• 약학회지
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• 제59권6호
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• pp.259-265
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• 2015

In recent, there are increasing reports about pharmacological activities of Crataegi Fructus which has been used for many centuries as medicinal and food sources in East Asia. However, its antifungal efficacy needs to be investigated. Thus, in the current study, we determined synergistic antifungal activity of the Crataegi Fructus extract (CFE) when combined with fluconazole (FLC) against disseminated candidiasis due to Candida albicans. This fungus is one of the most problematic fungal pathogens. Data resulting from a microdilution susceptibility test showed that CFE had a dose-dependent antifungal activity. When the extract was combined with FLC, the activity was synergistic. For example, the antifungal activity by the combination of CFE at $20{\mu}g/ml$ plus FLC at $0.1{\mu}g/ml$ was 4 times more effective than antifungal activity by FLC alone at the same concentration (P<0.05). In the murine model of disseminated candidiasis, the combination therapy potentiated resistance of mice, resulting in 80% of C. albicans-infected animals surviving the entire period of 40 days observation, whereas mice given CFE alone or FLC alone all died with 17 and 23 days, respectively, although they survived longer than the untreated control animals (P<0.05). The CFE's antifungal activity seemed to be related to the blockage of hyphal production of C. albicans yeast cells. In summary, CFE has a synergistic antifungal activity, which can be produced by combining CFE with FLC. Thus, our data strongly indicate that CFE may be a potential candidate as an antifungal agent for combination therapy.

• Journal of Microbiology and Biotechnology
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• 제28권11호
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• pp.1771-1781
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• 2018

The emergence of multidrug-resistant microorganisms, as well as fungal infectious diseases that further threaten health, especially in immunodeficient populations, is a major global problem. The development of new antifungal agents in clinical trials is inferior to the incidence of drug resistance, and the available antifungal agents are restricted. Their mechanisms aim at certain characteristics of the fungus in order to avoid biological similarities with the host. Synthesis of the cell wall and ergosterol are mainly targeted in clinical use. The need for new approaches to antifungal therapeutic agents or development alternatives has increased. This review explores new perspectives on mechanisms to effectively combat fungal infections and effective antifungal activity. The clinical drug have a common feature that ultimately causes caspase-dependent cell death. The drugs-induced cell death pathway is associated with mitochondrial dysfunction, including mitochondrial membrane depolarization and cytochrome c release. This mechanism of action also reveals antimicrobial peptides, the primary effector molecules of innate systems, to highlight new alternatives. Furthermore, drug combination therapy is suggested as another strategy to combat fungal infection. The proposal for a new approach to antifungal agents is not only important from a basic scientific point of view, but will also assist in the selection of molecules for combination therapy.

• 한국임상수의학회지
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• 제29권4호
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• pp.323-327
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• 2012

The effect of pH of chitosan solution (w/v) on antifungal activity against Malassezia pachydermatis isolated from a dog with otitis externa was evaluated. This study was investigated to find out the optimal pH of chitosan solution that could be able to eliminate yeast cells. For comparison of antifungal activity of chitosan solution 2% chlorhexidine that have been already proved the antifungal effect against M. pachydermatis was used as positive control. The chitosan solution at different pH (2.5, 3.0, 3.5, 4.0, 4.5, 5.0) were involved this experiment. The chitosan solutions at each pH could eliminate a number of yeast cells when they were compared to other antifungal agents. In chitosan solution's antifungal effect of varying degrees according to the pH M. pachydermatis was inhibited at pH of < 5.0. Especially it has been proved an effective antifungal effect at pH 3.5. Therefore, the pH of chitosan solution had a effect on antifungal activity and the optimal pH was 3.5 in vitro. The possibility of topical therapy with acidific solution of chitosan has a potential in skin infection against M. pachydermatis.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제28권1호
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• pp.81-85
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• 2002

This paper describes that invasive aspergillosis was found in oral cavity, especially in lower molar periodontium in a immunocompromised 34-year-old woman who had been admitted in hemato-oncology with the diagnosis of acute myeloid leukemia. Antifungal therapy and surgical excision of involved teeth, bone and gingiva were the treatment of choice. After treatment infected area was healed very well. We would like to report our case because we could not find any paper reporting on invasive aspergillosis occurring in lower molar periodontium.

