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• W2063556670 abstract "Oral candidiasis (OC) is common in patients undergoing hematopoietic cell transplant (HCT). Candida glabrata, the second most frequently isolated species in OC, has proven more difficult to treat and usually presents asymptomatically. The clinical significance of symptoms is contentious and the literature lacks effective therapeutic guidelines for treatment. We herein describe a series of 6 HCT patients with OC due to triazole-resistant C. glabrata. The data were prospectively collected. Mouth swabs for fungal stain, culture and sensitivity were sent from oral lesions and clinical symptoms recorded. The median age of the 4 females and 2 males was 50.5 years. All patients had signs of OC with tongue plaques manifesting at a median of 86 days post-HCT (range 30-1045) and symptoms of dry mouth, anorexia, nausea and/or vomiting. Dysguesia was noted in three patients and weight loss in five (median 18 kg). None had odynophagia and EGD performed in 3 patients was negative for esophageal candidiasis. A total of 24 isolates were evaluated, with those tested being resistant to fluconazole, itraconazole, and voriconazole with respective MIC’s of >256 μ/ml, 44 μ/ml and 14.7 μ/ml. All isolates were sensitive to amphotericin B (MIC 0.38 μ/ml). Concurrent systemic antifungal therapy at the time of diagnosis of OC comprised: fluconazole, voriconazole, caspofungin or micafungin, or combination regimens of caspofungin, micafungin, or amphotericin B lipid complex with voriconazole. The signs and symptoms persisted despite continuation or alterations in the systemic antifungal regimen. Topical application to the oral mucosa (5 ml 2-4 times/day) of amphotericin B oral suspension (ABOS), prepared by the pharmacy at a concentration of 100 mg/ml, resulted in dramatic clinical response with rapid resolution of symptoms in all 6 patients. OC relapsed at a median of 65.3 days in all the patients necessitating re-treatment with ABOS. All patients rapidly responded. We conclude that ABOS provides a simple, highly effective and low-cost option for treatment of C. glabrata OC. The use of newer antifungal agents combined with the incidence and morbidity of other non-albicans OC infections may provide future directions of study.Tabled 1HCT Patient CharacteristicsAgeSexDiagnosisTransplant CharacteristicsGI GvHDConcurrent Antifungal Therapy39FCML-BCMRD, Cy/TBI (12 Gy)AcuteFLUC, VORI51MMM/PCLMRD, Flu/Mel/CamChronicFLUC, VORI47FT-ALL/AMLMMUD, Cy/TBI/Cam (12 Gy)N/AFLUC60FDLBCL/NHLMUD, Flu/Mel/CamAcuteVORI, CASP, MICA50FCML-BCMMUD, Flu/TBI/Cam/CD45 (4.5 Gy)N/AVORI, CASP, ABLC, MICA58MMDSMRD, Flu/TBI/Cam (4.5 Gy)ChronicFLUC, VORI, CASP, MICAAbbreviations: CML-BC: Chronic Myelogenous Leukemia in Blast Crisis; MM/PCL: Multiple Myeloma/ Plasma Cell Leukemia; T-ALL/AML: T-cell Acute Lymphoblastic Leukemia/ Acute Myeloblastic Leukemia; DLBCL/NHL: Diffuse Large B-cell Lymphoma/Non Hodgkin’s Lymphoma; MDS: Myelodysplastic Syndrome; MRD: Matched Related Donor; MMUD: Mis-matched Unrelated Donor; MUD: Matched Unrelated Donor; Cy: Cyclophosphamide; TBI: Total Body Irradiation; Flu: Fludarabine; Mel: Melphalan; Cam: Alemtuzumab; CD45: Investigational Anti-CD45 Monoclonal Antibody; FLUC: Fluconazole; VORI: Voriconazole; CASP: Caspofungin; MICA: Micafungin; ABLC: Amphotericin B Lipid Complex Open table in a new tab Abbreviations: CML-BC: Chronic Myelogenous Leukemia in Blast Crisis; MM/PCL: Multiple Myeloma/ Plasma Cell Leukemia; T-ALL/AML: T-cell Acute Lymphoblastic Leukemia/ Acute Myeloblastic Leukemia; DLBCL/NHL: Diffuse Large B-cell Lymphoma/Non Hodgkin’s Lymphoma; MDS: Myelodysplastic Syndrome; MRD: Matched Related Donor; MMUD: Mis-matched Unrelated Donor; MUD: Matched Unrelated Donor; Cy: Cyclophosphamide; TBI: Total Body Irradiation; Flu: Fludarabine; Mel: Melphalan; Cam: Alemtuzumab; CD45: Investigational Anti-CD45 Monoclonal Antibody; FLUC: Fluconazole; VORI: Voriconazole; CASP: Caspofungin; MICA: Micafungin; ABLC: Amphotericin B Lipid Complex" @default.
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• W2063556670 date "2007-02-01" @default.
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• W2063556670 title "427: Triazole-resistant Candida glabrata oral candidiasis and associated gastrointestinal syndrome in allogeneic hematopoietic cell transplant" @default.
• W2063556670 doi "https://doi.org/10.1016/j.bbmt.2007.01.058" @default.
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