Voriconazole Use for Endemic Fungal Infections

Freifeld, Alison G.; Proia, Laurie A.; Andes, David R.; Baddour, Larry M.; Blair, Janis E.; Spellberg, Brad; Arnold, Sandra R.; Lentnek, Arnold; Wheat, L. Joseph

doi:10.1128/aac.01148-07

Cited by 130 publications

(74 citation statements)

References 25 publications

(27 reference statements)

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“…Subsequent reports support the use of voriconazole for salvage therapy of nonmeningeal coccidioidomycosis (181). From 2009 to 2011, there were two case series published that claimed a response in 6/7 and 14/21 patients treated with voriconazole (182,183). Most of the patients had refractory disease or were intolerant of other treatments.…”

Section: Advances In Antifungal Therapy For Coccidioidomycosismentioning

confidence: 99%

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

et al. 2013

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SUMMARY Coccidioidomycosis is the endemic mycosis caused by the fungal pathogens Coccidioides immitis and C. posadasii . This review is a summary of the recent advances that have been made in the understanding of this pathogen, including its mycology, genetics, and niche in the environment. Updates on the epidemiology of the organism emphasize that it is a continuing, significant problem in areas of endemicity. For a variety of reasons, the number of reported coccidioidal infections has increased dramatically over the past decade. While continual improvements in the fields of organ transplantation and management of autoimmune disorders and patients with HIV have led to dilemmas with concurrent infection with coccidioidomycosis, they have also led to advances in the understanding of the human immune response to infection. There have been some advances in therapeutics with the increased use of newer azoles. Lastly, there is an overview of the ongoing search for a preventative vaccine.

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Section: Advances In Antifungal Therapy For Coccidioidomycosismentioning

confidence: 99%

Recent Advances in Our Understanding of the Environmental, Epidemiological, Immunological, and Clinical Dimensions of Coccidioidomycosis

et al. 2013

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“…Itraconazole has better intrinsic activity against B. dermatitidis than fluconazole, but fluconazole penetrates better into the CNS than itraconazole. Voriconazole possesses both of these important characteristics (intrinsic activity and capability for CNS penetration), but clinical experience with this agent in patients with blastomycosis is limited (49). Itraconazole at 200 mg twice or thrice per day, fluconazole at 800 mg per day, and voriconazole at 200 to 400 mg twice per day are options for step-down therapy (27).…”

Section: Central Nervous System Blastomycosismentioning

confidence: 99%

Clinical and Laboratory Update on Blastomycosis

2010

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SUMMARY Blastomycosis is endemic in regions of North America that border the Great Lakes and the St. Lawrence River, as well as in the Mississippi River and Ohio River basins. Men are affected more often than women and children because men are more likely to participate in activities that put them at risk for exposure to Blastomyces dermatitidis. Human infection occurs when soil containing microfoci of mycelia is disturbed and airborne conidia are inhaled. If natural defenses in the alveoli fail to contain the infection, lymphohematogenous dissemination ensues. Normal host responses generate a characteristic pyogranulomatous reaction. The most common sites of clinical disease are the lung and skin; osseous, genitourinary, and central nervous system manifestations follow in decreasing order of frequency. Blastomycosis is one of the great mimickers in medicine; verrucous cutaneous blastomycosis resembles malignancy, and mass-like lung opacities due to B. dermatitidis often are confused with cancer. Blastomycosis may be clinically indistinguishable from tuberculosis. Diagnosis is based on culture and direct visualization of round, multinucleated yeast forms that produce daughter cells from a single broad-based bud. Although a long course of amphotericin B is usually curative, itraconazole is also highly effective and is the mainstay of therapy for most patients with blastomycosis.

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“…Our diagnosis of histoplasmosis was based on the characteristic morphologic features of the fungus, and repeat biopsy for fungal culture could not be done because of refractory thrombocytopenia and poor general condition of the patient. The most effective treatment is amphotericin B, though azoles particularly itraconazole and sometimes voriconazole have also been successfully used [5,11]. Since our patient was immunocompromised and recovery of neutrophils was unlikely without definite treatment for aplastic anemia, we used both amphotericin and voriconazole for the treatment of disseminated histoplasmosis.…”

Section: Dear Editormentioning

confidence: 99%