Failure of voriconazole to cure disseminated zygomycosis in an immunocompromised child

Abstract

This case emphasises that the lack of in vitro activity of voriconazole against zygomycetes is clinically relevant. Failure of voriconazole in suspected fungal infection should be investigated for the possibility of zygomycosis. Broad-range polymerase chain reaction may be able to identify the causative organism when cultures remain sterile.

In Vitro Activities of Amphotericin B, Caspofungin, Itraconazole, Posaconazole, and Voriconazole against 45 Clinical Isolates of Zygomycetes: Comparison of CLSI M38-A, Sensititre YeastOne, and the Etest

“…CAS and VC proved to be quite resistant in vitro, and this correlates well with previous reports on the clinical inefficacy of both drugs in the treatment of zygomycosis (6,7,10,27,29). While VC has been considered responsible for increased incidence in some institutions (16,19,20,22,23,25,28,31,32), POS seems to be very promising for the treatment of zygomycosis (3,11,13,26,30). This is the first study to evaluate the correlation between the CLSI M38-A procedure and the Etest and Sensititre YeastOne methods for testing the antifungal activity of POS, ITC, AMB, CAS, and VC against zygomycetes at different incubation times.…”

“…The most active drug was posaconazole, followed by amphotericin B and itraconazole. The correlation of the Etest and Sensititre with CLSI M38-A was moderate for posaconazole but poor for the others.The incidence of zygomycosis is increasing in some institutions, purportedly due to voriconazole prophylaxis (16,19,20,22,23,25,28,31,32). The introduction of new antifungal agents and the availability of alternative antifungal susceptibility procedures necessitate studies comparing the in vitro activity of these new antifungal agents against zygomycetes.…”

Septic Arthritis due to Absidia corymbifera in a Patient with HIV-1 Infection

“…The lack of initial surgery could explain the absence of improvement with amphotericin B, leading to the change to the antifungal regimen. Failure to voriconazol therapy is commonly reported in cases of zygomycetal infection leading to the investigation of the possibility of zygomycosis [15]. In our patient the lack of response to amphotericin B and voriconazol lead to the realization of arthrotomy despite the poor general condition of the patient and the presence of mild thrombocytopenia.…”

Identification of fungi in fungal ball sinusitis: comparison between MUC5B immunohistochemical and Grocott methenamine silver staining

“…Since Aspergillus and Mucor fungal ball sinusitis is associated with a different prognosis, i.e. Mucor infection has a more urgent course of disease, greater invasiveness, and higher fatality rate than Aspergillus infection, accurate identification of fungal species is of clinical significance [9,10].…”