Cargando…
Potential Implication of Azole Persistence in the Treatment Failure of Two Haematological Patients Infected with Aspergillus fumigatus
Invasive aspergillosis (IA) is a major cause of morbidity and mortality in patients receiving allogeneic haematopoieticcell transplantation. The deep immunosuppression and a variety of potential additional complications developed in these patients result in IA reaching mortality rates of around 50–6...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455522/ https://www.ncbi.nlm.nih.gov/pubmed/37623576 http://dx.doi.org/10.3390/jof9080805 |
_version_ | 1785096472511905792 |
---|---|
author | Peláez-García de la Rasilla, Teresa Mato-López, Álvaro Pablos-Puertas, Clara E. González-Huerta, Ana Julia Gómez-López, Alicia Mellado, Emilia Amich, Jorge |
author_facet | Peláez-García de la Rasilla, Teresa Mato-López, Álvaro Pablos-Puertas, Clara E. González-Huerta, Ana Julia Gómez-López, Alicia Mellado, Emilia Amich, Jorge |
author_sort | Peláez-García de la Rasilla, Teresa |
collection | PubMed |
description | Invasive aspergillosis (IA) is a major cause of morbidity and mortality in patients receiving allogeneic haematopoieticcell transplantation. The deep immunosuppression and a variety of potential additional complications developed in these patients result in IA reaching mortality rates of around 50–60%. This mortality is even higher when the patients are infected with azole-resistant isolates, demonstrating that, despite the complexity of management, adequate azole treatment can have a beneficial effect. It is therefore paramount to understand the reasons why antifungal treatment of IA infections caused by azole-susceptible isolates is often unsuccessful. In this respect, there are already various factors known to be important for treatment efficacy, for instance the drug concentrations achieved in the blood, which are thus often monitored. We hypothesize that antifungal persistence may be another important factor to consider. In this study we present two case reports of haematological patients who developed proven IA and suffered treatment failure, despite having been infected with susceptible isolates, receiving correct antifungal treatment and reaching therapeutic levels of the azole. Microbiological analysis of the recovered infective isolates showed that the patients were infected with multiple strains, several of which were persisters to voriconazole and/or isavuconazole. Therefore, we propose that azole persistence may have contributed to therapeutic failure in these patients and that this phenomenon should be considered in future studies. |
format | Online Article Text |
id | pubmed-10455522 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-104555222023-08-26 Potential Implication of Azole Persistence in the Treatment Failure of Two Haematological Patients Infected with Aspergillus fumigatus Peláez-García de la Rasilla, Teresa Mato-López, Álvaro Pablos-Puertas, Clara E. González-Huerta, Ana Julia Gómez-López, Alicia Mellado, Emilia Amich, Jorge J Fungi (Basel) Article Invasive aspergillosis (IA) is a major cause of morbidity and mortality in patients receiving allogeneic haematopoieticcell transplantation. The deep immunosuppression and a variety of potential additional complications developed in these patients result in IA reaching mortality rates of around 50–60%. This mortality is even higher when the patients are infected with azole-resistant isolates, demonstrating that, despite the complexity of management, adequate azole treatment can have a beneficial effect. It is therefore paramount to understand the reasons why antifungal treatment of IA infections caused by azole-susceptible isolates is often unsuccessful. In this respect, there are already various factors known to be important for treatment efficacy, for instance the drug concentrations achieved in the blood, which are thus often monitored. We hypothesize that antifungal persistence may be another important factor to consider. In this study we present two case reports of haematological patients who developed proven IA and suffered treatment failure, despite having been infected with susceptible isolates, receiving correct antifungal treatment and reaching therapeutic levels of the azole. Microbiological analysis of the recovered infective isolates showed that the patients were infected with multiple strains, several of which were persisters to voriconazole and/or isavuconazole. Therefore, we propose that azole persistence may have contributed to therapeutic failure in these patients and that this phenomenon should be considered in future studies. MDPI 2023-07-30 /pmc/articles/PMC10455522/ /pubmed/37623576 http://dx.doi.org/10.3390/jof9080805 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Peláez-García de la Rasilla, Teresa Mato-López, Álvaro Pablos-Puertas, Clara E. González-Huerta, Ana Julia Gómez-López, Alicia Mellado, Emilia Amich, Jorge Potential Implication of Azole Persistence in the Treatment Failure of Two Haematological Patients Infected with Aspergillus fumigatus |
title | Potential Implication of Azole Persistence in the Treatment Failure of Two Haematological Patients Infected with Aspergillus fumigatus |
title_full | Potential Implication of Azole Persistence in the Treatment Failure of Two Haematological Patients Infected with Aspergillus fumigatus |
title_fullStr | Potential Implication of Azole Persistence in the Treatment Failure of Two Haematological Patients Infected with Aspergillus fumigatus |
title_full_unstemmed | Potential Implication of Azole Persistence in the Treatment Failure of Two Haematological Patients Infected with Aspergillus fumigatus |
title_short | Potential Implication of Azole Persistence in the Treatment Failure of Two Haematological Patients Infected with Aspergillus fumigatus |
title_sort | potential implication of azole persistence in the treatment failure of two haematological patients infected with aspergillus fumigatus |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10455522/ https://www.ncbi.nlm.nih.gov/pubmed/37623576 http://dx.doi.org/10.3390/jof9080805 |
work_keys_str_mv | AT pelaezgarciadelarasillateresa potentialimplicationofazolepersistenceinthetreatmentfailureoftwohaematologicalpatientsinfectedwithaspergillusfumigatus AT matolopezalvaro potentialimplicationofazolepersistenceinthetreatmentfailureoftwohaematologicalpatientsinfectedwithaspergillusfumigatus AT pablospuertasclarae potentialimplicationofazolepersistenceinthetreatmentfailureoftwohaematologicalpatientsinfectedwithaspergillusfumigatus AT gonzalezhuertaanajulia potentialimplicationofazolepersistenceinthetreatmentfailureoftwohaematologicalpatientsinfectedwithaspergillusfumigatus AT gomezlopezalicia potentialimplicationofazolepersistenceinthetreatmentfailureoftwohaematologicalpatientsinfectedwithaspergillusfumigatus AT melladoemilia potentialimplicationofazolepersistenceinthetreatmentfailureoftwohaematologicalpatientsinfectedwithaspergillusfumigatus AT amichjorge potentialimplicationofazolepersistenceinthetreatmentfailureoftwohaematologicalpatientsinfectedwithaspergillusfumigatus |