Voriconazole-refractory invasive aspergillosis

• Published in: The Korean journal of internal medicine Vol. 32; no. 5; pp. 805 - 812
• Main Authors: Park, Se Yoon, Yoon, Jung-A, Kim, Sung-Han
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Association of Internal Medicine 01.09.2017; 대한내과학회
• Subjects: Antifungal Agents - adverse effects; Antifungal Agents - pharmacokinetics; Antifungal Agents - therapeutic use; Aspergillus - drug effects; Aspergillus - pathogenicity; Biopsy; Coinfection; Cytochrome P-450 CYP2C19 - genetics; Cytochrome P-450 CYP2C19 - metabolism; Diagnosis, Differential; Diagnostic Errors; Drug Monitoring; Drug Resistance, Fungal; Female; Humans; Immunocompromised Host; Invasive Pulmonary Aspergillosis - diagnosis; Invasive Pulmonary Aspergillosis - drug therapy; Invasive Pulmonary Aspergillosis - immunology; Invasive Pulmonary Aspergillosis - microbiology; Male; Middle Aged; Pharmacogenetics; Pharmacogenomic Variants; Predictive Value of Tests; Review; Tomography, X-Ray Computed; Voriconazole - adverse effects; Voriconazole - pharmacokinetics; Voriconazole - therapeutic use; 내과학; Aspergillus; Therapy; Immunocompromised host; Aspergillosis; Voriconazole
• ISSN: 1226-3303; 2005-6648; 2005-6648
• DOI: 10.3904/kjim.2017.109

Invasive aspergillosis (IA) is one of the most common life-threatening complications in immunocompromised patients. Voriconazole is currently the drug of choice for IA treatment. However, some patients with IA suffer clinical deterioration despite voriconazole therapy. Management of voriconazole-refractory IA remains challenging; no useful recommendations have yet been made. Voriconazole-refractory IA can be further categorized as disease attributable to misdiagnosis or co-infection with another mold; inadequate blood voriconazole blood; inadequate tissue drug concentrations attributable to angioinvasion; immune reconstitution inflammatory syndrome; or infection with voriconazole-resistant . Hence, when encountering a case of voriconazole-refractory IA, it is necessary to schedule sequential tests to decide whether medical treatment or surgical intervention is appropriate; to adjust the voriconazole dose via drug monitoring; to seek polymorphisms; to monitor serum galactomannan levels; and to examine the drug susceptibility of the causative species.