• 구강회복응용과학지
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• 제38권2호
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• pp.120-126
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• 2022

심한 의치성 구내염의 경우, 항진균제의 처방이 효과적이지 않은 경우가 있다. 이번 증례는 5개월간 fluconazole을 처방받았으나, 증상의 개선이 없었던 72세의 환자에 증례이다. 본원의 재진단을 거쳐 약물치료를 시행하였고, 임시의치를 제작하여, 구강회복을 기하고자 하였다. 그러나 계속되는 약물치료에도 구강상태가 호전되지 않는 증례에서 미생물학적인 분석 및 보조요법이 도움이 될 수 있음을 본 증례를 통해 살펴보고자 한다.

• Journal of Trauma and Injury
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• 제36권3호
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• pp.276-280
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• 2023

Fungal thrombophlebitis of the central vein is a rare, life-threatening disease associated with significant morbidity and mortality. It requires immediate central venous catheter removal and intravenous antifungal therapy, combined in some cases with either anticoagulation or aggressive surgical debridement. A 70-year-old male patient injured by a falling object weighing 1,000 kg was transferred to our hospital. A contained rupture of the abdominal aorta with retroperitoneal hematoma was treated with primary aortic repair, and a small bowel perforation with mesenteric laceration was treated with resection and anastomosis. After a computed tomography scan, the patient was diagnosed with thrombophlebitis of the left internal jugular vein and brachiocephalic vein. Despite antifungal treatment, fever and candidemia persisted. Therefore, emergency debridement and thrombectomy were performed. After the operation, the patient was treated with an oral antifungal agent and direct oral anticoagulants. During a 1-year follow-up, no signs of candidemia relapse were observed. There is no optimal timing of surgical treatment for relapsed fungal central thrombophlebitis. Surgical treatment should be considered for early recovery.

• Pediatric Infection and Vaccine
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• 제12권1호
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• pp.75-85
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• 2005

목 적 : 혈액종양 환아의 항암요법 후 발생한 호중구감소증 상태에서, 진균 감염은 높은 치명률을 가지는 것으로 알려져 있다. 진균 감염에 대한 경험적 항진균제로 주로 사용되는 ABV는 염증성 사이토카인인 IL-$1{\beta}$, TNF-${\alpha}$의 증가에 의해 발생하는 것으로 알려져 있는 발열, 오한, 발진, 신독성과 같은 부작용이 있다. Azole 계열의 ITZA도 광범위한 항진균 효과를 나타내고 있어 경험적 항진균제로의 사용이 고려되고 있는데 본 연구는 ABV와 ITZA의 정맥 주입에 따른 부작용의 발생 및 효능과 염증성 사이토카인 및 항염증성 사이토카인의 변화를 관찰하고자 한다. 방 법: 2004년 3월부터 2005년 2월까지 호중구감소증 상태에서 발열이 있어 치료한 급성 백혈병 환자를 대상으로 하였다. 대상으로 선정된 환자는 30명으로 ABV, ITZA 각각의 치료군은 15명이었다. 항진균제는 총 14일간 투여하였으며, 투여 후 혈청에 포함된 염증성 사이토카인(IL-$1{\beta}$, TNF-${\alpha}$)과 항염증성 사이토카인(IL-1Ra, IL-4)을 ELIZA를 통하여 측정하고, 치료 종료 시 치료 효과를 평가하였다. 결 과 : 두 치료군의 성별, 나이, 진단명, 항암치료의 단계, 마지막 항암요법의 시기 특성은 유의한 차이가 없었다. ABV 치료군에 비해 ITZA 치료군에서 정맥 주입 시 발생하는 이상 반응의 빈도가 적었다. 또한, ABV 치료군에서 ITZA 치료군에 비해 염증성 사이토카인인 IL-$1{\beta}$가 정맥주입 시 증가함을 보였고, IL-1Ra/IL-$1{\beta}$는 ABV 치료군에서는 감소하는 반면 ITZA 치료군에서는 증가함을 보였다. 결 론: 급성백혈병 소아에서 발열을 동반한 호중구감소증시 경험적 항진균제로 ABV와 ITZA를 사용하여 최종 치료 효과의 유의한 차이는 없었으나 정맥 투여와 연관된 이상 반응은 ABV 군에서 많았으며 호중구의 회복은 ITZA 군에서 빠른 것을 알 수 있었다. 이는 ABV나 ITZA 투여 시 시간에 따른 IL-Ra/IL-$1{\beta}$의 변화와 연관이 있을 것으로 생각된다.

