Signs Of Fungal Infection Research Articles

Haemopoietic Cell Transplantation of Patients with a History of Deep or Invasive Fungal Infection during Prophylaxis with Liposomal Amphotericin B

Relapse of a preceding fungal infection is a considerable risk during haemopoietic stem cell transplantation. The optimal secondary prophylaxis has not been found so far since the application of standard drugs is hampered by potential ineffectiveness or intolerable side effects. This investigation describes haemopoietic cell transplantation of patients with a history of invasive or systemic fungal infection (IFI). The strategy was either administration of liposomal amphotericin B as secondary prophylaxis or an early switch to liposomal amphotericin B after administration of azoles. The 43 patients had a history of proven (n = 14), probable (n = 14) and possible (n = 15) IFI. Twenty-eight patients (65%) could be discharged from the BMT ward without signs of mycosis. Transplant-related mortality was 35%. Overall, 12 fungus-related (IFI) deaths (28%) occurred. The percentage of fungus-related deaths was highest in the ‘proven’ group with 43% compared to 20 and 21% in the two other groups. Side effects of liposomal amphotericin B were low. A discontinuation of the drug was not necessary in any patient. Serum creatinine showed a slight increase to 128% (median) of the baseline allowing continuous administration of concomitant nephrotoxic drugs such as cyclosporin A. In conclusion, secondary prophylaxis with or early switch to liposomal amphotericin B facilitates allogeneic stem cell transplantation of patients with a history of IFI with minor side effects. However, fungal infections and transplant-related mortality remain major problems in this often heavily pretreated subgroup of patients.

Invasive fusariosis in two transplanted children.

Here we report on two children with leukaemia and Fusarium infection. The first patient was a boy with ALL in whom signs of fungal infection appeared during induction therapy and after 13 days of profound neutropenia (Fig. 1). Cultures were positive for Fusarium solani. The patient was treated with liposomal amphotericin B and gradually the fungal lesions resolved. Allogenic BMT was performed 11 months after the initial ALL diagnosis and 6 months after the last positive culture of Fusarium solani (Table 1). The patient engrafted, but developed acute and chronic graft-versus-host disease (GVHD). About 2 months before the patient died, both pharyngeal and faecal cultures were again transiently positive for Fusarium solani without any attributable symptoms. Liposomal amphotericin B was continued throughout the transplant course. Despite the aggressive therapy, the patient succumbed 6 months post-transplant. The parents refused an autopsy. The second patient was a boy who was transplanted 4 months after an AML relapse. Two months post-transplant after developing acute GVHD and following prolonged febrile neutropenia, empiric liposomal amphotericin B was initiated and thereafter given continuously. Five months after the first BMT he received a second graft from another donor for delayed rejection (Table 1). Six months after the first BMT and 1 month after the second one, small pustules were noticed on his skin. Ten days before his death, faecal surveillance cultures were positive for Fusarium. He died 6.5 months after the first BMT.

Prevalence of Foot and Ankle Conditions in a Multiethnic Community Sample of Older Adults

The prevalence of foot and ankle disorders was determined in a community-based, multiethnic (non-Hispanic White, African American, and Puerto Rican) random sample of 784 community-dwelling adults aged 65 or more years in 2001-2002 in Springfield, Massachusetts. Overall, the five most common conditions were toenail disorders (74.9%), lesser toe deformities (60.0%), corns and calluses (58.2%), bunions (37.1%), and signs of fungal infection, cracks/fissures, or maceration between toes (36.3%); 30.9% had some tenderness to palpation of the foot or ankle, and 14.9% had ankle joint pain on most days in the past 4 weeks. Toenail conditions, fungal symptoms, and ulcers or lacerations were more common in men, while bunions and corns and calluses were more common in women (p < 0.001). Significant racial/ethnic differences, independent of education or gender, were found for the prevalence of most toe deformities and flat feet, as well as for corns and calluses, fungal signs, edema, ankle joint pain, tenderness to palpation, and sensory loss. Foot and ankle disorders are common in these older adults. Examination of their prevalence in different segments of the community may inform future studies to determine etiology and means of prevention.