Oral Fluconazole Research Articles

Real-World Analysis of Oral Fluconazole 150 mg Prescribing Patterns in the Female United States Population and Projected National Utilization Estimates

In the United States (US), there are approximately 10 million offices annually for vaginal symptoms, of which approximately 20-25% are the result of Candida infections. A single fluconazole (FLU) 150 mg tablet is the only oral treatment approved for women with uncomplicated vulvovaginal candidiasis (VVC). For complicated and severe VVC, guidelines in the literature recommend oral FLU 150 mg, every 3 days for a total of 2 or 3 doses. The aim of this research was to examine rates and utilization patterns of FLU 150 mg tablets in a large, nationally representative database.

Efficacy of Azoles Antifungals in Treatment of Pityriasis Versicolor

Introduction: Pityriasis versicolor is superficial fungal infection. Topical drugs are often effective in treatment of limited disease while systemic drugs are more suitable in extensive cases. The systemic triazole drugs, itraconazole and fluconazole have shown promising results at different doses.
 Aims: To assess the efficacy and safety of oral fluconazole combined with ketoconazole shampoo and oral itraconazole in the treatment of Pityriasis versicolor.
 Methods: The study was conducted at department of Dermatology at Nepalgunj Medical College from March 2019 to February 2020. Total 100 patients of both genders with Pityriasis versicolor were randomly allocated into two groups with 50 patients in each group. Patients in Group I received oral fluconazole 300mg a week for two consecutive weeks along with ketoconazole 2% shampoo twice weekly for two weeks while those in Group II received itraconazole 200mg daily for one week. Efficacy was assessed in terms of negative fungal hyphae. The drug is considered safe if no patients were withdrawn for clinical adverse effects or laboratory abnormalities.
 Results: In this study age ranged from 18 to 50 years with mean age of 31.1 years in Group I and 31.92 years in Group II. Efficacy was seen in 78% of Group I patients as compared to 54% in Group II patients at two weeks and 94% in Group I and 90% in Group II at four weeks. No significant adverse effects were reported in any of the group.
 Conclusion: Fluconazole along with ketoconazole shampoo is more effective than itraconazole in treatment of pityriasis versicolor with minimal side effects, at lesser cost.

Disseminated dermatophytosis and acquired immunodeficiency syndrome:literature review and presentation of clinical experience

Introduction: Dermatophytosis are very common fungal infections caused by the fungal species Microsporum, Epidermophyton or Trichophyton, which mostly affect the skin, the interdigital region, groin and scalp. Although they do not cause serious diseases, in patients with the human immunodeficiency virus the infection manifests itself and evolves exuberantly, usually with extensive and disseminated lesions. Objective: To review the literature on dermatophytosis in people living with human immunodeficiency virus and to present the experience in clinical care in a patient living with human immunodeficiency virus with extensive and disseminated dermatophytosis. Methods: A literature review on the topic was carried out in the PubMed/National Library of Medicine – USA databases, using the keywords dermatophytosis, or dermatophytosis associated with the words AIDS, human immunodeficiency virus or immunodeficiency, from 1988–2022. The clinical experience showed a patient living with human immunodeficiency virus developing AIDS and presenting with disseminated skin lesions. Samples of the lesion were collected by scraping, which were submitted to culture and there was growth of fungi of the Trichophyton sp genus. A biopsy of the lesion was also performed using the Grocott-Gomori's Methenamine Silver stain. Results: We found 1,014 articles, of which only 34 presented a direct correlation with our paper, and were used to discuss the main themes narrated in this article. We present clinical experience in the management of a patient with human immunodeficiency virus/AIDS and low adherence to antiretroviral treatment, showing extensive and disseminated erythematous-squamous lesions with a clinical diagnosis of tinea corporis, manifesting with a clinical picture usually not found in immunocompetent patients. The diagnosis was confirmed by laboratory tests with isolation of the Trichophyton sp fungus. The patient was treated with oral fluconazole, with complete remission of the clinical picture after two months. She was also thoroughly encouraged to use the prescribed antiretroviral medication correctly. Conclusion: Dermatophytosis in patients living with human immunodeficiency virus can present extensive and disseminated forms. The antifungal treatment is quite effective, with remission of the condition. Antiretroviral therapy is an important adjuvant for better recovery of the sickness.

