Aspergillus sinusitis in cancer patients

Viollier, Anne-Françoise; Peterson, Douglas E.; Jongh, Carlos A. De; Newman, Kathryn A.; Gray, William C.; Sutherland, John C.; Moody, Mark; Schimpff, Stephen C.

doi:10.1002/1097-0142(19860715)58:2<366::aid-cncr2820580228>3.0.co;2-v

Cited by 79 publications

(23 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Aspergillus sinusitis predominantly occurs in allogeneic stem cell transplant recipients (2-3%) and is primarily caused by Aspergillus fumigatus or Aspergillus flavus [102,109]. Frequently, additional surgical intervention is required (BIII) [106], resulting in a higher survival rate.…”

Section: Specific Manifestationsmentioning

confidence: 99%

Treatment of invasive fungal infections in cancer patients—Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Böhme¹,

et al. 2008

View full text Add to dashboard Cite

International audienceInvasive fungal infections are a main cause of morbidity and mortality in cancer patients undergoing intensive chemotherapy regimens. Early antifungal treatment is mandatory to improve survival. Today, a number of effective and better-tolerated but more expensive antifungal agents compared to the former gold standard amphotericin B deoxycholate are available. Clinical decision-making must consider results from numerous studies and published guidelines, as well as licensing status and cost pressure. New developments in antifungal prophylaxis improving survival rates result in a continuous need for actualization. The treatment options for invasive infections include fluconazole, voriconazole, and amphotericin B and its lipid formulations, as well as echinocandins. Voriconazole, amphotericin B, amphotericin B lipid formulations, caspofungin, itraconazole, and posaconazole are available for the treatment of invasive aspergillosis. Additional procedures, such as surgical interventions, immunoregulatory therapy, and granulocyte transfusions, have to be considered. The Infectious Diseases Working Party of the German Society of Hematology and Oncology here presents its 2008 recommendations discussing the dos and do-nots, as well as the problems and possible solutions, of evidence criteria selection

show abstract

Section: Specific Manifestationsmentioning

confidence: 99%

Treatment of invasive fungal infections in cancer patients—Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Böhme¹,

et al. 2008

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4] Voriconazole is a drug of choice in the treatment of invasive aspergillosis. However, clinical experiences mainly concerned pulmonary localization of this infection and included only a few cases of AIAR.…”

Section: Improving Outcomes Of Acute Invasive Aspergillus Rhinosinusimentioning

confidence: 99%

Improving outcomes of acute invasive Aspergillus rhinosinusitis n patients with hematologici malignancies or aplastic anemia: the role of voriconazole

Girmenia¹,

Pizzarelli²,

Pozzi³

et al. 2008

Haematologica

View full text Add to dashboard Cite

Improving outcomes of acute invasive Aspergillus rhinosinusitis in patients with hematologic malignancies or aplastic anemia: the role of voriconazoleWe evaluated the outcomes of patients with hematologic diseases diagnosed with acute invasive Aspergillus rhinosinusitis comparing a group of patients diagnosed after voriconazole was available at our center with a historical group of patients diagnosed before voriconazole was available. Voriconazole use was associated with a decrease in mortality and earlier clinical response. Haematologica. 2008 Jan; 93:(1) 159-160. DOI: 10.3324/haematol.11811 Acute invasive Aspergillus rhinosinusitis (AIAR) is a lifethreatening fungal infection which appears almost exclusively in leukemia or aplastic anemia.1-4 Voriconazole is a drug of choice in the treatment of invasive aspergillosis. However, clinical experiences mainly concerned pulmonary localization of this infection and included only a few cases of AIAR.5,6 Before May 2003, deoxycholate amphotericin B (d-AmB) and liposomal amphotericin B (lipAmB) were the drugs of choice in AIAR therapy at our center. Voriconazole became available in May 2003 and was considered the first line therapy in microbiologically documented AIAR. In cases of possible fungal rhinosinusitis without microbiologic isolation of the pathogen, an AmB formulation was used as first line therapy. In the event of a subsequent microbiologic diagnosis of aspergillosis, AmB was replaced with intravenous voriconazole, unless a clear improvement in the infection had already been observed with AmB therapy.The aim of our study was to analyze the outcomes of 22 patients with hematologic diseases diagnosed with AIAR after voriconazole was available at our center (Voriconazole period group) compared with a historical group of 17 patients with AIAR who received AmB before voriconazole was available (Control group). The two groups were compared in an intention to treat analysis regardless of the initial antifungal drug employed. Only patients with AIAR defined as proven or probable according to standardized composite criteria were included. 7Characteristics of the two groups are shown in Table 1.The 17 control patients received primary therapy with dAmB (12 cases) and lip-AmB (5 cases). Four patients who received AmB-d switched to lip-AmB due to renal toxicity.Patients included in the voriconazole period group had received the triazole since the first day of treatment in 12 cases. The other 10 patients received primary therapy with d-AmB (4 cases) or lip-AmB (6 cases). In 7 of them, treatment was replaced with voriconazole, and the other 3 patients did not receive voriconazole due to early death in one case and early response to primary AmB therapy in two cases.At 3 months from the diagnosis of infection, 6 patients (27%) of the voriconazole period group had died at a median of 20.5 days, and 9 patients (53%) of the control group died at a median of 25 days. Overall survival at 3 months after the day of diagnosis of AIAR was highest among the patients of the voricona...

