جستجوی مقالات مرتبط با کلیدواژه « voriconazole » در نشریات گروه « پزشکی »

Fusarium spp. is an emerging pathogen that presents with varied clinical presentations but there are very few studies from India that elaborate on the spectrum of infection caused by the fungus. Hence, the present study was conducted in our institute to understand the clinical spectrum of fusariosis.

The present study was a retrospective study conducted at a tertiary care institute, in Hyderabad, Telangana, India for four years from January 2018 to December 2022. All the patients with clinically significant isolation of Fusarium spp. from various samples were included in the study.

There were 25 cases of fusariosis diagnosed during the study period. Fusarium was isolated predominantly from debrided tissue following road traffic accidents in 12/25 (84%) of the cases, nails in 3/25 (12%) and superficial leg ulcer in 1/25 (4%) of the cases. Speciation was done for four patients. Three were Fusarium incarnatum and one was Fusarium solani. The patients were treated surgically and with/without antifungal therapy and were discharged in a stable condition.

Traumatic injuries were the major cause of infections in the present study. As Fusarium is a virulent and highly resistant pathogen, an early suspicion and an appropriate diagnosis would lead to a better outcome in these patients.

Radiotherapy is a common treatment for head‑and‑neck malignancies and causes complications such as oral candidiasis and the change of oral Candida species from albicans to nonalbicans. Voriconazole has acceptable antifungal effect. The aim of this study was to determine and compare the antifungal effect of nystatin with voriconazole on these species.

The samples used in this in vitro study were identified by polymerase chain reaction‑restriction fragment length polymorphism from patients before and 2 weeks after head‑and‑neck radiotherapy in Seyed Al‑Shohada Hospital. The antifungal effect of nystatin and voriconazole was determined by microdilution method and measurement of the minimum inhibitory concentration (MIC) and the minimum fungicidal concentration, and the results were analyzed by Mann–Whitney analysis.

The results showed that all species before and after radiotherapy showed 100% sensitivity to nystatin. Prior to radiotherapy, 57.1% of albicans species isolated were in the sensitive range (MIC ≤1) and 42.9% were in the dose‑dependent range (MIC = 2) to voriconazole. After radiotherapy, 58.3% of albicans species were in the sensitive range and 41.7% of these species were in the dose‑dependent range to voriconazole.

The results of the present study showed that before radiotherapy, all species were sensitive to nystatin, while a percentage of albicans and nonalbicans were resistant to voriconazole. In the 2nd week of radiotherapy similar to prior to radiotherapy, all species isolated from patients were sensitive to nystatin, while a percentage of albicans and nonalbicans were resistant to voriconazole.

Wickerhamomyces myanmarensis is a new opportunistic yeast previously named Pichai myanmarensis, which belongs to the order Saccharomycetales. Since its discovery, one environmental isolate of W. myanmarensis has been reported from Myanmar, and one clinical sample from Iran.

We report a case of bloodstream infection related to an implantable venous access port. W. myanmarensis was isolated from patient's blood after chemotherapy, which was meant to control and heal T-cell lymphoblastic lymphoma. Broth dilution minimum inhibitory concentrations were performed according to the CLSI M27-A3 document. The patient recovered with intravenous voriconazole and was discharged with the recommended prescription of oral voriconazole as a maintenance drug.

So far, only one case of W. myanmarensis fungemia has been reported in the world in 2019. This is the second case of bloodstream infection with this yeast from a patient undergoing chemotherapy in Iran.

Head‑and‑neck radiotherapy can change oral Candida species and cause candidiasis resistance to common antifungals by making the changes to the oral cavity environment. Voriconazole is a synthetic azole with extensive antifungal activity. The current study aimed at comparing the antifungal activity of fluconazole and voriconazole on Candida species isolated from the oral cavity of patients undergoing head‑and‑neck radiotherapy.

