655. Therapeutic Strategy for Trichosporon Fungemia in Patients with Acute Leukemia: Clinical Evaluation of Seven Cases Who Recovered From This Infection
Session: Abstracts: Mycology
Friday, October 22, 2010
Background: Fatal Trichosporon fungemia (TF) has been increasingly recognized in patients with acute leukemia. However, little is known about effective therapies for TF in such patients. We clinically evaluated cases who recovered from this infection and analyzed the therapeutic strategy for TF.

Methods: We retrospectively reviewed patients with acute leukemia at our collaborating 5 hospitals in Japan between 1992 and 2009. Successful outcome was obtained in 7 out of 27 patients who developed TF.

Results: All 7 patients were adult male. Age ranged from 53 to 80 years (median; 62 years). Six patients had a history of intensive chemotherapy for acute leukemia.  All patients had neutropenia (< 500μl) at the onset of TF, and neutrophil recovery was obtained except one patient. Central venous catheter had been inserted in all patients before the onset of TF, and was removed in only one patient. Five patients were treated with a combination of amphotericin B and azole: voriconazole (VCZ) in one, and miconazole (MCZ) and fluconazle in two each, and 2 patients did with azole alone: MCZ in one, and VCZ in one. Although no data was obtained for VCZ, minimal inhibitory concentrations (MIC) of other azoles administered were low for strains from patients examined.

Conclusion: Although the resolution of TF mostly depended on neutrophil recovery, therapies containing azole showing a low MIC for Trichosporon may be useful in the treatment of TF in patients with acute leukemia.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Kazunori Nakase, Ph.D., MD. , Cancer Center, Mie University Hospital, Mie, Japan
K. Suzuki, MD. , Dept. of Hematology and Oncology, Mie University Hospital, Tsu, Japan
T. Kyo, MD. , Dept. Internal Med., Hiroshima Red Cross Hospital, Hiroshima, Japan
T. Kohara, M.T. , Dept. Clinical Lab., Hiroshima Red Cross Hospital, Hiroshima, Japan
Y. Sugawara, M.D. , Dept. of Hematology and Oncology, Mie University Hospital, Tsu, Japan
T. Shibazaki, Ph.D., M.D. , Dept. of Hematology and Oncology, Mie University Hospital, Tsu, Japan
T. Tsukada, Ph.D., M.D. , Dept. Internal Med., Takeuchi Hospital, Tsu, Japan
S. Kageyama, Ph.D., M.D. , Dept. of Hematology and Oncology, Mie University Hospital, Tsu, Japan
N. Katayama, Ph.D., M.D. , Dept. of Hematology and Oncology, Mie University Hospital, Tsu, Japan

Disclosures:

K. Nakase, None

K. Suzuki, None

T. Kyo, None

T. Kohara, None

Y. Sugawara, None

T. Shibazaki, None

T. Tsukada, None

S. Kageyama, None

N. Katayama, None

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