Data_Sheet_2_Case report: Successful combination therapy with isavuconazole and amphotericin B in treatment of disseminated Candida tropicalis infection.docx

Disseminated candidiasis is a severe complication in patients with hematological malignancies who have undergone chemotherapy or hematopoietic stem cell transplantation. It has a high mortality rate. When disseminated candidiasis caused by Candida tropicalis involves either the brain or heart, the prognosis is extremely poor. Traditional methods such as cultures are limited in diagnosing disseminated candidiasis. We describe a case report of a 55-year-old man with acute myeloid leukemia who developed candidemia caused by Candida tropicalis after chemotherapy, which disseminated extensively to the heart, brain, skin, liver, spleen and kidneys. In this instance, the patient was rapidly diagnosed with candida infection by metagenomic next generation sequencing, and successfully treated with combination therapy of isavuconazole and amphotericin B. The patient continued with treatment of leukemia while simultaneously receiving antifungal therapy, and both leukemia and disseminated candidiasis were effectively controlled. This case report provides real-world experience for treatment of patients with leukemia complicated by disseminated candidiasis.

播散性念珠菌病（disseminated candidiasis）是接受化疗或造血干细胞移植（hematopoietic stem cell transplantation）的血液系统恶性肿瘤患者的严重并发症，病死率极高。由热带假丝酵母菌（Candida tropicalis）引发的播散性念珠菌病若累及脑部或心脏，预后极差。传统培养类诊断方法在播散性念珠菌病的诊断中存在明显局限。本文报道1例55岁男性急性髓系白血病（acute myeloid leukemia）患者，其在化疗后出现热带假丝酵母菌所致的念珠菌血症，病原体广泛播散至心脏、脑部、皮肤、肝脏、脾脏及肾脏。本例患者通过宏基因组下一代测序（metagenomic next generation sequencing）实现快速诊断，并接受艾沙康唑（isavuconazole）与两性霉素B（amphotericin B）联合治疗后成功获得救治。患者在继续白血病治疗的同时辅以抗真菌治疗，最终白血病与播散性念珠菌病均得到有效控制。本病例报告为白血病合并播散性念珠菌病的临床治疗提供了真实世界实践经验。