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Sample records for aspergillosis

  1. Destructive aspergillosis

    OpenAIRE

    Singhal, Surinder K.; Dass, Arjun; Singh, G. B.; Punia, R. P. S.; Nagarkar, Nitin M.

    2005-01-01

    The incidence of mycotic infections of paranasal sinuses is on the rise. Aspergillosis is the commonest fungal infection involving the nose and paranasal sinuses. This disease has a varied presentation ranging from the allergic form to the more deadly invasive or destructive form. Destructive fungal disease is almost regarded as synonymous with mucormycosis. The destructive potential of aspergillosis has not been highlighted in the medical literature. We here report a case of aspergillosis, w...

  2. Pulmonary aspergillosis.

    Science.gov (United States)

    Chabi, M L; Goracci, A; Roche, N; Paugam, A; Lupo, A; Revel, M P

    2015-05-01

    Aspergillosis is a mycotic disease usually caused by Aspergillus fumigatus, a saprophytic and ubiquitous airborne fungus. Aspergillus-related lung diseases are traditionally classified into four different forms, whose occurrence depends on the immunologic status of the host and the existence of an underlying lung disease. Allergic broncho-pulmonary aspergillosis (ABPA) affects patients with asthma or cystic fibrosis. Saprophytic infection (aspergilloma) occurs in patients with abnormal airways (chronic obstructive pulmonary disease, bronchiectasis, cystic fibrosis) or chronic lung cavities. Chronic necrotizing aspergillosis (semi-invasive form) is described in patients with chronic lung pathology or mild immunodeficiency. Invasive aspergillosis (angio-invasive or broncho-invasive forms) occurs in severely immuno-compromised patients. Knowledge of the various radiological patterns for each form, as well as the corresponding associated immune disorders and/or underlying lung diseases, helps early recognition and accurate diagnosis. PMID:25753544

  3. Symptoms of Aspergillosis

    Science.gov (United States)

    ... Sporotrichosis Other pathogenic fungi Exserohilum Cladosporium Who Gets Fungal Infections? People living with HIV/AIDS Organ Transplant Patients ... C, Hekmat K, Cornely OA. Chronic pulmonary aspergillosis. Mycoses. 2014 May;57(5):257-70. Related Links ...

  4. Abdominal aspergillosis: CT findings

    Energy Technology Data Exchange (ETDEWEB)

    Yeom, Suk Keu, E-mail: pagoda20@hanmail.net [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Hye Jin, E-mail: kimhyejin@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Byun, Jae Ho, E-mail: jhbyun@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Kim, Ah Young, E-mail: aykim@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Lee, Moon-Gyu, E-mail: mglee@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of); Ha, Hyun Kwon, E-mail: hkha@amc.seoul.kr [Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 388-1, Poongnap2-dong, Songpa-gu, Seoul, 138-736 (Korea, Republic of)

    2011-03-15

    Objective: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients. Materials and methods: CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome. Results: All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum. Conclusion: Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.

  5. Abdominal aspergillosis: CT findings

    International Nuclear Information System (INIS)

    Objective: In order to retrospectively evaluate the CT findings of abdominal aspergillosis in immunocompromised patients. Materials and methods: CT scans were reviewed with regard to the sites, number, morphologic appearance, attenuation, and the contrast enhancement patterns of the lesions in six patients (5 women, 1 man; mean age, 43.4 years; range, 23-59 years) with pathologically proved abdominal aspergillosis by two gastrointestinal radiologists in consensus. Medical records were also reviewed to determine each patient's clinical status and outcome. Results: All patients were immunocompromised state: 4 patients received immunosuppressive therapy for solid organ transplantation and 2 patients received chemotherapy for acute myeloid leukemia. Aspergillosis involved blood vessels (n = 3), liver (n = 2), spleen (n = 2), gastrointestinal tract (n = 2), native kidney (n = 1), transplanted kidney (n = 1), peritoneum (n = 1), and retroperitoneum (n = 1). CT demonstrated solid organ or bowel infarction or perforation secondary to vascular thrombosis or pseudoaneurysm, multiple low-attenuating lesions of solid organs presenting as abscesses, concentric bowel wall thickening mimicking typhlitis, or diffuse or nodular infiltration of the peritoneum and retroperitoneum. Conclusion: Familiarity with findings commonly presenting as angioinvasive features or abscesses on CT, may facilitate the diagnosis of rare and fatal abdominal aspergillosis.

  6. CT findings of pulmonary aspergillosis

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    Cheon, Jung Eun; Im, Jung Gi; Goo, Jin Mo; Kim, Hong Dae; Han, Man Chung [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    1995-10-15

    The fungus aspergillus can cause a variety of pulmonary disorders. Aspergilloma is a noninvasive aspergillus colonization of virtually any type of preexisting pulmonary cavity or cystic space. Invasive pulmonary aspergillosis is serious, usually fatal infection in patients being treated with immunosuppressants or who have chronic debilitating disease. Allergic bronchopulmonary aspergillosis is characterized clinically by asthma, blood and sputum eosinophilia and positive immunologic reaction to aspergillus antigen. Awareness of the radiographic and CT findings of pulmonary aspergillosis is important in making the diagnosis of aspergillus-caused pulmonary disorders. In this pictorial essay, we illustrated various radiological findings of pulmonary aspergillosis focused on CT findings correlated with gross pathologic specimens.

  7. Pediatric Invasive Aspergillosis

    Directory of Open Access Journals (Sweden)

    Rachel L. Wattier

    2016-06-01

    Full Text Available Invasive aspergillosis (IA is a disease of increasing importance in pediatrics due to growth of the immunocompromised populations at risk and improvements in long-term survival for many of these groups. While general principles of diagnosis and therapy apply similarly across the age spectrum, there are unique considerations for clinicians who care for children and adolescents with IA. This review will highlight important differences in the epidemiology, clinical manifestations, diagnosis, and therapy of pediatric IA.

  8. Aspergillosis in Chronic Granulomatous Disease

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    Jill King

    2016-05-01

    Full Text Available Patients with chronic granulomatous disease (CGD have the highest life-time incidence of invasive aspergillosis and despite the availability of antifungal prophylaxis, infections by Aspergillus species remain the single most common infectious cause of death in CGD. Recent developments in curative treatment options, such as haematopoietic stem cell transplantation, will change the prevalence of infectious complications including invasive aspergillosis in CGD patients. However, invasive aspergillosis in a previously healthy host is often the first presenting feature of this primary immunodeficiency. Recognizing the characteristic clinical presentation and understanding how to diagnose and treat invasive aspergillosis in CGD is of utmost relevance to improve clinical outcomes. Significant differences exist in fungal epidemiology, clinical signs and symptoms, and the usefulness of non-culture based diagnostic tools between the CGD host and neutropenic patients, reflecting underlying differences in the pathogenesis of invasive aspergillosis shaped by the nicotinamide adenine dinucleotide phosphate (NADPH-oxidase deficiency.

  9. Aspergillosis in Chronic Granulomatous Disease

    OpenAIRE

    Jill King; Henriet, Stefanie S. V.; Adilia Warris

    2016-01-01

    Patients with chronic granulomatous disease (CGD) have the highest life-time incidence of invasive aspergillosis and despite the availability of antifungal prophylaxis, infections by Aspergillus species remain the single most common infectious cause of death in CGD. Recent developments in curative treatment options, such as haematopoietic stem cell transplantation, will change the prevalence of infectious complications including invasive aspergillosis in CGD patients. However, invasive asperg...

  10. Invasive aspergillosis in two patients with Pearson syndrome.

    NARCIS (Netherlands)

    Warris, A.; Verweij, P.E.; Barton, R.C.; Crabbe, D.C.G.; Evans, E.G.V.; Meis, J.F.G.M.

    1999-01-01

    Invasive aspergillosis is a serious opportunistic infection in the immunocompromised host. In the pediatric population invasive aspergillosis is seen predominantly in patients with hematologic malignancie, chronic granullamotous disease (CGD) and AIDS. Invasive aspergillosis carries a high case fata

  11. Primary Aspergillosis of the Larynx.

    Science.gov (United States)

    Law, Richard H; Reyes, Samuel A

    2016-01-01

    Laryngeal aspergillosis is most commonly seen as a result of secondary invasion from the lungs and tracheobronchial tree in immunocompromised hosts. Primary aspergillosis of the larynx is, however, rare with few cases documented over the past fifty years. We report a case of a 73-year-old woman who presented with persistent hoarseness. She is a nonsmoker with a history of asthma and chronic bronchiectasis treated with bronchodilators, inhaled and oral corticosteroids, and nebulized tobramycin. Direct laryngoscopy with vocal cord stripping confirmed the diagnosis of invasive aspergillosis with no manifestations elsewhere. The patient was successfully treated with oral voriconazole with no signs of recurrence. Although several major risk factors contributing to the development of primary aspergillosis of the larynx have been discussed in the literature, there has been no mention of inhaled antibiotics causing this rare presentation to the best of our knowledge. We, therefore, highlight the use of inhaled tobramycin as a unique catalyst leading to the rapid onset of this rare presentation. PMID:26955494

  12. Invasive aspergillosis in developing countries.

    Science.gov (United States)

    Chakrabarti, Arunaloke; Chatterjee, Shiv Sekhar; Das, Ashim; Shivaprakash, M R

    2011-04-01

    To review invasive aspergillosis (IA) in developing countries, we included those countries, which are mentioned in the document of the International Monetary Fund (IMF), called the Emerging and Developing Economies List, 2009. A PubMed/Medline literature search was performed for studies concerning IA reported during 1970 through March 2010 from these countries. IA is an important cause of morbidity and mortality of hospitalized patients of developing countries, though the exact frequency of the disease is not known due to inadequate reporting and facilities to diagnose. Only a handful of centers from India, China, Thailand, Pakistan, Bangladesh, Sri Lanka, Malaysia, Iran, Iraq, Saudi Arabia, Egypt, Sudan, South Africa, Turkey, Hungary, Brazil, Chile, Colombia, and Argentina had reported case series of IA. As sub-optimum hospital care practice, hospital renovation work in the vicinity of immunocompromised patients, overuse or misuse of steroids and broad-spectrum antibiotics, use of contaminated infusion sets/fluid, and increase in intravenous drug abusers have been reported from those countries, it is expected to find a high rate of IA among patients with high risk, though hard data is missing in most situations. Besides classical risk factors for IA, liver failure, chronic obstructive pulmonary disease, diabetes, and tuberculosis are the newly recognized underlying diseases associated with IA. In Asia, Africa and Middle East sino-orbital or cerebral aspergillosis, and Aspergillus endophthalmitis are emerging diseases and Aspergillus flavus is the predominant species isolated from these infections. The high frequency of A. flavus isolation from these patients may be due to higher prevalence of the fungus in the environment. Cerebral aspergillosis cases are largely due to an extension of the lesion from invasive Aspergillus sinusitis. The majority of the centers rely on conventional techniques including direct microscopy, histopathology, and culture to diagnose IA

  13. Allergic bronchopulmonary aspergillosis and bilateral fungal balls terminating in disseminated aspergillosis.

    Science.gov (United States)

    Anderson, C J; Craig, S; Bardana, E J

    1980-02-01

    A unique case of allergic bronchopulmonary aspergillosis associated with bilateral apical aspergillomas terminating in disseminated aspergillosis is presented. Postulated mechanisms of this combination are discussed with respect to the patient's clinical findings. The contribution of systemic and aerosolized corticosteroids are considered major contributing factors to dissemination of disease. PMID:7351446

  14. Aspergillosis

    Science.gov (United States)

    ... Candidiasis Oropharyngeal / Esophageal Candidiasis Genital / vulvovaginal candidiasis Invasive candidiasis Definition Symptoms Risk & Prevention Sources Diagnosis Treatment Statistics Healthcare Professionals ...

  15. Too Many Mouldy Joints – Marijuana and Chronic Pulmonary Aspergillosis

    OpenAIRE

    Gargani, Yousef; Bishop, Paul; Denning, David W.

    2011-01-01

    Chronic pulmonary aspergillosis is a progressive debilitating disease with multiple underlying pulmonary diseases described. Here we report the association of chronic pulmonary aspergillosis and long term marijuana smoking in 2 patients and review the literature related to invasive and allergic aspergillosis.

  16. Invasive aspergillosis in near drowning nonneutropenic patient

    Directory of Open Access Journals (Sweden)

    Kartik Munta

    2015-01-01

    Full Text Available Invasive aspergillosis in immunosuppressed people has been well documented, but to diagnose and treat in an immunocompetent individual after near drowning, it requires early suspicion and proper empirical treatment. We report a case diagnosed to have invasive aspergillosis with systemic dissemination of the infection to the brain, gluteal muscles, and kidneys after a fall in a chemical tank of a paper manufacturing company. He was ventilated for acute respiratory distress syndrome and managed with antibiotics and vasopressors. Due to nonresolving pneumonia and positive serum galactomannan, trans-tracheal biopsy was performed which confirmed invasive aspergillosis and was treated with antifungals. With the availability of galactomannan assay and better radiological investigative modalities, occurrence of such invasive fungal infections in cases of drowning patients should be considered early in such patients and treated with appropriate antifungals.

  17. Invasive aspergillosis: results of multicenter study

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    N. N. Klimko

    2014-01-01

    Full Text Available We present the results of a multicenter study of 445 patients with “proven” and “probable” invasive aspergillosis (EORTC/MSG, 2008. Invasive aspergillosis usually occurs in patients with hematological malignancies (88 %, main underlying diseases were acute myeloid and acute lymphoblastic leukemia. The risk factors: prolonged agranulocytosis (64 %, cytostatic chemotherapy (57 %, corticosteroid treatment (45 %, and allogeneic hematopoietic stem cells transplantation (29 %. The pathogens – A. fumigatus (42 %, A. niger (33 %, and A. flavus (21 %. The main site of infection were lungs (86 %. 12 week overall survival was 83 %. Bronchoscopy use for the early diagnosis (p = 0.01, adequatetherapy with voriconazole (p = 0.002 and secondary antifungal prophylaxis (p = 0.0003 were positive prognostic factors for survival of patients with invasive aspergillosis.

  18. Invasive aspergillosis: results of multicenter study

    Directory of Open Access Journals (Sweden)

    N. N. Klimko

    2014-09-01

    Full Text Available We present the results of a multicenter study of 445 patients with “proven” and “probable” invasive aspergillosis (EORTC/MSG, 2008. Invasive aspergillosis usually occurs in patients with hematological malignancies (88 %, main underlying diseases were acute myeloid and acute lymphoblastic leukemia. The risk factors: prolonged agranulocytosis (64 %, cytostatic chemotherapy (57 %, corticosteroid treatment (45 %, and allogeneic hematopoietic stem cells transplantation (29 %. The pathogens – A. fumigatus (42 %, A. niger (33 %, and A. flavus (21 %. The main site of infection were lungs (86 %. 12 week overall survival was 83 %. Bronchoscopy use for the early diagnosis (p = 0.01, adequatetherapy with voriconazole (p = 0.002 and secondary antifungal prophylaxis (p = 0.0003 were positive prognostic factors for survival of patients with invasive aspergillosis.

  19. [Invasive pulmonary aspergillosis. Necropsy series].

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    Alba, D; Gómez-Cerezo, J; Cobo, J; Fachal, C; Molina, F; Vázquez, J J

    1995-01-01

    Invasive pulmonary aspergillosis (IPA) is a severe infection which is usually diagnosed at postmortem examination. This infection occurs mainly in immunosuppressed patients, although it has also been reported in immunocompetent patients. Clinical records from patients diagnosed with IPA in our institution from 1983 to 1992 were retrospectively studied to analyse clinical and therapeutical characteristics of IPA. Sixteen episodes of IPA were recorded, all of them but one from necrotic specimens. A total of 18.7% of patients were immunocompetent, one patient had the acquired immunodeficiency syndrome (AIDS), and the remaining patients had a classical immunosuppression. Fever and dyspnea were noted in all patients; hemoptysis was recorded in 12.5% of patients. The predominant radiological pattern was a bilateral alveolar infiltrate (75%). Diagnosis was made at postmortem examination in 15 cases (93.7%), and a clinical premortem suspicion was obtained only in 25% of patients. IPA can occur in immunocompetent patients more frequently than considered until now. The suspicion index for IPA is low, even in immunosuppressed patients. PMID:7878262

  20. Aspergillosis in a red-crowned crane

    Science.gov (United States)

    Stroud, R.K.; Duncan, R.M.

    1983-01-01

    An unusual form of pulmonary aspergillosis in a red-crowned crane (Grus japonensis) is described in this report. The major lesion is unique because it closely resembles a lesion referred to as an aspergilloma. An aspergilloma is a single large granulomatous lesion that resembles a tumor and is caused by fungi of the genus Aspergillus.

  1. Azole-Resistant Central Nervous System Aspergillosis

    NARCIS (Netherlands)

    J.W.M. van der Linden; R.R. Jansen; D. Bresters; C.E. Visser; S.E. Geerlings; E.J. Kuijper; W.J.G. Melchers; P.E. Verweij

    2009-01-01

    Three patients with central nervous system aspergillosis due to azole-resistant Aspergillus fumigatus (associated with a leucine substitution for histidine at codon 98 [L98H] and a 34-base pair repeat in tandem in the promoter region) are described. The patients were treated with combination therapy

  2. Azole-resistant central nervous system aspergillosis.

    NARCIS (Netherlands)

    Linden, J.W.M. van der; Jansen, R.R.; Bresters, D.; Visser, C.E.; Geerlings, S.E.; Kuijper, E.J.; Melchers, W.J.G.; Verweij, P.E.

    2009-01-01

    Three patients with central nervous system aspergillosis due to azole-resistant Aspergillus fumigatus (associated with a leucine substitution for histidine at codon 98 [L98H] and a 34-base pair repeat in tandem in the promoter region) are described. The patients were treated with combination therapy

  3. Chemoprophylaxis for pulmonary aspergillosis during intensive chemotherapy.

    OpenAIRE

    Cowie, F.; Meller, S T; Cushing, P; Pinkerton, R

    1994-01-01

    Three children who developed pulmonary aspergillosis while being treated for leukaemia or non-Hodgkin's lymphoma. Each child continued with intensive myelosuppressive chemotherapy regimens during the infection and each was successfully treated with antifungal prophylaxis based on itraconazole by mouth. Amphotericin B was also given during periods of severe neutropenia. No reactivation of the fungal infection was seen.

  4. Republished: The clinical spectrum of pulmonary aspergillosis.

    Science.gov (United States)

    Kosmidis, Chris; Denning, David W

    2015-07-01

    The clinical presentation of Aspergillus lung disease is determined by the interaction between fungus and host. Invasive aspergillosis develops in severely immunocompromised patients, including those with neutropenia, and increasingly in the non-neutropenic host, including lung transplant recipients, the critically ill patients and patients on steroids. A high index of suspicion is required in patients without the classical risk factors as early presentation is usually silent and non-specific, pyrexia uncommon and timely treatment is crucial for survival. Invasive aspergillosis has also been diagnosed in normal hosts after massive exposure to fungal spores. Chronic pulmonary aspergillosis affects patients without obvious immune compromise, but with an underlying lung condition such as COPD or sarcoidosis, prior or concurrent TB or non-tuberculous mycobacterial disease. Aspergillus bronchitis may be responsible for persistent respiratory symptoms in patients with Aspergillus detected repeatedly in sputum without evidence of parenchymal Aspergillus disease, especially in patients with bronchiectasis and cystic fibrosis. Allergic bronchopulmonary aspergillosis affects patients with asthma and cystic fibrosis, and is important to recognise as permanent lung or airways damage may accrue if untreated. Changes in the classification of Aspergillus allergic lung disease have been proposed recently. Cases of extrinsic allergic alveolitis and chronic pulmonary aspergillosis have been observed after Aspergillus exposure. Asymptomatic colonisation of the respiratory tract needs close monitoring as it can lead to clinical disease especially with ongoing immunosuppression. The various syndromes should be viewed as a semicontinuous spectrum of disease and one form may evolve into another depending on the degree of ongoing immunosuppression. PMID:26187954

  5. The clinical spectrum of pulmonary aspergillosis.

    Science.gov (United States)

    Kosmidis, Chris; Denning, David W

    2015-03-01

    The clinical presentation of Aspergillus lung disease is determined by the interaction between fungus and host. Invasive aspergillosis develops in severely immunocompromised patients, including those with neutropenia, and increasingly in the non-neutropenic host, including lung transplant recipients, the critically ill patients and patients on steroids. A high index of suspicion is required in patients without the classical risk factors as early presentation is usually silent and non-specific, pyrexia uncommon and timely treatment is crucial for survival. Invasive aspergillosis has also been diagnosed in normal hosts after massive exposure to fungal spores. Chronic pulmonary aspergillosis affects patients without obvious immune compromise, but with an underlying lung condition such as COPD or sarcoidosis, prior or concurrent TB or non-tuberculous mycobacterial disease. Aspergillus bronchitis may be responsible for persistent respiratory symptoms in patients with Aspergillus detected repeatedly in sputum without evidence of parenchymal Aspergillus disease, especially in patients with bronchiectasis and cystic fibrosis. Allergic bronchopulmonary aspergillosis affects patients with asthma and cystic fibrosis, and is important to recognise as permanent lung or airways damage may accrue if untreated. Changes in the classification of Aspergillus allergic lung disease have been proposed recently. Cases of extrinsic allergic alveolitis and chronic pulmonary aspergillosis have been observed after Aspergillus exposure. Asymptomatic colonisation of the respiratory tract needs close monitoring as it can lead to clinical disease especially with ongoing immunosuppression. The various syndromes should be viewed as a semicontinuous spectrum of disease and one form may evolve into another depending on the degree of ongoing immunosuppression. PMID:25354514

  6. Invasive aspergillosis: new insights into disease, diagnostic and treatment.

    Science.gov (United States)

    Karthaus, Meinolf; Buchheidt, Dieter

    2013-01-01

    Aspergillus infections are a threat to in patients with hematological malignancies. Known risk factors are profound and long lasting neutropenia, uncontrolled graft versus host disease, continuous administration of steroids and environmental factors such as hospital construction. Numerous efforts have been undertaken for prophylaxis of invasive aspergillosis in high-risk populations. Most of them failed to demonstrate survival advantages. Prophylaxis makes sense, since diagnosis and treatment of invasive aspergillosis remain difficult. The introduction of non-culture based tools for the diagnosis of invasive aspergillosis is an important step forward for early and sensitive diagnosis of invasive aspergillosis. Early treatment is the cornerstone of a successful management of invasive aspergillosis. Substantial improvement came with the introduction of lipid formulations of amphotericin B in the early 1990s. Voriconazole was the first azole that improved the overall survival for patients with invasive aspergillosis. Newer azoles and the echinocandins were introduced for the treatment of invasive aspergillosis in the late 1990s. Voriconazole and liposomal amphotericin B allow a safer and more effective treatment of invasive aspergillosis when compared with amphotericin B-desoxycholate. Combination of antifungal agents has been introduced in clinical trials. Up to now no significant benefit has been obtained with antifungal combination compared to voriconazole alone. Because mortality of invasive aspergillosis remains up to more than 50%, prophylaxis, early diagnosis and early initiation of antifungal therapy are of utmost importance for the reduction of invasive aspergillosis related mortality. Despite all advances in the management of invasive aspergillosis important questions remain unresolved. This article reviews the current state and new insights in the management of invasive aspergillosis and points out clinicians unmet needs. PMID:23278538

  7. Invasive aspergillosis in a HIV patient on prolonged steroid therapy

    OpenAIRE

    Himanshu Reddy; Sameer Saraf; Mohit Mohan Singh

    2013-01-01

    Central Nervous System complications are the most dreaded complications in patients of HIV. CNS aspergillosis in HIV is a rare complication. The primary risk-factors for invasive aspergillosis are profound neutropenia and glucocorticoid use; risk increases with longer duration of these conditions. In our case report, the HIV patient was treated with Anti Tubercular Treatment and steroids for CNS tuberculosis previously. Use of steroids might have predisposed him for aspergillosis. Physicians ...

  8. Orbital Aspergillosis: Voriconazole – The New Standard Treatment?

    OpenAIRE

    Ohlstein, Derek H.; Hooten, Claudia; Perez, Javier; Clark, Charles L.; Samy, Hazem

    2012-01-01

    Background/Aim To describe a case of invasive orbital aspergillosis and evaluate treatments and outcomes. Methods A case report and review of orbital aspergillosis treatment with voriconazole in the English language literature. Conclusion Amphotericin B with debridement is the current standard of care for orbital aspergillosis; however, its prognosis is unfavorable. When compared to amphotericin B, voriconazole demonstrates a survival benefit, has less systemic toxicity, and is better tolerat...

  9. Central Nervous System Aspergillosis causing Spinal Cord Compression

    Directory of Open Access Journals (Sweden)

    Faraz Ahmed

    2010-07-01

    Full Text Available Central nervous system (CNS aspergillosis is a rare and uniformly fatal complication of disseminated disease, involving the cerebral hemispheres and cerebellum in the majority of cases. It is a ubiquitous mold and refers to a group of diseases caused by monomorphic mycelial fungi of the genus Aspergillosis fumigatus. Outbreaks of invasive aspergillosis are a problem in immunocompromized persons after they are exposed to air-borne spores.1 Aspergillosis causing spinal cord compression due to epidural abscess formation and hypertrophic pachymeningitis is a rare entity, thus such a case is presented herewith.

  10. Manifestation of invasive pulmonary aspergillosis in the formation of mycetoma

    International Nuclear Information System (INIS)

    Invasive pulmonary aspergillosis is characterized by radiological signs allowing a correct diagnosis, including differentiation from pulmonary candidiasis, when they are associated with appropriate clinical symptoms (neutropenia and fever persisting despite broad-spectrum antibiotics). In particular the formation of a pulmonary mycetoma in a previously normal lung is one of these signs. Unlike a simple fungus ball (the saprophytic form of aspergillosis), the rounded density of invasive pulmonary aspergillosis consists of sequestrum of devitalized lung tissue owing to blood vessel invasion by Aspergillus hyphae. This morphologic phenomenon is demonstrated in the present case report and is discussed together with the other roentgenological signs of the invasive aspergillosis. (orig.)

  11. Manifestation of invasive pulmonary aspergillosis in the formation of mycetoma

    Energy Technology Data Exchange (ETDEWEB)

    Roos, N.; Peters, P.E.; Schellong, S.; Eiff, M. von

    1989-05-01

    Invasive pulmonary aspergillosis is characterized by radiological signs allowing a correct diagnosis, including differentiation from pulmonary candidiasis, when they are associated with appropriate clinical symptoms (neutropenia and fever persisting despite broad-spectrum antibiotics). In particular the formation of a pulmonary mycetoma in a previously normal lung is one of these signs. Unlike a simple fungus ball (the saprophytic form of aspergillosis), the rounded density of invasive pulmonary aspergillosis consists of sequestrum of devitalized lung tissue owing to blood vessel invasion by Aspergillus hyphae. This morphologic phenomenon is demonstrated in the present case report and is discussed together with the other roentgenological signs of the invasive aspergillosis.

  12. Aspergillosis in HIV patients: a case series

    Directory of Open Access Journals (Sweden)

    F Laurent

    2012-11-01

    Full Text Available Purpose: Aspergillosis is uncommon in HIV patients and has been mostly reported in patients with CD4<50/µL. Data on risk factors and prognosis are scarce. We reviewed 19 cases of aspergillosis diagnosed in our HIV cohort. Methods: In the Brussels Saint-Pierre HIV cohort, 19 patients were diagnosed with aspergillosis between 1998 and 2012 (0.87/1000 patient/year of follow-up. We analyzed retrospectively and described localization and invasiveness of aspergillosis, risk factors, treatment and outcome of these patients. Results: Patients were mostly African (74% and mean age was 40 years (22–60. Clinical presentation were 10 invasive aspergillosis (IA (53%, 6 pulmonary aspergilloma (31% and 3 sinus fungal ball (16%. The global mortality was 42%. IA was proven for 3 patients, probable for 4 patients and possible for 3 patients according to IDSA definitions. Risk factors for IA included CD4<200/µL (70%; 40%<50 CD4/µL, corticotherapy (50%, neutropenia (20%, intravenous drug use (20%, cirrhosis (20%. IA arose in the time course of septic shock in 30% and opportunistic infections occurred concomitantly in 40%. Seven patients out of 10 with IA died including 3 patients before antifungal therapy. The 3 survivors recovered without relapse. Four patients were treated with voriconazole, 2 with itraconazole, 2 with liposomal amphotericine, 1 with caspofungine, and 2 with bitherapy. Among patients with aspergilloma (n=6, the major associated risk factor was tuberculosis sequelae (80%. Two patients were successfully treated with surgery and voriconazole, 1 died from massive hemoptysis, 2 were lost to follow-up, 1 is currently asymptomatic without treatment. Among patients with sinus fungal ball (n=3, all recovered without relapse with surgical treatment associated with voriconazole for one. Conclusion: Incidence of aspergillosis in HIV patients remains low but in accordance to previous reports, mortality of IA is high (70%. CD4<200 is the most common risk

  13. Chronic Pulmonary Aspergillosis Complicating Bronchial Atresia

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    Mazen O. Al-Qadi

    2014-01-01

    Full Text Available Bronchial atresia is a rare pulmonary developmental anomaly characterized by the presence of a focal obliteration of a segmental or lobar bronchial lumen. The lung distal to the atretic bronchus is typically emphysematous along with the presence of mucus filled ectatic bronchi (mucoceles. BA is usually asymptomatic but pulmonary infections can rarely develop in the emphysematous lung distal to the atretic bronchus. We present a unique case of chronic pulmonary aspergillosis (CPA in a patient with BA with no evidence of immune dysfunction. The patient was treated initially with voriconazole and subsequently underwent surgical excision of the involved area. On follow-up, she has done extremely well with no evidence for recurrence. In summary, we describe the first case of chronic pulmonary aspergillosis in an immunocompetent patient with bronchial atresia.

  14. Histological study of chronic pulmonary aspergillosis

    OpenAIRE

    Tochigi, Naobumi; Ishiwatari, Takao; Okubo, Yoichiro; Ando, Tsunehiro; Shinozaki, Minoru; Aki, Kyoko; GOCHO, KYOKO; Hata, Yoshinobu; Murayama, Somay Y.; Wakayama, Megumi; Nemoto, Tetsuo; Hori, Yasuhiro; SHIBUYA, KAZUTOSHI

    2015-01-01

    Background Chronic pulmonary aspergillosis (CPA) has been accepted the criteria for the diagnosis of pulmonary Aspergillus infection. Whereas, either pathophysiology or signs of CPA remains still controversial. Methods In this study, we histopathologically investigated 25 specimens of CPA, surgically resected. Results 21 (84 %) of that comprised male. There were 21 cases with mild impairment of the immune system and/or a scar mostly due to old tuberculosis. There is a tendency for a negative ...

  15. Cerebral Air Embolism from Angioinvasive Cavitary Aspergillosis

    Directory of Open Access Journals (Sweden)

    Chen Lin

    2014-01-01

    Full Text Available Background. Nontraumatic cerebral air embolism cases are rare. We report a case of an air embolism resulting in cerebral infarction related to angioinvasive cavitary aspergillosis. To our knowledge, there have been no previous reports associating these two conditions together. Case Presentation. A 32-year-old female was admitted for treatment of acute lymphoblastic leukemia (ALL. Her hospital course was complicated by pulmonary aspergillosis. On hospital day 55, she acutely developed severe global aphasia with right hemiplegia. A CT and CT-angiogram of her head and neck were obtained demonstrating intravascular air emboli within the left middle cerebral artery (MCA branches. She was emergently taken for hyperbaric oxygen therapy (HBOT. Evaluation for origin of the air embolus revealed an air focus along the left lower pulmonary vein. Over the course of 48 hours, her symptoms significantly improved. Conclusion. This unique case details an immunocompromised patient with pulmonary aspergillosis cavitary lesions that invaded into a pulmonary vein and caused a cerebral air embolism. With cerebral air embolisms, the acute treatment option differs from the typical ischemic stroke pathway and the provider should consider emergent HBOT. This case highlights the importance of considering atypical causes of acute ischemic stroke.

  16. Disseminated aspergillosis in an adolescent with acute lymphoblastic leukemia.

    NARCIS (Netherlands)

    Zwitserloot, A.M.; Warris, A.; Hek, L.G.F.M. van 't; Die, LE van; Verweij, P.E.; Mavinkurve-Groothuis, A.M.C.

    2008-01-01

    Disseminated aspergillosis in immunocompromised patients has a mortality rate of almost 100%. Despite the development of new antifungal agents, the outcome of disseminated aspergillosis has only improved slightly, particular in patients with central nervous system (CNS) involvement. The use of combi

  17. Eosinophilic pleural effusion complicating allergic bronchopulmonary aspergillosis.

    Science.gov (United States)

    Kirschner, Austin N; Kuhlmann, Erica; Kuzniar, Tomasz J

    2011-01-01

    Allergic bronchopulmonary aspergillosis (ABPA) is primarily a disease of patients with cystic fibrosis or asthma, who typically present with bronchial obstruction, fever, malaise, and expectoration of mucus plugs. We report a case of a young man with a history of asthma who presented with cough, left-sided pleuritic chest pain and was found to have lobar atelectasis and an eosinophilic, empyematous pleural effusion. Bronchoscopy and sputum cultures grew Aspergillus fumigatus, and testing confirmed strong allergic response to this mold, all consistent with a diagnosis of ABPA. This novel and unique presentation of ABPA expands on the differential diagnosis of eosinophilic pleural effusions. PMID:21311176

  18. Invasive pulmonary aspergillosis in computed tomography

    International Nuclear Information System (INIS)

    We examined 65 patients with proved invasive aspergillosis. 35 out of these patients were HIV negative and were treated with immune depressive agents for different systemic diseases. The plain chest film usually only showed unspecific opacities in the lung. HRCT however made the diagnosis possible or at lest highly probable because of a number of characteristic findings: Multiple opacities of different size and character - the air crescent sign -the halo sign - the sponge sign - (sub)segmental infarction pneumonia - patent bronchus within consolidated infiltration - cavern with septal internal structure. (orig.)

  19. Invasive Aspergillosis Associated with a Foreign Body

    Directory of Open Access Journals (Sweden)

    Akifuddin Syed

    2015-01-01

    Full Text Available Invasive aspergillosis is a serious complication in immunocompromised individuals. It is associated with a high mortality rate, which demands a combined approach involving radical surgery and antifungal therapy. Here, we describe a patient who presented with nonspecific fever, refractory to antimicrobial agents. Though it primarily involved the nasal cavity and sinuses, it perforated into the oral cavity causing palatal changes. Surprisingly, a foreign body was found in the involved tissues that might have acted as a nidus of infection. A sufficient dose (3 mg/kg/day of liposomal amphotericin B was initiated soon after a thorough debridement procedure and the patient survived.

  20. Renal aspergillosis secondary to renal intrumentation in immunocompetent patient

    OpenAIRE

    Paul, Sagorika; Singh, Viswajeet; Sankhwar, Satyanarayan; Garg, Manish

    2013-01-01

    Primary renal aspergillosis is a rare urological entity and immune-compromised persons are commonly prone to it. The clinical presentation resembles that of usual bacterial pyelonephritis. We report a case of localised unilateral renal aspergillosis with obstructive uropathy (hypoplastic contralateral kidney) in a young man, occurring after the endoscopic removal of impacted right upper ureteric calculus in a non-immunocompromised patient. In view of deranged renal function, he was initially ...

  1. Inhaled voriconazole for prevention of invasive pulmonary aspergillosis.

    Science.gov (United States)

    Tolman, Justin A; Wiederhold, Nathan P; McConville, Jason T; Najvar, Laura K; Bocanegra, Rosie; Peters, Jay I; Coalson, Jacqueline J; Graybill, John R; Patterson, Thomas F; Williams, Robert O

    2009-06-01

    Targeted airway delivery of antifungals as prophylaxis against invasive aspergillosis may lead to high lung drug concentrations while avoiding toxicities associated with systemically administered agents. We evaluated the effectiveness of aerosolizing the intravenous formulation of voriconazole as prophylaxis against invasive pulmonary aspergillosis caused by Aspergillus fumigatus in an established murine model. Inhaled voriconazole significantly improved survival and limited the extent of invasive disease, as assessed by histopathology, compared to control and amphotericin B treatments. PMID:19289523

  2. Isolated Aspergillosis Myocardial Abscesses in a Liver-Transplant Patient

    Directory of Open Access Journals (Sweden)

    Kim-Diêp Dang-Tran

    2014-01-01

    Full Text Available Cardiac abscess is an uncommon and fatal complication after transplantation. We report a case of an initially isolated aspergillosis myocardial abscess diagnosed by cardiac magnetic resonance imaging (CMRI. At that time, there was no other biological evidence or other extracardiac manifestations. A three-month course of dual antifungal therapy followed by a single antifungal therapy was empirically given. Six month after admission, Aspergillus fumigatus was isolated for the first time and the patient deceased from a disseminated aspergillosis.

  3. Allergic Broncho Pulmonary Aspergillosis Complicated by Nocardiosis

    Directory of Open Access Journals (Sweden)

    Brijesh Sharma

    2012-01-01

    Full Text Available We describe a 70-year-old male with a history of diabetes mellitus, hypertension, and asthma who presented with increasing breathlessness for 5 months. He was diagnosed to have allergic bronchopulmonary aspergillosis (ABPA by serological and radiographic criteria. He was treated with steroids and itraconazole. After initial improvement, he developed fever with cough and mucopurulent sputum. X-ray chest revealed multiple cavities with air fluid level. Patient was treated with antibiotics without any response. Sputum was negative for acid fast bacilli (AFB. Sputum culture for bacteria and fungus did not reveal any significant growth; however a delayed growth of Nocardia was noted on fungal plates. Modified Ziehl Nelsen stain was positive for AFB. Patient was treated with cotrimoxazole. We discuss the serological and radiological criteria of ABPA, presentation and treatment of nocardia pulmonary infection and other possible causes of necrotizing pneumonia in immunocompromised settings.

  4. Cerebral aspergillosis presenting as a mass lesion

    Directory of Open Access Journals (Sweden)

    Negar Azarpira

    2008-08-01

    Full Text Available Fungal infections of the central nervous system (CNS are almost always a surprising finding. Their presentation is usually subtle, often without any diagnostic characteristics, and they are frequently mistaken for pyogenic abscesses, or brain tumors. Aspergillosis of the central nervous system is an uncommon infection, mainly occurring in immunocompromised patients. It may present in several forms, including meningitis, mycotic aneurysms, infarcts and a tumoral form. We report an intracranial granuloma due to Aspergillus fumigatus involving the anterior cranial fossa and the frontal lobe. The clinical symptoms began one year before admission. Final diagnosis was made after craniotomy. The patient was treated with an extensive excision of the cerebral mass and medical antifungal therapy (intravenous amphotericin B, but she failed to respond to these treatments and died.

  5. Allergic Bronchopulmonary Aspergillosis: A Perplexing Clinical Entity.

    Science.gov (United States)

    Shah, Ashok; Panjabi, Chandramani

    2016-07-01

    In susceptible individuals, inhalation of Aspergillus spores can affect the respiratory tract in many ways. These spores get trapped in the viscid sputum of asthmatic subjects which triggers a cascade of inflammatory reactions that can result in Aspergillus-induced asthma, allergic bronchopulmonary aspergillosis (ABPA), and allergic Aspergillus sinusitis (AAS). An immunologically mediated disease, ABPA, occurs predominantly in patients with asthma and cystic fibrosis (CF). A set of criteria, which is still evolving, is required for diagnosis. Imaging plays a compelling role in the diagnosis and monitoring of the disease. Demonstration of central bronchiectasis with normal tapering bronchi is still considered pathognomonic in patients without CF. Elevated serum IgE levels and Aspergillus-specific IgE and/or IgG are also vital for the diagnosis. Mucoid impaction occurring in the paranasal sinuses results in AAS, which also requires a set of diagnostic criteria. Demonstration of fungal elements in sinus material is the hallmark of AAS. In spite of similar histopathologic features, co-existence of ABPA and AAS is still uncommon. Oral corticosteroids continue to be the mainstay of management of allergic aspergillosis. Antifungal agents play an adjunctive role in ABPA as they help reduce the fungal load. Saprophytic colonization in cavitary ABPA may lead to aspergilloma formation, which could increase the severity of the disease. The presence of ABPA, AAS, and aspergilloma in the same patient has also been documented. All patients with Aspergillus-sensitized asthma must be screened for ABPA, and AAS should always be looked for. PMID:27126721

  6. Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin - review of the literature

    OpenAIRE

    Karthaus M

    2011-01-01

    Abstract Major progress for the management of invasive aspergillosis has come from the introduction of new antifungals since the late 1990s. Although mortality of invasive aspergillosis remains as high as 30-50%. Backbone of management are prophylaxis, early diagnosis and early initiation of antifungals for reduction of invasive aspergillosis related mortality. Randomized trials have been undertaken for the prophylaxis as well as treatment of invasive aspergillosis in the last two decades. Po...

  7. An Economic Evaluation of Voriconazole versus Amphotericin B for the Treatment of Invasive Aspergillosis in Canada

    Directory of Open Access Journals (Sweden)

    Coleman Rotstein

    2004-01-01

    Full Text Available BACKGROUND: Invasive aspergillosis (IA is a serious fungal infection that affects immunocompromised patients. The Global Comparative Aspergillosis study demonstrated that voriconazole, a new broad-spectrum triazole, had better responses and improved survival compared with conventional amphotericin B deoxycholate (CAB and other licensed antifungal therapy (OLAT for the treatment of definite or probable aspergillosis.

  8. Accuracy of percutaneous lung biopsy for invasive pulmonary aspergillosis

    Energy Technology Data Exchange (ETDEWEB)

    Hoffer, F.A. [Dept. of Diagnostic Imaging, St. Jude Children' s Research Hospital, Memphis, TN (United States); Gow, K.; Davidoff, A. [Dept. of Surgery, St. Jude Children' s Research Hospital, Memphis, TN (United States); Flynn, P.M. [Dept. of Infectious Diseases, St. Jude Children' s Research Hospital, Memphis, TN (United States)

    2001-03-01

    Background. Invasive pulmonary aspergillosis is fulminant and often fatal in immunosuppressed patients. Percutaneous biopsy may select patients who could benefit from surgical resection. Objective. We sought to determine the accuracy of percutaneous biopsy for pediatric invasive pulmonary aspergillosis. Materials and methods. We retrospectively reviewed 28 imaging-guided percutaneous biopsies of the lungs of 24 children with suspected pulmonary aspergillosis. Twenty-two were being treated for malignancy and two for congenital immunodeficiency; 15 had received bone-marrow transplants. The accuracy of the percutaneous lung biopsy was determined by subsequent surgical resection, autopsy, or clinical course. Results. Histopathological studies showed ten biopsy specimens with septate hyphae, indicating a mold, and seven with Aspergillus flavus colonies in culture. The remaining 18 biopsies revealed no fungi. No patient had progressive aspergillosis after negative biopsy. Invasive pulmonary mold was detected by percutaneous biopsy with 100 % (10/10) sensitivity and 100 % (18/18) specificity. Percutaneous biopsy results influenced the surgical decision in 86 % (24 of 28) of the cases. Bleeding complicated the biopsy in 46 % (13/28) and hastened one death. Conclusion. Percutaneous biopsy of the lung is an accurate technique for the diagnosis of invasive pulmonary aspergillosis and correctly determines which immunosuppressed pediatric patients would benefit from therapeutic pulmonary resection. (orig.)

  9. Immunopathology and Immunogenetics of Allergic Bronchopulmonary Aspergillosis

    Directory of Open Access Journals (Sweden)

    Alan P. Knutsen

    2011-01-01

    Full Text Available Allergic bronchopulmonary aspergillosis (ABPA is a Th2 hypersensitivity lung disease in response to Aspergillus fumigatus that affects asthmatic and cystic fibrosis (CF patients. Sensitization to A. fumigatus is common in both atopic asthmatic and CF patients, yet only 1%–2% of asthmatic and 7%–9% of CF patients develop ABPA. ABPA is characterized by wheezing and pulmonary infiltrates which may lead to pulmonary fibrosis and/or bronchiectasis. The inflammatory response is characterized by Th2 responses to Aspergillus allergens, increased serum IgE, and eosinophilia. A number of genetic risks have recently been identified in the development of ABPA. These include HLA-DR and HLA-DQ, IL-4 receptor alpha chain (IL-4RA polymorphisms, IL-10 −1082GA promoter polymorphisms, surfactant protein A2 (SP-A2 polymorphisms, and cystic fibrosis transmembrane conductance regulator gene (CFTR mutations. The studies indicate that ABPA patients are genetically at risk to develop skewed and heightened Th2 responses to A. fumigatus antigens. These genetic risk studies and their consequences of elevated biologic markers may aid in identifying asthmatic and CF patients who are at risk to the development of ABPA. Furthermore, these studies suggest that immune modulation with medications such as anti-IgE, anti-IL-4, and/or IL-13 monoclonal antibodies may be helpful in the treatment of ABPA.

  10. Metal densities in paranasal sinuses - reliable evidence of aspergillosis

    International Nuclear Information System (INIS)

    The significance of mycotic concretions of 'metal density' in the diagnosis of aspergillosis of the paranasal sinuses has been analysed in 47 patients with this diagnosis. The incidence, types, radiological appearances and chemical composition of these very dense calcifications are discussed. Demonstration of these concretions, if metal foreign bodies and displaced dental fillings are excluded, are evidence for a mycosis of the paranasal sinuses. Absence of these dense structures does not exclude aspergillosis and was present in our clinical material in only 50% of cases. (orig.)

  11. Economic effects of aspergillosis management in high-risk patients.

    Science.gov (United States)

    Leather, Helen

    2005-04-01

    Aspergillosis mortality has risen exponentially over the last 2 decades, related primarily to the availability of medical treatments and procedures that prolong the survival of patients with other disorders who are at high risk because of immunologic compromise. In addition to excess mortality, aspergillosis results in increased costs for hospitalization and treatment, including management of adverse events associated with conventional amphotericin B treatment. Compared with amphotericin B, the triazole antifungal voriconazole has excellent efficacy and a favorable side-effect profile. Reliable oral bioavailability of voriconazole may permit switching to an oral formulation in the inpatient setting and offers the possibility of earlier hospital discharge and potentially substantial cost savings. PMID:15889762

  12. Aspergillosis of the sphenoid sinus simulating a pituitary tumor

    International Nuclear Information System (INIS)

    Sphenoidal aspergillosis is an unusual cause of sella turcica enlargement. Pituitary abscess secondary to Aspergillus had been reported. In the present case, a woman with sphenoid sinus aspergillosis mimiced a pituitary tumor. This patient survived her infection with intact pituitary function following a transsphenoidal approach. No postoperative amphotericine-B and 5-fluorocytosine were necessary. CT scan revealed a mass occupying the sphenoid sinus extending to the sella turcica. Factors that should alert the clinican to the presence of a sphenoidal and pituitary abscess in a patient with sella turcica enlargement are prior episodes of sinusitis, meningitis and immunosuppression and, as in the present case, hyperglycemia. (orig.)

  13. Diagnosis of allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis

    DEFF Research Database (Denmark)

    Skov, M; Koch, C; Reimert, C M;

    2000-01-01

    The diagnosis of allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) patients may be difficult to establish because ABPA shares many characteristics with coexisting atopy or other lung infections in these patients. This study aimed to evaluate the sensitivity and specificity of...

  14. Cerebral and spinal cord involvement resulting from invasive aspergillosis

    International Nuclear Information System (INIS)

    Although central nervous system involvement in disseminated aspergillosis is known to occur in immunocompromised patients, particularly after bone marrow transplantation, localized involvement of the spinal cord is exceedingly rare. In this report we present and illustrate detailed imaging findings of central nervous system invasion by Aspergillus fumigatus in a 30-year-old woman, with emphasis on the spinal cord involvement. (orig.)

  15. Critical assessment of issues in the diagnosis of invasive aspergillosis.

    NARCIS (Netherlands)

    Klont, R.R.; Meis, J.F.G.M.; Verweij, P.E.

    2001-01-01

    Invasive aspergillosis remains a devastating disease, which is partly because of the inability to identify infected patients at an early stage of the disease. Recently, new diagnostic tests and procedures have been developed to help in identifying high-risk patients. High-resolution computed tomogra

  16. A novel case of canine disseminated aspergillosis following mating

    OpenAIRE

    Walker, Jackson T.; Frazho, Jean K.; Randell, Susan C.

    2012-01-01

    An intact bitch with a history of mating was presented with severe lameness and a vulvar discharge. A mixed lytic, proliferative tibial lesion and open pyometra were diagnosed. Bone biopsy and uterine culture revealed disseminated aspergillosis. This is the first report of Aspergillus pyometra with dissemination following mating in the dog.

  17. Invasive central nervous system aspergillosis in bone marrow transplantation recipients: an overview

    International Nuclear Information System (INIS)

    Invasive central nervous system aspergillosis is being seen with an increased frequency, particularly due to the increased number of immunosuppressed patients. The major cause of invasive central nervous system aspergillosis is bone marrow transplantation. In most cases, aspergillosis develops in the paranasal sinuses and in the lungs, and secondarily spreads to the brain. Imaging of cerebral aspergillosis may present different patterns depending on the lesion's age and the immunologic status of the patient. Lesions of the spinal cord are far less common but has been encountered in our series. In this article we review the clinical and radiologic features of aspergillosis affecting the central nervous system in patients who underwent bone marrow transplantation. Different CT and MR patterns are presented, including pertinent clinical and pathologic material. Significant morbidity and mortality can be associated with this fungal infection, and it is therefore incumbent upon the radiologist to identify intracranial aspergillosis as early as possible so that appropriate therapy can be administered. (orig.)

  18. Invasive tracheobronchial aspergillosis progressing from bronchial to diffuse lung parenchymal lesions.

    Science.gov (United States)

    Ohta, Hiromitsu; Yamazaki, Susumu; Miura, You; Kanazawa, Minoru; Sakai, Fumikazu; Nagata, Makoto

    2016-03-01

    Invasive tracheobronchial aspergillosis that is entirely limited or predominantly confined to tracheobronchial lesions is a relatively rare form of invasive pulmonary aspergillosis. Extended parenchymal opacities that are radiological manifestations of invasive aspergillosis sometimes occur following invasive tracheobronchial aspergillosis. However, it remains unclear whether or not invasive tracheobronchial aspergillosis is the initial stage of invasive pulmonary aspergillosis. A 61-year-old woman was admitted because of severe diarrhea and dehydration. Three days after admission, she complained of dyspnea. A computed tomography (CT) scan of the chest showed bronchial wall thickening. She developed respiratory failure despite antibiotic therapy. A CT scan showed obstructions of bronchial lumens and bronchiectasis in the right upper lobe. A spergillus fumigatus was identified from samples obtained in bronchoscopic examination. Bronchial lesions rapidly progressed to be extended. A spergillus infection with multiple parenchymal opacities was observed on CT scan. She responded to treatment with antifungal drugs. PMID:26839700

  19. Aerosol and parenteral pneumocandins are effective in a rat model of pulmonary aspergillosis.

    OpenAIRE

    Kurtz, M B; Bernard, E M; Edwards, F F; Marrinan, J A; Dropinski, J; Douglas, C M; Armstrong, D

    1995-01-01

    The pneumocandins are semisynthetic analogs of echinocandin-like compounds that have shown efficacy in animal models of systemic candidiasis, disseminated aspergillosis, and pneumocystis pneumonia. However, the most common form of Aspergillus infection in susceptible patients is pulmonary aspergillosis, which was not directly tested in the mouse models used in the past. We have evaluated three pneumocandins, L-693,989, L-731,373, and L-733,560, in a rat model of pulmonary aspergillosis. Male ...

  20. Imaging features of gastric invasive aspergillosis: A report of two cases

    International Nuclear Information System (INIS)

    Invasive aspergillosis is an opportunistic infection that usually occurs in immunocompromised patients. Although there are a few rare reports of isolated invasive aspergillosis affecting the small intestine, isolated or disseminated gastric invasive aspergillosis is extremely rare. Herein, we report 2 cases of gastric invasive aspergillosis in a 72 year old woman and a 43 year old man; the woman had been recovering from ruptured left posterior communicating artery aneurysm, which presented as emphysematous gastritis and the man from acute subdural haemorrhage in the intensive care unit, which presented as a pseudoaneurysm on CT imaging

  1. Invasive aspergillosis in an immunocompetent patient with fever and a cardiac mass

    Directory of Open Access Journals (Sweden)

    Matthew LaBarbera

    2011-10-01

    Full Text Available Invasive aspergillosis is an often fatal disease that usually occurs in immunocompromised patients. We report a case of invasive aspergillosis presenting as a febrile respiratory infection with a cardiac mass in an immunocompetent patient. Invasive aspergillosis should be considered in the differential diagnosis of an otherwise undiagnosed febrile respiratory illness, even in immunocompetent patients. Echocardiography should be peformed to evaluate for endocarditis in such cases. Prompt initiation of appropriate antifungal therapy is warranted, even before the diagnosis of invasive aspergillosis is confirmed.

  2. Imaging features of gastric invasive aspergillosis: A report of two cases

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Dong Jin; Cho, Seung Hyun; Kim, Seong Hoon; Shin, Ji Yeol; Lee, Yil Gi [Daegu Fatima Hospital, Daegu (Korea, Republic of)

    2012-05-15

    Invasive aspergillosis is an opportunistic infection that usually occurs in immunocompromised patients. Although there are a few rare reports of isolated invasive aspergillosis affecting the small intestine, isolated or disseminated gastric invasive aspergillosis is extremely rare. Herein, we report 2 cases of gastric invasive aspergillosis in a 72 year old woman and a 43 year old man; the woman had been recovering from ruptured left posterior communicating artery aneurysm, which presented as emphysematous gastritis and the man from acute subdural haemorrhage in the intensive care unit, which presented as a pseudoaneurysm on CT imaging.

  3. Nasal Aspergillosis in a Dog: A Case Report

    Directory of Open Access Journals (Sweden)

    Camilo Padilla Peñuela

    2014-07-01

    Full Text Available Nasal aspergillosis is a major chronic disease affecting the nostrils in dogs. Clinical sinology is typical in every chronic nasal disease. Epistaxis and occasional pain occurs. Rhinoscopic assessment of the area evidences findings associated with the pathology and allows collecting samples for cytology and culture. Systemic therapy with oral antifungals has had variable utility, but now it has been replaced by direct topical medication to the affected area. This article describes the case of a 4-years-old male dog, submitted to consultation by unilateral muco-bloody nasal discharge with a week of evolution. The patient was treated by another vet center with cyclonamine and vitamin K for a possible clotting disorder. After a series of tests that included rhinoscopy and fungal culture, nasal aspergillosis was diagnosed. Intranasal clotrimazole was applied twice and it allowed the resolution of the clinical signs.

  4. Aspergillosis and proventricular impaction in an ostrich (Struthio camelus

    Directory of Open Access Journals (Sweden)

    Shahrzad Azizi

    2014-08-01

    Full Text Available Aspergillosis is the most common mycotic infection in a wide variety of bird and causes significant economic losses. The present study described concurrent occurrence of aspergillosis and proventricular impaction in a 4-year-old male ostrich. The bird had respiratory problems, coughing and anorexia. Postmortem examination revealed numerous greenish-white caseous foci, 0.5 to 1 cm in diameter distributed on the surfaces of the air sacs and throughout the lungs. In histopathological study, multifocal areas of caseous necrosis that surrounded by inflammatory cells including heterophils, lymphocytes and macrophages were present. Long branching septated hyphae were visible in the necrotic areas with hematoxylin and eosin and Periodic acid-Schiff staining. Thrombi were present in the blood vessels. The proventriculus was full of gravel.

  5. Chronic aspergillosis of the lungs: Unravelling the terminology and radiology

    Energy Technology Data Exchange (ETDEWEB)

    Desai, S.R.; Hedayati, V.; Patel, K. [King' s College Hospital NHS Foundation Trust, The Department of Radiology, King' s Health Partners, King' s College London, London (United Kingdom); Hansell, D.M. [The Royal Brompton and Harefield NHS Foundation Trust, Department of Radiology, London (United Kingdom)

    2015-10-15

    The propensity for Aspergillus spp. to cause lung disease has long been recognised but the satisfactory classification of these disorders is challenging. The problems caused by invasive disease in severely neutropenic patients, saprophytic infection of pre-existing fibrotic cavities and allergic reactions to Aspergillus are well documented. In contrast, a more chronic form of Aspergillus-related lung disease that has the potential to cause significant morbidity and mortality is under-reported. The symptoms of this form of Aspergillus infection may be non-specific and the radiologist may be the first to suspect a diagnosis of chronic pulmonary aspergillosis. The current review considers the classification conundrums in diseases caused by Aspergillus spp. and discusses the typical clinical and radiological profile of patients with chronic pulmonary aspergillosis. (orig.)

  6. Invasive pulmonary aspergillosis – case report and review of literature

    Directory of Open Access Journals (Sweden)

    Ashutossh Naaraayan

    2015-02-01

    Full Text Available Invasive pulmonary aspergillosis (IPA is a severe fungal infection with a high mortality rate. The incidence of IPA is on the rise due to an increase in the number of patients undergoing transplants and receiving chemotherapy and immunosuppressive therapy. Diagnosis is challenging due to the non-specific nature of symptoms. Voriconazole is the mainstay of therapy. We present a case of an elderly woman presenting with acute bronchitis and asthma exacerbation, who succumbed to overwhelming IPA. It is uncommon for IPA to develop in patients on short-term steroid therapy for asthma exacerbation. The possibility of aspergillosis in immunocompetent patients should be considered in those on systemic steroids and deteriorating pulmonary functions.

  7. Primary cutaneous aspergillosis due to Aspergillus flavus: a case report

    Institute of Scientific and Technical Information of China (English)

    ZHANG Qiang-qiang; LI Li; ZHU Min; ZHANG Chao-ying; WANG Jia-jun

    2005-01-01

    @@ Infections caused by opportunistic organisms which have been known as etiologic agents of disease become more and more frequent.Aspergillus spp. is one of the agents. Fungi of aspergillus genus are widely distributed in nature, particularly in the soil and in the decomposed vegetation. They are frequent opportunist pathogens in immunocompromised patients. The most frequent causative organisms that cause cutaneous aspergillosis are A.fumigatus and A.flavus.1-3 In this report, we present a case of primary cutaneous aspergillosis manifested by ulceration of the shank due to A. flavus. The patient had no deficiency of immunological status and severe disease associated with fungal infection. Excellent response was shown to anti-fungal therapy.

  8. Isavuconazole in the treatment of invasive aspergillosis and mucormycosis infections

    Science.gov (United States)

    Donnelley, Monica A; Zhu, Elizabeth S; Thompson, George R

    2016-01-01

    We have a limited arsenal with which to treat invasive fungal infections caused by Aspergillus and Mucorales. The morbidity and mortality for both pathogens remains high. A triazole antifungal, isavuconazole, was recently granted approval by the US Food and Drug Administration and the European Medicines Agency for the treatment of invasive aspergillosis and mucormycosis. A randomized double-blind comparison trial for the treatment of invasive aspergillosis found isavuconazole noninferior to voriconazole. A separate, open-label study evaluating the efficacy of isavuconazole in the treatment of mucormycosis found comparable response rates to amphotericin B and posaconazole treated historical controls. The prodrug isavuconazonium sulfate is commercially available in both an oral and intravenous formulation and is generally well tolerated. Isavuconazole’s broad spectrum of activity, limited side effect profile, and favorable pharmacokinetics will likely solidify its place in therapy. PMID:27330318

  9. Invasive nosocomial pulmonary aspergillosis: risk factors and hospital building works.

    OpenAIRE

    Perraud, M; Piens, M A; Nicoloyannis, N.; Girard, P.; Sepetjan, M; Garin, J. P.

    1987-01-01

    A retrospective epidemiological study of 22 observations of invasive pulmonary aspergillosis, of which 18 were fatal, occurring over a period of 30 months, implicated certain building sites within the hospital. The building works were responsible for the diffusion into the atmosphere of fungal spores from normally closed reservoirs, notably false ceilings, fibrous thermal and/or acoustic insulation materials and roller-blind casings. The results of our study permit us to suggest that protecti...

  10. Histopathological identification of aspergillosis in animals at Dhaka Zoo

    OpenAIRE

    Ahasan, S.A.; Chowdhury, E.H.; Rahman, M M; Rahman, M. A.

    2013-01-01

    Dhaka Zoo with 2000 animal heads of 184 species from significant genetic diversity and five million visitors’ influx round the year is placing it a public health important spot. This study was conducted to investigate aspergillosis in animals at Dhaka Zoo to ascertain animal health, welfare and public health safety standard. One hundred and two necropsied tissue samples preserved in 10% neutral buffered formalin at necropsy from 36 animals of 25 different species were collected from Dhaka Zoo...

  11. Recent developments in inhaled triazoles against invasive pulmonary aspergillosis

    OpenAIRE

    Merlos, Romain; Amighi, Karim; Wauthoz, Nathalie

    2014-01-01

    Invasive pulmonary aspergillosis (IPA) is a fungal infection that is seen with particular frequency in immunocompromised patients, and associated with high rates of mortality. To combat or prevent IPA, triazoles such as voriconazole or itraconazole and posaconazole have become accepted as first- and second-line therapy, respectively. However, triazoles are associated with issues of oral bioavailability, high liver metabolism, and/or drug–drug interactions, increasing the variability of system...

