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Infectious Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Imran Rizvi, Ravindra Kumar Garg
Aspergillosis is also common in immune compromised state. Aspergillosis varies from noninvasive form to life-threatening invasive form. Optic nerve involvement occurs as a result of extension from aspergillus rhino-sinusitis. Patient presents with facial pain, orbital swelling, rhinorrhea, vision loss and restricted eye movements. Multiple cranial nerves are frequently involved. Aspergillosis can also cause dacryocystitis, periorbital cellulitis, endophthalmitis and vitritis. Definite diagnosis requires biopsy. Microscopic examination shows branching and septate hyphae.60 Management of invasive rhino orbital aspergillosis requires surgical debridement along with antifungal therapy. Voriconazole is the drug of choice.60
Novel and emerging pharmacotherapy and device-based treatments for onychomycosis
Published in Robert Baran, Dimitris Rigopoulos, Chander Grover, Eckart Haneke, Nail Therapies, 2021
Jose W. Ricardo, Shari R. Lipner
Voriconazole is a triazole antifungal that has been approved for the treatment of systemic fungal infections, including candidemia, aspergillosis, and serious infections caused by Fusarium species. It has a broad-spectrum antifungal activity in vitro, but it has not been assayed for the treatment of onychomycosis in large scale trials. In a recently published report, a recalcitrant (itraconazole/terbinafine) case of fingernail onychomycosis showed complete response to oral voriconazole after 3 months of treatment.
Anti-Infective Agents
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: The use of Voriconazole is better to be avoided in pregnant women, especially during the 1st Trimester, because the pregnancy experience in humans is limited and the reproduction studies in animals have shown low risk.
Comparison of the inhibitory effect of ketoconazole, voriconazole, fluconazole, and itraconazole on the pharmacokinetics of bosentan and its corresponding active metabolite hydroxy bosentan in rats
Published in Xenobiotica, 2020
Mengchun Chen, Xufei Zhang, Yijie Chen, Wei Sun, Zhe Wang, Chengke Huang, Guoxin Hu, Ruijie Chen
Voriconazole was thought to be a substitute for ketoconazole because of its weaker hepatic toxicity (Mikus et al., 2011). As reported, voriconazole had a selective influence on CYP2C9 and CYP3A4 as a result of their sensitivities to different hepatic enzymes; it inhibited CYP3A4 more extensively than CYP2C9 (Hyland et al., 2003). In the present study, the AUC(0–t) and Cmax of BOS after treatment with voriconazole showed a relative decrease accompanied by increased CLz/F profile compared with the ketoconazole and fluconazole groups (Figure 3). In contrast, significant differences in OHBOS pharmacokinetics were observed in the voriconazole group compared with the ketoconazole and fluconazole groups. The AUC(0–t) and Cmax of OHBOS were significantly lower on co-administering BOS and voriconazole compared with those in the ketoconazole and fluconazole groups, leading to an augmentation in MRT(0-t). The reduced AUC(0–t) and Cmax and elevated MRT(0-t) in OHBOS metabolism were probably a result of an impaired hepatic injury induced by voriconazole. Also, a previous study demonstrated that voriconazole led to liver toxicity (Hulin et al., 2011). Thus, despite moderate hepatic damage caused by voriconazole compared with ketoconazole, the hepatic function needs long-term examinations when BOS and voriconazole are taken simultaneously.
Alfa-1-antitrypsin deficiency: a predisposing factor leading to invasive infections?
Published in Infectious Diseases, 2020
Sanne De Smet, Jan Dierick, Sophia Steyaert, Marie Schurgers, Christophe Van Steenkiste, Sarah Loof
There was need for non-invasive ventilation to support his respiration. Computed tomography scan (CT scan) of the thorax showed extended bilateral ground glass opacities. The differential diagnosis at this point included viral pneumonia, bacterial pneumonia, opportunistic infection (pneumocystis jirovecii or fungal) and ARDS. A bronchoscopy was performed, showing no endobronchial abnormalities. The PCR on the broncho-alveolar lavage (BAL) fluid was negative for Pneumocystis jirovecii but positive for galactomannan. Galactomannan testing was done by Enzyme-Linked Immuno Sorbent Assay (ELISA) and showed a ratio of 0.88 (reference level < 0.5). Bacterial culture on the BAL fluid remained negative. As the galactomannan was strongly positive in this assumed immunocompromised patient (ICU stay, 10 days treatment with corticosteroids, Listeria infection, AATD), the diagnosis of a probable invasive pulmonary aspergillosis (IPA) could be made. The patient was treated with voriconazole with quick resolution of the respiratory insufficiency and radiological abnormalities, resulting in his discharge from the ICU. Treatment with voriconazole was continued for 6 weeks with therapeutic drug monitoring. His neurological symptoms also improved and finally disappeared after 2 weeks of combined therapy with amoxicillin and gentamycin, after which monotherapy with amoxicillin was continued.
Risk factors associated with insufficient and potentially toxic voriconazole plasma concentrations: an observational study
Published in Journal of Chemotherapy, 2019
Xiaochen Wei, Mingfeng Zhao, Peng Fu, Xia Xiao
This was a single-center retrospective study conducted from March 2017 to February 2018 at Tianjin First Central Hospital, China. Patients who were receiving voriconazole for prophylaxis/treatment of IFIs were enrolled. IFIs were defined according to consensus definitions of the European Organization for Research and Treatment of Cancer Invasive Fungal Infections Cooperative Group (EORTC) and the Mycoses Study Group of the National Institute of Allergy and Infectious Disease (MSG).13 Patients were screened by applying the following inclusion criteria: (1) aged 18 years and older; (2) receiving oral voriconazole with the loading dose of 400 mg (weight ≥40 kg) or 200 mg (weight <40 kg) twice daily on first 24 h followed by 200 mg (weight ≥40 kg) or 100 mg (weight <40 kg) every 12 h, or intravenous voriconazole with two loading doses of 6 mg/kg at 12-h intervals for the first day followed by 4 mg/kg every 12 h; and (3) the duration of voriconazole therapy for at least 3 days and presence of at least one trough VTC measurement. Patients were excluded if: (1) they were younger than 18 years; (2) sampling was obtained prior to reaching a steady-state trough concentration that was defined as a level obtained after 3 days of therapy with voriconazole, and the samples were collected at interval windows of 10–12 h post-dose; (3) the initial TDM after dose adjustment; or (4) missing data.