Invasive aspergillosis successfully treated by combined antifungal therapy and immunosuppressive monotherapy two months following heart transplantation (original) (raw)
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Transplant Infectious Disease, 2004
We describe the rare case of a diabetic patient who was successfully treated for cytomegalovirus viremia and leishmaniasis following liver transplantation for hepatitis C virus-related cirrhosis, but also developed invasive sinus Aspergillus infection, while still on liposomal amphotericin B (AmBisome). The patient refused radical surgery including eye enucleation, and received a combination of intravenous caspofungin and voriconazole, along with repeated, conservative, local surgical debridement. At follow-up, 15 months after the onset of sinusitis, the patient remains culture-negative, fully active, and without evidence of local recurrence. Infection with Aspergillus species results in excess mortality rates ranging from 58% to 87% in immunosuppressed patients including organ transplant recipients (1, 2). Traditionally, the standard deoxycholate formulation of amphotericin B has been used in immunocompromised patients with invasive aspergillosis (3) with suboptimal results and signi¢cant toxicity associated with its use. Recently liposomal formulations, when available, have been preferentially used over the traditional formulation in clinical practice. The traditional amphotericin B regimen has been recently shown to be less e¡ective for invasive aspergillosis than therapy with the newer antifungal voriconazole (4). Caspofungin acetate belongs to the newer class of antifungal agents, the echinocandins. Good in vivo and in vitro results against Aspergillus infections have earned its approval for use in refractory invasive Aspergillus infections (5). Combination of antifungals has been reserved for refractory cases only. However, combination therapy may have an important role in treating invasive aspergillosis as a primary option and not as a last resort (6). It is important to note that recently, in vitro synergistic e¡ects have been shown between newer and more traditional antifungal agents (6, 7). Recent trials in invasive fungal infections have shown that combining either caspofungin or voriconazole with amphotericin B has a clear clinical
Italian Journal of Pediatrics, 2014
Invasive aspergillosis is an important cause of morbidity and mortality in immunocompromised patients. Among primary immunodefiencies, chronic granulomatous disease (CGD) has the highest prevalence of invasive fungal diseases. Voriconazole is recommended for the primary treatment of invasive aspergillosis in most patients. In patients whose aspergillosis is refractory to voriconazole, therapeutic options include changing class of antifungal, for example using an amphotericin B formulation, an echinocandin, combination therapy, or further use of azoles. Posaconazole is a triazole derivative which is effective in Aspergillosis prophylaxis and treatment. Rarely, surgical therapy may be needed in some patients. Lesions those are contiguous with the great vessels or the pericardium, single cavitary lesion that cause hemoptysis, lesions invading the chest wall, aspergillosis that involves the skin and the bone are the indications for surgical therapy. Chronic granulomatous disease (CGD) is an inherited immundeficiency caused by defects in the phagocyte nicotinamide adenine dinucleotidephosphate (NADPH) oxidase complex which is mainstay of killing microorganisms. CGD is characterized by recurrent life-threatening bacterial and fungal infections and by abnormally exuberant inflammatory responses leading to granuloma formation, such as granulomatous enteritis, genitourinary obstruction, and wound dehiscence. The diagnosis is made by neutrophil function testing and the genotyping. Herein, we present a case with CGD who had invasive pulmonary aspergillosis refractory to voriconazole and liposomal amphotericine B combination therapy that was controlled with posaconazole treatment and pulmonary surgery.
Antimicrobial agents and chemotherapy, 2017
Invasive pulmonary aspergillosis (IPA) is an important cause of morbidity and mortality in immunocompromised patients. We hypothesized that simultaneous inhibition of biosynthesis of ergosterol in the fungal cell membrane and (1→3)-β-D-glucan in the cell wall, respectively, by the antifungal triazole isavuconazole and the echinocandin micafungin, may result in improved outcome in experimental IPA in persistently neutropenic rabbits. Treatment groups included isavuconazole (ISA) at 20 (ISA20), 40 (ISA40), and 60 (ISA60) mg/kg/day, micafungin at 2 mg/kg/day (MFG2), or combinations of (ISA20+MFG2), (ISA40+MFG2), (ISA60+MFG2), and untreated rabbits (UC). Galactomannan index (GMI) and (1→3)-β-D-glucan levels were measured in serum. Residual fungal burden (CFU/g) was significantly reduced in ISA20-, ISA40-, ISA60-, ISA20+MFG2-, ISA40+MFG2-, and ISA60+MFG2-treated rabbits vs that of MFG2-treated or UC (p<0.01). Measures of organism-mediated pulmonary injury, lung weights and pulmonary i...
Can Long-term Antifungal Therapy Be an Alternative to Surgery in Pulmonary Aspergilloma?
Anadolu Kliniği Tıp Bilimleri Dergisi, 2018
Pulmonary aspergilloma is one of the clinical conditions with high mortality and morbidity in immunosuppressed patients. Surgical resection has been the leading treatment option; however, surgical treatment involves some risk of local and systemic dissemination and there are also patients who are functionally inappropriate to be treated surgically. In this paper, we present two patients with bilateral PA who underwent surgical and antifungal treatment. Antifungal therapy with voriconazole that was successful for both of our patients might be a promising approach to a group of PA patients who are not appropriate for surgery.