  12. Beware of the devastating pulmonary aspergillosis syndromes In certain environments

    LENUS (Irish Health Repository)

    Kooblall, M

    2016-02-01

    Nowadays with more stem cell transplants and immunosuppressive therapies there has been a rise in pulmonary aspergillosis syndromes. The following illustrates such a case. A 49 year old man had a past history of ankylosing spondylitis with a bilateral hip replacement. He was also on surveillance for a superficial bladder tumour since 2007. His chest x-ray in 2008 was normal. In 2010 his CXR showed patchy opacification in the right apex. CT thorax confirm fibrotic changes.

  13. Allergic bronchopulmonary aspergillosis complicating cystic fibrosis in childhood.

    OpenAIRE

    Brueton, M. J.; Ormerod, L P; Shah, K J; Anderson, C. M.

    1980-01-01

    Allergic bronchopulmonary aspergillosis, known to be associated with cystic fibrosis in older patients, occurred in 7 young atopic children with cystic fibrosis. The diagnosis was suggested by the onset of, or the increase in, asthmatic symptoms accompanied by major chest x-ray changes ranging from total collapse of a lung or lobe to extensive but changing areas of consolidation. Each of the children had a blood eosinophilia, positive type I skin tests to Aspergillus fumigatus, and reversible...

  14. CT evaluation of maxillary sinus aspergillosis: morphological patterns on CT

    International Nuclear Information System (INIS)

    In order to classify the involving patterns of maxillary sinus aspergillosis on CT that will be an important guidance for functional endoscopic sinus surgery (FESS) and to evaluate CT findings of each pattern. We reviewed CT findings of 37 cases of maxillary sinus aspergillosis which were confirmed pathologically. These were classified into three patterns according to the location: the maxillary pattern(I), the infundibular pattern(II), and combined pattern(III). All cases were correlated with FESS findings. We also evaluated CT density, presence of contrast enhancement and calcifications, and surrounding bony changes of each pattern. The combined pattern was most commonly seen in 24 of 37 cases (64.9%). The maxillary pattern was identified in 8 (21.6%), with 5 (13.5%) cases demonstrating the infundibular pattern. These patterns were consistent with FESS findings. Calcifications were seen in 28 cases (75.7%). 31 cases (83.3%) revealed hypodensity and 16 cases among them showed peripheral enhancement. Central high density with peripheral low density rim was shown in 25% (2/8) of the maxillary pattern and 12.5% (3/24) of combined pattern. Surrounding bony changes were noted mainly in infundibular pattern and combined pattern. Erosion of uncinate process showed all cases of both patterns. Erosion or elevation of ethmomaxillary plate was seen in 3 of 5 cases of infundibular pattern and all cases of the combined pattern. CT findings of maxillary sinus aspergillosis can be classified into 3 patterns according to their distribution. These classification could be helpful for planning FESS approach. Calcifications are the most characteristic findings of maxillary sinus aspergillosis whereas CT density or enhancement pattern do not contribute to diagnosis

  15. Childhood allergic bronchopulmonary aspergillosis presenting as a middle lobe syndrome

    OpenAIRE

    Shah, Ashok; Gera, Kamal; Panjabi, Chandramani

    2016-01-01

    Allergic bronchopulmonary aspergillosis (ABPA) is infrequently documented in children with asthma. Although collapse is not uncommon, middle lobe syndrome (MLS) as a presentation of ABPA is rather a rarity. A 9-year-old female child with asthma presented with increase in intensity of symptoms along with a right midzone patchy consolidation on a chest radiograph. In addition, an ill-defined opacity abutting the right cardiac border with loss of cardiac silhouette was noted. A right lateral vie...

  16. Refractory invasive aspergillosis controlled with posaconazole and pulmonary surgery in a patient with chronic granulomatous disease: case report

    OpenAIRE

    Kepenekli, Eda; Soysal, Ahmet; Kuzdan, Canan; Ermerak, Nezih Onur; Yüksel, Mustafa; Bakır, Mustafa

    2014-01-01

    Invasive aspergillosis is an important cause of morbidity and mortality in immunocompromised patients. Among primary immunodefiencies, chronic granulomatous disease (CGD) has the highest prevalence of invasive fungal diseases. Voriconazole is recommended for the primary treatment of invasive aspergillosis in most patients. In patients whose aspergillosis is refractory to voriconazole, therapeutic options include changing class of antifungal, for example using an amphotericin B formulation, an...

  17. Chronic invasive aspergillosis of paranasal sinuses: A case report with review of literature

    Directory of Open Access Journals (Sweden)

    Avinash P Tamgadge

    2012-01-01

    Full Text Available Aspergillosis of the nasal and paranasal sinuses is recognized as being second to candidiasis, among opportunistic fungal infections in immunocompromised patients. However, invasive variant in normal and mildly immunocompromised hosts is a very rare occurrence. We report one such case of aspergillosis involving paranasal sinuses in mildly immunocompromised patient.

  18. Prophylaxis and treatment of invasive aspergillosis with voriconazole, posaconazole and caspofungin - review of the literature

    Directory of Open Access Journals (Sweden)

    Karthaus M

    2011-04-01

    Full Text Available Abstract Major progress for the management of invasive aspergillosis has come from the introduction of new antifungals since the late 1990s. Although mortality of invasive aspergillosis remains as high as 30-50%. Backbone of management are prophylaxis, early diagnosis and early initiation of antifungals for reduction of invasive aspergillosis related mortality. Randomized trials have been undertaken for the prophylaxis as well as treatment of invasive aspergillosis in the last two decades. Posaconazole is recommended for prophylaxis against aspergillosis in patients treated for acute myelogenous leukemia, myelodysplastic syndrome or patients with graft versus host disease after allogeneic transplantation. Efficacy has been shown for first-line therapy of invasive aspergillosis with voriconazole and liposomal amphotericin B. Gastrointestinal resorption for the azoles posaconazole, voriconazole and itraconazole differ considerably. While oral voriconazole resportion is reduced when taken with food, posaconazole has to be taken with fatty food for optimal intestinal resorption. Beside all advances in the management of invasive aspergillosis important questions remain unresolved. This article reviews the current state of prophylaxis and treatment of invasive aspergillosis and points out clinicians unmet needs.

  19. Disseminated aspergillosis as the herald manifestation of chronic granulomatous disease in an adult patient.

    Directory of Open Access Journals (Sweden)

    Ilad Alavi Darazam

    2014-02-01

    Full Text Available Chronic granulomatous disease is an inherited defect in intracellular killing of ingested microorganisms characterized by recurrent life threatening bacterial and fungal infections including invasive aspergillosis in early childhood. We report a disseminated aspergillosis as the representative of adult onset chronic granulomatous disease without previous infection, with dramatic response to combination of antifungal and interferon therapy.

  20. Allergic bronchopulmonary aspergillosis: a unique presentation in a pediatric patient

    Energy Technology Data Exchange (ETDEWEB)

    Huppmann, Michael V.; Monson, Matthew [Walter Reed Army Medical Center, Department of Radiology, Washington, DC (United States)

    2008-08-15

    Infection by the Aspergillus species of fungus can result in a variety of clinically and radiographically unique pulmonary diseases. The specific disease manifested is most dependent upon the immunocompetency of the infected individual. Allergic bronchopulmonary aspergillosis (ABPA) is most commonly seen in patients with asthma and cystic fibrosis. Since its original description in 1952, much has been published describing the radiographic manifestations of this disease. In this article, we present the unusual case of a 13-year-old whose initial radiographic presentation was that of a dense lobar consolidation. Additionally, we highlight the contributory role of the radiologist in guiding the appropriate clinical work-up and treatment of this disease. (orig.)

  1. Pleural aspergillosis complicated by recurrent pneumothorax: a case report

    Directory of Open Access Journals (Sweden)

    Gao Jie

    2010-06-01

    Full Text Available Abstract Introduction Pneumothorax as the first symptom of pleural aspergillosis is rare. Case presentation A 31-year-old asthmatic Chinese man presented with recurrent spontaneous pneumothorax and underwent lobectomy due to persistent air leakage. Aspergillus was detected histopathologically in the visceral pleural cavity. He was treated with itraconazole at 200 mg a day, and nine months later he had no recurrent pneumothorax or aspergillus infection. Conclusion Recurrent pneumothorax may be a rare manifestation of aspergillus infection. Aspergillus species infection should be considered in the differential diagnosis of recurrent pneumothorax patients, particularly those with chronic lung disease.

  2. Allergic bronchopulmonary aspergillosis: a rare cause of pleural effusion.

    LENUS (Irish Health Repository)

    O'Connor, T M

    2012-02-03

    Aspergillus fumigatus is one of the most ubiquitous of the airborne saprophytic fungi. Allergic bronchopulmonary aspergillosis (ABPA) is a syndrome seen in patients with asthma and cystic fibrosis, and is characterized by hypersensitivity to chronic colonization of the airways with A. fumigatus. We report the case of a patient with ABPA presenting with pleural effusion. A 27-year-old male was referred with recurrent right pleural effusion. Past medical history was remarkable for asthma, allergic sinusitis, and recurrent pleurisy. Investigations revealed peripheral eosinophilia with elevated serum immunoglobulin E and bilateral pleural effusions with bilateral upper lobe proximal bronchiectasis. Precipitating serum antibodies to A. fumigatus were positive and the A. fumigatus immediate skin test yielded a positive reaction. A diagnosis of ABPA associated with bilateral pleural effusions was made and the patient was commenced on prednisolone. At review, the patient\\'s symptoms had considerably improved and his pleural effusions had resolved. ABPA may present with diverse atypical syndromes, including paratracheal and hilar adenopathy, obstructive lung collapse, pneumothorax and bronchopleural fistula, and allergic sinusitis. Allergic bronchopulmonary aspergillosis is a rare cause of pleural effusion and must be considered in the differential diagnosis of patients presenting with a pleural effusion, in particular those with a history of asthma.

  3. Isavuconazole in the treatment of invasive aspergillosis and mucormycosis infections

    Directory of Open Access Journals (Sweden)

    Donnelley MA

    2016-06-01

    Full Text Available Monica A Donnelley,1,2 Elizabeth S Zhu,1 George R Thompson 3rd3 1Department of Inpatient Pharmacy, University of California – Davis, Sacramento, 2Department of Clinical Sciences, Touro University College of Pharmacy, Vallejo, 3Department of Medicine, Division of Infectious Diseases, University of California – Davis, Davis, CA, USAAbstract: We have a limited arsenal with which to treat invasive fungal infections caused by Aspergillus and Mucorales. The morbidity and mortality for both pathogens remains high. A triazole antifungal, isavuconazole, was recently granted approval by the US Food and Drug Administration and the European Medicines Agency for the treatment of invasive aspergillosis and mucormycosis. A randomized double-blind comparison trial for the treatment of invasive aspergillosis found isavuconazole noninferior to voriconazole. A separate, open-label study evaluating the efficacy of isavuconazole in the treatment of mucormycosis found comparable response rates to amphotericin B and posaconazole treated historical controls. The prodrug isavuconazonium sulfate is commercially available in both an oral and intravenous formulation and is generally well tolerated. Isavuconazole’s broad spectrum of activity, limited side effect profile, and favorable pharmacokinetics will likely solidify its place in therapy. Keywords: isavuconazonium, antifungal, zygomycosis, mucor, mould infection, pharmacokinetics, pharmacodynamics, clinical efficacy, therapy, new agent

  4. [Invasive aspergillosis on a surgical intensive care unit].

    Science.gov (United States)

    Kujath, P; Klempien, I; Muhl, E; Kämmerer, R

    2000-01-01

    From 1-1-1995 until 1-3-2000 4777 patients were treated in a surgical intensive care unit. 12 patients (10 male/2 female, mean age 58 years) suffered from invasive aspergillosis. One patient had a purulent descending mediastinitis with evidence of Aspergillus fumigatus in the mediastinum and in both pleural cavities. One patient got a right upper lobectomie in cause of an aspergilloma. In 10 patients a broncho-alveolar aspergillosis was proved by at least two cultures from broncho-alveolar lavage (BAL) and biopsies. All our patients had a mean of 12.8 risk factors for systemic mycoses. The patients suffered from following underlying diseases: 3 x carcinoma of the esophagus (chemotherapy + radiation), 2 x ulcerative colitis, 1 x rupture of the aorta with insufficiency of the liver, 1 x acute leucosis and 1 x purulent mediastinitis. The therapy was based on infusion with amphotericin B up to 1.5 mg/kg/day in combination with flucytosine or itraconazole. In 4 patients inhalation of amphotericin B aerosol was applied. After therapeutic failure of amphotericin B-therapy 3 patients got voriconazole according to a study protocol. 10 patients died, 7 of them from their underlying disease. PMID:11291572

  5. A neonatal case of chronic granulomatous disease, initially presented with invasive pulmonary aspergillosis.

    Science.gov (United States)

    Saito, Sachiko; Oda, Arata; Kasai, Masashi; Minami, Kisei; Nagumo, Haruo; Shiohara, Masaaki; Ogiso, Yoshifumi; Kawakami, Yoshiyuki

    2014-03-01

    Chronic granulomatous disease (CGD) often presents with infectious illness, such as repeating bacterial and fungal infections, due to the inability to generate superoxide, which would destroy certain infectious pathogens, and is usually diagnosed in childhood. We describe a CGD case diagnosed in neonatal period, who initially presented with invasive aspergillosis. Neonatal invasive pulmonary aspergillosis is very rare and, to the best of our knowledge, this might be the youngest case in Japan. PMID:24674387

  6. Invasive maxillary sinus aspergillosis: a case report successfully treated with voriconazole and surgical debridement

    OpenAIRE

    B. Peral Cagigal; L.M. Redondo González; Verrier Hernández, Alberto

    2014-01-01

    Introduction: Invasive aspergillosis of the paranasal sinuses is a rare disease and often misdiagnosed; however, its incidence has seen substancial growth over the past 2 decades. Definitive diagnosis of these lesions is based on histological examination and fungal culture. Case Report: An 81-year-old woman with a history of pain in the left maxillary region is presented. The diagnosis was invasive maxillary aspergillosis in immunocompetent patient, which was successfully treated with voricon...

  7. Invasive pulmonary aspergillosis in neutropenic patients during hospital construction: before and after chemoprophylaxis and institution of HEPA filters.

    Science.gov (United States)

    Oren, I; Haddad, N; Finkelstein, R; Rowe, J M

    2001-04-01

    Between September 1993 and December 1993, during extensive hospital construction and indoor renovation, a nosocomial outbreak of invasive pulmonary aspergillosis occurred in acute leukemia patients treated in a regular ward that has only natural ventilation. The observed infection rate was 50%. Chemoprophylaxis with intravenous continuous low-dose amphotericin B was then instituted as a preventive measure. During the next 18 months invasive pulmonary aspergillosis developed in 43% of acute leukemia patients. After that period a new hematology ward was opened with an air filtration system through high-efficiency particulate air filtration (HEPA) filters, and a bone marrow transplantation program was started on the hematology service. During the following three years, none of the acute leukemia or bone marrow transplantation patients who were hospitalized exclusively in the hematology ward developed invasive pulmonary aspergillosis, although 29% of acute leukemia patients who were housed in a regular ward, because of shortage of space in the new facility, still contracted invasive pulmonary aspergillosis. Overall, 31 patients were diagnosed with invasive pulmonary aspergillosis during almost five years: 74% of patients recovered from invasive pulmonary aspergillosis, and 42% are long-term survivors; 26% of patients died of resistant leukemia with aspergillosis, but no one died of invasive pulmonary aspergillosis alone. In conclusion, during an on-going construction period, an extremely high incidence rate of invasive pulmonary aspergillosis in acute leukemia patients undergoing intensive chemotherapy was observed. Institution of low-dose intravenous amphotericin B prophylaxis marginally reduced the incidence rate of invasive pulmonary aspergillosis. Keeping patients in a special ward with air filtration through a HEPA system eliminated invasive pulmonary aspergillosis completely. Among patients who developed invasive pulmonary aspergillosis, early diagnosis and

  8. Histone deacetylase inhibition as an alternative strategy against invasive aspergillosis

    Directory of Open Access Journals (Sweden)

    Frederic eLamoth

    2015-02-01

    Full Text Available Invasive aspergillosis (IA is a life-threatening infection due to Aspergillus fumigatus and other Aspergillus spp. Drugs targeting the fungal cell membrane (triazoles, amphotericin B or cell wall (echinocandins are currently the sole therapeutic options against IA. Their limited efficacy and the emergence of resistance warrant the identification of new antifungal targets. Histone deacetylases (HDACs are enzymes responsible of the deacetylation of lysine residues of core histones, thus controlling chromatin remodeling and transcriptional activation. HDACs also control the acetylation and activation status of multiple non-histone proteins, including the heat shock protein 90 (Hsp90, an essential molecular chaperone for fungal virulence and antifungal resistance. This review provides an overview of the different HDACs in Aspergillus spp. as well as their respective contribution to total HDAC activity, fungal growth, stress responses, and virulence. The potential of HDAC inhibitors, currently under development for cancer therapy, as novel alternative antifungal agents against IA is discussed.

  9. CT of invasive pulmonary aspergillosis in children with cancer

    International Nuclear Information System (INIS)

    In treating cases of malignancy, the use of chemotherapy carries a high risk of lower respiratory tract infections, especially fungal pneumonopathy. This complication is a major cause of mortality and is often difficult to diagnose because of non-specific clinical or radiological changes, but the early recognition of invasive fungal disease is imperative. CT is an important non-invasive method for the detection and evaluation of opportunistic fungal infections. In these patients am improved survival rate can be achieved when early detection by CT leads to the prompt institution of high-dose antifungal therapy. We illustrate the spectrum of CT findings of invasive pulmonary aspergillosis encountered in children with cancer. These patients had previously been treated with high-dose chemotherapy with or without bone marrow rescue, and underwent radiological examinations because of clinical evidence of pneumonopathy. Representative cases demonstrate the clinical applications of CT in the evaluation and management of invasive fungal disease. (orig.)

  10. Radiological and MRI characteristics of invasive pulmonary aspergillosis

    International Nuclear Information System (INIS)

    46 patients with invasive pulmonary aspergillosis (IPA) were investigated by chest radiographs (n=46), plain film tomograms (n=16), CT (n=8) and MRI (n=13). Radiologic characteristics of early IPA were nodular or patchy infiltrates in the upper lobes of all patients. Enlargement of the infiltrates and/or development of segmental/lobar consolidations were typical for fully developing IPA. Air crescent signs were seen in 40% of patients during or after bone marrow restitution. CT added additional information by visualisation of small pleural based infiltrates, demonstration of air crescents and identification of halo phenomena. MRI revealed the target character of nodular aspergillomas with hypointense centres and rims of higher signal intensity. A gadolinium-DTPA rim enhancement could be observed in almost all nodular lesions. Hyperintense areas in nodular and segmental infiltrates on T1-weighted images were interpreted as aging haemorrhage (methemoglobin) in aspergillus-induced haemorrhagic infarcts or in focal parenchymal bleeding. (orig.)

  11. CT of invasive pulmonary aspergillosis in children with cancer

    Energy Technology Data Exchange (ETDEWEB)

    Taccone, A. (Dept. of Radiology, Gaslini Children' s Hospital, Genoa (Italy)); Occhi, M. (Dept. of Radiology, Gaslini Children' s Hospital, Genoa (Italy)); Garaventa, A. (Div. of Hematology and Oncology, Gaslini Children' s Hospital, Genoa (Italy)); Manfredini, L. (Div. of Hematology and Oncology, Gaslini Children' s Hospital, Genoa (Italy)); Viscoli, C. (Dept. of Infectious Diseases, Gaslini Children' s Hospital, Genoa (Italy))

    1993-06-01

    In treating cases of malignancy, the use of chemotherapy carries a high risk of lower respiratory tract infections, especially fungal pneumonopathy. This complication is a major cause of mortality and is often difficult to diagnose because of non-specific clinical or radiological changes, but the early recognition of invasive fungal disease is imperative. CT is an important non-invasive method for the detection and evaluation of opportunistic fungal infections. In these patients am improved survival rate can be achieved when early detection by CT leads to the prompt institution of high-dose antifungal therapy. We illustrate the spectrum of CT findings of invasive pulmonary aspergillosis encountered in children with cancer. These patients had previously been treated with high-dose chemotherapy with or without bone marrow rescue, and underwent radiological examinations because of clinical evidence of pneumonopathy. Representative cases demonstrate the clinical applications of CT in the evaluation and management of invasive fungal disease. (orig.)

  12. Allergic bronchopulmonary aspergillosis treated successfully for one year with omalizumab

    Directory of Open Access Journals (Sweden)

    Collins J

    2012-11-01

    Full Text Available Jennifer Collins,1 Gabriele deVos,2 Golda Hudes,2 David Rosenstreich21New York Eye and Ear Infirmary, New York, NY, 2Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USABackground: Current therapy for allergic bronchopulmonary aspergillosis (ABPA uses oral corticosteroids, exposing patients to the adverse effects of these agents. There are reports of the steroid-sparing effect of anti-IgE therapy with omalizumab for ABPA in patients with cystic fibrosis (CF, but there is little information on its efficacy against ABPA in patients with bronchial asthma without CF.Objective: To examine the effects of omalizumab, measured by asthma control, blood eosinophilia, total serum immunoglobulin E (IgE, oral corticosteroid requirements, and forced expiratory volume spirometry in patients with ABPA and bronchial asthma.Methods: A retrospective review of charts from 2004–2006 of patients treated with omalizumab at an academic allergy and immunology practice in the Bronx, New York were examined for systemic steroid and rescue inhaler usage, serum immunoglobulin E levels, blood eosinophil counts, and asthma symptoms, as measured by the Asthma Control Test (ACT.Results: A total of 21 charts were screened for the diagnosis of ABPA and bronchial asthma. Four patients with ABPA were identified; two of these patients were male. The median monthly systemic corticosteroid use at 6 months and 12 months decreased from baseline usage. Total serum IgE decreased in all patients at 12 months of therapy. Pre-bronchodilator forced expiratory vital capacity at one second (FEV1 was variable at 1 year of treatment. There was an improvement in Asthma Control Test (ACT symptom scores for both daytime and nighttime symptoms.Conclusions: Treatment with omalizumab creates a steroid-sparing effect, reduces systemic inflammatory markers, and results in improvement in ACT scores in patients with ABPA.Keywords: allergic bronchopulmonary aspergillosis

  13. Hyperostosis of the maxillary sinus wall in aspergillosis: is it a characteristic finding

    International Nuclear Information System (INIS)

    To determine whether the wall thickening of the maxillary sinus is a characteristic finding in aspergillosis. In 103 patients, including 26 with aspergillosis, 21 with inverted papilloma (IP), and 56 with unilateral chronic sinusitis, the thickness of the maxillary sinus wall was determined by CT scanning. All cases were proven pathologically, and patients with a history of previous surgery of bone destruction were excluded. Two neuroradiologists retrospectively reviewed the CT scans using bone window settings for sinus wall hyperostosis and the presence of intrasinus calcification. Thickening of the maxillary sinus wall was assessed visually in a semiquantitative manner, and graded as 'none' (absence of thickening), 'mild' (thickening of up to 1.5 times), or moderate ot severe(over 1.5 times thicker than normal contralateral sinus wall at its thickest point). Moderate to severe wall thickening was found only in patients with aspergillosis (21/26, 80.8%). Mild wall thickening was seen in two patients with aspergillosis (2/26, 7.7%), in 12 of 21 with IP (57.1%), and in 5 of 56 with chronic maxillary sinusitis (8.9%). Most cases of chronic maxillary sinusits( 51/56,91.1%), 9/21 IP cases (42.9%), and 3/26 cases of aspergillosis (11.5%) showed no thickening of the maxillary sinus wall. Calcifications were found in 18 patients with aspergillosis (69.2%), in no patient with IP (0%), and in one with chronic maxillary sinusitis (1.8%). We suggest that 'moderate to severe' wall thickening of the maxillary sinus is the characteristic finding of aspergillosis. Although various sinonasal diseases can cause bone change, CT findings of hyperostosis of the maxillary sinus and intrasinus calcification are very helpful in differentiating fungal sinusitis from other types of chronic inflammatory lesions

  14. Hyperostosis of the maxillary sinus wall in aspergillosis: is it a characteristic finding

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Ji Young; Cho, Woo Ho; Kim, Joung Sook; Kim, Myung Gyu; Kim, Young Hoon; Woo, Hoon Young [College of Medicine, Inje Univ., Kimhae (Korea, Republic of)

    2002-03-01

    To determine whether the wall thickening of the maxillary sinus is a characteristic finding in aspergillosis. In 103 patients, including 26 with aspergillosis, 21 with inverted papilloma (IP), and 56 with unilateral chronic sinusitis, the thickness of the maxillary sinus wall was determined by CT scanning. All cases were proven pathologically, and patients with a history of previous surgery of bone destruction were excluded. Two neuroradiologists retrospectively reviewed the CT scans using bone window settings for sinus wall hyperostosis and the presence of intrasinus calcification. Thickening of the maxillary sinus wall was assessed visually in a semiquantitative manner, and graded as 'none' (absence of thickening), 'mild' (thickening of up to 1.5 times), or moderate ot severe(over 1.5 times thicker than normal contralateral sinus wall at its thickest point). Moderate to severe wall thickening was found only in patients with aspergillosis (21/26, 80.8%). Mild wall thickening was seen in two patients with aspergillosis (2/26, 7.7%), in 12 of 21 with IP (57.1%), and in 5 of 56 with chronic maxillary sinusitis (8.9%). Most cases of chronic maxillary sinusits( 51/56,91.1%), 9/21 IP cases (42.9%), and 3/26 cases of aspergillosis (11.5%) showed no thickening of the maxillary sinus wall. Calcifications were found in 18 patients with aspergillosis (69.2%), in no patient with IP (0%), and in one with chronic maxillary sinusitis (1.8%). We suggest that 'moderate to severe' wall thickening of the maxillary sinus is the characteristic finding of aspergillosis. Although various sinonasal diseases can cause bone change, CT findings of hyperostosis of the maxillary sinus and intrasinus calcification are very helpful in differentiating fungal sinusitis from other types of chronic inflammatory lesions.

  15. INCIDENCE DENSITY, PROPORTIONATE MORTALITY, AND RISK FACTORS OF ASPERGILLOSIS IN MAGELLANIC PENGUINS IN A REHABILITATION CENTER FROM BRAZIL.

    Science.gov (United States)

    Silva Filho, Rodolfo Pinho da; Xavier, Melissa Orzechowski; Martins, Aryse Moreira; Ruoppolo, Valéria; Mendoza-Sassi, Raúl Andrés; Adornes, Andréa Corrado; Cabana, Ângela Leitzke; Meireles, Mário Carlos Araújo

    2015-12-01

    Aspergillosis, an opportunistic mycosis caused by the Aspergillus genus, affects mainly the respiratory system and is considered one of the most significant causes of mortality in captive penguins. This study aimed to examine a 6-yr period of cases of aspergillosis in penguins at the Centro de Recuperação de Animais Marinhos (CRAM-FURG), Rio Grande, Brazil. A retrospective cohort study was conducted using the institution's records of penguins received from January 2004 to December 2009. Animals were categorized according to the outcome "aspergillosis," and analyzed by age group, sex, oil fouling, origin, prophylactic administration of itraconazole, period in captivity, body mass, hematocrit, and total plasma proteins. A total of 327 Magellanic penguins (Spheniscus magellanicus) was studied, 66 of which died of aspergillosis. Proportionate mortality by aspergillosis was 48.5%, and incidence density was 7.3 lethal aspergillosis cases per 100 penguins/mo. Approximately 75% of the aspergillosis cases occurred in penguins that had been transferred from other rehabilitation centers, and this was considered a significant risk factor for the disease. Significant differences were also observed between the groups in regard to the period of time spent in captivity until death, hematocrit and total plasma proteins upon admission to the center, and body mass gain during the period in captivity. The findings demonstrate the negative impacts of aspergillosis on the rehabilitation of Magellanic penguins, with a high incidence density and substantial mortality. PMID:26667521

  16. Economic considerations in the treatment of invasive aspergillosis: a review of voriconazole pharmacoeconomic studies

    Directory of Open Access Journals (Sweden)

    Kem P Krueger

    2009-08-01

    Full Text Available Kem P Krueger, A Christie NelsonSchool of Pharmacy, University of Wyoming, Laramie, WY, USAAbstract: Invasive aspergillosis is a life-threatening fungal infection predominately affecting immunocompromised individuals. The incidence of inpatient-treated aspergillosis cases in the US is estimated to be between 3.02 and 3.80 per 10,000 hospitalized patients. The estimated difference in hospital costs of patients with an aspergillosis infection is US$36,867 to US$59,356 higher than those of patients without the infection. Voriconazole is a synthetic, broad spectrum triazole antifungal agent, with FDA-approved indications for the treatment of invasive aspergillosis, esophageal candidiasis, candidemia in nonneutropenic patients, invasive candidiasis, and infections due to Scedosporium apiospermum and Fusarium species in patients refractory to or intolerant of other therapy. Eight cost-effectiveness analyses, one cost-minimization analysis, and one cost analysis were identified from a Medline search. The 10 pharmacoeconomic analyses were conducted in six different countries comparing voriconazole to conventional amphotericin B, liposomal amphotericin B, itraconazole, and caspofungin. All the cost-effectiveness and cost-minimization analyses identified voriconazole as the most cost-effective therapy. The cost analysis demonstrated voriconazole cost-savings. While the acquisition costs of voriconazole are higher than those of conventional amphotericin B, the toxicity profile and rate of treatment success associated with voriconazole result in lower total treatment costs per successfully treated patient.Keywords: voriconazole, antifungal agents, invasive aspergillosis, pharmacoeconomics 

  17. Invasive aspergillosis in a user of inhaled cocaine: rhinosinusitis with bone and cartilage destruction

    Directory of Open Access Journals (Sweden)

    Luna Azulay-Abulafia

    2014-07-01

    Full Text Available Aspergillosis is an infection caused by saprophytic fungi of the genus Aspergillus, which typically occurs in immunosuppressed individuals, but has also been reported in immunocompetent patients. The main routes of entry are the respiratory tract, skin, cornea, and ear, and the infection may be localized or disseminated by contiguity or vascular invasion. We report a severe case of rhinosinusitis with cutaneous involvement, caused by invasive aspergillosis, in an immunocompetent user of inhaled cocaine. Invasive aspergillosis related to cocaine abuse has not yet been reported in the literature. After itraconazole treatment and surgical debridement, complete clinical remission was achieved. Nasal reconstruction with a skin graft over a silicone prosthesis resulted in a satisfactory esthetic outcome.

  18. Invasive pulmonary aspergillosis 10 years post bone marrow transplantation: a case report

    Directory of Open Access Journals (Sweden)

    Rashid Rifat

    2009-01-01

    Full Text Available Abstract Introduction Invasive pulmonary aspergillosis is a leading cause of mortality and morbidity in bone marrow transplant recipients. Establishing the diagnosis remains a challenge for clinicians working in acute care setting. However, prompt diagnosis and treatment can lead to favourable outcomes Case presentation We report a case of invasive aspergillosis occurring in a 39-year-old Caucasian female 10 years after an allogeneic haematopoietic bone marrow transplant, and 5 years after stopping all immunosuppression. Possible risk factors include bronchiolitis obliterans and exposure to building dust (for example, handling her husband's dusty overalls. There are no similar case reports in the literature at this time. Conclusion High clinical suspicion, especially in the setting of failure to respond to broad-spectrum antibiotics, should alert clinicians to the possibility of invasive pulmonary aspergillosis, which, in this case, responded to antifungal therapy.

  19. Etiologic Agents and Diseases Found Associated with Clinical Aspergillosis in Falcons

    Directory of Open Access Journals (Sweden)

    Walter Tarello

    2011-01-01

    Full Text Available The aim of this study was to describe parasitological, microbiological, and pathological findings associated with the isolation of Aspergillus species in 94 clinically diseased captive falcons from Dubai. Concomitant agents and/or diseases were identified in 64 cases, causing either single (=36 or multiple coinfections (=28. Diagnoses found more often in association with aspergillosis were chronic fatigue and immune dysfunction syndrome (CFIDS (=29, Caryospora sp. (=16, Serratospiculum seurati infestation (=14, cestodiasis (=6, bumblefoot (=5, trematodosis due to Strigea falconispalumbi (=5, trichomoniasis (=4, Babesia shortti (=4, Mannheimia (Pastorella haemolytica (=4, interstitial hepatitis (=4, Escherichia coli (=3, and Clostridium perfringens enterotoxemia (=2. Compared with a control group of 2000 diseased falcons without evidence of aspergillosis, the prevalence of Babesia shortti, CFIDS, Mannheimia (Pastorella haemolytica, Escherichia coli, and falcon herpes virus infection was conspicuously higher in association with aspergillosis. These entities may be considered suitable candidates as predisposing factors for the mycosis.

  20. CLINICAL AND PATHOLOGICAL FINDINGS OF ASPERGILLOSIS IN MAGELLANIC PENGUINS (Spheniscus magellanicus

    Directory of Open Access Journals (Sweden)

    MELISSA ORZECHOWSKI XAVIER

    2011-09-01

    Full Text Available We studied a series of fifteen fatal cases of aspergillosis in penguins (Spheniscus magellanicus, seen over a 4-year period at a rehabilitation center in Southern Brazil. The clinical and pathological findings based on the lesions found at necropsy are described herein. The majority of animals (11/15 had sudden death without clinical signs. In 33.3% (5/15 of the cases, aspergillosis was restricted to the respiratory system and 66.6% showed disseminateddisease, with liver, kidney, adrenal gland and gastrointestinal tract involvement. Typical lesions were characterized as white-yellowish granulomatous nodules. To the best of our knowledge, this is the largest series of aspergillosis cases described in penguins in SouthAmerica.

  1. Pathophysiological Implication of Computed Tomography Images of Chronic Pulmonary Aspergillosis.

    Science.gov (United States)

    Ando, Tsunehiro; Tochigi, Naobumi; Gocho, Kyoko; Moriya, Atsuko; Ikushima, Soichiro; Kumasaka, Toshio; Takemura, Tamiko; Shibuya, Kazutoshi

    2016-03-23

    Chronic pulmonary aspergillosis (CPA) is a refractory disorder that needs long-term antifungal treatment and occasionally results in fatal respiratory failure and hemoptysis. However, the pathological features of the disorder have not been thoroughly delineated. Thirty cases were therefore analyzed clinically and histologically to elucidate the pathophysiology of CPA. The subjects comprised 14 individuals who underwent surgical removal and 16 patients who died. No subject exhibited a severely immunocompromised state. The main symptoms included cough, hemosputum, and dyspnea. Chest computed tomography (CT) findings revealed a cavity, fungus ball, and consolidation and/or ground glass opacity (GGO); 27 serial CT scans showed enlarged consolidation and/or GGO (70%), dilatation of the cavity (26%), and extension to the opposite lung (22%). Histopathological findings revealed a cavity with ulceration, bronchitis, and various degrees of organizing pneumonia (OP) that were correlated with the area of consolidation and GGO on the CT scan. The essential pathophysiology of CPA can be understood as an active state of ulceration of the cavity and/or erosive bronchitis caused by contact with the fungus ball, which may play a significant role in the development of OP. Consequently, OP is thought to reflect respiratory failure that relates to the prognosis of CPA. PMID:26166500

  2. Chest radiographic and computed tomographic manifestations in allergic bronchopulmonary aspergillosis

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    Ritesh Agarwal

    2012-01-01

    Full Text Available AIM: To investigate the chest radiographic and high resolution computed tomography (HRCT chest manifestations in glucocorticoid-naïve allergic bronchopulmonary aspergillosis (ABPA patients. METHODS: This is a prospective observational study and includes 60 consecutive glucocorticoid-naïve patients with ABPA who underwent chest radiography and HRCT of the chest (1.25 mm every 10 mm in the routine diagnostic workup for ABPA. RESULTS: Chest radiographs were normal in 50% of cases. Of the remainder, most patients demonstrated permanent findings in the form of parallel line and ring shadows suggesting bronchiectasis. Consolidation was detected in 17 cases but in the majority, the corresponding HRCT chest scan showed mucus-filled bronchiectatic cavities. Chest HRCT was normal in 22 patients, while central bronchiectasis (CB was demonstrated in the remaining 38 patients. Bronchiectasis extended to the periphery in 33%-43% depending on the criteria used for defining CB. The other findings observed on HRCT were mucoid impaction, centrilobular nodules and high-attenuation mucus in decreasing order of frequency. CONCLUSION: Patients with ABPA can present with normal HRCT chest scans. Central bronchiectasis cannot be considered a characteristic feature of ABPA as peripheral bronchiectasis is commonly observed. Consolidation is an uncommon finding in ABPA.

  3. Allergic bronchopulmonary aspergillosis: Lessons for the busy radiologist

    Directory of Open Access Journals (Sweden)

    Ritesh Agarwal

    2011-01-01

    Full Text Available The probability of a radiologist interpreting a disease correctly is not only influenced by their training and experience but also on the knowledge of a particular entity. This editorial reviews certain myths and realities associated with radiological manifestations of allergic bronchopulmonary aspergillosis (ABPA. ABPA is a hypersensitivity disorder against the antigens of Aspergillus fumigatus. Although commonly manifesting with central bronchiectasis (CB, the disorder can present without any abnormalities on high-resolution computed tomography (HRCT of the chest, so-called serologic ABPA (ABPA-S. HRCT of the chest should not be used in screening or in the initial diagnostic work up of asthmatics, as asthma without ABPA can manifest with findings of CB. High-attenuation mucus (HAM is the pathognomonic sign of ABPA and is very helpful in the diagnosis of ABPA complicating asthma and cystic fibrosis. Instead of classifying ABPA based on the presence and absence of CB into ABPA-CB and ABPA-S respectively, ABPA should be classified as ABPA-S, ABPA-CB and ABPA-CB-HAM. The classification scheme based on HAM not only identifies an immunologically severe disease but also predicts a patient with increased risk of recurrent relapses.

  4. Childhood allergic bronchopulmonary aspergillosis presenting as a middle lobe syndrome.

    Science.gov (United States)

    Shah, Ashok; Gera, Kamal; Panjabi, Chandramani

    2016-01-01

    Allergic bronchopulmonary aspergillosis (ABPA) is infrequently documented in children with asthma. Although collapse is not uncommon, middle lobe syndrome (MLS) as a presentation of ABPA is rather a rarity. A 9-year-old female child with asthma presented with increase in intensity of symptoms along with a right midzone patchy consolidation on a chest radiograph. In addition, an ill-defined opacity abutting the right cardiac border with loss of cardiac silhouette was noted. A right lateral view confirmed a MLS, which was further corroborated by high resolution computed tomography. Central bronchiectasis was also observed, which prompted a work-up for ABPA. The child met 7/8 major diagnostic criteria for ABPA. She was then initiated on oral prednisolone that resulted in a marked clinical improvement within a fortnight. Radiological clearance occurred at 3 months with inflation of the middle lobe. ABPA presenting with MLS in a child is yet to be reported. A high index of suspicion is required to establish the diagnosis of ABPA in a child presenting with MLS. This would obviate the invasive investigations usually done to ascertain the cause of MLS. PMID:26844222

  5. Allergic bronchopulmonary aspergillosis in patients with cystic fibrosis.

    Science.gov (United States)

    Mroueh, S; Spock, A

    1994-01-01

    In order to determine the incidence of allergic bronchopulmonary aspergillosis (ABPA) in patients with cystic fibrosis (CF), we reviewed the records of 236 patients followed up at the Duke CF Center. Sixty patients (25 percent) had colonies of Aspergillus fumigatus. These patients were older and had more severe disease as assessed by lower Shwachman-Kulczycki (S-K) scores than the patients who did not have evidence of A fumigatus. In 15 of the patients with A fumigatus (6.5 percent of the total population), the diagnosis was ABPA. Age and S-K scores were not significantly different from those of the patients with A fumigatus without ABPA. Diagnostic features of the affected patients included wheezing refractory to bronchodilator therapy, persistent pulmonary infiltrates, peripheral eosinophilia, positive skin reactivity to an A fumigatus antigen and elevated total serum IgE levels. Steroid therapy was started for all patients, and clinical improvement was noted within 1 month as evidenced by decreased symptoms and weight gain. Chest x-ray films usually showed improvement. Vital capacity improved in all but two patients. Total IgE did not consistently decrease in response to therapy. Although the diagnosis of ABPA may be difficult to establish, ABPA commonly is associated with CF. Most patients respond to steroid therapy; however, the effect of therapy on the course of the disease is difficult to assess. PMID:8275769

  6. Radiodense concretions in maxillary sinus aspergillosis: pathogenesis and the role of CT densitometry

    International Nuclear Information System (INIS)

    The purpose of this study was to investigate by CT the origin of radiodense maxillary sinus concretions and whether CT densitometry is effective in the prediction of maxillary sinus aspergillosis and in the differentiation of the origin of these concretions. In a prospective study in 21 patients with radiodense maxillary sinus concretions detected by radiography, a preoperative CT study of the paranasal sinuses and the concretions was undertaken. Additional scans of the upper alveolar ridge were also performed. Radiological findings were compared with clinical symptoms and with CT findings, especially CT densitometry of the sinus concretions and dental root-filling material. All patients underwent a functional Caldwell-Luc operation; histological and microbiological examinations were performed. Fifteen of the 21 patients (71.4%) with radiodense concretions had a histological and microbiological diagnosis of sinus aspergillosis. The sinus concretions had CT densities higher than 2000 HU (Housfield units) in 15 patients and lower than 2000 HU in 6. Fourteen of 15 patients (93.3%) with concretions ahving CT densities higher than 2000 HU had a postoperative diagnosis of maxillary sinus aspergillosis. The mean CT density of the sinus concretions in patients with maxillary sinus aspergillosis was 2868 HU (range 1870-3070 HU), and in patients without aspergiollosis was 778 HU (range 228-2644 HU). The mean CT density of the dental root-filling material was 2866 HU (range 2156-3070 HU). Paranasal sinus CT with CT densitometry of a sinus concretion has a higher accuracy than standard radiogrpahy and clinical findings in the prediction of maxillary sinus aspergillosis (93.3% vs 71.4%). CT densitometry helps to confirm the dental origin of maxillary sinus concretions and to explain a possible dental pathogenesis of maxillary sinus aspergillosis. (orig.)

  7. Excellent outcome of Aspergillous endophthalmitis in a case of allergic bronchopulmonary aspergillosis

    Directory of Open Access Journals (Sweden)

    Balbir Khan

    2014-01-01

    Full Text Available While invasive aspergillosis occurs typically in severely immunocompromised patients, cases of surgical site infections have been reported in immunocompetent individuals. The purpose is to report an eye with post-operative Aspergillus endophthalmitis, which achieved a good visual outcome following early and aggressive treatment. A young patient, known case of allergic bronchopulmonary aspergillosis presented to us with post-cataract surgery endophthalmitis. He was treated with pars plana vitrectomy and intravitreal voriconazole and systemic itraconazole. The patient regained a vision of 20/30 with follow up of 2 years.

  8. The efficacy and tolerability of voriconazole in the treatment of chronic cavitary pulmonary aspergillosis.

    OpenAIRE

    Jain L, Denning DW.

    2006-01-01

    Voriconazole is the second oral drug licensed for the treatment of aspergillosis.A retrospective non-comparative study was conducted in 16 patients with chronic cavitary pulmonary aspergillosis (CCPA) treated with voriconazole.All patients had failed or were intolerant of itraconazole.The duration of therapy varied from 3 days to 16.5 months.Eleven patients received at least 3 months of therapy with no significant adverse events.Overall seven (64%) patients had a response at 3 months as asses...

  9. Necrotizing pulmonary aspergillosis and ventricular assist device infection: case report and review of literature.

    Science.gov (United States)

    Kornberger, A; Walter, V; Jaeger, F; Lehnert, T; Soriano, M; Moritz, A; Stock, U A; Beiras-Fernandez, A

    2015-10-01

    Necrotizing pulmonary aspergillosis and Aspergillus device infection are rare and have potentially fatal complications after left ventricular assist device (LVAD) implantation. To date, few cases of patients surviving Aspergillus device infection have been published, with survival reported only after device removal. We present a patient implanted with an LVAD in whom necrotizing pulmonary aspergillosis with device involvement was successfully treated by segmentectomy and prolonged antifungal treatment without device exchange or removal. Similar cases in the literature were searched for and are discussed in view of the severity of this complication. PMID:26224318

  10. MR imaging of cerebral aspergillosis in an infant with normal-immunity : a case report

    International Nuclear Information System (INIS)

    Cerebral aspergillosis is a rare condition, and like other opportunistic fungal infections, it most commonly occurs in immunocompromised patients. Because of the increasing use of chemotherapy in organ transplantation, cases involving neoplasms, corticosteroid therapy, and cases of lymphoma and leukemia, the incidence of fungal infections in the brain has recently increased. Cerebral aspergillosis in an infant with normal immunity is a very rare condition, and has not been reported in Korea. We report the MR findings of this condition in an infant with normal immunity. (author)

  11. NADPH oxidase promotes neutrophil extracellular trap formation in pulmonary aspergillosis.

    Science.gov (United States)

    Röhm, Marc; Grimm, Melissa J; D'Auria, Anthony C; Almyroudis, Nikolaos G; Segal, Brahm H; Urban, Constantin F

    2014-05-01

    NADPH oxidase is a crucial enzyme in antimicrobial host defense and in regulating inflammation. Chronic granulomatous disease (CGD) is an inherited disorder of NADPH oxidase in which phagocytes are defective in generation of reactive oxidant intermediates. Aspergillus species are ubiquitous, filamentous fungi, which can cause invasive aspergillosis, a major cause of morbidity and mortality in CGD, reflecting the critical role for NADPH oxidase in antifungal host defense. Activation of NADPH oxidase in neutrophils can be coupled to the release of proteins and chromatin that comingle in neutrophil extracellular traps (NETs), which can augment extracellular antimicrobial host defense. NETosis can be driven by NADPH oxidase-dependent and -independent pathways. We therefore undertook an analysis of whether NADPH oxidase was required for NETosis in Aspergillus fumigatus pneumonia. Oropharyngeal instillation of live Aspergillus hyphae induced neutrophilic pneumonitis in both wild-type and NADPH oxidase-deficient (p47(phox-/-)) mice which had resolved in wild-type mice by day 5 but progressed in p47(phox-/-) mice. NETs, identified by immunostaining, were observed in lungs of wild-type mice but were absent in p47(phox-/-) mice. Using bona fide NETs and nuclear chromatin decondensation as an early NETosis marker, we found that NETosis required a functional NADPH oxidase in vivo and ex vivo. In addition, NADPH oxidase increased the proportion of apoptotic neutrophils. Together, our results show that NADPH oxidase is required for pulmonary clearance of Aspergillus hyphae and generation of NETs in vivo. We speculate that dual modulation of NETosis and apoptosis by NADPH oxidase enhances antifungal host defense and promotes resolution of inflammation upon infection clearance. PMID:24549323

  12. Discrimination between invasive pulmonary aspergillosis and pulmonary lymphoma using CT

    Energy Technology Data Exchange (ETDEWEB)

    Kawel, Nadine, E-mail: nadine.kawel@gmx.de [Department of Radiology, Kantonsspital Graubuenden, Loestr. 170, 7000 Chur (Switzerland); Department of Radiology, University Hospital Basel, Petersgraben 4, 4031 Basel (Switzerland); Schorer, Georg M., E-mail: gmschorer@hotmail.com [Institute of Diagnostic Radiology, University Hospital of Zurich, Raemistr. 100, 8091 Zurich (Switzerland); Stiftung Zuercher Blutspendedienst SRK, Ruetistrasse 19, 8952 Schlieren (Switzerland); Desbiolles, Lotus, E-mail: lotus.desbiolles@usz.ch [Institute of Diagnostic Radiology, University Hospital of Zurich, Raemistr. 100, 8091 Zurich (Switzerland); Seifert, Burkhardt, E-mail: seifert@ifspm.uzh.ch [Biostatistics Unit ISPM, University of Zurich, Hirschengraben 84, 8001 Zurich (Switzerland); Marincek, Borut, E-mail: borut.marincek@usz.ch [Institute of Diagnostic Radiology, University Hospital of Zurich, Raemistr. 100, 8091 Zurich (Switzerland); Boehm, Thomas, E-mail: thomas_boehm@gmx.net [Department of Radiology, Kantonsspital Graubuenden, Loestr. 170, 7000 Chur (Switzerland); Institute of Diagnostic Radiology, University Hospital of Zurich, Raemistr. 100, 8091 Zurich (Switzerland)

    2011-03-15

    Objective: The purpose was to assess the characteristic CT features of invasive pulmonary aspergillosis (IPA) and pulmonary lymphoma (PL) and to analyze the potential to distinguish the two entities using CT. Methods: The CT images of 70 patients with either proven IPA (n = 35) or PL (n = 35) were evaluated retrospectively and independently by two radiologists (reader 1 [R1] and reader 2 [R2]), analyzing images for presence, number and characteristics of pulmonary nodules and masses, ground-glass opacities, consolidations and other interstitial changes. Results: Interreader agreement was moderate (4/33 CT features), good (9/33) or excellent (20/33). Pulmonary nodules (P = 0.045 [R1], P = 0.001 [R2]), nodules with spiculated outer contours (P < 0.001 [R1], P = 0.001 [R2]), nodules with a halo sign (P < 0.001 [R1+R2]), nodules with homogeneous (P = 0.030 [R1], P = 0.006 [R2]) and inhomogeneous (P = 0.001 [R1], P < 0.001 [R2]) attenuation patterns, nodules with cavitation (P = 0.006 [R1], P = 0.003 [R2]) and wedge-shaped, pleural-based consolidations (P < 0.001 [R1 + R2]) occurred significantly more often in patients with IPA, while masses without a halo sign (P = 0.03 [R1], P = 0.01 [R2]), lobar consolidations with bronchogram (P = 0.02 [R1 + R2]) and consolidations with homogeneous attenuation patterns (P < 0.001 [R1 + R2]) were found significantly more frequent in PL-patients. Conclusions: Those CT features can therefore be considered suggestive for either IPA or PL. However, in most cases the diagnosis cannot be made based on CT findings solely because no single feature gained a high sensitivity and specificity concomitantly. Furthermore, the logistic regression did not show a combination that was significantly better than the best univariate predictor.

  13. The radiological spectrum of invasive aspergillosis in children: a 10-year review

    Energy Technology Data Exchange (ETDEWEB)

    Thomas, Karen E. [Department of Diagnostic Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London (United Kingdom); Department of Diagnostic Radiology, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8 (Canada); Owens, Catherine M. [Department of Diagnostic Radiology, Great Ormond Street Hospital for Children, Great Ormond Street, London (United Kingdom); Veys, Paul A.; Novelli, Vas; Costoli, Vera [Host Defence Unit, Great Ormond Street Hospital for Children, London (United Kingdom)

    2003-07-01

    Invasive aspergillosis is an uncommon but life-threatening event in the immunocompromised child. Attempts at fungal isolation are often unrewarding and a high index of radiological suspicion is essential in the early diagnosis of infected children. To document the radiological spectrum of disease in invasive aspergillosis in the paediatric population. A retrospective review of the imaging performed in 27 consecutive patients (age 7 months to 18 years) with documented invasive Aspergillosis encountered over a 10-year period at a single institution. Radiographic findings of pulmonary disease (20 patients) included segmental and multilobar consolidation, perihilar infiltrates, multiple small nodules, peripheral nodular masses and pleural effusions. No cavitating lesions were seen on CXR. Small cavitating nodules were present on CT in two of eight children. Chest wall disease was particularly associated with underlying chronic granulomatous disease. Disseminated disease manifested as osteomyelitis (n=5), cerebral (n=3), oesophageal (n=1), hepatic (n=2), renal (n=2) and cutaneous (n=5) involvement. Imaging findings are discussed. Twelve patients (44%) subsequently died from Aspergillus-related complications. Invasive aspergillosis presents with a wide variety of radiographic findings involving multiple organ systems. Respiratory findings are varied but often non-specific, and a high index of suspicion is necessary in immunocompromised patients. In contrast to adult disease, the incidence of cavitation of pulmonary lesions appears low. (orig.)

  14. The radiological spectrum of invasive aspergillosis in children: a 10-year review

    International Nuclear Information System (INIS)

    Invasive aspergillosis is an uncommon but life-threatening event in the immunocompromised child. Attempts at fungal isolation are often unrewarding and a high index of radiological suspicion is essential in the early diagnosis of infected children. To document the radiological spectrum of disease in invasive aspergillosis in the paediatric population. A retrospective review of the imaging performed in 27 consecutive patients (age 7 months to 18 years) with documented invasive Aspergillosis encountered over a 10-year period at a single institution. Radiographic findings of pulmonary disease (20 patients) included segmental and multilobar consolidation, perihilar infiltrates, multiple small nodules, peripheral nodular masses and pleural effusions. No cavitating lesions were seen on CXR. Small cavitating nodules were present on CT in two of eight children. Chest wall disease was particularly associated with underlying chronic granulomatous disease. Disseminated disease manifested as osteomyelitis (n=5), cerebral (n=3), oesophageal (n=1), hepatic (n=2), renal (n=2) and cutaneous (n=5) involvement. Imaging findings are discussed. Twelve patients (44%) subsequently died from Aspergillus-related complications. Invasive aspergillosis presents with a wide variety of radiographic findings involving multiple organ systems. Respiratory findings are varied but often non-specific, and a high index of suspicion is necessary in immunocompromised patients. In contrast to adult disease, the incidence of cavitation of pulmonary lesions appears low. (orig.)

  15. Hypophyseal fossa aspergillosis mimicking a pituitary macro adenoma with bleed: A case report

    International Nuclear Information System (INIS)

    Background: Aspergillus infection of the sinuses is a common condition in those predisposed due to immunosuppression. However, its intracranial extension is rare, with sellar extension being even rarer and therefore is difficult to diagnose on imaging. Case Report: A case of sellar and sinusal aspergillosis mimicking a pituitary macroadenoma with bleed is presented. The initial CT examination of head of a diabetic patient revealed a hyperdense lesion in the hypophyseal fossa and in the sphenoid sinus with extension into the right cavernous sinus, showing foci of calcification. The differential diagnosis included fungal disease or meningioma and MRI was advised. Unfortunately, the imaging was done after a five months delay when CT and MRI revealed interval growth of the lesion. Although, the MRI presentation was highly suggestive of pituitary macroadenoma with bleeding, the diagnosis of invasive aspergillosis was made when clinical data became available. The diagnosis of aspergillosis was proven by histology. Conclusions: The diagnosis of hypophyseal extension of aspergillosis is difficult, because of its rarity. It is important to consider possibility of fungal infection in those predisposed to it. The judgment based only on MRI findings and incomplete clinical data could easily lead into false diagnosis of an invasive pituitary macroadenoma with bleed. (authors)

  16. [Contribution of air mycological control for the prevention of invasive nosocomial aspergillosis].

    Science.gov (United States)

    Paugam, A; Renaud, B; Bousset, B; Salmon, D; Dupouy-Camet, J

    1997-05-01

    This study analyses the results of systematic air sampling during 11 months in hospital areas where patients are particularly exposed to Invasive Nosocomial Aspergillosis (INA). The results demonstrate that isolement of Aspergillus fumigatus is occasional and allows the control and validation of cleaning, disinfection and filtration measures. The efficiency of this protocol suggests its prophylactic value in INA. PMID:9296094

  17. Invasive aspergillosis: epidemiology and environmental study in haematology patients (Sfax, Tunisia).

    Science.gov (United States)

    Hadrich, I; Makni, F; Sellami, H; Cheikhrouhou, F; Sellami, A; Bouaziz, H; Hdiji, S; Elloumi, M; Ayadi, A

    2010-09-01

    Invasive aspergillosis (IA) is a major opportunistic infection in haematology patients. Preventive measures are important to control IA because diagnosis is difficult and the outcome of treatment is poor. We prospectively examined the environmental contamination by Aspergillus and other fungal species and evaluated the prevalence of invasive aspergillosis in the protect unit of haematology. A three-year prospective study (December 2004-September 2007) was carried out in the department of haematology of Hedi Chaker Hospital. Suspected invasive aspergillosis cases were reviewed and classified as proven, probable and possible invasive aspergillosis using the EORTC criteria. During the study period, we collected weekly environmental samples (patient's rooms, tables and acclimatisers) and clinical samples from each patient (nasal, expectoration and auricular). Among 105 neutropenic patients, 16 had probable and 13 had possible IA. A total of 1680 clinical samples were collected and A. flavus was most frequently isolated (79.2%). Analysis of 690 environmental samples revealed that Penicillium (44%) was the most frequent followed by Cladosporium (20%), Aspergillus spp. (18%) and Alternaria (13%). The PCR-sequencing of 30 A. flavus isolates detected from clinical and environmental samples confirmed the mycological identification. Our findings underline the importance of environmental surveillance and strict application of preventive measures. PMID:19500260

  18. CNS aspergillosis in a patient with Crohn’s disease on immunosuppressants: a case report

    OpenAIRE

    Shah, Shreyansh; Shirani, Peyman; Schmolck, Heike; Young, William C.; Schulz, Paul E.

    2009-01-01

    Fungal infections of the central nervous system are an uncommon cause of rapid decline in consciousness. We describe the case of central nervous system aspergillosis in a patient on immunosupressants whose clinical course highlights the need for an aggressive approach to diagnosis.

  19. Early serum galactomannan trend as a predictor of outcome of invasive aspergillosis

    NARCIS (Netherlands)

    L.Y.A. Chai (Louis); B.J. Kullberg (Bart Jan); E.M. Johnson (Elizabeth); S. Teerenstra (Steven); L.W. Khin (Lay Wai); A.G. Vonk (Alieke); J. Maertens (Johan); O. Lortholary (Olivier); P.J. Donnelly (Peter); H.T. Schlamm (Haran); P.F. Troke (Peter); M.G. Netea (Mihai); R. Herbrecht (Raoul)

    2012-01-01

    textabstractThe monitoring and prediction of treatment responses to invasive aspergillosis (IA) are difficult. We determined whether serum galactomannan index (GMI) trends early in the course of disease may be useful in predicting eventual clinical outcomes. For the subjects recruited into the multi

  20. Diagnostic and Therapeutic Challenges in a Liver Transplant Recipient with Central Nervous System Invasive Aspergillosis

    OpenAIRE

    Dionissios, Neofytos; Shmuel, Shoham; Kerry, Dierberg; Katharine, Le; Simon, Dufresne; Sean, Zhang X; Kieren, Marr A

    2012-01-01

    This is a case report of central nervous system (CNS) invasive aspergillosis (IA) in a liver transplant recipient, which illustrates the utility of enzyme-based diagnostic tools for the timely and accurate diagnosis of IA, the treatment challenges and poor outcomes associated with CNS IA in liver transplant recipients.

  1. Liposomal nystatin in patients with invasive aspergillosis refractory to or intolerant of amphotericin B.

    NARCIS (Netherlands)

    Offner, F.; Krcmery, V.; Boogaerts, M.; Doyen, C.; Engelhard, D.; Ribaud, P.; Cordonnier, C.; Pauw, B.E. de; Durrant, S.; Marie, J.P.; Moreau, P.; Guiot, H.F.L.; Samonis, G.; Sylvester, R.J.; Herbrecht, R.

    2004-01-01

    We assessed the activity and safety of liposomal nystatin, a broad-spectrum antifungal agent, for invasive aspergillosis in patients refractory to or intolerant of amphotericin B. Thirty-three patients were enrolled, received at least one dose of the study drug, and were evaluable for safety. Twenty

  2. Secretion of a fungal protease represents a complement evasion mechanism in cerebral aspergillosis.

    Science.gov (United States)

    Rambach, Günter; Dum, David; Mohsenipour, Iradj; Hagleitner, Magdalena; Würzner, Reinhard; Lass-Flörl, Cornelia; Speth, Cornelia

    2010-04-01

    Complement represents a central immune weapon in the brain, but the high lethality of cerebral aspergillosis indicates a low efficacy of the antifungal complement attack. Studies with cerebrospinal fluid (CSF) samples derived from a patient with cerebral aspergillosis showed a degradation of complement proteins, implying that Aspergillus might produce proteases to evade their antimicrobial potency. Further investigations of this hypothesis showed that Aspergillus, when cultured in CSF to simulate growth conditions in the brain, secreted a protease that can cleave various complement proteins. Aspergillus fumigatus, the most frequent cause of cerebral aspergillosis, destroyed complement activity more efficiently than other Aspergillus species. The degradation of complement in CSF resulted in a drastic reduction of the capacity to opsonize fungal hyphae. Furthermore, the Aspergillus-derived protease could diminish the amount of complement receptor CR3, a surface molecule to mediate eradication of opsonized pathogens, on granulocytes and microglia. The lack of these prerequisites caused a significant decrease in phagocytosis of primary microglia. Additional studies implied that the complement-degrading activity shares many characteristics with the previously described alkaline protease Alp1. To improve the current therapy for cerebral aspergillosis, we tried to regain the antifungal effects of complement by repressing the secretion of this degrading activity. Supplementation of CSF with nitrogen sources rescued the complement proteins and abolished any cleavage. Glutamine or arginine are of special interest for this purpose since they represent endogenous substances in the CNS and might be included in a future supportive therapy to reduce the high lethality of cerebral aspergillosis. PMID:20303595

  3. Investigation of dissemination of aspergillosis in poultry and possible control measures

    Directory of Open Access Journals (Sweden)

    Kapetanov Miloš C.