Antifungal Drug Resistance of Dermatophytes Causing Superficial Fungal Infections

Background: Superficial fungal infections (SFI) are common skin diseases that were largely simple to treat. However, due to increasing antimicrobial resistance (AMR) of dermatophytes to antifungal drugs, treatment of SFI has become difficult. This study aims to analyze the AMR of dermatophytes and to correlate with the clinical response of antifungal drugs. Methods: A cross‑sectional evaluation was undertaken of 570 consecutive patients with SFI such as tinea corporis, tinea cruris, tinea faciei, and tinea pedis, who were treated with any of the oral antifungal drugs fluconazole, itraconazole and terbinafine. Clinical response was taken within 1 month of stopping the therapy. Microscopic as well as culture and antimicrobial sensitivity analysis were done to characterize and determine the susceptibility of dermatophytes to antifungal drugs aforementioned. Results: Among the 570 patients with SFI, the ratio of male (n=360, 63.16%) to female (n=210, 36.84%) was 1.7:1. The common age group affected by SFI was 31-40 years (27.71%, n=158). The tinea corporis was the most predominant (51.05%) followed by tinea cruris (13.68%). Clinical response analysis showed that the percentage of relapse of SFI after completion of treatment with fluconazole, itraconazole and terbinafine was about 55, 45 and 19, respectively. Culture and antimicrobial sensitivity analysis revealed that the percentage of resistance of dermatophytes from patients of SFI to fluconazole, itraconozole and terbinafine was approximately 70, 55 and 20, respectively. Conclusion: Results reported herein support the notion that the antifungal resistance is evolving in dermatophytes causing SFI, and about 20% dermatophytes are multidrug resistant.

A Rare Case Report of Pythium Insidiosum Keratitis in an Immunocompetent Patient

Corneal ulcers are one of the major causes of monocular blindness after cataracts in developing nations and have a varied aetiology. One of the emerging causes of corneal ulcers closely resembling fungi in its morphology is the Pythium insidiosum which is known to infect a variety of animals, but in humans, only a few cases have been reported causing ocular, cutaneous/subcutaneous, vascular, and disseminated infections. This was a case of a 29-year-old male, non agriculturist by occupation who presented to the Ophthalmology Outpatient Department with a history of diminution of vision, redness and watering of the left eye in the last 5 days. On further investigations, he was diagnosed to have a corneal ulcer with P.insidiosum being the aetiological agent. The patient was managed surgically by penetrating keratoplasty and medically by combination therapy consisting of moxifloxacin eyedrops every 4th hour, voriconazole eye drops 2 hourly, natamycin eye drops 2nd hourly, oral fluconazole 150 mg thrice daily for 1 week.

Topical Treatment of Recurrent Vulvovaginal Candidiasis: An Expert Consensus.

Background: Recurrent vulvovaginal candidiasis (RVVC), defined as three or more confirmed infections over 1 year, occurs in up to 10% of women. In these women, the objective is often symptomatic control rather than mycologic cure. Current Centers for Disease Control and Prevention (CDC) guidelines recommend oral fluconazole as first-line maintenance, but state if this oral regimen is not feasible, intermittent topical treatments can be considered. No specific recommendations for type or frequency of topical applications are provided by the CDC.Methods: A panel of vulvovaginal experts convened to develop a consensus recommendation for topical maintenance dosing for RVVC.Results: Data suggest that clotrimazole, miconazole, terconazole, and intravaginal boric acid are suggested recommendations for recurrent vulvovaginitis caused by both Candida albicans and nonalbicans species. Nystatin ovules may not be as effective as azoles. Identification of species will influence treatment decisions. In addition, treatment may be modified based on prior response to a specific agent, especially in nonalbicans species. Fluconazole, ibrexafungerp, and intravaginal boric acid should be avoided during pregnancy.Conclusions: The expert consensus for women with RVVC is an initial full course of treatment followed by topical maintenance beginning at one to three times weekly, based on chosen agent. Twice a week dosing was the regimen most often utilized. In some women, episodic treatment may be used, but maintenance should remain an option for this population.

