3 years ago

Salvage therapy with topical posaconazole in lung transplant recipients with invasive scedosporium infection

Enrique Cases Viedma, Amparo Solé, Ana A. García-Robles, Carlos Jordá, Juan Pablo Reig Mezquida, Nuria Mancheño, Javier Pemán, José Luis Poveda-Andrés
Scedosporium is an important pathogen in cystic fibrosis (CF) and post-transplant, but it rarely causes invasive infection. Treatment remains challenging, particularly due to the inherent resistance to multiple antifungal agents. We present three complicated invasive tracheobronchial and lung Scedosporium apiospermum infections following lung transplant. In two of three 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 two patients, with only a slight cough during administrations; the third patient suffered local irritation with poor tolerance, which led to its withdrawal. This is the first report on compassionate use of topical posaconazole as salvage therapy for resistant mold infections in lung transplantation recipients. These three cases represent the entire experience using this approach; no additional patients have received this therapy due to not having received any additional cases of Scedosporium tracheobronchitis. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/ajt.14580

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