Amphotericin B vs high-dose ketoconazole for empirical antifungal therapy among febrile, granulocytic cancer patients: A prospective, randomized study

Article Abstract:

Cancer patients are susceptible to serious bacterial and fungal infections due to their impaired immunity, which is caused both by their disease and its treatment, both of which can decrease the number of white blood cells available to fight infection. Patients who experience a significant drop in the number of one subpopulation of white blood cells known as granulocytes are known as granulocytopenic, and when these patients develop fever, they are typically placed on several potent antibiotics. When those fevers persist, antifungal agents are often added. The most commonly used antifungal is amphotericin B, which is often effective but which carries a very high risk of damaging the liver and kidney. A study was performed in which 32 granulocytopenic cancer patients were given oral ketoconazole, another antifungal agent, and a total of 52 patients were given amphotericin B intravenously, for presumed fungal infections, after failing to respond to antibacterial agents. A total of 10 patients were later documented to have definite fungal infections. All five who were proven to have the fungus Aspergillus died, three on amphotericin B and two on ketoconazole. The five who had been infected with a species of Candida consisted of three initially on ketoconazole, who responded when switched to amphotericin B, and two initially on amphotericin B who responded to that therapy. Some explanations as to why ketoconazole proved to be inadequate to treat presumed or documented fungal infections in these cancer patients include the fact that the drug merely inhibits growth of the fungi, rather than killing them, as does amphotericin B. Ketoconazole is taken orally, and thus its absorption and subsequent levels in the bloodstream are susceptible to disturbances in the gut, whereas amphotericin B is give intravenously, and impervious to influences by the gut. Finally, ketoconazole is inactive against a number of fungal species, whereas amphotericin B has a broader spectrum of potency. Thus, while the toxic effects are great, until a better agent is developed, amphotericin B must remain the drug of choice for granulocytic cancer patients with presumed or documented fungal infections. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Diseases, Cancer treatment, Mycoses, Amphotericin B, Ketoconazole

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Detection of circulating candida enolase by immunoassay in patients with cancer and invasive candidiasis

Article Abstract:

Candida albicans is a fungus that is commonly found in nature and is a normal inhabitant of the human gastrointestinal tract. When the normal bacterial flora of the intestines is disturbed, as can occur during treatment with antibiotics or during the course of diseases such as cancer, candida can cause severe and even fatal disease (candidiasis). This disease is difficult to diagnose and is a major cause of morbidity and mortality in cancer patients. The current method for diagnosis of candidiasis involves blood tests, computed tomography scanning (CT scan) or magnetic resonance imaging (MRI), and analysis of tissue biopsy samples. A newer method for the diagnosis of candidiasis has been developed and involves analyzing blood samples for the presence of a specific enzyme, called enolase, that is made by candida. This is done with a technique called immunoassay, which uses specific antibodies that will interact only with candida enolase present in a blood sample (enolase antigenemia). In order to evaluate the usefulness of this technique for identifying patients with candidiasis, 170 cancer patients at high risk for developing candidiasis were studied. A diagnosis of candidiasis was made based on analysis of blood samples and tissue samples. Twenty-four patients where diagnosed as having invasive candidiasis, 13 had deep tissue infection and 11 had detectable levels of fungus in their blood (fungemia). Eighty-five percent of the patients with deep tissue infection and 64 percent of the patients with fungemia tested positive for candida enolase, as measured by immunoassay. When cancer patients who did not have candidiasis were tested for the presence of candida enolase, only two percent of the samples tested positive, indicating that the test is specific for identifying patients with candidiasis. It is concluded that the presence of candida enolase in the blood is a marker for candidiasis and may be a useful method, in addition to blood cultures, to identify patients with candidiasis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Diagnosis, Immunoassay, Blood chemical analysis, blood

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Anidulafungin versus fluconazole for invasive candidiasis

Article Abstract:

Anidulafungin is compared with fluconazole in a randomized, double-blind, non-inferiority trial of treatment for invasive candidiasis, which indicated that anidulafungin is noninferior to fluconazole in the treatment of invasive candidiasis.

Health aspects, Fluconazole, Clinical report

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