Last generation triazoles for imported eumycetoma in eleven consecutive adults.

Abstract

BACKGROUND:

Optimal management of eumycetoma, a severely debilitating chronic progressive fungal infection of skin, disseminating to bone and viscera, remains challenging. Especially, optimal antifungal treatment and duration are ill defined.

METHODOLOGY/PRINCIPAL FINDINGS:

We conducted a monocentric retrospective study of 11 imported cases of eumycetoma treated by voriconazole or posaconazole for at least 6 months. Response to treatment was assessed through evolution of clinical and magnetic resonance imaging (MRI). (1→3) ß-D-glucan (BG) and positron emission tomography using [18F] fluorodeoxyglucose (PET/CT) results were also assessed. Identified species were Fusarium solani complex (n = 3); Madurella mycetomatis, (n = 3), and Exophiala jeanselmei, (n = 1). Moreover, two coelomycetes and one phaeohyphomycetes strains without species identification were retrieved. Serum BG and PET/CT were abnormal in 7/8 and 6/6 patients tested, respectively. Patients received last generation azoles for a mean duration of 25.9±18 months. Complete response (major clinical and MRI improvement) was observed in 5/11 patients, partial response (minor MRI improvement or stable MRI findings) in 5 and failure (MRI evidence of disease progression) in one, with a 73±39 [6-132] months mean follow-up. Relapse occurred in 2 patients after treatment discontinuation. Optimal outcome was associated with fungal species, initiation of last generation triazole therapy (<65 months since first symptoms), negative serum BG and PET/CT normalization.

CONCLUSIONS/SIGNIFICANCE:

MRI, PET/CT and serum BG appear as promising tools to assess optimal time of antifungal treatment for eumycetoma.

• Authors: Yoann Crabol, Sylvain Poiree, Marie-Elisabeth Bougnoux, Christophe Maunoury, Stéphane Barete, Valérie Zeller, Cédric Arvieux, Samuel Pineau, Karima Amazzough, Marc Lecuit, Fanny Lanternier, Olivier Lortholary, French Mycosis Study Group
• Journal: PLoS neglected tropical diseases (PLoS Negl Trop Dis) Vol. 8 Issue 10 Pg. e3232 (Oct 2014) ISSN: 1935-2735 [Electronic] United States
• PMID: 25299610 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antifungal Agents
• Proteoglycans
• Triazoles
• beta-Glucans
• Fluorodeoxyglucose F18
• polysaccharide-K
• posaconazole
• Voriconazole

Topics

• Adolescent
• Adult
• Antifungal Agents (therapeutic use)
• Child
• Exophiala (drug effects)
• Fluorodeoxyglucose F18
• Fusarium (drug effects)
• Humans
• Madurella (drug effects)
• Magnetic Resonance Imaging
• Male
• Mycetoma (diagnosis, drug therapy, microbiology)
• Positron-Emission Tomography
• Proteoglycans
• Retrospective Studies
• Skin (microbiology)
• Treatment Outcome
• Triazoles (therapeutic use)
• Voriconazole (therapeutic use)
• Young Adult
• beta-Glucans (blood)