Clinical evaluation of miconazole (MCZ) in systemic mycosis associated with hematologic malignancies and of the diagnostic value of plasma β-D-glucan levels

The effectiveness of miconazole (MCZ), an imidazole-derivative, anti-fungal agent, was evaluated in patients with systemic mycosis and states associated with hematologic malignancies including acute leukemia, chronic myelogeneous leukemia, myelodysplastic syndrome, malignant lymphoma and myeloma in which it was suspected. Plasma β-D-glucan levels, differences between Txicolor test and Endospecy test levels, were also followed. Thirteen patients with systemic mycosis and 23 patients with conditions suspected of representing fungal infections were treated with MCZ, 8001, 200mg daily i.v. Excellent-good responses were observed in 5 (38.5%) of the 13 patients with a definitive diagnosis of mycosis and in 11 (47.8%) of the 23 patients suspected of having a fungal infection, for an overall efficacy rate of 44.4% (16/36). Plasma β-D-glucan levels correlated well with the efficacy of MCZ in 10 out of 12 patients, however, there were several patients with low plasma β-D-glucan levels throughout the entire course. Plasma β-D-glucan levels were low (below 15 pg/ml on repeated determinations) even in 2 cases of pulmonary candidiasis and disseminated deep-seated mycosis diagnosed on the basis of several tissue histologies at autopsy. The results indicate that MCZ is an effective agent for the treatment of severe systemic fungal infections in patients with hematologic disorders. Deep-seated mycosis cannot be ruled out even when plasma levels of β-D-glucan are low.