Aspergillosis

The glucan synthase inhibitor caspofungin (intravenous formulation) is new on the market for the treatment of invasive aspergillosis in patients whose disease is refractory to, or who are intolerant of, other therapies. During the clinical trials fever, infused vein complications, nausea, vomiting and in combination with cyclosporin mild transient hepatic side effects were observed. Interaction with tacrolismius and with potential inducer or mixed inducer/inhibitors of drug clearance was also seen. 

Nodular or halo-like lesions detected by high-resolution computed tomography (HRCT) scans are often the first indication of invasive pulmonary aspergillosis. 

Many experts now consider voriconazole as the initial drug of choice for invasive aspergillosis in patients without significant contraindications (e.g., drug interactions or preexisting liver dysfunction) to azole therapy. 

Invasive molds, particularly Aspergillus, have become an increasingly important complication of cancer therapy and organ transplantation. Patients with acute leukemia and recipients of allogeneic hematopoietic cell transplants are at especially high risk for invasive aspergillosis due to prolonged neutropenia and deficiencies in cell-mediated immunity associated... 

Herbrecht R, Denning DW, Patterson TF, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002 347 408M15. 

Marr KA, Boeckh M, Carter RA, et al. Combination antifungal therapy for invasive aspergillosis. Clin Infect Dis 2004 39 797-802. Masur H, Kaplan JE, Holmes KK, et al. 1999 USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus. Clin Infect Dis 2000 30 S29-S65. 

Segal BH, Walsh TJ. Current approaches to diagnosis and treatment of invasive aspergillosis. Am J Respir Crit Care Med 2006 173 707-717. 

Carpenter KJ, Hogaboam CM. Immunosuppressive effects of CCL17 on pulmonary antifungal responses during pulmonary invasive aspergillosis. Infect Immun 2005 73(ll) 7198-7207. 

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