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Original Research: RESPIRATORY INFECTIONS |

Treatment of Chronic Pulmonary Aspergillosis by Voriconazole in Nonimmunocompromised Patients*

Juliette Camuset, MD; Hilario Nunes, MD; Marie-Christine Dombret, MD; Anne Bergeron, MD; Priscilla Henno, MD; Bruno Philippe, MD; Gaelle Dauriat, MD; Gilles Mangiapan, MD; Antoine Rabbat, MD; Jacques Cadranel, MD
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*From the Department of Pneumology and Respiratory Intensive Care (Drs. Camuset and Cadranel), Assistance Publique-Hopitaux de Paris, Tenon Hospital, Paris, France; the Department of Pneumology (Dr. Nunes), Assistance Publique-Hopitaux de Paris, Avicenne Hospital, Bobigny, France; the Department of Pneumology (Dr. Dombret), Assistance Publique-Hopitaux de Paris, Bichat Hospital, Paris, France; the Department of Pneumology (Dr. Bergeron), Assistance Publique-Hopitaux de Paris, Saint-Louis Hospital, Paris, France; the Department of Pneumology (Dr. Henno), Assistance Publique-Hopitaux de Paris, George Pompidou European Hospital, Paris, France; the Department of Pneumology (Dr. Philippe), Foch Hospital, Suresnes, France; the Department of Pneumology (Dr. Dauriat), Beaujon Hospital, Clichy, France; the Department of Pneumology (Dr. Mangiapan), Inter-Commune Hospital Centre, Creteil, France; and the Department of Pneumology (Dr. Rabbat), Assistance Publique-Hopitaux de Paris, Hôtel-Dieu Hospital, Paris, France.

Correspondence to: Jacques Cadranel, MD, Department of Pneumology and Respiratory Intensive Care, AP-HP, Tenon Hospital, 4 rue de la Chine, 75970 Paris, France; e-mail: jacques.cadranel@tnn.aphp.fr



Chest. 2007;131(5):1435-1441. doi:10.1378/chest.06-2441
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Background: There is no recognized medical treatment for chronic pulmonary aspergillosis (CPA) apart from surgery in patients with simple aspergilloma. To evaluate the efficacy of voriconazole in this setting, we conducted a retrospective multicenter study over a 3-year period.

Methods: For inclusion in the study, patients had to have received voriconazole for treatment of confirmed or probable CPA with a follow-up of at least 6 months. Clinical, radiologic, and mycologic data were collected at baseline, every 2 to 3 months, and at the end of treatment or at the date point.

Results: Twenty-four patients were included in the study, among which 9 patients presented with chronic cavitary pulmonary aspergillosis and 15 presented with chronic necrotizing pulmonary aspergillosis (CNPA). Voriconazole was given as a first-line treatment to 13 patients. The median duration of treatment and follow-up were 6.5 and 10 months, respectively. Three patients had to stop treatment with voriconazole because of toxicity. Symptoms and imagery findings were improved in 16 of 24 patients and 17 of 24 patients, respectively, at the end of follow-up. Mycology, which was positive at baseline in 21 of 23 patients, was negative in 18 of 19 patients at the end of follow-up; serologic test results were also negative in 6 of 19 evaluable patients, all of whom had CNPA. Improved radioclinical findings and mycologic eradication were observed at the end of follow-up in 11 of 19 patients (58%). Patients in whom the disease was controlled had a significantly longer median duration of treatment than patients in whom it was uncontrolled (9 vs 6 months, respectively; p = 0.04).

Conclusion: Voriconazole provides effective treatment of CPA with an acceptable level of toxicity.

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