3 A B C
A A 2 5 1 62
A 1 1 2 63
3 1 A proven invasive fungal diseases 1 2 3 BAL 24 : Fusarium spp. 4 2 : Candida Trichosporon B probable invasive fungal diseases Cpossible invasive fungal diseases 5 1 2 Grocott-Gomori methenamine Periodic Acid Schiff PAS Calcofluor Blancophor 3 proven mold invasive fungal disease 4 Fusarium spp. proven invasive fungal disease 5 6 3 2 64
A T 1 500 mm 3 10 2 3 0.3 mg kg 3 ABPA 4 90 TNF- 5 A CT halo sign Air-crescent sign B 6 MRI CT Bull s eye 1BAL 2 3 sign 4 ELISA a bbal CSF 5 Rhizopus spp. Rhizomucor spp. Absidia spp. -D- 6 PCR PCR BALF PCR 65
3 3 66
A 4 5 1 2 3 67
3 1 1 2 2 68
A 1 69
3 2 AMPH-B 2 2 AMPH-B 49 8.7 687 L-AMB 50 5.0 AMPH-B 38 2.7 384 ITCZ 47 2.7 L-AMB 31 5.0 837 VRCZ 26 1.9 L-AMB 34 4.3 1,095 34 3.2 70 71 72 73 70
A 3 1 2 71
3 3 72
A 4 5 1 2 3 73
3 74
A 75
3 76
B-1 B-1 6 9 1. 77
3 2. CNPA 78
B-1 3. IPA 79
3 4. HIV 80
B-1 81
B-2 B-2 10 15 1 2 82
B-2 3 83
3 4 84
B-2 5 85
3 86
C C 16 17 1 proven fungal infection 2. clinically documented fungal infection probable fungal infection 3. possible fungal infection 1 4 87
3 1 88
C 2. empiric therapy 1 95 CI 3 12.5 2.9 52.9 7 4.2 1.2 15.1 ICU 7 9.8 2.0 47.7 3.0 1.4 6.4 7 5.7 1.6 19.5 4.8 1.2 19.0 4.3 1.4 12.6 3.3 0.9 12.1 18.1 1.5 221.8 3.6 1.3 9.7 2 4.4 1.4 13.7 3 89
3 90
D D 18 19 91
3 1. empiric therapy 2. targeted therapy 1 92
D 1 Candida species FLCZ VRCZ AMPH-B C. albicans S S S S C. tropicalis S S S S C. parapsilosis S S S to? S C. glabrata S-DD to R S to S S to C. krusei R S to S S to C. Iusitaniae S S S S to R I RSS-DD 1.0 Candida spp. colonization index 0.8 0.6 0.4 0.2 0 0 10 20 30 40 50 60 100 140 Days 1 colonization 0.75 0.65 Candida spp. colonization index 0.55 0.45 0.35 0.25 0.15 0.05 0 0 1 2 3 4 5 6 7 8 9 10 Days 2 93
3 3. 1 2 94
E E 20 21 1.? 1 % 0 32 15 35 7 42 18 38 0 14 77 85 100 53 67 38 6 32 60 100 77 83 100 60 68 20 27 20 23 20 9 20 6 20 95
3 1 2.? 3.? 1 2 96
E 3 4 2 4. 2 possible -D- 1 G: 20 50 pg ml W: 10 20 pg ml 2 X CT 2 probable -D- G: 50 100 pg ml W: 20 50 pg ml 3 X CT -D- G: 100 pg ml W: 50 pg ml PCR 3 X CT proven G: RG W: - 1 -D- -D- 2 3 97
3 1. 3 3 Fos FLCZ 100 200 mg 5.0 mg kg 1 1 ITCZ MCFG AMPH-B L-AMB Fos FLCZ MCFG AMPH-B L-AMB 100 200 mg 1 1 50 mg 1 1 AMPH-B ITCZ MCFG 10 15 mg 1 1 3 200 mg 1 1 100 150 mg 1 1 0.2 0.3 mg kg AMPH-B 0.2 0.3 mg kg 1 1 1 1 1.0 5.0 mg kg 1 1 200 400 mg 7.0 8.0 mg kg 1 1 loading dose 400 800 mg 1 1 2 100 150 mg 1 1 L-AMB VRCZ MCFG 2.5 5.0 mg kg 1 1 4.0 mg kg loading dose 6.0 mg kg 1 2 150 300 mg 1 1 0.2 0.5 mg kg AMPH-B 0.5 1.0 mg kg 1 1 1 1 1.0 5.0 mg kg 1 1 L-AMB ITCZ loading dose 59 MCFG Fos FLCZ F-FLCZ FLCZF-FLCZ FLCZ AMPH-B 1 3 6 VRCZ 58 ITCZ58 2.5 5.0 mg kg 1 1 200 mg1 1 loading dose 200 mg 1 2 2 98
