Journal Article

Voriconazole for Invasive Bone Aspergillosis: A Worldwide Experience of 20 Cases

Houria Mouas, Irja Lutsar, Bertrand Dupont, Olivier Fain, Raoul Herbrecht, Francois-Xavier Lescure and Olivier Lortholary

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 40, issue 8, pages 1141-1147
Published in print April 2005 | ISSN: 1058-4838
Published online April 2005 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/428734
Voriconazole for Invasive Bone Aspergillosis: A Worldwide Experience of 20 Cases

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Background. Bone aspergillosis remains a rare but potentially devastating fungal disease. Although voriconazole is effective for invasive pulmonary aspergillosis, evidence of its efficacy for aspergillosis located in bone is limited.

Methods. We report our experience with voriconazole in 4 cases of invasive bone aspergillosis. In addition, all cases of probable and definite bone aspergillosis from the Pfizer clinical database were reviewed and analyzed to determine the safety and efficacy of voriconazole treatment. Global response was evaluated at the end of therapy on the basis of a composite assessment of overall clinical, radiological, and mycological responses.

Results. Twenty patients are described, of whom 18 had definite bone involvement diagnosed (spondylodiskitis in 9, sternum/rib osteomyelitis in 6, and peripheral bone involvement in 5). of 20 patients, 14 were immunocompromised. Oral or intravenous voriconazole was given as salvage therapy for 18 patients; 2 patients received voriconazole as first-line therapy. Median duration of voriconazole treatment was 83.5 days (range, 4–395 days). Global response at end of therapy was satisfactory in 11 (55%) of 20 patients, including complete responses in 4 patients and partial responses in 7 patients; there were no relapses of infection in the 4 patients with complete response to therapy with voriconazole. Treatment was generally well tolerated.

Conclusions. Long-term voriconazole treatment is a new therapeutic option for invasive aspergillosis with bone involvement.

Journal Article.  4357 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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