1994 Volume 42 Issue 11 Pages 1299-1304
Sixty-nine patients with hematopoetic malignancies who were complicated with severe opportunistic infection were studied. Ten of them were diagnosed as having mycosis, and 33 of the remaining 59 patients were suggested to have fungal infections.β-D-glucan was positive in 12 (17.4%) of the patients. The positivity rates for β-D-glucan in patients who were diagnosed as having mycosis, in those whose infection was strongly suspected to be mycosis were 80.0% and 12.1% respectively. The differences inthe positivity rates of β-D-glucan among those three groups were statistically significant. These results suggest that the measurement of β-D-glucan is useful for diagnosing deep mycosis. β-D-glucan was more frequently detected during the neutropenic state in patients with acute myeloid leukemia, while the frequency of positive β-D-glucan was higher during the lymphopenic state in patients with malignant lymphoma. Fluconazole (FLCZ) was effective against fungal infections in 27 (65.1%) of 43 patients in whom it was administered. Combined therapy with FLCZ and G-CSF was effective in 11 (61.1%) of 18 patients, while treatment with FLCZ alone was effective in 17 (68.0%) of 25 patients. These results suggest that G-CSF has no significant additive benefit to FLCZ against fungal infections. Although the measurement of β-D-glucan is useful for diagnosing deep mycosis, it was positive in only a few patients with localized fungal infection. In such patients, it is important to confirm the diagnosis by using the combination of several tests for fungal infection. FLCZ was considered effective for the treatment of mycosis associated with hematopoietic malignancies.
