TREATMENT OF INVASIVE ASPERGILLOSIS

With the increasing use of aggressive chemotherapy in patients with malignancies causing prolonged periods of granulocytopenia and severe mucosal damage and the progresses made in the prophylaxis and treatment of bacterial infections, the risk of invasive mycosis has increased particularly in patients with haematologic malignancies. Invasive aspergillosis used to occur almost exclusively in leukaemic patients. More recently the incidence of Aspergillus infections in these patients has increased and it also occurs in other immunocompromised hosts, such as patients with solid tumors or AIDS. Experiences from various institutions indicate a frequency of 10-30 % for aspergillosis in leukaemic patients. Amphotericin B has been considered the standard antifungal in the therapy of aspergillosis in immunocompromised hosts. There is, however, some evidence that amphotericin B is not always effective in aspergillosis especially during neutropenia. Initial clinical studies of itraconazole in patients with aspergillosis showed promising activity of this new triazole compound.