Last Generation Triazoles for Imported Eumycetoma in Eleven Consecutive Adults.

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Last Generation Triazoles for Imported Eumycetoma in Eleven Consecutive Adults.

PLoS Negl Trop Dis. 2014 Oct;8(10):e3232

Authors: Crabol Y, Poiree S, Bougnoux ME, Maunoury C, Barete S, Zeller V, Arvieux C, Pineau S, Amazzough K, Lecuit M, Lanternier F, Lortholary O, the French Mycosis Study Group

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.

PMID: 25299610 [PubMed - as supplied by publisher]