    2011-01-01

    Full Text Available Fungi belonging to genus Aspegillus are ubiquitous saprophytic microorganisms which are, in certain circumstances, responsible for clinical infections of respiratory tract in all poultry, particularly in young birds. In case of a lung form, Aspergillus fumigatus, A. niger and A. glaucus are the most frequently isolated fungi. In general, poultry is constantly exposed to these fungi in its environment. Predisposing factors, such as long exposition and highly contaminated environment and litter, high humidity in poultry houses, poor ventilation, malnutrition and stress, all contribute to clinical aspergillosis. Some geographic and seasonal regularities are observed in relation to the distribution of disease outbreaks. In this sense, cases of aspergillosis in our country were more frequently noted in wild areas located northern from the rivers Sava and Danube. Influence of some factors on the outbreak and spreading, as well as predominant clinical features of aspergillosis in poultry were investigated in this paper. Possible prophylactic and intervention measures were discussed. The occurrence of Aspergillus sp. in poultry was analyzed according to the clinical and laboratory investigations performed during the two selected years, 2000 and 2010. Widespread aspergillosis was noted in poultry flocks of different age, both in young and adult birds. During the years 2000 and 2010, acute aspergillosis was found in 12 and 16 commercial flocks of chickens and turkeys, respectively. Ocular infection with Aspergillus was determined in 10 day old broilers from two flocks. Aspergillus sp. was isolated from unhatched eggs (6.86%, litter (23.07%, environmental (36.17% and hatchery swabs (3.85%. Besides the appropriate antifungal therapy, enforcement of proper sanitary-hygiene measures on poultry farms and hatcheries, as well as microbiological control of feed are considered essential for an efficient control of infection and its spreading.

  4. Radiological and clinical findings of pulmonary aspergillosis following solid organ transplant

    Energy Technology Data Exchange (ETDEWEB)

    Park, Y.S. [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center (Korea, Republic of); Seo, J.B. [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center (Korea, Republic of)], E-mail: seojb@amc.seoul.kr; Lee, Y.K. [Department of Radiology, Bundang CHA Hospital, University of Pocheon Jungmoon College of Medicine (Korea, Republic of); Do, K.H.; Lee, J.S.; Song, J.-W.; Song, K.S. [Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center (Korea, Republic of)

    2008-06-15

    Aim: To evaluate the radiological and clinical findings in patients with pulmonary aspergillosis after solid organ transplantation. Materials and methods: This study included 13 consecutive patients (five liver, four kidney, and four heart transplant; 10 male and three female; median age 54 years; range 13-63 years) with histologically confirmed pulmonary aspergillosis after solid organ transplantation at a tertiary referral hospital. Chest radiographs and computed tomography (CT) examinations performed for diagnosis were available in all patients. Radiological findings, such as lesion characteristics, location, and associated findings, were assessed retrospectively by two radiologists. The changes in radiological findings and clinical response after treatment were also assessed. Clinical findings, such as time of onset, initial symptoms, clinical course, and laboratory findings, were reviewed. Results: The most common radiographic and CT findings were pulmonary nodules or masses (n = 12). The number of nodules or masses was less than 10 in eight patients. Associated findings were surrounding ground-glass opacity (n = 4), central low density (n = 8), central air cavity (n = 5), and air bronchogram (n = 3). Follow-up radiographs and/or CT after treatment showed improvement in eight patients, persistence in two, and deterioration in three. The onset time of pulmonary aspergillosis was a median of 32 days (range 15-165 days). The most common symptom at diagnosis was fever (n = 6). Ten of 13 patients did not have leucopaenia. There were two aspergillosis-associated deaths during the follow-up period. Conclusion: The most common radiological finding of pulmonary aspergillosis after solid organ transplantation is multiple nodules or masses, which commonly appear within 1 month following transplantation.

  5. Semi-invasive aspergillosis in an immunocompetent patient with Swyer-James-MacLeod Syndrome: a case report

    OpenAIRE

    Semedo Júlio ANMQ; Bugalho António A; Costa Carla A; Salgado Sara MST; Ribeiro José C; Carreiro Luís M

    2010-01-01

    Abstract Introduction Invasive and semi-invasive pulmonary aspergillosis usually occurs in immunocompromised patients. It has been described occasionally in patients with normal immunity and previous lung disease such as chronic obstructive pulmonary disease. Swyer-James-MacLeod Syndrome is a rare condition characterized by hyperlucency of one lung, lobe or part of a lobe due to decreased vascularity and air trapping. Case presentation We report a case of semi-invasive pulmonary aspergillosis...

  6. Putative invasive pulmonary aspergillosis in critically ill patients with chronic obstructive pulmonary disease: a matched cohort study

    OpenAIRE

    Delsuc, Claire; Cottereau, Aurélie; Frealle, Emilie; Bienvenu, Anne-Lise; Dessein, Rodrigue; Jarraud, Sophie; Dumitrescu, Oana; Le Maréchal, Marion; Wallet, Florent; Friggeri, Arnaud; Argaud, Laurent; Rimmelé, Thomas; Nseir, Saad; Ader, Florence

    2015-01-01

    Introduction Patients with advanced chronic obstructive pulmonary disease (COPD) are at risk for developing invasive pulmonary aspergillosis. A clinical algorithm has been validated to discriminate colonization from putative invasive pulmonary aspergillosis (PIPA) in Aspergillus-positive respiratory tract cultures of critically ill patients. We focused on critically ill patients with COPD who met the criteria for PIPA. Methods This matched cohort study included critically ill patients with CO...

  7. Bronchial stump aspergillosis after lobectomy for lung cancer as an unusual cause of false positive fluorodeoxyglucose positron emission tomography and computed tomography: a case report

    OpenAIRE

    Font Albert; Sanz-Santos Jose; Rosiñol Òria; Andreo Felipe; Garcia-Olivé Ignasi; Monsó Eduard

    2011-01-01

    Abstract Introduction Bronchial stump aspergillosis is a rare entity characterized by cough and hemoptysis. Case presentation We report the case of a 58-year-old Caucasian woman who developed bronchial stump aspergillosis two years after a left upper lobe resection for lung cancer. Bronchial stump aspergillosis was diagnosed as a result of a focus of increased fluorodeoxyglucose activity in a follow-up positron emission tomography and computed tomography scan. She was treated with oral antifu...

  8. Refractory invasive aspergillosis controlled with posaconazole and pulmonary surgery in a patient with chronic granulomatous disease: case report.

    Science.gov (United States)

    Kepenekli, Eda; Soysal, Ahmet; Kuzdan, Canan; Ermerak, Nezih Onur; Yüksel, Mustafa; Bakır, Mustafa

    2014-01-01

    Invasive aspergillosis is an important cause of morbidity and mortality in immunocompromised patients. Among primary immunodefiencies, chronic granulomatous disease (CGD) has the highest prevalence of invasive fungal diseases. Voriconazole is recommended for the primary treatment of invasive aspergillosis in most patients. In patients whose aspergillosis is refractory to voriconazole, therapeutic options include changing class of antifungal, for example using an amphotericin B formulation, an echinocandin, combination therapy, or further use of azoles. Posaconazole is a triazole derivative which is effective in Aspergillosis prophylaxis and treatment. Rarely, surgical therapy may be needed in some patients. Lesions those are contiguous with the great vessels or the pericardium, single cavitary lesion that cause hemoptysis, lesions invading the chest wall, aspergillosis that involves the skin and the bone are the indications for surgical therapy.Chronic granulomatous disease (CGD) is an inherited immundeficiency caused by defects in the phagocyte nicotinamide adenine dinucleotidephosphate (NADPH) oxidase complex which is mainstay of killing microorganisms. CGD is characterized by recurrent life-threatening bacterial and fungal infections and by abnormally exuberant inflammatory responses leading to granuloma formation, such as granulomatous enteritis, genitourinary obstruction, and wound dehiscence. The diagnosis is made by neutrophil function testing and the genotyping.Herein, we present a case with CGD who had invasive pulmonary aspergillosis refractory to voriconazole and liposomal amphotericine B combination therapy that was controlled with posaconazole treatment and pulmonary surgery. PMID:24401677

  9. Invasive aspergillosis osteomyelitis in children - a case report and review of the literature

    International Nuclear Information System (INIS)

    Immunocompromised patients are at high risk of secondary infection associated with high morbidity. In children these complications include fungal osteomyelitis due to continuous infiltration or hematogenous spread. The case of a 4-year-old boy is presented who developed lumbalgia and thigh pain during ongoing chemotherapy for acute lymphatic leukemia. MRI revealed infarct-like lesions in the femur and L5 vertebra, which were biopsied. The histologic diagnosis was consistent with angioinvasive aspergillosis. A multifocal osseous presentation has rarely been described in children and an overview of the literature is presented. Invasive aspergillosis is a rare complication to be considered in children with MRI-detected bony lesions of infarct-like appearance. (orig.)

  10. Human Immunodeficiency Virus and Allergic Bronchopulmonary Aspergillosis: Case Report and Review of Literature

    Science.gov (United States)

    Galiatsatos, Panagis; Melia, Michael T.; Silhan, Leann L.

    2016-01-01

    Allergic bronchopulmonary aspergillosis (ABPA) results from a hypersensitivity response to airways colonization with Aspergillus fumigatus, and it occurs most often in individuals with asthma or cystic fibrosis. Allergic bronchopulmonary aspergillosis is an indolent, but potentially progressive, disease in patients. In patients infected with human immunodeficiency virus (HIV), ABPA is rare, and its description in the literature is limited to case reports. We describe the occurrence of ABPA in a 37-year-old woman with well controlled HIV infection. This represents the first documented case of ABPA in an HIV-infected patient whose only pulmonary comorbidity included the ramifications of prior acute respiratory distress syndrome due to Pneumocystis jirovecii pneumonia. We also review prior case reports of ABPA in HIV-infected patients and consider risk factors for its development.

  11. Aspergillosis of bilateral breast and chest wall in an immunocompetent male masquerading as breast cancer

    Directory of Open Access Journals (Sweden)

    Jitendra G Nasit

    2013-01-01

    Full Text Available Fungal species are not frequently encountered in an immunocompetent host. Invasive aspergillosis typically occurs in severely immunocompromised patient. Aspergillus infection of breast and chest wall are rarely encountered in an immunocompetent as well as in immunocompromised host. Till date only 13 cases of fungal infection of breast and chest wall have been reported in the literature. This report presents a case of aspergillosis of bilateral breast and chest wall in an immunocompetent male, clinically mimicking breast cancer. Diagnosis was achieved by fine-needle aspiration cytology and subsequently Aspergillus flavus was identified on fungal culture. The patient was successfully treated with voriconazole. Prompt diagnosis by cytology and appropriate treatment is necessary to prevent adverse outcome. Here, we present this rare case of fungal infection of breast and chest wall with relevant review of the literature.

  12. Invasive aspergillosis osteomyelitis in children - a case report and review of the literature

    Energy Technology Data Exchange (ETDEWEB)

    Winterstein, Anton R.; Bohndorf, Klaus; Vollert, Kurt [Klinikum Augsburg, Department of Radiology, Augsburg (Germany); Wagner, Theodor [Klinikum Augsburg, Department of Pathology, Augsburg (Germany); Gnekow, Astrid [Klinikum Augsburg, Department of Pediatrics, Augsburg (Germany); Roemer, Frank W. [Klinikum Augsburg, Department of Radiology, Augsburg (Germany); Boston University School of Medicine, Department of Radiology, Boston, MA (United States)

    2010-08-15

    Immunocompromised patients are at high risk of secondary infection associated with high morbidity. In children these complications include fungal osteomyelitis due to continuous infiltration or hematogenous spread. The case of a 4-year-old boy is presented who developed lumbalgia and thigh pain during ongoing chemotherapy for acute lymphatic leukemia. MRI revealed infarct-like lesions in the femur and L5 vertebra, which were biopsied. The histologic diagnosis was consistent with angioinvasive aspergillosis. A multifocal osseous presentation has rarely been described in children and an overview of the literature is presented. Invasive aspergillosis is a rare complication to be considered in children with MRI-detected bony lesions of infarct-like appearance. (orig.)

  13. Intravascular large B-cell lymphoma complicated by invasive pulmonary aspergillosis: a rare presentation

    Science.gov (United States)

    Mahasneh, Tamadur; Harrington, Zinta; Williamson, Jonathan; Alkhawaja, Darweesh; Duflou, Jo; Shin, Joo-Shik

    2014-01-01

    We describe a patient with persisting fevers, a progressive pulmonary infiltrate, and high levels of serum lactate dehydrogenase. No underlying cause for these changes was found prior to her death despite extensive investigations. Postmortem tissue revealed invasive pulmonary aspergillosis and subsequent brain examination revealed vascular changes in keeping with intravascular large B-cell lymphoma (IVLBCL). On review, subtle yet extensive lymphomatous infiltrates involved the vasculature of multiple other organs, including the lungs. Aspergillosis is a relatively rare presenting feature of lymphoproliferative disorders, and IVLBCL is a rare subtype of diffuse large B-cell non-Hodgkin's lymphoma with, to our knowledge, very few case reports to date. Lymphoma should be considered in patients presenting with pneumonitis with bilateral lung infiltrates on imaging, with a high serum level of lactate dehydrogenase. PMID:25473570

  14. Management of granulomatous cerebral aspergillosis in immunocompetent adult patients: a review.

    Science.gov (United States)

    Ellenbogen, Jonathan Richard; Waqar, Mueez; Cooke, Richard P D; Javadpour, Mohsen

    2016-06-01

    Cerebral aspergillosis, is an infrequent, opportunistic infection of the central nervous system that accounts for 5-10% of all intracranial fungal pathology. It is uncommon in immunocompetent patients and has a significant disease burden, with high morbidity and mortality, even with appropriate treatment. Basic principles of abscess management should be employed, including aspiration and targeted anti-fungal therapy for 12-18 months. However, reported outcomes with a purely minimally invasive approach are poor and there should be a low threshold for surgical excision, especially in resource poor settings and in patients with deteriorating neurology harbouring sizeable masses. Evidence favouring gross total excision over subtotal resection is lacking, however. It is notable that these recommendations are largely based on retrospective case series and isolated case reports. There is a need therefore for international collaboration to evaluate management strategies for immunocompetent patients with cerebral aspergillosis. PMID:26853515

  15. Restoration of NET formation by gene therapy in CGD controls aspergillosis

    OpenAIRE

    M. Bianchi; Hakkim, A; Brinkmann, V; Siler, U; Seger, R.A.; Zychlinsky, A; Reichenbach, J.

    2009-01-01

    Chronic granulomatous disease (CGD) patients have impaired nicotinamide adenine dinucleotide phosphate (NADPH) oxidase function, resulting in poor antimicrobial activity of neutrophils, including the inability to generate neutrophil extracellular traps (NETs). Invasive aspergillosis is the leading cause of death in patients with CGD; it is unclear how neutrophils control Aspergillus species in healthy persons. The aim of this study was to determine whether gene therapy restores NET formation ...

  16. Aspergillus fumigatus Antigen Detection in Sera from Patients at Risk for Invasive Aspergillosis

    OpenAIRE

    Chumpitazi, Bernabé F. F.; Pinel, Claudine; Lebeau, Bernadette; Ambroise-Thomas, Pierre; Grillot, Renee

    2000-01-01

    We have developed an inhibition enzyme immunoassay (inhibition-EIA) to monitor for the occurrence of invasive aspergillosis (IA) in sera from 45 immunocompromised (IC) patients. The test uses rabbit polyclonal antibodies and a mixture of components from Aspergillus fumigatus, containing three predominant antigens with molecular weights of 18,000, 33,000, and 56,000. Circulating antigens were found in five of seven proven cases of IA due to A. fumigatus. In two of the five positive cases, anti...

  17. Etiologic Agents and Diseases Found Associated with Clinical Aspergillosis in Falcons

    OpenAIRE

    Walter Tarello

    2011-01-01

    The aim of this study was to describe parasitological, microbiological, and pathological findings associated with the isolation of Aspergillus species in 94 clinically diseased captive falcons from Dubai. Concomitant agents and/or diseases were identified in 64 cases, causing either single ( = 3 6 ) or multiple coinfections ( = 2 8 ). Diagnoses found more often in association with aspergillosis were chronic fatigue and immune dysfunction syndrome (CFIDS) ( = 2 9 ), Caryospora sp. ( = ...

  18. Comparison of Nonculture Blood-Based Tests for Diagnosing Invasive Aspergillosis in an Animal Model

    OpenAIRE

    White, P. Lewis; Wiederhold, Nathan P.; Loeffler, Juergen; Najvar, Laura K.; Melchers, Willem; Herrera, Monica; Bretagne, Stephane; Wickes, Brian; Kirkpatrick, William R.; Barnes, Rosemary A.; Donnelly, J. Peter; Patterson, Thomas F.

    2016-01-01

    The European Aspergillus PCR Initiative (EAPCRI) has provided recommendations for the PCR testing of whole blood (WB) and serum/plasma. It is important to test these recommended protocols on nonsimulated “in vivo” specimens before full clinical evaluation. The testing of an animal model of invasive aspergillosis (IA) overcomes the low incidence of disease and provides experimental design and control that is not possible in the clinical setting. Inadequate performance of the recommended protoc...

  19. The Diagnosis of Invasive and Noninvasive Pulmonary Aspergillosis by Serum and Bronchoalveolar Lavage Fluid Galactomannan Assay

    Directory of Open Access Journals (Sweden)

    Shuzhen Zhang

    2015-01-01

    Full Text Available The incidence and mortality of invasive pulmonary aspergillosis (IPA are rising, particularly in critically ill patients and patients with severe chronic obstructive pulmonary disease (COPD. Noninvasive aspergillosis occurring in these patients requires special attention because of the possibility of developing subsequent IPA, given the poor health and worsened immune state of these patients. We compared the performance of the Platelia galactomannan (GM enzyme immunoassay in the bronchoalveolar lavage fluid (BALF and serum. The sensitivity, and specificity of BALF-GM were 85.4% and 62.4%, and those of serum-GM were 67.9% and 93.5% at the cutoff index of 0.5. As the cutoff index increased, the specificity of BALF-GM detection was increased with the detriment of sensitivity. The area under the ROC curves was 0.817 (95% CI: 0.718–0.916 for BALF-GM and 0.819 (95% CI: 0.712–0.926 for serum-GM. The optimal cutoff index was 1.19 for BALF-GM, and the sensitivity and specificity were 67.9% and 89.2%. The BALF-GM assay is more sensitive in detecting pulmonary aspergillosis than serum-GM assay and fungal cultures. However, BALF-GM assay has a high false-positive rate at the cutoff index of 0.5. Hence, the diagnostic cutoff index of the BALF-GM assay should be improved to avoid the overdiagnosis of pulmonary aspergillosis in clinic.

  20. Invasive orbital aspergillosis in an apparently immunocompetent host without evidence of sinusitis

    OpenAIRE

    Jennifer Primeggia; George Cyriac; Princy Kumar

    2012-01-01

    Invasive aspergillosis is uncommon in healthy individuals. We report a case of Aspergillus fumigatus orbital cellulitiswith intracranial extension in an apparently immunocompetent patient with a history of benign lymphoid hyperplasiaof the lacrimal gland. A 68 year-old man with no significant past medical history underwent orbitotomy and biopsy of alacrimal gland mass. Pathology showed benign lymphoid hyperplasia of the lacrimal gland and he completed radiationtherapy. Three months after orbi...

  1. Efficacy of the Investigational Echinocandin ASP9726 in a Guinea Pig Model of Invasive Pulmonary Aspergillosis

    OpenAIRE

    Wiederhold, Nathan P.; Najvar, Laura K.; Matsumoto, Satoru; Bocanegra, Rosie A.; Herrera, Monica L.; Wickes, Brian L.; Kirkpatrick, William R.; Patterson, Thomas F.

    2015-01-01

    ASP9726 is an investigational echinocandin with in vitro activity against Aspergillus species. We evaluated the pharmacokinetics and efficacy of this agent in an established guinea pig model of invasive pulmonary aspergillosis. ASP9726 plasma concentrations were measured in guinea pigs administered either a single dose or multiple doses of this agent at 2.5, 5, and 10 mg/kg of body weight/day by subcutaneous injection. Immunosuppressed guinea pigs were inoculated with A. fumigatus AF293, and ...

  2. Aspergillosis in a Patient Receiving Temozolomide for the Treatment of Glioblastoma

    OpenAIRE

    Munhoz, Rodrigo Ramella; Pereira Picarelli, Andrea Arvai; Troques Mitteldorf, Cristina Aparecida; Feher, Olavo

    2013-01-01

    Leukopenia and selective CD4+ lymphopenia represent major adverse events associated with the use of temozolomide (TMZ), an oral alkylating agent incorporated in the treatment of glioblastoma (GBM). The increased risk of opportunistic infections, including those caused by Pneumocystis jiroveci and cytomegalovirus, has been previously described in the literature. Here we report the case, the first to our knowledge, of a patient with pulmonary invasive aspergillosis immediately after the complet...

  3. Invasive orbital aspergillosis in an apparently immunocompetent host without evidence sinusitis

    OpenAIRE

    Primeggia, Jennifer; Cyriac, George; Kumar, Princy

    2012-01-01

    Jennifer Primeggia, George Cyriac, Princy Kumar Invasive aspergillosis is uncommon in healthy individuals. We report a case of Aspergillus fumigatus orbital cellulitis with intracranial extension in an apparently immunocompetent patient with a history of benign lymphoid hyperplasia of the lacrimal gland. A 68 year-old man with no signiicant past medical history underwent orbitotomy and biopsy of a lacrimal gland mass. Pathology showed benign lymphoid hyperplasia of ...

  4. Early diagnosis and treatment of invasive pulmonary aspergillosis in a patient with cystic fibrosis

    OpenAIRE

    Mosquera, Ricardo Alberto; Estrada, Lila; Clements, Roya Mohebpour; Jon, Cindy K

    2013-01-01

    Invasive pulmonary aspergillosis is a rare and fatal complication in patients with cystic fibrosis (CF) who lack concomitant risk factors. The few documented cases in children have all resulted in deaths during hospitalisation. We present the case of a 12-year-old boy with CF who was admitted for an exacerbation which was unresponsive to antibiotic therapy. The findings on imaging raised concerns about a possible fungal infection. As a result, voriconazole therapy was started prior to his res...

  5. Cryptogenic organizing pneumonia associated with invasive pulmonary aspergillosis: a case report and review of the literature

    OpenAIRE

    Xie, Shuanshuan; Shen, Changxing; Zhang, Yunfeng; Lu, Kun; Hu, Feng; Tan, Min; Lin, Haiyan; Xu, Lei; Yuan, Qing; Song, Xiaolian; WANG, CHANGHUI

    2014-01-01

    Background: Concomitant occurrence of invasive pulmonary aspergillosis (IPA) with cryptogenic organizing pneumonia (COP) is scarce. Here, we report a case where COP was a presenting feature in a patient with diagnosed IPA, and review additional 58 COP patients reported in the literature from 1988 through 2013. Case outline: The study was reviewed and approved by the Institutional Ethics Committee of Shanghai Tenth People’s Hospital of Tongji University and was conducted in compliance with the...

  6. Allergic bronchopulmonary aspergillosis complicating Swyer-James-Macleod's syndrome: case report and review of literature.

    Science.gov (United States)

    Sehgal, I S; Dhooria, S; Behera, D; Agarwal, R

    2016-05-01

    Allergic bronchopulmonary aspergillosis (ABPA) is a pulmonary disorder that results from immune responses mounted against antigens of Aspergillus fumigatus, resulting in non-specific respiratory symptoms and structural lung damage. Classically defined in individuals suffering from bronchial asthma and cystic fibrosis, ABPA has recently been described in other lung diseases including COPD, pulmonary tuberculosis, idiopathic bronchiectasis and others. Herein, we report the first case of ABPA complicating Swyer-James-Macleod's syndrome that was successfully treated with oral antifungal therapy. PMID:27152607

  7. Invasive aspergillosis causing small bowel infarction in a patient of carcinoma breast undergoing chemotherapy

    Directory of Open Access Journals (Sweden)

    Jain Vinod

    2006-01-01

    Full Text Available Abstract Background To report a 45 year old lady presenting with proximal jejunal gangrene due to invasive Aspergillosis. The patient was undergoing adjuvant chemotherapy for advance carcinoma of breast (Stage IV. Methods The patient was referred to our surgical emergency for acute abdominal symptoms for 6 hours. Histopathology revealed bowel wall necrosis and vascular invasion by Aspergillus Fumigatus. Postoperative recovery was uneventful and the patient received Amphotericin-B (1 mg/kg/day for invasive aspergillosis. Invasive pulmonary aspergillosis was confirmed by isolating Aspergillus Fumigatus from bronchoalveolar lavage and by a positive circulating galactomannan test (ELISA Assay. Results Detailed history revealed dry cough and two episodes of haemoptesis for 2 weeks. Haemogram and counts revealed anemia and neutropenia. Plain X – ray of the abdomen showed multiple air fluid levels and ultrasound of the abdomen revealed distended bowel loops. On exploration small bowel was found to be gangrenous. The patient was successfully managed by supportive treatment and conventional intravenous Amphotericin-B for 2 weeks. The lady was discharged one week after completion of antifungal therapy and one month later she underwent toilet mastectomy. The lady came to follow up for 1 year and she is currently under hormone therapy. Conclusion With the emergence of new and powerful immunosuppressive, anticancer drugs and potent antibiotics the survival of transplant and critically ill patients has remarkably increased but it has shown a significant rise in the incidence of invasive opportunistic fungal infections. We conclude hat the diagnosis of invasive gastrointestinal aspergillosis may be considered in a neutropenic patient with acute abdominal symptoms.

  8. Aspergillosis in Intensive Care Unit (ICU patients: epidemiology and economic outcomes

    Directory of Open Access Journals (Sweden)

    Baddley John W

    2013-01-01

    Full Text Available Abstract Background Few data are available regarding the epidemiology of invasive aspergillosis (IA in ICU patients. The aim of this study was to examine epidemiology and economic outcomes (length of stay, hospital costs among ICU patients with IA who lack traditional risk factors for IA, such as cancer, transplants, neutropenia or HIV infection. Methods Retrospective cohort study using Premier Inc. Perspective™ US administrative hospital database (2005–2008. Adults with ICU stays and aspergillosis (ICD-9 117.3 plus 484.6 who received initial antifungal therapy (AF in the ICU were included. Patients with traditional risk factors (cancer, transplant, neutropenia, HIV/AIDS were excluded. The relationship of antifungal therapy and co-morbidities to economic outcomes were examined using Generalized linear models. Results From 6,424 aspergillosis patients in the database, 412 (6.4% ICU patients with IA were identified. Mean age was 63.9 years and 53% were male. Frequent co-morbidities included steroid use (77%, acute respiratory failure (76% and acute renal failure (41%. In-hospital mortality was 46%. The most frequently used AF was voriconazole (71% received at least once. Mean length of stay (LOS was 26.9 days and mean total hospital cost was $76,235. Each 1 day lag before initiating AF therapy was associated with 1.28 days longer hospital stay and 3.5% increase in costs (p  Conclusions Invasive aspergillosis in ICU patients is associated with high mortality and hospital costs. Antifungal timing impacts economic outcomes. These findings underscore the importance of timely diagnosis, appropriate treatment, and consideration of Aspergillus as a potential etiology in ICU patients.

  9. Early molecular diagnosis of aspergillosis in a patient with acute myeloid leukaemia

    OpenAIRE

    Greco, R; Mancini, N.; Peccatori, J.; Cieri, N.; Vago, L.; F. Giglio; Morelli, M; Ghidoli, N; Carletti, S; Levati, G; Crucitti, L; E. Sala; Lupo Stanghellini, M T; Lorentino, F; Forcina, A

    2014-01-01

    Diagnosis of invasive fungal infection remains challenging. Here we report a case of early diagnosis of invasive aspergillosis in a neutropenic patient affected by acute myeloid leukaemia, achieved through the detection of Aspergillus fumigatus species-specific ribonucleic acid sequences by a sensitive multiplex real-time polymerase chain reaction-based molecular assay. Thanks to the early diagnosis, targeted therapy was promptly established and the severe fungal infection controlled, allowin...

  10. Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations in allergic bronchopulmonary aspergillosis.

    OpenAIRE

    Miller, P. W.; Hamosh, A.; Macek, M.; Greenberger, P. A.; MacLean, J; Walden, S M; Slavin, R G; Cutting, G R

    1996-01-01

    The etiology of allergic bronchopulmonary aspergillosis (ABPA) is not well understood. A clinical phenotype resembling the pulmonary disease seen in cystic fibrosis (CF) patients can occur in some individuals with ABPA. Reports of familial occurrence of ABPA and increased incidence in CF patients suggest a possible genetic basis for the disease. To test this possibility, the entire coding region of the cystic fibrosis transmembrane regulator (CFTR) gene was analyzed in 11 individuals who met ...

  11. Intravascular large B-cell lymphoma complicated by invasive pulmonary aspergillosis: a rare presentation

    OpenAIRE

    Mahasneh, Tamadur; Harrington, Zinta; Williamson, Jonathan; Alkhawaja, Darweesh; Duflou, Jo; Shin, Joo-Shik

    2014-01-01

    We describe a patient with persisting fevers, a progressive pulmonary infiltrate, and high levels of serum lactate dehydrogenase. No underlying cause for these changes was found prior to her death despite extensive investigations. Postmortem tissue revealed invasive pulmonary aspergillosis and subsequent brain examination revealed vascular changes in keeping with intravascular large B-cell lymphoma (IVLBCL). On review, subtle yet extensive lymphomatous infiltrates involved the vasculature of ...

  12. Invasive pulmonary aspergillosis complicating chronic obstructive pulmonary disease in an immunocompetent patient.

    Directory of Open Access Journals (Sweden)

    Ali Z

    2003-01-01

    Full Text Available Immunocompromised individuals are susceptible to pulmonary aspergillus infection, but invasive aspergillus infection is extremely rare in the presence of normal immunity. We report a case of invasive aspergillosis in an immunocompetent 63-year-old male with chronic obstructive pulmonary disease (COPD. Patients with COPD may be at risk for developing pulmonary aspergillus infection, which should be considered as a diagnostic possibility in patients with unresolving pulmonary infection.

  13. Invasive aspergillosis in the aortic arch with infectious Aspergillus lesions in pulmonary bullae

    Directory of Open Access Journals (Sweden)

    Isao Watanabe

    2015-03-01

    Full Text Available A patient with pulmonary bullae died of massive hemoptysis. At autopsy a hole was observed in the aortic wall. A microscopic examination indicated small Aspergillus lesions in pulmonary bullae and extensive necrotic lesions with Aspergillus hyphae in the media of the thoracic aorta. These findings led to a diagnosis of invasive aspergillosis in the aortic arch. This is a rare case in which Aspergillus invaded the aorta in a patient without hematologic neoplasms or neutropenia.

  14. Invasive pulmonary aspergillosis caused by Aspergillus versicolor in a patient on mechanical ventilation

    OpenAIRE

    MV Pravin Charles; M Ravishankar; Easow, Joshy M; Noyal Mariya Joseph

    2011-01-01

    Aspergillus spp. often colonise the respiratory tract of critically ill patients in intensive care units and subsequently cause invasive disease. The risk of developing invasive disease is more in immunocompromised patients. Here we report a case of fatal invasive pulmonary aspergillosis caused by Aspergillus versicolor in a post-operative patient on mechanical ventilation, who did not respond to intravenous itraconazole. We then discuss the challenges involved in the accurate diagnosis of th...

  15. Invasive Pulmonary Aspergillosis in the Intensive Care Unit: A Case Report

    OpenAIRE

    Mehmet Akif Yazar; Aytuna Kuzucuoğlu,; Mehmet Barış Açıkgöz

    2016-01-01

    SUMMARY Invasive pulmonary aspergillosis (IPA) is an infection rarely seen in intensive care units (ICU). We aimed to discuss the case of IPA found in a patient followed up in our ICU due to chronic obstructive pulmonary disease (COPD). A 58-year old patient diagnosed with COPD has been admitted to our ICU due to respiratory failure. There were not any other diseases except from COPD. In his radiological imaging there were diffuse bilateral infiltrates in the ...

  16. Pulmonary Aspergillosis in a Previously Healthy 13-Year-Old Boy

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    Jonathan H. Rayment

    2016-01-01

    Full Text Available Chronic granulomatous disease (CGD is a rare, polygenic primary immunodeficiency. In this case report, we describe a previously healthy 13-year-old boy who presented with multifocal pulmonary aspergillosis and was subsequently diagnosed with an autosomal recessive form of chronic granulomatous disease. CGD has a variable natural history and age of presentation and should be considered when investigating a patient with recurrent or severe infections with catalase-positive organisms.

  17. Rescue therapy using an endobronchial valve and digital air leak monitoring in Invasive Pulmonary Aspergillosis

    Directory of Open Access Journals (Sweden)

    Selina Tsim

    2015-01-01

    Full Text Available In this case report, we describe the utilisation of two recently developed technologies for the successful management of a persistent air leak (PAL in a critically ill patient in whom cardiothoracic surgical intervention was not possible. We report the case of a young leukaemic woman with a PAL complicating Invasive Pulmonary Aspergillosis (IPA, who was effectively managed using an Endobronchial Valve, supplemented by objective, digital air leak data provided by a Thopaz® device (Medela, Switzerland.

  18. Clinical risk factors and bronchoscopic features of invasive aspergillosis in Intensive Care Unit patients

    OpenAIRE

    ALIYALI, M.; HEDAYATI, M.T.; HABIBI, M.R.; KHODAVAISY, S.

    2013-01-01

    Summary Introduction. Invasive aspergillosis (IA) is an important cause of morbidity and mortality in immunocompromised patients. During recent years, a rising incidence of IA in Intensive Care Unit (ICU) patients has been reported. The patterns of IA related infection may differ according to the type of underlying disease. Unfortunately little is known about the characteristics of IA in ICU patients. In the present study we assessed IA related clinical and bronchoscopy findings in ICU patien...

  19. Aspergilose pulmonar necrotizante crônica Chronic necrotizing pulmonary aspergillosis

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    Eduardo Felipe Barbosa Silva

    2009-01-01

    Full Text Available A aspergilose pulmonar necrotizante crônica é uma das formas de aspergilose pulmonar usualmente encontrada em pacientes com imunossupressão leve. Apresentamos o caso de uma paciente com queixas de tosse produtiva crônica, febre e astenia. Havia utilizado corticóides. A TC do tórax evidenciava consolidação com cavitação de permeio no lobo superior direito. A fibrobroncoscopia demonstrou secreção purulenta em árvore traqueobrônquica e lesão vegetante endobrônquica. Biópsias desta lesão e biópsia transbrônquica foram compatíveis com aspergilose. Diante do quadro clínico, radiológico e histopatológico, o diagnóstico de aspergilose pulmonar necrotizante crônica foi realizado. Tratada com itraconazol, a paciente apresentou boa evolução clínico-radiológica.Chronic necrotizing pulmonary aspergillosis is one of the forms of pulmonary aspergillosis typically found in mildly immunocompromised patients. We report the case of a female patient with complaints of chronic productive cough, fever and asthenia. She reported previous corticosteroid use. A CT scan of the chest revealed consolidation with interposed cavitation in the right upper lobe. Fiberoptic bronchoscopy revealed purulent fluid within the tracheobronchial tree and an endobronchial exophytic lesion. The results of the biopsy of that lesion and the transbronchial biopsy were consistent with aspergillosis. Based on the clinical, radiological and histopathological findings, the patient was diagnosed with chronic necrotizing pulmonary aspergillosis. Treated with itraconazole, the patient presented a favorable clinical-radiological evolution.

  20. Performance of serum biomarkers for the early detection of invasive aspergillosis in febrile, neutropenic patients: a multi-state model.

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    Michaël Schwarzinger

    Full Text Available BACKGROUND: The performance of serum biomarkers for the early detection of invasive aspergillosis expectedly depends on the timing of test results relative to the empirical administration of antifungal therapy during neutropenia, although a dynamic evaluation framework is lacking. METHODS: We developed a multi-state model describing simultaneously the likelihood of empirical antifungal therapy and the risk of invasive aspergillosis during neutropenia. We evaluated whether the first positive test result with a biomarker is an independent predictor of invasive aspergillosis when both diagnostic information used to treat and risk factors of developing invasive aspergillosis are taken into account over time. We applied the multi-state model to a homogeneous cohort of 185 high-risk patients with acute myeloid leukemia. Patients were prospectively screened for galactomannan antigenemia twice a week for immediate treatment decision; 2,214 serum samples were collected on the same days and blindly assessed for (1->3- β-D-glucan antigenemia and a quantitative PCR assay targeting a mitochondrial locus. RESULTS: The usual evaluation framework of biomarker performance was unable to distinguish clinical benefits of β-glucan or PCR assays. The multi-state model evidenced that the risk of invasive aspergillosis is a complex time function of neutropenia duration and risk management. The quantitative PCR assay accelerated the early detection of invasive aspergillosis (P = .010, independently of other diagnostic information used to treat, while β-glucan assay did not (P = .53. CONCLUSIONS: The performance of serum biomarkers for the early detection of invasive aspergillosis is better apprehended by the evaluation of time-varying predictors in a multi-state model. Our results provide strong rationale for prospective studies testing a preemptive antifungal therapy, guided by clinical, radiological, and bi-weekly blood screening with galactomannan

  1. Etiologic agents and diseases found associated with clinical aspergillosis in falcons.

    Science.gov (United States)

    Tarello, Walter

    2011-01-01

    The aim of this study was to describe parasitological, microbiological, and pathological findings associated with the isolation of Aspergillus species in 94 clinically diseased captive falcons from Dubai. Concomitant agents and/or diseases were identified in 64 cases, causing either single (n = 36) or multiple coinfections (n = 28). Diagnoses found more often in association with aspergillosis were chronic fatigue and immune dysfunction syndrome (CFIDS) (n = 29), Caryospora sp. (n = 16), Serratospiculum seurati infestation (n = 14), cestodiasis (n = 6), bumblefoot (n = 5), trematodosis due to Strigea falconispalumbi (n = 5), trichomoniasis (n = 4), Babesia shortti (n = 4), Mannheimia (Pastorella) haemolytica (n = 4), interstitial hepatitis (n = 4), Escherichia coli (n = 3), and Clostridium perfringens enterotoxemia (n = 2). Compared with a control group of 2000 diseased falcons without evidence of aspergillosis, the prevalence of Babesia shortti, CFIDS, Mannheimia (Pastorella) haemolytica, Escherichia coli, and falcon herpes virus infection was conspicuously higher in association with aspergillosis. These entities may be considered suitable candidates as predisposing factors for the mycosis. PMID:21754937

  2. Erythropoietin combined with liposomal amphotericin b improves outcome during disseminated aspergillosis in mice

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    nathalie erousseau

    2014-10-01

    Full Text Available Disseminated aspergillosis is responsible for a high mortality rate despite the use of antifungal drugs. Adjuvant therapies are urgently needed to improve the outcome. The aim of this study was to demonstrate that the cytoprotective effect of erythropoietin combined to amphotericin b can reduce the mortality rate in a murine model of disseminated aspergillosis. After infection with Aspergillus fumigatus, neutropenic mice were randomized to receive vehicle or 7,5 mg/Kg of Liposomal Amphotericin B (LAmB or 7,5 mg/Kg of LAmB combined with 1000 IU/Kg of EPO (16 mice per group. Aspergillus galactomannan and organ cultures were performed to evaluate fungal burden at day 5. Cumulative long-term survival was analyzed at day 12 post-infection according to the Kaplan-Meier method. At day 5, fungal burden was similar between non-treated and treated groups. At day 12, mortality rates were 75 %, 62.5 % and 31 % in control group, LAmB group and EPO/LAmB group, respectively. We observed a significant decreased in mortality using EPO/LAmB combination compared to control group (p < 0.01. LAmB single treatment did not improve the survival rate compared to control group (p = 0.155.Our results provided the first evidence that erythropoietin improved the outcome of mice presenting disseminated aspergillosis when combined with amphotericin b.

  3. Invasive Aspergillosis in a Renal Transplant Recipient Successfully Treated with Interferon-Gamma

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    C. Estrada

    2012-01-01

    Full Text Available Invasive aspergillosis is a serious complication of solid organ transplantation. An early diagnosis is hampered by the lack of reliable serum markers and, even if appropriately diagnosed and treated with current antifungal agents, has a high mortality rate. We report a case of invasive pulmonary and cerebral aspergillosis in a renal transplant patient treated with IFN-γ in conjunction with combination anti-fungal therapy for six weeks in whom complete resolution of the fungal infection was achieved. Renal function remained intact throughout the treatment period. Surveillance CT scans of the chest and head showed resolution of prior disease but revealed a new left upper lobe mass four months after completion of treatment with IFN-γ. Biopsy of the lesion was positive for primary lung adenocarcinoma, for which she underwent left upper lobe resection. The pathology report confirmed clear surgical margins and lymph nodes and no evidence of fungal hyphae. IFN-γ should be considered early in the management of invasive aspergillosis in renal transplant patients. To date, allograft rejection has not been encountered.

  4. Cutaneous, respiratory and hepatic aspergillosis in Brazilian white Pekin mallards (Anas platyrhynchos).

    Science.gov (United States)

    Copetti, Marina Venturini; Barcelos, Aleverson da Silva; Kommers, Glaucia Denise; Santurio, Janio Morais; Oliveira, Fabiano Nunes; Lovato, Maristela

    2015-04-01

    Aspergillosis is one of the most frequent mycosis affecting avian species. Here is reported an outbreak of aspergillosis affecting 60-day-old white Pekin mallards (Anas platyrhynchos). About 10% of animals in a lot of 200 mallards from a commercial husbandry presented respiratory disorders and skin lesions at slaughter. Three out of 13 animals sent to diagnosis showed, simultaneously, airsacculitis, lung and liver presenting white nodules with variable diameters and elevated, yellowish brown, crusted, multifocal skin lesions located at the base of the feather follicles in the breast. Histopathological examination of lung and liver samples revealed nodules of different sizes with small areas of necrosis surrounded by intense granulomatous inflammation and the presence of fungal hyphae. The skin samples showed dermatitis surrounding a severe necrotizing folliculitis, associated with fungal hyphae. Mycological evaluation of tissues allowed the isolation of Aspergillus fumigatus from the skin samples and Aspergillus flavus from lungs and liver samples. The application of quicklime (CaO) in the litter as part of the disinfection procedures could have contributed to the development of skin lesion in the mallards, predisposing the fungal installation in the damaged site. The occurrence of cutaneous lesions associated with A. fumigatus is a rare manifestation of aspergillosis in birds, and this appears to be the first case reported in white Pekin mallards. PMID:25481845

  5. A new and clinically relevant murine model of solid-organ transplant aspergillosis

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    Susanne Herbst

    2013-05-01

    Invasive fungal infections (IFIs are a major cause of death in organ transplant patients. The murine hydrocortisone-mediated immunosuppression model of pulmonary aspergillosis is commonly used to characterise IFIs in these patients. However, this model does not take into account the effects of calcineurin inhibitors on transplant immunity to IFIs or the fungal calcineurin pathway, which is required for both virulence and antifungal drug resistance. To address these two issues, a new and clinically relevant transplant immunosuppression model of tacrolimus (FK506 and hydrocortisone-associated pulmonary aspergillosis was developed. We first characterised IFIs in 406 patients with a lung transplant. This showed that all of the patients with pulmonary aspergillosis were immunosuppressed with calcineurin inhibitors and steroids. Murine pharmacokinetic studies demonstrated that an ideal dose of 1 mg/kg/day of FK506 intraperitoneally produced blood trough levels in the human therapeutic range (5–12 ng/ml. There was increased mortality from pulmonary aspergillosis in a transplant-relevant immunosuppression model using both FK506 and hydrocortisone as compared with immunosuppression using hydrocortisone only. Lung histopathology showed neutrophil invasion and tracheobronchitis that was associated with reduced lung tumour necrosis factor-α (TNFα, JE (homologue of human MCP-1 and KC (homologue of human IL-8 at 24 hours, but increased lung TNFα, JE and KC at 48 hours when fungal burden was high. Furthermore, FK506 directly impaired fungal killing in alveolar macrophages in vitro, with FK506-mediated inhibition of the radial growth of Aspergillus fumigatus in vitro occurring at the low concentration of 5 ng/ml. Taken together, these findings show that the immunosuppressive activity of FK506 outweighs its antifungal activity in vivo. These observations demonstrate that FK506 impairs innate immune responses and leads to an incremental increase in susceptibility to IFIs when

  6. Galactomannan and Real-Time PCR in the diagnosis of invasive Aspergillosis: preliminary data

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    Cristina Pedrotti

    2014-03-01

    Full Text Available The diagnosis of invasive aspergillosis is notoriously difficult. The standard culture-based methods have shown considerable limitations in performance. For this reason, non-culture methods have been increasingly employed for the diagnosis of invasive aspergillosis, and, among them, the methods based on Real-Time polymerase chain reaction (RT-PCR. In this study we assess the contribution in lowering diagnosis errors provided by the RT-PCR method when run alongside other methods. We analyzed 23 biological samples, 14 serum samples, and 9 bronchoalveolar lavage samples (BAL from 10 immunocompromised patients who were selected according to EORTC/MSG criteria (European Organization for Research and Treatment of Cancer/Mycoses Study Group. On the serum sample we searched the galactomannan (GM (Platelia Aspergillus® and the fungal genome (MycAssayTMAspergillus; the BAL samples were subjected also to the culture tests. In 11 serum samples the results showed concordance between GM and RT–PCR tests, while in 3 samples we report discordance: 2 results were GM positive and RT-PCR negative, and 1 results GM negative and RT-PCR indeterminate. In 5 BAL samples the results showed concordance between the two methods, while 4 were GM positive and RT-PCR negative. The data, although still preliminary, suggest an increased accuracy in the diagnosis of suspected invasive aspergillosis when employing both RT-PCR and GM tests given that the RT-PCR test eliminates the false positive results of the GM test. The PCR methods require, however, further applications of this type of diagnostic because of the severe limit given by the lack of standardization.

  7. Chest radiographic staging in allergic bronchopulmonary aspergillosis: relationship with immunological findings.

    LENUS (Irish Health Repository)

    Kiely, J L

    2012-02-03

    The question of whether a chest radiographic severity staging system could be correlated with standard blood\\/serum diagnostic indices in allergic bronchopulmonary aspergillosis (ABPA) was addressed in 41 patients. Asthma and positive Aspergillus fumigatus (AF) serology were considered essential diagnostic inclusion criteria. Eosinophil count, serum immunoglobulin (Ig)E and immediate skin hypersensitivity were also tested to grade patients as "definite" or "likely" ABPA. Definite cases had all five of these factors present, whereas likely cases had three or more. Chest radiographs were examined by experienced radiologists blinded to the clinical data. The six-stage radiographic score (0-5) was based on the severity and duration of changes seen: stage 0: normal; stage 1: transient hyperinflation; stage 2: transient minor changes; stage 3: transient major changes; stage 4: permanent minor changes; and stage 5: permanent major changes. Significant positive correlations (p<0.05) were observed between peak AF titres (expressed as an index), peak eosinophil count and radiographic severity stage. When considered as subgroups, these correlations approached, but did not reach, significance for the group with "likely" ABPA (n=28), but in the group with definite ABPA (n=13), there was a high correlation between radiographic score and peak AF index (r=0.59), as well as peak eosinophil count (r=0.62). This study suggests that the peak Aspergillus fumigatus index and eosinophil counts correlate best with the severity of radiographic stages in allergic bronchopulmonary aspergillosis. This chest radiographic staging system may be useful in the clinical assessment and management of patients with allergic bronchopulmonary aspergillosis, particularly in those patients with more severe radiographic stages.

  8. Occlusion of the syrinx as a manifestation of aspergillosis in Canada geese

    Science.gov (United States)

    Stroud, R.K.; Duncan, R.M.

    1982-01-01

    Aspergillosis has been described in many species of wild waterfowl, primarily as a disease of the respiratory tract. Typically, mycotic granulomas are found in the lungs. Air sacs may be thickened and contain discoid individual or coalescing greenish or bluish plaques resembling bread mold. Occasionally, there is systemic involvement, with granulomas in multiple organs. Carcasses often are emaciated, indicating a long-term course. In the present report, we describe a fatal acute manifestation of Aspergillus fumigatus infection that easily may be overlooked when examining wild waterfowl.

  9. Management of nasal aspergillosis in a dog with a single, noninvasive intranasal infusion of clotrimazole

    International Nuclear Information System (INIS)

    An 11-year-old, spayed female keeshond was presented for unilateral epistaxis and serous nasal discharge of four weeks duration. Initial nasal radiographs, rhinoscopy, and histopathology suggested severe, destructive lymphoplasmacytic rhinitis. The patient deteriorated while receiving an anti-inflammatory dose of prednisone. A computed tomographic scan of the nose demonstrated a soft-tissue density in both the right nasal cavity and frontal sinus. Samples for histopathology obtained at surgery were diagnostic for nasal aspergillosis. All clinical signs resolved with a single, noninvasive infusion of intranasal clotrimazole and a four-week course of oral itraconazole

  10. Voriconazole in the treatment of allergic bronchopulmonary aspergillosis in cystic fibrosis.

    LENUS (Irish Health Repository)

    Glackin, L

    2009-01-01

    Allergic bronchopulmonary aspergillosis (ABPA) can cause a significant clinical deterioration in patients with cystic fibrosis. There is very little research in the current literature with regard to alternatives for treatment, apart from long courses of steroids. We conducted a retrospective review of all our patients with ABPA treated with the antifungal voriconazole and found there was a significant drop in IgE levels post treatment as well as a decrease in steroid dosing. The improvement in FEV was not statistically significant; however there was a very wide variation in pre-treatment levels.

  11. Primary cutaneous aspergillosis due to Aspergillus niger in an immunocompetent patient

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    Mohapatra S

    2009-01-01

    Full Text Available Primary cutaneous aspergillosis is a rare entity, usually caused by A. fumigatus and A. flavus . Here, we present such a case, manifested by ulceration due to A. niger, which remained undiagnosed for a prolonged period. The immunological status was intact, although the patient had associated severe fungal infection. Recurrence of the lesion occurred despite repeated anti-fungal therapies. Anti fungal testing was done based on the broth dilution (M-38A, NCCLS, USA method. The culture isolate was found to be sensitive to fluconazole and amphotericin B. Continuation of antifungal therapy improved the symptoms, reducing the size of the lesion.

  12. Progression of hepatic aspergillosis following second renal transplantation in a patient with recurrent glomerulonephritis

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    Krishan L Gupta

    2012-01-01

    Full Text Available Invasive aspergillosis is a serious complication in renal transplant recipients. Hepatic involvement, although seen in liver transplant recipients, has not been reported following renal transplantation. We describe here an interesting occurrence of hepatic Aspergillus infection in a renal transplant recipient. The infection responded to anti-fungal therapy, but there was re-activation following a second renal transplant. In addition, the patient had recurrence of the underlying membrano-proliferative glomerulonephritis following both transplants. The relevant existing literature relating to these problems has been reviewed.

  13. Eradication of Pulmonary Aspergillosis in an Adolescent Patient Undergoing Three Allogeneic Stem Cell Transplantations for Acute Lymphoblastic Leukemia

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    Michaela Döring

    2012-01-01

    Full Text Available Systemic fungal infections are a major cause of infection-related mortality in patients with hematologic malignancies. This report addresses the case of an adolescent patient with acute lymphoblastic leukemia who underwent three allogeneic hematopoietic stem cell transplantations and developed pulmonary aspergillosis. Combination therapy with liposomal amphotericin B (L-AmB, 3 mg/kg bw/day and caspofungin (CAS, 50 mg/day during the first allogeneic hematopoietic stem cell transplantation (HSCT improved the pulmonary situation. After shifting the antifungal combination therapy to oral voriconazole (2 × 200 mg/day and CAS, a new pulmonal lesion occurred alongside the improvements in the existing pulmonary aspergillosis. An antifungal combination during a second HSCT with L-AmB (3 mg/kg bw/day and CAS showed an improvement in the pulmonary aspergillosis. A combination therapy with CAS and L-AmB (1 mg/kg bw/day during the third HSCT led once again to progress the pulmonary aspergillosis, after increasing the L-AMB to 3 mg/kg bw/day for recovery. The presented case provides an example of how, despite severe immunosuppression, a combination of antifungal drugs administered intravenously at therapeutic dosages may be more efficient than either intravenous monotherapy or combinations of intravenous and oral antifungals in selecting pediatric and adolescent patients with proven fungal infections.

  14. Molecular identification of Emericella echinulata as a cause of Cerebral Aspergillosis in a patient following small bowel and liver transplantation

    Science.gov (United States)

    Molecular methods are now more commonly used for identification of the aspergilli and their teleomorphs and have led to reports of species not previously recognized as causing human disease. We report the first case of cerebral aspergillosis in a compromised patient caused by Emericella echinulata,...

  15. Progressive increase in cavitation with the evolution of fungus ball: A clue to the diagnosis of chronic necrotizing pulmonary aspergillosis

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    Prasad R

    2009-01-01

    Full Text Available Chronic necrotizing pulmonary aspergillosis (CNPA is an uncommon pulmonary infection seen in the patients with chronic obstructive pulmonary disease, bronchiectasis, pneumoconiosis, diabetes mellitus, alcoholism, poor nutrition or low dose corticosteroid therapy. Here, we are presenting a case of CNPA with diabetes mellitus that was misdiagnosed as pulmonary tuberculosis.

  16. Invasive orbital aspergillosis in an apparently immunocompetent host without evidence of sinusitis

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    Jennifer Primeggia

    2012-09-01

    Full Text Available Invasive aspergillosis is uncommon in healthy individuals. We report a case of Aspergillus fumigatus orbital cellulitiswith intracranial extension in an apparently immunocompetent patient with a history of benign lymphoid hyperplasiaof the lacrimal gland. A 68 year-old man with no significant past medical history underwent orbitotomy and biopsy of alacrimal gland mass. Pathology showed benign lymphoid hyperplasia of the lacrimal gland and he completed radiationtherapy. Three months after orbitotomy and one month after completion of radiation therapy, he presented with orbitalcellulitis. Brain magnetic resonance imaging demonstrated invasion into the frontal lobe. Clinical and radiographicfindings failed to improve with prolonged antibiotic therapy; transcranial orbitotomy with right frontal craniotomy forabscess drainage and orbit washout was performed. Intraoperative cultures grew Aspergillus fumigatus. The patientcompleted a six month course of therapy with oral voriconazole and has remained free from relapse with long-termfollow-up. Efficacy of voriconazole was guided by serial imaging and voriconazole trough levels. Aspergillus may causeinvasive disease in immunocompetent hosts, even without evidence of sinusitis, and should be considered in the differentialdiagnosis when patients do not demonstrate clinical improvement with antibiotic therapy. J Microbiol Infect Dis2012; 2(3: 113-116Key words: Aspergillosis, orbital cellulitis, brain abscess

  17. Chronic necrotizing pulmonary aspergillosis in pneumoconiosis - Clinical and radiologic findings in 10 patients

    Energy Technology Data Exchange (ETDEWEB)

    Kato, T.; Usami, I.; Morita, H.; Goto, M.; Hosoda, M.; Nakamura, A.; Shima, S. [Nagoya City University, Nagoya (Japan). School of Medicine, Dept. of Internal Medicine

    2002-01-01

    The authors studied 10 male patients with pneumoconiosis who were seen at Asahi Rosai Hospital and received a clinical diagnosis of chronic necrotizing pulmonary aspergillosis (CNPA) during a 15-year period, and detailed the long-term clinical and radiologic courses of four cases. Their occupational histories included pottery making and coal mining. Chest radiographic findings by the International Labor Organization profusion grading system were greater than category 2. All patients were symptomatic, with a productive cough, haemoptysis, and dyspnea. Serum findings were positive for the aspergillosis antibody in seven patients. The radiologic findings consisted of parenchymal infiltrates and cavities mostly containing mycetoma, which generally involved the upper lobes. The disease progressed slowly; in one patient, broad destruction of the lung was observed after > 10 years without antifungal administration. Most of the patients experienced clinical and radiologic improvement after receiving antifungal therapy, by oral, inhaled, or intracavitary administration. It was concluded that chronic persistent or progressive upper-lobe infiltrates and cavities in patients with pneumoconiosis should raise the possibility of CNPA. Early diagnosis and initiation of effective therapy are recommended to achieve a better outcome.

  18. Epidemiology and antifungal resistance in invasive aspergillosis according to primary disease - review of the literature

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    Mayr A

    2011-04-01

    Full Text Available Abstract Aspergilli, less susceptible to antifungals emerge and resistance to azoles have been found mainly in Aspergillus fumigatus; this has launched a new phase in handling aspergillosis. Resistant strains have currently been reported from Belgium, Canada, China, Denmark, France, Norway, Spain, Sweden, The Netherlands, UK and the USA. Centres in the UK (Manchester and The Netherlands (Nijmegen have described particularly high frequencies (15 and 10% respectively, and a significant increase in azole resistance in recent years. The reason of this high incidence may be due to long term azole therapy in patients with chronic aspergillosis in Manchester, and due to high use of agricultural azoles in Nijmegen. The primary underlying mechanism of resistance is as a result of alterations in the cyp51A target gene, with a variety of mutations found in clinical isolates and one genotype identified in the environmental (LH98. Reports on well documented in vitro and in vivo resistance to echinocandins are rare for Aspergillus species and resistance may be under-diagnosed as susceptibility testing is less frequently performed due to technical reasons.

  19. Invasive aspergillosis in hematopoietic stem cell transplant recipients: a retrospective analysis

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    Viviane Maria Hessel Carvalho-Dias

    2008-10-01

    Full Text Available Invasive aspergillosis (IA currently is an important cause of mortality in subjects undergoing hematopoietic stem cell transplants (HSCT and is also an important cause of opportunistic respiratory and disseminated infections in other types of immunocompromised patients. We examined the medical records of 24 cases of proven and probable invasive aspergillosis (IA at the Hospital de Clinicas of the Federal University of Parana, Brazil, from January 1996 to October 2006. During this period occurred a mean of 2.2 cases per year or 3.0 cases per 100 HSTC transplants. There was a significant relationship between structural changes in the bone marrow transplant (BMT Unit and the occurrence of IA cases (p=0.034, relative risk (RR = 2.47. Approximately 83% of the patients died due to invasive fungal infection within 60 days of follow up. Some factors tended to be associated with mortality, but these associations were not significant. These included corticosteroid use, neutropenia (<100 cells/mm³ at diagnosis, patients that needed to change antifungal therapy because of toxicity of the initial first-line regimen and disseminated disease. These factors should be monitored in BMT units to help prevent IA. Physicians should be aware of the risk factors for developing invasive fungal infections and try to reduce or eliminate them. However, once this invasive disease begins, appropriate diagnostic and treatment measures must be implemented as soon as possible in order to prevent the high mortality rates associated with this condition.

  20. Immunodiagnosis of systemic aspergillosis. I. Antigenemia detected by radioimmunoassay in experimental infection

    International Nuclear Information System (INIS)

    Because systemic aspergillosis is difficult to diagnose ante mortem, a study to improve immunodiagnosis was undertaken in a rabbit model of disseminated infection. We found that the predominant humoral response of infected animals was directed against four Aspergillus antigens identified by crossed immunoelectrophoresis. One of these antigens, a cell-wall carbohydrate, was purified by gel-filtration chromatography and was used to develop a radiommunoassay. The sensitivity of this assay was increased by testing for serum-bound antigen as well as for free antigen. When the sensitivity of the RIA was evaluated in the animal model, antigenemia was detected in 78% of 51 rabbits with disseminated infection and ante mortem in 86% of 42 rabbits with lethal infection. By contrast, with immunoprecipitin analysis only eight of 51 rabbits were positive for antigen, and six of 51 rabbits were positive for Aspergillus antibody. The specificity of the RIA was also tested. Negative controls for antigen included sera from 76 normal rabbits and sera from 25 rabbits with systemic candidiasis. The Candida control group is pertinent because 48% of these rabbits had specific Candida antigenemia detected by a mannan RIA. This study demonstrates that Aspergillus antigenemia occurs during the course of experimental disseminated aspergillosis and illustrates the potential of an Aspergillus antigen RIA for sensitive, specific immunodiagnosis of human infections

  1. Evaluation of a Quantitative Serological Assay for Diagnosing Chronic Pulmonary Aspergillosis.

    Science.gov (United States)

    Fujiuchi, Satoru; Fujita, Yuka; Suzuki, Hokuto; Doushita, Kazushi; Kuroda, Hikaru; Takahashi, Masaaki; Yamazaki, Yasuhiro; Tsuji, Tadakatsu; Fujikane, Toshiaki; Osanai, Shinobu; Sasaki, Takaaki; Ohsaki, Yoshinobu

    2016-06-01

    The purpose of this study was to evaluate the clinical utility of a quantitative Aspergillus IgG assay for diagnosing chronic pulmonary aspergillosis. We examined Aspergillus-specific IgG levels in patients who met the following criteria: (i) chronic (duration of >3 months) pulmonary or systemic symptoms, (ii) radiological evidence of a progressive (over months or years) pulmonary lesion with surrounding inflammation, and (iii) no major discernible immunocompromising factors. Anti-Aspergillus IgG serum levels were retrospectively analyzed according to defined classifications. Mean Aspergillus IgG levels were significantly higher in the proven group than those in the possible and control groups (P < 0.01). Receiver operating characteristic curve analysis revealed that the Aspergillus IgG cutoff value for diagnosing proven cases was 50 mg of antigen-specific antibodies/liter (area under the curve, 0.94; sensitivity, 0.98; specificity, 0.84). The sensitivity and specificity for diagnosing proven cases using this cutoff were 0.77 and 0.78, respectively. The positive rates of Aspergillus IgG in the proven and possible groups were 97.9% and 39.2%, respectively, whereas that of the control group was 6.6%. The quantitative Aspergillus IgG assay offers reliable sensitivity and specificity for diagnosing chronic pulmonary aspergillosis and may be an alternative to the conventional precipitin test. PMID:27008878

  2. Liposomal amphotericin B (AmBisome) reduces dissemination of infection as compared with amphotericin B deoxycholate (Fungizone) in a rate model of pulmonary aspergillosis

    NARCIS (Netherlands)

    A.C.A.P. Leenders (Alexander); S. de Marie (Siem); M.T. ten Kate (Marian); I.A.J.M. Bakker-Woudenberg (Irma); H.A. Verbrugh (Henri)

    1996-01-01

    textabstractThe efficacy of AmBisome, a liposomal formulation of amphotericin B, was compared with that of Fungizone (amphotericin B desoxycholate), in a rat model of unilateral, pulmonary aspergillosis. Repeated administration of cyclophosphamide resulted in persistent

  3. Bronchial stump aspergillosis after lobectomy for lung cancer as an unusual cause of false positive fluorodeoxyglucose positron emission tomography and computed tomography: a case report

    Directory of Open Access Journals (Sweden)

    Font Albert

    2011-02-01

    Full Text Available Abstract Introduction Bronchial stump aspergillosis is a rare entity characterized by cough and hemoptysis. Case presentation We report the case of a 58-year-old Caucasian woman who developed bronchial stump aspergillosis two years after a left upper lobe resection for lung cancer. Bronchial stump aspergillosis was diagnosed as a result of a focus of increased fluorodeoxyglucose activity in a follow-up positron emission tomography and computed tomography scan. She was treated with oral antifungal therapy and presented with good evolution after three months of treatment. Conclusion Bronchial stump aspergillosis is an unusual complication after pulmonary resection. Clinicians should be aware of it when a local recurrence of cancer around the bronchial stump is suspected based on a positive positron emission tomography and computed tomography finding.

