Pulmonary Mucormycosis
Conditions
Keywords
pulmonary mucormycosis, bronchoscopy, treatment
Brief summary
Evaluation of the effectiveness and safety of transbronchoscopic local precision infusion of amphotericin B + transoral nebulized inhalation of amphotericin B + transbronchoscopic interventional debridement + liposomal amphotericin B + posaconazole or Isavuconazole multimodal treatment of pulmonary mucormycosis
Detailed description
Key rationale for the treatment of mucormycosis is early surgical intervention, including local debridement and removal of infected tissues or organs if possible. Systemic antifungal therapy is also necessary for mucormycosis, including amphotericin B liposomes and deoxycholates, Isavuconazole, posaconazole, and so on. Antifungal drug therapy has a mortality rate of up to 40%, which can be reduced to 23% when combined with surgical treatment. However, some patients who are unable to tolerate surgical procedures on the chest when in bad condition, especially patients with hematological malignancies undergoing hematopoietic stem cell transplantation, are susceptible to multiple mucormycosis of the lungs, and the mortality rate of untreated systemically disseminated mucormycosis infections is high at 80%. Isavuconazole, so we aim to explore the multimodal treatment of liposomal amphotericin B + posaconazole or esaconazole + transbronchoscopic localized precise instillation of amphotericin B + oral nebulized inhalation of amphotericin B + transbronchoscopic interventional debridement to alleviate the pulmonary mucormycosis in chest imaging and reduce the mortality rate of patients with mucormycosis infection.
Interventions
PROCEDUREtransbronchoscopic interventional debridement
1. combination drug therapy：liposomal amphotericin B + posaconazole or Isavuconazole：3-5mg/kg/day+ Posaconazole 300 mg once daily; target blood trough concentration is \>1ug/mL; if posaconazole is unavailable, Isavuconazole 200 mg once daily may be an alternative. 2. transbronchoscopic local precision infusion of amphotericin B: Maximum dose not more than 30mg per session 3. transoral nebulized inhalation of amphotericin B：amphotericin B 10mg + 5ml of sterilized water for injection, inhalation 2/day. 4)transbronchoscopic interventional debridement
Sponsors
Beijing Tsinghua Chang Gung Hospital
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Prospective, Intervention, observational, Propensity Matching Analysis study
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Subjects suspected of pulmonary mucormycosis by clinical radiology will be enrolled in the study if the pathologic or microbiological diagnosis of mucormycosis (smear showing sterile mycelium, culture or molecular evidence of mucormycosis) is confirmed. * Cases of diffuse mucormycosis will only be included if lung infection is confirmed pathologically or microbiologically by respiratory secretions or biopsy samples. * Ability to tolerate bronchoscopy.
Exclusion criteria
* Pregnant and breastfeeding female patients * Age \<18 years * Patients with HIV infection * Contraindications to bronchoscopy (including platelet count \< 100 x 109/L, active hemoptysis, severe respiratory or heart failure, severe arrhythmia, unstable angina or hypertension, severe pneumothorax or mediastinal emphysema, patients with acute myocardial infarction, cerebral infarction, and cerebral hemorrhage within 3 months * Patients unable to tolerate bronchoscopy
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the rate of complete or partial response at 4 weeks | 4 weeks | * Complete response: Resolution of all clinical signs and symptoms and more than 90% of lesions visible on radiology * Partial response: Clinical improvement and \>50% improvement in findings on radiology |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| the rate of complete or partial response at 12 weeks | 12 weeks | * Complete response: Resolution of all clinical signs and symptoms and more than 90% of lesions visible on radiology * Partial response: Clinical improvement and \>50% improvement in findings on radiology |
| Survival rate at 6 months | 6 months | estimates using all-cause mortality at 12 months |
| the incidence of adverse reactions related to this comprehensive treatment at 4 weeks | 4 weeks | The adverse reactions were assessed based on the Common Terminology Criteria for Adverse Events 5.0(CTCAE5.0) |
Countries
China
Outcome results
None listed