An unusual case of Candida parapsilosis causing infectious crystalline keratopathy in Steven–Johnson syndrome

A 41-year-old female, a known case of Steven–Johnson syndrome (SJS) with ocular involvement, had a pthisical right eye (RE) and a history of mucous membrane grafting (MMG) in the left eye. Two weeks post-MMG, the patient developed a pearly white crystalline anterior stromal infiltrate suggestive of infectious crystalline keratopathy (ICK). The Gram stain showed gram-positive, round-to-oval budding cells and the culture on sheep blood agar showed smooth white yeast colonies. VITEK 2 compact automated microbiology system-enabled species-level identification was Candida parapsilosis in addition to the antifungal sensitivity. Based on the sensitivity report, the patient responded well to oral fluconazole and topical voriconazole with corneal scar formation. Clinical and microbiological evaluations of ICK in an unusual setting like SJS is prudent for a successful outcome.

Treatment of Cutaneous Leishmaniasis in a Nonendemic Country: A Case Series of Children in Australia.

We describe 4 cases of cutaneous leishmaniasis in children in Australia. Treatment is challenging given lack of firm guidelines and limited access to conventional modalities used in endemic countries. Topical paromomycin or oral fluconazole were effective outpatient-based first-line treatments, however, topical paromomycin use was limited by expense to import or compound locally.

703. Peritoneal Coccidioidomycosis in a Pediatric Patient: An Extremely Rare Presentation and Literature Review

BackgroundChronic peritonitis is an unusual manifestation of coccidiomycosis (CM) that is challenging to diagnose and manage due to its propensity for relapse. It is even more unusual to diagnose peritoneal CM in the pediatric population, with only two other cases reported in the literature. MethodsWe present the case of a previously healthy 5-year-old Filipino female in Florida who was diagnosed with peritoneal CM. After months of unintentional weight loss and worsening abdominal distention, she presented to medical care. Imaging revealed significant abdominal ascites and nodularities throughout the peritoneum. The peritoneal fluid demonstrated a lymphocytic pleocytosis and infectious workup was benign. CA125 levels were elevated, but peritoneal adenosine deaminase was within normal limits. A biopsy of the affected tissue revealed diffuse granulomas surrounding spherules that were positive on GMS and PAS staining, concerning for CM. Exposure history revealed that she was raised in California and moved to Florida one year prior to presentation. Complement fixation titers were significantly elevated at ≥ 1:512 and immunodiffusion titers were positive. A Coccidioides PCR was sent from the tissue to the Mayo clinic and was positive, and fungal cultures from the tissue grew C. immitis/posadasii. Immunologic workup was reassuring. She was started on oral Fluconazole with rapid resolution of her symptoms. ResultsInvolvement of the peritoneum in CM is extremely rare. Abdominal distention due to ascites is the most common presentation, and the peritoneal fluid is typically exudative. Imaging may reveal peritoneal deposits which can mimic other infections and malignancy. Diagnosis can be based on histopathological demonstration of fungal structures, cultures, antibody testing, antigen detection and/or PCR. Treatment guidelines suggest azole therapy for nonmeningeal disseminated CM with at least 6–12 months of treatment for extrapulmonary coccidioidal soft tissue infection. ConclusionPeritoneal CM is an extremely uncommon condition and it is even more rare in the pediatric population, but should be considered in those in the appropriate clinical settings, particularly if they have history to suggest exposure to regions where this fungus is endemic. Disclosures All Authors: No reported disclosures

Population Pharmacokinetic Analysis and Dosing Optimization of Prophylactic Fluconazole in Japanese Patients with Hematological Malignancy.

