MARTY FM, COSIMI L, MARASCO WA, RUBIN RH, BADEN LR; Interscience Conference on Antimicrobial Agents and Chemotherapy (43rd: 2003: Chicago, Ill.).

Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 2003 Sep 14-17; 43: abstract no. M-985.

Brigham & Women's Hospital, Boston, MA.

BACKGROUND: Since Voriconazole (VORI) became available in 9/2002, we have noted a sharp increase in its use for prophylaxis and empiric therapy in high-risk patients. Given VORI's limited activity against Zygomycota, we postulated that an increased incidence of infections due to these fungi may be encountered (Louis Weinstein's principle). METHODS: We reviewed records for all patients who had undergone allogeneic hematopoietic stem cell transplantation (AHSCT) at our institution for evidence of zygomycosis from 9/1/2002 to 5/8/2003. Identified cases were reviewed in detail. RESULTS: 4 cases were identified. Median age was 44 years, 3 were male. The diagnosis was made a median of 125 days after transplant. All patients had been diagnosed and were being treated for Graft-Versus-Host Disease (3 acute, grades II-IV; 1 chronic, extensive). VORI had been prescribed to all for a median of 36.5 days (range 21-99) prior to diagnosis and 20.5 days (range 0-94) prior to the onset of symptoms that lead to the diagnosis of zygomycosis. VORI was given as empiric therapy for possible fungal pneumonia in 1 case and as prophylaxis in the other 3. Lung infiltrates and necrotic cutaneous lesions developed in 2 patients, a sinoorbital syndrome in one. Diagnosis was proven histologically in these. The fourth patient died of progressive pneumonia and Rhizopus sp. was isolated from a BAL specimen. Breakthrough invasive fungal infection (IFI) was not considered initially by clinicians. From 1/1/2000 to 9/1/2002, only 2 cases of zygomycosis were documented in AHSCT at our institution. CONCLUSION: These findings suggest that breakthrough zygomycosis is an emerging syndrome in AHSCT who receive VORI for prophylactic or empiric use. Physicians should be aware of the limitations of VORI's spectrum and promptly consider IFI in patients who remain at high-risk despite this strategy.

Publication Types:

• Meeting Abstracts

Keywords:

• Bone Marrow Transplantation
• Graft vs Host Disease
• Hematopoietic Stem Cell Transplantation
• Humans
• Male
• Mycoses
• Pyrimidines
• Rhizopus
• Transplantation Conditioning
• Transplantation, Homologous
• Triazoles
• Zygomycosis
• Zygomycota
• diagnosis
• prevention & control
• surgery
• therapy
• transplantation
• voriconazole

Other ID:

• GWAIDS0025243

UI: 102264867

From Meeting Abstracts