Nihal ÖZDEMİR, Başak KOÇ, Serda KANTARCIOĞLU, Sebuh KURUOĞLU, Tiraje CELKAN

Akut Lenfoblastik Lösemili Üç yaşında Bir Çocukta İnvaziv Mantar Enfeksiyonunun Posakonazol ile Başarılı Tedavisi

İnvaziv mantar enfeksiyonları, özellikle albicans dışı Candida gibi mayalar, artan immün-baskılanmış hasta sayısı ve oluşan mantar direnci nedeniyle artış göster- mektedir. Son on yılda bu enfeksiyonların tedavisi için yeni antifungal ilaçlar geliştirilmiştir. Bu yazıda akut lenfoblastik lösemili 3 yaşında bir kız çocukta Candida albicans’a bağlı gelişen invazif kandida enfeksiyonu bil- dirilmiştir. Lipozomal amfoterisin B, kaspofungin ve vori- konazolün tek başına ve bu ilaçların birlikte tedavisine rağmen hastanın ateşi ve klinik durumunda düzelme olmamış, tedaviye posakonazol eklenmesiyle düzelme görülmüştür. Devam tedavisi sırasında mantar enfeksiyo- nu kontrol altında kalmış ve posakonazol profilaksisi altında tekrarlamamıştır

Anahtar Kelimeler:

Candida albicans, mantar enfeksiyonu, antifungal

Akut Lenfoblastik Lösemili Üç yaşında Bir Çocukta İnvaziv Mantar Enfeksiyonunun Posakonazol ile Başarılı Tedavisi

Invasive fungal infections, especially non-Candida albicans, are increasing because of the increasing number of immuno- compromised patients and resistance to fungal infectons. New drugs for the treatment of antifungal infections have been developed in the last decade. We report a 3-year-old girl with acute lymphoblastic leukemia who developed inva- sive Candida infection caused by Candida albicans. Despite single and combined therapy with liposomal amphotericin B, caspofungin and voriconazole, patient’s fever and clinical condition were improved only after addition of posaconazole to the treatment. During maintenance therapy BFM-95 ALL treatment for standard risk group for ALL, fungal infection remained under control and did not recur under posacon- azole prophylaxis

Keywords:

Candida albicans, fungal infection, anti-fungal,

PDF

___

Pagano L, Caira M, Candoni A, et al. The epidemio- logy of fungal infections in patients with hematologic malignancies: the SEIFEM- 2004 study. Haematologica 2006;91:1068-75.
Ascioglu S, Rex JH, de Pauw B, et al. Defining oppor- tunistic invasive fungal infections in immunocompro- mised patients with cancer and hematopoietic stem cell transplants: an international consensus. Invasive Fungal Infections Cooperative Group of the European Organization for Research and Treatment of Cancer; Mycoses Study Group of the National Institute of Allergy and Infectious Diseases. Clin Infect Dis. 2002;34:7-14.
Steinbach WJ, Benjamin DK. New antifungal agents under development in children and neonates. Curr Opin Infect Dis. 2005;18:484-9.
Dvorak CC, Fisher BT, Sung L, et al. Antifungal proph- ylaxis in pediatric hematology/oncology: new choices & new data. Pediatr Blood Cancer 2012;59:21-6.
Krishna G, Sansone-Parsons A, Martinho M, Kantesaria B, Pedicone L. Posaconazole plasma concentrations in juvenile patients with invasive fungal infection. Antimicrob Agents Chemother. 2007;51:812-8.
Cesaro S, Milano GM, Aversa F. Retrospective survey on the off-label use of posaconazole in pediatric hema- tology patients. Eur J Clin Microbiol Infect Dis. 2011;30:595-6.
Groll AH, Lehrnbecher T. Posaconazole for paediatric patients: status of development and future perspectives. Mycoses 2008;51 (Suppl. 2):5-11.
Grigull L, Beier R, Schrauder A, et al. Invasive fungal infections are responsible for one-fifth of the infectious deaths in children with ALL. Mycoses 2003;46:441-6.
Özdemir N, Tüysüz G, Çelik N, et al. Febrile neutrope- nia in children with acute lymphoblastic leukemia: single center experience. Turkish Archives of Pediatrics/ Türk Pediatri Arşivi 2016;51(2):79-86.
Cornely OA, Maertens J, Winston DJ, et al. Posaconazole vs. fluconazole or itraconazole prophylaxis in patients with neutropenia. N Engl J Med. 2007;25;356:348-59.
Lehrnbecher T, Attarbaschi A, Duerken M, et al. Posaconazole salvage treatment in paediatric patients: a multicentre survey. Eur J Clin Microbiol Infect Dis. 2010;29:1043-5.
Rachwalski EJ, Wieczorkiewicz JT, Scheetz MH. Posaconazole: an oral triazole with an extended spect- rum of activity. Ann Pharmacother. 2008;42:1429-38.
Schiller DS, Fung HB. Posaconazole: an extended- spectrum triazole antifungal agent. Clin Ther. 2007;29:1862-86.
Raad II, Graybill JR, Bustamante AB et al. Safety of long-term oral posaconazole use in the treatment of refractory invasive fungal infections. Clin Infect Dis. 2006;42:1726-34.
Arendrup MC, Dzajic E, Jensen RH, et al. Epidemiological changes with potential implication for antifungal prescription recommendations for fungae- mia: data from a nationwide fungaemia surveillance programme. Clin Microbiol Infect. 2013;19:E343-53.
Firinu D, Massidda O, Lorrai MM, et al. Successful treatment of chronic mucocutaneous candidiasis cau- sed by azole-resistant Candida albicans with posacona- zole. Clin Dev Immunol. 2011;2011:283239.
Chen YL, Lehman VN, Averette AF, Perfect JR, Heitman J. Posaconazole exhibits in vitro and in vivo synergistic antifungal activity with caspofungin or FK506 against Candida albicans. PLoS One 2013;8:e57672.