We conducted population pharmacokinetic (PPK) analysis and Monte Carlo simulations to determine the appropriate prophylactic dose of fluconazole to prevent invasive candidiasis in patients with hematological malignancies. Patients receiving chemotherapy or hematopoietic stem cell transplantation at Yokohama City University Hospital between November 2018 and March 2020 were included. Additionally, patients receiving oral fluconazole for prophylaxis were recruited. We set the free area under the curve/minimum inhibitory concentration (MIC) = 50 as the target and determined the largest MIC (breakpoint MIC) that could achieve more than 90% probability of target attainment. The blood fluconazole concentration of 54 patients (119 points) was used for PPK analysis. The optimal model was the one-compartment model with first-order administration and first-order elimination incorporating creatinine clearance (CLcr) as a covariate of clearance and body weight as a covariate of distribution volume. We conducted Monte Carlo simulation with fluconazole at 200 mg/day or 400 mg/day dosing schedules and patient body weight and CLcr ranging from 40 to 70 kg and 40–140 mL/min, respectively. The breakpoint MICs on the first dosing day and at steady state were 0.5–1.0 μg/mL and 1.0–2.0 μg/mL for 200 mg/day and 1.0–2.0 μg/mL and 2.0–4.0 μg/mL for 400 mg/day, respectively. The recommended dose was 400–700 mg/day for the loading dose and 200–400 mg/day for the maintenance dose. Our findings suggest that the optimal prophylactic dose of fluconazole in hematological malignancy patients depends on CLcr and body weight, and a sufficient loading and maintenance dose may be needed to completely prevent invasive candidiasis.

Treatment of vulvovaginal candidiasis in preparation programs for in vitro fertilization

Vulvovaginal candidiasis (VVC) is considered as the second most common cause of vaginitis after bacterial vaginosis. About three quarters of women of reproductive age have a history of at least one episode of VVC, and about a half of women have two or more episodes. Candida albicans is responsible for85% to 90% of vulvovaginal candidiasis. There are uncomplicated and complicated forms of VVC. Uncomplicated forms are not severe cases caused by C. albicans. Complicated forms are cases caused by other Candida species, severe cases, cases that develop during pregnancy or associated with other diseases such as diabetes mellitus or immunosuppressive conditions. Reccurent cases are also complicated ones. Therapeutic schemes should depend on the form of the VVC. Short-term topical therapy or a single oral dose are effective in 90% of uncomplicated cases. Complicated forms of VVC require longer treatment. Oral fluconazole can be administered three times with a break of 72 hours. Topical azoles can be administered daily for at least 1 week. So, sertaconazole in the form of suppositories is used once intravaginally. The data on the use of probiotics in the treatment of VVC today are contradictory and heterogeneous. Treatment of VVC during pregnancy, especially in the first trimester, may be associated with adverse perinatal outcomes. On the other hand, during pregnancy, VVC can be more severe than in non-pregnant women, especially in the second half of pregnancy. In addition, the risk of transmission to a newborn is about 50%. Thus, the identification and treatment of VVC is one of the important tasks in pregnancy planning, including assisted reproduction.

THE DILEMMA OF MILIARY COCCIDIODOMYCOSIS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Coccidioidomycosis, a fungal infection endemic to the Southwest United States, can take on many appearances on chest imaging. A miliary pattern is seen less frequently. In the immunocompromised patient, this can be a quandary for physicians as it may mimic tuberculosis. CASE PRESENTATION: A 34-year-old woman with systemic lupus erythematosus, on immunosuppressive therapy, presented with two months of fevers, fatigue, and 25-pound weight loss. Additional symptoms included dry cough, pleuritic chest pain, and vision changes. Other history was notable for birthplace in a developing country and immigration to Arizona in early childhood. On presentation, a computed tomography of the chest revealed diffuse miliary nodules with confluent necrotizing pneumonia in the left lower lobe. Ophthalmology was consulted for her vision disturbances and found creamy chorioretinal lesions bilaterally on fundoscopic exam. Quantiferon testing was indeterminate. Beta-D glucan was elevated, as were coccidioidomycosis IgM and IgG antibodies. Bronchoscopy with bronchoalveolar lavage was subsequently performed, as the patient was unable to provide satisfactory sputum samples. These cultures were negative for tuberculosis, and the initiation of antitubercular therapy was avoided. Intravenous Amphotericin and oral Fluconazole was initiated during her hospitalization, followed by a prolonged course of Fluconazole at discharge. DISCUSSION: There was concern for disseminated tuberculosis, given the patient's miliary pattern on imaging, chorioretinitis, and history of birth place. As coccidioidomycosis is endemic to Arizona, the patient was empirically started on antifungal treatment, but precautions and workup of active tuberculosis were still taken. Antitubercular therapy was to be held until the appropriate respiratory samples were collected. The patient afforded this delay as she remained hemodynamically stable without oxygen requirements. This decision also minimized the risk of building resistance and subjecting the patient to potentially harmful side effects. Cultures resulted negative for tuberculosis, and the patient's rapid clinical improvement on antifungal therapy supported her diagnosis of pulmonary coccidioidomycosis. She was placed on oral fluconazole and prednisolone eye drops at discharge; her follow up with Infectious Diseases nine months later found the patient to be asymptomatic with near complete resolution of the nodules on chest imaging. CONCLUSIONS: Coccidioidomycosis can have acute to subacute presentations of pneumonia with imaging findings ranging from focal infiltrates and nodular opacities to cavitary lesions. A miliary pattern can also occur, which should prompt a thorough infectious history and consideration for more invasive testing prior to empiric treatment of tuberculosis in a stable patient. REFERENCE #1: Adam RD, Elliott SP, Taljanovic MS. The Spectrum and Presentation of Disseminated Coccidioidomycosis. The American Journal of Medicine. 2009;122(8):770-777. doi:10.1016/j.amjmed.2008.12.024 REFERENCE #2: Sotello D, Rivas M, Fuller A, Mahmood T, Orellana-Barrios M, Nugent K. Coccidioidomycosis with diffuse miliary pneumonia. Proc (Bayl Univ Med Cent). 2016 Jan;29(1):39-41. doi: 10.1080/08998280.2016.11929351. PMID: 26722164; PMCID: PMC4677849. DISCLOSURES: No relevant relationships by Nicholas Schlund, source=Web Response No relevant relationships by Aishan Shi, source=Web Response No relevant relationships by Ashley Thomas, source=Web Response

