Intranasal amphotericin B reduces the frequency of invasive aspergillosis in neutropenic patients

Article Abstract:

Aspergillosis is an infection of bodily tissues or mucous membranes with the fungal species Aspergillus. It commonly occurs in patients who have depressed immune systems, such as cancer patients or those that have had organ transplants. A major risk for so-called opportunistic infections is neutropenia, a depletion of neutrophils (a type of immune cell) that often occurs in these patients. This study examined the records of patients with neutropenia for proven or suspected infection with Aspergillus from January 1977 to December 1988. The hospital unit and the air in it were examined for reservoirs of Aspergillus spores. The various prevention and treatment methods used during this time period were compared to see which ones were effective. During the period studied, 158 episodes requiring intensive treatment (including bone marrow transplant) for leukemia, lymphoma, or aplastic anemia occurred in 130 patients. Aspergillus infection did not occur in 89 (56.3 percent) of the episodes and colonies were detected in 31 (19.6 percent) of the episodes, but no clinical symptoms occurred. Suspected infection occurred in 16 patients (10.1 percent), all of whom were successfully treated with amphotericin B nasal spray, introduced as a treatment in 1985. Infection was definite in 22 patients (13.9 percent) and 12 of these patients died from the infection. Death from infection was highly correlated to whether or not the underlying disease entered remission at some point. The incidence of proven Aspergillus infection greatly decreased after nasal amphotericin B was introduced. Examinations in the hospital unit found spores present in each month examined. These results indicate that amphotericin B is very effective in preventing invasive aspergillosis in neutropenic patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cases, Complications and side effects, Drug therapy, Aspergillosis, Opportunistic infections, Mycoses, Neutropenia

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Prospective evaluation of a candida antigen detection test for invasive candidiasis in immunocompromised adult patients with cancer

Article Abstract:

Chemotherapy usually reduces the ability of the immune system to fight infection. Patients receiving chemotherapy for the treatment of cancer are at risk for developing fungal infections, particularly candida albicans, because of their compromised immune system. Candida infections constitute 70 to 80 percent of all fungal infections in these patients. Invasive candida infections are difficult to diagnose. Patients having fever, which does not resolve after a course of antibiotics, are given the antifungal agent amphotericin B. Improvement in the patient's condition usually indicates that a fungus was the infective agent. Immunocompromised patients are unable to produce antibodies in response to candida albicans exposure. Therefore, blood tests which measure candida antibodies are not reliable. The diagnostic accuracy of a new test for candida detection, Cand-Tec, was evaluated. The test was performed on 142 patients receiving chemotherapy and radiation therapy. The sensitivity of the test was low; Cand-Tec was unable to provide a definitive diagnosis of invasive candida infection. Although this test could detect candida infection in the blood, it was not useful for detecting candida infection in the esophagus. The use of Cand-Tec did not increase early diagnosis of invasive candida infections which are currently detected by blood culture, tissue biopsy or after autopsy. Therefore, the current method of trial-and-error treatment with amphotericin B should be continued until better detection methods become available. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Candidiasis, Candida albicans

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Evaluation of the bactericidal activity of temafloxacin

Article Abstract:

Temafloxacin is one of the fluoroquinolones, a newly discovered group of antibiotics. Temafloxacin is equally or more effective in killing various types of bacteria compared with other fluoroquinolones, such as ciprofloxacin, ofloxacin and norfloxacin. To determine the effectiveness of various fluoroquinolones, including temafloxacin, various bacteria were tested. The bacteria tested include Chlamydia trachomatis, Streptococcus pyogenes, Streptococcus pneumoniae and Staphylococcus aureus. In determining various parameters of bactericidal activity, that is, the ability of the antibiotic to kill bacteria, researchers examined the rate of killing, the minimum concentration of drug necessary for killing, and the postantibiotic effect (the time required for the bacteria to regrow after a brief exposure to the drug). Other bacteria must be tested and the clinical significance of these finding requires further evaluation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antibacterial agents, Fluoroquinolones, Quinolones, Temafloxacin

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