Successful treatment of Purpureocillium lilacinum pulmonary infection with isavuconazole: A case report

BACKGROUND Purpureocillium lilacinum(P.lilacinum)is a saprophytic fungus widespread in soil and vegetation.As a causative agent,it is very rarely detected in humans,most commonly in the skin.CASE SUMMARY In this article,we reported the case of a 72-year-old patient with chronic lymphocytic leukemia who was admitted with cough and fever.Computed tomography revealed an infection in the right lower lobe.Bronchoalveolar lavage fluid culture and metagenomic next-generation sequencing were ultimately confirmed to have a pulmonary infection with P.lilacinum.She was eventually discharged with good outcomes after treatment with isavuconazole.CONCLUSION Pulmonary infection with P.lilacinum was exceedingly rare.While currently there are no definitive therapeutic agents,there are reports of high resistance to amphotericin B and fluconazole and good sensitivity to second-generation triazoles.The present report is the first known use of isavuconazole for pulmonary P.lilacinum infection.It provides new evidence for the characterization and treatment of clinical P.lilacinum lung infections.

Monte Carlo Analysis of Different Administration Regiments for Isavuconazole against <i>Candida spp.</i>and <i>Aspergillus spp.</i>

In our study, we aimed to optimize the dosage regimen of Isavuconazole against Candida spp. and Aspergillus spp. by Monte Carlo simulation (MSC). Pharmacokinetic parameters and microbiological data of Isavuconazole were collected. Then we used MSC to simulate 10,000 patients analyzed by Crystal Ball to calculate probability of target attainment (PTA) and cumulative fraction of response (CFR). With dosages of 100 mg, 200 mg, and 400 mg in oral group and dosages of 100 mg, and 200 mg in intravenous administration, all have different degrees of antifungal effect. But when the dosage regimen was 50 mg IV, the therapeutic effect of Isavuconazole against Aspergillus spp. and Candida spp. were not good.