Treatment of Scedosporiosis with Voriconazole: Clinical Experience with 107 Patients

Abstract

The efficacy of voriconazole in 107 patients with scedosporiosis was analyzed. Principal infection sites were the lungs/sinuses (24%), central nervous system (CNS) (20%), and bone (18%), while 21% of patients had disseminated infection. Solid organ transplantation (22%), hematological malignancy (21%), and surgery/ trauma (15%) were the predominant underlying conditions. A successful therapeutic response was achieved in 57% of patients (median, 103 therapy days), with >98% of those responding receiving >28 days of therapy. Patients receiving primary therapy showed a 61% response versus 56% for the others. The best therapeutic responses were seen for skin/subcutaneous (91%) or bone (79%) infections, and the lowest for CNS infections (43%). Patients without major immune suppression (72%) or those with solid organ transplantation (63%) or various hematological conditions (60%) showed the best responses by underlying condition. Median known survival time was 133 days (therapy successes, 252 days; failures, 21 days). In all, 43 (40%) patients died, 73% due to scedosporiosis. Patients with Scedosporium prolificans infection had significantly reduced survival times (P ‫؍‬ 0.0259) and were more likely to die from fungal infection (P ‫؍‬ 0.002) than were Scedosporium apiospermum-infected patients. In a subset of 43 patients where voriconazole baseline MICs were available, response to voriconazole was higher for S. apiospermum-infected patients (54% response; MIC 50 , 0.25 g/ml) than for S. prolificans-infected patients (40% response; MIC 50 , 4.0 g/ml). Voriconazole demonstrated clinically useful activity in the treatment of both S. apiospermum and S. prolificans infections and was well tolerated.

Voriconazole for secondary prophylaxis of invasive fungal infections in allogeneic stem cell transplant recipients: results of the VOSIFI study

“…and Fusarium spp. ; 32,33 furthermore, it possesses potent in vitro activity against a wide range of other molds. 12 Voriconazole is available in both oral and intravenous formulations, which allows continuation of therapy in patients who have difficulty in swallowing (due to © F e r r a t a S t o r t i F o u n d a t i o n severe mucositis, for example) and can, therefore, cover the entire risk period of invasive fungal infections in HSCT patients, unlike other azoles that are only available as oral formulations.…”

“…However, the affected patient responded clinically to voriconazole before transplantation and did not, therefore, fulfill exclusion criteria; furthermore, a favorable outcome to vorinoconazole treatment in S. prolificans scedosporiosis, although unusual, has been reported. 32 The main strengths of our study are its prospective design and the extensive 1-year post-transplant follow-up, as well as the high level of certainty of the diagnosis of invasive fungal infections. Of note, had the EORTC criteria not been modified to accept a halo sign as a diagnosis of probable aspergillosis, only five of 45 (11%) patients would have been considered possible cases.…”

<i>Scedosporium prolificans</i> Endocarditis: Case Report and Literature Review

“…Selecting appropriate antifungal drugs is difficult due to the organism's intrinsic resistance to most antifungal agents (4 (17), indicating that this drug may be clinically useful for treatment in these patients. Combination antifungal drug therapy was successful in several cases.…”

Isolation of Scedosporium apiospermum (Teleomorph: Pseudallescheria apiosperma) from an Acute Myeloid Leukemia Patient

“…Yeni triazoller (vorikonazol, ravukonazol, posakonazol) S.apiospermum'a karşı iyi in vitro aktivite göstermektedir. Vorikonazol tedavisinin Pseudallescheria nedenli enfeksiyonlarda başa-rılı olduğuna dair giderek artan sayıda yayın bildirilmektedir 6,14,15 . Troke ve arkadaşları 15 ,…”