Voriconazole-associated zygomycosis: a significant consequence of evolving antifungal prophylaxis and immunosuppression practices?

Pongas, Georgios; Lewis, Russell E.; Samonis, George; Kontoyiannis, Dimitrios P.

doi:10.1111/j.1469-0691.2009.02988.x

Cited by 112 publications

(86 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In experimental models, preexposure of Mucormycetes to voriconazole selectively enhanced their virulence in fly and murine infection models (179). Voriconazole-associated mucormycosis appears to have a poor outcome, perhaps reflecting the advanced immunosuppressive state of infected patients along with delayed diagnosis of the infection (264).…”

Section: Clinical Presentationmentioning

confidence: 99%

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

2011

View full text Add to dashboard Cite

SUMMARY Rhizopus , Mucor , and Lichtheimia (formerly Absidia ) species are the most common members of the order Mucorales that cause mucormycosis, accounting for 70 to 80% of all cases. In contrast, Cunninghamella , Apophysomyces , Saksenaea , Rhizomucor , Cokeromyces , Actinomucor , and Syncephalastrum species individually are responsible for fewer than 1 to 5% of reported cases of mucormycosis. In this review, we provide an overview of the epidemiology, clinical manifestations, diagnosis of, treatment of, and prognosis for unusual Mucormycetes infections (non- Rhizopus , - Mucor , and - Lichtheimia species). The infections caused by these less frequent members of the order Mucorales frequently differ in their epidemiology, geographic distribution, and disease manifestations. Cunninghamella bertholletiae and Rhizomucor pusillus affect primarily immunocompromised hosts, mostly resulting from spore inhalation, causing pulmonary and disseminated infections with high mortality rates. R. pusillus infections are nosocomial or health care related in a large proportion of cases. While Apophysomyces elegans and Saksenaea vasiformis are occasionally responsible for infections in immunocompromised individuals, most cases are encountered in immunocompetent individuals as a result of trauma, leading to soft tissue infections with relatively low mortality rates. Increased knowledge of the epidemiology and clinical presentations of these unusual Mucormycetes infections may improve early diagnosis and treatment.

show abstract

Section: Clinical Presentationmentioning

confidence: 99%

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

2011

View full text Add to dashboard Cite

show abstract

“…As with any antimicrobial class of drugs, widespread and prolonged use of triazoles may lead to the emergence of drug-resistant organisms [14]. Several reports have linked voriconazole use to a rising incidence of zygomycosis [15,16]. Moreover, unlike with fluconazole, many clinicians routinely obtain serum levels of these azoles in order to ensure efficacy and minimize toxicity.…”

Section: Chemoprophylaxismentioning

confidence: 99%

Challenges in the management of invasive aspergillosis in hematopoietic stem cell transplantation

Chandrasekar

Ramesh

2009

Expert Review of Anti-infective Therapy

View full text Add to dashboard Cite

“…However, in most patients with hematologic diseases there is the potential for pharmacokinetic drug-drug interactions given that voriconazole is metabolized through the cytochrome P450 system [Pongas et al 2009]. For example, interactions between liver-metabolized chemotherapy agents (e.g.…”

Section: Monitoring Voriconazole Plasma Levelsmentioning

confidence: 99%

Voriconazole and its clinical potential in the prophylaxis of systemic fungal infection in patients with hematologic malignancies: a perspective review

Zabalza

Gorosquieta

Equiza

et al. 2013

Therapeutic Advances in Hematology

View full text Add to dashboard Cite

Invasive fungal infections (IFIs) have become high prevalence in patients with hematologic malignancies. Drug-based strategies for IFIs include various approaches such as prophylactic, empiric, preemptive, and directed treatment. Prophylaxis is an attractive strategy in high-risk patients, given the lack of reliable diagnostics and the high mortality rate associated with IFIs. Prophylaxis includes the use of antifungal drugs in all patients at risk. An ideal antifungal compound for prophylaxis should have a potent and broad activity, be available both orally and intravenously, and have a low toxicity profile. Voriconazole fulfills all these criteria. The clinical efficacy of voriconazole against the majority of fungal pathogens makes it potentially very useful for the prevention of IFIs in patients with hematologic malignancies. Voriconazole appears to be very effective for the primary and secondary prevention of IFIs in these patients and recipients of allogeneic hematopoietic stem-cell transplantation. Randomized controlled trials evaluating voriconazole as primary antifungal prophylaxis in patients with neutropenia treated for a variety of hematologic malignancies have been performed, confirming its value as a prophylactic agent. Voriconazole is generally safe and well tolerated; however, its use is also associated with a number of concerns. In most patients with hematologic malignancies there is the potential for pharmacokinetic drug-drug interactions given that voriconazole is metabolized through the P450 cytochrome system.

show abstract

Voriconazole-associated zygomycosis: a significant consequence of evolving antifungal prophylaxis and immunosuppression practices?

Cited by 112 publications

References 29 publications

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

Mucormycosis Caused by Unusual Mucormycetes, Non-Rhizopus, -Mucor, and -Lichtheimia Species

Challenges in the management of invasive aspergillosis in hematopoietic stem cell transplantation

Voriconazole and its clinical potential in the prophylaxis of systemic fungal infection in patients with hematologic malignancies: a perspective review

Contact Info

Product

Resources

About