Therapeutic outcome in invasive aspergillosis.
A review of series of > or = 4 cases of invasive aspergillosis (total, 1,223 cases) was undertaken to establish the crude mortality and rate of response to therapy with amphotericin B in the major at-risk host groups. In association with pulmonary, sinus, and cerebral aspergillosis in immunocompromised patients, the crude mortality rates were 86%, 66%, and 99%, respectively. No untreated patient survived. Among 84 patients treated for 1-13 days, only one survived. Among those with invasive pulmonary aspergillosis treated for > or = 14 days, the response rates to amphotericin B deoxycholate were 83% (in cases of heart and renal transplantation), 54% (leukemia), 33% (bone marrow transplantation) and 20% (liver transplantation). Patients with AIDS mostly received both amphotericin B and itraconazole, and 37% of those treated for > or = 14 days responded to therapy. Substantial variation in outcome from series to series was related to underlying disease status, site of disease, and management. Invasive aspergillosis remains a devastating opportunistic infection despite current treatment.
Denning
D W
DW
Department of Infectious Diseases and Tropical Medicine (Monsall Unit), North Manchester General Hospital, Crumpsall, United Kingdom.
D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology; D003840:Deoxycholic Acid / Q000627:therapeutic use; D004338:Drug Combinations; D006801:Humans; D017964:Itraconazole / Q000627:therapeutic use; D009894:Opportunistic Infections / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology
D000935:Antifungal Agents; D004338:Drug Combinations; D003840:Deoxycholic Acid; D017964:Itraconazole; D000666:Amphotericin B; C059765:amphotericin B, deoxycholate drug combination