treatment of Systematic Sporotrichosis with Ketoconazole

Calhoun, David L.; Waskin, Hetty; White, Michael P.; Bonner, James R.; Mulholland, John H.; Rumans, Larry W.; Stevens, David A.; Galgiani, John N.

doi:10.1093/clinids/13.1.47

Cited by 40 publications

(17 citation statements)

References 11 publications

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“…This finding is similar to observations from regions such as Chiba, Japan, and Abancay, Peru, where the frequency of disseminated sporotrichosis ranges from 0.5% to 9%, 2,21 but contrasts with trials carried out in the United States, where up to half of patients showed extracutaneous manifestations, mainly pulmonary or osteoarticular involvement. 56,57 AIDS and other immunodeficiencies such as alcoholism, diabetes, and chronic obstructive pulmonary disease appear to be risk factors for the development of extracutaneous and disseminated forms of the disease, 8,58-61 but, once again, ecologic factors may be involved in the predominance of one form over the others.…”

Section: Discussionmentioning

confidence: 99%

“…Many authors agree that direct examination of pus or biopsy specimen material from lesions is usually unhelpful for the Table III. Comparison between number of cases of sporotrichosis diagnosed and number of inhabitants of Rio Grande do Sul, Brazil 1967-19701971-19801981-19901991 No. of cases/y, mean 9.0 9.8 10.7 6.0 2.0* Metropolitan population 10 diagnosis of sporotrichosis because of the paucity of fungal cells.…”

Section: Discussionmentioning

confidence: 99%

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Epidemiology of sporotrichosis: A study of 304 cases in Brazil

Rosa¹,

Scroferneker²,

Vettorato³

et al. 2005

Journal of the American Academy of Dermatology

159

120

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Epidemiology of sporotrichosis: A study of 304 cases in Brazil

Rosa¹,

Scroferneker²,

Vettorato³

et al. 2005

Journal of the American Academy of Dermatology

159

120

View full text Add to dashboard Cite

“…Meanwhile, the clinical correlation between MICs and therapeutic responses has not been established; the low MICs of IZ give certain support to consider this azole as the treatment of choice for mild sporotrichosis (10). KZ has also been administered at doses from 400 to 800 mg/day in patients infected by S. schenckii with favorable results (3).…”

Section: Discussionmentioning

confidence: 99%

In Vitro Susceptibility of Sporothrix schenckii to Six Antifungal Agents Determined Using Three Different Methods

Alvarado-Ramírez

Torres-Rodríguez

2007

Antimicrob Agents Chemother

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The in vitro susceptibility of Sporothrix schenckii to antifungal drugs has been determined with three different methods. Nineteen Peruvian clinical isolates of S. schenckii were tested against amphotericin B (AB), flucytosine (FC), fluconazole (FZ), itraconazole (IZ), voriconazole (VZ), and ketoconazole (KZ). Modified NCCLS M38-A, Sensititre YeastOne (SYO), and ATB Fungus 2 (ATBF2) methods were used to determine the MICs. ATCC isolates of Candida parapsilosis, Candida krusei, and Aspergillus flavus were used for quality control. Sporothrix inocula were prepared with the mycelial form growing on potato dextrose agar at 28 ؎ 2°C. MICs of AB, FC, FZ, and IZ were determined with all three methods, VZ with M38-A and SYO, and KZ with only SYO. The three methods showed high MICs of FZ and FC (MIC 90 of 0.5 g/ml), being homogeneously lower than those of IZ and KZ. The M38-A method showed a variable MIC range of VZ (4.0 to 16 g/ml); the geometric mean (GM) was 9.3 g/ml. The MIC range of AB was wide (0.06 to 16 g/ml), but the GM was 1.2 g/ml, suggesting that the MIC is strain dependent. Agreement (two log 2 dilutions) between commercial techniques and the modified M38-A method was very high with FZ, IZ, and FC. In AB and VZ, the agreement was lower, being related to the antifungal concentrations of each method. The highest activity against S. schenckii was found with IZ and KZ. Lack of activity was observed with FZ, VZ, and FC. When AB is indicated for sporotrichosis, the susceptibility of the strain must be analyzed. Commercial quantitative antifungal methods have a limited usefulness in S. schenckii. Sporotrichosis is a subacute or chronic infection that affects humans and other mammals and is produced by the dimorphic fungus Sporothrix schenckii.The infection is acquired when the fungus penetrates through the skin due to trauma, at times minimal, or more rarely through the respiratory tract, causing pulmonary infection (20). The most frequent manifestation of sporotrichosis is the cutaneous-lymphatic form followed by fixed cutaneous infection. In patients with severe underlying disease and the immunodepressed, the disease can spread and cause death (5). The standard treatment of cutaneous-lymphatic sporotrichosis is potassium iodine, with which complete remission of lesions can be achieved in 2 to 3 months (11). Despite the development of new antifungal drugs, potassium iodine continues to be a commonly used therapy probably because of its wide availability. However, the use of potassium iodine may be associated with mild adverse effects, such as gastric intolerance, or more serious adverse events, such as vasculitis, periarthritis, and hypothyroidism, among others (23). Orally administered itraconazole (IZ) has been shown to be effective in the treatment of cutaneous-lymphatic and systemic sporotrichosis (1, 24), whereas visceral and disseminated forms have classically been treated with amphotericin B (AB), with various results (12,22).Studies on the susceptibility of S. schenckii to commonly used antifungals have ra...

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“…Ketoconazole has been used successfully to treat patients with systemic sporotrichosis without HIV infection, and better results were obtained when high doses of ketoconazole were used (400-800 mg per day). In most cases longterm therapy (>1 year) is needed, and relapses after discontinuation of therapy are common (9).…”

Section: Sporotrichosis Is Caused By the Dimorphic Fungusmentioning

confidence: 99%

Efficacy of acute phase and maintenance therapy with itraconazole in an AIDS patient with sporotrichosis

Bolao

Podzamczer

Ventin

et al. 1994

Eur. J. Clin. Microbiol. Infect. Dis.

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An AIDS patient with sporotrichosis who improved with itraconazole therapy after consecutive failure of ketoconazole, saturated solution of potassium iodide, fluconazole and amphotericin B is presented. In addition, long-term therapy with high doses of itraconazole was well tolerated and effective in avoiding relapse. Itraconazole may be suitable for use in HIV-infected patients with sporotrichosis, who probably require chronic suppressive therapy to prevent relapse of symptomatic disease.

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treatment of Systematic Sporotrichosis with Ketoconazole

Cited by 40 publications

References 11 publications

Epidemiology of sporotrichosis: A study of 304 cases in Brazil

Epidemiology of sporotrichosis: A study of 304 cases in Brazil

In Vitro Susceptibility of Sporothrix schenckii to Six Antifungal Agents Determined Using Three Different Methods

Efficacy of acute phase and maintenance therapy with itraconazole in an AIDS patient with sporotrichosis

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