Management of Aspergillus osteomyelitis: Report of failure of liposomal amphotericin B and response to voriconazole in an immunocompetent host and literature review

I. Stratov, T. M. Korman, P. D. R. Johnson

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63 Citations (Scopus)

Abstract

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. Lipid formulations of amphotericin B (L-AmB) are expensive agents, which allow the administration of higher doses with less side-effects [3], but superior efficacy has not been demonstrated. Voriconazole is a new second-generation triazole undergoing clinical trials with a 50% response rate for invasive aspergillosis in immunocompromised patients [4]. Its efficacy in the treatment of bone infections is not known. We present a case of proven Aspergillus osteomyelitis in an immunocompetent host that progressed despite surgery and prolonged treatment with L-AmB, but which responded rapidly when antimicrobial therapy was switched to voriconazole. The case is followed by a review of the management of Aspergillus osteomyelitis in immunocompetent patients.

Original languageEnglish
Pages (from-to)277-283
Number of pages7
JournalEuropean Journal of Clinical Microbiology and Infectious Diseases
Volume22
Issue number5
Publication statusPublished - 1 May 2003
Externally publishedYes

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