par Meunier, Françoise 
Référence Schweizerische Medizinische Wochenschrift, 113, SUPPL. 14, page (15-19)
Publication Publié, 1983
Référence Schweizerische Medizinische Wochenschrift, 113, SUPPL. 14, page (15-19)
Publication Publié, 1983
Article révisé par les pairs
| Résumé : | The prevention of fungal infections in granulocytopenic patients seems necessary to improve the final outcome of neoplastic patients. In particular, aspergillosis and candidiasis represent common life-threatening infections among the patients with acute hematological malignancies. Despite extensive investigations during this last decade, the optimal approaches to prevent these complications are still controversial. This situation probably reflects and stresses the numerous factors which predispose to these opportunistic fungal infections. Therefore, the effective prophylaxis of candidiasis and aspergillosis should result from the use of basic and specific approaches. General and simple measures including well trained personnel (physicians, nurses but also individuals in charge of the housekeeping, etc.), careful patient teaching of personal hygiene and control of the food intake (limited to cooked food diet), will reduce the acquisition of potential fungal pathogens. Moreover, the isolation in a laminar air flow room seems to be the optimal specific technique to prevent the colonization as well as the development of pulmonary aspergillosis. The meticulous evaluation of the respiratory sinus status as well as surveillance cultures obtained from the nose have been shown to be helpful to predict patients at high risks. Until now, there is no systemic chemoprophylaxis available to decrease the incidence of invasive aspergillosis. However, the topical application of antifungal agent using nasal spray or aerosols should be further investigated. Exogenous candidiasis such as catheter or TPN products related yeast infections can be avoided by aseptic manipulations. Endogenous candidiasis, resulting from the dissemination of the yeasts from the gastro-intestinal tract (which represents the major reservoir), are still much more difficult to prevent. An overgrowth of candida species is frequent in granulocytopenic patients and despite numerous studies, there is no standard regimen that can be recommended. Overall, high doses of nystatin, amphotericin B or ketoconazole are effective to decrease the colonization rate of the gastro-intestinal tract. However, the clinical impact of these observations has not yet been clearly demonstrated. Moreover, it seems necessary to stress the importance of the patient's compliance to the prescribed regimen. Finally, the potential selection of resistant yeasts must also be taken into consideration and further studies must be performed before a final evaluation can be made. Nevertheless, depsite all the prophylactic means used, febrile episodes should alert the patient as well as the medical staff. Deep-seated fungal infections should be suspected whenever granulocytopenic patients remain febrile despite the administration of broad spectrum antibiotics and empirical antifungal treatment should be considered early in the evolution. |
