gms | German Medical Science

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010)

Deutsche Gesellschaft für Infektiologie,
Deutsche AIDS-Gesellschaft,
Deutsche Gesellschaft für Tropenmedizin und Internationale Gesundheit,
Paul-Ehrlich-Gesellschaft für Chemotherapie

23.06. - 26.06.2010, Köln

Analysis of 59 case reports of zygomycosis treated with posaconazole

Analyse von 59 Fallberichten mit Posaconazol behandelter invasiver Zygomykosen

Meeting Abstract

  • A. Birtel - University of Cologne, 1st Department of Internal Medicine, Cologne, Germany
  • M.J. Rüping - University of Cologne, 1st Department of Internal Medicine, Cologne, Germany
  • J.J. Vehreschild - University of Cologne, 1st Department of Internal Medicine, BMBF 01KI0771, Cologne, Germany
  • G. Fätkenheuer - University of Cologne, 1st Department of Internal Medicine, BMBF 01KI0771, Cologne, Germany
  • O.A. Cornely - University of Cologne, 1st Department of Internal Medicine, Cologne, Germany; University of Cologne, Clinical Trials Centre Cologne, ZKS Köln, BMBF 01KN0706, Cologne, Germany; University of Cologne, Center for Integrated Oncology CIO Köln-Bonn, Cologne, Germany

10. Kongress für Infektionskrankheiten und Tropenmedizin (KIT 2010). Köln, 23.-26.06.2010. Düsseldorf: German Medical Science GMS Publishing House; 2010. DocP34

DOI: 10.3205/10kit090, URN: urn:nbn:de:0183-10kit0903

Veröffentlicht: 2. Juni 2010

© 2010 Birtel et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: Zygomycosis is an emerging invasive fungal infection. The disease is difficult to diagnose and even if treated adequately mortality reaches 40%. The majority of patients is immunosuppressed. Standard of care is surgical debridement in combination with systemically active antifungal drugs. Lipid-based amphotericin B is the first-line therapy while posaconazole may be a promising alternative. No controlled trials have been conducted.

Methods: We searched the literature on case reports of zygomycosis treated with posaconazole.

Results: From 2003 to 2009, 59 cases have been published. Diagnosis was based on histology alone in 2 (3.4%), microbiological evidence was found in 39 (66.1%), no data on the diagnostic approach was reported in 18 (30.5%) patients. The most frequent isolates were Rhizopus spp. (16/59; 27.1%), followed by Mucor spp. (12/59; 20.4%). The site of infection was predominantly the rhino-cerebral region in 28 (47.5%), followed by lungs and soft tissue in 7 (11.9%), each. Disseminated infection was found in 8 (13.6%) patients. Treatment modalities were distributed as follows: surgical debridement in 36 (61%), posaconazole monotherapy in 2 (3.4%), combination of posaconazole and lipid-based amphotericin B in 43 (72.9%), other combinations comprised deferasirox, caspofungin, gCSF, and hyperbaric oxygen. Complete response was achieved in 41 (69.5%), partial response in 4 (6.8%), stable disease in 3 (5.1%) patients. Overall mortality was 16.9% patients (lacking data for 1 patient).

Conclusion: In published case reports posaconazole was frequently used as a component of combination treatment. Response and overall mortality appeared better than expected, which could be a possible publication bias. A randomized controlled trial on this unmet medical need is urgently needed.