotrichosis. A dose of at least 200 mg/d appears to be needed to prevent relapse.
两性霉素B被推荐用于治疗申克孢子丝菌引起的全身感染。然而，该药物有毒，使用后常出现复发情况，并且一些申克孢子丝菌分离株具有耐药性。最近的研究表明，较新的唑类化合物，如伊曲康唑，对皮肤和淋巴管型孢子丝菌病有效，但关于其在全身感染中的疗效数据较少。我们使用伊曲康唑序贯治疗了6例全身型孢子丝菌病患者：3例患有骨和关节疾病，3例表现为皮下结节的播散性感染。在所有6例病例中，感染的症状和体征均有所改善，皮下结节消退，影像学检查恢复正常，伤口引流停止，关节活动度和功能恢复。未观察到毒性反应。1例播散性感染患者在每日接受100 mg伊曲康唑治疗时出现复发。平均随访时间为18个月。因此，伊曲康唑在治疗全身型孢子丝菌病方面似乎很有前景。为预防复发，似乎需要至少200 mg/d的剂量。
