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Treatment of invasive Aspergillus sinusitis with liposomal-amphotericin B
Abstract:
Invasive sinonasal aspergillosis is a severe and frequently fatal infection in immunosuppressed patients with hematologic malignancies. Seven patients with sinonasal aspergillosis who failed to respond to conventional amphotericin B (AmpB) were treated with liposomal AmpB (L-AmpB).AmpB was incorporated into multilamellar vesicles consisting of dimyristoyl phosphatidyl-choline and dimyristoyl phosphatidylglycerol in a 7:3 molar ratio. Five patients had underlying hematologic malignancies, one patient had aplastic anemia, and one patient had no underlying disease. All patients had biopsy-proven invasive Aspergillus sinusitis, and had failed conventional antifungal therapy including AmpB. Five patients were cured and two did not respond to treatment. Fever and chills were infrequent and, when they occurred, mild, and responded well to conventional management. No severe renal or central nervous system toxicity was observed. L-AmpB is effective and less toxic than conventional AmpB in the treatment of invasive Aspergillus sinusitis.
Insights
Liposomal amphotericin B (L-AmpB) effectively treated invasive sinonasal aspergillosis in patients unresponsive to conventional amphotericin B (AmpB). This antifungal therapy demonstrated reduced toxicity, offering a safer alternative for severe fungal infections.
Area of Science:
- Mycology
- Infectious Diseases
- Hematology
Background:
- Invasive sinonasal aspergillosis is a life-threatening infection, particularly in immunocompromised individuals with hematologic malignancies.
- Conventional amphotericin B (AmpB) therapy can be limited by toxicity and treatment failure.
Purpose of the Study:
- To evaluate the efficacy and safety of liposomal amphotericin B (L-AmpB) in patients with invasive sinonasal aspergillosis who did not respond to conventional AmpB.
Main Methods:
- Seven patients with biopsy-proven invasive Aspergillus sinusitis and prior AmpB failure were treated with L-AmpB.
- L-AmpB was formulated using dimyristoyl phosphatidyl-choline and dimyristoyl phosphatidylglycerol.
Main Results:
- Five out of seven patients achieved a cure.
- Adverse events such as fever and chills were mild and infrequent.
- No severe renal or central nervous system toxicity was observed.
Conclusions:
- Liposomal amphotericin B is an effective and less toxic alternative to conventional AmpB for treating invasive sinonasal aspergillosis.
- L-AmpB offers a promising therapeutic option for immunocompromised patients with refractory fungal sinusitis.