Salvage therapy with topical posaconazole in lung transplant recipients with invasive Scedosporium infection |
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| Authors: | Amparo Solé Ana A. García‐Robles Carlos Jordá Enrique Cases Viedma Nuria Mancheño José Luis Poveda‐Andrés Juan Pablo Reig Mezquida Javier Pemán |
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| Affiliation: | 1. Lung Transplant and Cystic Fibrosis Unit, La Fe University and Polytechnic Hospital, Valencia, Spain;2. Pharmacy Unit, La Fe University and Polytechnic Hospital, Valencia, Spain;3. Respiratory Endoscopy Unit, La Fe University and Polytechnic Hospital, Valencia, Spain;4. Pathology Service, La Fe University and Polytechnic Hospital, Valencia, Spain;5. Microbiology Unit, La Fe University and Polytechnic Hospital, Valencia, Spain |
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| Abstract: | Scedosporium is an important pathogen in cystic fibrosis (CF) and post‐transplantation, but it rarely causes invasive infection. Treatment remains challenging, particularly due to the inherent resistance to multiple antifungal agents. We present 3 complicated invasive tracheobronchial and lung Scedosporium apiospermum infections following lung transplantation. In 2 of 3 cases, the infection was clinically and radiologically cured with frequent cleansing bronchoscopies, combining triazole with terbinafine therapy and nebulized posaconazole. These cases highlight the importance of adjunctive nebulized therapy in addition to prolonged triazole treatment to manage complex invasive Scedosporium infections in immunosuppressed patients. Posaconazole (PSZ) was delivered during the bronchoscopy procedure through intrabronchial administration, whereas an eFlow rapid® device was used for nebulized therapy. Topical posaconazole was well tolerated in 2 patients, with only a slight cough during administrations; the third patient had local irritation with poor tolerance, which led to its withdrawal. This is the first report on compassionate use of topical PSZ as salvage therapy for resistant mold infections in lung transplant recipients. These 3 cases represent the entire experience using this approach; no additional patients have received this therapy due to there not having been any additional cases of Scedosporium tracheobronchitis presented. |
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| Keywords: | antibiotic: antifungal clinical research/practice infection and infectious agents – fungal infectious disease lung disease: infectious lung transplantation/pulmonology pharmacology |
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