Clinical study of miconazole in deep-seated mycoses with evaluation of serological diagnosis

Sixty three cases of deep-seated mycosis, mainly complications of diseases of the central nervous system or lung, were treated with daily doses of 800–1,200 mg of miconazole for 20.1 ±12.2 days. Mycological eradication rates were 50% (9 of 18) for confirmed cases of deep-seated mycosis, and 66.7% (6 of 9) for candidemia. Clinical response rates were 61.9% (13 of 21) for confirmed cases of deep-seated mycosis and 90% (9 of 10) for candidemia. Side effects, including abdominal symptoms in 10 cases, of miconazole were observed in 11 of 63 cases (17.5%). Abnormal laboratory data, such as liver dysfunction in 3 cases, were observed in 6 of 63 cases (9.5%). Sero-diagnostic methods for deep-seated mycoses were studied. To measure the fungal index mean beta-glucan, we used the endotoxin test D minus endospecy, with positive results of greater than 60 pg/ml in 7 of 11 cases (63.6%) of candidemia. Cand-Tec titers of more than 4 × were seen in 7 of 10 cases (70%), and mannnan was positive in 6 of 10 cases (60%). However, a D-arabinitol/creatinine ratio of more than 2.0 was seen in only 2 of 7 cases. In pulmonary aspergillosis, anti-aspergillus antibody was positive in 3 of 4 cases. In pulmonary cryptococcosis, capsular antigen was positive in 3 of 4 cases. These data suggest that a combination of various serodiagnostic methods is useful for diagnosing in deep-seated mycoses.