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Last Generation Triazoles for Imported Eumycetoma in Eleven Consecutive Adults
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نویسنده
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crabol y. ,poiree s. ,bougnoux m.-e. ,maunoury c. ,barete s. ,zeller v. ,arvieux c. ,pineau s. ,amazzough k. ,lecuit m. ,lanternier f. ,lortholary o.
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منبع
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plos neglected tropical diseases - 2014 - دوره : 8 - شماره : 10
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چکیده
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Background: optimal management of eumycetoma,a severely debilitating chronic progressive fungal infection of skin,disseminating to bone and viscera,remains challenging. especially,optimal antifungal treatment and duration are ill defined. methodology/principal findings: we conducted a monocentric retrospective study of 11 imported cases of eumycetoma treated by voriconazole or posaconazole for at least 6 months. response to treatment was assessed through evolution of clinical and magnetic resonance imaging (mri). (1→3) ß-d-glucan (bg) and positron emission tomography using [18f] fluorodeoxyglucose (pet/ct) results were also assessed. identified species were fusarium solani complex (n = 3); madurella mycetomatis,(n = 3),and exophiala jeanselmei,(n = 1). moreover,two coelomycetes and one phaeohyphomycetes strains without species identification were retrieved. serum bg and pet/ct were abnormal in 7/8 and 6/6 patients tested,respectively. patients received last generation azoles for a mean duration of 25.9±18 months. complete response (major clinical and mri improvement) was observed in 5/11 patients,partial response (minor mri improvement or stable mri findings) in 5 and failure (mri evidence of disease progression) in one,with a 73±39 [6–132] months mean follow-up. relapse occurred in 2 patients after treatment discontinuation. optimal outcome was associated with fungal species,initiation of last generation triazole therapy (<65 months since first symptoms),negative serum bg and pet/ct normalization. conclusions/significance: mri,pet/ct and serum bg appear as promising tools to assess optimal time of antifungal treatment for eumycetoma. © 2014 crabol et al.
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آدرس
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centre d’infectiologie necker pasteur,université paris descartes,sorbonne paris cité,institut imagine,hôpital universitaire necker-enfants malades,aphp,paris, France, service d’imagerie médicale,hôpital necker-enfants malades,paris, France, laboratoire de parasito-mycologie,hôpital universitaire necker-enfants malades,cnrs ura3012,paris, France, unité de médecine nucléaire et tep,université paris descartes,hôpital européen georges pompidou,paris, France, service de dermatologie,hôpital tenon,aphp,université pierre et marie curie,paris, France, service de médecine interne,groupe hospitalier diaconesses croix saint-simon,paris, France, service de maladies infectieuses et réanimation médicale du centre hospitalier universitaire de rennes,rennes, France, hôpital universitaire de nantes,service des maladies infectieuses et tropicales,nantes, France, centre d’infectiologie necker pasteur,université paris descartes,sorbonne paris cité,institut imagine,hôpital universitaire necker-enfants malades,aphp,paris, France, centre d’infectiologie necker pasteur,université paris descartes,sorbonne paris cité,institut imagine,hôpital universitaire necker-enfants malades,aphp,paris,france,unité de biologie des infections,institut pasteur,inserm,paris,u1117, France, centre d’infectiologie necker pasteur,université paris descartes,sorbonne paris cité,institut imagine,hôpital universitaire necker-enfants malades,aphp,paris, France, centre d’infectiologie necker pasteur,université paris descartes,sorbonne paris cité,institut imagine,hôpital universitaire necker-enfants malades,aphp,paris,france,unité de mycologie moléculaire,institut pasteur,centre national de référence mycoses invasives et antifongiques,paris, France
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Authors
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