Verticillium Bronchial Infection: Treatment Approach
Critical Clarification
Verticillium is a plant pathogen, not a human pathogen, and does not cause bronchial infections in humans. 1 This organism causes wilt diseases in over 200 plant species but has no established role in human pulmonary disease. 1
Likely Clinical Scenario
If Verticillium was identified on bronchoscopy, this represents one of several possibilities:
1. Laboratory Contamination or Misidentification (Most Likely)
- Verticillium species are soil-borne fungi that could contaminate respiratory specimens during collection or processing. 1
- The specimen should be recultured and the organism re-identified by an experienced mycology laboratory, as this may represent misidentification of a true human pathogen such as:
- Aspergillus species (most common dematiaceous/mold infection)
- Other dematiaceous fungi (Cladophialophora, Exophiala, etc.)
2. If Confirmed as Dematiaceous Fungus (Assuming Misidentification)
Voriconazole is the first-line therapy for pulmonary infections caused by dematiaceous fungi, with dosing of 6 mg/kg IV every 12 hours for 2 doses, followed by 4 mg/kg IV every 12 hours, or oral therapy at 200 mg twice daily. 2
Alternative Treatment Options:
- Itraconazole 200 mg twice daily orally (with serum level monitoring to achieve >1.0 mg/L) for patients intolerant to voriconazole. 2
- Liposomal amphotericin B (L-AmB) 3-5 mg/kg/day IV for severe or rapidly progressing disease, often used initially before transitioning to oral azole therapy. 2
Treatment Duration and Monitoring:
- Minimum treatment duration is 6-12 weeks, continuing throughout immunosuppression until lesions resolve. 2
- Therapeutic drug monitoring is essential for voriconazole to ensure adequate serum levels. 2, 3
- Serial CT imaging should be performed to assess lesion progression/resolution. 2
3. Surgical Considerations
- Surgical resection may be necessary for localized lesions amenable to resection, lesions near great vessels or pericardium, or persistent hemoptysis from cavitary lesions. 2
Common Pitfall to Avoid
Do not initiate antifungal therapy for "Verticillium" without confirming the organism identity. This is almost certainly a misidentification or contaminant. Consult infectious disease specialists and repeat cultures with expert mycological identification before committing patients to prolonged antifungal therapy with its associated toxicities and costs.