The safety and efficacy of itraconazole for the treatment of patients with eumycetoma due to Madurella mycetomatis
The safety and efficacy of itraconazole for the treatment of patients with eumycetoma due to Madurella mycetomatis
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DOI：
10.1016/j.trstmh.2010.11.008
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发表时间：
2011-03-01
影响因子：
2.2
通讯作者：
Zijlstra, E. E.
中科院分区：
文献类型：
--
作者：
Fahal, A. H.;Rahman, I. A.;Zijlstra, E. E.
本前瞻性研究旨在确定伊曲康唑治疗马杜洛菌所致足菌肿患者的安全性和有效性。该研究包括13名确诊疾病的患者；所有患者均口服伊曲康唑，剂量为每日400毫克，持续三个月，之后剂量减少至每日200毫克，持续九个月。所有患者每日400mg伊曲康唑均表现出良好的临床反应，但当剂量减少至200mg时，临床反应逐渐缓慢。术后手术探查显示，所有患者病灶定位良好，包被厚囊，手术切除容易。在所有这些损伤中均发现了菌落，并在培养中存活。术后活检显示颗粒形态无明显变化。一个恒定的发现是在一个由纤维组织围成的腔中存在5-7粒颗粒。颗粒周围的反应为I型组织反应，其特征是颗粒周围有中性粒细胞区。术后随访时间不等（18-36个月），仅有1例复发。对于真菌性肿患者，术前可采用伊曲康唑进行初步治疗，以加强病灶的包封和定位，方便大面积局部切除，避免不必要的大面积毁伤手术和复发。(C) 2010年皇家热带医学和卫生学会。Elsevier Ltd.出版。版权所有。
This prospective study aimed to determine the safety and efficacy of itraconazole for the treatment of patients with mycetoma due to Madurella mycetomatis. The study consisted of 13 patients with confirmed disease; all were treated with oral itraconazole in a dose of 400 mg daily for three months after which the dose was reduced to 200 mg daily for nine months. All patients showed good clinical response to 400 mg itraconazole daily, but when the dose was reduced to 200 mg daily, the clinical response was gradual and slow. Post-treatment surgical exploration showed that, in all patients, the lesions were well localized, encapsulated with thick capsule and they were easily removed surgically. In all these lesions, grains colonies were encountered and they were viable on culture. Post-operative biopsies showed no significant changes in the morphology of the grains. A constant finding was the presence of between 5-7 grains in a single cavity walled by fibrous tissue. The reaction surrounding the grains was a Type I tissue reaction characterized by a neutrophil zone around grains. Patients were followed up post-operatively for variable periods (range 18-36 months) and only one patient had recurrence. Initial pre-operative treatment with itraconazole may be recommended for eumycetoma patients to enhance lesions encapsulation and localization which can facilitate wide local excision to avoid unnecessary massive mutilating surgery and recurrence. (C) 2010 Royal Society of Tropical Medicine and Hygiene. Published by Elsevier Ltd. All rights reserved.