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Voriconazole-refractory invasive aspergillosis
Se Yoon Park1, Jung-A Yoon1, Sung-Han Kim1
1Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
The Korean Journal of Internal Medicine
|August 25, 2017
Summary
Managing invasive aspergillosis (IA) refractory to voriconazole is challenging. Sequential testing and tailored interventions, including drug monitoring and susceptibility testing, are crucial for effective treatment of refractory IA.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Pharmacology
Background:
- Invasive aspergillosis (IA) is a severe complication in immunocompromised individuals.
- Voriconazole is the primary treatment, but refractory cases present significant challenges.
- Current management guidelines for voriconazole-refractory IA are lacking.
Observation:
- Some patients experience clinical decline despite voriconazole therapy for IA.
- Reasons for refractory IA include misdiagnosis, co-infections, inadequate drug levels, and resistant fungal strains.
- Factors like CYP2C19 genotype and angioinvasion affect voriconazole efficacy.
Findings:
- Voriconazole-refractory IA necessitates a systematic diagnostic approach.
- Key investigations include drug monitoring, CYP2C19 genotyping, galactomannan testing, and fungal susceptibility analysis.
- Identifying the cause of refractoriness guides decisions on medical or surgical interventions.
Implications:
- A structured diagnostic workup is essential for optimizing treatment in refractory IA.
- Personalized therapeutic strategies, including dose adjustment and alternative treatments, are vital.
- Further research is needed to establish definitive recommendations for managing voriconazole-refractory IA.
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