Treatment of chronic pulmonary aspergillosis with voriconazole: review of a case series
- 787 Downloads
Chronic pulmonary aspergillosis (CPA) is a rare disease that primarily affects subjects with moderate immunodepression and/or structural alterations in the lung.
Data for patients with probable CPA were collected over 24 months. Patients with probable CPA received oral voriconazole, and clinical, laboratory and radiological follow-up was performed at 3, 6 and 12 months.
21 patients (mean age 52.4 years) were evaluated. Factors predisposing to CPA were tuberculosis (n = 8), chronic obstructive pulmonary disease (n = 7), corticosteroids (n = 14), chemo- or radio-therapy (n = 6), tracheostomy or endotracheal prosthesis (n = 5), smoking (n = 4), asthma (n = 3), and chronic liver disease (n = 3). Sputum or bronchial aspirate cultures were positive for Aspergillus spp. in 14 cases (66.6 %). (1,3)-β-d-glucan on serum was positive in 16 cases (76.2 %). Excavated pulmonary thickening was evident in 14 patients (66.6 %) and in 9 of these cases (64.2 %) aspergilloma was present. [18F]2-fluoro-2-deoxy-d-glucose-PET-CT was positive in 13/15 patients, and simple aspergilloma was diagnosed after surgical excision in one of the negative cases. All patients were treated with oral voriconazole. Therapy was discontinued due to skin toxicity (n = 3), liver toxicity (n = 2) and severe mental disorder (n = 1). At 12 months’ follow-up, nine patients (42.9 %) were considered cured or improved. Seven patients (33.3 %) died during follow-up, mainly due to underlying disease.
A reasonable proportion of patients achieved cure or improvement with voriconazole, but 28.5 % of treated patients had to discontinue therapy because of toxicity. The high mortality makes it difficult to fully assess the real efficacy of voriconazole and to establish the correct duration of therapy.
KeywordsAspergillosis Aspergillus fumigatus Lung disease Voriconazole Triazole
Medical writing assistance was provided by Carmen Innes on behalf of Springer Healthcare Communications. An unrestricted grant for editorial assistance was provided by Pfizer, Italy. Pfizer has not been involved in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article.
Conflict of interest
The authors declare that they have no conflicts of interest.
- 3.Kousha M, Tadi R, Soubani AO. Pulmonary aspergillosis: a clinical review. Eur Respir Rev. 2011;156–74.Google Scholar
- 31.Hachem RY, Kontoyiannis DP, Chemaly RF, et al. Utility of galactomannan enzyme immunoassay and (1,3)beta-d-glucan in diagnosis of invasive fungal infections: low sensitivity for Aspergillus fumigatus infection in hematologic malignancy patients. J Clin Microbiol. 2009;47:129–33.CrossRefPubMedCentralPubMedGoogle Scholar