Voriconazole-refractory invasive aspergillosis.
- Author:
Se Yoon PARK
1
;
Jung A YOON
;
Sung Han KIM
Author Information
- Publication Type:Review
- Keywords: Aspergillosis; Voriconazole; Therapy; Aspergillus; Immunocompromised host
- MeSH: Appointments and Schedules; Aspergillosis*; Aspergillus; Coinfection; Cytochrome P-450 CYP2C19; Diagnostic Errors; Drug Monitoring; Fungi; Humans; Immune Reconstitution Inflammatory Syndrome; Immunocompromised Host; Voriconazole
- From:The Korean Journal of Internal Medicine 2017;32(5):805-812
- CountryRepublic of Korea
- Language:English
- Abstract: Invasive aspergillosis (IA) is one of the most common life-threatening complications in immunocompromised patients. Voriconazole is currently the drug of choice for IA treatment. However, some patients with IA suffer clinical deterioration despite voriconazole therapy. Management of voriconazole-refractory IA remains challenging; no useful recommendations have yet been made. Voriconazole-refractory IA can be further categorized as disease attributable to misdiagnosis or co-infection with another mold; inadequate blood voriconazole blood; inadequate tissue drug concentrations attributable to angioinvasion; immune reconstitution inflammatory syndrome; or infection with voriconazole-resistant Aspergillus. Hence, when encountering a case of voriconazole-refractory IA, it is necessary to schedule sequential tests to decide whether medical treatment or surgical intervention is appropriate; to adjust the voriconazole dose via drug monitoring; to seek CYp2c19 polymorphisms; to monitor serum galactomannan levels; and to examine the drug susceptibility of the causative Aspergillus species.
