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Fluconazole in patients at risk from invasive aspergillosis
R Kappe1, K J Osterziel, R Rüchel
1Department of Medicine, University of Heidelberg, Germany.
Abstract:
We report on four cases of aspergillosis which developed during therapy with fluconazole in patients who were immunosuppressed or granulocytopenic. Fluconazole may obscure the onset of aspergillosis. We feel that it should neither be given prophylactically nor for fever of unknown origin in patients who are at high risk of contracting aspergillosis.
Insights
Fluconazole therapy may mask invasive aspergillosis in high-risk patients. This antifungal should not be used prophylactically or for unexplained fevers in immunocompromised individuals.
Area of Science:
- Mycology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Invasive aspergillosis is a severe opportunistic infection.
- Immunosuppressed and granulocytopenic patients are at high risk.
- Fluconazole is a common antifungal agent.
Observation:
- Four cases of invasive aspergillosis occurred during fluconazole therapy.
- Patients were either immunosuppressed or granulocytopenic.
- Fluconazole appeared to obscure the clinical presentation of aspergillosis.
Findings:
- Fluconazole therapy did not prevent invasive aspergillosis in high-risk patients.
- The drug may delay diagnosis by masking early signs.
- Aspergillosis developed despite fluconazole treatment.
Implications:
- Fluconazole should not be used prophylactically for aspergillosis.
- Treatment of fever of unknown origin with fluconazole in high-risk patients is not recommended.
- Clinicians must maintain a high index of suspicion for aspergillosis in these patients.