抄録
In recent years there has been a considerable increase in the incidence of deep mycoses in the field of internal medicine in Japan. Advances in medical mycology in this area over the past 10 years and future concerns are discussed.
Sustained candidemia caused by candidal suppurativie peripheral thrombophlebitis during prolonged intravenous therapy is curable by excision of the affected vein and by adjunct therapy with antifungal agents.
The latex agglutination test for cryptococcal antigen in the CSF is of diagnostic and prognostic value. The test is also valuable to indicate completion of chemotherapy. Cryptococcuria should be attached great importance in prediction of disseminated cryptococcosis.
A discrete clinical entity and a variant of invasive aspergillosis (such as chronic necrotizing pulmonary aspergillosis or pseudomembranous necrotizing bronchial aspergillosis) have been reported. The natural history of pulmonary aspergilloma is fairly clarified. There have been a considerable numbers of reported cases of acute leukemia with previously normal roentgenographs which subsequently developed air crescents (an appearance mimicking pulmonary aspergilloma) as a manifestation of invasive pulmonary aspergillosis. Such a change in roentgenographic appearance should be kept in mind when diagnosis is discussed with patients. Recenly, diagnosis of invasive aspergillosis by an ELISA for circulating antigen has been attempted.
It remains quite difficult to diagnose and treat pulmonary mucormycosis except for chronic localized pulmonary involvement. It is difficult not to be somewhat pessimistic as one considers our present state of knowledge of mucormycosis.
There have also been large numbers of reported deep mycoses due to species formerly considered nonpathogenic as well as new clinical conditions due to species previously recognized as pathogenic.
Several imported cases of coccidioidomycosis, paracoccidioidomycosis and histoplasmosis have been reported in Japan.
Combined antifungal therapy using amphotericin B and flucytosine is recommended in cryptococcal meningitis and perhaps also in candidosis. Distribution and activity of amphtericin B in humans have been investigated by HPLC and carry promising results. Therapeutic efficacy of liposomal amphotericin B has been demonstrated in a small number of patients with hematologic malignancies complicated by fungal infections. Miconazole is now available and ketoconazole also will be available in the near future in Japan. Further studies in many more cases of deep mycoses are necessary for a full evaluation of medical therapy with these synthetic imidazoles.
Future problems include : (i) serologic diagnosis (especially diagnosis by determinations of fungal antigen titers). (ii) full evaluation of existing antimycotics and of combination therapy with antimycotics. (iii) an institution of ideal empiric chemotherapy in pneumonias including mycotic involvements in immunosuppressed patients. (iv) developments of new antimycotics.
