Increase in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole

Article Abstract:

Chemotherapeutic agents invariably destroy some normal healthy cells in addition to the cancerous cells for which they are administered. Cells of the bone marrow are particularly susceptible, and patients receiving chemotherapeutic treatment are often rendered more susceptible to infection. Fungal infections pose a particular threat. Most common among the fungal infections are infections with various Candida species, popularly referred to as "yeast" infections. The predominant Candida species causing illness and death among patients receiving chemotherapy are C. albicans and C. tropicalis. Fluconazole is a recently introduced antifungal antibiotic that kills a wide variety of fungi and is less toxic than some other antifungal drugs. However, the introduction of fluconazole for the prevention of fungal infections has corresponded with an increase in the rate of infection with some Candida species. The case records of 419 patients were reviewed, and it was found that the 84 patients who were given fluconazole had a seven times greater rate of infection with C. krusei than did 335 patients who were treated with the drug miconazole. The rate of infection with the most common pathogens, C. albicans and C. tropicalis, was reduced to zero, however. The powerful, but highly toxic, drug amphotericin B controlled the C. krusei infection in 10 of 11 affected patients. Studies in the laboratory have indicated that C. krusei is not susceptible to the antifungal effects of fluconazole. The observations among these patients indicate that the use of antibiotics to prevent infections with the most common pathogens may simply set the stage for less common fungi to assume a role of greater importance. The understanding of the factors that lead to fungal infection may permit the development of combinations of antibiotics that are more effective in preventing infection by a wider array of fungi. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Prevention, Bone marrow, Bone marrow transplantation, Candidiasis, Fluconazole

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Infection in organ-transplant recipients

Article Abstract:

People who receive organ transplants are at risk of infection because they must take drugs to suppress their immune system so the organ is not rejected. Over 80% of these patients do not get serious infections but have the same risk as the general population. Ten percent become infected with viruses such as cytomegalovirus, Epstein-Barr virus, or the hepatitis B or C virus. Five to 10 percent of transplant recipients reject the organ and they have a high risk of infection. All transplant recipients should take trimethoprim-sulfamethoxazole for 4 to 12 months after the operation to prevent infection.

Health aspects, Infection, Risk factors, Organ transplant recipients

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