Age (years)
Comorbidities
Time from LT
Fungal pathogen
Antifungal treatment indication
Treatment site
Justification for voriconazole nebulization initiation
Dosage
Voriconazole powder for solution for infusion brand
Other treatments
DOT
Outcome
35
CF
3 m
Scedosporium prolificans
Respiratory distress
Hospital ward Outpatient treatment Lack of response to oral voriconazole 40mg/24h 40mg/12h Kern® Voriconazole (oral)
122
Clinical, radiological an microbiological response
21
CF
NT
Aspergillus citrinoterreus
- Aspergillus terreus
(R to amphotericin and voriconazole)
Fungal colonization
Hospital ward Outpatient treatment Symptomatic liver toxicity to systemic azoles 40mg /12h 40mg/24h 40mg 3/ w Kern® Normon® Isavuconazole (oral)
>420
Resolved liver toxicity Fungal colonization remains present Nebulized voriconazole treatment continues and it is well tolerated
35
CF
0 d
Scedosporium prolificans (multi-drug R, S to voriconazole)
LT fungal prophylaxis after isolation of S. prolificans in the graft preservation fluid
Hospital ward Outpatient treatment ICU Need of topical antifungal prophylaxis after LT active against Scedosporium prolificans R to amphotericin 40mg/12h Kern® Micafungin (neb)
>170
Successful LT Nebulized voriconazole treatment continues and it is well tolerated
69
Nonspecific interstitial pneumonia
4 y
Aspergillus flavus (R to amphotericin)
Bronchitis
Hospital ward Outpatient treatment Lack of response to anidulafungin Symptomatic toxicity to azoles (dizziness, myopathy). 40mg/12h 40mg/24h Accord® Isavuconazole (oral)
911
Aspergillus flavus is still present in bronchoalveolar lavage After voriconazole treatment, Aspergillus flavus showed resistance to this treatment and treatment was changed to nebulized liposomal amphotericin
60
Idiopathic pulmonary fibrosis
1 m
Scedosporoium apiospermum complex
Colonization
Outpatient treatment Combination of nebulized and systemic treatment to readily reach therapeutic voriconazole concentration in the lung. 40mg/12h Kern® - Voriconazole (oral)
>156
Microbiological response Oral treatment was stopped due to visual and liver toxicity Nebulized voriconazole treatment continues and it is well tolerated
65
Chronic obstructive pulmonary disease
7 m
Aspergillus fumigatus
- Aspergillus flavus
Respiratory distress
Hospital ward Avoiding clinically relevant drug-drug interaction among systemic azoles and sirolimus 40mg/12h Kern® None
26
Patient died due to graft failure
64
Chronic obstructive pulmonary disease
NT
Purpureocilium lilacinus (multi-drug R; S to voriconazole, posaconazole and isavuconazole)
Respiratory distress
Hospital ward Symptomatic toxicity so systemic azoles Kidney failure Avoiding clinically relevant drug-drug interaction among systemic azoles and sirolimus. 40mg/12h Teva® None
30
Patient died, P. lilacinus was not found in the last bronchoalveolar lavage
18
CF
NT
Scedosporium apiospermum complex (multi-drug R, S to voriconazole, posaconazole, isavuconazole and micafungin)
Colonization
Outpatient treatment Symptomatic toxicity to systemic azoles (rash) 40mg/48h 40mg /24h Teva® Kern® Normon® Posaconazole (oral)
>840
Colonization remained Nebulized voriconazole treatment continues and it is well tolerated
30
CF
7 y / 0 d*
Aspergillus flavus complex (R to amphotericin) Aspergillus terreus complex (R to amphotericin)
Surgery complications after second LT
ICU Lack of response to previous treatments 40mg/24h Kern® Isavuconazole (IV) Micafungin (IV) Liposomal amphoterin (IP)
28
Patient died due to IPA
5
Interstitial neumopathy
9 m
Aspergillus flavus complex (R to amphotericin)
Respiratory distress
P-ICU Lack of response to previous treatments. 10mg/24h Normon® Liposomal amphotericin (neb) Isavuconazole (IV) Anidulafungin (IV)
81
Microbiological response Nebulized voriconazole treatment continues and it is well tolerated