A CRYPTIC COUGH: A RARE CASE OF CRYPTOCOCCAL PNEUMONIA

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Cryptococcal pneumonia is an opportunistic fungal infection caused by Cryptococcus neoformans. Many cases initially present in the lungs of those suffering from HIV/AIDS, diabetes, or on chronic immunosuppressants1. We present a case of a 28-year-old woman with no prior medical history who develops a severe case of cryptococcal pneumonia with factors of exposure or risk. CASE PRESENTATION: 28-year-old female with no prior medical history presents in the setting of a productive cough with yellow-brown sputum for 2 weeks that increased with frequency and severity. The patient presented to the emergency department and an initial computed tomography (CT) angiogram of the chest was performed that revealed a significant left lower lobe pneumonia, leading to her admission (Figure 1). The patient was initially started on levofloxacin and linezolid;however, MRSA, blood and sputum cultures, viral panel, HIV, and Covid-19 tests were all negative. A bronchoalveolar lavage was performed which also had negative cultures and cytology. The patient began to develop fevers, and a cryptococcal antigen was tested that was positive. The patient was started on fluconazole IV, and underwent a successful left video-assisted thoracoscopic surgery (VATS) with lower lobe resection, with the pathology revealing non-necrotizing and focal necrotizing granulomas. A GMS stain revealed numerous yeast forms with narrow based budding, morphologically consistent with Cryptococcus neoformans. The patient had a lumbar puncture that was negative for Cryptococcal antigen, and patient was discharged on oral fluconazole. The fungal culture from the BAL was eventually positive for C. neoformans, 2 weeks later. DISCUSSION: Cryptococcal pneumonia of this magnitude is incredibly rare in an immunocompetent patient, especially someone as young as this patient. The patient did not have any exposure nor risk factors, yet required a VATS procedure to confirm the infection. It would be expected with a cryptococcal pneumonia this severe would produce a more systemic response;however, multiple blood cultures and lumbar punctures were negative for any dissemination. The etiology in this case is still unknown, albeit a significant amount of the population has been exposed to Cryptococcus at some point as a child, especially those living in urban areas2. Our patient was fortunate and has responded quite well to fluconazole therapy, and continues to follow up outpatient without complications. CONCLUSIONS: Cryptococcal pneumonia caused by Cryptococcus neoformans is an opportunistic fungal infection, but has the ability to cause severe illness in those immunocompetent. Blood cryptococcal antigen, lumbar puncture, and at times surgical pathology may be required for those with severe illness, and early antifungal therapy may hasten recovery. REFERENCE #1: Perfect JR, Dismukes WE, Dromer F, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the infectious diseases society of america. Clin Infect Dis. 2010;50(3):291-322. doi:10.1086/649858 REFERENCE #2: Goldman DL, Khine H, Abadi J, et al. Serologic evidence for Cryptococcus neoformans infection in early childhood. Pediatrics. 2001;107(5):E66. doi:10.1542/peds.107.5.e66 DISCLOSURES: No relevant relationships by Wahaaj Khan, source=Web Response No relevant relationships by Joseph Kim, source=Web Response No relevant relationships by Christian von Gizycki, source=Web Response No relevant relationships by Momina Zaman, source=Web Response

