Diagnostic Importance of Hyphae on Heart Valve Tissue in Histoplasma Endocarditis and Treatment With Isavuconazole

Wiley, Zanthia; Woodworth, Michael H.; Jacob, Jesse T; Lockhart, Shawn R.; Rouphael, Nadine; Gullett, Jonathan C.; Guarner, Jeannette; Workowski, Kimberly A.

doi:10.1093/ofid/ofx241

Cited by 10 publications

(6 citation statements)

References 4 publications

(5 reference statements)

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“…A total of 12 cases, including the current case report of histoplasmosis treated with isavuconazole, were found and the results are summarised in table 2. Eight of 12 (67%) cases were disseminated infections,4–7 3 of 12 (25%) were primary pulmonary infections5 and 1 of 12 (8%) was of a local infection following a puncture wound 8. Most cases occurred in an immunocompromised host (data not available for all cases).…”

Section: Discussionmentioning

confidence: 99%

“…Most cases occurred in an immunocompromised host (data not available for all cases). Nine of the 12 cases (75%) treated with isavuconazole resulted in a successful outcome with either full or partial improvement 4–8. Although information on long-term follow-up for all cases was not available, isavuconazole treatment was generally given for an extended period, ranging from 6 months to lifelong therapy.…”

Section: Discussionmentioning

confidence: 99%

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Disseminated histoplasmosis in an immunosuppressed patient successfully treated with isavuconazole

Sircar,

Tran,

Vaidya

et al. 2023

BMJ Case Rep

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Histoplasmosis is an endemic fungal infection caused by the dimorphic fungus,Histoplasma capsulatum,which is treated with intravenous amphotericin B and oral itraconazole as first-line and second-line therapy. We report a case of a man in his early 70s treated with methotrexate and infliximab for rheumatoid arthritis who developed disseminated histoplasmosis. The patient was unable to absorb itraconazole due to intractable diarrhoea and developed a severe, anaphylactoid reaction or an immune reconstitution inflammatory syndrome when treated with liposomal amphotericin B. He was subsequently treated with isavuconazole and steroids and made a full recovery.A literature review revealed other cases of histoplasmosis which were treated with isavuconazole including both primary pulmonary and disseminated presentations. Cases of blastomycosis which were treated with isavuconazole are also reviewed including those with severe immunocompromised statuses including solid-organ transplant and tumour necrosis factor-alpha antagonist recipients. Our report describes the potential role of isavuconazole in cases of histoplasmosis where first-line and second-line therapies have failed or are contraindicated (excluding meningitis).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Disseminated histoplasmosis in an immunosuppressed patient successfully treated with isavuconazole

Sircar,

Tran,

Vaidya

et al. 2023

BMJ Case Rep

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“…Out of the four with disseminated disease, half had treatment success, one had a partial success, and another had progression. Isavuconazole was also used successfully in a case of Histoplasma endocarditis [10] and in a case of oesophageal histoplasmosis in the context of advanced HIV infection [11].…”

Section: Discussionmentioning

confidence: 99%

HIV-associated disseminated histoplasmosis successfully treated with isavuconazole consolidation therapy

Mazzella

Stone

Pool

et al. 2020

Medical Mycology Case Reports

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“…AF TDM cases in real-life settings (pathogens, underlying diseases, 69,71–73,75,81 trends per year, 84,234,235,236,238,239,241,244,245,344–348 CNS 532–539 localization 541–566 ) 364,370,499,522,527–530 Trends are concerning a majority of mucomycosis and aspergillosis, in oncohematology and transplantation. VRZ, more recently PSZ tablets and ISZ are the most represented.…”

Section: Tdm For Af Drugsmentioning

confidence: 99%

Antifungal Drugs TDM: Trends and Update

Kably

Launay

Derobertmasure

et al. 2022

Therapeutic Drug Monitoring

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The increasing burden of invasive fungal infections results in growing challenges to antifungal (AF) therapeutic drug monitoring (TDM). This review aims to provide an overview of recent advances in AF TDM. Methods:We conducted a PubMed search for articles during 2016-2020 using "TDM" or "pharmacokinetics" or "drug-druginteraction" with "antifungal," consolidated for each AF. Selection was limited to English language articles with human data on drug exposure.Results: More than 1000 articles matched the search terms. We selected 566 publications. The latest findings tend to confirm previous observations in real-life clinical settings. The pharmacokinetic variability related to special populations is not specific but must be considered. AF benefit-to-risk ratio, drug-drug interaction (DDI) profiles, and minimal inhibitory concentrations for pathogens must be known to manage at-risk situations and patients. Itraconazole has replaced ketoconazole in healthy volunteers DDI studies. Physiologically based pharmacokinetic modeling is widely used to assess metabolic azole DDI. AF prophylactic use was studied more for Aspergillus spp. and Mucorales in oncohematology and solid organ transplantation than for Candida (already studied). Emergence of central nervous system infection and severe infections in immunocompetent individuals both merit special attention. TDM is more challenging for azoles than amphotericin B and echinocandins. Fewer TDM requirements exist for fluconazole and isavuconazole (ISZ); however, ISZ is frequently used in clinical situations in which TDM is recommended. Voriconazole remains the most challenging of the AF, with toxicity limiting high-dose treatments. Moreover, alternative treatments (posaconazole tablets, ISZ) are now available.Conclusions: TDM seems to be crucial for curative and/or longterm maintenance treatment in highly variable patients. TDM poses fewer cost issues than the drugs themselves or subsequent treatment issues. The integration of clinical pharmacology into multidisciplinary management is now increasingly seen as a part of patient care.

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Diagnostic Importance of Hyphae on Heart Valve Tissue in Histoplasma Endocarditis and Treatment With Isavuconazole

Cited by 10 publications

References 4 publications

Disseminated histoplasmosis in an immunosuppressed patient successfully treated with isavuconazole

Disseminated histoplasmosis in an immunosuppressed patient successfully treated with isavuconazole

HIV-associated disseminated histoplasmosis successfully treated with isavuconazole consolidation therapy

Antifungal Drugs TDM: Trends and Update

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