• Journal of Yeungnam Medical Science
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• 제24권1호
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• pp.79-84
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• 2007

Sphenoid sinus aspergillosis is notorious for its serious complications, such as permanent cranial nerve deficits and possible death. The most common associated symptoms are headache, followed by visual changes, and cranial nerve palsies. Because of an insidious onset, frequently resulting in missed and delayed diagnosis, sphenoid sinus aspergillosis is a potentially lethal medical condition. We report a case of visual loss secondary to isolated sphenoid sinus aspergillosis. A 69-year-old man presented to our hospital with the complaint of headache. The headache started one year previously and was described as severe dull pain localized bilaterally to the temporo-orbital region. The patient took daily NSAIDs for the pain. The neurological examination was normal. The MRI of the brain showed a left sphenoid sinusitis. A transnasal endoscopic superior meatal sphenoidotomy was performed. Aspergillosis was confirmed after a surgical biopsy was obtained. The patient was discharged from hospital without antifungal therapy. One month later, the patient complained of headache and loss of vision bilaterally. The orbital MRI showed a left cavernous sinus and bilateral optic nerve invasion. The loss of visions was permanent. In our case, the diagnosis was delayed; antifungal agents were not administered after surgery and the patient lost his vision as a result. Therefore, early diagnosis and proper treatment are important. Although the treatment of an invasive type of aspergillus has not been established, surgical removal of a nidus and aggressive antifungal therapy are recommended.

• Journal of Korean Neurosurgical Society
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• 제47권1호
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• pp.74-77
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• 2010

Rhino-orbital-cerebral (ROC) mucormycosis is an uncommon, acute and aggressive fungal infection. It remains a challenging problem to clinicians despite aggressive debridement surgery and antifungal therapy. The authors describe a case of ROC mucormycosis with pericranial abscess occurring in a female patient with uncontrolled diabetes mellitus. The infection initially developed in the right-sided nasal sinus and later progressed through the paranasal sinuses with the invasion of the peri-orbital and frontotemporal region, due to the delayed diagnosis and treatment. Numerous non-septate hyphae of the zygomycetes were identified by a punch biopsy from the nasal cavity and by an open biopsy of the involved dura. The patient was treated successfully with extensive debridement of her necrotic skull and surrounding tissues, drainage of her pericranial abscess and antifungal therapy, including intravenous amphotericin B for 61 days and oral posaconazole for the following 26 days. She returned to a normal life and has had no recurrence since the end of her treatment 15 months ago.

• 한국임상약학회지
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• 제34권1호
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• pp.71-78
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• 2024

Background: Oral cancer drugs, particularly tyrosine kinase inhibitors (TKIs), are increasingly popular due to their convenience. However, they pose challenges like drug interactions, especially with medications like azole antifungals. While the FDA provides some guidance, more detailed information is needed to manage these interactions effectively. A meta-analysis was conducted to understand the impact of interactions between TKIs and azole antifungals on adverse events during clinical studies. Methods: A meta-analysis followed PRISMA guidelines. Data from PubMed, EMBASE, and references were searched until November 30, 2021. Inclusion criteria encompassed studies on TKI-antifungal interactions in English. Study selection and quality assessment were conducted by two independent investigators. Results: Out of 158 articles, 11 were selected for analysis. Combination therapy showed a slight increase in adverse events but was not statistically significant (OR 1.02, 95% CI 0.49-2.13, p=0.95). AUC and Cmax fold changes did not significantly impact adverse event development. Both itraconazole and ketoconazole showed no significant difference in adverse event development compared to TKI alone. Conclusions: Study finds TKI-DDI not significantly linked to AE increase; azole antifungal types not related to AE. Future DDI research crucial for drug development.