  4. Aspergilosis necrotizante crónica en un paciente con secuelas de tuberculosis pulmonar Chronic necrotizing aspergillosis in a patient with pulmonary tuberculosis sequelae

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    Alcides Zambrano F

    2007-03-01

    Full Text Available Aspergillus fumigatus puede causar diferentes patologías en el ser humano: aspergiloma, aspergilosis broncopulmonar alérgica, aspergilosis necrotizante crónica, aspergilosis invasora. En la aspergilosis necrotizante crónica hay invasión local del parénquima y destrucción. A diferencia de la aspergilosis invasora no invade vasos sanguíneos ni se disemina a otros órganos. La aspergilosis necrotizante crónica se presenta en pacientes de edad media o ancianos con patología pulmonar previa: EPOC, secuelas de tuberculosis, resección pulmonar, neumoconiosis, radioterapia, infarto pulmonar o sarcoidosis. La clínica es indolente e inespecífica, con fiebre, tos, expectoración y baja de peso. Se desconoce la incidencia de aspergilosis necrotizante crónica en nuestro medio. La aspergilosis necrotizante crónica es potencialmente fatal, por lo que requiere de un diagnóstico y tratamiento oportuno. Creemos que, debe considerarse esta entidad ante un cuadro consuntivo y febril prolongado, en pacientes con enfermedades predisponentes que producen una leve baja de la inmunidad. Describimos el caso de un paciente atendido en el Instituto Nacional del TóraxAspergillus fumigatus is the causative agent of differents pathologies in the human being: aspergilloma, allergic bronchopulmonary aspergillosis, chronic necrotizing aspergillosis and invasive aspergillosis. In chronic necrotizing aspergillosis there is local invasion of the lung tissue and parenchyma destruction. Chronic necrotizing aspergillosis is different from invasive aspergillosis, because the abscence of vascular invasion or dissemination. Chronic necrotizing aspergillosis is seen in middle-aged and elderly with underlying lung diseases: COPD, tuberculosis sequelae, lung resection, pneumoconiosis, radiotherapy, lung infarction or sarcoidosis. Clinical manifestations are non specific, being the most usual fever, cough, sputum production and weight loss. Incidence of chronic necrotizing

  5. Comparative Efficacies of Conventional Amphotericin B, Liposomal Amphotericin B (AmBisome), Caspofungin, Micafungin, and Voriconazole Alone and in Combination against Experimental Murine Central Nervous System Aspergillosis

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    Clemons, Karl V.; Espiritu, Marife; Parmar, Rachana; Stevens, David A.

    2005-01-01

    Central nervous system (CNS) aspergillosis is a severe disease that responds poorly to current therapies. The current studies examined the efficacies of several antifungal agents alone or in combination with a murine model of CNS aspergillosis. Immunosuppressed mice were infected intracerebrally with Aspergillus fumigatus and treated with an amphotericin B preparation, an echinocandin, or voriconazole (VCZ) given alone or in combination. Monotherapy studies showed that micafungin (MICA), casp...

  6. Primary aspergilloma and subacute invasive aspergillosis in two AIDS patients Aspergiloma primário e aspergilose invasiva subaguda em dois pacientes com AIDS

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    Roberto Martinez; Gleusa de Castro; Alcyone A. Machado; Maria Janete Moya

    2009-01-01

    Although uncommon, invasive aspergillosis in the setting of AIDS is important because of its peculiar clinical presentation and high lethality. This report examines two AIDS patients with a history of severe cellular immunosuppression and previous neutropenia, who developed subacute invasive aspergillosis. One female patient developed primary lung aspergilloma, with dissemination to the mediastinum, vertebrae, and spine, which was fatal despite antifungal treatment. The second patient, who ha...

  7. Aspergillosis of the maxillary sinus. A clinical analysis of 24 cases. Comparision with 30 cases of non-fungal maxillary sinusitis

    International Nuclear Information System (INIS)

    The clinical and radiographic findings of 24 patients with aspergillosis of the maxillary sinus treated from 1989 through 2004 were compared with those of 30 patients with non-fungal maxillary sinusitis to clarify factors related to differential diagnosis. The subjects with aspergillosis were 9 men and 15 women aged 26 to 78 years (mean, 52 years). The patients with non-fungal sinusitis were 25 men and 5 women aged 23 to 73 years (mean, 46 years). The most common clinical finding at presentation was cheek pain, followed by nasal symptoms in the aspergillosis group. Nasal symptoms were more common in the non-fungal group than in the aspergillosis group. Thus, pain was more often associated with aspergillosis. Radiographically, diffuse radiopacity was observed in the maxillary sinus of all patients in both groups. In addition, dense antral radiopacities indicative of calcification were seen in a patient with aspergillosis. On X-ray-CT scans, bone thickening of antral walls (23 cases), sand-like high density areas (20 cases), extension of soft tissue masses to the nasal cavity (17 cases), foamy low density areas (13 cases), and bone destruction (6 cases) were seen in the aspergillosis group. These findings were rarely seen in the non-fungal group. All patients in both groups were treated by radical surgery of the maxillary sinus. The postoperative course was uncomplicated, and there was no recurrence as of 1 year postoperatively. In conclusion, the presence of pain, bone thickening of antral walls, sand-like high density areas, extension of soft tissue masses to the nasal cavity, foamy low density areas, and bone destruction on X-ray-CT scans were valuable for diagnosing aspergillosis of the maxillary sinus. (author)

  8. Successful Off-Label Use of Recombinant Factor VIIa and Coil Embolization in an Adolescent with Massive Hemoptysis Due to Invasive Pulmonary Aspergillosis

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    Dilek Gürlek Gökçebay

    2015-03-01

    Full Text Available Invasive fungal infections have turned out to be a significant cause of morbidity and mortality in pediatric patients with malignant disorders. Massive hemoptysis, a rare complication of invasive pulmonary aspergillosis, may threaten the lives of patients, usually during the resolution of neutropenia. In this report, we describe a patient with massive hemoptysis due to invasive pulmonary aspergillosis whose bleeding was controlled successfully with off-label use of recombinant factor VIIa and subsequent coil embolization of the right pulmonary artery.

  9. Successful management of invasive aspergillosis with voriconazole and amphotericin B therapy in a patient with Acute Mycloid Leukemia (AML-M2)

    International Nuclear Information System (INIS)

    An eleven year old boy presented with one month's history of fever and weight loss. He was diagnosed with Acute Mycloid Leukemia (AML-M2). During treatment he developed recurrent infections with neutropenia requiring prolonged antibiotics and subsequently developed invasive aspergillosis. He was treated with amphotericin B and Voriconazole. This case shows the efficacy and safety of combined antifungal therapy, including voriconazole, for invasive aspergillosis complicating AML. (author)

  10. Aspergilosis: una patología a considerar Aspergillosis: a phatology to be considered

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    Héctor Guillermo Oxilia

    2008-03-01

    Full Text Available La aspergilosis pulmonar es una infección micótica causada por el Aspergillus fumigatus, saprófito del esputo humano normal. Se estudiaron cinco casos de pacientes con aspergilosis, cuatro de ellos adultos, tres del sexo femenino y uno masculino, todos de presentación no invasiva, y uno, pediátrico, sexo masculino, del tipo invasiva. Fueron estudiados con radiología convencional, tomografía computada (TC helicoidal, TC multislice y video cápsula endoscópica. Afecta 3:1 a los hombres en relación con las mujeres. Hay tres formas de presentación: a invasiva: en los pacientes neutropénicos, donde predomina la afectación pulmonar, con diseminación a cerebro, corazón, riñón, tracto gastrointestinal, hígado, tiroides y bazo; tiene mal pronóstico y la mortalidad es muy elevada; b semiinvasiva: compromete fundamentalmente a pacientes con patología pulmonar preexistente; c no invasiva: afecta cavidades preexistentes, cavernas TBC ( tuberculosis o quistes, donde coloniza el hongo, y se denomina aspergiloma o micetoma.Pulmonary aspergillosis is a mycotic infection caused by the Aspergillus fumigatus, saprophyte of the normal human sputum. Five patients with non invasive aspergillosis were studied, of whom 4 were adults (3 women, 1 man and one, pediatric, with invasive aspergillosis. All of them were studied by conventional X-ray, spiral CT, multislice CT and video capsule endoscopy. The presentation is predominant among men (3 to 1. There are three forms of presentation: a invasive: in neutropenic patients it prevails the lung affectation; the brain, heart, kidney gastrointestinal tract, liver, thyroid and spleen spreading has a bad prognosis and mortality rate is very high; b semiinvasive: it mainly compromises patients with pre-existing pulmonary pathology; c non invasive: affects pre-existing cavities, TBC caverns or cysts where the fungus establishes; it is called aspergilloma or mycetoma.

  11. Diagnosis and treatment of pulmonary aspergillosis%肺曲霉菌病的诊治分析

    Institute of Scientific and Technical Information of China (English)

    卢旭东; 陆益民

    2015-01-01

    目的:探讨肺曲霉菌病的临床特征、影像学特点、诊断和治疗方法,提高对该病的认识。方法回顾性分析2003—2013年昆山市第一人民医院收治的肺曲霉菌病患者58例的临床资料。结果58例患者中,仅28例初步诊断考虑有肺曲霉菌感染,19例误诊为肺癌或肺结核;26例经手术治疗,32例为内科保守治疗;53例治疗后好转,5例患者死亡。结论肺曲霉菌病诊断困难,且常需与支气管哮喘、支气管扩张、肺结核及肺癌等疾病相鉴别。肺曲霉菌球经手术切除及抗真菌药物治疗后预后较好;变应性支气管肺曲霉菌病需长期激素联合抗真菌治疗;而侵袭性肺曲霉菌病病死率较高,预后较差。%Objective To explore the clinical characteristic,imaging features,diagnosis and therapies of pulmonary aspergillosis,to improve the cognition of pulmonary aspergillosis. Methods The clinical data of 58 pulmonary aspergillosis pa-tients were retrospectively analyzed from 2003 to 2013 in the First People's Hospital of Kunshan. Results In the 58 patients, only 28 cases were primary diagnosed,19 cases were misdiagnosed as tuberculosis or lung cancer;26 cases were treated with operation,32 cases were treated with conservative treatmen;53 cases were improved after treatment,5 patients died. Conclu-sion Clinical diagnosis of pulmonary aspergillosis is difficult,needs to differentiate from bronchial asthma,bronchiectasis, pulmonary tuberculosis and lung cancer. The prognosis of aspergilloma patients is good after operation resection and antifungal therapy;allergic bronchopulmonary aspergillosis patients need long - term hormone combined with antifungal therapy;the mor-tality of invasive pulmonary aspergillosis patients is high,has a poor prognosis.

  12. Multiple bronchoceles in a non-asthmatic patient with allergic bronchopulmonary aspergillosis.

    Science.gov (United States)

    Amin, Muhammad Umar; Mahmood, Rabia

    2008-09-01

    Allergic bronchopulmonary aspergillosis (ABPA) is a hypersensitivity reaction due to a fungus, Aspergillus fumigatus. It is typically seen in patients with long-standing asthma. Our patient was a non-asthmatic 18 years old male who presented with chronic cough for 2 years. Peripheral blood eosinophilia and elevated scrum IgE were observed. His x-ray chest revealed v-shaped opacity in the left upper lobe close to the hilum. High resolution computed tomographic scan of the chest revealed multiple dilated bronchi filled with mucous (bronchoceles) and central bronchiectasis (CB) involving main segmental bronchi. Central bronchiectasis (CB) was typical of ABPA but bronchocele formation was a rare manifestation of the disease. The patient was managed with oral prednisolone and was relieved of his symptoms. Occurrence of ABPA in non-asthmatics is very rare and deserves reporting. PMID:18846804

  13. Invasive pulmonary aspergillosis in acute leukemia: Contribution of CT to early diagnosis and aggressive management

    International Nuclear Information System (INIS)

    More than 80% of patients with invasive pulmonary aspergillosis (IPA) who received antileukemic chemotherapy survived the infection as a result of early diagnosis and aggressive therapy. CT helped to establish the early diagnosis of IPA in these patients. Since first describing the CT findings of IPA, the authors have added ten new cases, each subsequently confirmed. The CT ''halo sign,'' a zone of lower attenuation surrounding a pulmonary mass, was seen in eight of nine patients on early scans obtained during aplasia. A characteristic progression from multiple fluffy masses to cavitation suggested IPA in five of seven patients. CT findings affected patient management in seven of ten patients and were one criterion for increasing antifungal therapy. The CT appearance of healing IPA resembled that of resolving pulmonary infarcts, and was used to monitor disease activity in the long term

  14. Case Report Associated with Aspergillosis and Hepatitis E Virus Coinfection in Himalayan Griffons

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    Heng Li

    2015-01-01

    Full Text Available This study involved a death which occurred in four Himalayan griffons housed in Beijing zoo, China. Based on pathogen identification and the pathological changes observed, we did characterize the fungi and Hepatitis E virus (HEV in four dead Himalayan griffons. Pathological changes were severe. Membranous-like material was observed on the surface of the internal organs. Spleen was necrotic. Focal lymphocyte infiltration in the liver and many sunflower-like fungi nodules were evident in the tissues, especially in the kidney. PCR was used to identify the pathogen. Based on the 18SrRNA genomic sequence of known fungi, the results confirmed that all four dead Himalayan griffons were infected with Aspergillus. At the same time the detection of HEV also showed positive results. To the best of our knowledge, this work appears to be the first report of concurrent presence of Aspergillosis and Hepatitis E virus in rare avian species.

  15. [Diagnosis of invasive pulmonary aspergillosis: value of bronchoalveolar lavage galactomannan for immunocompromised patients].

    Science.gov (United States)

    Paugam, A; Baixench, M-T; Lebuisson, A; Dupouy-Camet, J

    2010-02-01

    Invasive pulmonary aspergillosis (IPA) is an emerging disease associated with high mortality. The diagnosis is difficult, based on a combination of elements that are clinical, radiological and biological. For early detection of cases of IPA, during 25 months, we have systematically carried out on the LBA (N=355) of immunocompromised patients (N=313) a determination of Aspergillus galactomannan (GM) by ELISA (PlateliaAspergillus, BioRad). We observed 14 cases of probable API. The sensitivity of GM compared to direct examination (DE) and culture is, respectively, 64% versus 29% and 57%. The determination of GM is definitely more sensitive than the ED. Excellent specificity (98%) allows its implementation as a screening test in patients at risk. PMID:19892488

  16. Use of Nebulized Amphotericin B in the Treatment of Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis

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    M. Proesmans

    2010-01-01

    Full Text Available Background. Systemic steroids and adjunctive antifungal therapy are the cornerstone in treating allergic bronchopulmonary aspergillosis (ABPA in the context of CF. Aim. Evaluate the use of inhaled amphotericin B (iAMB as antifungal agent in this context. Methods. Report of 7 CF patients with recurrent or difficult to treat ABPA and failure to taper systemic corticosteroids treated with AMB deoxycholate (AMB-d (Fungizone 25 mg 3× a week or AMB lipid complex (ABLC (Abelcet 50 mg twice weekly. Successful therapy was defined as steroid withdrawal without ABPA relapse within 12 months. Results. Therapy was successful in 6 of 7 patients treated with iAMB. In 5/6, lung function improved. The patient with treatment failure has concomitant MAC lung infection. Conclusion. Inhaled AMB may be an alternative to commonly used adjunctive antifungal therapy in the treatment of ABPA. More data are needed on safety and efficacy.

  17. Complete heart block in a neutropenic patient with aspergillosis: An unusual adverse effect of caspofungins

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    Sasmita Biswal

    2012-01-01

    Full Text Available We present a case of complete heart block (CHB in a 58-year-old female patient with acute myeloid leukemia (AML with no past history of cardiac disease, who received caspofungin in the treatment of disseminated fungal infection. To our knowledge, this is the first case of CHB associated with caspofungins. Subsequent to induction chemotherapy the patient developed invasive pulmonary aspergillosis with sudden tachypnea, dyspnoea, fever, bilateral pulmonary infiltrates and acute respiratory insufficiency consequent to neutropenia with ANC<500. During the first dose of antifungal therapy with caspofungins, she developed complete atrioventricular block and cardiac arrest. Complete heart block is an unusual adverse effect of caspofungins which has not been reported previously. Caspofungins release histamine in peripheral blood cells, so possible histamine-mediated symptoms ranging from severe fatal anaphylaxis can occur. These data suggest that infusion-related reactions associated with caspofungin may be mediated by histamine release secondary to caspofungin therapy.

  18. Invasive Pulmonary Aspergillosis in a Sickle Cell Patient Transplant Recipient: A Successful Treatment

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    Katia Paciaroni

    2015-08-01

    Full Text Available Sickle Cell Anaemia (SCA is the most common inherited blood disorder and is associated with severe morbidity and decreased survival. Allogeneic Haematopoietic Stem Cell Transplantation (HSCT is the only curative approach. Nevertheless the decision to perform a marrow transplant includes the risk of major complications  and mortality transplant related. The infections represent the main cause of mortality for SCA patients undergoing transplant. Invasive Pulmonary Aspergillosis (IPA is a devastating opportunistic infection and remains a significant cause of morbidity and mortality in HSCT recipients. Data regarding IPA in the setting of SCA are lacking. In the present report,  we describe a patient with SCA who developed IPA after allogeneic bone marrow transplant. The fungal infection was treated by systemic antifungal therapy in addition to the surgery, despite  mild chronic GVHD and with continuing immunosuppression therapy. This case shows that IPA occurring in bone marrow recipient with SCA can be successful treated

  19. Allergic bronchopulmonary aspergillosis (ABPA): studies on the general and specific humoral response.

    Science.gov (United States)

    Sandhu, R S; Bardana, E J; Khan, Z U; Dordevich, D M

    1978-04-14

    Serum specimens from 138 patients suffering from chronic respiratory disorders including 63 with allergic bronchopulmonary aspergillosis (ABPA), 2o with suspected ABPA, 15 with pulmonary tuberculosis, 14 with bronchial asthma, 10 with chronic bronchitis and 6 with miscellaneous pulmonary conditions were studied for circulating antibodies to Aspergillus. The ammonium sulfate test was empolyed with an iodine-125 labeled mycelial component derived from Aspergillus fumigatus. When compared to normal controls from the same area, this test indicated that sera from 82 per cent of patients with ABPA had elevated binding titers to the radiolabeled antigenic component. Immunodiffusion using a culture filtrate antigen from A. fumigatus, revealed precipitating antibody to this fungus in 89 percent of sera from ABP patients. The majority of patients with ABPA demonstrated marked elevations of total serum IgE, moderate elevations of serum IgA and IgD and slightly increased levels of IgG and IgM. PMID:652026

  20. Comparison of Nonculture Blood-Based Tests for Diagnosing Invasive Aspergillosis in an Animal Model.

    Science.gov (United States)

    White, P Lewis; Wiederhold, Nathan P; Loeffler, Juergen; Najvar, Laura K; Melchers, Willem; Herrera, Monica; Bretagne, Stephane; Wickes, Brian; Kirkpatrick, William R; Barnes, Rosemary A; Donnelly, J Peter; Patterson, Thomas F

    2016-04-01

    The EuropeanAspergillusPCR Initiative (EAPCRI) has provided recommendations for the PCR testing of whole blood (WB) and serum/plasma. It is important to test these recommended protocols on nonsimulated "in vivo" specimens before full clinical evaluation. The testing of an animal model of invasive aspergillosis (IA) overcomes the low incidence of disease and provides experimental design and control that is not possible in the clinical setting. Inadequate performance of the recommended protocols at this stage would require reassessment of methods before clinical trials are performed and utility assessed. The manuscript describes the performance of EAPCRI protocols in an animal model of invasive aspergillosis. Blood samples taken from a guinea pig model of IA were used for WB and serum PCR. Galactomannan and β-d-glucan detection were evaluated, with particular focus on the timing of positivity and on the interpretation of combination testing. The overall sensitivities for WB PCR, serum PCR, galactomannan, and β-d-glucan were 73%, 65%, 68%, and 46%, respectively. The corresponding specificities were 92%, 79%, 80%, and 100%, respectively. PCR provided the earliest indicator of IA, and increasing galactomannan and β-d-glucan values were indicators of disease progression. The combination of WB PCR with galactomannan and β-d-glucan proved optimal (area under the curve [AUC], 0.95), and IA was confidently diagnosed or excluded. The EAPRCI-recommended PCR protocols provide performance comparable to commercial antigen tests, and clinical trials are warranted. By combining multiple tests, IA can be excluded or confirmed, highlighting the need for a combined diagnostic strategy. However, this approach must be balanced against the practicality and cost of using multiple tests. PMID:26791366

  1. Efficacy of the investigational echinocandin ASP9726 in a guinea pig model of invasive pulmonary aspergillosis.

    Science.gov (United States)

    Wiederhold, Nathan P; Najvar, Laura K; Matsumoto, Satoru; Bocanegra, Rosie A; Herrera, Monica L; Wickes, Brian L; Kirkpatrick, William R; Patterson, Thomas F

    2015-05-01

    ASP9726 is an investigational echinocandin with in vitro activity against Aspergillus species. We evaluated the pharmacokinetics and efficacy of this agent in an established guinea pig model of invasive pulmonary aspergillosis. ASP9726 plasma concentrations were measured in guinea pigs administered either a single dose or multiple doses of this agent at 2.5, 5, and 10 mg/kg of body weight/day by subcutaneous injection. Immunosuppressed guinea pigs were inoculated with A. fumigatus AF293, and ASP9726 (2.5, 5, and 10 mg/kg/day), voriconazole (10 mg/kg by oral gavage twice daily), or caspofungin (3 mg/kg/day by intraperitoneal injection) was administered for 8 days. Changes in fungal burden were measured by enumerating CFU and by quantitative PCR of specimens from within the lungs, as well as by analysis of serum (1 → 3)-β-D-glucan and galactomannan. Lung histopathology was also evaluated. ASP9726 plasma concentrations increased in a dose-proportional manner, and the drug was well tolerated at each dose. Each dose of ASP9726, voriconazole, and caspofungin significantly reduced pulmonary fungal burden as measured by quantitative PCR and by determining (1 → 3)-β-D-glucan and galactomannan levels, but only voriconazole significantly reduced numbers of CFU. ASP9726 at 5 mg/kg also significantly improved survival. Histopathology demonstrated morphological changes in hyphae in animals exposed to ASP9726 and caspofungin, consistent with the activities of the echinocandins. These results suggest that ASP9726 may be efficacious for the treatment of invasive pulmonary aspergillosis. PMID:25753643

  2. Five-years surveillance of invasive aspergillosis in a university hospital

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    Gastmeier Petra

    2011-06-01

    Full Text Available Abstract Background As the most common invasive fungal infection, invasive aspergillosis (IA remains a serious complication in immunocompromised patients, leading to increased mortality. Antifungal therapy is expensive and may result in severe adverse effects. The aim of this study was to determine the incidence of invasive aspergillosis (IA cases in a tertiary care university hospital using a standardized surveillance method. Methods All inpatients at our facility were screened for presence of the following parameters: positive microbiological culture, pathologist's diagnosis and antifungal treatment as reported by the hospital pharmacy. Patients fulfilling one or more of these indicators were further reviewed and, if appropriate, classified according to international consensus criteria (EORTC. Results 704 patients were positive for at least one of the indicators mentioned above. Applying the EORTC criteria, 214 IA cases were detected, of which 56 were proven, 25 probable and 133 possible. 44 of the 81 (54% proven and probable cases were considered health-care associated. 37 of the proven/probable IA cases had received solid organ transplantation, an additional 8 had undergone stem cell transplantation, and 10 patients were suffering from some type of malignancy. All the other patients in this group were also suffering from severe organic diseases, required long treatment and experienced several clinical complications. 7 of the 56 proven cases would have been missed without autopsy. After the antimycotic prophylaxis regimen was altered, we noticed a significant decrease (p = 0.0004 of IA during the investigation period (2003-2007. Conclusion Solid organ and stem cell transplantation remain important risk factors for IA, but several other types of immunosuppression should also be kept in mind. Clinical diagnosis of IA may be difficult (in this study 13% of all proven cases were diagnosed by autopsy only. Thus, we confirm the importance of IA

  3. A case of invasive aspergillosis in CGD patient successfully treated with Amphotericin B and INF-γ

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    Gerami-Shoar Mohsen

    2005-03-01

    Full Text Available Abstract Background Chronic granulomatous disease (CGD is a rare disorder of phagocytes in which absence of superoxide and hydrogen peroxide production in phagocytes predisposes patients to bacterial and fungal infections. The most common fungal infections in these patients are caused by Aspergillus species. Case presentation Here, we describe Aspergillus osteomyelitis of the ribs and hepatic abscess in a 5-year-old boy. The patient was successfully treated with Amphotericin B and INF-γ. Conclusion With respect to the high frequency of aspergillosis in the CGD patient, immune deficiency should be investigated in patients with invasive aspergillosis. Moreover, using antifungal drugs as prophylaxis can improve the quality of life in these patients.

  4. Role of Toll-like receptors in lung innate defense against invasive aspergillosis. Distinct impact in immunocompetent and immunocompromized hosts.

    Science.gov (United States)

    Chignard, Michel; Balloy, Viviane; Sallenave, Jean-Michel; Si-Tahar, Mustapha

    2007-09-01

    Toll-like receptors are key to pathogen recognition by a host and to the subsequent triggering of an innate immune response. Experimental and clinical evidence shows that defects in Toll-like receptors or in signaling pathways downstream from these receptors render hosts susceptible to various types of infection, including aspergillosis. Patients receiving an immunosuppressive regimen, including corticosteroid therapy or cytotoxic chemotherapy, are also susceptible to infections. Aspergillus fumigatus is an opportunistic pathogen that infects the lungs of immunosuppressed hosts. Here, we review the evidence that experimental inactivation of various Toll-like receptors and of their signaling pathways may worsen cases of invasive pulmonary aspergillosis. Moreover, the literature clearly indicates that the type of immunosuppression is very important, as it influences whether or not Toll-like receptors contribute to infection. The involvement of Toll-like receptors, based on the immunological status of the patient, should be considered if an immunosuppressive treatment must be administered. PMID:17604224

  5. Prevalence and fungal profile of pulmonary aspergillosis in immunocompromised and immunocompetent patients of a tertiary care hospital

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    Prakash Ved, Mishra Prem P, Verma Shashi K, Sinha Shivani, Sharma Mahendra

    2014-03-01

    Full Text Available Background: Aspergillus is a fungus which may present an array of pulmonary manifestations, depending on the patient’s immunological and physiological state. Although the incidence of pulmonary aspergillosis occurs primarily in immunocompromised patients but the incidence is also rising in immunocompetent individuals, especially in developing countries. Aim: The objective of the study was to determine the prevalence and predisposing factors of pulmonary aspergillosis along with species identification. Materials and Methods: One hundred and three patients admitted to the Department of Chest and Tuberculosis and in the Department of Medicine from Jan 2012 to Jan 2013 were included in this study. The patients were epitomized on the basis of clinical signs and symptoms, physical examination, chest radiography, CT scans, histopathological examination, bronchoscopy and fungal examination including potassium hydroxide mount, fungal culture of sputum and bronchoalveolar lavage. Species identification was done by colony characteristics, slide culture and Lactophenol Cotton blue mount. Results: Out of the 103 patients, (63 males and 40 females Aspergillus species has been isolated from 17 (16.5% males and 07 (6.79% females. Various predisposing factors of pulmonary aspergillosis have been identified in which pulmonary tuberculosis, chronic smoking and environmental exposure to asbestos, cement its tops the list. Many of the patients had multiple predisposing factors. Aspergillus species were isolated in 24 (23.3% cases. Aspergillus fumigatus was the predominant species isolated in 13 (54.16% cases followed by Aspergillus flavus in 07 (29.16% cases, Aspergillus niger in 03 (12.5 % and Aspergillus terrus in 1 (4.16% cases. Conclusion: It is concluded that the prevalence of pulmonary Aspergillosis is quite high in immunocompromised individuals and low in immunocompetent individuals. An adequate and efficient evaluation of the etiological agents has a

  6. Role of Toll-like receptors in lung innate defense against invasive aspergillosis. Distinct impact in immunocompetent and immunocompromized hosts.

    OpenAIRE

    Chignard, Michel; Balloy, Viviane; Sallenave, Jean-Michel; Si-Tahar, Mustapha

    2007-01-01

    Toll-like receptors are key to pathogen recognition by a host and to the subsequent triggering of an innate immune response. Experimental and clinical evidence shows that defects in Toll-like receptors or in signaling pathways downstream from these receptors render hosts susceptible to various types of infection, including aspergillosis. Patients receiving an immunosuppressive regimen, including corticosteroid therapy or cytotoxic chemotherapy, are also susceptible to infections. Aspergillus ...

  7. Co-infection of invasive pulmonary aspergillosis and cutaneous Fusarium infection in a patient with pyoderma gangrenosum

    OpenAIRE

    AMIRRAJAB, Nasrin; Aliyali, Masoud; Mayahi, Sabah; Najafi, Narges; Abdi, Ruhollah; Nourbakhsh, Omid; SHOKOHI, Tahereh

    2015-01-01

    We report an unusual case of co-infection of invasive pulmonary aspergillosis (IPA) and fusarial skin infection in a patient with classic pyoderma gangrenosum with unknown causes, which were previously controlled with oral prednisolone, cyclosporine. The diagnosis was made on direct microscopy and culture of endobronchial washing, bronchoalveolar lavage and skin lesion biopsy. The treatment failed, and the patient expired 12 days following hospitalization. This report highlights the rarity of...

  8. 302 Screening for Allergic Bronchopulmonary Aspergillosis in Patients with Aspergillus + Asthma From 2000 to 2010

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    Greenberger, Paul

    2012-01-01

    Background Approximately 25% of patients with persistent asthma have immediate skin reactivity to Aspergillus species. The purpose of this study was to screen all patients with immediate hypersensitivity to Aspergillus for evidence of Allergic Bronchopulmonary Aspergillosis (ABPA). Methods All patients with asthma underwent immediate cutaneous testing including prick (epicutaneous) with a mix of Aspergillus species and if negative, intradermal at 1000 PNU/mL, Aspergillus fumigatus (Af). Sera ...

  9. Nosocomial invasive aspergillosis in a heart transplant patient acquired during a break in the HEPA air filtration system.

    Science.gov (United States)

    Muñoz, P; Guinea, J; Peláez, T; Durán, C; Blanco, J L; Bouza, E

    2004-03-01

    We report a case of nosocomially acquired invasive aspergillosis (IA) in a low-risk heart transplant recipient due to a break in the air conditioning system. A high overload of Aspergillus spores in the intensive care unit room led this patient to acquire IA. Identical environmental and patient isolates allowed our hypothesis to be confirmed and a very precise incubation time to be estimated. PMID:15225229

  10. Sinus aspergillosis.

    Science.gov (United States)

    De Foer, C; Fossion, E; Vaillant, J M

    1990-01-01

    The prevalence of Aspergillus sinusitis is often underestimated because the vast majority of cases are classified as "unspecified sinusitis". Two possible aetio-pathogenic mechanisms can be involved in the development of this fungal infection. Traditionally, the literature emphasised the "anglophone" hypothesis which is based on the inhalation of spores. More recently, the "french" model, based on oro-sinusal fistula and/or the perforation of the maxillary sinus by root canal-filling material, is believed to explain the majority of cases in our industrialised environments. Still, neither model explains the totality of cases and several remain beyond comprehension. The disease most commonly presents as a chronic bacterial sinusitis. The process can however become invasive, thus resembling malignancy, with eventually a fatal outcome. Doctors and dentists should know the possible danger, presented by zinc-oxide-eugenol-paste in the sinus. Radical surgery is the treatment of choice, since a prolonged conservative approach (antibiotics, corticosteroids) can only worsen the prognosis. This paper discusses different aspects of the disease, and presents 10 cases, observed at the University Hospitals of Paris (France) and Leuven (Belgium). PMID:2406288

  11. Fatal Case of Probable Invasive Aspergillosis after Five Years of Heart Transplant: A Case Report and Review of the Literature

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    Toufik Mahfood Haddad

    2015-01-01

    Full Text Available Invasive fungal infections are very common in solid organ transplants and occur most frequently in the first three months after transplant. A 49-year-old female with a history of two remote heart transplants with the most recent one occurring 5 years ago was admitted for increasing shortness of breath, cough, and fever. Computerized tomography (CT scan of the chest showed left lower lung ground-glass and tree-in-bud opacities. She was started on broad spectrum antibiotics along with ganciclovir and micafungin. Ganciclovir was added due to the patient’s past history of CMV infection and empiric fungal coverage with micafungin. Bronchoalveolar lavage (BAL was performed as her respiratory status worsened and voriconazole was added for possible aspergillosis in combination therapy with micafungin. BAL galactomannan returned positive which was suggestive of aspergillosis. Patient worsened clinically and subsequently succumbed to cardiorespiratory arrest despite our best efforts. It is important to have a high degree of clinical suspicion for invasive aspergillosis in transplant patients even many years after transplant and initiate aggressive therapy due to poor outcomes.

  12. Selection of the antifungal agent decides prognosis of invasive aspergillosis: case report of a successful outcome with voriconazole.

    Science.gov (United States)

    Arakawa, Hisaya; Suto, Chikako; Notani, Hiroko; Ishida, Takashi; Abe, Kayoko; Ookubo, Yasuo

    2014-02-01

    Invasive aspergillosis is a rare disease and is often misdiagnosed. The clinical course is quite aggressive and it is a potentially fatal disease. We report a case of invasive aspergillosis involving the dura mater and optic nerves which was successfully treated with voriconazole, even though the patient had residual monocular blindness. An 86-year-old Japanese man complained of developing loss of vision in his left eye while taking oral fluconazole prescribed by an otolaryngologist for mycosis of the left maxillary sinus. He was referred to our hospital. At the first visit, he already had no light perception in the left eye, with decreased ocular motility in all directions and orbital apex syndrome. His corrected distance visual acuity (CDVA) in the right eye was 20/25 with enlargement of Mariotte's blind spot. Magnetic resonance imaging revealed inflammation around both optic nerves that also involved the dura mater. His antifungal therapy was changed to intravenous voriconazole. Although his right CDVA temporarily declined to 20/50, it improved to 20/16 by 10 months after the initiation of treatment. Maxillary sinus biopsy detected Aspergillus. Invasive aspergillosis progresses rapidly and aggressively. The present case highlights the importance of early diagnosis and selection of an appropriate antifungal agent. PMID:23397120

  13. Proteomic demonstration of the recurrent presence of inter-alpha-inhibitor H4 heavy-chain during aspergillosis induced in an animal model.

    Science.gov (United States)

    Desoubeaux, Guillaume; Jourdan, Marie-Lise; Valera, Lionel; Jardin, Bénédicte; Hem, Sonia; Caille, Agnès; Cormier, Bénédicte; Marchand-Adam, Sylvain; Bailly, Éric; Diot, Patrice; Chandenier, Jacques

    2014-05-01

    Invasive pulmonary aspergillosis remains a matter of great concern in oncology/haematology, intensive care units and organ transplantation departments. Despite the availability of various diagnostic tools with attractive features, new markers of infection are required for better medical care. We therefore looked for potential pulmonary biomarkers of aspergillosis, by carrying out two-dimensional (2D) gel electrophoresis comparing the proteomes of bronchial-alveolar lavage fluids (BALF) from infected rats and from control rats presenting non-specific inflammation, both immunocompromised. A bioinformatic analysis of the 2D-maps revealed significant differences in the abundance of 20 protein spots (ANOVA P-value0.8). One of these proteins, identified by mass spectrometry, was considered of potential interest: inter-alpha-inhibitor H4 heavy-chain (ITIH4), characterised for the first time in this infectious context. Western blotting confirmed its overabundance in all infected BALF, particularly at early stages of murine aspergillosis. Further investigations were carried on rat serum, and confirmed that ITIH4 levels increased during experimental aspergillosis. Preliminary results in human samples strengthened this trend. To our knowledge, this is the first description of the involvement of ITIH4 in aspergillosis. PMID:24360996

  14. Management of invasive aspergillosis in patients with COPD: rational use of voriconazole

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    Florence Ader

    2009-07-01

    Full Text Available Florence Ader1, Anne-Lise Bienvenu2, Blandine Rammaert3, Saad Nseir41Service des Maladies Infectieuses et Tropicales; 2Service de Parasitologie et Mycologie Médicale, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Hôpital de La Croixrousse, Lyon, France; 3Service des Maladies Infectieuses et Tropicales, Université Paris Descartes, Hôpital Necker Enfants Malades, Centre d’infectiologie Necker-Pasteur, Paris, France; 4Service de Réanimation Médicale, Hôpital A. Calmette, Centre Hospitalier Régional Universitaire, Lille, FranceAbstract: Invasive pulmonary aspergillosis (IPA is an important cause of mortality in patients with hematologic malignancies. The reported incidence of IPA in the context of chronic obstructive pulmonary disease (COPD seems to increase. Approximately 1%–2% of overall fatal cases of IPA occur in COPD patients. The combination of factors such as lung immune imbalance, long-term corticosteroid use, increasing rate of bacterial exacerbations over time, and malnutrition are responsible for the emergence of IPA in these patients. The diagnosis of IPA is difficult to establish, which explains the delay in implementing accurate antifungal therapy and the high mortality rate. Persistent pneumonia nonresponsive to appropriate antibiotic treatment raises the concern of an invasive fungal infection. Definite diagnosis is obtained from tissue biopsy evidencing Aspergillus spp. on microscopic examination or in culture. Culture and microscopy of respiratory tract samples have a sensitivity and specificity of around 50%. Other diagnostic tools can be useful in documenting IPA: computed tomography (CT scan, nonculture-based tests in serum and/or in bronchoalveolar lavage such as antibody/antigen tests for Aspergillus spp. More recent tools such as polymerase chain reaction or [1→3]-β-D-glucan have predictive values that need to be further investigated in COPD patients. Antifungal monotherapy using azole

  15. In vivo hypoxia and a fungal alcohol dehydrogenase influence the pathogenesis of invasive pulmonary aspergillosis.

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    Nora Grahl

    2011-07-01

    Full Text Available Currently, our knowledge of how pathogenic fungi grow in mammalian host environments is limited. Using a chemotherapeutic murine model of invasive pulmonary aspergillosis (IPA and (1H-NMR metabolomics, we detected ethanol in the lungs of mice infected with Aspergillus fumigatus. This result suggests that A. fumigatus is exposed to oxygen depleted microenvironments during infection. To test this hypothesis, we utilized a chemical hypoxia detection agent, pimonidazole hydrochloride, in three immunologically distinct murine models of IPA (chemotherapeutic, X-CGD, and corticosteroid. In all three IPA murine models, hypoxia was observed during the course of infection. We next tested the hypothesis that production of ethanol in vivo by the fungus is involved in hypoxia adaptation and fungal pathogenesis. Ethanol deficient A. fumigatus strains showed no growth defects in hypoxia and were able to cause wild type levels of mortality in all 3 murine models. However, lung immunohistopathology and flow cytometry analyses revealed an increase in the inflammatory response in mice infected with an alcohol dehydrogenase null mutant strain that corresponded with a reduction in fungal burden. Consequently, in this study we present the first in vivo observations that hypoxic microenvironments occur during a pulmonary invasive fungal infection and observe that a fungal alcohol dehydrogenase influences fungal pathogenesis in the lung. Thus, environmental conditions encountered by invading pathogenic fungi may result in substantial fungal metabolism changes that influence subsequent host immune responses.

  16. First line of defense: Innate cell-mediated control of pulmonary Aspergillosis

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    Vanessa eEspinosa

    2016-03-01

    Full Text Available Mycotic infections and their effect on the human condition have been widely overlooked and poorly surveilled by many health organizations even though mortality rates have increased in recent years. The increased usage of immunosuppressive and myeloablative therapies for the treatment of malignant as well as non-malignant diseases has contributed significantly to the increased incidence of fungal infections. Invasive fungal infections have been found to be responsible for at least 1.5 million deaths worldwide. About 90% of these deaths can be attributed to Cryptococcus, Candida, Aspergillus, and Pneumocystis. A better understanding of how the host immune system contains fungal infection is likely to facilitate the development of much needed novel antifungal therapies. Innate cells are responsible for the rapid recognition and containment of fungal infections and have been found to play essential roles in defense against multiple fungal pathogens. In this review we summarize our current understanding of host-fungi interactions with a focus on mechanisms of innate cell-mediated recognition and control of pulmonary aspergillosis.

  17. Initial computed tomography findings of invasive pulmonary aspergillosis in non-hematological patients

    Institute of Scientific and Technical Information of China (English)

    XU Si-cheng; QIU Li-hua; LIU Wen-ya; FENG Yu-lin

    2012-01-01

    Background The computed tomography (CT) findings of invasive pulmonary aspergillosis (IPA) are unclear in nonhematological patients.The present study was a retrospective evaluation of CT images in non-hematological patients with IPA.Methods All adult patients who met the 2008 European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) criteria for proven or probable IPA were included during a 5-year study at our institutions.Initial CT findings in our cohort were retrospectively reviewed by two independent thoracic radiologists blinded to patient demographics and clinical outcomes.The presence,pattern,and distribution of abnormalities were recorded.Results Twenty-three non-hematological patients with pathologically confirmed IPA were included in our study.Areas of ground-glass opacities were present in 14 patients (61%),which were bilateral in 10 patients and unilateral in four.This pattern mainly involved the middle and upper lung zones.Air-space consolidation was identified in 12 patients (52%),and the areas were distributed along the bronchus or subpleura in most cases.Other findings,including five small nodules (22%),three macronodules (13%),and one halo sign (4%),were less common.Conclusions CT findings of IPA in non-hematological patients frequently manifested as acute bronchopneumonia,and ground-glass opacities and air-space consolidations were the most common CT findings of IPA in these patients.

  18. Second-Hand Smoke Increases Bronchial Hyperreactivity and Eosinophilia in a Murine Model of Allergic Aspergillosis

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    Brian W. P. Seymour

    2003-01-01

    Full Text Available Involuntary inhalation of tobacco smoke has been shown to aggravate the allergic response. Antibodies to fungal antigens such as Aspergillus fumigatus (Af cause an allergic lung disease in humans. This study was carried out to determine the effect of environmental tobacco smoke (ETS on a murine model of allergic bronchopulmonary aspergillosis (ABPA. BALB/c mice were exposed to aged and diluted sidestream cigarette smoke to simulate 'second-hand smoke'. The concentration was consistent with that achieved in enclosed public areas or households where multiple people smoke. During exposure, mice were sensitized to Af antigen intranasally. Mice that were sensitized to Af antigen and exposed to ETS developed significantly greater airway hyperreactivity than did mice similarly sensitized to Af but housed in ambient air. The effective concentration of aerosolized acetylcholine needed to double pulmonary flow resistance was significantly lower in Af + ETS mice compared to the Af + AIR mice. Immunological data that supports this exacerbation of airway hyperresponsiveness being mediated by an enhanced type 1 hypersensitivity response include: eosinophilia in peripheral blood and lung sections. All Af sensitized mice produced elevated levels of IL4, IL5 and IL10 but no IFN-γ indicating a polarized Th2 response. Thus, ETS can cause exacerbation of asthma in ABPA as demonstrated by functional airway hyperresponsiveness and elevated levels of blood eosinophilia.

  19. Systemic biomarkers of inflammation and haemostasis in patients with chronic necrotizing pulmonary aspergillosis

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    Rødland Ernst

    2012-06-01

    Full Text Available Abstract Background The purpose of this study was to investigate mediators of inflammation and haemostasis in patients with chronic necrotizing pulmonary aspergillosis (CNPA, a locally, destructive process of the lung due to invasion by Aspergillus species. Methods Measurements of selected biomarkers in 10 patients with CNPA and 19 healthy, matched controls were performed with enzyme-linked immunosorbent assay (ELISA and multiplex methodology. The gene expressions of relevant biomarkers were analyzed with real-time quantitative RT-PCR. Results Increased concentrations of circulating mediators of inflammation interleukin (IL-6, IL-8, RANTES, TNF-α, ICAM-1 and mediators involved in endothelial activation and thrombosis (vWF, TF and PAI-1 were observed in patients with CNPA. The concentration of the anti-inflammatory cytokine IL-10 was increased both in plasma and in PBMC in the patient population. The gene expression of CD40L was decreased in PBMC from the patient group, accompanied by decreased concentrations of soluble (s CD40L in the circulation. Conclusions The proinflammatory response against Aspergillus may be counteracted by reduced CD40L and sCD40L, as well as increased IL-10, which may compromise the immune response against Aspergillus in patients with CNPA.

  20. Antifungal treatment in allergic bronchopulmonary aspergillosis with and without cystic fibrosis: a systematic review.

    Science.gov (United States)

    Moreira, A S; Silva, D; Ferreira, A Reis; Delgado, L

    2014-10-01

    Allergic bronchopulmonary aspergillosis (ABPA) is a rare disease that affects patients with asthma or cystic fibrosis. Its debilitating course has led to the search for new treatments, including antifungals and monoclonal antibodies. To evaluate the efficacy and safety of antifungal treatments in patients with ABPA and either asthma or cystic fibrosis, we performed a systematic review of the literature on the effects of antifungal agents in ABPA using three biomedical databases. Quality assessment was performed using the GRADE methodology and, where appropriate, studies with comparable outcomes were pooled for meta-analysis. Thirty-eight studies - four randomized controlled trials and 34 observational studies - met the eligibility criteria. The antifungal interventions described were itraconazole, voriconazole, posaconazole, ketoconazole, natamycin, nystatin and amphotericin B. An improvement in symptoms, frequency of exacerbations and lung function was reported in most of the studies and was more common with oral azoles. Antifungals also had a positive impact on biomarkers and radiological pulmonary infiltrates, but adverse effects were also common. The quality of the evidence supporting these results was low or very low due to a shortage of controlled studies, heterogeneity between studies and potential bias. Antifungal interventions in ABPA improved patient and disease outcomes in both asthma and cystic fibrosis. However, the recommendation for their use is weak and clinicians should therefore weigh up desirable and undesirable effects on a case-by-case basis. More studies with a better methodology are needed, especially in cystic fibrosis, to increase confidence in the effects of antifungal treatments in ABPA. PMID:24809846

  1. Efficacy of oleylphosphocholine (OlPC) in vitro and in a mouse model of invasive aspergillosis.

    Science.gov (United States)

    Paulussen, Caroline; Boulet, Gaëlle; Bosschaerts, Tom; Cos, Paul; Fortin, Anny; Maes, Louis

    2015-03-01

    Invasive aspergillosis (IA) has become increasingly common and is characterised by high morbidity and mortality. Upcoming resistance threatens treatment with azoles and highlights the continuous need for novel therapeutics. This laboratory study investigated the in vitro and in vivo potential of the alkylphospholipid oleylphosphocholine (OlPC) against Aspergillus. In vitro activities of OlPC, miltefosine, posaconazole and voriconazole were determined for Aspergillus fumigatus, A. niger, A. terreus and A. flavus. In vivo efficacy of OlPC was evaluated in a systemic A. fumigatus mouse model, adopting a short-term and long-term oral or intraperitoneal dosing regimen. OlPC showed good in vitro activity against A. fumigatus (IC50 = 1.04 μmol l(-1)). Intraperitoneal administration of 50 mg kg(-1) day(-1) OlPC significantly reduced the fungal organ burdens at 4 days post-infection (dpi). Although 5- and 10-day OlPC treatment improved survival, organ burdens were not affected at 10 and 15 dpi. While this study showed excellent in vitro activity of OlPC against Aspergillus spp., its therapeutic efficacy in an acute mouse model for IA was less convincing. Given the limited therapeutic options in the current antifungal market for invasive infections, OlPC activity should be assessed in a less stringent in vivo model, potentially in combination treatment with other already marketed antifungal drugs. PMID:25590577

  2. Autoinduction of voriconazole metabolism in a child with invasive pulmonary aspergillosis.

    Science.gov (United States)

    Hsu, Alice Jenh; Dabb, Alix; Arav-Boger, Ravit

    2015-04-01

    Inter- and intra-patient variability in voriconazole pharmacokinetics has been described in children as the result of age-specific differences in hepatic metabolism, saturable nonlinear pharmacokinetics, CYP450 2C19 polymorphisms, decreased bioavailability compared with adults, and drug-drug interactions. We introduce dose-dependent autoinduction of metabolism as another cause for altered voriconazole pharmacokinetics in children and summarize previously published literature on this phenomenon. A 10-year-old girl with severe aplastic anemia developed invasive pulmonary aspergillosis after high-dose cyclophosphamide therapy and required high doses of voriconazole for longer than 2 months. She initially achieved a therapeutic trough of 1.4 μg/ml on voriconazole 11 mg/kg/dose orally every 12 hours but required dose escalations to 9.3 mg/kg/dose orally every 8 hours to maintain a trough above 1 μg/ml. Because there were no changes in concomitant medications, route of administration, adherence, or oral intake, we conclude that the only plausible explanation for the precipitous drop in voriconazole troughs was autoinduction of metabolism, a phenomenon previously reported in adults receiving higher than usual doses or prolonged courses (longer than 2 months). These data highlight the need for continued therapeutic drug monitoring of voriconazole after initial therapeutic troughs are achieved because autoinduction of metabolism can lead to significant declines in subsequent voriconazole troughs, potentially leading to treatment failure. PMID:25884532

  3. A murine model of allergic bronchopulmonary aspergillosis with elevated eosinophils and IgE.

    Science.gov (United States)

    Kurup, V P; Mauze, S; Choi, H; Seymour, B W; Coffman, R L

    1992-06-15

    A model of allergic bronchopulmonary aspergillosis was developed by exposing BALB/c mice to Aspergillus fumigatus (AF) Ag. Animals immunized intranasally (i.n.) with soluble AF Ag produced low levels of serum IgE compared to animals given alum precipitated AF Ag i.p. The latter treatment also produced higher levels of serum IgG1 and AF-specific IgG1 than soluble AF given i.p. or i.n.. Blood and lung eosinophilia was detected in mice repeatedly exposed to AF by i.n. but not in the groups injected i.p. Particulate AF Ag-induced striking blood and lung eosinophilia and elevated levels of serum IgE in mice preexposed to AF Ag. The results indicate that route of inoculation and physical nature of Ag determine the immune response and can be manipulated to obtain enhanced IgE, eosinophils, or both in the animal model. PMID:1602128

  4. Successful non-standard approaches to massive hemoptysis in invasive pulmonary aspergillosis

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    Mitrović Mirjana

    2012-01-01

    Full Text Available Introduction. Invasive pulmonary aspergillosis (IA is the most frequent invasive fungal infection in patients with hematological malignancies. Massive hemoptysis (MH with blood loss more than 300- 600 ml in 24 hours is a rare (5-10% of IA patients but frequently fatal complication. Standard treatment of MH, such as oxygenation, a semi-sitting position with the bleeding site down, bronchoscopical suctioning, antifungal therapy, transfusion support and surgical resection might be either ineffective or not feasible in some cases. Outline of Cases. We report two patients with life threatening, non-controlled, massive hemoptysis who were successfully managed by non-standard measures. A 61-year-old male with acute myeloid leukemia developed pulmonary IA and massive hemoptysis after consolidation cure by chemotherapy. The bleeding site was localized in the VI lung segment by bronchoscopy. Local application of fibrinogen-thrombin concentrate (fibrin glue stopped the bleeding. A 22-year-old female patient with the diagnosis of severe aplastic anemia developed IA and massive hemoptysis early after application of immunosuppressive therapy (antilymphocyte globulin, cyclosporine and corticosteroids. Conventional transfusion therapy, desmopresine and antifibrinolytics were ineffective. This urgent condition was successfully treated with human activated recombinant factor VII (rFVIIa, NovoSeven®. Conclusion. Our experience together with data from the available literature suggests a potential benefit of fibrinogen-thrombin concentrate and rFVIIa in the treatment of refractory critical bleeding in hematooncological patients.

  5. Laboratory Diagnosis of Invasive Aspergillosis: From Diagnosis to Prediction of Outcome

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    Richard C. Barton

    2013-01-01

    Full Text Available Invasive aspergillosis (IA, an infection caused by fungi in the genus Aspergillus, is seen in patients with immunological deficits, particularly acute leukaemia and stem cell transplantation, and has been associated with high rates of mortality in previous years. Diagnosing IA has long been problematic owing to the inability to culture the main causal agent A. fumigatus from blood. Microscopic examination and culture of respiratory tract specimens have lacked sensitivity, and biopsy tissue for histopathological examination is rarely obtainable. Thus, for many years there has been a great interest in nonculture-based techniques such as the detection of galactomannan, β-D-glucan, and DNA by PCR-based methods. Recent meta-analyses suggest that these approaches have broadly similar performance parameters in terms of sensitivity and specificity to diagnose IA. Improvements have been made in our understanding of the limitations of antigen assays and the standardisation of PCR-based DNA detection. Thus, in more recent years, the debate has focussed on how these assays can be incorporated into diagnostic strategies to maximise improvements in outcome whilst limiting unnecessary use of antifungal therapy. Furthermore, there is a current interest in applying these tests to monitor the effectiveness of therapy after diagnosis and predict clinical outcomes. The search for improved markers for the early and sensitive diagnosis of IA continues to be a challenge.

  6. Paving the way for predictive diagnostics and personalized treatment of invasive aspergillosis

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    Ana eOliveira-Coelho

    2015-05-01

    Full Text Available Invasive aspergillosis (IA is a life-threatening fungal disease commonly diagnosed among individuals with immunological deficits, namely hematological patients undergoing chemotherapy or allogeneic hematopoietic stem cell transplantation. Vaccines are not available, and despite the improved diagnosis and antifungal therapy, the treatment of IA is associated with a poor outcome. Importantly, the risk of infection and its clinical outcome vary significantly even among patients with similar predisposing clinical factors and microbiological exposure. Recent insights into antifungal immunity have further highlighted the complexity of host-fungus interactions and the multiple pathogen-sensing systems activated to control infection. How to decode this information into clinical practice remains however a challenging issue in medical mycology. Here, we address recent advances in our understanding of the host-fungus interaction and discuss the application of this knowledge in potential strategies with the aim of moving towards personalized diagnostics and treatment (theragnostics in immunocompromised patients. Ultimately, the integration of individual traits into a clinically applicable process to predict the risk and progression of disease, and the efficacy of antifungal prophylaxis and therapy, holds the promise of a pioneering innovation benefiting patients at risk of IA.

  7. Cerebral aspergillosis: comparison of radiological and neuropathologic findings in patients with bone marrow transplantation

    International Nuclear Information System (INIS)

    Thirty-six lesions in six patients who died from cerebral Aspergillus infection after bone marrow transplantation (BMT) were studied with regard to signal intensity, contrast enhancement, size, and location. The diagnosis was confirmed in all cases by autopsy. Retrospective correlation of histopathological and radiological findings was possible for 14 lesions. Most of the lesions (22/36) had isointense to low signal intensity on T2-weighted images (T2WI). Histopathologically, hemorrhagic necrosis was determined in three of them. Areas of high signal intensity on T1-weighted images (T1WI) were related to gross hemorrhage. Two infarctions showed intravascular accumulation of fungal hyphae with secondary thrombosis of the vessel. The remaining 12 lesions had high signal intensity on T2WI and low on T1WI. Histopathologically, four were infectious and four were unspecific demyelinated lesions. In conclusion, cerebral aspergillosis typically presented with large lesions showing isointense to low signal intensity on T2WI that could have areas of high signal on T1WI. Contrast enhancement was only visible in 15 lesions, and the predominant locations were the subcortical white matter, the cerebellum, and the basal ganglia. Small lesions with high signal on T2WI and low signal on T1WI could not necessarily be related to Aspergillus infection. (orig.)

  8. Cystic fibrosis transmembrane conductance regulator (CFTR) gene mutations in allergic bronchopulmonary aspergillosis

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    Miller, P.W.; Hamosh, A.; Macek, M. Jr. [John Hopkins Univ. School of Medicine, Baltimore, MD (United States)] [and others

    1996-07-01

    The etiology of allergic bronchopulmonary aspergillosis (ABPA) is not well understood. A clinical phenotype resembling the pulmonary disease seen in cystic fibrosis (CF) patients can occur in some individuals with ABPA. Reports of familial occurrence of ABPA and increased incidence in CF patients suggest a possible genetic basis for the disease. To test this possibility, the entire coding region of the cystic fibrosis transmembrane regulator (CFTR) gene was analyzed in 11 individuals who met strict criteria for the diagnosis of ABPA and had normal sweat electrolytes ({le}40 mmol/liter). One patient carried two CF mutations ({Delta}F508/R347H), and five were found to carry one CF mutation (four {Delta}F508; one R117H). The frequency of the {Delta}F508 mutation in patients with ABPA was significantly higher than in 53 Caucasian patients with chronic bronchitis (P < .0003) and the general population (P < .003). These results suggest that CFTR plays an etiologic role in a subset of ABPA patients. 54 refs., 2 tabs.

  9. Successful voriconazole treatment of invasive pulmonary aspergillosis in a patient with acute biphenotypic leukemia

    Directory of Open Access Journals (Sweden)

    Hirano,Teiichi

    2009-08-01

    Full Text Available A 23-year old woman with acute biphenotypic leukemia (ABL complained of chest pain with cough, high fever and hemoptysis during induction chemotherapy, although she had been treated with anti-biotics and micafungin. We made a clinical diagnosis of invasive pulmonary aspergillosis (IPA based on a consolidation in the right upper lung field on a chest radiograph as well as a high level of serum beta-D-glucan (with no evidence of tuberculosis and candidiasis. We changed her treatment from micafungin to voriconazole. Later, we discovered an air-crescent sign by CT scan that supported the diagnosis of IPA. Following voriconazole treatment, clinical symptoms ceased and abnormal chest shadows improved gradually and concurrently with a recovery of neutrophils. IPA must be considered in immunocompromised patients with pulmonary infiltrates who do not respond to broad-spectrum antibiotics. Serological tests and CT findings can aid in early diagnosis of IPA, which, along with treatment for IPA, will improve clinical outcomes.

  10. Capítulo 5 - Aspergilose: do diagnóstico ao tratamento Chapter 5 - Aspergillosis: from diagnosis to treatment

    Directory of Open Access Journals (Sweden)

    Maria da Penha Uchoa Sales

    2009-12-01

    Full Text Available A aspergilose é uma doença multifacetada cujas manifestações clínicas são determinadas pela resposta imune do hospedeiro; podem se apresentar de forma alérgica, saprofítica ou invasiva. A aspergilose broncopulmonar alérgica caracteriza-se por asma corticoide dependente, febre, hemoptise e destruição da via aérea, que pode progredir para fibrose com faveolamento. O tratamento consiste da associação de corticosteroide e itraconazol. A aspergilose pulmonar invasiva requer documentação histopatológica e cultura positiva de material estéril para o diagnóstico. Possui pior prognóstico. O voriconazol apresenta melhor resposta terapêutica, proporcionando maior sobrevida e segurança do que a anfotericina B. A aspergilose pulmonar necrotizante crônica causa destruição progressiva do pulmão em pacientes com doença pulmonar crônica e leve grau de imunossupressão. O tratamento é realizado com itraconazol oral. A aspergilose pulmonar cavitária crônica causa múltiplas cavidades, contendo ou não aspergiloma, associadas a sintomas pulmonares e sistêmicos. O aspergiloma é caracterizado por tosse produtiva crônica e hemoptise em portadores de doença pulmonar crônica, associados a uma cavidade contendo massa arredondada, às vezes móvel, e separada da parede por espaço aéreo. A ressecção cirúrgica é o tratamento definitivo para ambas. Antifúngicos triazólicos promovem beneficio terapêutico a longo prazo com risco mínimo.Aspergillosis is a multifaceted disease whose clinical manifestations (allergic, saprophytic and invasive forms are determined by the host immune response. Allergic bronchopulmonary aspergillosis is characterized by corticosteroid-dependent asthma, fever, hemoptysis and destruction of the airways, which can evolve to fibrosis with honeycombing. The treatment consists of the combined use of a corticosteroid and itraconazole. Invasive pulmonary aspergillosis, which has a worse prognosis, is diagnosed

  11. Prospective Evaluation of a New Aspergillus IgG Enzyme Immunoassay Kit for Diagnosis of Chronic and Allergic Pulmonary Aspergillosis.