Cutaneous Manifestation of Disseminated Cryptococcosis Mimicking Herpes Zoster

Cutaneous cryptococcosis is classified either as localized cutaneous cryptococcosis, in which the lesions are confined to one area of the skin, or as disseminated cryptococcosis, in which cutaneous manifestations are more widespread. We report a case of fatal disseminated cryptococcosis with characteristic cutaneous manifestations. An 84-year-old woman with diabetes presented with crusted plaques and ulcers that were painful, diffuse, and erythematous to crusted and on only the left side of her face, neck, and upper chest. She was referred to our hospital from a local clinic, where herpes zoster had been suspected. She had no specific systemic symptoms. Histological examination of the skin lesion revealed granulomatous reactions and purple to reddish encapsulated spores. Cryptococcus neoformans was identified in fungal culture, and hospitalization was recommended. Oral fluconazole was prescribed, and she was admitted to another hospital. After 2 weeks, the patient's condition deteriorated, and she was transferred to our hospital. C. neoformans antigen was detected in the blood and urine during the evaluation for systemic involvement. The patient was treated with intravenous amphotericin B and fluconazole; however, she died 10 days after admission. Cutaneous manifestations of disseminated cryptococcosis can appear in various forms and mimic molluscum contagiosum, Kaposi's sarcoma, and cellulitis. In this case, the skin lesions occurred on only the left side of the face, neck, and chest, as in herpes zoster. Cutaneous cryptococcosis can occur before the onset of symptoms of systemic involvement; therefore, diagnosis is important. Systemic evaluation may reveal early markers of disseminated cryptococcosis.

Oral Fluconazole Therapy in Patients With Active Ulcerative Colitis Who Have Detectable Candida in the Stool : A Double-Blind Randomized Placebo-controlled Trial.

There is an emerging role of fungal dysbiosis in the pathogenesis of inflammatory bowel disease. Prevalence of Candida in patients with active ulcerative colitis (UC) and the effect of fluconazole therapy in reducing disease activity of UC are not known. All consecutive consenting patients with active UC defined as Mayo score ≥3 were evaluated for presence of Candida by stool culture and predictors for presence of Candida were identified. Those who had evidence of Candida in the stool were randomized to receive oral fluconazole 200 mg daily or placebo for 3 weeks along with standard medical therapy. Patients were assessed by clinical, sigmoidoscopy, and laboratory parameters at baseline and at 4 weeks. The primary outcome was clinical and endoscopic response at 4 weeks defined by a 3-point reduction in Mayo score. Secondary outcomes were reduction in fecal calprotectin, histologic response, and adverse events. Of the 242 patients with active UC, 68 (28%) patients had Candida in stool culture. Independent predictors for presence of Candida in patients with active UC were partial Mayo score of ≥3 and steroid exposure. Among those with Candida on stool culture (n=68), 61 patients fulfilled eligibility criteria and were randomized to receive fluconazole (n=31) or placebo (n=30). Three-point reduction in Mayo score though was numerically higher in the fluconazole group than the placebo group but was not statistically significant [5 (16.1%) vs. 1 (3.33%); P =0.19]. Postintervention median Mayo score was lower in fluconazole than placebo group [4 (3, 5) vs. 5 (4, 6); P =0.034]. Patients in fluconazole group had more often reduction in fecal calprotectin [26 (83.9%) vs. 11 (36.7%); P =0.001] and histologic scores [23 (74.1%) vs. 10 (33.3%); P =0.001] compared with placebo. All patients were compliant and did not report any serious adverse event. Candida colonization is found in 28% of patients with UC. Steroid exposure and active disease were independent predictors for the presence of Candida . There was no statistically significant difference in the number of patients who achieved 3-point reduction in Mayo score between 2 groups. However, clinical, histologic, and calprotectin levels showed significant improvement in fluconazole group.

