EFFICACY OF FLUCONAZOLE ON SYSTEMIC MYCOSIS ASSOCIATED WITH HEMATOLOGIC MALIGNANCIES AND A STUDY ON DIAGNOSTIC VALUE OF PLASMA β-D-GLUCAN LEVELS

Abstract

Efficacy of fluconazole (FLCZ), an anti-fungal agent of triazole derivatives, was evaluated in patients with systemic mycoses and suspected mycoses associated with hematologic malignancies including leukemia, myelodysplastic syndrome and malignant lymphoma. Plasma β-D-glucan levels, the differences between the levels determined toxicolor test and in endospecy test, were also investigated.
Fourteen patients with systemic mycoses and 31 patients with suspected mycotic infections were treated with intravenous administration of FLCZ at a daily dose of 400 mg. Exellent to good responses were observed in 4 of the 14 patients (28.6%) with definitive diagnosis of mycosis, and in 18 of the 31 patients (58.1%) with suspected fungal infections, with an overall efficacy rate of 48.9% (22/45).
Levels of plasma β-D-glucan correlated well with efficacies of FLCZ in 19 of 30 patients. In several cases, however, plasma β-D-glucan levels were low during the entire course of treatment. Even in 10 cases of definite mycosis, 4 cases showed low levels of plasma β-D-glucan (below 15 μg/ml by repeated determinations).
The results indicate that FLCZ is an effective agent for the treatment of severe systemic fungal infections in patients with hematologic disorders. Deep seated mycosis cannot be ruled out even when its plasma levels of β-D-glucan are low.