    Science.gov (United States)

    Dumollard, C; Bailly, S; Perriot, S; Brenier-Pinchart, M P; Saint-Raymond, C; Camara, B; Gangneux, J P; Persat, F; Valot, S; Grenouillet, F; Pelloux, H; Pinel, C; Cornet, M

    2016-05-01

    Anti-Aspergillus IgG antibodies are important biomarkers for the diagnosis of chronic pulmonary aspergillosis (CPA) and allergic bronchopulmonary aspergillosis (ABPA). We compared the performance of a new commercial enzyme immunoassay (EIA) (Bordier Affinity Products) with that of the Bio-Rad and Virion\\Serion EIAs. This assay is novel in its association of two recombinant antigens with somatic and metabolic antigens of Aspergillus fumigatus In a prospective multicenter study, 436 serum samples from 147 patients diagnosed with CPA (136 samples/104 patients) or ABPA (94 samples/43 patients) and from 205 controls (206 samples) were tested. We obtained sensitivities of 97%, 91.7%, and 86.1%, and specificities of 90.3%, 91.3%, and 81.5% for the Bordier, Bio-Rad, and Virion\\Serion tests, respectively. The Bordier kit was more sensitive than the Bio-Rad kit (P < 0.01), which was itself more sensitive than the Virion\\Serion kit (P = 0.04). The Bordier and Bio-Rad kits had similar specificity (P = 0.8), both higher than that of the Virion\\Serion kit (P = 0.02). The area under the receiver operating characteristic (ROC) curves confirmed the superiority of the Bordier kit over the Bio-Rad and the Virion\\Serion kits (0.977, 0.951, and 0.897, respectively; P < 0.01 for each comparison). In a subset analysis of 279 serum samples tested with the Bordier and Bio-Rad kits and an in-house immunoprecipitin assay (IPD), the Bordier kit had the highest sensitivity (97.7%), but the IPD tended to be more specific (71.2 and 84.7%, respectively; P = 0.10). The use of recombinant, somatic, and metabolic antigens in a single EIA improved the balance of sensitivity and specificity, resulting in an assay highly suitable for use in the diagnosis of chronic and allergic aspergillosis. PMID:26888904

  12. Initial CT manifestations of invasive pulmonary aspergillosis in 45 non-HIV immunocompromised patients: association with patient outcome?

    International Nuclear Information System (INIS)

    Purpose: To assess early high-resolution computer tomographic (CT) signs of invasive pulmonary aspergillosis (IPA) in non-HIV immunosuppressed patients and their potential association with patient's outcome, including frequency and severity of pulmonary hemorrhage, taking also in consideration the impact of other known risk factors contributory to IPA. Material and methods: A retrospective review of serial CT scans was performed in 45 immunocompromised patients with a total of 46 episodes of invasive pulmonary aspergillosis. All patients underwent CT beginning with the day they showed clinical or laboratory signs of infection. Serial follow-up CT included more than two, up to 12 CT examinations. Patient's outcome was judged by clinical and radiological follow-up and classified as survival, death by IPA, or death unrelated to IPA. The influence of patient's age, underlying disease, hematopoietic stem cell transplantation, neutropenia, graft versus host disease, and antifungal therapy onset was also statistically considered. Results: Three main CT findings were identified: small nodules (<1 cm) 43% (20/46), large nodules 21% (10/46) and consolidations, either in patchy ± segmental 26% (12/46), or peribronchial distribution ± tree in bud 9% (4/46). In 11 patients (24%) we found a combination of two or more of these signs: 9 (19%) patients presented concurrent small nodules accompanied by reticulation, tree in bud or peribronchial infiltrates, while 2 (4%) patients showed large pulmonary nodules accompanied by large consolidations. An accompanying 'halo' sign was observed in 38 patients (82%). Crescent sign followed by cavitation was encountered in 29 patients (63%). Two patients succumbed to massive pulmonary bleeding caused by IPA. Twenty-one patients (15/46) deceased in this series, 12 of them succumbed to IPA, 1 died from cerebral invasive aspergillosis, while in 9 patients the cause of death was not primarily IPA. Manifest pulmonary hemorrhage occurred in 19% (9

  13. Co-infection of invasive pulmonary aspergillosis and cutaneous Fusarium infection in a patient with pyoderma gangrenosum

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    Nasrin Amirrajab

    2015-01-01

    Full Text Available We report an unusual case of co-infection of invasive pulmonary aspergillosis (IPA and fusarial skin infection in a patient with classic pyoderma gangrenosum with unknown causes, which were previously controlled with oral prednisolone, cyclosporine. The diagnosis was made on direct microscopy and culture of endobronchial washing, bronchoalveolar lavage and skin lesion biopsy. The treatment failed, and the patient expired 12 days following hospitalization. This report highlights the rarity of coexistence of IPA and a chronic fusarial skin infection and thereby reinforcing the physician′s attention toward the possibility of invasive fungal infection in the immunosuppressed patients.

  14. The T788G Mutation in the cyp51C Gene Confers Voriconazole Resistance in Aspergillus flavus Causing Aspergillosis

    OpenAIRE

    Liu, Wei; Sun, Yi; Chen, Wei; Liu, Weixia; Wan, Zhe; Bu, Dingfang; Li, Ruoyu

    2012-01-01

    With voriconazole (VRC) being approved as the first choice in treating invasive aspergillosis (IA) and its increasing use in treatment, a VRC-resistant strain of Aspergillus flavus, the second leading cause of IA after Aspergillus fumigatus, has emerged. The VRC-resistant strain of A. flavus was isolated for the first time from the surgical lung specimen of an IA patient with no response to VRC therapy. In order to ascertain the mechanism of VRC resistance, the azole target enzyme genes in th...

  15. Successful management of pulmonary hemorrhage and aspergillosis in a patient with acute myeloid leukemia (AML-M3

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    Hulya Gunbatar

    2015-01-01

    Full Text Available A 35-year-old man presented with a one month history of gingival bleeding. He was diagnosed with Acute Myeloid Leukemia (AML-M3. During treatment he developed alveolar hemorrhage for which he was treated with a steroid. After the steroid treatment he developed a nodule, a cavitary lesion and atelectasia in the left lung. He was treated with voriconazole. After therapy with voriconazole his lesion significantly decreased. This case illustrates the efficacy and safety of antifungal therapy with voriconazole for aspergillosis complicated by AML.

  16. Initial CT manifestations of invasive pulmonary aspergillosis in 45 non-HIV immunocompromised patients: association with patient outcome?

    Energy Technology Data Exchange (ETDEWEB)

    Horger, Marius [Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)]. E-mail: mshorger@med.uni-tuebingen.de; Hebart, Holger [Department of Internal Medicine-Oncology, Eberhard-Karls-University, Ottfried-Mueller-Str. 5, 72070 Tuebingen (Germany); Einsele, Hermann [Department of Internal Medicine-Oncology, Eberhard-Karls-University, Ottfried-Mueller-Str. 5, 72070 Tuebingen (Germany); Lengerke, Claudia [Department of Internal Medicine-Oncology, Eberhard-Karls-University, Ottfried-Mueller-Str. 5, 72070 Tuebingen (Germany); Claussen, C.D. [Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany); Vonthein, Reinhard [Department of Medical Biometry, Eberhard-Karls-University Tuebingen, Westbahnhofstrasse 55, 72070 Tuebingen (Germany); Pfannenberg, Christina [Department of Diagnostic Radiology, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076 Tuebingen (Germany)

    2005-09-01

    Purpose: To assess early high-resolution computer tomographic (CT) signs of invasive pulmonary aspergillosis (IPA) in non-HIV immunosuppressed patients and their potential association with patient's outcome, including frequency and severity of pulmonary hemorrhage, taking also in consideration the impact of other known risk factors contributory to IPA. Material and methods: A retrospective review of serial CT scans was performed in 45 immunocompromised patients with a total of 46 episodes of invasive pulmonary aspergillosis. All patients underwent CT beginning with the day they showed clinical or laboratory signs of infection. Serial follow-up CT included more than two, up to 12 CT examinations. Patient's outcome was judged by clinical and radiological follow-up and classified as survival, death by IPA, or death unrelated to IPA. The influence of patient's age, underlying disease, hematopoietic stem cell transplantation, neutropenia, graft versus host disease, and antifungal therapy onset was also statistically considered. Results: Three main CT findings were identified: small nodules (<1 cm) 43% (20/46), large nodules 21% (10/46) and consolidations, either in patchy {+-} segmental 26% (12/46), or peribronchial distribution {+-} tree in bud 9% (4/46). In 11 patients (24%) we found a combination of two or more of these signs: 9 (19%) patients presented concurrent small nodules accompanied by reticulation, tree in bud or peribronchial infiltrates, while 2 (4%) patients showed large pulmonary nodules accompanied by large consolidations. An accompanying 'halo' sign was observed in 38 patients (82%). Crescent sign followed by cavitation was encountered in 29 patients (63%). Two patients succumbed to massive pulmonary bleeding caused by IPA. Twenty-one patients (15/46) deceased in this series, 12 of them succumbed to IPA, 1 died from cerebral invasive aspergillosis, while in 9 patients the cause of death was not primarily IPA. Manifest pulmonary

  17. The Plasmair Decontamination System Is Protective Against Invasive Aspergillosis in Neutropenic Patients.

    Science.gov (United States)

    Fernandez-Gerlinger, Marie-Paule; Jannot, Anne-Sophie; Rigaudeau, Sophie; Lambert, Juliette; Eloy, Odile; Mignon, François; Farhat, Hassan; Castaigne, Sylvie; Merrer, Jacques; Rousselot, Philippe

    2016-07-01

    OBJECTIVE Invasive aspergillosis (IA) is a rare but severe infection caused by Aspergillus spp. that often develops in immunocompromised patients. Lethality remains high in this population. Therefore, preventive strategies are of key importance. The impact of a mobile air decontamination system (Plasmair, AirInSpace, Montigny-le-Bretonneux, France) on the incidence of IA in neutropenic patients was evaluated in this study. DESIGN Retrospective cohort study METHODS Patients with chemotherapy-induced neutropenia lasting 7 days or more were included over a 2-year period. Cases of IA were confirmed using the revised European Organization for Research and Treatment of Cancer (EORTC) criteria. We took advantage of a partial installation of Plasmair systems in the hematology intensive care unit during this period to compare patients treated in Plasmair-equipped versus non-equipped rooms. Patients were assigned to Plasmair-equipped or non-equipped rooms depending only on bed availability. Differences in IA incidence in both groups were compared using Fisher's exact test, and a multivariate analysis was performed to take into account potential confounding factors. RESULTS Data from 156 evaluable patients were available. Both groups were homogenous in terms of age, gender, hematological diagnosis, duration of neutropenia, and prophylaxis. A total of 11 cases of probable IA were diagnosed: 10 in patients in non-equipped rooms and only 1 patient in a Plasmair-equipped room. The odds of developing IA were much lower for patients hospitalized in Plasmair-equipped rooms than for patients in non-equipped rooms (P=.02; odds ratio [OR] =0.11; 95% confidence interval [CI], 0.00-0.84). CONCLUSION In this study, Plasmair demonstrated a major impact in reducing the incidence of IA in neutropenic patients with hematologic malignancies. Infect Control Hosp Epidemiol 2016;37:845-851. PMID:27340735

  18. Common Genetic Polymorphisms within NFκB-Related Genes and the Risk of Developing Invasive Aspergillosis

    Science.gov (United States)

    Lupiañez, Carmen B.; Villaescusa, María T.; Carvalho, Agostinho; Springer, Jan; Lackner, Michaela; Sánchez-Maldonado, José M.; Canet, Luz M.; Cunha, Cristina; Segura-Catena, Juana; Alcazar-Fuoli, Laura; Solano, Carlos; Fianchi, Luana; Pagano, Livio; Potenza, Leonardo; Aguado, José M.; Luppi, Mario; Cuenca-Estrella, Manuel; Lass-Flörl, Cornelia; Einsele, Hermann; Vázquez, Lourdes; Ríos-Tamayo, Rafael; Loeffler, Jurgen; Jurado, Manuel; Sainz, Juan

    2016-01-01

    Invasive Aspergillosis (IA) is an opportunistic infection caused by Aspergillus, a ubiquitously present airborne pathogenic mold. A growing number of studies suggest a major host genetic component in disease susceptibility. Here, we evaluated whether 14 single-nucleotide polymorphisms within NFκB1, NFκB2, RelA, RelB, Rel, and IRF4 genes influence the risk of IA in a population of 834 high-risk patients (157 IA and 677 non-IA) recruited through a collaborative effort involving the aspBIOmics consortium and four European clinical institutions. No significant overall associations between selected SNPs and the risk of IA were found in this large cohort. Although a hematopoietic stem cell transplantation (HSCT)-stratified analysis revealed that carriers of the IRF4rs12203592T/T genotype had a six-fold increased risk of developing the infection when compared with those carrying the C allele (ORREC = 6.24, 95%CI 1.25–31.2, P = 0.026), the association of this variant with IA risk did not reach significance at experiment-wide significant threshold. In addition, we found an association of the IRF4AATC and IRF4GGTC haplotypes (not including the IRF4rs12203592T risk allele) with a decreased risk of IA but the magnitude of the association was similar to the one observed in the single-SNP analysis, which indicated that the haplotypic effect on IA risk was likely due to the IRF4rs12203592 SNP. Finally, no evidence of significant interactions among the genetic markers tested and the risk of IA was found. These results suggest that the SNPs on the studied genes do not have a clinically relevant impact on the risk of developing IA.

  19. Genome-wide Expression Profiling Reveals S100B as Biomarker for Invasive Aspergillosis

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    Andreas eDix

    2016-03-01

    Full Text Available Invasive aspergillosis (IA is a devastating opportunistic infection and its treatment constitutes a considerable burden for the health care system. Immunocompromised patients are at an increased risk for IA, which is mainly caused by the species Aspergillus fumigatus. An early and reliable diagnosis is required to initiate the appropriate antifungal therapy. However, diagnostic sensitivity and accuracy still needs to be improved, which can be achieved at least partly by the definition of new biomarkers. Besides the direct detection of the pathogen by the current diagnostic methods, the analysis of the host response is a promising strategy towards this aim. Following this approach, we sought to identify new biomarkers for IA. For this purpose, we analyzed gene expression profiles of haematological patients and compared profiles of patients suffering from IA with non-IA patients. Based on microarray data, we applied a comprehensive feature selection using a random forest classifier. We identified the transcript coding for the S100 calcium-binding protein B (S100B as a potential new biomarker for the diagnosis of IA. Considering the expression of this gene, we were able to classify samples from patients with IA with 82.3% sensitivity and 74.6% specificity. Moreover, we validated the expression of S100B in a real-time reverse transcription polymerase chain reaction (RT-PCR assay and we also found a down-regulation of S100B in A. fumigatus stimulated DCs. An influence on the IL1B and CXCL1 downstream levels was demonstrated by this S100B knockdown. In conclusion, this study covers an effective feature selection revealing a key regulator of the human immune response during IA. S100B may represent an additional diagnostic marker that in combination with the established techniques may improve the accuracy of IA diagnosis.

  20. Genome-Wide Expression Profiling Reveals S100B as Biomarker for Invasive Aspergillosis.

    Science.gov (United States)

    Dix, Andreas; Czakai, Kristin; Springer, Jan; Fliesser, Mirjam; Bonin, Michael; Guthke, Reinhard; Schmitt, Anna L; Einsele, Hermann; Linde, Jörg; Löffler, Jürgen

    2016-01-01

    Invasive aspergillosis (IA) is a devastating opportunistic infection and its treatment constitutes a considerable burden for the health care system. Immunocompromised patients are at an increased risk for IA, which is mainly caused by the species Aspergillus fumigatus. An early and reliable diagnosis is required to initiate the appropriate antifungal therapy. However, diagnostic sensitivity and accuracy still needs to be improved, which can be achieved at least partly by the definition of new biomarkers. Besides the direct detection of the pathogen by the current diagnostic methods, the analysis of the host response is a promising strategy toward this aim. Following this approach, we sought to identify new biomarkers for IA. For this purpose, we analyzed gene expression profiles of hematological patients and compared profiles of patients suffering from IA with non-IA patients. Based on microarray data, we applied a comprehensive feature selection using a random forest classifier. We identified the transcript coding for the S100 calcium-binding protein B (S100B) as a potential new biomarker for the diagnosis of IA. Considering the expression of this gene, we were able to classify samples from patients with IA with 82.3% sensitivity and 74.6% specificity. Moreover, we validated the expression of S100B in a real-time reverse transcription polymerase chain reaction (RT-PCR) assay and we also found a down-regulation of S100B in A. fumigatus stimulated DCs. An influence on the IL1B and CXCL1 downstream levels was demonstrated by this S100B knockdown. In conclusion, this study covers an effective feature selection revealing a key regulator of the human immune response during IA. S100B may represent an additional diagnostic marker that in combination with the established techniques may improve the accuracy of IA diagnosis. PMID:27047454

  1. Bone suppression increases the visibility of invasive pulmonary aspergillosis in chest radiographs.

    Directory of Open Access Journals (Sweden)

    Steven Schalekamp

    Full Text Available Chest radiographs (CXR are an important diagnostic tool for the detection of invasive pulmonary aspergillosis (IPA in critically ill patients, but their diagnostic value is limited by a poor sensitivity. By using advanced image processing, the aim of this study was to increase the value of chest radiographs in the diagnostic work up of neutropenic patients who are suspected of IPA.The frontal CXRs of 105 suspected cases of IPA were collected from four institutions. Radiographs could contain single or multiple sites of infection. CT was used as reference standard. Five radiologists and two residents participated in an observer study for the detection of IPA on CXRs with and without bone suppressed images (ClearRead BSI 3.2; Riverain Technologies. The evaluation was performed separately for the right and left lung, resulting in 78 diseased cases (or lungs and 132 normal cases (or lungs. For each image, observers scored the likelihood of focal infectious lesions being present on a continuous scale (0-100. The area under the receiver operating characteristics curve (AUC served as the performance measure. Sensitivity and specificity were calculated by considering only the lungs with a suspiciousness score of greater than 50 to be positive.The average AUC for only CXRs was 0.815. Performance significantly increased, to 0.853, when evaluation was aided with BSI (p = 0.01. Sensitivity increased from 49% to 66% with BSI, while specificity decreased from 95% to 90%.The detection of IPA in CXRs can be improved when their evaluation is aided by bone suppressed images. BSI improved the sensitivity of the CXR examination, outweighing a small loss in specificity.

  2. Clinical and economic analysis of voriconazole using for treatment of invasive aspergillosis in Russian Federation

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    V. I. Ignatieva

    2015-06-01

    Full Text Available Introduction. Based on clinical studies data voriconazole is recommended as the drug of choice for treatment of invasive aspergillosis (IA – a widespread infectious complications occurring in immunocompromised patients and is characterized by severe clinical course and high mortality.The aim of this study was to assess the cost-effectiveness of voriconazole compared to other preparations recommended in the Russian practice for the treatment of IA in adult patients.Materials and methods. The authors constructed a «decision tree» type of model, which compared the three treatment alternatives for the IA in adult patients, depending on the drug in first-line therapy: 1 voriconazole, 2, caspofungin, or 3 amphotericin B lipid complex (LC. Efficacy was assessed as the probability of patient survival within 14 weeks of starting treatment. We took into account the drugs cost and an increase in the hospitalization duration due to the development of serious adverse events. The model parameters were determined on the basis of the published results of clinical studies, the costs were calculated on the basis of medicines prices in the public procurement and the average bed-day cost in system of obligatory health insurance. Probabilistic sensitivity analysis was performed.Results. It has been shown that the use of voriconazole for treatment of IA is the dominant strategy compared to the use of caspofungin and amphotericin B LC, providing cost reduction while achieving maximum effect. Probabilistic sensitivity analysis (1000 simulations showed stability of the revealed pattern.Conclusion. The use of voriconazole in the treatment of IA allows to save the greatest number of lives at minimal cost compared to other preparations recommended in the Russian practice.

  3. Implementation of different histochemical methods in diagnostics of brain Aspergillosis in turkey chicks

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    Kureljušić Branislav

    2011-01-01

    Full Text Available Aspergillosis is a frequent fungal disease in different species of birds and mammals caused by fungi of the genus Aspergillus. It is characterized by inflammatory changes primarily in the respiratory system, even though it sometimes takes on a generalized form when several organ systems are affected. Mucotic-granulomatous meningoencephalitis with a predominant localization in the cerebellum has been described in turkeys, ducks and geese. Within this paper, examinations have been performed on a flock of broiler turkeys aged 12 days who had sustained evident neurological disorders in the form of ataxy, torticollis, paresis, and paralysis of the hind extremities and wings. In three of the ten autopsied chicks the macroscopic findings indicated granulomatous encephalitis of the cerebellum. A white-coloured granuloma, around 3mm in diameter, was situated cranioventrally and was clearly visible on the sagital section of the cerebellum. Mucological examinations of the cerebellum lesion resulted in the isolation of the fungi Aspergillus fumigatus. Haematoxylin-eosin (HE, Grocott and PAS methods were used for the evaluation of histopathological changes and proving Aspergillus fumigatusa hyphae. The microscopic examination of brain tissue sections stained with the HE method revealed the existence of a granuloma with a centrally placed necrotic area. The necrotic area was infiltrated with heterophilic granulocytes and surrounded by macrophage, giant cells and lymphocytes. A connective tissue capsule was located on the periphery of the granuloma. The fungi hyphae, as integral parts of the granuloma, were difficult to observe, and in some samples stained using the HE method they could not be seen at all. On the other hand, sections stanied using the Grocott and PAS methods showed prominent septed and branched hyphae in different parts of the granuloma. With the objective of making an etiological diagnosis of mucotic diseases, it is necessary to apply several

  4. Antigenic and anticorpal diagnosis of invasive aspergillosis and candidosis in immunocompromised host

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    Marco Machetti

    2009-03-01

    Full Text Available Invasive aspergillosis (IA and candidemia are an increasing cause of morbidity and mortality in immunocompromised patients, but diagnostic procedures are often hampered by critical patients conditions. In recent years, non-culture methods have reached a standardization level suitable to be marketed and widely employed. A method for a panfungal antigenic diagnosis, is the detection in serum of (1→3-ß-D-Glucan (BDG, a polisaccaridic component of fungal cell wall. Best results can be obtained in Aspergillus, Candida and Fusarium infections, while the test performs poorly with Cryptococcus and in zygomycosis. The use of this method are limited by the high costs and by the need of disposable materials certified as glucan-free, in order to avoid false positive results. Galactomannan (GM antigen detection is a method for non-invasive diagnosis of IA. The assay, in latex agglutination (LA and enzymeimmunoassay (EIA format, detect GM in serum, whose presence correlates with IA. Sensitivity and specificity strongly fluctuate (50-100% and 81-98% respectively depending on the time of sampling, the positivity cut-off employed, the concomitant administration of antifungal drugs and of some antibiotics. Nevertheless the method is a very useful and widely employed tool for the diagnosis of IA. For the diagnosis of candidemia, two Candida antigens may be detected in serum: the 56°C heat-labile antigen in LA format, and the mannan antigen, in LA and EIA format. Both the methods perform quite well, but sensitivities and specificities are not so good to allow a routinely and useful use in clinical practice.

  5. Pulmonary aspergillosis as first manifestation of chronic granulomatous disease in enzygotic twins-use of FDG-PET in diagnosing spread of disease

    International Nuclear Information System (INIS)

    Purpose. To present the unusual case of chronic granulomatous disease (CGD) manifestating as pulmonal aspergillosis in female enzygotic twins during the neonatal period. To demonstrate and to discuss the complex diagnosis and the diagnostic value of FDG-PET in monitoring the spread and activity of the disease. Patients. Plain chest X-ray and CT of the lung showed multiple, mostly round lesions in one of the former preterm twins at the age of 8 weeks. The girl with known ASD II was then suffering from dyspnoea and recurrent pulmonary infections. Because of the imaging findings invasive pulmonary aspergillosis due to an underlying immunodeficiency was suspected. Results. Aspergillosis was confirmed histologically and microbiologically by specimens taken from an open lung biopsy. Because of coexisting granulocytic dysfunction the diagnosis of CGD was made. This diagnosis was equally confirmed by noninvasive methods in the asymptomatic sister. FDG-PET did not show any evidence of extrapulmonary spread of disease. Conclusion. CGD can present as isolated pulmonal aspergillosis even in the neonatal period when an immunodeficiency is discussed. In enzygotic twins screening of the asymptomatic twin is mandatory. FDG-PET is a useful tool in screening for spread of the disease and in evaluating disease activity. (orig.)

  6. Comparison of topical administration of clotrimazole through surgically placed versus nonsurgically placed catheters for treatment of nasal aspergillosis in dogs: 60 cases (1990-1996)

    International Nuclear Information System (INIS)

    To examine the clinical response to topical administration of clotrimazole in dogs with nasal aspergillosis, to compare effect of surgically placed versus nonsurgically placed catheters used for administration on outcome, and to examine whether subjective scoring of computed tomographic images can predict outcome. Retrospective case series. 60 dogs with nasal aspergillosis. Information including signalment, history, diagnostics, treatment method, and outcome was retrieved from medical records of dogs with nasal aspergillosis treated between 1990 and 1996 at the University of California School of Veterinary Medicine or cooperating referral practices. Final outcome was determined by telephone conversations with owners and referring veterinarians. Images obtained before treatment were subjectively assessed to develop an algorithm for predicting outcome. Clotrimazole solution (1%) was infused during a 1-hour period via catheters surgically placed in the frontal sinus and nose (27 dogs) and via nonsurgically placed catheters in the nose (18). An additional 15 dogs received 2 to 4 infusions by either route. Topical administration of clotrimazole resulted in resolution of clinical disease in 65% of dogs after 1 treatment and 87% of dogs after one or more treatments. The scoring system correctly classified dogs with unfavorable and favorable responses 71 to 78% and 79 to 93% of the time, respectively. Topical administration of clotrimazole, using either technique, was an effective treatment for nasal aspergillosis in dogs. Use of non-invasive intranasal infusion of clotrimazole eliminated the need for surgical trephination of frontal sinuses in many dogs and was associated with fewer complications

  7. Cost analysis of voriconazole versus liposomal amphotericin B for primary therapy of invasive aspergillosis among patients with haematological disorders in Germany and Spain

    OpenAIRE

    Ostermann, Helmut; Solano, Carlos; Jarque, Isidro; Garcia-Vidal, Carolina; Gao, Xin; Barrueta, Jon Andoni; De Salas-Cansado, Marina; Stephens, Jennifer; Xue, Mei; Weber, Bertram; Charbonneau, Claudie

    2014-01-01

    Background: The current healthcare climate demands pharmacoeconomic evaluations for different treatment strategies incorporating drug acquisition costs, costs incurred for hospitalisation, drug administration and preparation, diagnostic and laboratory testing and drug-related adverse events (AEs). Here we evaluate the pharmacoeconomics of voriconazole versus liposomal amphotericin B as first-line therapies for invasive aspergillosis (IA) in patients with haematological malignancy and prolonge...

  8. Enhanced antifungal efficacy in experimental invasive pulmonary aspergillosis by combination of AmBisome with Fungizone as assessed by several parameters of antifungal response

    NARCIS (Netherlands)

    M.J. Becker (Martin); S. de Marie (Siem); M.H.A.M. Fens (Marcel); W.C.J. Hop (Wim); H.A. Verbrugh (Henri); I.A.J.M. Bakker-Woudenberg (Irma)

    2002-01-01

    textabstractIn common with a proportion of patients with invasive pulmonary aspergillosis (IPA), the efficacy of AmBisome treatment regimens in our rat model remains suboptimal. To investigate whether this might be the result of initially low antifungal activity of amphotericin B a

  9. Immunodiagnosis of systemic aspergillosis. I. Antigenemia detected by radioimmunoassay in experimental infection. [/sup 125/I tracer technique

    Energy Technology Data Exchange (ETDEWEB)

    Weiner, M.H.; Coats-Stephen, M.

    1979-01-01

    Because systemic aspergillosis is difficult to diagnose ante mortem, a study to improve immunodiagnosis was undertaken in a rabbit model of disseminated infection. We found that the predominant humoral response of infected animals was directed against four Aspergillus antigens identified by crossed immunoelectrophoresis. One of these antigens, a cell-wall carbohydrate, was purified by gel-filtration chromatography and was used to develop a radiommunoassay. The sensitivity of this assay was increased by testing for serum-bound antigen as well as for free antigen. When the sensitivity of the RIA was evaluated in the animal model, antigenemia was detected in 78% of 51 rabbits with disseminated infection and ante mortem in 86% of 42 rabbits with lethal infection. By contrast, with immunoprecipitin analysis only eight of 51 rabbits were positive for antigen, and six of 51 rabbits were positive for Aspergillus antibody. The specificity of the RIA was also tested. Negative controls for antigen included sera from 76 normal rabbits and sera from 25 rabbits with systemic candidiasis. The Candida control group is pertinent because 48% of these rabbits had specific Candida antigenemia detected by a mannan RIA. This study demonstrates that Aspergillus antigenemia occurs during the course of experimental disseminated aspergillosis and illustrates the potential of an Aspergillus antigen RIA for sensitive, specific immunodiagnosis of human infections.

  10. Correlation between Circulating Fungal Biomarkers and Clinical Outcome in Invasive Aspergillosis.

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    Dionysios Neofytos

    Full Text Available Objective means are needed to predict and assess clinical response in patients treated for invasive aspergillosis (IA. We examined whether early changes in serum galactomannan (GM and/or β-D-glucan (BDG can predict clinical outcomes. Patients with proven or probable IA were prospectively enrolled, and serial GM and BDG levels and GM optical density indices (GMI were calculated twice weekly for 6 weeks following initiation of standard-of-care antifungal therapy. Changes in these biomarkers during the first 2 and 6 weeks of treatment were analyzed for associations with clinical response and survival at weeks 6 and 12. Among 47 patients with IA, 53.2% (25/47 and 65.9% (27/41 had clinical response by weeks 6 and 12, respectively. Changes in biomarkers during the first 2 weeks were associated with clinical response at 6 weeks (GMI, P = 0.03 and 12 weeks (GM+BDG composite, P = 0.05; GM, P = 0.04; GMI, P = 0.02. Changes in biomarkers during the first 6 weeks were also associated with clinical response at 6 weeks (GM, P = 0.05; GMI, P = 0.03 and 12 weeks (BDG+GM, P = 0.02; GM, P = 0.02; GMI, P = 0.01. Overall survival rates at 6 weeks and 12 weeks were 87.2% (41/47 and 79.1% (34/43, respectively. Decreasing biomarkers in the first 2 weeks were associated with survival at 6 weeks (BDG+GM, P = 0.03; BDG, P = 0.01; GM, P = 0.03 and at 12 weeks (BDG+GM, P = 0.01; BDG, P = 0.03; GM, P = 0.01; GMI, P = 0.007. Similar correlations occurred for biomarkers measured over 6 weeks. Patients with negative baseline GMI and/or persistently negative GMI during the first 2 weeks were more likely to have CR and survival. These results suggest that changes of biomarkers may be informative to predict and/or assess response to therapy and survival in patients treated for IA.

  11. Gamma scintigraphy imaging of murine invasive pulmonary aspergillosis with a 111In-labeled cyclic peptide

    International Nuclear Information System (INIS)

    Introduction: Invasive pulmonary aspergillosis (IPA) is a leading cause of infection-associated death in immunosuppressed patients. Early detection and early administration of antifungal therapy are critical factors in improving outcome for patients with IPA. Here, we evaluated the imaging properties of a 111In-labeled cyclic peptide targeted to Aspergillus fumigatus in an immunosuppressed murine model of IPA. Methods: A cyclic peptide c(CGGRLGPFC)-NH2 was labeled with 111In by means of diethylenetriaminepentaacetic acid (DTPA). Two days after intranasal inoculation of 17.5x106 conidia of A. fumigatus, mice were injected 111In-DTPA-c(CGGRLGPFC)-NH2 intravenously. Biodistribution data were obtained at 2 h, and γ-images were acquired at 10 min and 2 h after radiotracer injection. Healthy mice were used as controls. In addition, a group of infected mice were co-injected with the radiotracer and unlabeled c(CGGRLGPFC)-NH2 to evaluate the inhibition of radiotracer's binding to infected lungs. Autoradiographs of lungs from infected and healthy mice were compared with corresponding photographs of transaxial sections of the lung tissues stained for A. fumigatus hyphae. Results: The labeling efficiency was >98%, with specific radioactivity of up to 74 MBq/nmol peptide. Significantly higher uptake of 111In-DTPA-c(CGGRLGPFC)-NH2 was observed in the lungs of mice infected with A. fumigatus than in those of healthy mice (0.37±0.06 %ID/g vs. 0.14±0.02 %ID/g, P=.00044). Simultaneous injection with unlabeled peptide reduced radioactivity in the infected lungs by 41% (P=.0037). Increased radioactivity in the lungs of infected mice was visible in γ images at both 10 min and 2 h after radiotracer injection. Moreover, autoradiography confirmed radiotracer uptake in infected lungs, but not in the lungs of healthy mice or infected mice co-injected with unlabeled peptide. Conclusions: γ-Imaging with 111In-DTPA-c(CGGRLGPFC)-NH2 clearly delineated experimental IPA in mice. Peptides

  12. Detection of a Serum Siderophore by LC-MS/MS as a Potential Biomarker of Invasive Aspergillosis

    Science.gov (United States)

    Carroll, Cassandra S.; Amankwa, Lawrence N.; Pinto, Linda J.; Fuller, Jeffrey D.; Moore, Margo M.

    2016-01-01

    Invasive aspergillosis (IA) is a life-threatening systemic mycosis caused primarily by Aspergillus fumigatus. Early diagnosis of IA is based, in part, on an immunoassay for circulating fungal cell wall carbohydrate, galactomannan (GM). However, a wide range of sensitivity and specificity rates have been reported for the GM test across various patient populations. To obtain iron in vivo, A. fumigatus secretes the siderophore, N,N',N"-triacetylfusarinine C (TAFC) and we hypothesize that TAFC may represent a possible biomarker for early detection of IA. We developed an ultra performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) method for TAFC analysis from serum, and measured TAFC in serum samples collected from patients at risk for IA. The method showed lower and upper limits of quantitation (LOQ) of 5 ng/ml and 750 ng/ml, respectively, and complete TAFC recovery from spiked serum. As proof of concept, we evaluated 76 serum samples from 58 patients with suspected IA that were investigated for the presence of GM. Fourteen serum samples obtained from 11 patients diagnosed with probable or proven IA were also analyzed for the presence of TAFC. Control sera (n = 16) were analyzed to establish a TAFC cut-off value (≥6 ng/ml). Of the 36 GM-positive samples (≥0.5 GM index) from suspected IA patients, TAFC was considered positive in 25 (69%). TAFC was also found in 28 additional GM-negative samples. TAFC was detected in 4 of the 14 samples (28%) from patients with proven/probable aspergillosis. Log-transformed TAFC and GM values from patients with proven/probable IA, healthy individuals and SLE patients showed a significant correlation with a Pearson r value of 0.77. In summary, we have developed a method for the detection of TAFC in serum that revealed this fungal product in the sera of patients at risk for invasive aspergillosis. A prospective study is warranted to determine whether this method provides improved early detection of IA. PMID:26974544

  13. Combination antifungal therapy and surgery for the treatment of invasive pulmonary aspergillosis after hematopoietic stem cell transplantation

    Directory of Open Access Journals (Sweden)

    Tiziana Toffolutti

    2011-06-01

    Full Text Available An 8-year old boy, affected by severe aplastic anemia, developed a probable pulmonary invasive aspergillosis (IA early after a second unrelated allogeneic hematopoietic stem cell transplant (HSCT. He was treated promptly with the combination of liposomal amphotericin B and caspofungin. Despite the initial stabilization, the patient deteriorated and the antifungal therapy was switched to voriconazole and caspofungin. The patient gradually improved and was discharged home on day +29 post-HSCT on oral voriconazole. On day +119, a sudden episode of hemoptysis occurred and a right superior lobectomy was decided to remove the residual aspergilloma. The patient is now alive and well more than 24 months from HSCT. This case demonstrated that antifungal combination therapy and surgery are valid options to cure pulmonary IA even in patients at high-risk and severely immunosuppressed.

  14. Analysis of initial and follow-up CT findings in patients with invasive pulmonary aspergillosis after solid organ transplantation

    International Nuclear Information System (INIS)

    Aim: To assess initial and follow-up CT findings of invasive pulmonary aspergillosis (IPA) in solid organ transplant (SOT) recipients using new diagnostic criteria, and to compare initial CT findings of survivors with those of patients who died. Materials and methods: Forty-six adult SOT patients who met the 2008 EORTC/MSG criteria for proven or probable invasive pulmonary aspergillosis were assessed. Initial CT findings of the 21 survivors and 15 patients who died of IPA-related causes were compared using the internationally recognized thoracic glossary of terms. The extents of the largest lesions in each of 18 surviving were measured and changes of those lesions were recorded. Results: Consolidation or mass was the most common finding, observed in 33 of 46 patients (72%), followed by large nodules (59%), ground-glass opacity (50%), and infarcted consolidation (48%). Consolidation or mass was significantly less frequent in survivors than in patients who died (62% versus 93%). Cavitation was more common (43% versus 13%), and significantly smaller (7.5 cm2 versus 19 cm2, p = 0.014) in survivors. Follow-up CT in survivors showed that the halo sign resolved rapidly within 4 weeks. The extent of consolidation, infarcted consolidation, and internal low-density area decreased gradually with time to reduce to half the size in 3 weeks. Large nodules persisted for the first 7 days (84%), followed by slow regression. Conclusion: Consolidation or mass is the most common CT finding of IPA in SOT recipients. Absence of consolidation or mass and presence of small cavities may be associated with better prognosis. The time for resolution of each pattern after treatment varies.

  15. Aspergillosis Superinfection as a Cause of Death of Crizotinib-Induced Interstitial Lung Disease Successfully Treated with High-Dose Corticosteroid Therapy

    Directory of Open Access Journals (Sweden)

    Laura Deiana

    2015-03-01

    Full Text Available Crizotinib is an efficacious and well-tolerated drug in the management of ALK-positive lung cancer. Crizotinib treatment, however, is rarely complicated by the occurrence of acute interstitial lung disease (ILD that is often fatal. There is no treatment for this serious adverse event. We report a female non-small cell lung cancer patient who developed ILD after a few days of crizotinib therapy. She showed a significant improvement after a high dose of pulse corticosteroid therapy, both radiologically and clinically. Unfortunately, the patient subsequently developed an aspergillosis superinfection leading to death. Our experience suggests that high-dose steroid therapy may be efficacious in the management of a severe complication of crizotinib therapy. However, potent antifungal therapy should be considered to prevent the risk of severe aspergillosis.

  16. Pharmacodynamic Activity of Amphotericin B Deoxycholate Is Associated with Peak Plasma Concentrations in a Neutropenic Murine Model of Invasive Pulmonary Aspergillosis

    OpenAIRE

    Wiederhold, Nathan P.; Tam, Vincent H.; Chi, Jingduan; Prince, Randall A.; Kontoyiannis, Dimitrios P.; Lewis, Russell E.

    2006-01-01

    We conducted a dose fractionation study of neutropenic, corticosteroid-immunosuppressed mice to characterize the pharmacodynamic/pharmacokinetic (PK/PD) parameter most closely associated with amphotericin B (AMB) efficacy in the treatment of invasive pulmonary aspergillosis. Pharmacokinetic parameter estimates were determined by a nonparametric population pharmacokinetic analysis of plasma drug concentrations following single intraperitoneal doses (0.25, 1.0, and 3.0 mg/kg of body weight) of ...

  17. Activity of voriconazole (UK-109,496) against clinical isolates of Aspergillus species and its effectiveness in an experimental model of invasive pulmonary aspergillosis.

    OpenAIRE

    Murphy, M.; Bernard, E M; Ishimaru, T.; Armstrong, D.

    1997-01-01

    Voriconazole, a new azole antifungal agent, showed potent activity against clinical isolates of Aspergillus spp. in vitro. For A. fumigatus, the MIC range was < 0.03 to 0.5 microgram/ml and the MIC at which 90% of isolates are inhibited was 0.25 microgram/ml. In an experimental model of invasive pulmonary aspergillosis which mimics infection in humans, oral voriconazole at dosages of 30 mg/kg of body weight per day significantly delayed or prevented mortality.

  18. Outcome and medical costs of patients with invasive aspergillosis and acute myelogenous leukemia-myelodysplastic syndrome treated with intensive chemotherapy: An observational study

    OpenAIRE

    Slobbe, Lennert; Polinder, Suzanne; Doorduijn, Jeanette; Lugtenburg, Pieternella; Barzouhi, Abdelilah; Steyerberg, Ewout; Rijnders, Bart

    2008-01-01

    textabstractBackground. Invasive aspergillosis (IA) is a leading cause of mortality in patients with acute leukemia. Management of IA is expensive, which makes prevention desirable. Because hospital resources are limited, prevention costs have to be compared with treatment costs and outcome. Methods. In 269 patients treated for acute myelogenous leukemia-myelodysplastic syndrome (AML-MDS) during 2002-2007, evidence of IA was collected using high-resolution computed tomography and galactomanna...

  19. Use of Mesenchymal Cells to Modulate Immune Suppression and Immune Reconstruction in a Patient with Aplastic Anemia Complicated by Invasive Sino-Orbital Aspergillosis

    OpenAIRE

    Hakan Özdoğu; Mahmut Yeral; Can Boğa; İlknur Kozanoğlu

    2014-01-01

    Cultured human bone marrow mesenchymal cells (MSCs) have immunomodulatory and tissue regenerative properties. This report summarizes the result of post-transplant treatment with MSCs of a 26-year-old patient with aplastic anemia complicated by invasive sino-orbital aspergillosis. The patient was treated with MSCs to benefit from the dual effects of MSCs in immune reconstitution: suppression against alloreactive T cells and facilitation of the re-engraftment process. The patient did not develo...

  20. Prevalence of Allergic Broncho Pulmonary Aspergillosis in patients with Asthma attending allergy clinic in a North West Indian Tertiary Care Institute

    OpenAIRE

    Mathur, Navgeet; Mathur, Medha

    2016-01-01

    Context: Allergic Broncho Pulmonary Aspergillosis (ABPA) is an allergic disorder. Aspergillus fumigatus is the most common pathogen responsible for occurrence of ABPA. There can be serious consequences of ABPA including worsening of symptoms of asthma and more sinister complications like extensive fibrosis and bronchiectasis.Aims: To find out the prevalence of ABPA among asthma patients and association of former with factors like age, sex, occupation, family history of bronchial asthma, socio...

  1. Genetically-Determined Hyperfunction of the S100B/RAGE Axis Is a Risk Factor for Aspergillosis in Stem Cell Transplant Recipients

    OpenAIRE

    Cunha, Cristina; Giovannini, Gloria; Pierini, Antonio; Alain S Bell; Sorci, Guglielmo; Riuzzi, Francesca; Donato, Rosario; Rodrigues, Fernando; Velardi, Andrea; Aversa, Franco; Romani, Luigina; Carvalho, Agostinho

    2011-01-01

    Invasive aspergillosis (IA) is a major threat to the successful outcome of hematopoietic stem cell transplantation (HSCT), although individual risk varies considerably. Recent evidence has established a pivotal role for a danger sensing mechanism implicating the S100B/receptor for advanced glycation end products (RAGE) axis in antifungal immunity. The association of selected genetic variants in the S100B/RAGE axis with susceptibility to IA was investigated in 223 consecutive patients undergoi...

  2. Detection of Aspergillus fumigatus in a Rat Model of Invasive Pulmonary Aspergillosis by Real-Time Nucleic Acid Sequence-Based Amplification▿

    OpenAIRE

    Zhao, Yanan; Park, Steven; Warn, Peter; Shrief, Raghdaa; Harrison, Elizabeth; Perlin, David S.

    2010-01-01

    Rapid and sensitive detection of Aspergillus from clinical samples may facilitate the early diagnosis of invasive pulmonary aspergillosis (IPA). A real-time nucleic acid sequence-based amplification (NASBA) method was investigated by use of an inhalational rat model of IPA. Immunosuppressed male Sprague-Dawley rats were exposed to Aspergillus fumigatus spores for an hour in an aerosol chamber. Bronchoalveolar lavage (BAL) fluid, lung tissues, and whole blood were collected from five infected ...

  3. Pnlmanory aspergillosis with tuberculosis:an analysis of 17 cases%肺结核合并肺曲霉菌病17例临床分析

    Institute of Scientific and Technical Information of China (English)

    薛卉; 杨育波; 孙莹; 张东

    2011-01-01

    目的 探讨肺结核合并肺曲霉菌病的易患因素、临床特征、治疗方法 及预后.方法 回顾性分析天津海河医院2007-2010年肺结核合并肺曲霉菌病患者17例的临床资料.结果 长期应用糖皮质激素、广谱抗生素及老龄为肺结核病并发肺曲霉菌病的风险因素.肺曲霉菌病与肺结核病的临床表现及X线表现相似.17例肺结核合并肺曲霉菌病患者经治疗后,2例死亡,15例好转.结论 临床医师应加强对结核病合并曲霉菌感染的警惕性,关注其易感因素,早期诊断,早期合理治疗是提高肺结核合并肺曲霉菌病治愈率的关键.%Objective To investigate the major predisposing factor, clinical features,diagnosis,antifungal therapy and prognosis of pulmonary aspergillosis in patients with ptdmanory tuberculosis (TB). Methods 17 cases of pulmonary aspergillosis with TB patients admitted in the Tianjin haihe hospital from 2007 to 2010 were reviewed. Results prolonged use of steroid, broad spectrum antibiotics and advance in age are risk factors of TB patients complicated with aspergillosis. The clinic and X-ray exhibitions of TB were similar to that of aspergillosis. Among the 17 cases of TB patients with aspergillosis,9 cases patients died after treated,15 cases improved, conclusion It is common that fungal infection occurred in pulmonary TB cases. Concern predisposing factor,early diagnosis,early rational treatment plays a vital role in curing TB combining with lung thread fungus infection.

  4. 侵袭性肺曲霉病20例%Invasive pulmonary aspergillosis: 20 cases

    Institute of Scientific and Technical Information of China (English)

    江浩; 赵蓓蕾; 施毅; 曹鄂洪; 宋勇; 张桂; 孙文逵

    2009-01-01

    目的 分析侵袭性肺曲霉病(IPA)的临床、影像学、病理和微生物学特征,提高对IPA的认识.方法 回顾性分析2005年1月至2008年8月我院经肺组织病理检查和(或)肺组织培养确诊的20例IPA病人的临床资料.结果 有基础疾病者(A组)13例,包括恶性肿瘤9例(其中血液系统恶性肿瘤5例)、慢性阻塞性肺疾病2例、肺结核1例、支气管扩张症1例;无基础疾病者(B组)7例,其中2例有长期绒毛玩具接触史,1例有霉变稻谷接触史,3例有污水吸入史.20例病人肺部均有病变,同一病人可以出现多种改变.16例为多发性肺部病变,其中7例为两肺多发性浸润性阴影和(或)实变影,9例为多发性结节影;4例为单发性病变,包括孤立结节影2例,节段性肺实变2例.8例(40.0%)形成空洞,空洞内均未见液平面.18例给予抗真菌药物治疗,总有效率为55.6%(10/18),A组和B组有效率分别为45.5%和5/7.治疗有效者平均症状缓解时间为(12.0±2.8)d,胸部CT检查肺部病灶好转时间为(17.4±2.9)d,胸部CT检查显效时间(34.3±9.9)d,活动性病灶基本吸收时间为(56.4±6.2)d.结论 IPA可发生于无基础疾病的免疫功能正常病人.IPA的胸部CT检查表现以两肺多发性病变(多发结节)为主,易形成无"液平面"的空洞.肺部活动性病灶基本吸收时间约需6周或更长.%Objective To analyze the clinical, radiological, pathological and microbiological features of invasive pulmonary aspergillosis (IPA) to improve clinical management.Methods Retrospective analysis of 20 pathologically and/or microbiologically confirmed IPA cases in our hospital from January 2005 to August 2008. Results Group A (with underlying diseases) included 13 patients (underlying malignancy in 9 patients, including 5 cases of hematological malignancy, COPD in 2 patients, pulmonary tuberculosis and bronchiectasis in 1 each). Group B (without underlying disease) included 7 patients (2 patients with a long time

  5. Aspergilose orbitária: relato de caso Ocular aspergillosis: case report

    Directory of Open Access Journals (Sweden)

    Patrícia Ioschpe Gus

    2005-02-01

    inicia-se o manejo, segundo o quadro de sintomas.Presence of fungus in the conjunctiva is a constant threat to the eyes, because these microorganisms, defined as opportunistic, may provoke severe ocular infections, in situations as low organic resistance, use of immunosuppressants, antibiotics and epithelial alteration. Our goal here is to report a case of ocular aspergillosis in an immunosupressed patient where paroxysmal nocturnal hemoglobinuria was diagnosed. A 51-year-old immunosupressed, thrombocytopenic patient was hospitalized with a diagnosis of paroxysmal nocturnal hemoglobinuria. On examination, she had a visual acuity of 20/40 in the right eye (RE and light perception in the left (LE. She presented hyposphagma, bilateral conjunctival edema on biomicroscopy and had some multiple and circumscribed conjunctival abscesses in both eyes; clear cornea in both eyes. Fundoscopy of the RE did show any particularity, in the LE there was a smear hemorrhage. Computed tomograph showed a fat periocular infiltration. Magnetic resonance lead to the same finding, compatible with orbital cellulitis. Hemoculture showed Aspergillus growth and direct smears of conjunctival material was negative. There was great improvement while treating her with amphotericin B, but there was complete remission after using 5% natamicyn eye drops. Orbital infections caused by Aspergillus are uncommon, usually appearing in immunosuppressed patients. Frequently they progress insidiously, and can be confounded with other orbital processes. Immunological impairment can inhibit the expression of local and systemic symptoms, resulting in diagnostic confusion. The diagnosis is established by laboratory tests, but culture can be negative in spite of the classical presentation, making the beginning of treatment difficult. In these cases management starts according to the symptoms.

  6. Evolution of procalcitonin, C-reactive protein and fibrinogen levels in neutropenic leukaemia patients with invasive pulmonary aspergillosis or mucormycosis.

    Science.gov (United States)

    Roques, Marjorie; Chretien, Marie Lorraine; Favennec, Camille; Lafon, Ingrid; Ferrant, Emmanuelle; Legouge, Caroline; Plocque, Alexia; Golfier, Camille; Duvillard, Laurence; Amoureux, Lucie; Bastie, Jean Noel; Maurin-Bernier, Lory; Dalle, Frederic; Caillot, Denis

    2016-06-01

    Unlike bacterial infections, the value of procalcitonin (PCT) in detecting fungal infections in leukaemia patients is not clear. To determine whether the monitoring of PCT coupled with C-reactive protein (CRP) and fibrinogen (Fib) could be helpful in the management of pulmonary aspergillosis (IPA) or mucormycosis (PM), we retrospectively analysed the evolution of PCT, CRP and Fib levels in 94 leukaemia patients with proven/probable IPA (n = 77) or PM (n = 17) from D-12 to D12 relative to IFI onset defined as D0. Overall, 2140 assays were performed. From D-12 to D0, 12%, 5% and 1.4% of patients had PCT >0.5, 1 and 1.5 μg l(-1) , respectively, while CRP was >50, 75 and 100 mg l(-1) in 84%, 70% and 57% and Fib was >4, 5 and 6 g l(-1) in 96%, 80% and 61% of cases respectively (P 1.5 μg l(-1) , while CRP >100 mg l(-1) and Fib >6 g l(-1) were observed in 80% and 75% of cases respectively (P < 10(-7) ). In leukaemia patients, IPA or PM was accompanied by a significant increase in CRP and Fib while PCT remained low. PMID:26931315

  7. Phototoxicity, Pseudoporphyria, and Photo-onycholysis Due to Voriconazole in a Pediatric Patient With Leukemia and Invasive Aspergillosis.

    Science.gov (United States)

    Willis, Zachary I; Boyd, Alan S; Di Pentima, M Cecilia

    2015-06-01

    Voriconazole is a triazole antifungal agent superior to amphotericin B in the treatment of invasive aspergillosis. It is generally well tolerated and has excellent oral bioavailability, providing significant benefit in the treatment of invasive fungal infections. There have been numerous reports of dermatologic reactions to this agent, including erythroderma, cheilitis, Stevens-Johnson syndrome, discoid lupus erythematosus, pseudoporphyria, squamous cell carcinoma, and photosensitivity reactions. Pseudoporphyria, a dermatologic condition mimicking porphyria cutanea tarda, has been described as an adverse effect of voriconazole use. Clinical findings include photosensitivity, vesicles, bullae, milia, and scarring in sun-exposed areas. Photo-onycholysis is a phenomenon of nail discoloration and onycholysis that has been described in the setting of a phototoxic drug reaction and pseudoporphyria. Implicated drugs have most commonly been tetracyclines, fluoroquinolones, and psoralens; others have been reported as well. We report a case of a pediatric patient with leukemia who developed symptoms consistent with pseudoporphyria and later photo-onycholysis while being treated with voriconazole. To our knowledge, this is the first reported case of pseudoporphyria due to voriconazole in a pediatric patient and the first reported case of photo-onycholysis as a consequence of voriconazole use. PMID:26407422

  8. Allergic bronchopulmonary aspergillosis in Italian cystic fibrosis patients: Prevalence and percentage of positive tests in the employed diagnostic criteria

    International Nuclear Information System (INIS)

    The prevalence of allergic bronchopulmonary aspergillosis (ABPA) in cystic fibrosis (CF) patients is difficult to determine because the data in the literature are not homogeneous or comparable. ABPA and CF have similar clinical symptoms which make diagnosis difficult and underestimate the real dimensions of the problem. We conducted an epidemiological study on 3089 Italian CF patients to determine the prevalence of ABPA in Italy and verify the percentage of positive tests in the employed diagnostic criteria. Our results indicate that the prevalence of ABPA in Italian CF patients is 6.18%, mainly in adolescents and young adults. ABPA is diagnosed using clinical symptoms (presence of episodic bronchial obstructions or typical radiographic features) and on the basis of other criteria which can only be partially fulfilled in paediatric patients. Among the diagnostic tests the most sensitive are the total IgE (84.5%), specific IgE anti-Aspergillus fumigatus (81.6%) and the prick test (68.3%). In the absence of clinical symptoms and gold standard diagnostic tests, serological positivity and/or the skin test are not sufficient evidence to confirm the presence of ABPA

  9. Galactomannan antigen assay from bronchoalveolar lavage fluid in diagnosis of invasive pulmonary aspergillosis in intensive care units patients

    Directory of Open Access Journals (Sweden)

    Farzin Khorvash

    2014-01-01

    Full Text Available Background : Invasive pulmonary aspergillosis (IPA is an important infection in critically ill patients including patients of intensive care units (ICU. Different diagnostic tools are available and since its mortality is high, it is vital to start the antifungal therapy as soon as possible. Knowing the epidemiology of this disease in each ICU and area will help to better and more rapid management of such patients. The aim of this study is to determine the frequency of IPA based on the level of galactomannan in bronchoalveolar lavage fluid in ICU of Al-Zahra hospital, Isfahan, Iran. Materials and Methods : This was a cross sectional study, which was conducted in Al-Zahra hospital, Isfahan, Iran, between 2010 to 2011. The study population was all the patients admitted to ICU and were suspected to have invasive Aspergillus spp pneumonia. The level of galactomannan in bronchoalveolar lavage was measured and demographic data were gathered by the questionnaire. Results : The frequency of IPA in this study was calculated as 2.43% while galactomannan level in bronchoalveolar lavage fluid of this patient (2.50 was significantly higher than others (0.03 ± 0.02. Conclusion : Larger studies are required to determine the exact frequency of IPA and the best antifungal therapy for it.

  10. Mixed types of pulmonary aspergillosis%混合型肺曲霉病三例并文献复习

    Institute of Scientific and Technical Information of China (English)

    牟向东; 余进; 聂立功; 程渊; 王广发

    2014-01-01

    Objective To describe the clinical features of mixed types of pulmonary aspergillosis (MTPA),and therefore to improve the diagnosis and treatment of MTPA.Methods This study retrospectively analyzed 3 patients with MTPA in Peking University First Hospital from November 2010 to 2012." Invasive pulmonary aspergillosis (IPA),pulmonary aspergilloma,allergic bronchopulmonary aspergillosis (ABPA)" were used as the Chinese and English keywords,to search the literatures from Wanfang database and Pubmed database until to May 2014.Results There were 3 patients with MTPA,respectively with aspergilloma and IPA (patient 1),ABPA and IPA (patient 2),aspergilloma and IPA (patient 3).The cultures of respiratory secretions of the patients all yielded A.fumigatus.Patient 1 was treated by amphotericin B; Patient 2 was treated by intravenous itraconazole and glucocorticoid; Patient 3 was treated by oral voriconazole and inhaled corticosteroid,and the aspergilloma was surgically removed at the same time.Eventually,patients 1 and 2 died,while the symptoms of patient 3 were significantly improved.Drug sensitivity test of A.fumigatus showed resistance to amphotericin B or itraconazole.By far there was no concept of MTPA in the literatures and there were only 3 relevant case reports.Conclusion MTPA is a new subtype of pulmonary aspergillosis,which is more complicated and severe,and perhaps with drug resistance.MTPA should be treated by comprehensive therapies on the basis of sensitive and effective antifungal drugs.%目的 探讨混合型肺曲霉病(MTPA)的临床特点,提高对该病的诊治水平.方法 回顾性分析2010年11月至2012年11月北京大学第一医院收治的3例MTPA的临床特点.以“侵袭性肺曲霉病”、“肺曲霉球”及“变应性支气管肺曲霉病”两两组合为检索词,通过万方数据库和中国期刊全文数据库进行检索,以“混合型肺曲霉病”为检索词均未检索到相关文献;以“invasive pulmonaryaspergillosis

  11. The clinical characteristics of hepatic failure with aspergillosis%肝衰竭合并曲霉菌感染的临床特征分析

    Institute of Scientific and Technical Information of China (English)

    苏海滨; 王慧芬; 闫涛; 林芳; 赵鸿; 李雷; 牟劲松; 李晨; 许海苗

    2010-01-01

    目的 了解肝衰竭合并曲霉菌感染的临床特征.方法 收集我院1985年1月-2006年6月所有合并真菌感染的肝衰竭患者507例,以合并曲霉菌感染的肝衰竭患者104例为主要分析对象.两组间数据的比较用配对t检验,率的比较用χ2检验. 结果 507例肝衰竭合并真菌感染患者中,曲霉菌感染104例(20.5%).抗真菌治疗的有效率和基础疾病的治愈好转率,曲霉菌感染患者分别为36.5%和26.0%,非曲霉菌感染患者分别为57.8%和36.7%,P=0.000和P=0.049.共分离出曲霉菌108株,烟曲霉菌最为多见,共53株(49.1%),肺脏为曲霉菌主要感染部位90例次(63.8%),感染后临床表现常不典型.在抗真菌治疗有效的患者,肝功能呈好转趋势. 结论肝衰竭合并曲霉菌感染的诊断、治疗困难.对于临床上怀疑有曲霉菌感染的肝衰竭患者,早期积极治疗有助于患者恢复.%Objective To study the clinical characteristics of hepatic failure with aspergillosis. Methods The data of hepatic failure patients with fungal infection hospitalized in our hospital form January 1985 to June 2006 were collected. This research mainly focused on the clinical characteristics of the patients co-infected with aspergillosis. Results The occurrence of aspergillosis was 20.5% (104 cases) among 507 hepatic failure patients with fungal infection. Compared with other fungal infection in hepatic failure patients, the effective rate of antifungal therapy and the improvement rate of underlying disease were worse in patients with aspergilus infection (36.5% vs 57.8%, P = 0.000; 26.0% vs 36.7%, P = 0.049). Aspergillus fumigatus was the most common species among 108 fungal species. The species next to Aspergillus fumigatus were Aspergillus niger and Aspergillus flavus. The mainly infected organ was lung and its clinical manifestation was atypical. Liver function could be improved with effective anti-fungus-therapy. Conclusions Diagnosis and treatment of aspergillosis is

  12. Computer tomography in pulmonary invasive aspergillosis in hematological patients with neutropenia: An useful tool for diagnosis and assessment of outcome in clinical trials

    Energy Technology Data Exchange (ETDEWEB)

    Caillot, Denis, E-mail: denis.caillot@chu-dijon.f [Dijon University Hospital Center, Dijon (France); Latrabe, Valerie [Bordeaux University Hospital Center, Bordeaux (France); Thiebaut, Anne [Lyon University Hospital Center, Lyon (France); Herbrecht, Raoul [Strasbourg Regional University Hospital Center, Strasbourg (France); De Botton, Stephane [Lille Regional University Hospital Center, Lille (France); Pigneux, Arnaud [Bordeaux University Hospital Center, Bordeaux (France); Monchecourt, Francoise; Mahi, Lamine [Gilead Sciences, Paris (France); Alfandari, Serge [Lille Regional University Hospital Center, Lille (France); Couaillier, Jean-Francois [Dijon University Hospital Center, Dijon (France)

    2010-06-15

    Background and objective: The exact timing of the evolution of lesion volumes of invasive pulmonary aspergillosis (IPA) on CT scan images could be helpful in the management of hematological patients but has never been evaluated in a prospective study. We analyzed the CT scan data from the prospective Combistrat trial. Design and methods: Volumes of aspergillosis lesions from 30 patients (including 24 acute myeloid leukaemia) with probable (n = 26) or proven (n = 4) IPA according to the EORTC-MSG modified criteria, were measured prospectively on the thoracic CT scans at the enrolment in the study on day 0 (D0), D7, D14 and end of treatment (EOT). Results: For the overall population, the volume of pulmonary aspergillosis lesions increased significantly from D0 to D7 (1.6 fold; p = 0.003). Then this volume decreased significantly from D7 to D14 (1.36 fold at D14 with p = 0.003 for D14 vs. D7, but with p = 0.56 for D14 vs. D0). At EOT (= D17, median value), the volume of lesions was significantly lower than D14 (0.76 fold the initial volume; p < 0.001) but it was not significantly different when compared to D0 (p = 0.11). Conclusions: The results of this prospective study suggest that the sequential analysis of CT scan in neutropenic patients with IPA depicts more precisely the evolution of lesion volumes than comparison to baseline images. Moreover, the systematic use of chest CT appears to be a useful tool for diagnosis and outcome evaluation of IPA in clinical trials.