Оптимизация тактики обследования и лечения женщин репродуктивного возраста с патологией шейки матки при хронических цервицитах и вагинитах

The article is a description of the effectiveness of treatment of patients of reproductive age with chronic nonspecific exo-, endocervicitis and vaginitis in the presence of benign and precancerous diseases of the cervix of the uterus of mild degree. Comparative characteristics of the use of the combined preparation for intravaginal administration Elzhina and intravaginal administration of metronidazole with oral fluconazole were carried out. The advantages of using the drug Elzhina in terms of preoperative preparation over the use of radio wave excisional and surgical methods of treatment are noted. The efficacy, tolerability, and safety of the therapy were also evaluated in both treatment options. It is noted that the drug containing ornidazole 500 mg, prednisolone 3 mg, econazole 150 mg, neomycin 65 000 IU, will reduce the severity of inflammatory processes, which has a beneficial effect on the results of radio wave and surgical methods for the treatment of benign and precancerous diseases of the cervix. Against the background of chronic, long-term nonspecific exo-, endocervicitis and vaginitis

A Four Year Retrospective Study of the Pattern of Fungal Laryngitis in a Tertiary Voice Care Centre.

Isolated Fungal Laryngitis (FL) has recently shown an increased incidence globally and is now being reported even in immunocompetent individuals. In our Voice Clinic we have documented an increasing number of cases of FL, specifically laryngeal candidiasis, with the lesion over the striking zone (anterior 1/3rd posterior-2/3rd) of vocal folds. Our objective was to study the sites of involvement of FL within the glottis along with a review of literature. A 4year retrospective study was performed by reviewing clinical and stroboscopic recordings of all patients diagnosed as FL at our Voice clinic. Age, gender, presenting complaints, co-morbidities, history of steroid intake orally or via inhalation and stroboscopic findings were noted as was response to antifungals and duration of treatment. A total of 55 cases were diagnosed with FL (all laryngeal candidiasis) between 2016 and 2019. Majority of them were immunocompetent, middle aged (41-60years) males. Hoarseness was the most common presenting complaint. On stroboscopy, the striking zone involvement was seen in 89.1% cases. On comparing site of involvement a chi-square value of 115.58; p <0.0001 was obtained. Complete resolution of the disease was observed after 3weeks of oral Fluconazole in 65.5% patients while 27.3% needed treatment for 6weeks and 7.2% did not improve necessitating excision of the lesion. Our study indicates the striking zone to be the most common site of involvement in patients with glottic FL. Statistical comparison between the sites of larynx affected revealed a p value< 0.0001.

Antifungal susceptibility testing with YeastONE™ is not predictive of clinical outcomes of Cryptococcus neoformans var. grubii fungemia.

Mortality rates due to Cryptococcus neoformans var. grubii fungemia remain significant despite treatment with antifungal drugs. The predictive function of antifungal susceptibility and its correlation with treatment outcome remains controversial. A retrospective study was conducted from January 1, 2009, to December 31, 2016, on 85 patients with C. neoformans var. grubii fungemia confirmed by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry. Antifungal drug susceptibility was determined using the YeastONE™ colorimetric broth microdilution method coupled with Vizion™ System following the Clinical and Laboratory Standards Institute guidelines. Six antifungal agents-amphotericin B, fluconazole, flucytosine, itraconazole, posaconazole, and voriconazole-were tested. The patients' demographic data and clinical information were abstracted for further analyses. Antifungal regimens consisting of amphotericin B with or without fluconazole or flucytosine were administered for induction treatment of these patients, followed with intravenous or oral fluconazole for maintenance therapy. Clinical outcomes were defined by 14- and 30-day mortality rates. Risk factors associated with outcomes were fitted in a logistic regression model by univariate or multivariate method. Eighty-five patients with C. neoformans var. grubii fungemia were enrolled in the study. The Sequential Organ Failure Assessment Score, Glasgow Coma Scale, Charlson comorbidity score, and adequate duration of therapy for amphotericin B were predictors for mortality in univariate analysis. Antifungal susceptibility testing with YeastONE™ does not predict clinical outcomes of C. neoformans var. grubii fungemia. Greater disease severity, high comorbidities, poor consciousness level, and inappropriate treatment were associated with increased mortality in cryptococcemia cases.