E 2. 3 4 Fos FLCZ 200 400 mg 10.0 12.0 mg kg 1 1 loading dose 400 800 mg 1 1 2 MCFG 100 150 mg 1 1 VRCZ 4.0 mg kg loading dose 6.0 mg kg 1 2 AMPH-B 0.5 1.0 mg kg 1 1 L-AMB 2.5 5.0 mg kg 1 1 ITCZ 200 mg 1 1 loading dose 200 mg 1 2 2 VRCZ 4.0 mg kg loading dose 6.0 mg kg 1 2 MCFG 150 300 mg 1 1 AMPH-B 5-FC L-AMB ITCZ Fos FLCZ 5-FC ITCZ 5-FC VRCZ AMPH-BL-AMB 5-FC FLCZ loading dose 59 Fos FLCZ F-FLCZ FLCZF-FLCZ FLCZ AMPH-B 1 3 6 ITCZ58 VRCZ 58 1.0 1.5 mg kg 1 1 100 mg kg 4 5.0 mg kg 1 1 200mg1 1 loading dose 200 mg 1 2 2 400 mg 1 1 loading dose 400 800 mg 1 1 2 100 mg kg 4 200 mg 1 1 loading dose 200 mg 1 2 2 100 mg kg 4 4.0 mg kg loading dose 6.0 mg kg 1 2 0.5 1.0 mg kg L-AMB 2.5 5.0 mg kg 1 1 100 mg kg 4 200 400 mg 99
3 3. 4 1 2 3 100
E 4. 101
3 102
F F 22 23 1. 2. 3. 103
3 4. 104
F 1. 2. empiric therapy 105
3 3. 4. 5. 1. 1 1 FDA AMPH-B FLCZ ITCZ 5-FC MCFG VRCZ A B C D X B C C C C C B D 106
F 2. 107
3 108
G G 24 25 1 2. 3. 1 2 3 109
3 1. 2. 3. 110
G 111
H H 26 27 112
H 1. 2. 3. 4. 5. 113
3 6. 1. 2. 3. 4. 114
H 1 MIC: g ml AMPH-B 5-FC MCZ FLCZ ITCZ MCFG VRCZ 0.6 mg kg 1.5 g 1,000 mg 200 mg 100 mg 2.5 mg kg 400 mg 2 0.6 1.50 10 35 0.3 0.8 41.08 0.492 19.165 2.13 0.1 0.24 34.96 ND ND 1.13 0.1 0.23 22.2 0.6 30.25 0.02 0.034 0.81 Candida albicans 0.5 1.0 64.0 0.06 0.25 0.25 0.50 0.03 0.06 0.0078 0.05 C. glabrata 0.25 0.50 0.13 0.25 0.50 2.0 8.0 0.25 1.00 0.0078 0.0156 0.38 C. krusei 0.50 1.00 16.0 32.0 2.0 4.0 64.0 0.25 1.00 0.0625 4.0 0 0.29 C. parapsilosis 0.50 1.00 0.13 0.50 1.00 2.00 0.50 2.00 0.13 0.50 0.25 2.00 0.01 C. tropicalis 0.50 1.00 0.25 4 4.00 64.0 0.50 8.0 0.0313 0.0625 0.04 5. 1 115
3 6. 2 AMPH-B MCZ FLCZ ITCZ MCFG VRCZ g 0.1 ml 5 40 100 10 5 100 g ml 1.25 10 125 12.5 1.25 125 2 116
H 117
I I 28 29 1 1 Extramucosal non-invasive fungal rhinosinusitis Superficial sinonasal mycosis Fungal ball Allergic fungal rhinosinusitis Invasive fungal rhinosinusitis Chronic invasive indolent fungal rhinosinusitis Acute fulminant fungal rhinosinusitis 1. 2. 3. 118
I 4. 5. 6. 1. 1 2 2. 119
3 120
J HIV J 30 33 1. 1 2 3 2. 1 121
3 2 HIV HIV 3. 1 HIV 4. PCP 1PCP HIV 122
J HIV 2PCP 3 ST 123
3 124
K 1 125
3 1 1. 2. 126
K 3. 127
2007 Guidelines for Management of Deep-seated Mycoses 2007 ISBN978-4-87794-085-0 C3047 3333E