The present in vitro study was performed on samples isolated from patients undergoing head‑and‑neck radiotherapy, before and during radiotherapy. After the identification of the species, the antifungal effect of fluconazole and voriconazole was determined by the microdilution method, and the minimum inhibitory concentration (MIC), the minimum fungicidal concentration, and the antifungal susceptibility of the isolated strains were also measured. The data were analyzed by the Chi‑squared and then two‑sided Fisher’s exact tests. P < 0.05 was considered statistically significant.

The study findings showed no significant difference in the susceptibility of Candida albicans to voriconazole and fluconazole before and during radiotherapy. Before radiotherapy, both voriconazole and fluconazole had similar effects on Candida tropicalis, but after radiotherapy, voriconazole was less effective. However, both before and during radiotherapy, fluconazole had a greater antifungal effect than voriconazole on Candida glabrata strains. The MICs of voriconazole and fluconazole for both Candida parapsilosis and Candida krusei isolates were within the susceptible or dose‑dependent range.

The current study results showed that voriconazole was not more effective than fluconazole in the treatment of oral candidiasis in patients undergoing head‑and‑neck radiotherapy.

Scedosporium spp. is a saprophytic fungus that may cause invasive pulmonary infection due to the aspiration of contaminated water in both immunosuppressed and immunocompetent hosts.

Case report:

 Herein, we report a fatal case of pulmonary infection caused by Scedosporium species associated with a car crash and near-drowning in a sewage canal.Scedosporium aurantiacum isolated from bronchoalveolar lavage was identified by PCR-sequencing of β-tubulin genes. The minimum inhibitory concentration values for amphotericin B, itraconazole, posaconazole, isavuconazole were >16 µg/ml, and >8 µg/ml for anidulafungin, micafungin, and caspofungin. Voriconazole was found to be the most active agent with a MIC of 1 µg/ml.

This report, as the first case of pulmonary scedosporiosis after near-drowningin Iran, highlights the importance of high suspicion in near-drowning victims, promptidentification of Scedosporium spp., and early initiation of appropriate antifungal therapy.

Scedosporium apiospermum (SA) is commonly present in temperate climates. It can induce cutaneous and subcutaneous tissue infections as well as disseminated infections in immunocompromised or immunocompetent hosts. The eye is rarely involved. Keratomycosis is usually caused by plant-related injuries. Here, we describe a patient with a severe and sight-threatening corneal abscess caused by SA, which was associated with contact lens wear and was successfully treated with a combination of surgical and medical therapies.

An otherwise healthy 22-year-old woman, with history of contact lens wearing, was referred to the Ophthalmic Department of Bari University, Bari, Italy for evaluation of a corneal abscess and hypopyon in her left eye. Intensive topical and systemic antibiotic therapy was initiated after obtaining con-junctival swabs. Within 2 days, her ophthalmic condition had worsened, and her best-corrected visual acuity (BCVA) dropped to counting fingers. She underwent penetrating keratoplasty, after which her ophthalmic condition improved. Microbiological culture, obtained from the explanted cornea, revealed SA infection. This was addressed with specific topical and systemic therapy using voriconazole. Two weeks later, the con-dition of her left eye was stable, with mild corneal edema and no sign of acute graft rejection. Her BCVA improved to 20/25, and all medications were discontinued, except for the steroid eye drop. The patient was scheduled for a 1-month follow-up.

Prompt identification of the etiological agent is mandatory to perform appropriate therapy in cases of keratomycosis. Surgery to remove the infected cornea is helpful in patients with deteriorating condition, in whom the initial medical therapy has failed. Topical and systemic antimycotic therapy, based on microbiological culture, is recommended as an adjunctive therapy for the surgical management of severe corneal mycotic abscesses.

Trichosporon species are ubiquitous in nature which are associated with fatal opportunistic invasive infections, especially in immunocompromised patients. The present study aimed to evaluate the epidemiological and clinical details, as well as the antifungal susceptibility pattern of the patients with Trichosporon infections.

In total, 50 clinical isolates of Trichosporon species from various samples were included in this study. The samples were isolated over a period of 18 months from patients in a tertiary hospital in North India. The isolates were characterised phenotypically with Vitek MS (bioMérieux, France). Trichosporon spp. were isolated from urine (30%), nail (30%), tissue (16%), pleural fluid (14%), and sputum (5%). In total, majority of the isolates were of Trichosporon asahii (92%),followed by Trichosporon mucoides (6%), and Trichosporon ovoides (2%). It is noteworthy that most of the reported cases were from intensive care unit (34%).

