Successful Treatment of Aspergillus Prosthetic Valve Endocarditis with Oral Voriconazole

Reis, Lisa J.; Barton, Todd D.; Pochettino, Alberto; Velázquez, Omaida C.; McGarvey, Michael L.; Milas, Bonnie L.; Reboli, Annette C.; Schuster, Mindy G.

doi:10.1086/432580

Cited by 38 publications

(18 citation statements)

References 6 publications

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“…The efficacy of voriconazole in the treatment of Aspergillus spp infections has also been confirmed in a number of individual case reports, including infections of the skin (La Nasa et al 2004), bone (Swift and Denning 1998; Stratov et al 2003), mediastinum (Levin et al 2004), eye (Aliyeva et al 2004; Bethell et al 2004), prosthetic valve (Reis et al 2005), and CNS (Moling et al 2002; de Lastours et al 2003; Marbello et al 2003; Tattevin et al 2004; Schwartz et al 2005). Furthermore, recently published data suggest that voriconazole is a useful adjunctive therapy for allergic bronchopulmonary aspergillosis in children with cystic fibrosis (Hilliard et al 2005).…”

Section: Clinical Use Against Fungal Pathogensmentioning

confidence: 87%

Voriconazole in the management of nosocomial invasive fungal infections

Pemán¹,

Salavert²,

Cantón³

et al. 2006

Therapeutics and Clinical Risk Management

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Voriconazole is a new triazole developed for the treatment of life-threatening fungal infections. The drug is available for both oral and intravenous administration; the oral formulation has excellent bioavailability. The side-effect profile of voriconazole presents an acceptable safety and tolerability spectrum: transient visual disturbances, liver enzyme abnormalities, and skin rashes are the most frequently reported side effects but rarely lead to discontinuation. The potential for drug–drug interactions is high, because of its extensive hepatic metabolism. Careful attention to dosage is required, and serum levels and the effects of interacting drugs should be monitored. Review of 25 470 isolates of yeasts and 3216 isolates of filamentous fungi showed voriconazole to have broad-spectrum activity against pathogenic yeasts including intrinsically fluconazole-resistant isolates such as Candida krusei, dimorphic fungi, and opportunistic moulds like Aspergillus spp, amphotericin-B-resistant Aspergillus terreus, Fusarium spp, and Scedosporium apiospermum. It displays excellent clinical efficacy in patients with fluconazole-resistant and -susceptible Candida infections, invasive bone and central nervous system aspergillosis, and various refractory fungal infections. Voriconazole has been approved by the US Food and Drug Administration and by the European Medicines Agency for the treatment of invasive aspergillosis, serious infections caused by Fusarium and S. apiospermum, fluconazole-resistant invasive Candida infections, and candidemia in nonneutropenic patients.

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Section: Clinical Use Against Fungal Pathogensmentioning

confidence: 87%

Voriconazole in the management of nosocomial invasive fungal infections

Pemán¹,

Salavert²,

Cantón³

et al. 2006

Therapeutics and Clinical Risk Management

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“…In the literature a patient with prosthetic valve endocarditis due to Aspergillus fumigatus was successfully treated with aggressive surgical debridement alone. 9 …”

Section: Discussionmentioning

confidence: 99%

Two Cases of Aspergillus Endocarditis in Non Neutropenic Children on Chemotherapy for Acute Lymphoblastic Leukaemia

Nikolousis

Velangi

2011

Hematology Reports

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Fungal endocarditis (FE) is a rare complication in immunocompromised patients which is difficult to diagnose and has been characterized by excessive mortality (> 50%) and morbidity, regardless of treatment. The lack of clinical trials due to the small number of cases contributes further to a poor outcome. In our two cases of aspergilllus endocarditis we reviewed the clinical features, echocardiographic findings, microbiologic data, treatment, and outcome of these 2 cases and provide a current characterization of the syndrome. In this paper we have demonstrated the diversity of presentation of a critical fungal infection in immunocompromised but non neutropenic paediatric patients. The prompt diagnosis and initiation of treatment is crucial for a favourable outcome along with the use of double antifungal treatment with liposomal amphotericin and voriconazole initially which could be later switched to oral voriconazole with a good tissue penetration. Histological samples as well as radiological evidence and echocardiograms should be reviewed by experienced clinicians in order to aid diagnosis and promptly initiate treatment for these patients in order to achieve a favourable outcome

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“…Valve replacement should be performed as soon as possible, though if prevented liposomal amphotericin B and caspofungin can be used (Boland et al 2011 ). There is however an account of successfully treating A. fumigatus prosthetic valve endocarditis with oral voriconazole (Reis et al 2005 ). Less evidence is available for the treatment of infected hip joints, though it has been reported that voriconazole and amphotericin B have been used together in bone cement to treat a C. albicans infected hip (Deelstra et al 2013 ).…”

Section: Conventional Antifungal Approachesmentioning

confidence: 99%