title: Treatment of chronic pulmonary aspergillosis with voriconazole: review of a case series.
abstract: OBJECTIVE
  Chronic pulmonary aspergillosis (CPA) is a rare disease that primarily affects subjects with moderate immunodepression and/or structural alterations in the lung.
  
  
  METHODS
  Data for patients with probable CPA were collected over 24 months. Patients with probable CPA received oral voriconazole, and clinical, laboratory and radiological follow-up was performed at 3, 6 and 12 months.
  
  
  RESULTS
  21 patients (mean age 52.4 years) were evaluated. Factors predisposing to CPA were tuberculosis (n = 8), chronic obstructive pulmonary disease (n = 7), corticosteroids (n = 14), chemo- or radio-therapy (n = 6), tracheostomy or endotracheal prosthesis (n = 5), smoking (n = 4), asthma (n = 3), and chronic liver disease (n = 3). Sputum or bronchial aspirate cultures were positive for Aspergillus spp. in 14 cases (66.6 %). (1,3)-β-D-glucan on serum was positive in 16 cases (76.2 %). Excavated pulmonary thickening was evident in 14 patients (66.6 %) and in 9 of these cases (64.2 %) aspergilloma was present. [(18)F]2-fluoro-2-deoxy-D-glucose-PET-CT was positive in 13/15 patients, and simple aspergilloma was diagnosed after surgical excision in one of the negative cases. All patients were treated with oral voriconazole. Therapy was discontinued due to skin toxicity (n = 3), liver toxicity (n = 2) and severe mental disorder (n = 1). At 12 months' follow-up, nine patients (42.9 %) were considered cured or improved. Seven patients (33.3 %) died during follow-up, mainly due to underlying disease.
  
  
  CONCLUSIONS
  A reasonable proportion of patients achieved cure or improvement with voriconazole, but 28.5 % of treated patients had to discontinue therapy because of toxicity. The high mortality makes it difficult to fully assess the real efficacy of voriconazole and to establish the correct duration of therapy.
authors.affiliation: Istituto di Malattie Infettive, Università di Verona, Verona, Italy, giulia.cucchetto@yahoo.it.
authors.forename: G
authors.initials: G
authors.lastname: Cucchetto
authors.forename: A
authors.initials: A
authors.lastname: Cazzadori
authors.forename: M
authors.initials: M
authors.lastname: Conti
authors.forename: G L
authors.initials: GL
authors.lastname: Cascio
authors.forename: P
authors.initials: P
authors.lastname: Braggio
authors.forename: E
authors.initials: E
authors.lastname: Concia
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000935:Antifungal Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D055732:Pulmonary Aspergillosis / Q000188:drug therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D065819:Voriconazole / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D065819:Voriconazole