Intravenous catheters, antibiotics, and antifungal uptake were significantly associated risk factors with Trichosporon infection. All invasive isolates were observed to be resistant in vitro to caspofungin and exhibited high minimum inhibitory concentration (MIC) values against amphotericin B, fluconazole, and 5-flucytosine. The MICs for voriconazole and posaconazole were low.

Trichosporonosis is being increasingly reported all around the world, including India. The results of this study highlighted the importance of early detection and treatment for this emerging yeast and also added to the ongoing surveillance for the antifungal susuceptibility pattern for this fungus.

Didymella pedeiae is a dematiaceous fungus that belongs to the Coelomycetes class. While species within this class are known to cause human infection, D. pedeiae had previously only been known as phytopathogens and had never been isolated from a human sample.

Case report: 

A 51-year-old Iranian female patient with ovarian cancer was admitted with unilateral lesions in paranasal sinuses and a five-month history of nasal obstruction,headache, postnasal drainage, swelling on the left side of the face, and orbital pain.Paranasal sinus computerized tomography scan revealed a soft tissue mass that filled the left nasal cavity, ethmoid, sphenoid, and frontal sinuses with more involvement in the maxillary and ethmoid sinuses. Antifungal treatment was simultaneously initiated with itraconazole+prednisolone 15 mg/day, and levofloxacin. Due to poor clinical response,IV voriconazole and amphotericin B were added to the treatment as well. The patient recovered completely after 10 weeks of therapy.

 Here, we report the first case of human D. pedeiae infection in a patient with ovarian cancer.

Aspergillus fumigatus is an opportunistic fungal pathogen causes invasive aspergillosis in immunocompromised patients. Raphanus sativus L. var. niger and Trachyspermum ammi are two medical herbs which seemed to have an antifungal activity that can be integrated alternative medicine into conventional medicine. The aim of study was to evaluate the effect of R. sativus and T. ammi on the resistant and susceptible A. fumigatus isolates.In present study, 185 environmental samples from 11 cities of Iran were processed and screened in terms of azole resistance using selective plates. The isolates were confirmed by partial sequencing of the b-tubulin gene. Afterwards, in vitro antifungal susceptibility tests against triazole agents and R. niger and T. ammi extract were performed based on the CLSI, M38-A2 document. The ingredients in the extract by gas chromatography method were isolated and identified by mass spectrometry. Overall, 51 A. fumigatus isolates were detected. According to in vitro antifungal susceptibility tests, 45 A. fumigatus isolates had high MICs of itraconazole (≥8 mg/L) and voriconazole (>2 mg/L) and 6 A. fumigatus isolates were susceptible. The MIC 50 and MIC 90 for R. sativus was 1.95 mg/ml and 3.9 mg/ml respectively. Also, The MIC 50 and MIC 90 for trachyspermum ammi was recorded as 2.30 mg/ml and 4.85 mg/ml respectively. The main identified compounds were Tramadol (58.37%), Butanol (23.42%), Benzofuran (18.21%). Our results indicated that R. sativus and T. ammi extracts significantly inhibited the growth of A. fumigatus isolates and have an appropriate antifungal activity.

Fungal infections of the central nervous system (CNS) usually present as subacute meningitis or intracranial space-occupying lesion with mass effect on surrounding structures and consequent focal neurological deficits. Intracranial fungal granulomas are often misdiagnosed clinically and radiologically as neoplastic lesions. Biopsy of the lesion is the only reliable technique to establish the correct diagnosis as well as to detect the causative fungal species. Voriconazole is a broad-spectrum triazole antifungal agent. It can be given orally and intravenously and has lesser adverse effects.

Methods and Materials:

 In this article, we report a series of 6 cases of biopsy-proven fungal granuloma with varied clinical and radiological presentations who were given treatment with voriconazole for 6 months and demonstrated favorable response.

