Fatal pulmonary infection in a leukaemic patient caused by Hormographiella aspergillata (original) (raw)
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Disseminated invasive aspergillosis in a patient with acute leukaemia
2006
A 46 year old previously healthy woman was diagnosed with acute lymphoblastic leukaemia. The induction phase was complicated by α-haemolytic streptococcal bacteremia which responded to antibacterial therapy. Subsequently, the patient developed pneumonie due to Chlamydia pneumoniae which responded to macrolides. Following this infection the patient developed recurrent fever and new pulmonary infiltrates were noted. Bronchoscopy was performed and treatment was administered with liposomal amphotericin B (L-AmB, AmBisome) for two days, but was complicated by acute renal failure. Aspergillus fumigatus was cultured from bronchoalveolar lavage fluid. L-AmB was discontinued and voriconazole and caspofungin were administered. Despite aggressive antifungal therapy the patient developed progressive invasive infection, with central nervous system involvement as well as lesions appearing in the kidneys and liver. The patient died one week following the diagnosis of aspergillosis. (www.actabiomedica.it)
Invasive Pulmonary Aspergillosis with Disseminated Infection in Immunocompetent Patient
Canadian Respiratory Journal, 2016
Invasive pulmonary aspergillosis (IPA) is a rare pathology with increasing incidence mainly in critical care settings and recently in immunocompetent patients. The mortality of the disease is very high, regardless of an early diagnosis and aggressive treatment. Here, we report a case of a 56 yr old previously healthy woman who was found unconscious at home and admitted to the emergency room with mild respiratory insufficiency. In the first 24 hours she developed an acute respiratory failure with new radiographic infiltrates requiring Intensive Care Unit admission. A severe obstructive pattern with impossibility of ventilation because of bilateral atelectasis was observed, requiring emergent venovenous extracorporeal membrane oxygenator device insertion. Bronchoscopy revealed occlusion of main bronchi, demonstrating by biopsy an invasive infection byAspergillus fumigatusandA. flavus. Despite an aggressive treatment and vital support the patient had a fatal outcome. The forensic study...
A novel cause of invasive pulmonary infection in an immunocompetent patient: Aspergillus candidus
Journal of Infection, 2005
Aspergillus candidus, a common contaminant of grain dust, may represent an important respiratory hazard to grain workers, considering its immunomodulating capability by producing p-terphenyl metabolites and terprenins, potent cytotoxic substances. However, there are only three cases of A. candidus infection in the English literature, one fatal solitary brain mass and two onychomycosis. We describe the first case of invasive pulmonary infection and skin abscesses due to A. candidus, determination of minimal inhibitory concentration for anti-fungals, and the successful treatment with liposomal amphotericin B and itraconazole. Possible mechanisms involved in the dissemination of infection in an immunocompetent host are discussed.
Diagnostic microbiology and infectious disease, 2014
Interpretation of Aspergillus galactomannan (GM) and PCR results in bronchoalveolar lavage (BAL) fluid for the diagnosis of invasive pulmonary aspergillosis (IPA) in patients with haematological malignancies requires clarification. A total of 116 patients underwent BAL for investigation of new lung infiltrates: 40% were neutropenic, 68% and 36% were receiving mould-active antifungal agents and β-lactam antibiotics. The diagnosis of proven IPA (n = 3), probable IPA (n = 15), and possible invasive fungal disease (IFD, n = 50) was made without inclusion of GM results. BAL GM (at cut-off of 0.8) had lower diagnostic sensitivity for IPA than PCR (61% versus 78%) but higher specificity (93% versus 79%). Both tests had excellent negative predictive values (85-90%), supporting their utility in excluding IPA. The use of BAL GM and PCR results increased the certainty of Aspergillus aetiology in 7 probable IPA cases where fungal hyphae were detected in respiratory samples by microscopy, and up...
Annals of clinical microbiology and antimicrobials, 2006
Aspergillus is a ubiquitous soil-dwelling fungus known to cause significant pulmonary infection in immunocompromised patients. The incidence of aspergillosis has increased during the past two decades and is a frequently lethal complication of acute leukemia patients that occurs following both chemotherapy and bone marrow transplantation. The diagnosis of invasive pulmonary aspergillosis (IPA) according to the criteria that are established by European Organization for the Research and Treatment of Cancer and Mycoses Study Group raise difficulties in severely ill patients. Despite established improvements in field of diagnosis (galactomannan antigen, quantitative PCR, real-time PCR for Aspergillus spp., and findings of computed tomography) and treatment with new antifungals, it is still a major problem in patients with acute leukemia. However, prompt and effective treatment of IPA is crucial because most patients will need subsequent chemotherapy for underlying hematologic disease as ...
Pediatric Hematology-Oncology, 2010
This study aimed to document outcome of invasive respiratory aspergillosis (IRA) in pediatric malignancy patients. Patients with febrile neutropenia episodes followed between January 2003 and May 2007 were enrolled. Antifungal therapy was added to those who were still febrile on the 5th day of febrile neutropenia treatment. Patients were screened with computerized tomographies. IRA was identified in 22 of 98 patients. There were 13 males and the mean age was 97 months. Proven infection was established in 3, probable in 7, and possible in 12 patients. Liposomal amphotericin B was administered to all patients and was successful in 10 patients. Modifications with caspofungin or voriconazole were done in liposomal amphotericin B failures. The median duration of antifungal therapy was 5.5 months. The median follow-up time was 29 months. There was no evidence of IRA in 12 patients after completion of cancer chemotherapy. Six patients died due to underlying disease, whereas IRA was either in remission or stable disease. Four patients were lost due to IRA. The remission rate for IRA was 82%. Survival at 37 months was 55% (95% confidence ınterval 25-47 months). The amount of time that absolute neutrophil count after initiation of treatment
Pulmonary Aspergillosis: A Clinical Note
International Journal of Current Pharmaceutical Research
Aspergillosis is a mycotic sickness ordinarily brought about by Aspergillus fumigatus, a saprophytic and universal airborne growth. Obtrusive aspiratory aspergillosis happens essentially in patients with serious immunodeficiency. The meaning of this contamination has decisively expanded with developing quantities of patients with impeded insusceptible state related with the administration of danger, organ transplantation, immune system and fiery circumstances; fundamentally sick patients and those with constant obstructive aspiratory infection seem, by all accounts, to be at an expanded gamble. Persistent pneumonic aspergillosis influences patients without clear resistant split the difference, yet with a fundamental lung condition like COPD or sarcoidosis, earlier or simultaneous TB or non-tuberculous mycobacterial illness. Aspergillus bronchitis might be liable for tenacious respiratory side effects in patients with Aspergillus identified more than once in sputum without proof of p...