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The incidence of disseminated and deep mycotic infections was investigated in 64 autopsy cases with disorders of the hematopoietic tissue experienced in the past 5 years. The overall incidence of fungal infections was 45%. The average incidence among patients with acute leukemia was similar to that found in patients with non-leukemic diseases including malignant lymphoma, aplastic anemia, multiple myeloma, etc. Candida albicans and Aspergillus dominated the major pathogenic fungal strains followed by Mucor and Cryptococcus. Fungi were identified most frequently in the lung and digestive tract. The incidence of these mycotic infections and severe bacterial infections was strikingly high among patients whose circulating neutrophil counts within a week before demise were below 500/mm3. Ulceration, erosion and necrotic changes in the gastrointestinal mucosa were also common in severely neutropenic patients.
In a separate study, 10 hospitalized patients with acute leukemia were given an oral regimen of the combination of gentamycin sulfate 600 mg, amphotericin B 2000 mg and kanamycin 2000 mg daily divided in 4 doses while they were neutropenic below 500/mm3. Only well-cooked diet was offered to these patients while they were given this oral antibiotic regimen. Serial fungal colony counts of feces of these patients revealed that the growth of fungi in feces was clearly suppressed while the patients were under this antibiotic regimen. There was no evidence of clinically apparent mycotic infections in these patients during the study.
Seven of the 10 patients underwent complete or incomplete hematological remission while the remaining 3 died during the hospitalization without achieving remission from anti-leukemic chemotherapy. The direct causes of death in these 3 mortalities were Pseudomonas septicemia, hemorrhage and probable bacterial infection, respectively. A single incidence of nausea was observed during the therapy. The combination of gentamycin sulfate, amphotericin B and kanamycin by oral route appears to be a useful adjunct to the anti-leukemic therapy of patients whose resistance against mycotic and bacterial infections is at harzard from severe neutropenia.