  13. 肺曲霉病外科治疗分析(附15例报告)%Surgical treatment of pulmonary aspergillosis ( Report of 15 cases )

    Institute of Scientific and Technical Information of China (English)

    郭楠楠; 李珊珊; 于长海; 俞建琦; 张文

    2012-01-01

    目的:探讨肺曲霉病的诊断、外科手术治疗原则、方法及效果.方法:回顾性分析我科2005年至2011年手术治疗的15例采用外科手术治疗的肺曲霉病患者的临床资料和随访结果.结果:15例患者术后证实均为曲霉病,术前诊断符合率为93.3%( 14/15),影像学诊断符合率为73.3%(11/15),全组无手术死亡,随访4个月~6年无肺曲霉病复发和播散.结论:手术治疗肺曲霉病能消除症状,预防咯血复发,减少抗真菌药物对患者影响,可根治进而延长患者生命提高患者生活质量.因此,一旦确诊应积极手术治疗.%Objective; We attempt to discuss the diagnosis of pulmonary aspergillosis and to research its surgical treatment in the aspects of principle, method and effect. Methods;Review the clinical information and the follow-up results of patients who infected the pulmonary aspergillosis and accepted the operation subsequent-ly in our department from 2005 to 2011. Results; 15 patients were diagnosed definitely with pulmonary aspergil-losis after operation. The consistency rate in preoperative diagnosis was 14/15. The consistency rate of imagine was 11/15. No one was dead after operation. Finally, no patient has the recurrence and spreading of pulmonary aspergilloma after a serious of tracking observation from 4 months to 6 years. Conclusion; The operation not on-ly eliminates the symptoms, prevents the recurrence of hemoptysis and alleviates the side effect of antifungal a-gents, but may also be a radical cure of pulmonary aspergillosis and improve the living standards of patients. Therefore, surgical treatment should be advocated when the diagnosis was confirmed.

  14. Impact of cyp51A Mutations on the Pharmacokinetic and Pharmacodynamic Properties of Voriconazole in a Murine Model of Disseminated Aspergillosis

    OpenAIRE

    Mavridou, Eleftheria; Bruggemann, Roger J. M.; Melchers, Willem J. G.; Verweij, Paul E.; Mouton, Johan W.

    2010-01-01

    The in vivo efficacy of voriconazole against 4 clinical Aspergillus fumigatus isolates with MICs ranging from 0.125 to 2 mg/liter (CLSI document M38A) was assessed in a nonneutropenic murine model of disseminated aspergillosis. The study involved TR/L98H, M220I, and G54W mutants and a wild-type control isolate. Oral voriconazole therapy was started 24 h after intravenous infection of mice and was given once daily for 14 consecutive days, with doses ranging from 10 to 80 mg/kg of body weight, ...

  15. Emerging aspergillosis by azole-resistant Aspergillus fumigatus at an intensive care unit in the Netherlands, 2010 to 2013.

    Science.gov (United States)

    van Paassen, Judith; Russcher, Anne; In 't Veld-van Wingerden, Astrid Wm; Verweij, Paul E; Kuijper, Eduard J

    2016-07-28

    The prevalence of invasive aspergillosis (IA) at the intensive care unit (ICU) is unknown and difficult to assess since IA also develops in patients lacking specific host factors. In the Netherlands, increasing azole-resistance in Aspergillus fumigatus complicates treatment of patients with IA. The aim of this study was to determine the prevalence of IA by azole-resistant A. fumigatus at the ICU among patients receiving antifungal treatment and to follow their clinical outcome and prognosis. A retrospective cohort study was conducted in a university hospital ICU from January 2010 to December 2013. From all patients who received antifungal treatment for suspected IA, relevant clinical and microbiological data were collected using a standardised questionnaire. Of 9,121 admitted ICU-patients, 136 had received antifungal treatment for suspected IA, of which 38 had a positive A. fumigatus culture. Ten of the 38 patients harboured at least one azole-resistant isolate. Resistance mechanisms consisted of alterations in the cyp51A gene, more specific TR34/L98H and TR46/T289A/Y121F. Microsatellite typing did not show clonal relatedness, though isolates from two patients were genetically related. The overall 90-day mortality of patients with IA by azole-resistant A. fumigatus and patients with suspicion of IA by azole-susceptible isolates in the ICU was 100% (10/10) vs 82% (23/28) respectively. We conclude that the changing pattern of IA in ICU patients requires appropriate criteria for recognition, diagnosis and rapid resistance tests. The increase in azole resistance rates also challenges a reconsideration of empirical antifungal therapy. PMID:27541498

  16. Improved Detection of Invasive Pulmonary Aspergillosis Arising during Leukemia Treatment Using a Panel of Host Response Proteins and Fungal Antigens.

    Directory of Open Access Journals (Sweden)

    Allan R Brasier

    Full Text Available Invasive pulmonary aspergillosis (IPA is an opportunistic fungal infection in patients undergoing chemotherapy for hematological malignancy, hematopoietic stem cell transplant, or other forms of immunosuppression. In this group, Aspergillus infections account for the majority of deaths due to mold pathogens. Although early detection is associated with improved outcomes, current diagnostic regimens lack sensitivity and specificity. Patients undergoing chemotherapy, stem cell transplantation and lung transplantation were enrolled in a multi-site prospective observational trial. Proven and probable IPA cases and matched controls were subjected to discovery proteomics analyses using a biofluid analysis platform, fractionating plasma into reproducible protein and peptide pools. From 556 spots identified by 2D gel electrophoresis, 66 differentially expressed post-translationally modified plasma proteins were identified in the leukemic subgroup only. This protein group was rich in complement components, acute-phase reactants and coagulation factors. Low molecular weight peptides corresponding to abundant plasma proteins were identified. A candidate marker panel of host response (9 plasma proteins, 4 peptides, fungal polysaccharides (galactomannan, and cell wall components (β-D glucan were selected by statistical filtering for patients with leukemia as a primary underlying diagnosis. Quantitative measurements were developed to qualify the differential expression of the candidate host response proteins using selective reaction monitoring mass spectrometry assays, and then applied to a separate cohort of 57 patients with leukemia. In this verification cohort, a machine learning ensemble-based algorithm, generalized pathseeker (GPS produced a greater case classification accuracy than galactomannan (GM or host proteins alone. In conclusion, Integration of host response proteins with GM improves the diagnostic detection of probable IPA in patients

  17. NAC is associated with additional alleviation of lung injury induced by invasive pulmonary aspergillosis in a neutropenic model

    Institute of Scientific and Technical Information of China (English)

    Peng XU; Jie-ming QU; Jin-fu XU; Jing ZHANG; Hong-ni JIANG; Hui-jun ZHANG

    2009-01-01

    Aim:Neutropenic individuals are at high risk for invasive pulmonary aspergillosis (IPA),a life-threatening infection.To evaluate the therapeutic potential of antioxidants,IPA was induced in neutropenic mice and the effect of N-acetyl-l-cysteine (NAC) on oxidative stress levels and lung injury was analyzed.Methods:Mice were pretreated with three daily intraperitoneal injections of 150 mg/kg cyclophosphamide,followed by intratracheal inoculation with 4.5×106 conidia of Aspergillus fumigatus.The infected mice were then randomly assigned to an amphotericin B (AMB) group,an AMB plus NAC group,or an untreated control (C) group.In each group,the duration of treatment was 24,48,or 72 h,and activities such as appearance,feeding,and dermal temperature were observed throughout the experiment.Sera and lung tissues were collected and analyzed by quantitative enzyme-linked immunosorbent assay (ELISA) for total protein,superoxide dismutase(SOD),malondialdehyde (MDA),tumor necrosis factor-α (TNF-α),and interleukin-lO (IL-10) levels.The wet/dry weight ratio of the lung was also calculated and lung sections were stained with hematoxylin-eosin for pathological examination and with methenamine silver stain for fungus detection.Results:Compared with the mice untreated with NAC,mice in the AMB plus NAC group had increased SOD and reduced MDA levels both systemically and locally at 24,48,and 72 h after inoculation with conidia.NAC treatment also decreased the pulmonary protein content at 48 and 72 h and the lung wet/dry weight ratio at 24 and 48 h.Additionally,NAC enhanced pulmonary production of TNF-α and IL-10 at 24 h and 48 h.Conclusion:In combination with antifungal therapy,NAC treatment can alleviate oxidative stress and lung injury associated with IPA in neutropenic mice.

  18. Recombinant Allergens Combined with Biological Markers in the Diagnosis of Allergic Bronchopulmonary Aspergillosis in Cystic Fibrosis Patients▿

    Science.gov (United States)

    Fricker-Hidalgo, Hélène; Coltey, Bérangère; Llerena, Catherine; Renversez, Jean-Charles; Grillot, Renée; Pin, Isabelle; Pelloux, Hervé; Pinel, Claudine

    2010-01-01

    Allergic bronchopulmonary aspergillosis (ABPA) is a frequent complication in cystic fibrosis patients. The diagnosis remains difficult and requires a combination of clinical, radiological, biological, and mycological criteria. The aim of this study was to analyze the added value of two recombinant antigens, rAspf4 and rAspf6, associated with the detection of specific IgG; precipitins; total IgE; and Aspergillus fumigatus in sputum for the diagnosis of ABPA. In a retrospective study, we determined the specific IgE responses to these recombinants in 133 sera of 65 cystic fibrosis patients. We selected an average of five serum samples from each of the 17 patients with ABPA (13 proven and 4 probable ABPA) and from 3 patients with Aspergillus bronchitis and rhinosinusitis. One serum sample for the 45 patients without ABPA was tested. The sensitivity of specific IgE detection against rAspf4 calculated per patient (92.3%) was significantly higher (P < 0.05) than that of rAspf6 (53.8%). When rAspf4 IgE detection was associated with anti-Aspergillus IgG enzyme-linked immunosorbent assay (ELISA) and precipitin detection, the sensitivity rose to 100%. The specificities of rAspf4 and rAspf6 IgE detection were 93.7% and 91.6%, respectively. Other diagnostic criteria had slightly lower specificities (87.5% for anti-Aspergillus IgG ELISA, 89.6% for precipitins, 84.4% for total IgE, and 85.0% for positive A. fumigatus culture in sputum). In conclusion, this retrospective study showed the relevance of rAspf4 IgE detection, in combination with other biological markers (Aspergillus IgG ELISA, precipitins, and total IgE), for improving the biological diagnosis of ABPA. PMID:20631331

  19. Development of monoclonal antibody-based galactomannoprotein antigen-capture ELISAs to detect Aspergillus fumigatus infection in the invasive aspergillosis rabbit models.

    Science.gov (United States)

    Wang, Z-Y; Cai, J-P; Qiu, L-W; Hao, W; Pan, Y-X; Tung, E T K; Lau, C C Y; Woo, P C Y; Lau, S K P; Yuen, K-Y; Che, X-Y

    2012-11-01

    Aspergillus fumigatus is one of the most prominent opportunistic fungal pathogens in immunocompromised hosts. Early recognition of this infection along with prompt antifungal therapy may increase the survival rate. We expressed two potential bio-markers of A. fumigatus infection-galactomannoprotein Afmp1p and Afmp4p in Pichia pastoris. We generated 33 monoclonal antibodies (MAbs), 20 against recombinant Afmp1p (rAfmp1p) and the other 13 against recombinant Afmp4p (rAfmp4p). Subsequently, we developed two antigen-capture enzyme-linked immunosorbent assays (ELISAs) which employed MAbs as both the capture and the detection antibodies for rAfmp1p and rAfmp4p. The two antigen-capture ELISAs specifically detected Afmp1p/Afmp4p in cultures of A. fumigatus and had no cross-reaction with other tested pathogenic fungi, including Penicillium marneffei and other pathogenic Aspergillus species. The Afmp1p-captured ELISA would be positive even when the culture supernatant of A. fumigatus had been diluted to 128-fold of its original concentration. The two antigen ELISAs could capture circulating or excreted antigens during the acute phase of invasive aspergillosis (IA) in the animal model, and had no cross-reactivity to other Aspergillus-challenged animal models. We developed two antigen-capture ELISAs for the laboratory diagnosis of A. fumigatus infection. These two antigen-capture ELISAs may be useful in the clinical diagnosis of aspergillosis. PMID:22669560

  20. Aspergilosis pulmonar necrotizante crónica como complicación de silicosis Chronic necrotizing pulmonary aspergillosis as a complication of silicosis

    Directory of Open Access Journals (Sweden)

    J.J. Blanco

    2011-04-01

    Full Text Available La aspergilosis pulmonar necrotizante crónica es una rara enfermedad que tiende a afectar a personas con enfermedad pulmonar subyacente o inmunocomprometidos en grado leve. Es una complicación excepcional de la silicosis y su diagnóstico precisa un alto índice de sospecha pues simula otras enfermedades como tuberculosis y neoplasia, complicaciones más frecuentes en estos pacientes. Presentamos tres casos con larga historia de exposición a sílice y diagnóstico de fibrosis masiva progresiva que presentaron aspergilosis pulmonar. Revisamos sus características clínicas, radiológicas y tratamiento.Chronic necrotizing pulmonary aspergillosis is un uncommon disease which is found in people with underlying lung disease or in mildly immunocompromised patients. It is an exceptional complication in silicosis and its diagnosis is difficult because it simulates other diseases like tuberculosis and cancer which are more common in such patients. We report on three cases with a long history of silica dust exposure with pulmonary aspergillosis complicating progressive massive fibrosis (PMF. We review their clinical, radiological and treatment features.

  1. Gamma scintigraphy imaging of murine invasive pulmonary aspergillosis with a {sup 111}In-labeled cyclic peptide

    Energy Technology Data Exchange (ETDEWEB)

    Yang Zhi [Department of Experimental Diagnostic Imaging, Infection Control and Employee Health, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030 (United States); Kontoyiannis, Dimitrios P. [Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030 (United States); Wen Xiaoxia; Xiong Chiyi; Zhang Rui [Department of Experimental Diagnostic Imaging, Infection Control and Employee Health, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030 (United States); Albert, Nathaniel D. [Department of Infectious Diseases, Infection Control and Employee Health, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030 (United States); Li Chun [Department of Experimental Diagnostic Imaging, Infection Control and Employee Health, University of Texas M.D. Anderson Cancer Center, Houston, TX 77030 (United States)], E-mail: cli@mdanderson.org

    2009-04-15

    Introduction: Invasive pulmonary aspergillosis (IPA) is a leading cause of infection-associated death in immunosuppressed patients. Early detection and early administration of antifungal therapy are critical factors in improving outcome for patients with IPA. Here, we evaluated the imaging properties of a {sup 111}In-labeled cyclic peptide targeted to Aspergillus fumigatus in an immunosuppressed murine model of IPA. Methods: A cyclic peptide c(CGGRLGPFC)-NH{sub 2} was labeled with {sup 111}In by means of diethylenetriaminepentaacetic acid (DTPA). Two days after intranasal inoculation of 17.5x10{sup 6} conidia of A. fumigatus, mice were injected {sup 111}In-DTPA-c(CGGRLGPFC)-NH{sub 2} intravenously. Biodistribution data were obtained at 2 h, and {gamma}-images were acquired at 10 min and 2 h after radiotracer injection. Healthy mice were used as controls. In addition, a group of infected mice were co-injected with the radiotracer and unlabeled c(CGGRLGPFC)-NH{sub 2} to evaluate the inhibition of radiotracer's binding to infected lungs. Autoradiographs of lungs from infected and healthy mice were compared with corresponding photographs of transaxial sections of the lung tissues stained for A. fumigatus hyphae. Results: The labeling efficiency was >98%, with specific radioactivity of up to 74 MBq/nmol peptide. Significantly higher uptake of {sup 111}In-DTPA-c(CGGRLGPFC)-NH{sub 2} was observed in the lungs of mice infected with A. fumigatus than in those of healthy mice (0.37{+-}0.06 %ID/g vs. 0.14{+-}0.02 %ID/g, P=.00044). Simultaneous injection with unlabeled peptide reduced radioactivity in the infected lungs by 41% (P=.0037). Increased radioactivity in the lungs of infected mice was visible in {gamma} images at both 10 min and 2 h after radiotracer injection. Moreover, autoradiography confirmed radiotracer uptake in infected lungs, but not in the lungs of healthy mice or infected mice co-injected with unlabeled peptide. Conclusions: {gamma}-Imaging with {sup

  2. [Preoperative Arterial Embolization with N-butyl-2 Cyanoacrylate for Chronic Cavitary Pulmonary Aspergillosis with Trauma Induced Type Ⅰ Diabetes Mellitus].

    Science.gov (United States)

    Nakanishi, Yusuke; Kojima, Fumitsugu; Kamo, Minobu; Wakejima, Ryo; Okura, Mariko; Jinta, Torahiko; Chonabayashi, Naohiko; Bando, Toru

    2016-03-01

    A 50-year-old man with hemoptysis, given a diagnosis of left upper lobe pulmonary aspergilloma with cavity and fungus ball by computed tomography. He has a history of typeⅠ diabetes mellitus due to traumatic injury of pancreas and underwent diaphragm plasty. Despite of systemic anti-fungal medication, symptom and radiological findings were not progressed and surgical intervention was planned. Before surgery we performed intercostal artery embolization, in order to minimize bleeding on dissecting adhesion between the chest wall and the lobe with aspergilloma. Left upper lobectomy with muscle-flap prombage was done safely with a blood loss of 450 ml. Postoperative course was favorable. Intercostal artery embolization with N-butyl-2cyanoacrylate is an effective way to minimize hemorrhage during surgical resection for pulmonary aspergillosis with sever adhesion. PMID:27075282

  3. Orbital Apex Syndrome Caused by Invasive Aspergillosis as an Adverse Effect of Systemic Chemotherapy for Metastatic Colorectal Cancer: a Case Report.

    Science.gov (United States)

    Miyamoto, Yuji; Sakamoto, Yasuo; Ohuchi, Mayuko; Tokunaga, Ryuma; Shigaki, Hironobu; Kurashige, Junji; Iwatsuki, Masaaki; Baba, Yoshifumi; Yoshida, Naoya; Watanabe, Masayuki; Baba, Hideo

    2016-02-01

    Continuous therapy with cytotoxic drugs suppresses humoral immune function and may result in local infection. We present a case of orbital apex syndrome caused by Aspergillus infection during chemotherapy for metastatic colorectal cancer. A 74-year-old man with colorectal liver metastases under long-term continuous systemic chemotherapy presented with painful, progressive orbital apex syndrome. Magnetic resonance imaging disclosed a small enhancing lesion around the right ethmoid sinus. We initially diagnosed colorectal cancer metastasis and he underwent biopsy via the endoscopic endonasal transethmoid approach. However, pathological examination of the cultured specimen revealed Aspergillus fumigatus. The patient was treated with voriconazole and the orbital apex syndrome resolved after 1 month. Orbital aspergillosis is a life-threatening disease and should be listed as a differential diagnosis of uncommon local infections during continuous chemotherapy. PMID:26851046

  4. Use of Mesenchymal Cells to Modulate Immune Suppression and Immune Reconstruction in a Patient with Aplastic Anemia Complicated by Invasive Sino-Orbital Aspergillosis

    Directory of Open Access Journals (Sweden)

    Hakan Özdoğu

    2014-06-01

    Full Text Available Cultured human bone marrow mesenchymal cells (MSCs have immunomodulatory and tissue regenerative properties. This report summarizes the result of post-transplant treatment with MSCs of a 26-year-old patient with aplastic anemia complicated by invasive sino-orbital aspergillosis. The patient was treated with MSCs to benefit from the dual effects of MSCs in immune reconstitution: suppression against alloreactive T cells and facilitation of the re-engraftment process. The patient did not develop acute or chronic graft-versus-host disease. The aspergillus infection healed completely. The engraftment failure was also ended without any complications. During his last visit in his fourth year after transplantation, the patient was in hematological remission. Human bone marrow-derived MSCs seem to have an important role in preventing or overcoming immunological complications in patients who undergo stem cell transplantation.

  5. 20例侵袭性肺曲霉病临床分析%Clinical analysis on 20 cases of invasive pulmonary aspergillosis

    Institute of Scientific and Technical Information of China (English)

    梁永祥; 黄富; 朱杏培; 吴金环

    2012-01-01

    Objective To investigate high-risk factors,clinical features,imaging features,treatment and prognosis factors in the incidence of invasive pulmonary aspergillosis.Methods A retrospective analysis was carried out to 20 cases of clinical data in our hospital diagnosed as pulmonary aspergillosis infection from January 2008 to June 2012.Results In the 20 cases of invasive pulmonary aspergillosis,there were 15 patients found with immunodeficiency,5 cases of previously healthy.Clinical features:fever 14 cases (70%),cough in 12 patients (60%),sputum in 10 patients (50%),shortness of breath,8 cases (40%),pleural effusion in 4 cases (20%),4 cases of chest pain (20%),hemoptysis in 12 cases (60%).Imaging features:5 cases of nodules,lumps shadow 3 cases,2 cases of ground-glass infiltrates,4cases of empty and crescent sign 3 cases,large tracts of real change 3 cases.18 patients with the antifungal drug voriconazole,2 cases of surgical treatment.Prognosis:cured 10 cases,5 cases effective,2 cases giving up,and 3 patients died.Conclusion The clinical features and imaging features of invasive pulmonary aspergillosis are not specific,the diagnosis relies on etiology and pathological examination.Early diagnosis to patients with immunodeficiency by using voriconazole therapy can improve the cure rate,and provide a good prognosis for patients without high risk factors.%目的 探讨侵袭性肺曲霉病发病的高危因素、临床特点、影像学特征、治疗及预后因素.方法 回顾分析2008年1月至2012年6月在本院确诊肺曲霉病感染的20例临床资料.结果 20例侵袭性肺曲霉病患者中15例患者有免疫缺陷,5例既往体健.临床特点:发热14例(70%)、咳嗽12例(60%)、咳痰10例(50%)、气促8例(40%)、胸腔积液4例(20%)、胸痛4例(20%)、咯血12例(60%)等.影像学特征:结节影5例,团块影3例,磨玻璃浸润影2例,空洞4例及新月征3例,大片实变3例.治疗予抗真菌药物伏立康

  6. A model for treating avian aspergillosis: serum and lung tissue kinetics for Japanese quail (Coturnix japonica) following single and multiple aerosol exposures of a nanoparticulate itraconazole suspension.

    Science.gov (United States)

    Rundfeldt, Chris; Wyska, Elżbieta; Steckel, Hartwig; Witkowski, Andrzej; Jeżewska-Witkowska, Grażyna; Wlaź, Piotr

    2013-11-01

    Aspergillosis is frequently reported in parrots, falcons and other birds held in captivity. Inhalation is the main route of infection for Aspergillus fumigatus, resulting in both acute and chronic disease conditions. Itraconazole (ITRA) is an antifungal commonly used in birds, but administration requires repeated oral dosing and the safety margin is narrow. We describe lung tissue and serum pharmacokinetics of a nanoparticulate ITRA suspension administered to Japanese quail by aerosol exposure. Aerosolized ITRA (1 and 10% suspension) administered over 30 min did not induce adverse clinical reactions in quail upon single or 5-day repeated doses. High lung concentrations, well above the inhibitory levels for A. fumigatus, of 4.14 ± 0.19 μg/g and 27.5 ± 4.58 μg/g (mean ± SEM, n = 3), were achieved following single-dose inhalation of 1% and 10% suspension, respectively. Upon multiple dose administration of 10% suspension, mean lung concentrations reached 104.9 ± 10.1 μg/g. Drug clearance from the lungs was slow with terminal half-lives of 19.7 h and 35.8 h following inhalation of 1% and 10% suspension, respectively. Data suggest that lung clearance is solubility driven. Lung concentrations of hydroxy-itraconazole reached 1-2% of the ITRA lung tissue concentration indicating metabolism in lung tissue. Steady, but low, serum concentrations of ITRA could be measured after multiple dose administration, reaching less than 0.1% of the lung tissue concentration. This formulation may represent a novel, easy to administer treatment modality for fungal lung infection, preventing high systemic exposure. It may also be useful as metaphylaxis to prevent the outbreak of aspergillosis in colonized animals. PMID:23815436

  7. Primary aspergilloma and subacute invasive aspergillosis in two AIDS patients Aspergiloma primário e aspergilose invasiva subaguda em dois pacientes com AIDS

    Directory of Open Access Journals (Sweden)

    Roberto Martinez

    2009-02-01

    Full Text Available Although uncommon, invasive aspergillosis in the setting of AIDS is important because of its peculiar clinical presentation and high lethality. This report examines two AIDS patients with a history of severe cellular immunosuppression and previous neutropenia, who developed subacute invasive aspergillosis. One female patient developed primary lung aspergilloma, with dissemination to the mediastinum, vertebrae, and spine, which was fatal despite antifungal treatment. The second patient, who had multiple cavitary brain lesions, and eye and lung involvement, recovered following voriconazole and itraconazole, and drugs for increasing neutrophil and CD4+ lymphocyte levels. These cases demonstrate the importance of Aspergillus infections following neutropenia in AIDS patients, and emphasize the need for early and effective antifungal therapy.A aspergilose invasiva em pacientes com aids, embora incomum, é relevante pela apresentação clínica peculiar e alta letalidade. Este relato descreve os casos de dois pacientes com aids com grave imunossupressão celular e neutropenia prévia, os quais tiveram aspergiloma pulmonar primário, com disseminação para mediastino, vértebras e medula espinhal, evoluindo para óbito apesar do tratamento antifúngico. O segundo paciente, que tinha lesões cavitárias múltiplas no cérebro e infecção ocular e pulmonar, recuperou-se após tratamento com voricanazol, itraconazol e com drogas para aumentar o número de neutrófilos e de linfócitos CD4+. Estes casos demonstram o risco de infecção por Aspergillus após episódios de neutropenia em pacientes com aids e alertam para o início precoce de terapia antifúngica eficaz.

  8. Comparison of Commercial Latex Agglutination and Sandwich Enzyme Immunoassays with a Competitive Binding Inhibition Enzyme Immunoassay for Detection of Antigenemia and Antigenuria in a Rabbit Model of Invasive Aspergillosis

    OpenAIRE

    Hurst, Steven F.; Reyes, Guadalupe H.; McLaughlin, David W.; Reiss, Errol; Morrison, Christine J.

    2000-01-01

    A commercial latex agglutination assay (LA) and a sandwich enzyme immunoassay (SEIA) (Sanofi Diagnostics Pasteur, Marnes-la-Coquette, France) were compared with a competitive binding inhibition assay (enzyme immunoassay [EIA]) to determine the potential uses and limitations of these antigen detection tests for the sensitive, specific, and rapid diagnosis of invasive aspergillosis (IA). Toward this end, well-characterized serum and urine specimens were obtained by using a rabbit model of IA. S...

  9. Comparison of Galactomannan Detection, PCR-Enzyme-Linked Immunosorbent Assay, and Real-Time PCR for Diagnosis of Invasive Aspergillosis in a Neutropenic Rat Model and Effect of Caspofungin Acetate

    OpenAIRE

    Scotter, Jennifer M.; Chambers, Stephen T

    2005-01-01

    The performance of different in vitro diagnostic tests for the diagnosis of invasive aspergillosis (IA) was investigated in a transiently neutropenic rat model. Rats were immunosuppressed with cyclophosphamide and then inoculated intravenously with 1.5 × 104 CFU Aspergillus fumigatus spores. Animals were then either treated with caspofungin acetate, 1 mg/kg/day for 7 days, or not treated. PCR-enzyme-linked immunosorbent assay (ELISA), real-time PCR, and galactomannan (GM) detection were perfo...

  10. 急性白血病合并侵袭性曲霉病的临床治疗%Treatment of acute leukemia complicated by invasive aspergillosis in children

    Institute of Scientific and Technical Information of China (English)

    刘英; 唐锁勤; 王建文; 龙卉; 冯晨; 张昊

    2009-01-01

    Objective To study the antifungal treatment and intensive chemotherapy in children with acute leukemia and invasive aspergillosis. Methods The diagnosis and treatment of 4 cases of childhood acute leukemia complicated by invasive aspergillosis between July 2007 and July 2008 were studied retrospectively. Results Three children who underwent remission induction chemotherapy for ALL and one who underwent consolidation chemotherapy for AML developed invasive aspergillosis. One child with proven aspergillosis and 3 with possible aspergillosis all had halo sign on CT at diagnosis. Voriconazole or amphotericin B was given as primary therapy. Improvements of fungal lesions were shown by CT after two to four weeks of antifungal therapy. Complete radiologic remissions were achieved between 4 months and one year. The intensive chemotherapy schedule was continued in all of 4 cases. The median time from fungal infection to the continuation of chemotherapy was 35 days. None showed recurrence of fungal infection. Conclusions The halo sign on CT may be a reliable indicator for the early diagnosis of invasive aspergillosis. The preemptive antifungal therapy on the basis of the identification of a halo sign and the reversal of immunosuppression may improve the outcome of invasive aspergillosis. Prolonged antifungal treatment during subsequent cycles of chemotherapy permits completion of scheduled intensive chemotherapy without fungal recurrence.%目的 探讨急性白血病合并侵袭性曲霉病患儿抗真菌治疗和连续强烈化疗的治疗经验.方法 回顾分析我院2007年7月至2008年7月收治的4例儿童急性白血病合并侵袭性曲霉病的诊断和治疗.结果 3例急性淋巴细胞白血病(ALL)诱导缓解化疗和1例急性髓细胞白血病(AML)巩固化疗的患儿合并侵袭性曲霉病,1例确诊,3例拟诊,诊断时CT表现均有晕轮征.抗霉菌初始用药首选伏立康唑或两性霉素B.治疗2~5周病灶好转,4月至1年病灶缓解.4

  11. Clinical analysis of 16 cases of invasive pulmonary aspergillosis%侵袭性肺曲菌病16例临床分析

    Institute of Scientific and Technical Information of China (English)

    王真真; 戴新建; 郑纪阳

    2013-01-01

    Objective: To investigate the clinical characteristics of invasive pulmonary aspergillosis. Methods: The clinical data of 16 patients with IPA from January 2010 to July 2012 in our respiratory medicine department were retrospectively analyzed. Results: Among 16 patients with IPA, 15 cases have basic disease. Chronic obstructive pulmonary disease, diabetes mellitus, radiotherapy and chemotherapy of malignant tumor were the main basis of IPA. The clinical symptoms mostly presented as fever, emptysis, dyspnea and cough. CT features included single or multiple nodules, consolidations, and cavities were found in 2 patients. Every patient received antifungal therapies, 13 patients were recurred. Conclusion: The clinical symptoms and imaging feature for invasive pulmonary aspergillosis are non-specific, and with a high mortality rate. Early diagnosis and reasonable treatments for IPA could remarkably improve the prognosis of IPA.%目的:总结侵袭性肺曲菌病(IPA)的临床特点.方法:对2010年1月至2012年7月间在我院呼吸科诊断为IPA的患者的危险因素、临床特征、治疗与转归进行回顾性分析.结果:16例IPA患者中15例合并有基础疾病,主要为慢性阻塞性肺疾病、糖尿病及恶性肿瘤放化疗.临床表现主要为发热、咯血、呼吸困难、咳嗽咳痰,影像学多表现为单发或多发结节影或实变影,有2例出现空洞.所有病例均接受抗真菌治疗,13例痊愈.结论:IPA临床症状和影像学表现不典型,病死率高,对临床诊断病例应尽早治疗,从而改善预后.

  12. Cytokine and transcription factor expression by Aspergillus fumigatus-stimulated peripheral blood mononuclear cells in dogs with sino-nasal aspergillosis.

    Science.gov (United States)

    Vanherberghen, M; Bureau, F; Peters, I R; Day, M J; Lynch, A; Fievez, L; Billen, F; Clercx, C; Peeters, D

    2013-08-15

    The causal agent of sino-nasal aspergillosis is usually Aspergillus fumigatus, which is a saprophytic and ubiquitous fungus that causes a severe rhinosinusitis in apparent healthy dogs. Affected dogs do not have systemic immuno-suppression. It has been shown previously that dogs affected by this disease have local over-expression of interleukin (IL)-10 and Th1 cytokines in nasal mucosal tissue. The aim of the present study was to assess the response of peripheral blood mononuclear cells (PBMC) from affected and unaffected dogs to antigen-specific stimulation with heat-inactivated Aspergillus spp. conidia, by quantifying gene expression for specific Th1, Th2, Th17 and Treg cytokines and their related transcription factors. Quantification of IL-4 and IFN-γ protein in culture supernatant was performed by enzyme-linked immunosorbent assay (ELISA). PBMC from dogs with SNA produced adequate mRNA encoding IFN-γ and IFN-γ protein. The expression of IL-17A mRNA was significantly greater in PBMC of affected compared with unaffected dogs. The amount of IL-10 mRNA in PBMC from affected dogs decreased after antigen-specific challenge. These results suggest that the incapacity of affected dogs to clear these fungal infections is not related to a defect in Th1 immunity or to an overwhelming regulatory reaction, but rather to an uncontrolled pro-inflammatory reaction driven by Th17 cells. PMID:23759303

  13. New therapeutic strategies for invasive aspergillosis in the era of azole resistance: how should the prevalence of azole resistance be defined?

    Science.gov (United States)

    Alanio, Alexandre; Denis, Blandine; Hamane, Samia; Raffoux, Emmanuel; Peffault de la Tour, Régis; Touratier, Sophie; Bergeron, Anne; Bretagne, Stéphane

    2016-08-01

    Given reports showing a high prevalence of azole resistance in Aspergillus fumigatus, alternatives to azole therapy are discussed when a threshold of 10% of azole-resistant environmental isolates is reached. This raises the issue of calculation of this threshold, either on the prevalence of azole-resistant isolates as a whole or on the prevalence of azole-resistant cases in populations at risk of invasive aspergillosis (IA). For isolate evaluation, there are high disparities in routine microbiological procedures for the isolation of A. fumigatus and azole resistance detection. There are also huge differences between the microbiological work-up for diagnosing IA. Some centres rely on galactomannan detection alone without actively trying to culture appropriate samples, which affects reliability of the figures on the prevalence of resistance and thus the threshold of resistance. Moreover, reports from the laboratory could mix up figures from completely different patient populations: frequent azole-resistant isolates from pneumology patients and rare azole-resistant isolates from haematology patients. Therefore, to sum isolates from different specimens and different wards can lead to erroneous calculations for the restricted populations at risk of developing IA. In conclusion, assessing the incidence of azole resistance in A. fumigatus should be based on harmonized consensual microbiological methods and reports should be restricted to IA episodes in identified populations at risk of IA when the issue is to define an operational threshold for modifying recommendations. PMID:27494830

  14. Risk factors for the development of posterior subcapsular cataracts in patients with cystic fibrosis and allergic bronchopulmonary aspergillosis treated with corticosteroids.

    Science.gov (United States)

    Majure, M; Mroueh, S; Spock, A

    1989-01-01

    Posterior subcapsular cataracts (PSCC) occur in a high percentage of patients treated with long-term systemic corticosteroids (Naumann Gott, Apple DJ, eds: Pathology of the Eye. New York: Springer-Verlag, 1986). Fifteen patients with cystic fibrosis treated at Duke University Medical Center between January 1982 and October 1987 required prednisone for treatment of allergic bronchopulmonary aspergillosis (ABPA). Two of these patients (13.3%) were noted to have PSCC during prednisone therapy. We retrospectively examined factors associated with steroid administration that may have been predictive of the development of PSCC in these patients including: 1) steroid therapy for longer than 2 years, 2) steroid dose of 10 mg/day or greater for longer than 6 months, 3) steroid dose of 40 mg/day or greater for longer than 2 months, and 4) change in linear growth pattern during steroid therapy. None of these factors predicted the risk of developing PSCC. Therefore, we recommend that all patients with cystic fibrosis who receive steroids for the treatment of a concomitant condition such as ABPA should undergo careful examination for opacities of the ocular lens at each clinical visit regardless of the duration or dose of steroids. PMID:2748222

  15. 伏立康唑在肾移植术后侵袭性肺曲霉菌病中的应用%Voriconazole for invasive pulmonary aspergillosis after renal transplantation

    Institute of Scientific and Technical Information of China (English)

    邢利; 苗书斋; 曲青山; 蒋欣; 李玉华; 胡俊杰

    2012-01-01

    OBJECTIVE To observe the clinical efficacy and safety of voriconazole in treatment of invasive pulmonary aspergillosis after renal transplantation so as to provide basis for clinical therapy. METHODS A total of 17 invasive pulmonary aspergillosis patients who used voriconazole after renal transplantation were retrospectively analyzed, the relevant support therapy was supplemented. RESULTS Of 3 diagnosed patients, 2 cases were cured, 9 of 11 clinically diagnosed patients were cured, 2 of 3 suspected patients were cured, the mean cure rate was 76.5%. CONCLUSION No matter is it the diagnosed, clinically diagnosed or suspected invasive pulmonary aspergillosis after renal transplantation, the broad-spectrum antifungal drugs such as voriconazole should be applied in the early stage so as to improve the clinical symptoms and raise the cure rate.%目的 观察伏立康唑在肾移植术后侵袭性肺曲霉菌病中的临床疗效和安全性,为临床治疗提供依据.方法 回顾性分析17例肾移植术后侵袭性肺曲霉菌病患者早期应用伏立康唑,同时辅以相关支持治疗.结果 3例确诊患者中,2例治愈;11例临床诊断患者9例治愈;3例拟诊患者2例治愈,平均治愈率为76.5%.结论 无论确诊、临床诊断或拟诊的肾移植术后侵袭性肺曲霉菌病,尽早应用广谱抗真菌药物-伏立康唑,均能改善症状并提高治愈率.

  16. 慢性肺曲霉病28例临床分析%Clinicial analysis of chronic pulmonary aspergillosis in 28 cases

    Institute of Scientific and Technical Information of China (English)

    董双霞; 郑纪阳; 戴新建; 黄晓颖

    2015-01-01

    Objective:To study the clinical features and method of diagnosis and treatment in chronic pul-monary aspergillosis. Methods:Twenty-eight cases of chronic pulmonary aspergillosis from May 2010 to Feb 2015 in Wenzhou Central Hospital were retrospectively analyzed. Results:Twenty-four cases had basic disease or mildly immunodepression, in whom the most common was pulmonary tuberculosis and the followed by was bronchiectasis. There was no speciifcity in clinical manifestations, the common presentations included produc-tive cough, haemoptysis.Imaging examination showed the diseased region mainly located in upper lobe, the main characteristic lesion, were pulmonary cavity with aspergills ball, inlfitrating shadows around, pleural thickening, and the air crescent sign founded in 10 cases. Nine cases were pathologically diagnosed by surgery or lung punc-ture, and 19 cases were diagnosed by bronchoalveolar lavage lfuid or sputum culture. The antifungal therapy was given in 19 cases, which improved symptoms in 17 cases and cured in 2 cases. Surgery treatment performed in 6 cases, and 4 cases of them with good prognosis. Conclusion:Lacking speciifcity of clinical manifestations, it is easy to be misdiagnosed and missed diagnosis. Imaging examination plays an important role in disease diagnosis, and making a deifnite diagnosis requires pathological or etiological foundation. Patients with complete lesion re-section and in good condition recommended surgery as soon as possible, others needed the anti-fungal treatment to improve the outcome.%目的:探讨慢性肺曲霉病的临床特点及诊治方法。方法:回顾性分析2010年5月至2015年2月温州市中心医院28例慢性肺曲霉病的病例资料。结果:28例中存在基础疾病或轻度免疫功能受限24例,最常见为陈旧性肺结核,其次为支气管扩张。临床表现无特异性,最常见的症状是咳嗽、咳痰和咯血。影像学检查病变部位以肺上叶多见,病灶特点

  17. 慢性空洞性肺曲菌病临床表现%Clinical manifestation of chronic cavitary pulmonary aspergillosis

    Institute of Scientific and Technical Information of China (English)

    刘爱华; 陆京伯; 苏瑾; 吴雷

    2010-01-01

    Objective To discuss the clinical manifestation,imaging characteristic,diagnosis and treatment of chronic cavitary pulmonary aspergillosis(CCPA).Methods Clinical data of three patients with CCPA were summarized,who had ever been misdiagnosed as pulmonary tuberculosis for a long time and failed to treatment with antituberculosis drugs,even aggravated to have lung injury,and were pathologically confirmed as CCPA by surgery or transbronchial lung biopsy.Results Chronic cough,fatigue,or short breath were common clinical symptoms of CCPA.Imaging results showed that cavitary lesions appeared in the upper lobe of lung,which increased progressively,and sometimes were multiple.Histological examination showed that fungal hyphae cound be found in the cavity,chronic inflammation and pulmonary fibrosis appeared in surrounding lung tissue,accompanying pleural thickening.Conclusions CCPA is a subtype of chronic pulmonary aspergillosis,which is rare in clinic.The imaging characteristic is mainly that cavitary lesions increase progressively.Fungal hyphae can be found in the cavity by histological examination.For CCPA patients,antifungal therapy should be taken actively,and surgery can be taken if necessary.%目的 探讨慢性空洞性肺曲菌病的临床症状、影像学特点、诊断和治疗方法.方法 对3例误诊为肺结核而长期抗结核治疗无效,甚至导致肺毁损,经手术切除病变肺叶或经支气管肺活检术,病理确诊为慢性空洞性肺曲菌病的临床资料进行总结.结果 慢性空洞性肺曲菌病常见的临床症状为慢性咳嗽、疲劳不适,严重者出现气短.影像学显示空洞出现在肺上叶,且进行性增大,有时为多发.组织学检查在空洞内可找到真菌菌丝,周围肺组织有慢性炎症和肺纤维化,伴有胸膜肥厚.结论 慢性空洞性肺曲菌病是慢性肺曲菌病的一种亚型,临床上少见,常见影像学特点是肺内空洞进行性增大,组织学检查在空洞内可找到真菌

  18. Second-hand Smoke Increases Nitric Oxide and Alters the IgE Response in a Murine Model of Allergic Aspergillosis

    Directory of Open Access Journals (Sweden)

    Brian W. P. Seymour

    2005-01-01

    Full Text Available This study was performed to determine the effects of environmental tobacco smoke (ETS on nitric oxide (NO and immunoglobulin (Ig production in a murine model of allergic bronchopulmonary aspergillosis (ABPA. Adult BALB/c mice were exposed to aged and diluted sidestream cigarette smoke from day 0 through day 43 to simulate “second-hand smoke”. During exposure, mice were sensitized to soluble Aspergillus fumigatus (Af antigen intranasally between day 14 and 24. All Af sensitized mice in ambient air (Af + AIR made elevated levels of IgE, IgG1, IgM, IgG2a and IgA. Af sensitized mice housed in ETS (Af + ETS made similar levels of immunoglobulins except for IgE that was significantly reduced in the serum and bronchoalveolar lavage (BAL. However, immunohistochemical evaluation of the lung revealed a marked accumulation of IgE positive cells in the lung parenchyma of these Af + ETS mice. LPS stimulation of BAL cells revealed elevated levels of NO in the Af + AIR group, which was further enhanced in the Af+ETS group. In vitro restimulation of the BAL cells on day 45 showed a TH0 response with elevated levels of IL3, 4, 5, 10 and IFN-γ. However, by day 28 the response shifted such that TH2 cytokines increased while IFN-γ decreased. The Af + ETS group showed markedly reduced levels in all cytokines tested, including the inflammatory cytokine IL6, when compared to the Af+AIR group. These results demonstrate that ETS affects ABPA by further enhancing the NO production and reduces the TH2 and the inflammatory cytokines while altering the pattern of IgE responses.

  19. Influence of pre-existing invasive aspergillosis on allo-HSCT outcome: a retrospective EBMT analysis by the Infectious Diseases and Acute Leukemia Working Parties.

    Science.gov (United States)

    Penack, O; Tridello, G; Hoek, J; Socié, G; Blaise, D; Passweg, J; Chevallier, P; Craddock, C; Milpied, N; Veelken, H; Maertens, J; Ljungman, P; Cornelissen, J; Thiebaut-Bertrand, A; Lioure, B; Michallet, M; Iacobelli, S; Nagler, A; Mohty, M; Cesaro, S

    2016-03-01

    Historically, invasive aspergillosis (IA) has been a major barrier for allogeneic hematopoietic stem cell transplantation (allo-HSCT). The influence of invasive IA on long-term survival and on transplant-related complications has not been investigated in a larger patient cohort under current conditions. Our aim was to analyze the long-term outcome of patients undergoing allo-HSCT with a history of prior IA. We used European Society for Blood and Marrow Transplantation database data of first allo-HSCTs performed between 2005 and 2010 in patients with acute leukemia. One thousand one hundred and fifty patients with data on IA before allo-HSCT were included in the analysis. The median follow-up time was 52.1 months. We found no significant impact of IA on major transplant outcome variables such as overall survival, relapse-free survival, non-relapse mortality, cumulative incidence of acute GvHD grade II-IV, chronic GvHD, pulmonary complications and leukemia relapse. However, we found a trend toward lower overall survival (P=0.078, hazard ratio (HR) (95% confidence interval (CI)): 1.16 (0.98, 1.36)) and higher non-relapse mortality (P=0.150, HR (95% CI): 1.19 (0.94, 1.50)) in allo-HSCT recipients with pre-existing IA. Our data suggest that a history of IA should not generally be a contraindication when considering the performance of allo-HSCT in patients with acute leukemia. PMID:26501769

  20. Genetically-determined hyperfunction of the S100B/RAGE axis is a risk factor for aspergillosis in stem cell transplant recipients.

    Directory of Open Access Journals (Sweden)

    Cristina Cunha

    Full Text Available Invasive aspergillosis (IA is a major threat to the successful outcome of hematopoietic stem cell transplantation (HSCT, although individual risk varies considerably. Recent evidence has established a pivotal role for a danger sensing mechanism implicating the S100B/receptor for advanced glycation end products (RAGE axis in antifungal immunity. The association of selected genetic variants in the S100B/RAGE axis with susceptibility to IA was investigated in 223 consecutive patients undergoing HSCT. Furthermore, studies addressing the functional consequences of these variants were performed. Susceptibility to IA was significantly associated with two distinct polymorphisms in RAGE (-374T/A and S100B (+427C/T genes, the relative contribution of each depended on their presence in both transplantation counterparts [patient SNP(RAGE, adjusted hazard ratio (HR, 1.97; P = 0.042 and donor SNP(RAGE, HR, 2.03; P = 0.047] or in donors (SNP(S100B, HR, 3.15; P = 7.8e-(4 only, respectively. Functional assays demonstrated a gain-of-function phenotype of both variants, as shown by the enhanced expression of inflammatory cytokines in RAGE polymorphic cells and increased S100B secretion in vitro and in vivo in the presence of the S100B polymorphism. These findings point to a relevant role of the danger sensing signaling in human antifungal immunity and highlight a possible contribution of a genetically-determined hyperfunction of the S100B/RAGE axis to susceptibility to IA in the HSCT setting.

  1. Genetically-determined hyperfunction of the S100B/RAGE axis is a risk factor for aspergillosis in stem cell transplant recipients.

    Science.gov (United States)

    Cunha, Cristina; Giovannini, Gloria; Pierini, Antonio; Bell, Alain S; Sorci, Guglielmo; Riuzzi, Francesca; Donato, Rosario; Rodrigues, Fernando; Velardi, Andrea; Aversa, Franco; Romani, Luigina; Carvalho, Agostinho

    2011-01-01

    Invasive aspergillosis (IA) is a major threat to the successful outcome of hematopoietic stem cell transplantation (HSCT), although individual risk varies considerably. Recent evidence has established a pivotal role for a danger sensing mechanism implicating the S100B/receptor for advanced glycation end products (RAGE) axis in antifungal immunity. The association of selected genetic variants in the S100B/RAGE axis with susceptibility to IA was investigated in 223 consecutive patients undergoing HSCT. Furthermore, studies addressing the functional consequences of these variants were performed. Susceptibility to IA was significantly associated with two distinct polymorphisms in RAGE (-374T/A) and S100B (+427C/T) genes, the relative contribution of each depended on their presence in both transplantation counterparts [patient SNP(RAGE), adjusted hazard ratio (HR), 1.97; P = 0.042 and donor SNP(RAGE), HR, 2.03; P = 0.047] or in donors (SNP(S100B), HR, 3.15; P = 7.8e-(4)) only, respectively. Functional assays demonstrated a gain-of-function phenotype of both variants, as shown by the enhanced expression of inflammatory cytokines in RAGE polymorphic cells and increased S100B secretion in vitro and in vivo in the presence of the S100B polymorphism. These findings point to a relevant role of the danger sensing signaling in human antifungal immunity and highlight a possible contribution of a genetically-determined hyperfunction of the S100B/RAGE axis to susceptibility to IA in the HSCT setting. PMID:22114731

  2. Detection of Aspergillus-specific antibodies by agar gel double immunodiffusion and IgG ELISA in feline upper respiratory tract aspergillosis.

    Science.gov (United States)

    Barrs, V R; Ujvari, B; Dhand, N K; Peters, I R; Talbot, J; Johnson, L R; Billen, F; Martin, P; Beatty, J A; Belov, K

    2015-03-01

    Feline upper respiratory tract aspergillosis (URTA) is an emerging infectious disease. The aims of this study were: (1) to assess the diagnostic value of detection of Aspergillus-specific antibodies using an agar gel double immunodiffusion (AGID) assay and an indirect immunoglobulin G (IgG) ELISA; and (2) to determine if an aspergillin derived from mycelia of Aspergillus fumigatus, Aspergillus niger and Aspergillus flavus can be used to detect serum antibodies against cryptic Aspergillus spp. in Aspergillus section Fumigati. Sera from cats with URTA (group 1: n = 21) and two control groups (group 2: cats with other upper respiratory tract diseases, n = 25; group 3: healthy cats and cats with non-respiratory, non-fungal illness, n = 84) were tested. Isolates from cats with URTA comprised A. fumigatus (n = 5), A. flavus (n = 1) and four cryptic species: Aspergillus felis (n = 12), Aspergillus thermomutatus (Neosartorya pseudofischeri, n = 1), Aspergillus lentulus (n = 1) and Aspergillus udagawae (n = 1). Brachycephalic purebred cats were significantly more likely to develop URTA than other breeds (P = 0.013). The sensitivity (Se) of the AGID was 43% and the specificity (Sp) was 100%. At a cut-off value of 6 ELISA units/mL, the Se of the IgG ELISA was 95.2% and the Sp was 92% and 92.9% for groups 2 and 3 cats, respectively. Aspergillus-specific antibodies against all four cryptic species were detected in one or both assays. Assay Se was not associated with species identity. Detection of Aspergillus-specific antibodies by IgG ELISA has high Se and Sp for diagnosis of feline URTA. PMID:25634077

  3. Safety and efficacy of a caspofungin-based combination therapy for treatment of proven or probable aspergillosis in pediatric hematological patients

    Directory of Open Access Journals (Sweden)

    Giraldi Eugenia

    2007-04-01

    Full Text Available Abstract Background Fungal infections are diagnosed increasingly often in patients affected by hematological diseases and their mortality has remained high. The recent development of new antifungal drugs gives the clinician the possibility to assess the combination of antifungal drugs with in-vitro or in animal-model synergistic effect. Methods We analyzed retrospectively the safety and efficacy of caspofungin-based combination therapy in 40 children and adolescents, most of them were being treated for a malignant disease, who developed invasive aspergillosis (IA between November 2002 and November 2005. Results Thirteen (32.5% patients developed IA after hematopoietic stem cell transplantation (HSCT, 13 after primary diagnosis, usually during remission-induction chemotherapy, and 14 after relapse of disease. Severe neutropenia was present in 31 (78% out of the 40 patients. IA was classified as probable in 20 (50% and documented in 20 (50% patients, respectively. A favorable response to antifungal therapy was obtained in 21 patients (53% and the probability of 100-day survival was 70%. Different, though not significant, 100-day survival was observed according to the timing of diagnosis of IA: 51.9% after HSCT; 71.4% after relapse; and 84.6% after diagnosis of underlying disease, p 0.2. After a median follow-up of 0.7 years, 20 patients are alive (50%. Overall, the combination therapy was well tolerated. In multivariate analysis, the factors that were significantly associated to a better overall survival were favorable response to antifungal therapy, p 0.003, and the timing of IA in the patient course of underlying disease, p 0.04. Conclusion This study showed that caspofungin-based combination antifungal therapy is an effective therapeutic option also for pediatric patients with IA. These data need to be confirmed by prospective, controlled studies.

  4. Detection of Aspergillus fumigatus in a rat model of invasive pulmonary aspergillosis by real-time nucleic acid sequence-based amplification.

    Science.gov (United States)

    Zhao, Yanan; Park, Steven; Warn, Peter; Shrief, Raghdaa; Harrison, Elizabeth; Perlin, David S

    2010-04-01

    Rapid and sensitive detection of Aspergillus from clinical samples may facilitate the early diagnosis of invasive pulmonary aspergillosis (IPA). A real-time nucleic acid sequence-based amplification (NASBA) method was investigated by use of an inhalational rat model of IPA. Immunosuppressed male Sprague-Dawley rats were exposed to Aspergillus fumigatus spores for an hour in an aerosol chamber. Bronchoalveolar lavage (BAL) fluid, lung tissues, and whole blood were collected from five infected rats at 1, 24, 48, 72, and 96 h postinfection and five uninfected rats at the end of the experiment. Total nucleic acid (TNA) was extracted on an easyMAG instrument. A primer-molecular beacon set targeting 28S rRNA was designed to detect Aspergillus spp. The results were compared to those of quantitative PCR (qPCR) (18S rDNA) and quantitative culture. The analytical sensitivity of the real-time NASBA assay was tissue burdens, while the CFU counts were stable over time. The fungal burdens in BAL fluid were more variable and not indicative of a progressive infection. The results of both real-time assays correlated well for both sample types (r = 0.869 and P tissue, r = 0.887 and P < 0.0001 for BAL fluid). For all whole-blood specimens, NASBA identified Aspergillus-positive samples in the group from which samples were collected at 72 h postinfection (three of five samples) and the group from which samples were collected at 96 h postinfection (five of five samples), but no positive results were obtained by culture or PCR. Real-time NASBA is highly sensitive and useful for the detection of Aspergillus in an experimental model of IPA. PMID:20129972

  5. Aspergillosis in immunocompromised children acute myeloid leukemia and bone marrow aplasia.: Report of two cases Aspergilose em crianças imunocomprometidas com leucemia mielóide aguda e aplasta de medula óssea: Registro de 2 casos

    Directory of Open Access Journals (Sweden)

    Maria Zilda de Aquino

    1994-10-01

    Full Text Available Two cases of Aspergillosis in immunocompromised children are reported. Both were caused by Aspergillns flavus. Early diagnosis and treatment led to the remission of the process. One patient had acute myeloid leukemia; the fungus was isolated from the blood. The other patient with bone marrow aplasia, presented an invasive aspergillosis of the paranasal sinuses with dissemination of fungal infection; the diagnosis was obtained by histology and culture of biopsied tissue from a palatal ulceration.No presente trabalho são registrados dois casos de aspergilose em crianças imunocomprometidas. O estudo micológico completo identificou Aspergillus flavus como agente dos dois processos. A presença cada vez mais frequente da aspergilose invasiva deve-se ao número crescente de pacientes imunocomprometidos, muitos com hemopatias graves submetidos à quimioterapia. O diagnóstico precoce em um dos casos possibilitou remissão do processo. Tratava-se de paciente com leucemia mielóide aguda, tendo sido isolado o fungo do sangue circulante. O segundo caso evoluiu para óbito, com infecção fúngica generalizada.

  6. 侵袭性肺曲霉病的临床特征分析%Clinical Manifestations and Imaging Findings of Patients with Invasive Pulmonary Aspergillosis

    Institute of Scientific and Technical Information of China (English)

    刘丹丹; 陈慧; 邵长周; 何礼贤

    2014-01-01

    目的:探讨侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)的临床特征。方法:回顾分析83例 IPA 患者的临床及影像学资料。结果:IPA 患者的主要临床表现为发热、咳嗽、咳痰、喘息、呼吸困难、咯血。IPA 患者的影像学表现多样,典型表现如晕征和新月征则较少见(主要见于免疫抑制患者)。83例中原发性 IPA 患者18例,均治愈;继发性 IPA 患者65例,治愈23例,好转出院25例,患者要求出院12例,病死 5例。结论:IPA 好发于有基础疾病和免疫抑制的患者,其临床和影像学表现不典型;原发性 IPA 较继发性 IPA 预后好。%Objective:To investigate the clinical features of invasive pulmonary aspergillosis (IPA).Methods:The clinical fea-tures and imaging characteristics of 83 patients with IPA were retrospectively and comparatively analyzed.Results:The clinical manifestations of IPA included fever,cough,sputum,wheezing,dyspnea,hemoptysis.Imaging findings in patients with IPA were diverse.Typical manifestations such as Halo sign and crescent sign were rare,which were mainly observed in immuno-suppressed patients.All of the 18 cases of primary IPA were cured.Among the 65 secondary IPA patients,23 cases were cured,25 cases improved and discharged,12 cases discharged without medical advice,and 5 cases died.Conclusions:IPA oc-curred often in patients with underlying diseases and immune suppression,having atypical clinical manifestations and imaging findings.Patients with primary IPA have better prognosis than those with secondary IPA.

  7. Invasive pulmonary aspergillosis in autoimmune bullous diseases patients:three cases report%自身免疫性大疱病合并侵袭性肺曲霉病:3例报告

    Institute of Scientific and Technical Information of China (English)

    余进; 牟向东; 万喆; 阙呈立; 李若瑜

    2012-01-01

    Objective To study the diagnosis and treatment of invasive pulmonary aspergillosis in autoimmune bullous diseases patients under long-term glucocorticoids treatment by retrospectively reviewing three cases. Methods Report three cases of autoimmune bulious diseases with invasive pulmonary aspergillosis. KOH smear and culture, antigen detection, chest CT scan and his-topathologic test were used to diagnose the patients. The organisms isolated from the sputum were identified as Aspergillus fumigatus A. Flavus and Emericella echinulata by morphological and molecular methods. Results Three cases were diagnosed as invasive pulmonary aspergillosis. The patients were cured with voriconazole treatment and other antifungal agents. Conclusion Autoimmune bullous diseases patients should be watched out emerging invasive apergillosis during long-term glucocorticoids therapy. Combined laboratory examinations will be helpful in early diagnosis and increasing efficacy.%目的 通过典型病例回顾探讨自身免疫性大疱病糖皮质激素治疗过程中合并肺曲霉病的诊断和治疗情况.方法 报告3例自身免疫性大疱病合并侵袭性肺曲霉病病例.3例病例均行痰镜检、培养、抗原检测、胸部CT或者坏死组织病理检查.分离病原菌经形态学和分子生物学鉴定为烟曲霉、黄曲霉和刺孢裸胞壳.结果 3例病例证实为侵袭性肺曲霉病.进行以伏立康唑为主的综合治疗后均治愈.结论 自身免疫性大疱病糖皮质激素治疗过程中应警惕肺曲霉病的发生.多种实验室检查可以帮助早期诊断,提高疗效.

  8. Elevated levels of manna-binding lectin (MBL) and eosinophilia in patients of bronchial asthma with allergic rhinitis and allergic bronchopulmonary aspergillosis associated with a novel intronic polymorphism in MBL

    DEFF Research Database (Denmark)

    Kaur, S.; Gupta, G.K.; Shah, A.;

    2006-01-01

    Mannan-binding lectin (MBL), an important component of innate immunity, binds to a range of foreign antigens and initiates the lectin complement pathway. Earlier studies have reported high plasma MBL levels in allergic patients in comparison to healthy controls. In view of varied plasma MBL levels...... being determined by genetic polymorphisms in its collagen region, we investigated the association of single nucleotide polymorphisms (SNPs) in the collagen region of human MBL with respiratory allergic diseases. The study groups comprised patients of bronchial asthma with allergic rhinitis (n = 49) and...... allergic bronchopulmonary aspergillosis (APBA) (n = 11) and unrelated age-matched healthy controls of Indian origin (n = 84). A novel intronic SNP, G1011A of MBL, showed a significant association with both the patient groups in comparison to the controls (P < 0.01). Patients homozygous for the 1011A allele...

