A case of invasive central nervous system aspergillosis treated with micafungin with monitoring of micafungin concentrations in the cerebrospinal fluid.
Invasive aspergillosis has an extremely high mortality rate. In Japan, micafungin, an echinocandin drug that has a new mechanism of action as an antifungal agent and has a clinical effect against Aspergillus species, became available in 2002. However, little is known about its penetration into the central nervous system (CNS), or its efficacy for the treatment of invasive CNS aspergillosis. We report a 65-y-old female with diabetes mellitus and CNS aspergillosis who was treated with micafungin. During treatment, micafungin concentrations were measured in the cerebrospinal fluid and plasma. On a dose of 300 mg/d, the ratio of the micafungin concentration in the cerebrospinal fluid to that in plasma was extremely low (0.2%-0.05%); nevertheless, the patient did not have a relapse of invasive CNS aspergillosis after micafungin treatment.
Okugawa
Shu
S
Department of Infectious Disease, the University of Tokyo, Graduate School of Medicine, Tokyo, Japan.
Ota
Yasuo
Y
Tatsuno
Keita
K
Tsukada
Kunihisa
K
Kishino
Satoshi
S
Koike
Kazuhiko
K
D000368:Aged; D000666:Amphotericin B / Q000009:adverse effects; D000935:Antifungal Agents / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D054714:Echinocandins; D005260:Female; D006801:Humans; D055666:Lipopeptides; D008074:Lipoproteins / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D000077551:Micafungin; D020953:Neuroaspergillosis / Q000188:drug therapy* / Q000517:prevention & control / Q000601:surgery; D010456:Peptides, Cyclic / Q000134:cerebrospinal fluid / Q000627:therapeutic use*; D012008:Recurrence
D000935:Antifungal Agents; D054714:Echinocandins; D055666:Lipopeptides; D008074:Lipoproteins; D010456:Peptides, Cyclic; D000666:Amphotericin B; D000077551:Micafungin