Long-term itraconazole prophylaxis against Aspergillus infections in thirty-two patients with chronic granulomatous disease☆,☆☆,★
Section snippets
Patients
Every patient with CGD who was followed at Hôpital des Enfants Malades, Paris, was included in this trial. The diagnosis of CGD was based on personal and family history and confirmed by laboratory tests: defective reduction of nitroblue tetrazolium, impaired bacterial killing, absence of stimulated oxygen consumption, absence of superoxide formation, impaired chemiluminescence production by neutrophils, and absence of granulocyte cytochrome b559. The mode of inheritance was determined according
Efficacy of itraconazole prophylaxis
A fungal pulmonary infection was observed in five patients. In two patients, aspergillosis occurred within 4 months after interruption of curative treatment by amphotericin B. One of them had pulmonary chest wall and subcutaneous involvement treated with amphotericin B for 4 months; the infection was not completely healed when prophylaxis with itraconazole was begun at a dosage of 5 mg/kg per day. The other boy had been treated with amphotericin B (7 months), and the aspergillosis recurred
DISCUSSION
Ingestion of itraconazole is well tolerated; the known adverse drug reactions include gastrointestinal disturbances, headache, and diarrhea. Hypokalemia and increased serum liver enzyme values have been reported,20, 21 as have three cases of hepatitis.22 Our results are in accordance with these findings. A wider clinical experience is needed to confirm the absence of hepatic toxic effects during long-term treatment of children, because ketoconazole-induced hepatitis appears to be idiosyncratic.
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Cited by (144)
ESCMID-ECMM guideline: diagnosis and management of invasive aspergillosis in neonates and children
2019, Clinical Microbiology and InfectionDiagnosis and management of Aspergillus diseases: executive summary of the 2017 ESCMID-ECMM-ERS guideline
2018, Clinical Microbiology and InfectionChronic granulomatous disease as an SOS call for multicenter cooperative effort to prevent infections: A meta-analysis of the treatments
2016, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :All studies were written in English. The 4 studies5,12–14 ranged in size from 35 to 128 patients for a total of 366 patients (Table 1). Two of the 4 studies were RCTs of medium quality according to the Jadad score (Table 1).
Chronic granulomatous disease: Three cases with different presentations
2015, Revista Chilena de PediatriaCommon Presentations and Diagnostic Approaches
2014, Stiehm's Immune DeficienciesDisorders of Leukocyte Function
2013, Emery and Rimoin's Principles and Practice of Medical Genetics
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From the Unité d'Immunologie et d'Hématologie and Unité d'Endocrinologie Pédiatrique, Hôpital des Enfants Malades, Paris, and the Laboratoires Janssen, Campus de Maigremont, Val de Reuil, France.
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Reprint requests: Richard Mouy, MD, Unité d'Immunologie et d'Hématologie, Hôpital des Enfants Malades, 149, rue de Sèvres, 75743 Paris Cedex 15, France.
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