The Spectrum of the Disease in 98 Patients

Young, Robert C.; Bennett, John E.; Vogel, Charles L.; Carbone, Paul P.; DeVita, Vincent T.

doi:10.1097/00005792-197003000-00002

Cited by 926 publications

(323 citation statements)

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“…Opportunistic fungal infections have emerged as a major threat to patients undergoing intensive chemotherapy for malignancies such as acute myelogenous leukemia [1][2][3][4][5][6][7][8]. Thus the question of prevention of fungal infection in such patients has become an important concern.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Ketoconazole on Amphotericin B in a Model of Disseminated Aspergillosis

Schaffner

1985

Journal of Infectious Diseases

177

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The potential of ketoconazole prophylaxis to antagonize the activity of amphotericin B against aspergilli was investigated in vitro and in neutropenic mice. Exposure of Aspergillus fumigatus (six strains) and of Aspergillus f/avus or Aspergillus niger to ketoconazole resulted in a uniform increase of the minimal fungicidal activity of amphotericin B, from 0.15-0.63 mg/liter to >2.5 mg/liter in a microwell assay. To test the relevance of this antagonism in vivo, we challenged neutropenic mice iv with a lethal dose of conidia from two strains of A. fumigatus and then treated the mice first with ketoconazole and then with amphotericin B or amphotericin B plus ketoconazole. Pretreatment with ketoconazole for 48 hr completely abolished the protective effect of a subsequent therapy with amphotericin B, whether ketoconazole therapy was stopped (P < . (01) or not (P < .001). Ketoconazole given alone had no significant effect on survival. Our data show that ketoconazole not only antagonized the fungicidal activity of amphotericin B in vitro but also abolished in vivo the protective effect of the only drug shown to be useful in the therapy of aspergillosis. The clinicalimportance of this antagonism, which is not limited to Aspergilli in vitro, requires careful consideration before ketoconazole prophylaxis can be recommended for patients at high risk of developing invasive opportunistic fungal infections.

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Section: Discussionmentioning

confidence: 99%

The Effect of Ketoconazole on Amphotericin B in a Model of Disseminated Aspergillosis

Schaffner

1985

Journal of Infectious Diseases

177

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“…The common radiographic findings are rounded, often multiple bilateral peripheral lung opacities; progression, cavitation and consolidation frequently occur (5,6). Occasionally, air crescents may be seen (7).…”

Section: Discussionmentioning

confidence: 99%

Locally Invasive Pulmonary Aspergillosis in a Healthy Man Successfully Treated with Oral Fluconazole.

et al. 1992

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A 74-year-old healthy man with locally invasive form of pulmonary aspergillosis (PA) is reported. Chest X-ray film showed a segmental infiltration of right upper lobe (RUL) without cavitation, and the transbronchial lung biopsy specimen contained numerous hyphae of asper gillus species. Complication of bronchial asthma, or bronchiectasis were absent, and hyphae of aspergillus were present at only one segment of RUL. After 5 months of therapy with oral fluconazole, the PA had dramatically improved. Fluconazole was found to be effective for the locally invasive form of PA in a healthy man.

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“…In a series of 98 such patients mainly with lymphoreticular or hematopoietic malignancies, the pleura was not involved, although the lungs were involved in over 90% and in many the disease was invasive and widespread. [3] Among the described cases of pleural aspergillosis, etiologic factors include: pre-existing pulmonary tuberculosis -87%; bronchopleural fistula -74%; pleural drainage -56%; and lung resection -17%. [2] In most patients multiple antibiotic therapy was administered.…”

Section: An Unusual Cause Of Empyema Thoracismentioning

confidence: 99%