  9. Aspergillosis: a limiting factor during recovery of captive magellanic penguins Aspergilose: um fator limitante na reabilitação de pingüins-de-Magalhães

    Directory of Open Access Journals (Sweden)

    Melissa O. Xavier

    2007-09-01

    Full Text Available The article describes the epidemiology, macroscopic and histological lesions as well as the isolation of Aspergillus flavus and A. fumigatus from Magellanic penguins (Spheniscus magellanicus during recovery in the Center for Recovery of Marine Animals (CRAM - 32ºS/52ºW, over a period of two years. From January 2004 to December 2005 the Center received 52 Magellanic penguins, and 23% (12/52 died. Necropsies were performed and tissue samples were collected for histological and microbiological examination. From 12 dead animals, aspergillosis was confirmed in five animals, corresponding to 42% of the mortality. Granulomatous nodules were observed mainly on air sacs and lungs. Histologically, septate and branching hyphae, measuring 3-5 µm and PAS positive were found. Two of these cases were caused by A. fumigatus, two other by A. flavus, and in one the diagnostic was established by macroscopic lesions observed in the necropsy without sample collection for fungal isolation and identification. The five aspergillosis cases occurred in the first year of the study, when a disinfection program was not yet established in the CRAM. This paper points out the importance of aspergillosis in the rehabilitation process of captive penguins, and emphasize the necessity of an environmental disinfection on the aspergillosis prevention, mycosis that caused a high rate of mortality of the seabirds found on the Brazilian coast and admitted in the CRAM.O trabalho descreve fatores epidemiológicos, achados de necropsia, histológicos e o isolamento de Aspergillus flavus e A. fumigatus em pingüins-de-Magalhães (Spheniscus magellanicus em reabilitação no Centro de Recuperação de Animais Marinhos (CRAM - 32ºS/52ºW, durante um período de dois anos. De janeiro de 2004 a dezembro de 2005 foram recebidos no Centro, 52 pingüins-de-Magalhães, dos quais 23% (12/52 morreram. Esses animais foram necropsiados e amostras de tecidos foram coletadas para exame histol

  10. 不同免疫状态下肺曲霉菌感染24例临床分析%Pulmonary aspergillosis: clinical analysis in immunocompetent and immunocompromised patients

    Institute of Scientific and Technical Information of China (English)

    彭敏; 蔡柏蔷; 施举红; 罗金梅; 王澎; 冯瑞娥; 肖毅; 许文兵; 朱元珏

    2011-01-01

    目的探讨不同免疫状态下肺曲霉菌感染的临床特点、治疗及预后因素.方法回顾性分析2000年1月至2010年3月北京协和医院有组织病理或者培养证据确诊肺曲霉菌感染的24例病例资料.结果免疫正常组7例,免疫缺陷组17例.和免疫正常组相比,免疫缺陷组病程短(<1个月更多见,88.2%对14.3%),发热症状常见(88.2%对28.6%),咯血少见(11.8%对71.4%),差异均有统计学意义.免疫正常组影像表现为单发病灶者占57.1%高于免疫缺陷组患者(11.8%,P<0.05).免疫缺陷组主要用药物治疗,免疫正常组中57.1%手术切除.免疫正常组均存活;免疫缺陷组病死率为52.9%,并且死亡可能与存在严重合并症,免疫缺陷宿主因素不能纠正以及外周血淋巴细胞下降等因素有关.结论不同免疫状态的肺曲菌感染患者临床表现及影像表现不同.免疫缺陷的肺曲霉菌感染患者预后差,其中有严重合并症、宿主因素不能纠正、外周血淋巴细胞下降可能与预后不良有关.治疗应根据患者的免疫状态而有所不同.%Objective To analyze the clinical characteristics and treatment of pulmonary aspergillosis in im-munocompetent and immunocompromised patients. Methods Patients diagnosed as proven pulmonary aspergillosis in Peking Union Medical College Hospital from Jan 2000 to Mar 2010 were included in this analysis. Clinical characteristics were studied retrospectively. Results 24 patients were included,7 immunocompetent and 17 immunocompromised patients. Fever was more common in immunocompromised patients than immunocompetent patients (88. 2% vs 28. 6% ,P <0. 05), While hemoptysis was more common in immunocompetent patients than in immunocompromised patients(71.4% vs 11.8% ,P <0.05). A single or localized lesion on CT scan was more common in immunocompetent patients than in immunocompromised patients(57. 1% vs 11. 8% ,P<0. 05). Surgical resection was performed in 5 (71% ) immunocompetent patients

  11. 8例变态反应性支气管肺曲霉菌病的临床分析%Clinical Analysis of 8 Allergic Bronchopulmonary Aspergillosis

    Institute of Scientific and Technical Information of China (English)

    赵玉国

    2013-01-01

    目的:研究变态反应性支气管肺曲霉菌病(ABPA)的的诊断和治疗方法,并总结其临床特点。方法回顾性分析本人在省人民医院进修期间收集8例ABPA患者的临床表现,血清学结果,胸部放射学,病理检查结果,总结其临床特点,结果 ABPA的临床表现主要包括:哮鸣音、咳嗽、咳痰、咯血、呼吸困难和发热。所有病例血清IgE水平(3040±306) U/mL和外周血嗜酸性粒细胞计数(0.19±0.02)均升高。6例患者曲霉抗原皮肤测试阳性。CT可见中心支气管扩张,支气管壁增厚。、黏液或痰栓、游走性片状、结节状或肿块状肺浸润。所有患者均进行皮质类固醇与抗真菌治疗结合治疗。结论 ABPA的临床特征包括哮喘病史,血清总IgE水平升高,曲霉IgE抗体的存在,外周血嗜酸性粒细胞增高,特异性CT表现等。曲霉抗原皮肤测试、血清总IgE水平和胸部CT扫描对ABPA的诊断有重要意义。口服糖皮质激素和抗真菌的药物是有效的治疗方法。%Objective?To sdudy the diagnostic and treatment methods of allergic bronchopulmonary aspergillosis (ABPA), and summarizes its clinical features. Methods Retrospective analysis of 8 ABPA patients’ clinical manifestations, serological results, chest radiology, and pathology results, and summarize the clinical features. Results ABPA clinical manifestations include:wheeze, cough, sputum, hemoptysis, dyspnea, and fever. All cases serum IgE levels (3040±306)U/mL and peripheral blood eosinophilic granulocyte count (0.19±0.02) were increased. Six cases of patients with aspergillus antigen skin test positive. CT visible center of bronchiectasis, bronchial wall thickening. Mucus or sputum, migratory flake, nodular or mass-like pulmonary infiltration. All patients were corticosteroids and antifungal therapy combined treatment. Conclusion The clinical features of ABPA include a history of asthma, elevated total serum

  12. Risk and Prevention of Aspergillosis

    Science.gov (United States)

    ... Candidiasis Oropharyngeal / Esophageal Candidiasis Genital / vulvovaginal candidiasis Invasive candidiasis Definition Symptoms Risk & Prevention Sources Diagnosis Treatment Statistics Healthcare Professionals ...

  13. Treatment and Outcomes of Aspergillosis

    Science.gov (United States)

    ... whose infections don’t get better after taking voriconazole. These include itraconazole, lipid amphotericin formulations, caspofungin, micafungin, and posaconazole. Whenever possible, immunosuppressive medications ...

  14. Azole-Resistant Invasive Aspergillosis

    DEFF Research Database (Denmark)

    Stensvold, Christen Rune; Jørgensen, Lise Nistrup; Arendrup, Maiken Cavling

    2012-01-01

    gene coupled with point mutation (s) in CYP51A (TR34/L98H and TR46/Y121F/T289A). In the third a single target enzyme alteration (G432S) is found. These resistant “environmental” strains have been detected in many West-European countries as well as in the Asia- Pacifics. Noticeably, these two continents...

  15. Analysis of allergic bronchopulmonary aspergillosis in 8 children%儿童变应性支气管肺曲霉病8例

    Institute of Scientific and Technical Information of China (English)

    陈兰勤; 殷菊; 徐保平; 胡英惠; 申昆玲

    2015-01-01

    目的 总结儿童变应性支气管肺曲霉病(ABPA)病例的临床特点,提高对该病的认识,以期早期诊断及治疗.方法 以首都医科大学附属北京儿童医院2010年3月至2013年12月确诊的所有ABPA病例为研究对象,收集病例的临床资料、实验室检查、影像学检查及治疗预后等资料,并进行描述性分析.结果 确诊ABPA患儿8例,均为学龄期儿童,年龄为7岁2个月~13岁8个月.8例患儿中最显著的临床表现为咳嗽(8例)、咯痰(8例)、喘息(6例)、发热(4例)及咯血(3例).8例患儿中有6例外周血嗜酸性粒细胞计数明显升高,2例嗜酸性粒细胞计数正常;7例患儿血清总IgE水平显著升高(1.000 ~5.000 IU/L),1例患儿血清IgE水平轻度升高.血清变应原检测结果显示所有患儿对包括户尘螨、真菌等多种致敏原过敏,8例患儿对烟曲霉均有不同程度过敏,但仅有2例患儿痰和/或支气管灌洗液真菌培养烟曲霉阳性.影像学检查均有明显的肺部浸润表现,7例患儿具有典型中心型支气管扩张表现.肺功能表现有阻塞性通气功能障碍或混合性通气功能障碍.诊断ABPA后有7例患儿进行治疗,包括口服糖皮质激素、抗真菌治疗(伊曲康唑或伏立康唑口服)及其他对症治疗.治疗后患儿临床症状缓解,血清总IgE水平及嗜酸性粒细胞计数下降.结论 儿童ABPA相对少见,临床表现缺乏特异性,但血清总IgE水平显著升高、血嗜酸性粒细胞计数升高、烟曲霉特异性IgE/IgG抗体阳性及中心型支气管扩张等表现相对特异,是ABPA的主要诊断标准.ABPA对全身糖皮质激素及抗真菌药物治疗反应较好.%Objective To summarize the clinical features of the allergic bronchopulmonary aspergillosis (ABPA) in children,in order to improve the understanding for ABPA and make early diagnosis and treatment of the disease.Methods A retrospective study was performed on ABPA patients diagnosed in Department of

  16. Tomografia computadorizada na avaliação da aspergilose pulmonar angioinvasiva em pacientes com leucemia aguda Computed tomography in the assessment of angioinvasive pulmonary aspergillosis in patients with acute leukemia

    Directory of Open Access Journals (Sweden)

    Renata Carneiro Leão

    2006-10-01

    Full Text Available OBJETIVO: O objetivo deste trabalho foi avaliar os principais achados na tomografia computadorizada de pacientes portadores de leucemia aguda complicada com aspergilose pulmonar angioinvasiva. MATERIAIS E MÉTODOS: Foram estudadas, retrospectivamente, as tomografias computadorizadas de 19 pacientes, avaliando-se a presença de consolidações, nódulos e massas, com ou sem sinal do halo, escavação e sinal do crescente aéreo. RESULTADOS: Áreas de consolidação foram o achado mais comum, ocorrendo em 12 dos 19 casos. A maioria delas apresentou o sinal do halo, enquanto escavação foi encontrada em 5 dos 12 casos com consolidações, sendo um deles com sinal do crescente aéreo. Nódulos e massas ocorreram em, respectivamente, seis e quatro casos, a maioria com sinal do halo. Escavação foi encontrada em apenas um caso de massa. Outros achados observados foram pavimentação em mosaico (dois casos, áreas de vidro fosco esparsas (três casos e envolvimento pleural (sete casos, sob a forma de derrame ou espessamento. CONCLUSÃO: Áreas de consolidação, massas ou nódulo, mesmo solitário, com sinal do halo, quando vistos na tomografia computadorizada em um contexto clínico apropriado, são altamente sugestivos de aspergilose angioinvasiva.OBJECTIVE: The aim of this study was to evaluate the main findings of computed tomography in patients presenting acute leukemia complicated by angioinvasive aspergillosis. MATERIALS AND METHODS: Computed tomography images of 19 patients were retrospectively studied for the presence of consolidations, nodules and masses, with or without presentation of halo sign, cavitation and air crescent sign. RESULTS: Consolidation was the most frequent finding, occurring in 12 of the 19 cases, most of them presenting the halo sign; cavitation was found in 5 of 12 cases, one of them with air crescent sign. Nodules and masses occurred respectively in six and four cases, most of them with halo sign. Cavitation was found

  17. Recent advance of the diagnosis and treatment of allergic bronchopulmonary aspergillosis%变应性支气管肺曲菌病的诊治最新进展

    Institute of Scientific and Technical Information of China (English)

    张永祥; 刘希芝; 王海英

    2012-01-01

    Allergic bronchopulmonary aspergillosis (ABPA) is an immunologic pulmonary disorder caused by hypersensitivity to Aspergillus fumigatus,most often occurring in a patient with asthma or cystic fibrosis.Diagnostic criteria include clinica manifestations of chronic asthma,recurrent pulmonary infiltrates with bronchiectasis,serum eosinophilia,elevated serum total IgE and Aspergillus fumigatus skin test positive,etc.Because many patients with ABPA may be minimally symptomatic or asymptomatic,a high index of suspicion for ABPA should be maintained while managing any patient with asthma,and further screening Aspergillus fumigatus by skin testing to prevent misdiagnosis.Early recognition allows treatment with corticosteroids,which are effective but may be required indefinitely,and combined hormone with newer antifungal azoles may be more effective.This review summarizes the advances in the diagnosis and management of ABPA.%变应性支气管肺曲菌病(allergic bronchopulmonary aspergillosis,ABPA)是机体对烟曲霉过敏引起的一种免疫性肺部疾病,最常见于哮喘和囊性纤维化患者.诊断标准包括慢性哮喘的临床表现、反复肺浸润与支气管扩张、血嗜酸粒细胞增高、血清总IgE增高及烟曲霉皮肤试验阳性等.由于许多ABPA患者症状轻微或无症状,对于哮喘患者一定要想到ABPA的可能,并进一步筛查皮肤试验,以防漏诊.早期诊断可早期给予糖皮质激素治疗,但激素可能要长期应用,激素联合较新的唑类抗真菌药可能更有效.本文对近几年来ABPA的流行病学、发病机制、诊断及处理进行综述.

  18. Breakthrough Scedosporium apiospermum (Pseudallescheria boydii) brain abscess during therapy for invasive pulmonary aspergillosis following high-risk allogeneic hematopoietic stem cell transplantation. Scedosporiasis and recent advances in antifungal therapy.

    Science.gov (United States)

    Safdar, A; Papadopoulos, E B; Young, J W

    2002-12-01

    Systemic scedosporiasis due to the anamorph or asexual form Scedosporium apiospermum (Pseudallescheria boydii) has become an important cause of opportunistic mycosis, especially in patients undergoing high-risk hematopoietic stem cell transplantation. We report a case of rapidly progressive cerebellar hyalohyphomycosis due to Scedosporium apiospermum in an allogeneic marrow graft recipient receiving treatment for severe graft-versus-host disease. This fatal breakthrough intracranial abscess, due to amphotericin B-resistant (minimum inhibitory concentration > 16 micro g/ml) mold, developed during the course of systemic antifungal therapy given for multicentric pulmonary aspergillosis. Despite treatment with high-dose Abelcet (10 mg/kg daily), free amphotericin B was not detected in postmortem cerebellar tissue. A broad-spectrum triazole-based agent (voriconazole/UK-109, 496--Vfend), and a novel fungal cell wall inhibitor, an echinocandin/pneumocandin analog (caspofungin/MK-0991--Cancidas), which exhibit excellent in vitro activity against most clinical Pseudallescheria boydii-Scedosporium apiospermum isolates, have recently become available in the United States and may provide much needed treatment options for patients at risk. PMID:12535265

  19. Diagnosis and treatment of invasive pulmonary aspergillosis in 21 children with non-hematologic diseases%非血液病患儿侵袭性肺曲霉病21例的诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    张晓艳; 赵顺英; 钱素云; 胡英慧; 曾津津; 江载芳

    2009-01-01

    Objective To explore diagnosis and treatments of invasive pulmonary aspergillosis (IPA) in children with non-hematologic diseases. Method Twenty one patients without hematological malignancy were diagnosed with proven or possible IPA from July 2002 to June 2008. The risk factors, clinical manifestations, chest radiographic findings, microbiological and histopathological evidence, diagnostic procedures, treatment and prognosis were retrospectively reviewed. Result Five children had proven IPA, and 16 patients had possible IPA. Thirteen children were classified as having acute invasive pulmonary asergillosis (AIPA), eight children as having chronic necrotizing pulmonary aspergillosis (CNPA). Definitive diagnosis of primary immunodeficiency (PID) was made in 6 children (4 with chronic granulomatous disease, 2 with cellular immunodeficiency); three children were suspected of having PID. Corticosteroids and multiple broad-spectrum antibiotics had been administered in 5 patients (3 of these 5 patients also had invasive mechanical ventilation). Two children had underlying pulmonary disease. Three patients had unknown risk factors. Among these three patients, two had history of environmental exposure. Fever and cough were present in all the children. Fine rales were found in nineteen children. Six children had hepatosplenomegaly. The common roentgenographic feature of AIPA in 13 patients was nodular or mass-like consolidation with multiple cavity. "air-crescent" was seen in 10 of patients with AIPA. Lobar consolidation with cavity and adjacent pleural thickening was found in all children with CNPA. The positive rate of sputum and/or BALF culture in MPA and CNFA were 72.1% and 22.4%, respectively. A large number of septate hyphae on wet smear were found in all of the children whose sputum and/or BALF culture were positive. Lung biopsy was performed in 3 children with CNPA, and necrosis, granulomatous inflammation, as well as septate, branching hyphae were observed on

  20. Pulmonary aspergillosis as first manifestation of chronic granulomatous disease in enzygotic twins-use of FDG-PET in diagnosing spread of disease; Pulmonale Aspergillose als Erstmanifestation einer septischen Granulomatose (chronic granulomatous disease, CGD) bei eineiigen weiblichen Zwillingsfruehgeborenen und Ausbreitungsdiagnostik mittels FDG-PET

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    Theobald, I.; Fischbach, R.; Heindel, W. [Muenster Univ. (Germany). Radiologische Klinik und Poliklinik; Huelskamp, G.; Frosch, M.; Roth, J. [Klinik und Poliklinik fuer Kinderheilkunde und Allgemeine Kinderheilkunde des UKM, Muenster (Germany); Franzius, C. [Klinik und Poliklinik fuer Nuklearmedizin des UKM, Muenster (Germany)

    2002-01-01

    Purpose. To present the unusual case of chronic granulomatous disease (CGD) manifestating as pulmonal aspergillosis in female enzygotic twins during the neonatal period. To demonstrate and to discuss the complex diagnosis and the diagnostic value of FDG-PET in monitoring the spread and activity of the disease. Patients. Plain chest X-ray and CT of the lung showed multiple, mostly round lesions in one of the former preterm twins at the age of 8 weeks. The girl with known ASD II was then suffering from dyspnoea and recurrent pulmonary infections. Because of the imaging findings invasive pulmonary aspergillosis due to an underlying immunodeficiency was suspected. Results. Aspergillosis was confirmed histologically and microbiologically by specimens taken from an open lung biopsy. Because of coexisting granulocytic dysfunction the diagnosis of CGD was made. This diagnosis was equally confirmed by noninvasive methods in the asymptomatic sister. FDG-PET did not show any evidence of extrapulmonary spread of disease. Conclusion. CGD can present as isolated pulmonal aspergillosis even in the neonatal period when an immunodeficiency is discussed. In enzygotic twins screening of the asymptomatic twin is mandatory. FDG-PET is a useful tool in screening for spread of the disease and in evaluating disease activity. (orig.) [German] Ziel. Im Rahmen einer Fallbeschreibung wird eine aussergewoehnlich fruehe Erstmanifestation einer septischen Granulomatose (chronic granulomatous disease ''CGD'') als invasive pulmonale Aspergillose in der Neonatalzeit bei eineiigen weiblichen Zwillingen vorgestellt. Zusaetzlich wird auf die komplexe Diagnostik unter besonderem Hinweis des Stellenwerts der FDG-PET zur Ausbreitungsdiagnostik und Aktivitaetsbeurteilung eingegangen. Patienten. Bei dem 8 Wochen alten ehemaligen Fruehgeborenen zeigten Roentgenthoraxbild und CT der Lunge multiple, meist rundliche Lungeninfiltrate. Bei bekanntem ASD lagen Dyspnoe und rezidivierende

  1. 重症患者侵袭性肺曲霉病5例临床诊治分析%Analysis of the diagnosis and treatment of 5 cases of critically ill patients with pulmonary invasive aspergillosis

    Institute of Scientific and Technical Information of China (English)

    龚书榕; 于荣国

    2015-01-01

    Objective To raise clinicians’ awareness of clinical manifestations, imaging diagnosis and treatment of invasive pulmonary aspergillosis (IPA) so as to improve the treatment success rate.Method Five critically ill cases admitted to our department from January 2010 to July 2014 with invasive aspergillosis infection were observed.Result The appliance of glucocorticoid and broad spectrum antibiotics was a high risk factor for this group of patients who had multiple clinical manifestations. Four patients underwent lung CT scan, three of whom presented typical signs separately such as aspergilloma with halo sign, air-crescent sign and hollow shape in consolidation area. The data of two cases were on the basis of microbiological testing. The five patients all received antifungal therapy using voriconazole powder for infusion solution; three patients’ lesions in lungs were absorbed and cured; one patient’s condition improved but one died from multiple organ failure caused by aggravating infection.Conclusion Non-neutropenic critically ill patients with IPA in the intensive care unit (ICU) usually have no typical signs, but the typical signs in the lung CT image are one of the most important bases of clinical diagnosis of IPA infection. Considering the high-risk host factors and other secondary clinical features of IPA, clinicians should start the empiric therapy as early as possible according to the clinical experience, especially for those critically ill patients.%目的:加强临床医师对侵袭性肺曲霉病(invasive pulmonary aspergillosis,IPA)的临床表现、影像学诊断和治疗的认识,提高救治成功率。方法对本科2010年1月至2014年7月收治的5例重症患者IPA病例进行临床分析。结果该组患者多具有应用激素及广谱抗菌药物的高危因素,临床表现多样,4例行肺部CT检查,其中3例肺部CT分别呈现典型征象如曲霉球伴晕轮征、实变区域空洞形成及空气新月征。2

  2. Immunological Mechanism,Diagnosis and Treatment of Allergic Bronchopulmonary Aspergillosis%变应性支气管肺曲霉菌病的免疫机制与诊治

    Institute of Scientific and Technical Information of China (English)

    张鼎; 胡建; 廖纪萍; 迟春花

    2015-01-01

    Allergic bronchopulmonary aspergillosis(ABPA)is one kind of hypersensitivity pulmonary diseases in response to Aspergillus fumigatus that occurred smore often in patients with asthma and cystic fibrosis.ABPA develops in genetically susceptible patients related to human leukocyte antigen (HLA)-DR2 and DR5 restrictions,increased sensitivity to interleukin-4 stimulation,and increased Aspergillus fumigatus allergen-specific Th2CD4 + T-cell-mediated responses.Main symptoms of ABPA include cough,expectoration and wheeze.The new diagnostic criterion for ABPA was suggested by International Society for Human and Animal Mycology workgroup in 2013.Avoidance of fungi,steroids,antifungals and anti-IgE monoclonal antibody therapy play important roles in treatment of ABPA.%变应性支气管肺曲霉菌病(allergic bronchopulmonary aspergillosis,ABPA)是一种人体对曲霉菌发生变态反应所引起的疾病,好发于哮喘及囊性纤维化患者。发病机制复杂,与个体人类白细胞抗原(human leukocyte antigen,HLA)-DR2/DR5表达、对白细胞介素-4的易感性及由 CD4+辅助 T 细胞2介导的免疫反应相关。多表现为咳嗽、咯痰、喘息。2013年国际人和动物真菌学会工作组提出新的诊断标准。治疗包括避免变应原接触,可应用糖皮质激素、抗真菌药物及靶向治疗。

  3. 1例糖尿病合并侵袭性肺曲霉菌感染患者的药学监护%Pharmaceutical care on a diabetic patient with invasive pulmonary aspergillosis

    Institute of Scientific and Technical Information of China (English)

    刘丽娜; 刘晓东; 肇丽梅

    2014-01-01

    Objective To investigate better patient care via the improved use of medicines and pharmaceutical services for hospital inpatients .Methods Through a case of invasive pulmonary aspergillosis in a diabetic patient , the efficacy of prescribed treat-ment was evaluated , and adverse drug reactions were prevented by clinical pharmacists .Results Pharmaceutical services were provid-ed , adverse drug reactions were reduced and the use of medicines was improved by clinical pharmacists .Conclusion Clinical phar-macists could help provide tailored treatment to the needs of individuals , ensure patient safety and appropriate use of medicines .%目的:探讨临床药师为住院患者提供药学服务的内容,以及如何最大限度地发挥药物的临床疗效。方法对1例老年男性糖尿病合并侵袭性肺曲霉菌感染患者进行跟踪治疗,评估药物治疗方案,预防并及时处理药物不良反应。结果临床药师通过参与临床工作,实施药学监护,降低药物不良反应的危害,提高患者用药疗效。结论临床药师全程参与治疗过程,可以为患者提供个体化治疗方案,提高用药合理性与安全。

  4. Retrospective analysis of 22 cases of pulmonary aspergillosis in non-neutropenic patients%非粒细胞减少患者肺曲霉病22例回顾性分析

    Institute of Scientific and Technical Information of China (English)

    王凌伟; 杨蓬; 陈春婵; 李秀媚; 邱晨

    2012-01-01

    Objective To improve the cognition, diagnosis and treatment of pulmonary aspergillosis (PA) in non-neutropenic patients. Method Clinical, radiological data of 22 cases of PA in non-neutropenic patients, including underlying diseases, clinical symptoms, radiological characteristics and treatment strategies were collected and analyzed retrospectively, and the outcomes were followed-up. Result The average age was (57. 3 ±21.4) years with 12 male and 10 female. The cases of " proven" , " probable" and " possible" were 8, 8 and 6, respectively. 11 patients were considered as having IPA, including 1 with underlying aspergilloma; 6 were having simple pulmonary aspergilloma, and 5 CNPA. The leading underlying diseases were pulmonary tuberculosis (8/22) , diabetes mellitus (6/22) , hypertension (5/22) and chronic obstructive pulmonary disease (COPD) (5/22) in pulmonary aspergillosis (PA). Chronic cough, expectoration, hemoptysis and recurrent dyspnea were the most common symptoms of PA. Radiological manifestations were infiltration or consolidation (10/22) , cavity or typical pulmonary aspergilloma (12/22) and nodule or lump mass (1/22). The first-line antifugal treatment was voriconazole (10/22) , caspofungin (4/22) , itraconazole (3/22). Conclusion Diabetes mellitus and COPD patients are vulnerable to have IPA and patients without underlying diseases may also develop IPA as primary community infection. Pulmonary tuberculosis with cavitary changes is responsible for simple pulmonary aspergilloma. We should pay more attention to differentiate simple aspergilloma from choronic necrotizing pulmonary aspergillosis which need long-term antifungal therapy. There are no specific clinical manifestations in non-neutropenic patients with IPA. Holo sign, air crescent sign or extrapulmonary dissemination are absent in these cases. Voriconazole is the fist-line antifugal treatment.%目的 提高对非粒细胞减少患者肺曲霉病的认识及诊疗水平.方法 回顾性分析22

  5. 手术联合抗真菌药物治疗肝移植术后颅内曲霉菌感染:附1例报告并文献复习%Combined surgical resection and antifungal therapy for intracranial aspergillosis after liver transplantation:a case report and literature review

    Institute of Scientific and Technical Information of China (English)

    王腾飞; 张威; 方振宇; 王洪海; 杨涛

    2015-01-01

    目的:探讨肝移植术后曲霉菌感染及颅内曲霉菌感染患者的病因、临床表现、诊断及治疗。方法回顾性分析天津市第一中心医院1例经典原位肝移植术后并发颅内曲霉菌感染患者的临床资料、诊断及治疗经过,并进行文献复习。结果患者于移植术后1个月无明显诱因出现肌肉抽搐,抽搐时意识清晰,磁共振成像(MRI)提示:右侧额叶可见占位病变,病灶中心呈长T1长T2信号影,周围可见环形等T1短T2信号影,增强后病灶呈环形强化,中心未强化,周围低密度影未见强化,诊断为颅内曲霉菌感染。患者停用吗替麦考酚酯(MMF)及激素,单用他克莫司(FK506)抗排斥反应,且FK506血药浓度维持在较低水平,同时应用卡泊芬净抗真菌治疗,2周后查头颅MRI见右侧额叶脓肿无明显变化。为治愈颅内感染,患者于全麻下行右额叶脓肿切除术,术中可见坚韧的脓肿壁,大小约1.5 cm×2.0 cm,脑脓肿完整切除后送病理,术后病理回报:颅内曲霉菌感染。术后继续给予卡泊芬净抗真菌治疗,并定期复查头颅CT。颅内脓肿切除术后患者未再发抽搐、高热。术后1个月复查头颅CT显示,颅脑术后改变较前好转,右侧额颞部皮下组织肿胀较前减轻,其他无异常。患者痊愈后出院。结论由于颅内曲霉菌感染抗真菌药往往在局部难以达到有效的抑菌浓度,对于肝移植术后孤立的颅内曲霉菌感染病灶,联合应用局部手术切除和抗真菌药物,同时减少抗排斥反应药物的剂量,可能是理想的治疗方案。%Objective To investigate the etiology,clinical presentation,diagnosis and treatment of Intracranial aspergillosis after liver transplantation. Methods Clinical data, diagnosis and treatment of one case with intracranial aspergillosis after liver transplantation were analyzed and correlative literatures were reviewed

  6. A clinical analysis on invasive pulmonary aspergillosis in patients with hepatic failure%肝衰竭患者合并侵袭性肺曲霉菌病临床分析

    Institute of Scientific and Technical Information of China (English)

    邓西龙; 陈志敏; 黄煌; 潘越峻; 李粤平

    2012-01-01

    Objective To explore the risk factors,clinical characteristics,and proguosis ofinvasive pulmonary aspergillosis ( IPA ) in patients with hepatic failure.Methods The clinical data of 15 patients with hepatic failure complicated with IPA were analyzed retrospectively.Results All the patients had an underlying disorder that was chronic hepatitis B,but had no granulocytopenia or agranulocytosis.The MELD score was ( 37.13 ± 11.03 )46.7% ( 7/15 ) of the patients had history of hormone uses ; 60% ( 9/15 ) had history of broad-spectrum antibiotic uses ( single or mulitple ) 60% ( 9/15 )of patients received previous blood purification.33.3% ( 5/15 )had a reduction in CD4+ T cells or ratio imbalance.Clinical manifestations lacked of obvious specificity.Roentgenographic examination of the lungs showed changes in all the patients; GM test was positive in 73.3% ( 11/15 )of the patients.20% ( 3/15 )of the patients improved after treatment; 80% ( 12/15 ) did not repond to therapies; and 40% ( 6/15 ) were dead within 7 days after diagnosis.Conclusions Patients with hepatic failure have multiple risk factors of invasive pulmonary aspergillosis.IPA is one of the reasons for deterioration in patients with hepatic failure.Early CT examination combined with GM tests can increase the early diagnostic rate.Early effective antifungal therapy can improve the prognosis of the disease.%目的 了解肝衰竭患者合并侵袭性肺曲霉菌病的危险因素、临床特征和预后,提高对肝衰竭合并侵袭性肺曲霉菌病的认识.方法 对15例肝衰竭合并侵袭性肺曲霉菌病患者的临床资料,包括基础疾病、住院时间、ICU住院时间、激素和抗生素使用情况、临床表现、诊断分层、治疗情况以及预后等进行回顾性分析.结果 全部患者存在慢性乙型肝炎基础疾病,均无粒细胞减少或缺乏.患者MELD评分(37.13±11.03)分.其中46.7%( 7/15)的患者有激素使用史;60%( 9/15)

  7. Clinical characteristics and treatment of invasive pulmonary aspergillosis in patients with liver failure%肝功能衰竭合并侵袭性肺曲霉病的临床特征与治疗

    Institute of Scientific and Technical Information of China (English)

    邹颖; 钱志平; 张宇一; 王介非; 黄金伟; 李光辉

    2012-01-01

    OBJECTIVE To analyze the clinical features of invasive pulmonary aspergillosis (IPA) in patients with liver failure and to improve the identification of aspergillosis at an early stage. METHODS Medical records of 39 liver failure patients with IPA admitted in Shanghai public health center from Jan 2006 to May 2011were reviewed. T test or non-parametric test was performed for inter-group comparison of means, and chi-square test was performed for enumeration data. RESULTS The clinical features of IPA with liver failure were atypical. The most common initial symptom was fever, accounting for 66. 7%. Early imaging showed multiple nodules or masses shadow with negative results in 1,3-β-D glucan test. The patients condition rapidly deteriorated after infection accompanied by significantly increased TB, Scr, INR, WBC and MELD score and significantly decreased Alb, Gib, PTA, HB, and PLT. Among the 39 cases, anti-fungal therapy was only effective in 8 patients who were discharged after improvement of hepatic function, while the other 31 patients were dead within 2 months of onset. The mortality rate was 79. 5%. 17 patients died during hospitalization with an average time of (5. 3±4. 7) days from the first symptom to death. There was no statistical significance between the survivors and the dead patients in respect of demographic characteristics, stage of liver failure and constitution of cause before IPA. However, the survivors had better MELD scores and received definite diagnosis and effective anti-fungal therapy earlier than dead patients. All the 8 survivors received a long-term treatment with echinocandin including two cases received combination of viriconazole. The mean therapeutic course lasted for (70. 9 + 26. 4) days. No serious adverse drug reactions such as hepatic function relapse were observed. The drugs were well tolerated. CONCLUSION Disease condition is rapidly deteriorated after liver failure complicated with IP A, with extremely high mortality. However

  8. Clinical analysis of 16 cases of invasive pulmonary aspergillosis in children%儿童侵袭性肺曲霉菌病16例临床分析

    Institute of Scientific and Technical Information of China (English)

    李勇; 农光民; 蒋敏; 刘静; 梁秀安

    2016-01-01

    目的 探讨儿童侵袭性肺曲霉菌病(IPA)的诊断及治疗.方法 回顾性分析2006年1月至2014年6月广西医科大学第一附属医院确诊或临床诊断IPA的16例患儿临床资料.四格表确切概率法进行组间比较.结果 16例患儿中男11例,女5例,确诊1例,临床诊断15例.宿主高危因素为:长时间使用多种广谱抗菌药物16例,中性粒细胞减少症9例,有创机械通气3例,原发性免疫缺陷病2例,长期使用糖皮质激素2例,麻疹2例,先天性肺发育不良1例.16例患儿均有发热、咳嗽、咳痰(痰响)(0/7和1/7).诊断时,中性粒细胞减少症组“晕轮征”(5/9)、胸膜下楔形实变影(7/9)高于非中性粒细胞减少症组(0/7和1/7)(P<0.05);抗曲霉菌治疗15 d~1个月后,空洞、“空气新月征”阳性率高于诊断时(P<0.05).血清半乳甘露糖聚糖抗原检测阳性率高于痰培养及血清G实验(P<0.05).13例首选伏立康唑治疗,7例有效.结论 中性粒细胞减少症是儿童IPA常见宿主高危因素.胸膜下楔形实变影、“晕轮征”及“空气新月征”对诊断有提示意义,前两者在有中性粒细胞减少症患儿早期更多见.血清GM实验有较高的诊断价值.大部分IPA患儿伏立康唑治疗有效.%Objective To investigate the diagnosis and treatment of invasive pulmonary aspergillosis (IPA) in children.Method The clinical data of 16 cases of proven or probable IPA who had been in our Hospital from January 2006 to June 2014 were retrospectively analyzed.Result Among the 16 patients,11 were males and 5 were females.One child had proven IPA and 15 children had probable IPA.Host risk included long duration use of multiple broad-spectrum antibiotics in 16 cases,neutropenia in 9 cases,invasive mechanical ventilation in 3 cases,primary immunodeficiency disease in 2 cases,long-term use of glucocorticoids in 2 cases,measles in 2 cases,and congenital pulmonary hypoplasia in 1 case.Fever,cough and expectoration were

  9. Cerebral aspergillosis due to Aspergillus fumigatus in AIDS patient: first culture - proven case reported in Brazil Aspergilosis cerebral causada por Aspergillus fumigatus en paciente con SIDA: primer reporte de caso demostrado por cultivo en Brasil

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    José E. Vidal

    2005-06-01

    Full Text Available Cerebral aspergillosis is a rare cause of brain expansive lesion in AIDS patients. We report the first culture-proven case of brain abscess due to Aspergillus fumigatus in a Brazilian AIDS patient. The patient, a 26 year-old male with human immunodeficiency virus (HIV infection and history of pulmonary tuberculosis and cerebral toxoplasmosis, had fever, cough, dyspnea, and two episodes of seizures. The brain computerized tomography (CT showed a bi-parietal and parasagittal hypodense lesion with peripheral enhancement, and significant mass effect. There was started anti-Toxoplasma treatment. Three weeks later, the patient presented mental confusion, and a new brain CT evidenced increase in the lesion. He underwent brain biopsy, draining 10 mL of purulent material. The direct mycological examination revealed septated and hyaline hyphae. There was started amphotericin B deoxycholate. The culture of the material demonstrated presence of the Aspergillus fumigatus. The following two months, the patient was submitted to three surgeries, with insertion of drainage catheter and administration of amphotericin B intralesional. Three months after hospital admission, his neurological condition suffered discrete changes. However, he died due to intrahospital pneumonia. Brain abscess caused by Aspergillus fumigatus must be considered in the differential diagnosis of the brain expansive lesions in AIDS patients in Brazil.La aspergilosis cerebral es una causa rara de lesión expansiva cerebral en pacientes con SIDA. Presentamos el primer reporte de un absceso cerebral causado por Aspergillus fumigatus en un paciente brasileño con SIDA. El paciente, de 26 años de edad, presentaba antecedentes de infección por el virus de la inmunodeficiencia humana (VIH, tuberculosis pulmonar y toxoplasmosis cerebral. Manifestó fiebre, tos, disnea y dos episódios de convulsiones. La tomografía computadorizada (TC demostró una lesión hipodensa parasagital y bi-parietal con

  10. 恶性血液病患者侵袭性肺曲霉菌感染的治疗分析%Analysis of treatment and influence factors of invasive pulmonary aspergillosis in patients with hematological malignancies

    Institute of Scientific and Technical Information of China (English)

    吴隼; 字友梅; 黄琰; 马栋; 杨满; 贺立山

    2014-01-01

    OBJECTIVE To investigate clinical effect of antifungal therapy for invasive pulmonary aspergillosis (IPA) in patients with hematological malignancies ,and analyze the influence factors for the reference for clinical data .METHODS According to the therapeutic regimen ,82 patients with hematological malignancies and IPA were randomly divided into 3 groups including voriconazole group (n=28) ,caspofungin group (n=27) and combination group (n=27) .The clinical effect ,adverse reactions ,and influence factors of the effect were analyzed with SAS 9 .0 software .RESULTS Totally 241 patients with hematologic malignancies were investigated in this study ,82 ca-ses were diagnosed as IPA ,the infection rate was 34 .0% .The effect of antifungal therapy in combination group was significantly better than that in voriconazole and caspofungin groups (P0 .05) .The age≥50 years ,haematopoietic stem cell transplant (HSCT ) ,HLA dismatch and IPA history were negative factors for the treatment effect of hematological malignancies combined with IPA .CONCLUSION Combined therapy of voriconazole and caspofungin for hematological malignancies and IPA is better than single medication in efficacy , without increasing the adverse drug reactions .The efficacy of IPA treatment may be related to age ,HSCT ,HLA dismatch and IPA history .%目的:研究恶性血液病患者侵袭性肺曲霉菌感染(IPA )抗真菌治疗效果及其影响因素,为临床资料提供参考依据。方法选择2008年1月-2013年4月收治的82例患者,根据不同的用药方案随机分为伏立康唑组28例、卡泊芬净组27例、联合组27例3组,比较各组患者的临床疗效、不良反应,并对疗效的影响因素,采用SAS 9.0软件进行分析。结果共调查恶性血液病患者241例,其中IPA 82例,感染率为34.0%;联合组的抗真菌疗效显著优于伏立康唑组、卡泊芬净组( P<0.05);单药与两药联合用药的不良反应差异

  11. 抗真菌治疗中血液样本PCR诊断侵袭性真菌性肺炎的价值%The value of PCR analysis of blood samples in diagnosing invasive aspergillosis during antifungal therapy

    Institute of Scientific and Technical Information of China (English)

    刘晓宇; 郑玉荣; 邓曦东; 刘运秋

    2012-01-01

    Objective To evaluate the value of PCR analysis of blood samples in diagnosing invasive aspergillosis( IA) during antifungal therapy. Methods IA in blood and bronchoalveolar lavage fluids and/or tissue specimens was detected by PCR in 86 patients whith fungal pneumonia and underwent antifungal therapy. On the basis of EORTC/MSG criteria, the patients were divided into three groups of A(confirmed),B(clinically diagnosed) and C(suspectable) and the PCR results were compared among three groups. Results A total of 496 whole-blood samples,37 fine-needle aspirations or tissue biopsy specimens and 53 tracheal secretions was analyzed using PCR The sensitivities of whole-blood samples and bronchoalveolar lavage fluids and/or tissue specimens in group A were 61.5% and 66. 7%, respectively, which in group B were 51.8% and 57. l%,and in group C were 55. 0% and 45. 0%,respectively. The specificity was 100% in three groups. The mortalities in positive and negative patients in group A were 63.0% and 41. 0%,respectively. Conclusion The benefits of PCR diagnosis are limited during antifungal therapy. Aspergillus PCR is recommended to be performed as an adjutant manner to the microscopic examination and culture technique.%目的 评估抗真菌治疗期间,全血曲霉菌PCR方法检测侵袭性曲霉菌感染(IA)的价值.方法 入选86例真菌性肺炎而接受抗真菌治疗的血液病患者.IA感染通过血液样本、支气管肺泡灌洗液和组织样本,经过细菌培养、组织病理学检测及PCR测定进行确认.依据欧洲癌症研究治疗组织真菌病研究组(EORTC/MSG)标准,将患者分为确诊、临床诊断和拟诊三组,比较全血样本和支气管肺泡灌洗液或组织样本的PCR结果.结果 86例患者496个血液样本,37个针吸或组织活检样本和53个支气管肺泡灌洗或气管分泌物样本.PCR测定在血液样本和支气管肺泡灌洗或组织样本中的灵敏度在确诊组分别为61.5%和66.7

  12. Aspergillosis - chest x-ray (image)

    Science.gov (United States)

    ... usually occurs in immunocompromised individuals. Here, a chest x-ray shows that the fungus has invaded the lung ... are usually seen as black areas on an x-ray. The cloudiness on the left side of this ...

  13. Clinical analysis of voriconazole in treatment of invasive pulmonary aspergillosis in children with hematological disease%伏立康唑治疗儿童血液病合并侵袭性肺曲霉菌感染的临床分析

    Institute of Scientific and Technical Information of China (English)

    周海霞; 李原; 钱江潮; 王菊香; 方希敏; 黄珍; 曾炜炜; 陈敏; 徐智胜

    2012-01-01

    OBJECTIVE To evaluate the clinical efficacy and safety of voriconazole in the treatment of invasive pulmonary aspergillosis in the children with hematological disease. METHODS A total of 10 children with invasive pulmonary aspergillosis complicated by hematological disease who enrolled the hospital from Feb 2009 to Jun 2011 were analyzed respectively, the diagnosis was confirmed by CT and GM test. All of them were treated with intravenous voriconazole 7 mg/kg, once per 12 hours lasting for about 10-14 days before changing to oral maintenance therapy of the same dosage for 4 - 8 weeks. The efficacy and safety of voriconazole were comprehensively evaluated according to clinical evaluation criteria. RESULTS The overall response rate of the 10 patients was 90. 0% (9 of 10) after voriconazole treatment; the clinical effective time was 2 - 5 days by judging from the symptoms and physical condition of the 9 patients; the incidence of drug related adverse events was 20.0%. CONCLUSION Both the oral and intravenous use of voriconazole show good antifungal activity, which therefore can be used as the first-line antibiotics for the treatment of pulmonary aspergillosis in the children with hematological disease.%目的 观察伏立康唑治疗儿童血液病合并侵袭性肺曲霉菌感染(IPA)的临床疗效及安全性.方法 回顾性分析医院2009年2月-2011年7月血液病伴发侵袭性肺曲霉菌感染住院患儿10例,所有患儿均经CT检查和GM试验临床诊断;伏立康唑针每次7 mg/kg,静脉滴注,1次/12 h,10~14 d后改用伏立康唑片剂,剂量不变,口服1次/12 h,总疗程4~8周;根据临床疗效标准,综合评价该药物的疗效和安全性.结果 10例患儿中,9例治疗有效,总有效率为90.0%,治疗有效的9例患儿从症状及体征上判定临床有效的时间为2~5 d;伏立康唑治疗过程中两例发生轻微不良反应,不良反应发生率20.0%.结论 伏立康唑口服和静脉给药均有很好的抗真

  14. 儿童变应性支气管肺曲霉菌病四例报告并文献复习%Allergic bronchopulmonary aspergillosis:a report of four cases with literature review

    Institute of Scientific and Technical Information of China (English)

    徐慧; 赵宇红; 王维; 刘金荣; 赵顺英

    2015-01-01

    目的 分析儿童变应性支气管肺曲霉菌病(ABPA)的临床特点.方法 回顾性分析首都医科大学附属北京儿童医院呼吸二科病房2010年4月至2014年3月确诊的4例ABPA患儿的临床资料.分析近10年国内外数据库中报道的儿童ABPA检索资料.结果(1)4例ABPA患儿,2例确诊为囊性纤维化,1例同时诊断为哮喘.临床表现:咳嗽3例,胸闷(黏液栓堵塞)1例,反复喘息史2例;4例肺部影像学均表现有中心性支气管扩张,其中1例表现为游走性片状阴影;4例患儿血清总IgE升高,烟曲霉抗原速发皮试、血烟曲霉特异性IgE和IgG均为阳性.4例均使用糖皮质激素及抗真菌药物(伊曲康唑或伏立康唑)口服治疗,病情均得到不同程度的缓解.(2)在近10年国内外数据库中检索儿童ABPA,国外病例报告15篇,共报道22例,其中16例发生于囊性纤维化,3例发生于哮喘,16例囊性纤维化合并ABPA患儿中,仅1例以ABPA为首发症状.国内ABPA病例报告仅1例.结论 对于哮喘、过敏性疾病的患儿,如伴有IgE的异常增高、影像学出现支气管扩张、反复肺不张时需考虑ABPA的可能;对于临床确诊为ABPA的患儿,应注意除外囊性纤维化.%Objective To understand the clinical characteristics of allergic bronchopulmonary aspergillosis(ABPA) so as to diagnose and treat the disease earlier.Method A retrospective study was conducted on ABPA patients diagnosed in the Second Department of Respiratory Medicine,Beijing Children's Hospital Affiliated to Capital Medical University from April 2010 to March 2014.The literature of children's ABPA retrieved from the databases at home and abroad in recent 10 years were analyzed.Result (1)Among the 4 cases of ABPA,cystic fibrosis (CF) and asthma were diagnosed in 2 and 1 cases,respectively.Cough was present in 3 patients,recurrent wheezing in 2 and chest tightness in 1 case.CT scans showed central bronchiectasis in all 4 cases,while 1 patient had migratory

  15. Clinical analysis of chronic airway diseases combined with invasive pulmonary aspergillosis%慢性气道疾病合并侵袭性肺曲霉病临床分析

    Institute of Scientific and Technical Information of China (English)

    戴然然; 张旻

    2013-01-01

    目的 回顾性总结慢性气道疾病合并侵袭性肺曲霉病(IPA)患者的临床资料,分析慢性气道疾病患者发生IPA的危险因素、临床特点、诊断、治疗和预后.方法 收集2007年1月-2012年8月上海交通大学医学院附属瑞金医院呼吸科和上海交通大学附属第一人民医院呼吸科病房收治的慢性气道疾病合并IPA患者的临床资料.分析其危险因素、临床表现、实验室检查和影像学检查特征、诊断、治疗及预后.结果 共入选18例患者,2例患者经肺活组织穿刺病理学检查明确诊断为IPA,16例患者临床诊断为IPA.男14例,女4例,年龄29~80岁,中位年龄为62.2岁.慢性阻塞性肺疾病(COPD) 13例,支气管哮喘3例,支气管扩张2例.COPD和支气管哮喘患者住院后均应用糖皮质激素治疗,包括静脉注射甲泼尼龙及口服泼尼松,疗程均>2周.3例支气管哮喘患者平时均不规则口服泼尼松.2例COPD和2例支气管哮喘患者有口服邮购的“中成药”(含糖皮质激素)史,疗程均>半年.2例支气管扩张患者因反复感染,长期口服抗生素.13例COPD患者中4例合并糖尿病.所有患者均接受抗真菌药物治疗,其中6例患者死于IPA和呼吸衰竭.结论 慢性气道疾病易合并严重的IPA,大部分患者由于基础疾病急性加重反复使用糖皮质激素治疗,临床和影像学检查无特异性,当临床高度怀疑IPA时应给予尽早诊断和治疗,可以降低病死率.%Objective To retrospectively study the clinical data of the patients with chronic airway disease combined with invasive pulmonary aspergillosis (IPA), and to analyze the risk factors, clinical features, diagnosis, treatment and prognosis of IPA. Methods Clinical data of chronic airway disease patients with IPA were collected. All the patients were hospitalized in Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Shanghai First People's Hospital Affiliated to Shanghai

  16. 雾化吸人两性霉素B对侵袭性肺曲霉病预防效果的Meta分析%Efficacy and Safety of Inhaled Amphotericin B in Prophylaxis of Invasive Pulmonary Aspergillosis:A Meta-analysis

    Institute of Scientific and Technical Information of China (English)

    卢鑫; 孙文逵; 高伟; 苏欣; 施毅

    2012-01-01

    目的 采用Meta分析方法对现已发表的关于雾化吸入两性霉素B(AmB)预防侵袭性肺曲霉病(IPA)的文献进行综合分析,从动物实验和临床研究两个方面分别评价雾化吸入AmB对IPA的预防作用.方法 检索MEDLINE生物医学数据库、科学引文索引(ISI)、医学文摘资料库(EMBASE)及万方数据库,检索发表于2011年3月以前关于雾化吸入AmB预防IPA的文献,由2名评价员分别筛选符合标准的文献,进行质量评价和数据提取.采用RevMan4.22软件进行异质性分析,合并效应量的检验采用优势比(OR)及95%可信区间(95%CI).结果 共纳入符合标准的动物实验文献5篇,包括实验动物626只;临床研究文献6篇,包括1354例真菌感染高危病人.Meta分析结果显示感染前雾化吸入AmB的实验动物存活率高于安慰剂对照组(38.3%比9.7%,OR=13.93,95%CI7.46 ~26.01,P<0.000 01).真菌感染高危人群中,预防性雾化吸入AmB的患者IPA发生率较安慰剂或空白对照组为低(2.6%比9.2%,OR =0.27,95%CI0.16 ~0.46,P<0.000 01);雾化预防组与对照组患者IPA相关病死率及总死亡率差异无统计学意义(RR =0.65,95% CI0.33~1.30,P=0.23;OR=1.17,95% CI0.73 ~ 1.89,P=0.51);雾化吸入AmB绝大部分不良反应程度轻微.结论 预防性雾化吸入AmB能有效降低实验动物肺曲霉感染死亡率,对粒细胞缺乏等高危人群预防性雾化吸入AmB能有效降低IPA发生率,不良反应轻微,但未降低曲霉感染相关病死率及总死亡率.需要更多高质量大型临床研究进一步提供循证医学证据.%Objective To evaluate the efficacy and safety of inhaled amphotericin B ( AmB) in prophylaxis of invasive pulmonary aspergillosis ( IP A) in both animal studies and clinical researches. Methods MEDLINE.ISI.EMBASE and Wanfang Periodical Databases were searched until march 2011 for case-control study on the efficacy and safety of inhaled AmB in prophylaxis of IPA. The

  17. A systematic review of the accuracy of diagnostic test of serum galactomannan antigen detection for invasive aspergillosis%血清半乳甘露聚糖检测诊断侵袭性曲霉病价值的荟萃分析

    Institute of Scientific and Technical Information of China (English)

    孙文逵; 张峰; 徐小勇; 申玉英; 施毅

    2010-01-01

    Objective To assess the value of galactomannan(GM) double-direct sandwich enzymelinked immunosorbent assay(ELISA) in the diagnosis of invasive aspergillosis(IA). Methods A search in MEDLINE,EMbase,OVID,CBMdisc and CHKD from Jan. 1991 to Dec. 2008 was conducted to collect all articles about diagnostic tests of serum GM detection. Then the methodological quality was assessed by QUADAS-items, sources of heterogeneity investigated, pooled effect quantities evaluated, and meta-analysis studies, SROC curves, and subgroup analysis performed. Results Thirty-six articles with a population of 4959 patients were included. The average prevalence of IA was 10% (532/4959). Our meta-analysis reported a median heterogeneity ( I2 = 48.6%, P < 0.05 ), with a pooled DOR value of 19.10 ( 95% CI 12.67-28.79), a pooled sensitivity of 0.66(95% CI 0.61-0.70), a pooled specificity of 0.90(95% CI 0.89-0.90 ), a pooled positive likelihood ratio of 5.48 (95% CI 4.27-7.02 ), a pooled negative likelihood ratio of 0.38(95% CI 0.29-0.50) , and an area under curve of SROC 0.88. The rate of underdiagnosis of serum GM detection was 34% (168/490) and the rate of misdiagnosis was 10% (466/4469). With a rise in the cut-off value the sensitivity of GM test decreased and specificity increased. Two consecutive positive tests decreased the sensitivity but increased the specificity. Age had no significant effect on the diagnosis by GM test. Both antifungal prophylaxis and antifungal therapy had no significant effect on sensitivity and specificity of GM test for IA diagnosis. Conclusion Serum GM detection is an effective diagnostic tool for invasive aspergillosis in high-risk populations.%目的 评价ELISA法检测血清半乳甘露聚糖(GM)诊断侵袭性曲霉病(IA)的价值.方法 检索Medline生物医学数据库、医学文摘资料库(EMbase)、OVID全文期刊库、中国生物医学文献数据库、中国生物医学期刊文献数据库及万方数据库等,检索时间为1991年1月至2008

  18. 两性霉素B静脉和雾化联合给药治疗肺曲霉病1例报告%The intravenous infusion of amphotericin B combined with aerosol inhalation for pulmonary aspergillosis:1 case report

    Institute of Scientific and Technical Information of China (English)

    杨玉亚; 叶晓芬; 蔡映云

    2014-01-01

    1例47岁男性患者因“肺曲霉病”住院治疗。因抗真菌药敏试验显示耐药或用药后治疗效果欠佳及肝功能异常而先后停用卡泊芬净和伏立康唑。换用两性霉素B脂质体静脉滴注治疗病灶吸收缓慢,且肾功能有受损趋势。给予联合两性霉素B(AmB)雾化吸入治疗,因出现呛咳、咽痛等局部刺激症状而停用。临床药师认为两性霉素B雾化吸入疗效好,安全性高,局部药物浓度维持时间长,虽然局部不良反应发生率较高,但降低吸入药物浓度可以避免或减轻不良反应。建议继续联合雾化吸入两性霉素B。临床医生采纳临床药师意见,减低雾化吸入两性霉素B的浓度,待患者耐受后再逐渐提高浓度和剂量。联合给药2周后,咳嗽症状基本消失。复查纤支镜示支气管腔病灶显著减少。随访肾功能无进一步恶化。%A 47-year-old man was hospitalized for pulmonary aspergillosis. The use of caspofungin and voriconazole were gradually stopped because the antifungal susceptibility test indicated resistance to caspofungin, the therapeutic efifcacy was unsatisfactory and hepatic dysfunction occurred to him owing to the treatment of voriconazole. Amphotericin B (AmB) liposome was used instead by intravenous infusion. Consequently, lesions were slowly absorbed, however it’s likely to impair his renal function. The patient had local irritations such as bucking and pharyngalgia when aerosol AmB inhalation was coadministrated. So taking aerosol AmB inhalation was also stopped. Clinical pharmacist considers that aerosol inhalation of AmB has better curative effect and safety, and its local concentration can be maintained for a long time. Although the incidence rate of local adverse reaction is higher, it could be avoided or relieved by reducing the inspired concentration. So clinical pharmacist advised to continue the combination therapy with aerosol AmB inhalation, and the

  19. 肺部 CT 联合血清半乳甘露聚糖实验在白血病并发侵袭性肺曲霉菌病诊断及疗效评价中的应用%The diagnosis and therapeutic evaluation of invasive pulmonary aspergillosis in leukemia patients using CT combined with galactomannan test

    Institute of Scientific and Technical Information of China (English)

    李明; 李功杰; 周娟; 盛复庚; 乔鹏岗

    2016-01-01

    Objective To investigate the role of chest CT image combine serum galactomannan (GM)test as predictors of therapeutic effect in leukemia patients with invasive pulmonary aspergillosis (IPA).Methods In this retrospective study from Jan 2010 to Dec 2012,we analyzed both of chest CT image and GM test in 25 patients classified as "clinical diagnosis" IPA. Result Chest CT image had four kinds of manifestations:nodules with halo sign (1 7 cases),wedge-shaped consolidation (3 cases),diffuse lesser tubercle (4 cases)and scattered patchy shadows with satellite lesions (1 case).Antifungal treatment was effectivein 1 5 cases with GM index being down to normal at the same time.In 8 cases in progress,GM index raised according-ly;when new antifungal therapy was accepted and worked well,the GM index was lower down.In 2 cases of inflammation out of control,GM index was positive constantly.Conclusion Chest CT image combine serum GM test can be considered as a val-uable tool to monitoring treatment effect in leukemia patient with IPA.%目的:探讨肺部 CT 联合血清半乳甘露聚糖实验在白血病并发侵袭性肺曲霉菌病诊断及疗效评价中的应用价值。方法对我院2010年1月~2012年12月期间,收集临床诊断为 IPA 的白血病患者25例,回顾性分析其 CT 影像和 GM 实验。结果 CT 表现出现结节及晕征17例,出现楔形实变影3例,弥漫分布粟粒或小结节模糊影4例;1例表现为两肺散在斑片影伴周围“卫星灶”。15例抗真菌治疗有效,治疗过程中 GM 值降低至正常;8例进展、GM 值升高,之后调整抗真菌治疗方案有效、GM 值降低;2例患者感染无法控制,GM 值上升或虽有下降但一直处于阳性水平。结论肺部 CT 检查联合血清半乳甘露聚糖(GM)实验可监测临床诊断侵袭性肺曲霉病(IPA)的疗效。

  20. Allergic bronchopulmonary aspergillosis among patients with bronchial asthma

    Directory of Open Access Journals (Sweden)

    Al-Najada M, Al-Nadi K, Sharara AM

    2010-06-01

    Full Text Available To determine the different presentations encountered upon diagnosis of ABPA among patients with bronchial asthma and the two-year-follow-up results. Patients and method All patients with bronchial asthma and ABPA were included in the study .Specially formulated sheet was done include age, gender, duration of bronchial asthma ,new clinical,radiological,and laboratory findings suggestive of ABPA and two year follow up of them. Diagnosis of ABPA was based on Rosenberg-Patterson criteria. Result Fifteen patients with ABPA 3.9% out of 385 patients with bronchial asthma were included in our study, (5malesand (10 females there mean age was 28.8 years , and mean duration of asthma was 8.9 years, and they represent all stages of asthma severity. Fleeting shadows mainly in the upper lobes were the most common radiological findings observed in nine patients (60%, five patients (33.3% had proximal bronchiectasis detected by high resolution chest ct-scan, one of our patients had collapsed consolidation. All patients had moderate to severe eosinophilia and positive immediate skin test for aspergillus. Conclusion As the prevalence of ABPA is not uncommon among patients with bronchial asthma regardless the severity and the level control of asthma, high index of suspicious for ABPA should be maintained when followed up any patient with bronchial asthma.

  1. Efficacy of Caspofungin and Voriconazole Combinations in Experimental Aspergillosis

    OpenAIRE

    MacCallum, Donna M; Whyte, Julie A.; Odds, Frank C.

    2005-01-01

    Guinea pigs were infected with Aspergillus fumigatus at two challenge doses and treated for 7 days with a placebo, intraperitoneal caspofungin (1 mg/kg daily), oral voriconazole (1 mg/kg twice a day), or a combination of the caspofungin and voriconazole treatments. The combination therapy statistically significantly prolonged survival over that with the control at both challenge doses and achieved a statistically significant reduction in kidney burdens as measured by quantitative PCR. The sam...

  2. Aspergillus niger: an unusual cause of invasive pulmonary aspergillosis

    OpenAIRE

    Person, A. K.; Chudgar, S. M.; Norton, B. L.; Tong, B. C.; Stout, J E

    2010-01-01

    Infections due to Aspergillus species cause significant morbidity and mortality. Most are attributed to Aspergillus fumigatus, followed by Aspergillus flavus and Aspergillus terreus. Aspergillus niger is a mould that is rarely reported as a cause of pneumonia. A 72-year-old female with chronic obstructive pulmonary disease and temporal arteritis being treated with steroids long term presented with haemoptysis and pleuritic chest pain. Chest radiography revealed areas of heterogeneous consolid...