Out of 6 patients (4 males and 2 females), 1 was immunocompromised (DM with uncontrolled hyperglycemia). Headache was the most commonly observed symptom. Paranasal sinus and anterior cranial fossa were the most commonly affected site. Four patients received voriconazole therapy for 12 months and 1 received the same for 6 months before showing clinical resolution of disease. There was 1 death in the study group from non-related medical complications.

Our series focuses on the correct diagnosis of fungal granuloma which can be achieved by biopsy and clinical evidence of the efficacy of voriconazole against intracranial fungal granuloma.

Children with acute myeloid leukemia and relapses of leukemia are at high risk of developing fungal infections and need antifungal prophylaxis. This study aimed to compare the efficacy and toxicity of two different dosage regimens of voriconazole (VRCZ) during prophylactic administration in children with malignancyand neutropenia.

This prospective study was conducted at the Belarusian Research Center for Pediatric Oncology, Hematology, and Immunology fromMay 2017 to December 2019. The present study included 21 Caucasian patients with malignant hematological diseases (20 patients with acute myeloid leukemia and relapses of leukemia and 1 patient with Non-Hodgkin's lymphoma) aged 2-18 years. All patients were randomly divided into two groups that received different dosage regimens of VRCZ prophylaxis. Patients in the “high-dose” group received VRCZat a dose of 9 mg/kg twice a day PO, or 8 mg/kg twice a day IV without a loading dose (children of 2-11 and adolescents and of 12-14 years old with

In the high-dosegroup (n=20 episodes of prophylaxis), invasive fungal infections (IFI) signs were recorded in one (5%) case. In the low-dose group (n=20 episodes), IFI signs were observed in six (30%) cases (P=0.0375). The residual serum concentration was significantly higher in patients who received high doses of VRCZ (p <0.0001). Most patients with IFI (n=6, 86%) had a mean value (i.e.,

The likelihood of IFI was significantly lower in children who prophylactically received VRCZ in high doses (P=0.0375) and had ≥ 0.74 μg/ml residual serum concentration of the medication (P=0.0258). Residual serum concentration of VRCZ reached a plateau by day sixth of the treatment. In children, the dosage was the only highly significant factor affecting the metabolism of VRCZ.

Natural isopropyl cresols, such as thymol and carvacrol, have been known to have antifungal activities.

The current study aimed to investigate the anti-adherence and antifungal activities of thymol, carvacrol, fluconazole, and voriconazole against oral isolates of Candida albicans (C. albicans), C. glabrata, and C. krusei.

The susceptibility assay for the test compounds was performed using the disk diffusion method against all Candida isolates. Also, anti-adherence activity was examined using a rapid and highly reproducible 96 well microtiter-based method.

Both natural phenols and antifungal drugs revealed various efficacies against studied Candida species. The susceptibility to fluconazole and voriconazole were 100% for C. albicans, 50% and 90% for C. glabrata, and 0% and 100% for C. krusei isolates, respectively. The mean diameter of the inhibition zone was greater for thymol than carvacrol in C. albicans (19.89±0.80 mm versus 17.05± 0.61 mm), C. glabrata (18.87 ± 0.71 mm versus 15.77 ± 0.57 mm), and C. krusei (15.11 ± 0.91 mm versus 13.91 ± 1.04 mm) isolates tested. Thymol showed more effective inhibition on adherence of all Candida species than other treatments. The mean relative adherence ratios for C. albicans, C. glabrata, and C. krusei were 0.50, 0.60, and 0.64, respectively.

This study demonstrated significant inhibitory properties of thymol and carvacrol on the adherence and growth of azole susceptible- and -resistant Candida isolates. Also, thymol was more effective for preventing the adherence of yeast cells to polystyrene in comparison to carvacrol.

Skin rashes, mostly seen in children and adolescents, are considered among the most common side effects of azole antifungals. Although therapeutic concentrations of voriconazole (VCZ) have been documented for infected skin, there is no evidence specifying whether specific dermatologic side effects could predict high VCZ serum concentration, especially in high-risk leukemic children.

