Itraconazole therapy for blastomycosis and histoplasmosis

Dismukes, William E.; Bradsher, Robert W.; Cloud, Gretchen; Kauffman, Carol A.; Chapman, Stanley W.; George, Ronald B.; Stevens, David A.; Girard, William M.; Saag, Michael S.; Bowles-Patton, Cynthia

doi:10.1016/0002-9343(92)90575-v

Cited by 290 publications

(106 citation statements)

References 31 publications

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“…Grandes efusões pericárdicas devem ser drenadas. Linfadenites mediastinais de grande volume e sintomáticas podem ser tratadas com itraconazol associado à prednisona 3 .…”

Section: Terapêuticaunclassified

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Histoplasmose

Ferreira

Borges

2009

Rev. Soc. Bras. Med. Trop.

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RESUMOA histoplasmose é uma micose causada por fungo dimórfico, o Histoplasma capsulatum. É considerada classicamente uma micose endêmica, embora o fungo tenha um comportamento oportunístico em pacientes com depressão da imunidade celular. O homem adquire a infecção através da inalação de conídeos presentes na natureza (cavernas com morcegos, galinheiros, etc). O quadro clínico pode variar, desde infecções assintomáticas até quadros graves disseminados, que acometem pacientes com Aids, transplantados ou com neoplasias hematológicas. O diagnóstico baseia-se no encontro do fungo em fluidos orgânicos (escarro, sangue, líquor) ou tecidos (histopatologia), na cultura de materiais biológicos e na sorologia. O tratamento das formas agudas graves, respiratória crônica ou de formas localizadas pode ser feito com azólicos orais (itraconazol) e nas disseminadas, a Anfotericina B (preferencialmente as formulações lipídicas) constitui a droga da eleição para iniciar a terapia. A histoplasmose representa, hoje uma das micoses sistêmicas mais importantes nas Américas, com ampla distribuição em todas as regiões do Brasil. Palavras-chaves:Histoplasmose. Histoplasma capsulatum. Micose sistêmica. Síndrome da imunodeficiência adquirida. ABSTRACTHistoplasmosis is a fungal infection caused by the dimorphic fungus Histoplasma capsulatum. It is classically considered an endemic mycosis, even though the fungus has an opportunistic behavior in immunocompromised patients. People acquired the infection through the inhalation of conidial forms present in the environmental, such as caves dwelling bats and soils inhabited by chickens. The clinical features may vary from asymptomatic infections to disseminated severe forms that affect patients with acquired immunodeficiency syndrome or hematological malignancies and allograft recipients. The diagnosis is based on the detection of the fungus in organic fluids (sputum, blood, liquor) or tissues (histopathological assays), in the culture of biological samples and serological assays. The treatment of severe chronic respiratory acute or localized forms can be performed with oral azolic (itraconazol) and in the disseminated forms, the amphotericin B (preferentially the lipidic formulations) consists in the elected drug to initiate the therapy. Nowadays, histoplasmosis represents one of the most important systemic mycosis in the Americas, with broad distribution in all regions of Brazil. Key-words: Histoplasmosis. Histoplasma capsulatum. Systemic mycosis. Acquired immunodeficiency syndrome.A histoplasmose é uma micose sistêmica causada por um fungo dimórfico, o Histoplasma capsulatum. A doença foi pela primeira vez descrita por Samuel Darling, no Panamá, que entre 1905 e 1906 necropsiou três casos disseminados da doença, dois dos quais provenientes da Ilha de Martinica, onde hoje esta micose é reconhecidamente endêmica. A doença descrita por este patologista era similar à leishmaniose visceral e, portanto, foi por ele considerada erroneamente ser causada por um protozoário encapsulado. Somente em 193...

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“…Grandes efusões pericárdicas devem ser drenadas. Linfadenites mediastinais de grande volume e sintomáticas podem ser tratadas com itraconazol associado à prednisona 3 .…”

Section: Terapêuticaunclassified

“…Os títulos de anticorpos específicos circulantes baixam consideravelmente quando há resposta ao tratamento. O monitoramento das recidivas deve persistir por pelo menos um ano após a retirada da droga 3 .…”

Section: Terapêuticaunclassified

Histoplasmose

Ferreira

Borges

2009

Rev. Soc. Bras. Med. Trop.

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“…Some are of the opinion that in immunocompetent patients with uncomplicated pulmonary forms of the disease, therapy may not be necessary [6,27,32]. Considering the complication of blastomycosis and the relative safety of oral antifungal medication, we tend to agree with others [3,10,18], that when blastomycosis is suspected, even in its mildest form (as in the case of our healthy patient), antifungal therapy should be instituted.…”

Section: Discussionmentioning

confidence: 73%

Blastomycosis of the lumbar spine: case report and review of the literature, with emphasis on diagnostic laboratory tools and management

Hadjipavlou

Mader

Nauta

et al. 1998

European Spine Journal

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“…However, fluconazole has been found to reduce C. albicans viability in vitro when longer incubation periods are used (15,22,23). Chronic fungal infections are often long standing and may be treated for months with azole antifungal agents (6,8,14). Individual organisms in experimental subcutaneous C. albicans abscesses have been shown to proliferate relatively slowly (21), and it is likely that slow growth may be a characteristic of most chronic fungal infections.…”

Section: Fluconazole Is Very Useful For Treating Infections Caused Bymentioning

confidence: 99%

Effect of Prolonged Fluconazole Treatment on Candida albicans in Diffusion Chambers Implanted into Mice

Sohnle

Hahn

2002

Antimicrob Agents Chemother

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Fluconazole is an azole agent with primarily fungistatic activity in standard in vitro susceptibility tests. The present study was undertaken to develop a diffusion chamber model system in mice in order to study the in vivo effects of prolonged fluconazole treatment on Candida albicans. Chambers containing 100 C. albicans yeast cells were implanted subcutaneously on the flanks of C57BL/6 mice and were then retrieved 6 or 14 weeks later (after fluconazole treatment for 4 or 12 weeks, respectively). Leukocyte counts demonstrated that implantation of the chambers did elicit an inflammatory response but that only small numbers of inflammatory cells were able to enter the chamber interior. Treatment with fluconazole at 10 mg/kg of body weight/day for 12 weeks not only reduced the numbers of viable organisms within the chambers compared to those in untreated mice (mean ؎ standard deviation of log 10 CFU of 0.7 ؎ 1.2 versus 2.3 ؎ 2.0; P < 0.001 by the Bonferroni test) but also increased the numbers of chambers that became sterile over the treatment period (14 of 16 versus 6 of 19; P ‫؍‬ 0.0009 by the chi-square test). However, treatment for only 4 weeks had minimal effects on the numbers of chamber CFU, and none of the chambers became sterile during this period. Distribution of retrieved organisms between interior fluid and the chamber filters was approximately equal in all the treatment groups. This model system appears to be useful for evaluating the effects of antifungal drugs over prolonged periods in vivo. Its use in the present study demonstrates that fluconazole can increase the rate of sterilization of C. albicans foci that are protected from the host's inflammatory response.

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Itraconazole therapy for blastomycosis and histoplasmosis

Cited by 290 publications

References 31 publications

Histoplasmose

Histoplasmose

Blastomycosis of the lumbar spine: case report and review of the literature, with emphasis on diagnostic laboratory tools and management

Effect of Prolonged Fluconazole Treatment on Candida albicans in Diffusion Chambers Implanted into Mice

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