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Management of Aspergillus Osteomyelitis: Report of Failure of Liposomal Amphotericin B and Response to Voriconazole in an Immunocompetent Host and Literature Review

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Abstract

Presented here is a case of Aspergillus osteomyelitis in an immunocompetent patient that progressed despite surgery and prolonged treatment with liposomal amphotericin B; the report is followed by a review of the literature. The review of this case and 41 similar cases found an overall cure rate of 69%. The importance of surgery when amphotericin B is used as first-line therapy is indicated by a 14% cure rate when amphotericin B is used alone compared to 75% when combined with surgery. When therapy is failing or surgery is contraindicated, dose escalation using a lipid formulation was not effective. On review, the addition of another agent, in particular 5-fluorocytosine, appears to be more beneficial. The patient reported here responded rapidly to voriconazole, a promising new antifungal agent for Aspergillus infections.

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Authors and Affiliations

  1. Department of Microbiology and Immunology, The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia

    I. Stratov

  2. Department of Infectious Diseases, Monash Medical Centre, Locked bag 29, Clayton Road, Clayton, Victoria 3168, Australia

    T. M. Korman

  3. Department of Infectious Diseases, Austin Repatriation Medical Centre, Studley Road, Heidelberg, Victoria 3084, Australia

    P. D. R. Johnson

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  1. I. Stratov
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  2. T. M. Korman
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  3. P. D. R. Johnson
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Correspondence to I. Stratov.

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Stratov, I., Korman, T.M. & Johnson, P.D.R. Management of Aspergillus Osteomyelitis: Report of Failure of Liposomal Amphotericin B and Response to Voriconazole in an Immunocompetent Host and Literature Review. Eur J Clin Microbiol Infect Dis 22, 277–283 (2003). https://doi.org/10.1007/s10096-003-0909-3

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