P Kochendörfer | PubMed Health

PubMed1990

[Fungal peritonitis].

Mycotic peritonitis can be demonstrated by microbiological, histological and serological tests. The disease can be proved histologically by a deep invasion of fungi. Initially, the mycotic peritonitis can be caused by polymicrobial infections and also by genuine mycotic invasion after perforation of the gastrointestinal tract. In the final phase of the disease only these fungi are of relevance. In most of the cases candida albicans can be verified. In the procedure of programmed peritoneal lavage the mycotic peritonitis provides a severe complication. Untreated, it would cause death by dissemination, fungemia and candida sepsis. 8 out of 12 patients with candida peritonitis died. Most of the patients had been severely ill previously and had shown several risk factors promoting mycotic disease. Antimycotic treatment has to be initiated as soon as possible, in order to diminish the high lethality.

Adult↗

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Comparative study of the efficacy of fluconazole versus amphotericin B/flucytosine in surgical patients with systemic mycoses.

In an open, prospective, randomized study, the efficacy of fluconazole was compared with that of the combination amphotericin B/flucytosine. Forty surgical patients with deep-seated mycoses were included in the study. Absolute inclusion criteria were histological finding of fungi in a tissue sample taken during surgery from e.g. peritoneum, pancreas, lungs or trachea, a positive blood culture or candida lesion of the eye. According to the random list 20 patients received up to 0.5 mg amphotericin B per kg body weight in combination with 3 x 2.5 g flucytosine (5-FC) daily and 20 patients received fluconazole, 400 mg on the first day and then 300 mg daily. The two therapy groups were comparable in terms of age, sex and underlying diseases. Gastrointestinal perforations (27 times) were the most frequent underlying diseases. Candida albicans was the fungus most frequently detected microbiologically (34 times). The pathogens were eliminated from 12 patients in the fluconazole group and 14 patients in the combination group. The median elimination time was 8.5 days in the fluconazole group and 5.5 days in the amphotericin B/5-FC group. Six patients died in the fluconazole group, whereas five patients died in the comparison group. Side effects which necessitated switching of therapy occurred twice in the combination group. In deep-seated candida mycoses, surgical patients receiving the combination therapy with amphotericin B/5-FC showed an earlier elimination than patients on monotherapy with fluconazole. With respect to cure rates there was no difference between these two regimens.

Adult↗