Voriconazole-refractory invasive aspergillosis

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-ref...

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Published inThe 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
LanguageEnglish
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
Online AccessGet full text
ISSN1226-3303
2005-6648
2005-6648
DOI10.3904/kjim.2017.109

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Abstract 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.
AbstractList 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 Aspergillus . 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 CYP2C19 polymorphisms; to monitor serum galactomannan levels; and to examine the drug susceptibility of the causative Aspergillus species.
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.
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 Aspergillus. 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 CYP2C19 polymorphisms; to monitor serum galactomannan levels; and to examine the drug susceptibility of the causative Aspergillus species.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 Aspergillus. 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 CYP2C19 polymorphisms; to monitor serum galactomannan levels; and to examine the drug susceptibility of the causative Aspergillus species.
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 Aspergillus. 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 CYP2C19 polymorphisms; to monitor serum galactomannan levels; and to examine the drug susceptibility of the causative Aspergillus species. KCI Citation Count: 2
Author Yoon, Jung-A
Park, Se Yoon
Kim, Sung-Han
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Issue 5
Keywords Aspergillus
Therapy
Immunocompromised host
Aspergillosis
Voriconazole
Language English
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Snippet Invasive aspergillosis (IA) is one of the most common life-threatening complications in immunocompromised patients. Voriconazole is currently the drug of...
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SubjectTerms 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
Title Voriconazole-refractory invasive aspergillosis
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Volume 32
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ispartofPNX The Korean Journal of Internal Medicine, 2017, 32(5), , pp.805-812
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