Secondary peritonitis in a patient with cirrhosis involving Hyphopichia burtonii, an emerging fungal pathogen

Feldman, Esther; Bellinghausen, Amy L.; Vodkin, Irine E.; Abeles, Shira R.

doi:10.1016/j.idcr.2023.e01730

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…Candida albicans was also the main causative agent of fungal peritonitis (48.0%–81.8%), followed by Candida klebsiella (15.0%–25.0%), Candida smoothes (6.6%–20.0%), and novel Cryptococcus spp. were seen in some individuals ( Tariq et al, 2019 ; Feldman et al, 2023 ). Pulmonary IFI is mainly caused by Aspergillus spp., with Aspergillus fumigatus being the most common, followed by Aspergillus flavus and Aspergillus niger; Aspergillus pyogenes and Aspergillus terreus are less frequently reported ( Su et al, 2010 ; Jović et al, 2019 ; Lahmer et al, 2019 ).…”

Section: Hepatic Insufficiency Combined With Ifimentioning

confidence: 99%

The impact of gene polymorphism and hepatic insufficiency on voriconazole dose adjustment in invasive fungal infection individuals

Li,

Zhang

et al. 2023

Front. Genet.

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Voriconazole (VRZ) is a broad-spectrum antifungal medication widely used to treat invasive fungal infections (IFI). The administration dosage and blood concentration of VRZ are influenced by various factors, posing challenges for standardization and individualization of dose adjustments. On the one hand, VRZ is primarily metabolized by the liver, predominantly mediated by the cytochrome P450 (CYP) 2C19 enzyme. The genetic polymorphism of CYP2C19 significantly impacts the blood concentration of VRZ, particularly the trough concentration (Ctrough), thereby influencing the drug’s efficacy and potentially causing adverse drug reactions (ADRs). Recent research has demonstrated that pharmacogenomics-based VRZ dose adjustments offer more accurate and individualized treatment strategies for individuals with hepatic insufficiency, with the possibility to enhance therapeutic outcomes and reduce ADRs. On the other hand, the security, pharmacokinetics, and dosing of VRZ in individuals with hepatic insufficiency remain unclear, making it challenging to attain optimal Ctrough in individuals with both hepatic insufficiency and IFI, resulting in suboptimal drug efficacy and severe ADRs. Therefore, when using VRZ to treat IFI, drug dosage adjustment based on individuals’ genotypes and hepatic function is necessary. This review summarizes the research progress on the impact of genetic polymorphisms and hepatic insufficiency on VRZ dosage in IFI individuals, compares current international guidelines, elucidates the current application status of VRZ in individuals with hepatic insufficiency, and discusses the influence of CYP2C19, CYP3A4, CYP2C9, and ABCB1 genetic polymorphisms on VRZ dose adjustments and Ctrough at the pharmacogenomic level. Additionally, a comprehensive summary and analysis of existing studies’ recommendations on VRZ dose adjustments based on CYP2C19 genetic polymorphisms and hepatic insufficiency are provided, offering a more comprehensive reference for dose selection and adjustments of VRZ in this patient population.

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