Korean J Intern Med.  2017 Sep;32(5):805-812. 10.3904/kjim.2017.109.

Voriconazole-refractory invasive aspergillosis

Affiliations
  • 1Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. kimsunghanmd@hotmail.com

Abstract

Invasive aspergillosis (IA) is one of the most common life-threatening complications in immunocompromised patients. Voriconazole is currently the drug of choice for IA treatment. However, some patients with IA suffer clinical deterioration despite voriconazole therapy. Management of voriconazole-refractory IA remains challenging; no useful recommendations have yet been made. Voriconazole-refractory IA can be further categorized as disease attributable to misdiagnosis or co-infection with another mold; inadequate blood voriconazole blood; inadequate tissue drug concentrations attributable to angioinvasion; immune reconstitution inflammatory syndrome; or infection with voriconazole-resistant Aspergillus. Hence, when encountering a case of voriconazole-refractory IA, it is necessary to schedule sequential tests to decide whether medical treatment or surgical intervention is appropriate; to adjust the voriconazole dose via drug monitoring; to seek CYp2c19 polymorphisms; to monitor serum galactomannan levels; and to examine the drug susceptibility of the causative Aspergillus species.

Keyword

Aspergillosis; Voriconazole; Therapy; Aspergillus; Immunocompromised host
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