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

Voriconazole-refractory invasive aspergillosis

• Park SY
• Yoon JA
• Kim SH

• KMID: 2411481
• DOI: http://doi.org/10.3904/kjim.2017.109

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

MeSH Terms

Appointments and Schedules
Aspergillosis*
Aspergillus
Coinfection
Cytochrome P-450 CYP2C19
Diagnostic Errors
Drug Monitoring
Fungi
Humans
Immune Reconstitution Inflammatory Syndrome
Immunocompromised Host
Voriconazole
Cytochrome P-450 CYP2C19
Voriconazole