Limited penetration of posaconazole into cerebrospinal fluid in an allogeneic stem cell recipient with invasive pulmonary aspergillosis.

摘要

Invasive mold infections are a potentially lethal complication in patients receiving allogeneic hematopoietic SCT (alloHSCT) and have a major impact on morbidity and mortality. Cumulative incidences of invasive aspergillosis range up to 7% in patients with alloHSCT. Cerebral aspergillosis carries particularly a poor prognosis. In a recent analysis of patients with invasive aspergillosis after alloHSCT, 14 (42%) of 33 patients had central nervous system (CNS) involvement. None of these 14 patients with cerebral aspergillosis responded to amphotericin B therapy and all patients experienced rapid deterioration. The mortality was 100% and the median survival from the onset of symptoms or signs of cerebral aspergillosis was only 7 days.1 Penetration of amphotericin B, itraconazole and echinocandins into the CNS is low to negligible, whereas voriconazole penetrates well into the CNS. In a recent retrospective analysis, improved response (35%) and survival (31%) rates were observed in 81 patients treated with voriconazole for cerebral aspergillosis.