Management of Aspergillus osteomyelitis: report of failure of liposomal amphotericin B and response to voriconazole in an immunocompetent host and literature review.
Presented here is a case of Aspergillus osteomyelitis in an immunocompetent patient that progressed despite surgery and prolonged treatment with liposomal amphotericin B; the report is followed by a review of the literature. The review of this case and 41 similar cases found an overall cure rate of 69%. The importance of surgery when amphotericin B is used as first-line therapy is indicated by a 14% cure rate when amphotericin B is used alone compared to 75% when combined with surgery. When therapy is failing or surgery is contraindicated, dose escalation using a lipid formulation was not effective. On review, the addition of another agent, in particular 5-fluorocytosine, appears to be more beneficial. The patient reported here responded rapidly to voriconazole, a promising new antifungal agent for Aspergillus infections.
Department of Microbiology and Immunology, The University of Melbourne, Grattan Street, Parkville, Victoria 3010, Australia. i.stratov@pgrad.unimelb.edu.au
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Stratov
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Korman
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Johnson
D000666:Amphotericin B / Q000008:administration & dosage*; D000935:Antifungal Agents / Q000008:administration & dosage; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D001230:Aspergillus / Q000187:drug effects* / Q000302:isolation & purification; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D025141:Drug Resistance, Fungal; D005500:Follow-Up Studies; D006801:Humans; D007121:Immunocompetence; D008159:Lumbar Vertebrae / Q000473:pathology; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D011743:Pyrimidines / Q000008:administration & dosage*; D018570:Risk Assessment; D012720:Severity of Illness Index; D013166:Spondylitis / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D017211:Treatment Failure; D016896:Treatment Outcome; D014230:Triazoles / Q000008:administration & dosage*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D000666:Amphotericin B; D065819:Voriconazole