27437 Disseminated Candida tropicalis in an immunocompromised pediatric patient

We report a case of a 12-year-old female with newly diagnosed B-cell acute lymphoblastic leukemia status post induction chemotherapy with hospital course complicated by Candida tropicalis fungemia requiring fluconazole. Two weeks after treatment initiation, she presented with a new onset fever and discrete erythematous papules, some with pseudovesicular appearance, along with erythematous macules and thin plaques localized to the upper extremities. At presentation, labs demonstrated pancytopenia, elevated beta-D-glucan assay (>500), and Candida tropicalis growth on both wound and tissue culture. Blood cultures were negative. Computed tomography with contrast demonstrated hypodense areas involving the liver, spleen, and pectoralis major muscle concerning for fungemic microabscesses. A right arm punch biopsy revealed a dense dermal inflammatory infiltrate consisting of numerous neutrophils, histiocytes, lymphocytes and eosinophils. Periodic acid Schiff diastase and Gomori methenamine silver stains highlighted many associated fungal organisms. A diagnosis of disseminated candida tropicalis was rendered. Treatment was changed from oral fluconazole to intravenous micafungin. Although her cutaneous involvement improved, she remained febrile. She was switched to amphotericin B and prednisone with marked improvement. This case highlights the difficulty in management of disseminated Candida tropicalis in immunosuppressed pediatric patients. The observed disseminated disease may be explained by emerging resistance of Candida tropicalis to fluconazole. Improvement of fever with prednisone supports the hypothesis that disseminated candidiasis causes an inflammatory response and emphasizes the importance of adjuvant corticosteroid therapy. Cutaneous involvement may indicate underlying disseminated disease, and dermatologists are crucial in the diagnosis and treatment of this opportunistic, often fatal disease.

Alemtuzumab for Treatment-Naïve and Relapsed-Refractory Severe Acquired Aplastic Anemia

Introduction: Antithymocyte globulin (ATG) + cyclosporine is effective in restoring hematopoiesis in severe aplastic anemia (SAA). Horse ATG appears to be better than rabbit ATG. Limitations to ATG use in developing countries include cost, horse ATG availability and the reduced number of hospital beds in hematology treatment centers are frequent. Alemtuzumab, a humanized anti-CD52 mAb, might be active in SAA because of its lymphocytotoxic properties. Subcutaneous alemtuzumab have about ORR 66% and is available in Brazil through a compassionate use program. Methods: Fourteen consecutive transplant-ineligible SAA patients were treated. Alemtuzumab was administered subcutaneously in a single at escalating dose of 3-10-30-(30)-(30) mg. Premedication included intravenous steroid, antihistamine and oral acetaminophen. The total dose was 103 mg for 14 patients, and 43 mg for one elderly frail patient. Low dose (1 mg/kg) oral cyclosporine was started on day 7, and then adjusted according to plasma levels (targeting 100-200 ng/ml using a monoclonal assay) at the time of immune reconstitution. Anti-infectious prophylaxis included oral acyclovir and trimethoprim-sulphametoxazole, weekly monitoring of CMV viraemia, and oral quinolone and fluconazole in case of severe neutropenia (<0.5x 109/L). Results: Fifteen SAA patients were treated. Primary outcome was hematologic response at 3months. Median age was 48 years, and 9 (60%) were male. Eight patients were treatment-naive, and 7 (46%) were relapsed-refractory. Eight patients presented PNH clone at the initial investigation, with a size clone between 0.001 to 55 in granulocytes and 0.001 to 98 in monocytes. Median time between SAA diagnosis and alemtuzumab treatment was 9 months (range 1-300). No treatment-related serious adverse events due were observed. Infectious complications were rare. The overall response rate was 66% (60% with PR, 40% CR). The median follow-up is about 29 months (range 5-69). The 3-year overall survival was 73%. Conclusion: The combination of subcutaneous alemtuzumab + cyclosporine appears to be effective and sufficiently safe in transplant-ineligible SAA patients. Moreover, it is feasible in a scenario of limited resources and low accessibility to ATG. DisclosuresNo relevant conflicts of interest to declare.