Transplantation candidiasis

Prophylaxis To decrease the incidence of candidiasis in patients undergoing bone marrow transplantation who receive cytotoxic chemotherapy or radiation therapy. Vaginal candidiasis Vaginal candidiasis (vaginal yeast infections caused by Candida). 

Prevention of candidiasis in bone marrow transplant 400 mg once daily. In patients who are anticipated to have severe granulocytopenia (less than 500 neutrophils/mm ), start fluconazole prophylaxis several days before the anticipated onset of neutropenia, and continue for 7 days after the neutrophil count rises above 1000 cells/mm. ... 

For the treatment of patients with esophageal candidiasis, and for prophylaxis of Candida infections in patients undergoing hematopoietic stem cell transplantation (HSCT). 

A significant decrease in mortality from deep-seated mycoses was noted among bone marrow transplant recipients treated prophylactically with fluconazole, but similar benefits have not been seen in leukemia patients receiving prophylactic fluconazole. Fluconazole taken prophylactically by end-stage AIDS patients can reduce the incidence of cryptococcal meningitis, esophageal candidiasis, and superficial fungal infections. 

Prevention of candidiasis in patients undergoing hone marrow transplantation PO 400... 

Patients with solid organ transplants tend to suffer from oral candidiasis and cryptococcosis, whereas neutropenic patients (chemotherapy because of cancer or bone marrow transplantation) are susceptible to aspergillosis, systemic candidiasis or mucormycosis. AIDS patients - as a general sign of their defective immune system - present with more severe courses of infectious diseases in general, including mycoses like candidiasis, dermatophytosis or seborrhoic dermatitis. 

Topical therapy with clotrimazole or nystatin for 7 days is usually adequate for treating mucocutaneous candidiasis in most solid-organ transplant patients. Use of topical therapy will reduce the number of systemic drugs that these patients receive and hence minimize the risk of drug-drug interactions. Failure to respond to topical agents warrants the use of fluconazole. Low-dose amphotericin B 5-10 mg daily for 7 to 10 days is reserved for the unusual cases of treatment failure. 

Fungal infections have emerged as a major cause of death among cancer patients and transplant recipients. In addition, patients with acquired immune-deficiency syndrome (AIDS) experience substantially more frequent and severe forms of cryptococcosis, histoplasmosis, coccidioidomycosis, and mucocutaneous (esophageal, oral, and vulvovaginal) candidiasis. 

Marr KA, Seidel K, Slavin MA, et al. Prolonged fluconazole prophylaxis is associated with persistent protection against candidiasis-related death in allogeneic marrow transplant recipients Long-term follow-up of a randomized, placebo-controlled trial. Blood 2000 96 2055-2061. 

Thymus transplantation has also been employed experimentally in a variety of conditions including chronic mucocutaneous candidiasis, ataxia-telangiectsia, and Wiscott-Aldrich syndrome, but in these cases results have generally been disappointing (reviewed in Pahwa et al., 1979 Skotnicki et al., 1984). Thus, the only immunodeficiency state that has clearly demonstrated a lasting improvement of T cell immunity following thymus transplantation is DiGeorge s syndrome. 

Micafungin sodium is an antifungal agent that inhibits synthesis of 1,3-B-D-glucan, an essential component of fungal cell walls, but not present in mammalian cells. It is indicated in the treatment of esophageal candidiasis and prophylaxis of Candida infections in patients undergoing hematopoietic stem-cell transplantation. 

---