show abstract

“…4 The overall mortality is up to 82% and reflects the clinical importance of Aspergillus infection in immunosuppressed or neutropenic patients. 5 Solitary extrapulmonary Aspergillus infection occurs most frequently in the maxillary sinuses 6,7 and colonization of the nasal sinuses can lead to endogenous spread to the lungs causing invasive pulmonary aspergillosis. The skin is a rare site of infection, 8 and cutaneous infections are most often found at the entry site of Hickman catheters.…”

mentioning

confidence: 99%

Skin involvement as the first manifestation of systemic aspergillosis in patients after allogeneic hematopoietic cell transplantation

Schimmelpfennig

Naumann

Zuberbier

et al. 2001

Bone Marrow Transplant

View full text Add to dashboard Cite

Summary:Skin involvement due to a systemic infection with Aspergillus species in the course of allogeneic hematopoietic cell transplantation is extremely rare. We report the clinical course of two patients with hematologic malignancies who underwent allogeneic hematopoietic cell transplantation (HCT) and developed disseminated skin involvement as the first clinical symptom of a proven systemic Aspergillus infection. Bone Marrow Transplantation (2001) 27, 753-755. Keywords: cutaneous Aspergillus infection; HCT; BMT; STX; skin infection Aspergillus species are increasingly recognized as major fungal pathogens in severely immunosuppressed or neutropenic patients, particularly after allogeneic hematopoietic cell transplantation (HCT). 1 The risk of developing systemic Aspergillus infection increases with the duration of immunosuppression. The most common manifestation of an Aspergillus infection in these patients is invasive pulmonary aspergillosis characterized by hyphal invasion and destruction of pulmonary tissue. 2,3 Hematogenous dissemination as a secondary event occurs in 20-50% of these patients and most commonly involves the central nervous system and the gastrointestinal tract. 4 The overall mortality is up to 82% and reflects the clinical importance of Aspergillus infection in immunosuppressed or neutropenic patients. 5 Solitary extrapulmonary Aspergillus infection occurs most frequently in the maxillary sinuses 6,7 and colonization of the nasal sinuses can lead to endogenous spread to the lungs causing invasive pulmonary aspergillosis. The skin is a rare site of infection, 8 and cutaneous infections are most often found at the entry site of Hickman catheters. 4,7,9,10 Cutaneous aspergillosis is a poorly described entity Case report No. 1A 50-year-old male with Philadelphia-positive chronic myeloid leukemia in accelerated phase received a non-T cell-depleted bone marrow graft (1.2 × 10 8 MNC/kg BW) from his HLA-identical, MLC-negative brother. He was conditioned with busulfan (10 mg/kg), thiotepa (750 mg/kg) and cyclophosphamide (120 mg/kg) and received methotrexate and cyclosporine as GVHD prophylaxis. On day −1 twice daily prophylactic aerosol inhalation of 10 mg amphotericin B was started. On day +2 he developed fever of unknown origin and was empirically treated with a combination of cefotaxim, piperacillin and vancomycin. Because there was no resolution of the fever, intravenous (i.v.) amphotericin B was started at a dose of 0.8 mg/kg/day on day +4. On day +9 a round warm red swelling resembling a small furuncle appeared on the right thigh. This lesion grew rapidly and was extremely painful. On day +13 this lesion measured approximately 5 cm in diameter and in the centre a circular area of necrosis, 2 cm in diameter, had developed (Figure 1). Until that time microbiological examination of multiple blood cultures had yielded no positive result. Necrotic tissue from the lesion on the right thigh was sent for microbiological culture and histological examination. Both microbiological and histological exa...

show abstract

Aspergillus sinusitis in cancer patients

Cited by 79 publications

References 13 publications

Treatment of invasive fungal infections in cancer patients—Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Treatment of invasive fungal infections in cancer patients—Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Improving outcomes of acute invasive Aspergillus rhinosinusitis n patients with hematologici malignancies or aplastic anemia: the role of voriconazole

Skin involvement as the first manifestation of systemic aspergillosis in patients after allogeneic hematopoietic cell transplantation

Contact Info

Product

Resources

About