| Autor: |
Elder, Joshua J., Harwood, Kyle A., Gulley, Savannah L., Infanti, Lisa M., Holt, Mason T. |
| Předmět: |
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| Zdroj: |
Journal of Hematology Oncology Pharmacy; Jun2022, Vol. 12 Issue 3, p151-157, 7p |
| Abstrakt: |
BACKGROUND: Fusariosis is an opportunistic fungal infection that leads to significant morbidity and mortality in many immunocompromised patients. The incidence of mortality ranges from 50% to 70% in immunocompromised hosts, such as patients undergoing hematopoietic stem-cell transplant (HSCT) or patients diagnosed with a hematologic malignancy. Although recommendations exist for the preferred treatment, the optimal treatment of Fusarium infections remains unclear, and escalation to combination, salvage, or adjunctive therapies may be warranted. OBJECTIVE: To describe the clinical presentation and management of highly resistant, disseminated Fusarium infections in 2 immunocompromised pediatric patients. DISCUSSION: The difficulty of prompt detection and diagnosis of Fusarium infection and the nonstandardized susceptibility breakpoints are factors contributing to high mortality rates in immunocompromised patients with Fusarium infection. After disease stabilization, managing prophylactic therapies remains a crucial hurdle to prevent relapse or progression of invasive Fusarium infections. The 2 cases presented here provide the clinical rationale for using combination intravenous antifungal therapy with voriconazole and liposomal amphotericin B. The first case involved a 6-year-old patient with stage IV neuroblastoma requiring HSCT; the second case was a 13-year-old patient with B-cell acute lymphoblastic leukemia who was undergoing induction chemotherapy. Both patients had renal dysfunction and ultimately received maintenance therapy with a prophylactic regimen of liposomal amphotericin B. CONCLUSION: The treatment of Fusarium infection in immunosuppressed patients, including those with malignancy, presents many challenges for clinicians. The 2 complex patients discussed here provide strategies to address the common clinical hurdles encountered in the treatment of this patient population, highlighting the need for further management guidance. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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