Herein, we report a unique skin side effect of VCZ in a 5-year-old boy with T-cell acute lymphoblastic leukemia (ALL) referred to Amir Medical Oncology Center in Shiraz, Iran. The patient experienced erythroderma and macular rashes shortly after VCZ consumption, leading to generalized exfoliative skin rashes. Concurrent to these skin manifestations, VCZ serum concentration reached the supratherapeutic levels despite the recommended VCZ doses. As a result, VCZ was withheld, and the patient was treated with caspofungin. The lesions were resolved gradually within 2 weeks, and the patient successfully completed his treatment course with caspofungin.

The unique case presented in this study emphasizes the need for a high index of suspicion for VCZ toxicity in any patient with atypical dermatologic manifestations, especially generalized exfoliative skin rashes. Based on this report, VCZ supratherapeutic concentration could be predicted early in the course of treatment. Additional therapeutic dose monitoring should be considered to establish a confirmatory diagnosis. It is required to further investigate the toxic effect of high VCZ concentration on the skin epithelium.

This study aimed to determine the portion of Iranian patients who attain therapeutic serum concentrations of voriconazole (VRCZ) following administration of fixed doses. In addition, the effect of CYP2C19 polymorphism on serum levels of VRCZ was also investigated.

Forty‑eight adult patients of Iranian origin with hematologic malignancies, who received VRCZ for treatment of invasive aspergillosis, were recruited into the study. Blood samples were drawn at day 4 of treatment to measure trough drug concentrations and determine genotyping of CYP2C19 polymorphisms of each patient. High‑performance liquid chromatography method was used for measuring VRCZ serum level and CYP2C19 polymorphisms were conducted by Sanger sequencing. Demographic and clinical characteristics of patients alongside with CYP2C19 polymorphisms were assessed to determine the effective factor/s on VRCZ serum concentration.

Seventy‑three percent of patients achieved therapeutic serum concentrations of VRCZ with administration of usual fixed doses in clinical practice. There was no correlation between weight‑adjusted dose and serum concentrations of VRCZ. Mean serum levels were significantly different neither in genders nor in routes of administrations. Extensive and ultrarapid metabolizers (URMs) comprised 48.7% and 21.6% study population, respectively. CYP2C19 polymorphism dramatically influenced the trough levels of VRCZ, so that all patients with subtherapeutic levels expressed URM phenotype.

With respect to high incidence of URM phenotype in Iranian population, and observed association of this phenotype with sub‑therapeutic levels in our study, performing therapeutic drug monitoring is strongly recommended for all patients.

Fungal infections of the central nervous system (CNS) are life-threatening conditions that are frequently misdiagnosed with bacterial and viral CNS infections. Cerebral phaeohyphomycosis is a cerebral infection caused by dematiaceous fungi, especially Cladophialophora bantiana. Very few cases of fungal CNS infection have been reported across the world. High clinical suspicion should be cast for the patients with brain abscess that do not respond to conventional antibiotic therapy.

We report a case of a 21-year-old male presenting with headache, seizures and weakness in the limbs. Radiological examination revealed multiple brain abscesses. After surgical excision and laboratory evaluation, it was found to be caused by C. bantiana. The patient’s outcome was good with surgical excision and voriconazole therapy.

Brain abscess caused by C. bantiana is on rise, especially in immunocompromised groups. Thus, high clinical suspicion, accurate diagnosis and management are the fundamentals for good prognosis.

Voriconazole as a triazole antifungal agent is widely used for prophylaxis or treatment of fungal infections in allogeneic hematopoietic stem cell transplantation (HSCT). It can increase blood concentrations of other medications including cyclosporine A (CsA) which are substrates for cytochrome P450 3A4. The aim of this study was to evaluate comparatively the interaction between oral/intravenous (IV) voriconazole and oral CsA.

Twenty‑nine recipients of allogeneic HSCT who had been already on a steady dose of CsA and were started on oral or IV voriconazole were evaluated in a prospective cohort study. Blood concentration of CsA was determined before and 5–8 days after voriconazole initiation. Plasma concentration of voriconazole was measured in steady state. The changes in blood concentration of CsA after administration of voriconazole were evaluated.

