Candida infections in patients with acute leukemia: Ineffectiveness of nystatin prophylaxis and relationship between oropharyngeal and systemic candidiasis

Abstract

Ninety‐three hospitalizations of 70 patients, who underwent induction chemotherapy for acute leukemia to determine the effectiveness of oral nystatin in preventing oropharyngeal and systemic candidiasis were reviewed. Sixty‐two percent of patients who received prophylactic nystatin and 58% of patients who did not receive nystatin developed oropharyngeal candidiasis; 11% of patients who received prophylaxis and 21% of those who did not receive prophylaxis developed systemic candidiasis. The use of oral nystatin did not significantly diminish the risk of developing either type of Candida infection. Oropharyngeal candidiasis occurred more commonly in patients who had severe and prolonged leukopenia, had received more parenteral antibiotics, and had developed chemotherapy‐induced mucositis. Systemic candidiasis developed almost exclusively in patients who had prior oropharyngeal candidiasis. Guidelines for the empiric use of amphotericin B in these patients are provided.

Liposomal amphotericin (AmBisome) in the prophylaxis of fungal infections in neutropenic patients: a randomised, double-blind, placebo-controlled study

“…This is a potentially important observation since it has been shown that colonisation with Candida spp, particularly of multiple sites, is highly predictive of subsequent invasive candidiasis. [26][27][28][29][30] A similar significant reduction in colonisation was also noted in an earlier study with AmBisome in BMT recipients. 20 Interestingly, in neither study was a statistically significant reduction in infection rates seen as a result of reducing colonisation.…”

Toxicity and therapeutic effects in mice of liposome-encapsulated nystatin for systemic fungal infections

“…It has been used as suspensions prepared in various ways and administered to patients orally (1,2,7,14,17). However, most of these studies failed to document a beneficial effect of NYS administration against systemic fungal infections (2,14,17).…”

Kemoterapi̇ye Bağli Mukozi̇t

“…Özellikle Otolog veya allogeneik kök hücre transplantasyonu uygulanan hastalarda mukozit derecesi ile sistemik bakteriyemi arasında direkt ilişki vardır. Öte yandan sistemik kandidiazis tespit edilen tüm hastalarda oral kandidiazisin de belirlenmesi kaynağın oral mukoza olabileceğini kuvvetle düşündürmektedir [10][11][12] Yüzeyel orofaringeal kandidiazis topikal nistatin ile tedavi edilebilir. Genellikle sistemik tedavi gerektirmez.…”

“…Profilaktik oral flukonazol genellikle öneril-mekle birlikte profilaktik nistatin önerilmemektedir. 12 Oral kavitede viral enfeksiyon da gelişebilir. Bunlardan en sık görüleni herpes simpleks tip 1 reaktivasyonudur.…”