The concentration/dose (C/D) ratio of CsA increased significantly (P < 0.001) after voriconazole initiation in both routes of administration (8.40%–174.10% increase in C/D ratio). The C/D ratio alteration of CsA did not differ significantly between oral and IV voriconazole group (P = 0.405). There was a significant correlation in all patients between plasma concentration of voriconazole and percentage of CsA C/D ratio increment (P = 0.046).

There was a significant intrapatient variability in the magnitude of CsA blood concentration increment after voriconazole initiation. We also demonstrated that magnitude of drug interaction did not differ in IV and oral voriconazole administration. Furthermore, we found that the magnitude of drug interaction was correlated with plasma concentration of voriconazole.

Aspergillosis is a widely distributed infectious disease, which is difficult to manage. According to recent studies, the prevalence of resistant Aspergillus fumigatus has increased from 3.3% to 6.6%. Acquired triazole resistance in Aspergillus species is an evolving global health challenge, which has made the control of diseases caused by Aspergillus a concern. This study was performed to investigate prevalence of azole resistance in Aspergillus isolates from environmental samples.

In this study, 316 soil samples were collected from three hospitals and a university campus in Gorgan (Iran) from July to September 2017. Two grams of each sample were suspended in 5 ml of 0.2M NaCl with 1% Tween 20. Then, 100 µl of the suspension was plated on sabouraud dextrose agar (SDA) supplemented with chloramphenicol, SDA supplemented with chloramphenicol and voriconazole (VOR, 1 mg/L) and SDA supplemented with chloramphenicol and itraconazole (ITC, 4 mg/L). The plates were incubated at 37 °C and examined for growth after 24, 48 and 72 hours.

We detected Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger and Aspergillus nidulans isolates in 187(59.2%), 84(26.6%), 147(46.5%) and 65(20.6%) samples, respectively. We found no VOR resistant isolate. However, 21 (25%) A. flavus and 16 (8.6%) A. fumigatus isolates were intermediate for VOR. In addition, seven (8.3%) A. flavus, 68 (36.4%) A. fumigatus, 41 (27.9%) A. niger and three (4.5%) A. nidulans isolates were resistant to ITC.

We were able to detect A.fumigatus, A. flavus, A. niger from all four sampling sites in Gorgan, North of Iran. A. fumigatus is the most prevalent and most resistant isolate in the studied area. History of previous agriculture activity and use of pesticides in the proximity of sampling sites may have affected the rate of ITC resistance.

This study is an attempt to investigate the effect of nano-liposome containing voriconazole on voriconazole-resistant A. flavus strains on the one hand, and to consider the expression of cyp51A and MDR1genes, regarded as important genes involved in the development of resistance to triazoles before and after voriconazole and voriconazole-loaded nano-liposomes exert their effects, on the other hand. Strains of A. flavus isolated from patients were investigated and their susceptibility to voriconazole was determined. Next, having applied a slight modification to the thin film hydration-sonication technique, the liposomal formulation of voriconazole was produced. After that, the voriconazole-loaded nano-liposome was subjected to in-vitro antifungal susceptibility testing to obtain minimum inhibitory concentration against fungal isolates. Cyp51A and MDR1 mRNA levels were amplified by qRT-PCR instrument. The effect of nano-liposome containing voriconazole on the reduction of MIC in A. flavus isolates were considered to be significant. After using MIC50 concentration of VCZ, the cyp51A gene expression in voriconazole-susceptible A. flavus strains and voriconazole-resistant strains 10folds and 7folds depicted a downregulation, respectively, which was more pronounced in the expression of a liposomal formulation of VCZ (13folds and 15folds respectively). Identically, the same procedure was applied to MDR1, even though it induced 1, 2, 3, 4-fold reductions. Considering the benefits of liposome-containing voriconazole formulation, such as the reduction of the side effects of the pure drug as well as minimizing the drug's toxicity coupled with the enhanced drug bioavailability and stability, the formulation can be used in drug-sensitive and drug-resistant species.