  3. Bulky mediastinal aspergillosis mimicking cancer in an immunocompetent patient.

    Science.gov (United States)

    Stern, Jean-Baptiste; Wyplosz, Benjamin; Validire, Pierre; Angoulvant, Adela; Fregeville, Aude; Caliandro, Raffaele; Gossot, Dominique

    2014-10-01

    We describe the case of a previously healthy 42-year-old woman who presented with a chronic cough and occasional night sweats. Radiologic exploration showed a bulky mediastinal mass surrounding the aortic arch, associated with a left subclavicular lymph node and a cerebral round lesion, mimicking a disseminated lung cancer. Surgical left subclavicular and computed tomography-guided mediastinal biopsy specimens showed granulomatous patterns. Mycologic culture of both samples grew Aspergillus flavus. Resolution was obtained after 9 months of oral voriconazole therapy. PMID:25282220

  4. Invasive Pulmonary Aspergillosis in a Patient with Acute Lymphoblastic Leukemia

    Directory of Open Access Journals (Sweden)

    Orhan Ayyıldız

    2004-01-01

    Full Text Available Fungal infections are common and life-threatening among immunosupressive patients.Invasive pulmonar aspergilloz (IPA generally occurs when Aspergillus inhaled, but rarelywith the hematogen spread of dermal or gastrointestinal Aspergillus. We present here, IPA ina 58 year-old male patient with acute lymphoblastic leukemia (ALL. He was admitted to ourclinic with fatigue, weakness, pansitopenia, and with petechia. Supportive treatment,vincristine and prednisone was initiated. Chest roentgenogram was normal. Dyspnea andfever (39.5’C were seen after 1 month of therapy. Thorax high resolution computerizedtomography was obtained and cavitary lesion was seen in the left upper-anterior segment oflung. Sputum and blood culture were negative. In spite of the empiric use of Meropenem 3gr/d, Vancomycin 2 gr/d and fluconazole 200 mg/d, fever was not turned to normal andclinical symptoms were not healed. On the fifth days of therapy amphotericin-B was initiatedand the other antibiotics were stopped after 3 days. General symptoms were healed on the 8thdays. Radiologic findings were improved partially after 20 days. The patient clinically is welland remains in remission and radiologic findings were turn to near normal after 10 monthsof treatment. We aimed to emphasis about treatment of empirical Amphotericin-B incritically ill patient with ALL.

  5. The Treatment of Chronic Pleural Empyema with Aspergillosis

    Directory of Open Access Journals (Sweden)

    Feride Sapmaz

    2012-07-01

    Full Text Available Chronic pleural empyema with aspergillus is a rare complication that usually presents after lung resection operations. Etiologic factors of pleural aspergillus includes healed or presence pulmonary tuberculosis, bronchopleural fistula, pleural catheterisation or drainage, lung resection, complex antibiotic uses. Medical and surgical treatments of chronic pleural empyema with aspergillus were examined in this study. Antifungal agents is used as medical treatment. Surgical therapy has a widely spectrum which includes tube tho-racostomy, open drainage, (Eleosser flap, Clagett Procedures, thoracostoma, decortication, omentum and/or extrathoracic or abdominal muscles transpo-sition to intrathoracic space.

  6. Trends in invasive fungal infections, with emphasis on invasive aspergillosis

    NARCIS (Netherlands)

    Erjavec, Z.; Kluin-Nelemans, H.; Verweij, P. E.

    2009-01-01

    P>Patterns of invasive fungal infections are changing in many ways. Although yeast infections appear to have reached a stable incidence, the number of infections as a result of Aspergillus species appears to be increasing. Especially for mould infection, the diagnosis remains difficult and the detec

  7. [A case of invasive pulmonary aspergillosis accompanied with Aspergillus meningitis].

    Science.gov (United States)

    Akutsu, K; Goto, H; Sakurada, S; Ota, T; Yuasa, K; Iguchi, M; Okamura, T; Ieki, R; Kawamura, T

    1996-06-01

    A 53-year-old female was admitted to our hospital complaining of chest pain and gait disturbance. Examinations on admission showed that she was immunocompetent except the negative tuberculin test. The chest X-ray showed infiltrative shadows with old tuberculous lesions in the bilateral upper lung fields. In CT, a mass lesion was revealed in the lesion, which destructed the fifth thoracic vertebra and invaded into the epidural space. She died of meningitis on the 18th day after admission. On autopsy, it was made clear that the mass lesion was caused by Aspergillus fumigatus, and that the meningitis was the result of the invasion of the fungus into the epidural space. PMID:8741716

  8. Immunohistochemistry for the diagnosis of aspergillosis in turkey poults

    DEFF Research Database (Denmark)

    Jensen, H.E.; Christensen, J.P.; Bisgaard, M.; Nielsen, O.L.

    1997-01-01

    From each of two flocks (A and B) of poults comprising 14,100 females and 11,300 males, respectively, 15 poults were examined pathologically. Poults of flock A. had signs of neurological disturbances whereas birds from flock B showed respiratory symptoms. Gross lesions were observed only in two p...

  9. Hypothermic Endpoint for an Intranasal Invasive Pulmonary Aspergillosis Mouse Model

    OpenAIRE

    Adamson, Trinka W; Diaz-Arevalo, Diana; Gonzalez, Tracey M; Liu, Xueli; Kalkum, Markus

    2013-01-01

    Immunocompromised mice were infected intranasally with Aspergillus fumigatus as part of a vaccine efficacy study. Although body temperature was measured throughout the study, a formal evaluation of its usefulness as an endpoint criterion was not performed. We retrospectively evaluated survival data and temperature records to determine whether body temperature can be used as an objective predictor of death and included in the humane endpoint criteria for this mouse model. CF1 mice were immunos...

  10. The potential impact of the pulmonary microbiome on immunopathogenesis of Aspergillus-related lung disease

    NARCIS (Netherlands)

    Kolwijck, E.; Veerdonk, F.L. van de

    2014-01-01

    Aspergillosis is an infection or allergic response caused by fungi of the genus Aspergillus. The most common forms of aspergillosis are allergic bronchopulmonary aspergillosis, chronic pulmonary aspergillosis, and invasive pulmonary aspergillosis. Aspergillus also plays an important role in fungal s

  11. Pulmonary aspergillosis appearing as chronic nodular disease in chronic granulomatous disease

    International Nuclear Information System (INIS)

    Chronic nodular pneumonia is unusual in children. Three children are described who presented with diffuse nodular pulmonary disease and in whom lung biopsy demonstrated Aspergillus infection. One child was known to have chronic granulomatous disease of childhood (CGD) and further investigation demonstrated CGD in the other two patients as well. These cases indicate that Aspergillus infection and CGD should be considered in the differential diagnosis in children who present with chronic diffuse nodular pneumonia. (orig.)

  12. Lessons About the Pathogenesis and Management of Aspergillosis from Studies in Chronic Granulomatous Disease

    OpenAIRE

    Gallin, John I.; Zarember, Kol

    2007-01-01

    Chronic Granulomatous Disease (CGD) is a rare disorder caused by mutations in the NADPH oxidase. The CGD phenotype includes granuloma formation and susceptibility to infection with microorganisms including Aspergillus. The immune adjuvant interferon-γ and the antifungal agent itraconazole have reduced the incidence of infections in CGD. Studies using CGD phagocytes have shown that reactive oxygen species (ROS), products of the NAPDH oxidase, are critical for killing Aspergillus hyphae. But de...

  13. Immunodiagnosis of opportunistic mycoses: detection of fungal antigenemia by radioimmunoassays in systemic candidiasis and aspergillosis

    International Nuclear Information System (INIS)

    The authors have developed radioimmunoassays to the Candida carbohydrate, mannan, and to an Aspergillus cell wall carbohydrate. They evaluate these radioimmunoassays with sera from rabbit models of disseminated mycoses, and further evaluate the radioimmunoassays for their diagnostic usefulness in a panel of patient sera. (Auth.)

  14. CO-EXISTING MUCORMYCOSIS WITH ASPERGILLOSIS IN A PATIENT WITH DIABETES MELLITUS- FIRST CASE REPORT

    Directory of Open Access Journals (Sweden)

    Nitin M Nagarkar

    2014-10-01

    Full Text Available 50 year male patient presented with a history of left nasal bleeding with discharge, left facial palsy for the last 15 days with uncontrolled diabetes. Black eschar was seen in nasal cavities with defect in hard palate on the left side (3×3cm. Debridement and cumulative dose (2.3gm of amphotericin was given.

  15. CO-EXISTING MUCORMYCOSIS WITH ASPERGILLOSIS IN A PATIENT WITH DIABETES MELLITUS- FIRST CASE REPORT

    OpenAIRE

    Nitin M Nagarkar; Hitesh Verma; Punia RPS

    2014-01-01

    50 year male patient presented with a history of left nasal bleeding with discharge, left facial palsy for the last 15 days with uncontrolled diabetes. Black eschar was seen in nasal cavities with defect in hard palate on the left side (3×3cm). Debridement and cumulative dose (2.3gm) of amphotericin was given.

  16. Vacuum-Assisted Closure and Primary Cutaneous Aspergillosis in a Burn - A Management Dilemma!

    OpenAIRE

    Lohana, P.; Hogg, F. J.

    2010-01-01

    The advent of vacuum-assisted closure (VAC) devices has changed many wound management practices by application of topical negative pressure. A 20-year-old male sustained 21% total body surface area circumferential full-thickness burns to both legs from knees to feet. The VAC dressing was used in the management of his wounds. The patient had persistent pyrexia and graft destruction and subsequently the wounds cultured Aspergillus fumigatus. The increasing popularity of the VAC dressing is well...

  17. Aspergilose pulmonar necrotizante crônica Chronic necrotizing pulmonary aspergillosis

    OpenAIRE

    Eduardo Felipe Barbosa Silva; Melânio de Paula Barbosa; Marco Antônio Alves de Oliveira; Rosane Rodrigues Martins; Jefferson Fontinele e Silva

    2009-01-01

    A aspergilose pulmonar necrotizante crônica é uma das formas de aspergilose pulmonar usualmente encontrada em pacientes com imunossupressão leve. Apresentamos o caso de uma paciente com queixas de tosse produtiva crônica, febre e astenia. Havia utilizado corticóides. A TC do tórax evidenciava consolidação com cavitação de permeio no lobo superior direito. A fibrobroncoscopia demonstrou secreção purulenta em árvore traqueobrônquica e lesão vegetante endobrônquica. Biópsias desta lesão e biópsi...

  18. Tracheoesophageal fistula resulting from invasive aspergillosis in acute lymphoblastic leukemia: a case report

    International Nuclear Information System (INIS)

    Tracheoesophageal fistula (TEF) in adult patients is an uncommon complication in leukemia. We present here on a case of TEF in a 46-year-old woman with ALL. The patient was asymptomatic and TEF is resulted from aspergillus bronchitis during the chemotherapy for acute lymphoblastic leukemia (ALL)

  19. Tracheoesophageal fistula resulting from invasive aspergillosis in acute lymphoblastic leukemia: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Si Won [Daejeon St. Mary' s Hospital, College of Medicine, Catholic University, Daejeon (Korea, Republic of)

    2006-04-15

    Tracheoesophageal fistula (TEF) in adult patients is an uncommon complication in leukemia. We present here on a case of TEF in a 46-year-old woman with ALL. The patient was asymptomatic and TEF is resulted from aspergillus bronchitis during the chemotherapy for acute lymphoblastic leukemia (ALL)

  20. Aspergilosis: una patología a considerar Aspergillosis: a phatology to be considered

    OpenAIRE

    Héctor Guillermo Oxilia; Rodrigo Guillermo Oxilia; Lorena Morales; Fernando Falco

    2008-01-01

    La aspergilosis pulmonar es una infección micótica causada por el Aspergillus fumigatus, saprófito del esputo humano normal. Se estudiaron cinco casos de pacientes con aspergilosis, cuatro de ellos adultos, tres del sexo femenino y uno masculino, todos de presentación no invasiva, y uno, pediátrico, sexo masculino, del tipo invasiva. Fueron estudiados con radiología convencional, tomografía computada (TC) helicoidal, TC multislice y video cápsula endoscópica. Afecta 3:1 a los hombres en relac...

  1. Post-transplant aspergillosis and the role of combined neurosurgical and antifungal therapies under belatacept immunosuppression

    DEFF Research Database (Denmark)

    Ekkehard, Kasper; Bartek, Jiri; Johnson, Jesper Scott;

    2011-01-01

    lesion revealed Aspergillus fumigatus. With modification of immunosuppression and directed antifungal therapy there was complete resolution of the chest lesion; the brain lesion initially responded well but later progressed in size. Surgical intervention via a left fronto-temporal craniotomy with...

  2. A pulmonary aspergillosis case with fatal course in a patient with SIRS clinic

    Directory of Open Access Journals (Sweden)

    Nedim Çekmen

    2011-01-01

    Full Text Available A 77-year-old male patient with a history of tuberculosis applied to emergency service with complaints of confusion, shortness of breath, tachycardia, hypothermia and hypotension. A bronchoalveolar lavage culture was collected because a fungus ball was seen on repeat chest X-ray and thoracic CT of the patient. Aspergillus fumigatus grew and voricona-zole treatment was started, but the patient was lost from multiple organ failure (MOF. In diagnosis of patients with SIRS clinic, causative factor may be aspergillus located in an old tuberculosis cavity, and this may have a fatal course in an old patient having previous pulmonary and systemic diseases.

  3. Coinfection of pulmonary mucormycosis and aspergillosis presenting as bilateral vocal cord palsy

    Science.gov (United States)

    Mahadevaiah, Arun H; Rajagopalan, Natarajan; Patil, Mahantesh; C, Shivaprasad

    2013-01-01

    Invasive pulmonary coinfection with Mucor and Aspergillus is rare. Bilateral vocal cord paralysis resulting from coinfection with these two fungi to our knowledge has not been reported in the literature. We report a young woman with diabetes who presented with symptoms of community acquired pneumonia in association with hoarseness of voice. Investigations revealed air space consolidation of the right upper lobe, evidence of mediastinal involvement extending into the paratracheal space and entrapment of right upper lobe pulmonary artery. Bronchoscopy revealed bilateral vocal cord paralysis and sloughing of mucosa of the right upper lobe bronchus and the bronchus intermedius. Microbiological and pathological results confirmed Mucor and Aspergillus. Extensive vascular and mediastinal involvement precludes surgical debridement. Despite aggressive medical management the patient deteriorated and died of respiratory failure. Strong suspicion of invasive fungal infections in immune compromised patients presenting with unresolving pneumonia and hoarseness of voice, early aggressive treatment is crucial for the patient survival. PMID:23964036

  4. Aspergilose orbitária: relato de caso Ocular aspergillosis: case report

    OpenAIRE

    Patrícia Ioschpe Gus; Marcia Cristina Bayer; Guilherme Herrmann Matos; Cristiane Von Werne Baes; Maria Fernanda Melo Martins; Júlio Vargas Neto; Thor Gunnar Onsten

    2005-01-01

    A presença de fungos na conjuntiva representa constante ameaça para os olhos, pois estes microrganismos, definidos como oportunistas, podem provocar infecções oculares graves, em situações como baixa resistência orgânica, uso de medicações imunossupressoras, antibióticos e alteração epitelial. O objetivo desta, é relatar um caso de aspergilose ocular em paciente imunodeprimida com diagnóstico de hemoglobinúria paroxística noturna. Paciente feminina de 51 anos, internou imunossuprimida e plaqu...

  5. A case of invasive aspergillosis in CGD patient successfully treated with Amphotericin B and INF-γ

    OpenAIRE

    Gerami-Shoar Mohsen; Saadat Farshid; Zomorodian Kamiar; Mamishi Setareh; Tarazooie Bita; Siadati Seyad Ahmad

    2005-01-01

    Abstract Background Chronic granulomatous disease (CGD) is a rare disorder of phagocytes in which absence of superoxide and hydrogen peroxide production in phagocytes predisposes patients to bacterial and fungal infections. The most common fungal infections in these patients are caused by Aspergillus species. Case presentation Here, we describe Aspergillus osteomyelitis of the ribs and hepatic abscess in a 5-year-old boy. The patient was successfully treated with Amphotericin B and INF-γ. Con...

  6. The use of abatacept in debilitating cavitating lung disease associated with rheumatoid arthritis, bronchocentric granulomatosis and aspergillosis.

    LENUS (Irish Health Repository)

    Neff, K

    2010-06-01

    A case of debilitating cavitating lung disease associated with rheumatoid arthritis and bronchocentric granulomatosis, which failed to respond to conventional medical or surgical treatment, is described. The patient was treated over 10 years with steroids, antimicrobial agents, disease-modifying antirheumatoid drugs and surgery. Lung function continued to decline and the patient presented for admission with recurrent pneumonia. Abatacept was initiated to modify the underlying immunopathology. Following 12 months of treatment with abatacept the patient has demonstrable improvement in lung function and lung anatomy, and has not presented to hospital with pneumonia. She has tolerated the treatment without complication. The use of abatacept has stabilised the lung disease in this case in the medium term and prevented readmission to hospital. These results suggest a larger role for abatacept in those with such disease in the future and may warrant further investigation.

  7. The role of azoles in the management of azole-resistant aspergillosis: from the bench to the bedside.

    Science.gov (United States)

    Seyedmousavi, Seyedmojtaba; Mouton, Johan W; Melchers, Willem J G; Brüggemann, Roger J M; Verweij, Paul E

    2014-07-01

    Azole resistance is an emerging problem in Aspergillus fumigatus and is associated with a high probability of treatment failure. An azole resistance mechanism typically decreases the activity of multiple azole compounds, depending on the mutation. As alternative treatment options are limited and in some isolates the minimum inhibitory concentration (MIC) increases by only a few two-fold dilutions steps, we investigated if voriconazole and posaconazole have a role in treating azole-resistant Aspergillus disease. The relation between resistance genotype and phenotype, pharmacokinetic and pharmacodynamic properties, and (pre)clinical treatment efficacy were reviewed. The results were used to estimate the exposure needed to achieve the pharmacodynamic target for each MIC. For posaconazole adequate exposure can be achieved only for wild type isolates as dose escalation does not allow PD target attainment. However, the new intravenous formulation might result in sufficient exposure to treat isolates with a MIC of 0.5 mg/L. For voriconazole our analysis indicated that the exposure needed to treat infection due to isolates with a MIC of 2 mg/L is feasible and maybe isolates with a MIC of 4 mg/L. However, extreme caution and strict monitoring of drug levels would be required, as the probability of toxicity will also increase. PMID:25066814

  8. Aspergilosis broncopulmonar alérgica. Complicaciones poco usuales de la afección ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS. UNUSUAL COMPLICATIONS

    OpenAIRE

    EDGARDO CARRASCO C.

    2004-01-01

    Se revisa definición, etiología, etapas clínicas, tratamiento y complicaciones de la Aspergilosis Broncopulmonar Alérgica (ABPA). En el Instituto Nacional del Tórax se han seguido 35 casos de ABPA durante un promedio de 15 años. De esta serie se presentan dos pacientes de sexo femenino que corresponden a ABPA complicada por infección por Mycobacterium avium-intracellulare (MAI). Las pacientes que tenían 71 y 72 años de edad respectivamente, presentaron una infección pulmonar por MAI, 3 y diez...

  9. [Mycologic surveillance of the environment for preventive invasive aspergillosis. Proposals for standardization of the methodologies and implementation].

    Science.gov (United States)

    Gangneux, J P; Poirot, J L; Morin, O; Derouin, F; Bretagne, S; Datry, A; Kauffmann-Lacroix, C; Paugam, A; Chandenier, J; Bouakline, A; Bordes, M; Chachaty, E; Dupeyron, C; Grawey, I; Lecso, G; Lortholary, J; Mourlhou, P; Nesa, D; Saheb, F; Cornet, M; Vimont, A M; Cordonnier, C

    2002-05-25

    A MAJOR RISK: The infection of immunodepressed patients by Aspergillus-type fungi increases morbidity and mortality, particularly in hematology units or during solid organ transplantation. Although present diagnostic means benefit from the progress over the last years, they remain limited and chemoprophylaxis protocols have still not demonstrated significant efficacy. THE NEED FOR RECOMMENDATIONS: Today, the handling of environmental risks is the only strategy that has proved its efficacy and usefulness. On the basis of administrative recommendations and data from the literature, a multicentric and pluri-disciplinary task force, grouping clinicians, microbiologists and hygienists, has assessed different methods and has proposed recommendations for the standardization and optimization of fungal surveillance of the environment. PMID:12148454

  10. Strategies for treating aspergillosis due to azole-resistant Aspergillus fumigatus : from the bench to the bedside

    NARCIS (Netherlands)

    Seyedmousavi Tasieh, S.

    2014-01-01

    In humans, Aspergillus fumigatus is the most common and life-threatening aerial fungal pathogen, especially among immunocompromised patients, with an overall mortality ranging between 30 to 88%. Azole antifungals, such as voriconazole and posaconazole, are recommended first choice drugs to manage as

  11. Aspergilosis pulmonar secundaria a neutropenia inducida por metimazol: reporte de un caso Pulmonary aspergillosis due to methimazole-induced neutropenia: a case report

    Directory of Open Access Journals (Sweden)

    Miguel E. Pinto

    2012-06-01

    Full Text Available Se reporta el caso de una paciente de 48 años de edad con diagnóstico reciente de enfermedad de Graves, quien acudió a emergencia por presentar fiebre, palpitaciones y dolor faríngeo. Su tratamiento regular incluía metimazol. Al ingreso, los análisis mostraron TSH suprimido, T4 libre elevado y neutropenia. La paciente fue hospitalizada, se administraron antibióticos y factor estimulante de colonia. Después de diez días de tratamiento, la paciente presentó leucocitosis, fiebre y hemoptisis. La tomografía de tórax mostró una cavidad con múltiples nódulos en el lóbulo superior derecho. Los cultivos fueron positivos a Aspergillus fumigatus y Aspergillus flavus. Se inició tratamiento con anfotericina B y luego se cambió a voriconazol, a pesar de lo cual no hubo mejoría del cuadro. La paciente falleció por falla multiorgánica.A 48-year old woman with a recent diagnosis of Graves’ disease arrived at the emergency room with fever, palpitations, and a sore throat. Her regular treatment included methimazole. On admission, laboratory results showed suppressed TSH, elevated free thyroxine, and neutropenia. She was admitted and started on antibiotics and granulocyte-macrophage colony stimulating factor (gm-csf. After ten days, the patient developed leukocytosis, fever, and hemoptysis. Chest CT scan showed a lung cavity with multiple nodules in the upper right lobe. Cultures from a lung biopsy were positive for Aspergillus Fumigatus and Aspergillus Flavus. Amphotericin B was started but then switched to voriconazole, with both treatments failing to result in clinical improvement. The patient died of multi-organ failure.

  12. Aspergillosis Superinfection as a Cause of Death of Crizotinib-Induced Interstitial Lung Disease Successfully Treated with High-Dose Corticosteroid Therapy

    OpenAIRE

    Deiana, Laura; Grisanti, Salvatore; Ferrari, Vittorio; Tironi, Andrea; Brugnoli, Giulia; Ferrari, Laura; Bozzola, Giordano; Berruti, Alfredo

    2015-01-01

    Crizotinib is an efficacious and well-tolerated drug in the management of ALK-positive lung cancer. Crizotinib treatment, however, is rarely complicated by the occurrence of acute interstitial lung disease (ILD) that is often fatal. There is no treatment for this serious adverse event. We report a female non-small cell lung cancer patient who developed ILD after a few days of crizotinib therapy. She showed a significant improvement after a high dose of pulse corticosteroid therapy, both radio...

  13. Image findings of a false positive radioactive iodine-131 uptake mimicking metastasis in pulmonary aspergillosis identified on single photon emission computed tomography-computed tomography

    Directory of Open Access Journals (Sweden)

    Kamaleshwaran Koramadai Karuppusamy

    2015-01-01

    Full Text Available High doses of iodine-131 are commonly used in patients with differentiated thyroid cancer after total or subtotal thyroidectomy, in order to ablate the remaining cancer or normal thyroid tissue. Multiple different false-positive scans can occur in the absence of residual thyroid tissue or metastases. The authors present a case of abnormal uptake of radioactive iodine in the aspergilloma, potentially masquerading as pulmonary metastases.

  14. Aspergilosis pulmonar secundaria a neutropenia inducida por metimazol: reporte de un caso Pulmonary aspergillosis due to methimazole-induced neutropenia: a case report

    OpenAIRE

    Miguel E. Pinto; Claudia Banda; Carlos Seas

    2012-01-01

    Se reporta el caso de una paciente de 48 años de edad con diagnóstico reciente de enfermedad de Graves, quien acudió a emergencia por presentar fiebre, palpitaciones y dolor faríngeo. Su tratamiento regular incluía metimazol. Al ingreso, los análisis mostraron TSH suprimido, T4 libre elevado y neutropenia. La paciente fue hospitalizada, se administraron antibióticos y factor estimulante de colonia. Después de diez días de tratamiento, la paciente presentó leucocitosis, fiebre y hemoptisis. La...

  15. The pH-responsive PacC transcription factor of Aspergillus fumigatus governs epithelial entry and tissue invasion during pulmonary aspergillosis.

    Directory of Open Access Journals (Sweden)

    Margherita Bertuzzi

    2014-10-01

    Full Text Available Destruction of the pulmonary epithelium is a major feature of lung diseases caused by the mould pathogen Aspergillus fumigatus. Although it is widely postulated that tissue invasion is governed by fungal proteases, A. fumigatus mutants lacking individual or multiple enzymes remain fully invasive, suggesting a concomitant requirement for other pathogenic activities during host invasion. In this study we discovered, and exploited, a novel, tissue non-invasive, phenotype in A. fumigatus mutants lacking the pH-responsive transcription factor PacC. Our study revealed a novel mode of epithelial entry, occurring in a cell wall-dependent manner prior to protease production, and via the Dectin-1 β-glucan receptor. ΔpacC mutants are defective in both contact-mediated epithelial entry and protease expression, and significantly attenuated for pathogenicity in leukopenic mice. We combined murine infection modelling, in vivo transcriptomics, and in vitro infections of human alveolar epithelia, to delineate two major, and sequentially acting, PacC-dependent processes impacting epithelial integrity in vitro and tissue invasion in the whole animal. We demonstrate that A. fumigatus spores and germlings are internalised by epithelial cells in a contact-, actin-, cell wall- and Dectin-1 dependent manner and ΔpacC mutants, which aberrantly remodel the cell wall during germinative growth, are unable to gain entry into epithelial cells, both in vitro and in vivo. We further show that PacC acts as a global transcriptional regulator of secreted molecules during growth in the leukopenic mammalian lung, and profile the full cohort of secreted gene products expressed during invasive infection. Our study reveals a combinatorial mode of tissue entry dependent upon sequential, and mechanistically distinct, perturbations of the pulmonary epithelium and demonstrates, for the first time a protective role for Dectin-1 blockade in epithelial defences. Infecting ΔpacC mutants are hypersensitive to cell wall-active antifungal agents highlighting the value of PacC signalling as a target for antifungal therapy.

  16. 实体器官移植后侵袭性肺曲菌病的CT表现%CT manifestations of invasive pulmonary aspergillosis after solid organ transplantation

    Institute of Scientific and Technical Information of China (English)

    董莘; 李海斌

    2013-01-01

    BACKGROUND:The morbidity and mortality of lung infection after solid organ transplantation remains high, especial y the opportunistic aspergil osis infection. The early diagnosis of invasive pulmonary aspergil osis is difficult. OBJECTIVE:To summarize the CT manifestations of invasive pulmonary aspergil osis after solid organ transplantation. METHODS:The VIP database, CNKI database, Medline database, Highwire database and Foreign Journals Integration System were retrieved with the key words of“solid organ transplantation/renal transplantation/liver transplantation/lung transplantation/heart transplantation, aspergil osis, fungus, mold, pulmonary invasive, tomography computerized”in Chinese and English for the articles published from January 2001 to October 2012. The clinical reports related with the CT manifestations of invasive pulmonary aspergil osis among the reports of pulmonary aspergil osis infections and the fungus or mold lung infections were selected. Secondary manual retrieval of solid organ transplantation was performed, and the literatures on the CT manifestations of invasive pulmonary aspergil osis after solid organ transplantation were included. Reproductive research and atypical report were excluded. RESULTS AND CONCLUSlON:The typical chest CT manifestations of invasive pulmonary aspergil osis after solid organ transplantation included nodules, masses, consolidations and ground-glass opacities. With infection time prolonged, the halo sign, reversed halo sign, cavitis and air crescent sign appeared successively. Different incidences of these signs may be associated with the time interval between onset to a CT examination, fungus preventive treatment time and early antifungal treatment. Meaningful results are the relationship between invasive pulmonary aspergil osis signs and the prognosis of patients. No consolidations or masses and presence of smal cavitis may be related with a better prognosis. Greater nodules, multi-infarct consolidation, renal replacement therapy and persistent positive serum galactomannan is a 90-day independent predictor for mortality. Halo sign on behalf of bleeding has nothing to do with the 90-day mortality. Although the report is less, the CT pulmonary angiography is a promising diagnostic tool for the diagnosis of invasive fungal pneumonia, which can early detect the vascular occlusion used to reflect the invasive vascular involvement, and its sensitivity and specificity are better than the halo sign, and approximate to serum galactomannan test.%背景:实体器官移植后肺部感染的发病率和死亡率居高不下,尤其是作为机会感染的曲菌,早期诊断侵袭性肺曲霉菌病是困难的。目的:总结实体器官移植后侵袭性曲菌性肺炎的CT表现。方法:以“实体器官移植/肾移植/肝移植/肺移植/心脏移植,曲菌,真菌,霉菌,肺,侵袭性,体层摄影术,X线计算机”为中文捡索词,以“solid organ transplantation/renal transplantation/liver transplantation/lung transplantation/heart transplantation, aspergil osis , fungus , mold , pulmonary invasive, tomography computerized”为英文检索词,检索维普和中国知网(CNKI)期刊全文数据库、Medline,highwire和外文生物医学期刊全文数据库(Foreign Journals Integration System)2001年1月至2012年10月有关肺曲菌感染和真菌或霉菌肺感染报告中主要涉及曲菌的侵袭性曲菌肺炎 CT 表现的临床报道。然后二次人工检索实体器官移植后,纳入有关实体器官移植后侵袭性曲菌肺炎CT表现的文献,排除重复性研究和不典型报道。结果与结论:实体器官移植后侵袭性肺曲霉菌病典型的胸部 CT 表现包括结节、肿块、实变以及磨玻璃影。随感染时间依次出现晕征、反晕征、空洞和空气半月征。这些征象的发生率的不同可能与 CT 检查时间和早期抗真菌治疗已经真菌预防性治疗有关。有意义的结果是侵袭性肺曲霉菌病征象与患者预后的关系。无实变或肿块和小腔空洞存在可能与更好预后相关。大结节、多发梗死性实变、肾脏替代治疗和持久性的血清半乳甘露聚糖阳性是90 d的死亡率独立的预测因子。而代表出血的晕征与90 d的死亡率无关。尽管报告较少,用 CT 肺血管造影诊断侵袭性真菌性肺炎是有前景的诊断手段,可以早期发现反映侵袭性血管受累的血管闭塞征,其敏感性和特异性优于晕征,与血清曲菌半乳甘露聚糖试验近似。

  17. Inhibition of conidiophore development in Aspergillus fumigatus by an Escherichia coli DH5α strain, a promising antifungal candidate against aspergillosis.

    Science.gov (United States)

    Balhara, M; Ruhil, S; Kumar, M; Dhankhar, S; Chhillar, A K

    2014-03-01

    The opportunistic human pathogen Aspergillus fumigatus produces a massive number of asexual spores (conidia) as the primary means of dispersal, survival, genome protection and infection of hosts. In this report, we investigated secretory and cytosolic proteins of non-pathogenic bacterial species (mostly belonging to human microbiome) for antifungal potential against A. fumigatus, A. flavus and A. niger. Our preliminary results revealed that cytosolic proteins of E. coli DH5α were most active and the less toxic against various pathogenic isolates of A. fumigatus (the major pathogenic species), depicting a minimum inhibitory concentration (MIC) of 62.50 μg/mL, 62.50 μg/mL and 12.50 μg/disc using microbroth dilution assay (MDA), percentage spore germination inhibition assay (PSGI) and disc diffusion assay (DDA), respectively. E. coli protein was non-toxic against human erythrocytes at doses up to 1000 μg/mL as compared to standard drug, amphotericin B which lysed 100% of erythrocytes at a concentration of 37.50 μg/mL. Time kill analysis proved it to be fungicidal in a concentration and time-dependent manner. Scanning electron microscopic studies (SEM) were carried out to prevail what kind of damage it causes to A. fumigatus. SEM results reported that conidiophore (structures forming conidia) development was halted as a major consequence, reducing the number of conidiophores to insignificant values as well as alteration in their morphological attributes. This feature may contribute to the development of new prevention strategies against Aspergillus infections. Hyphal atrophy was also observed, evidenced by shrinking and flattening of hyphal walls and reduced, abrupt hyphal branching. Such actions may effectively reduce the invasive ability of Aspergillus as well as it can sterilize the fungal burden by obstructing the conidiation pathway of A. fumigatus. Hence, E. coli DH5α, being a commensal species, can lead to the development of antifungal molecule with novel targets in fungal metabolism, which will help in combating the antifungal resistance and toxicity associated with current therapy. PMID:23978655

  18. Interaction between aspergilli and streptomycetes in the soil of potted indoor plants: a preliminary report (contribution to the epidemiology of human aspergillosis).

    Science.gov (United States)

    Staib, F; Mishra, S K; Blisse, A

    1980-02-29

    The soil of potted ornamental plants as a reservoir for Aspergillus species pathogenic for man is of epidemiological and ecological interest. Isolation of A. niger as the sole hyphomycete from the soil of potted African violets (Saintpaulia ionantha, Gesneriaceae), prompted us to look for A. inger on the surface of the roots of this plant. Small pieces of the roots were inoculated in the nutrient-free agar-gel with and without antibiotics. On the antibiotic-free gel, a dense growth of Streptomyces griseus was consistently observed around the root pieces. But the gel fortified with antibiotics showed pure growth of only A. niger. One of the two strains of S. ariseus isolated from the African violet, showed inhibitory effect against a number of fungi including A. niger but the other strain had no effect on this fungus. The possible influence of streptomycetes on the occurrence of aspergilli in the soil of potted ornamental plants is discussed. PMID:6769046

  19. A guide to the recent literature on aspergillosis as caused by Aspergillus fumigatus, a fungus frequently found in self-heating organic matter.

    Science.gov (United States)

    Marsh, P B; Millner, P D; Kla, J M

    1979-11-30

    Spores of Aspergillus fumigatus have been found to be abundantly present in the outdoor air at a site where large scale experimental composting of sewage sludge is in progress at Beltsville, Maryland. The health significance of this finding, for that site and for others in the future, is still only incompletely understood. Further studies are in progress to characterize absolute concentrations of the spores of the fungus in air at the site, spore dispersal by air from composting operations, and background environmental spore levels in air. The present paper contains a list of references to papers on health effects of A. fumigatus, many published in the past ten years, along with a review of the same designed to assist the reader in finding information on particular aspects of the subject in the literature. It is intended primarily as an aid to individuals interested in sludge composting and wishing to attain an insight into the A. fumigatus-composting situation, but it may also interest others concerned with other substrates which become moldy at 40--50 C. A. fumigatus has been found in great numbers in naturally and artificially heated environments such as decaying leaves, compost heaps, solar heated sloughs, cooling canals for nuclear power generators, silos, grain storage bins, boiler rooms, detritus around steam turbines and sauna baths. The evident practical merits of sludge composting have been described elsewhere; the information presented here has its main significance in respect to requirements for choice of locations for composting sites and to process and design criteria. PMID:396477

  20. Aspergilosis necrotizante crónica en un paciente con secuelas de tuberculosis pulmonar Chronic necrotizing aspergillosis in a patient with pulmonary tuberculosis sequelae

    OpenAIRE

    Alcides Zambrano F.; Andrea Biere A; Dionis Isamitt D

    2007-01-01

    Aspergillus fumigatus puede causar diferentes patologías en el ser humano: aspergiloma, aspergilosis broncopulmonar alérgica, aspergilosis necrotizante crónica, aspergilosis invasora. En la aspergilosis necrotizante crónica hay invasión local del parénquima y destrucción. A diferencia de la aspergilosis invasora no invade vasos sanguíneos ni se disemina a otros órganos. La aspergilosis necrotizante crónica se presenta en pacientes de edad media o ancianos con patología pulmonar previa: EPOC, ...

  1. Le cas clinique du mois. Aspergillose pulmonaire: un cas d'aspergillose necrosante chronique

    OpenAIRE

    Golinval, Olivier; Louis, Renaud

    2007-01-01

    Pulmonary aspergillosis are uncommon diseases. The clinical expression of which are depending on the immunological status. The spectrum of pulmonary aspergillosis goes from hypersensitization to the invasive and disseminated aspergillosis. We report here the clinical history of a patient with severe COPD and receiving regular oral corticoids who had a persistent lung infiltration. The infiltration became cavitary and proved to be a chronic necrotizing pneumonia due to Aspegillus fumigatus. Th...

  2. Eosinophil Deficiency Compromises Lung Defense against Aspergillus fumigatus

    OpenAIRE

    Lilly, Lauren M.; Scopel, Michaella; Nelson, Michael P.; Burg, Ashley R.; Dunaway, Chad W; Steele, Chad

    2014-01-01

    Exposure to the mold Aspergillus fumigatus may result in allergic bronchopulmonary aspergillosis, chronic necrotizing pulmonary aspergillosis, or invasive aspergillosis (IA), depending on the host's immune status. Neutrophil deficiency is the predominant risk factor for the development of IA, the most life-threatening condition associated with A. fumigatus exposure. Here we demonstrate that in addition to neutrophils, eosinophils are an important contributor to the clearance of A. fumigatus f...

  3. Invasive Aspergillus fumigatus infection after Plasmodium falciparum malaria in an immuno-competent host: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Stremmel Wolfgang

    2009-07-01

    Full Text Available Abstract Invasive fungal infection is rarely reported in association with malaria, even though malaria-associated inhibition of phagocyte function is a well-known condition. Invasive aspergillosis is frequently found in severely immuno-compromised patients but not in healthy individuals. Here, a case of pulmonary invasive aspergillosis in a previously healthy patient with severe P. falciparum malaria is presented, who was successfully treated with voriconazol and caspofungin. This is the first survival of malaria-associated invasive aspergillosis.

  4. Solitary pulmonary nodule

    Science.gov (United States)

    ... as aspergillosis , coccidioidomycosis , cryptococcosis , or histoplasmosis Primary lung cancer is the most common cause of cancerous (malignant) pulmonary nodules. This is cancer that starts in the ...

  5. Surto de aspergilose pulmonar invasiva em enfermaria de transplante de medula óssea: achados tomográficos Outbreak of invasive pulmonary aspergillosis among patients hospitalized in a bone marrow transplant ward: tomographic findings

    OpenAIRE

    Daniela Batista de Almeida Freitas; Ana Cláudia Piovesan; Gilberto Szarf; Dany Jasinowodolinski; Gustavo de Souza Portes Meirelles

    2009-01-01

    OBJETIVO: Avaliar os principais aspectos encontrados na TC de seis pacientes internados em uma enfermaria de transplante de medula óssea, diagnosticados com aspergilose pulmonar invasiva (API) durante um surto intra-hospitalar da doença. MÉTODOS: Foram revisadas 10 TC de tórax de seis pacientes internados na enfermaria de hematologia e transplante de medula óssea do Hospital São Paulo em São Paulo (SP) entre abril de 2007 e outubro de 2007, neutropênicos ou imunossuprimidos, que evoluíram com...

  6. 黄曲霉致鼻-眼-耳-脑侵袭性曲霉病的抗真菌治疗%Antifungal therapy in severe rhinosino-optical-otic and cerebral invasive aspergillosis caused by Aspergillus flavus

    Institute of Scientific and Technical Information of China (English)

    朱红梅; 贾袆鹏; 陈敏; 赵瑾; 温海

    2009-01-01

    报告1例抗真菌治疗有效的重症鼻、眼、耳、脑侵袭性曲霉病.患者男,37岁,因右眼眶肿物11 a,右眼视力下降8a,失明伴头痛、头晕进行性加重1 a就诊.11 a前曾行右上颌窦根治术.临床表现为右眼球突出眼眶,角膜混浊,球结膜充血,眼球内可见白色絮状团块,并有大量透亮稀薄液态分泌物流出.右眼球不能自主活动,完全无光感.右眼眶下方、右上颌窦骨质缺损,塌陷.右侧外耳道骨壁、乳突均受累及.右侧鼻道及外耳道亦见较多透亮稀薄液态分泌物.右眼、右鼻腔、右耳分泌物真菌涂片均见菌丝及孢子,培养结果 均为同一黄曲霉.经两性霉素B及伊曲康唑、氟胞嘧啶联合抗真菌治疗6周后,予口服伊曲康唑维持治疗近18个月,目前病变区显著缩小,头痛、头晕症状消失.

  7. Aspergillosis: a limiting factor during recovery of captive magellanic penguins Aspergilose: um fator limitante na reabilitação de pingüins-de-Magalhães

    OpenAIRE

    Xavier, Melissa O.; Mauro P Soares; Ana Raquel M. Meinerz; Márcia O. Nobre; Luiza G. Osório; Rodolfo P. da Silva Filho; Mário Carlos A. Meireles

    2007-01-01

    The article describes the epidemiology, macroscopic and histological lesions as well as the isolation of Aspergillus flavus and A. fumigatus from Magellanic penguins (Spheniscus magellanicus) during recovery in the Center for Recovery of Marine Animals (CRAM - 32ºS/52ºW), over a period of two years. From January 2004 to December 2005 the Center received 52 Magellanic penguins, and 23% (12/52) died. Necropsies were performed and tissue samples were collected for histological and microbiologica...

  8. Monoclonal Antibodies to Hyphal Exoantigens Derived from the Opportunistic Pathogen Aspergillus terreus

    Science.gov (United States)

    Aspergillus terreus has been difficult to identify in cases of aspergillosis, and clinical identification has been restricted to the broad identification of aspergillosis lesions in affected organs or the detection of fungal carbohydrates. As a result, there is a clinical need to...

  9. USE OF THE GEOGRAPHIC INFORMATION SYSTEM TO INVESTIGATE MERCURY LEVELS IN CORRELATION WITH POSTMORTEM FINDINGS OF ASPERGILLUS INDUCED LESIONS IN THE COMMON LOON (GAVIA IMMER) IN THE NORTHEASTERN USA

    Science.gov (United States)

    This study employed the Geographic Information System (GIS) to correlate total mercury levels in liver tissue with post-mortem findings of aspergillosis in common loons (Gavia immer) in the northeast United States of America (USA). Aspergillosis is an opportunistic fungal infecti...

  10. Inhaled Voriconazole for Prevention of Invasive Pulmonary Aspergillosis▿

    OpenAIRE

    Tolman, Justin A; Wiederhold, Nathan P.; McConville, Jason T.; Najvar, Laura K.; Bocanegra, Rosie; Peters, Jay I.; Coalson, Jacqueline J.; Graybill, John R.; Patterson, Thomas F.; Williams, Robert O.

    2009-01-01

    Targeted airway delivery of antifungals as prophylaxis against invasive aspergillosis may lead to high lung drug concentrations while avoiding toxicities associated with systemically administered agents. We evaluated the effectiveness of aerosolizing the intravenous formulation of voriconazole as prophylaxis against invasive pulmonary aspergillosis caused by Aspergillus fumigatus in an established murine model. Inhaled voriconazole significantly improved survival and limited the extent of inv...

  11. Pharmacodynamics of Voriconazole in Children : Further Steps along the Path to True Individualized Therapy

    NARCIS (Netherlands)

    Huurneman, Luc J.; Neely, Michael; Veringa, Anette; Docobo Perez, Fernando; Ramos-Martin, Virginia; Tissing, Wim J.; Alffenaar, Jan-Willem C.; Hope, William

    2016-01-01

    Voriconazole is the agent of choice for the treatment of invasive aspergillosis in children at least 2 years of age. The galactomannan index is a routinely used diagnostic marker for invasive aspergillosis and can be useful for following the clinical response to antifungal treatment. The aim of this

  12. Exploring azole antifungal drug resistance in Aspergillus fumigatus with special reference to resistance mechanisms

    NARCIS (Netherlands)

    Chowdhary, A.; Sharma, C.; Hagen, F.; Meis, J.F.G.M.

    2014-01-01

    Aspergillus fumigatus, a ubiquitously distributed opportunistic pathogen, is the global leading cause of aspergillosis. Azole antifungals play an important role in the management of aspergillosis. However, over a decade, azole resistance in A. fumigatus isolates has been increasingly reported with v

  13. Successful Treatment of Fanconi Anemia and T-Cell Acute Lymphoblastic Leukemia

    Directory of Open Access Journals (Sweden)

    Terrie Flatt

    2012-01-01

    Full Text Available Fanconi anemia is associated with an increased risk of malignancy. Patients are sensitive to the toxic effects of chemotherapy. We report the case of a patient with Fanconi anemia who developed T-cell acute lymphoblastic leukemia. He experienced chemotherapy-related complications including prolonged neutropenia, grade IV vincristine neuropathy, and disseminated aspergillosis. He was successfully treated with modified dosing of cytarabine and intrathecal methotrexate followed by allogeneic bone marrow transplant. The aspergillosis was treated with systemic antifungal treatment and surgical resection. Now 30 months after bone marrow transplant the patient is without evidence of aspergillosis or leukemia.

  14. Aspergillus antigen testing in bone marrow transplant recipients

    OpenAIRE

    Williamson, E; Oliver, D.; Johnson, E.; Foot, A.; D. Marks; Warnock, D.

    2000-01-01

    Aims—To assess the clinical usefulness of a commercial aspergillus antigen enzyme linked immunosorbent assay (ELISA) in the diagnosis of invasive aspergillosis (IA) in bone marrow transplant recipients, and to compare it with a commercial latex agglutination (LA) test.

  15. Mycoses

    International Nuclear Information System (INIS)

    Roentgenological pictures of lungs mycoses: actinomycosis, aspergillosis, c andidiasis, histoplasmosis, cryptococcosis, and coccidioidomycosis, have been studied. Special attention is paid to the problems of high-quality X-ray diagn osis in case of the above-mentioned pneumomycoses

  16. Chronic granulomatous disease associated with chronic glomerulonephritis

    DEFF Research Database (Denmark)

    Frifelt, J J; Schønheyder, Henrik Carl; Valerius, Niels Henrik;

    1985-01-01

    A boy with chronic granulomatous disease (CGD) developed glomerulonephritis at the age of 12 years. The glomerulonephritis progressed to terminal uraemia at age 15 when maintenance haemodialysis was started. The clinical course was complicated by pulmonary aspergillosis and Pseudomonas septicaemia...

  17. Susceptibility testing of sequential isolates of Aspergillus fumigatus recovered from treated patients.

    NARCIS (Netherlands)

    Danaoui, E.; Meletiadis, J.; Tortorano, A.M.; Symoens, F.; Nolard, N.; Viviani, M.A.; Piens, M.A.; Lebeau, B.; Verweij, P.E.; Grillot, R.

    2004-01-01

    Two-hundred sequential Aspergillus fumigatus isolates recovered from 26 immunocompromised patients with invasive aspergillosis or bronchial colonization were tested for their in vitro susceptibility to posaconazole, itraconazole, voriconazole, terbinafine and amphotericin B. Twenty-one patients were

  18. Medications that Weaken Your Immune System and Fungal Infections

    Science.gov (United States)

    ... 7 , 8 Pneumocystis pneumonia (PCP) 9 , 10 Invasive Candida infection 7 Invasive aspergillosis 7 Other fungal infections, such as oral candidiasis (thrush) , are usually not life threatening. 11 What ...

  19. Detection of Aspergillus Galactomannan Antigenemia To Determine Biological and Clinical Implications of Beta-Lactam Treatments

    OpenAIRE

    Bart-Delabesse, Emmanuelle; Basile, Maria; Al Jijakli, Ahmad; Souville, Didier; Gay, Frédérick; Philippe, Bruno; Bossi, Philippe; Danis, Martin; Vernant, Jean-Paul; Datry, Annick

    2005-01-01

    Detection of Aspergillus galactomannan (GM) in serum with the Platelia Aspergillus enzyme immunoassay (EIA) is useful for diagnosing invasive aspergillosis. From May 2003 to November 2004, 65 patients who did not develop aspergillosis had at least two positive sera while receiving a beta-lactam treatment (GM index [GMI], ≥0.5). Of the 69 treatment episodes scored, 41 consisted of a beta-lactam other than piperacillin-tazobactam (n = 29), namely, amoxicillin-clavulanate (n = 25), amoxicillin (...

  20. Development of Novel PCR Assays To Detect Azole Resistance-Mediating Mutations of the Aspergillus fumigatus cyp51A Gene in Primary Clinical Samples from Neutropenic Patients

    OpenAIRE

    Spiess, Birgit; Seifarth, Wolfgang; Merker, Natalia; Howard, Susan J.; Reinwald, Mark; Dietz, Anne; Hofmann, Wolf-Karsten; Buchheidt, Dieter

    2012-01-01

    The increasing incidence of azole resistance in Aspergillus fumigatus causing invasive aspergillosis (IA) in immunocompromised/hematological patients emphasizes the need to improve the detection of resistance-mediating cyp51A gene mutations from primary clinical samples, particularly as the diagnosis of invasive aspergillosis is rarely based on a positive culture yield in this group of patients. We generated primers from the unique sequence of the Aspergillus fumigatus cyp51A gene to establis...

  1. Immunosuppressive Compounds Exhibit Particular Effects on Functional Properties of Human Anti-Aspergillus TH1 Cells

    OpenAIRE

    Tramsen, Lars; Schmidt, Stanislaw; Roeger, Frauke; Schubert, Ralf; Salzmann-Manrique, Emilia; Latgé, Jean-Paul; Klingebiel, Thomas; Lehrnbecher, Thomas

    2014-01-01

    Allogeneic hematopoietic stem cell transplant (HSCT) recipients are at high risk for invasive aspergillosis. Whereas adoptive immunotherapy transferring donor-derived anti-Aspergillus TH1 cells has been shown to be beneficial for HSCT recipients suffering from invasive aspergillosis, little is known about the impact of commonly used immunosuppressants on the functional properties of anti-Aspergillus TH1 cells. Anti-Aspergillus TH1 cells were coincubated with different concentrations of methyl...

  2. Cerebral Aspergillus arteritis with bland infarcts: A report of two patients with poor outcome

    Directory of Open Access Journals (Sweden)

    Uppin Megha

    2007-01-01

    Full Text Available Two patients with cerebrovascular aspergillosis, in the form of arteritis, thrombosis and bland infarcts are reported. One patient had systemic lupus erythematosus with disseminated aspergillosis in lungs, kidneys and brain. The other patient was immunocompetent and had sphenoid sinusitis. Both the patients were diagnosed at autopsy only, despite extensive imaging and laboratory studies. High index of clinical suspicion and early aggressive antifungal therapy are required since definite diagnostic modalities are not available.

  3. Micromorphological changes on the embryonic membranes of turkey eggs infected with Aspergillus fumigatus and their importance for embryonic survival

    OpenAIRE

    Jezdimirović Nemanja V.; Kureljušić Branislav I.; Kureljušić Jasna M.; Jakić-Dimić Dobrila P.; Ilić Živka Đ.; Miljković Biljana; Radanović Oliver Č.; Cvetojević Đorđe N.; Ivetić Vojin L.; Jezdimirović Milanka B.

    2013-01-01

    Aspergillosis is a frequent fungal disease of young and adult poultry in our commercial flocks. Infection can occur after hatching by inhalation of Aspergillus conidia which can be present in contaminated hatcheries, or later, by spores from moldy litter, dust, faeces or feed. Spores from the surface of egg shell can penetrate inside of an egg. The main characteristic of aspergillosis is granulomatous inflammation of respiratory system, although generalized form is possible as well. Mul...

  4. Pseudomembranous aspergillus bronchitis in a double-lung transplanted patient: unusual radiographic and CT features

    International Nuclear Information System (INIS)

    Pseudomembranous aspergillus bronchitis is considered as an early form of invasive pulmonary aspergillosis, a well-known airway infection in immunocompromised patients. Radiologic features concerning invasive aspergillosis of the airways have been reported. However, we describe here an unusual feature of invasive aspergillus bronchitis, never reported to date, observed in a double-lung transplanted patient. Chest radiograph and CT revealed significant peribronchial thickening without any parenchymal involvement. (orig.)

  5. Anestesia para tratamento de aspergilose cardíaca em paciente com trombocitopenia: o uso criterioso da aprotinina Anestesia para tratamiento de aspergilosis cardiaca en paciente con trombocitopenia: el uso con criterio de la aprotinina Anesthesia for treatment of cardiac aspergillosis in a patient with thrombocytopenia and the judicious use of aprotinin

    Directory of Open Access Journals (Sweden)

    Raquel Reis Soares

    2007-12-01

    Full Text Available JUSTIFICATIVA E OBJETIVOS: A aprotinina tem sido muito utilizada em intervenções cirúrgicas cardíacas como recurso terapêutico para redução dos efeitos da circulação extracorpórea (CEC sobre a coagulação e fibrinólise. A recuperação da hemostasia adequada ao final do procedimento é um dos objetivos do anestesiologista. Porém, o uso da aprotinina tem indicação específica. O objetivo deste trabalho foi apresentar o caso de um paciente com plaquetopenia intensa submetido à intervenção cirúrgica cardíaca no qual a interconsulta com a Hematologia e o planejamento adequado permitiram o sucesso do procedimento. RELATO DO CASO: Paciente do sexo masculino, 18 anos, 64 kg, estado físico ASA IV, portador de aplasia de medula, em investigação para ser submetido a transplante de medula. Apresentava febre persistente, de um mês de evolução, sem melhora com antibioticoterapia. Na investigação com métodos de imagem, diagnosticou-se massa intra-atrial esquerda. Ao exame laboratorial apresentava hemoglobina de 9 g.dL-1 e trombocitopenia - 6.000 plaquetas.mm-3. Foi submetido à esternotomia com CEC para retirada de trombo intracavitário. Com objetivo de controlar o sangramento intra-operatório foram administrados: plaquetaférese, hidrocortisona e aprotinina. Durante a intervenção cirúrgica não houve aumento do sangramento nem instabilidade hemodinâmica e o paciente foi encaminhado à Unidade de Terapia Intensiva (UTI sem intercorrências. O exame anatomopatológico revelou trombo repleto de Aspergillus (massa fúngica. No sétimo dia de pós-operatório o paciente evoluiu com insuficiência respiratória e parada cardiorrespiratória sem resposta às manobras de reanimação. CONCLUSÕES: Apesar do grande risco de sangramento no paciente descrito, conseguiu-se realizar intervenção cirúrgica cardíaca com CEC sem intercorrências graças ao uso de aprotinina e plaquetoaférese.JUSTIFICATIVA Y OBJETIVOS: La aprotinina ha sido muy utilizada en intervenciones quirúrgicas cardiacas como recurso terapéutico para la reducción de los efectos de la circulación extracorpórea (CEC sobre la coagulación y la fibrinólisis. La recuperación de la hemostasia adecuada al final del procedimiento es uno de los objetivos del anestesiólogo. Sin embargo, el uso de la aprotinina tiene una indicación específica. El objetivo de este trabajo fue presentar el caso de un paciente con plaquetopenia intensa sometido a la intervención quirúrgica cardiaca en el cual la interconsulta con hematología y la planificación adecuada permitieron el éxito del procedimiento. RELATO DEL CASO: Paciente del sexo masculino, 18 años, 64 kg, estado físico ASA IV, portador de aplasia de medula, en investigación para ser sometido al transplante de médula. Presentaba fiebre persistente, de un mes de evolución, sin mejoría con antibioticoterapia. En la investigación con métodos de imagen, se diagnosticó masa intra atrial izquierda. En el examen de laboratorio presentaba hemoglobina de 9 g.dL-1 y trombocitopenia - 6.000 plaquetas mm-3. Se sometió a la esternotomía con CEC para retirada de trombo intracavitario. Con el objetivo de controlar el sangramiento intraoperatorio fueron administrados: plaqueto-aferesis, hidrocortisona y aprotinina. Durante la intervención quirúrgica no hubo aumento del sangramiento ni inestabilidad hemodinámica y el paciente fue llevado a la Unidad de Terapia Intensiva (UTI sin intercurrencias. El examen anátomo patológico reveló trombo repleto de Aspergilus (masa fúngica. Al sétimo día del postoperatorio el paciente evolucionó con insuficiencia respiratoria y parada cardiorrespiratoria sin respuesta a las maniobras de reanimación. CONCLUSIONES: A pesar del gran riesgo de sangramiento en el paciente descrito, se logró realizar la intervención quirúrgica cardiaca con CEC sin intercurrencias gracias al uso de aprotinina y plaquetoaféresis.BACKGROUND AND OBJECTIVES: Aprotinin has been widely used in cardiac surgeries as a therapeutic resource for reducing the effects of cardiopulmonary bypass (CPB on coagulation and fibrinolysis. Recovery of adequate hemostasia at the end of the procedure is one of the objectives of the anesthesiologist. However, aprotinin has specific indications. The objective of this report was to present the case of a patient with severe thrombocytopenia undergoing cardiac surgery in which consultation with Hematology and adequate planning were responsible for the success of the procedure. CASE REPORT: An 18-year old male patient, weighing 64 kg, physical status ASA IV, with a diagnosis of bone marrow aplasia, was being investigated to undergo bone marrow transplantation. He had persistent fever for a month, which did not improve with antibiotics. During the investigation with imaging exams, a left atrial mass was discovered. Laboratory exams revealed hemoglobin 9 g.dL-1 and thrombocytopenia with 6,000 platelets.mm³. He underwent a sternotomy with CPB to remove the intracavitary thrombus. In order to control intraoperative bleeding, the following was administered: plateletpheresis, hydrocortisone, and aprotinin. Increased bleeding and hemodynamic instability did not develop during the surgery, and the patient was transferred to the Intensive Care Unit (ICU without intercurrences. The anatomo-pathologic exam revealed the thrombus to be filled with Aspergillus (fungal mass. On the seventh postoperative day the patient developed respiratory failure and cardiorespiratory arrest that did not respond to resuscitation maneuvers. CONCLUSIONS: Despite the increased risk of bleeding in this patient, cardiac surgery with CPB was performed without intercurrences due to the use of aprotinin and plateletpheresis.

  6. Analysis of the clinical value of GM test and G test in invasive Pulmonary Aspergillosis in the Examination%GM试验和G试验在肺侵袭性曲霉菌感染检查中的临床价值分析

    Institute of Scientific and Technical Information of China (English)

    胡海宗; 谢小丽

    2014-01-01

    目的 分析GM试验和G试验在肺侵袭性曲霉菌感染检查中的临床价值.方法 选取我院收治的疑似肺曲霉菌感染患者49例,对其痰液、肺泡灌洗液以及静脉血展开培养、G试验、GM试验,分析实验结果.结果 本组49例患者经痰液与肺泡灌洗液培养均发现丝状菌生长,G试验阳性者44例,GM试验者41例.结论 G试验与GM试验的操作简单、报告迅速,在临床肺曲霉菌感染诊断中发挥了重要作用,值得关注.

  7. Clinical evidence for caspofungin monotherapy in the first-line and salvage therapy of invasive Aspergillus infections.

    Science.gov (United States)

    Heinz, Werner J; Buchheidt, Dieter; Ullmann, Andrew J

    2016-08-01

    In 2001, caspofungin received market authorisation by the FDA and EMA and is globally licensed for several indications, including candidiasis, empirical antifungal therapy in patients with neutropenic fever of unknown origin and treatment of invasive aspergillosis in patients refractory to or intolerant of amphotericin B, lipid formulations of amphotericin B or itraconazole. Despite the lack of phase III data in first-line treatment of invasive aspergillosis, increasing evidence supports the use of first-line therapy. Here, we analyse the evidence of therapeutic activity, represented by favourable response rates, of caspofungin for invasive aspergillosis. A systematic literature search was conducted to identify international presentations and papers reporting monotherapy with caspofungin. Efficacy data are summarised separately for first-line and salvage therapy. Thirty-one papers and published abstracts reported caspofungin therapy for aspergillosis. Fifteen full papers and two abstracts fulfilled the criteria of reporting significant outcome data for caspofungin monotherapy for invasive aspergillosis. Consistent with other analyses and the known safety profile, few adverse events and associated terminations of caspofungin medication have been reported. Although a randomised, comparative, prospective study using caspofungin in this indication is still lacking, growing evidence supports the efficacy of this echinocandin not only for salvage but also for first-line therapy. PMID:27324802

  8. Serological monitoring of antibodies for an early diagnosis ofaspergillosis in captive penguins

    Directory of Open Access Journals (Sweden)

    Ângela L. Cabana

    2015-06-01

    Full Text Available Abstract: This study aimed to evaluate the efficacy of detection of anti-Aspergillus fumigatus antibodies in captive penguins by double radial agar gel immunodiffusion (AGID for the aspergillosis diagnosis. We included 134 Magellanic penguins (Spheniscus magellanicus in rehabilitation at the Center for Recovery of Marine Animals (CRAM / FURG. All of them were monitored by AGID weekly until its final destination (death or release, totalizing 660 serum samples studied. All animals were clinically accompanied and post-mortem examinations was performed in penguins that died during the studied period. A total of 28% (37/134 of the penguins died, 89.2% (33/37 due to aspergillosis, 11% (4/37 by other causes and 97 were released. From the 33 animals with proven aspergillosis, 21 presented anti- A. fumigatus antibodies by AGID, being the average interval between death and positive AGID 16.4 days. Twelve animals with negative serology died of aspergillosis. The sensitivity and specificity rates were 63.6% and 95% respectively, and the positive and negative predictive values were 80.7% and 88.9% respectively. These data demonstrate that the serological monitoring for detection of antibodies by AGID can be an important tool for the diagnosis of aspergillosis in penguins.

  9. Aspergillus-Related Lung Disease

    Directory of Open Access Journals (Sweden)

    Alia Al-Alawi

    2005-01-01

    Full Text Available Aspergillus is a ubiquitous dimorphic fungus that causes a variety of human diseases ranging in severity from trivial to life-threatening, depending on the host response. An intact host defence is important to prevent disease, but individuals with pre-existing structural lung disease, atopy, occupational exposure or impaired immunity are susceptible. Three distinctive patterns of aspergillus-related lung disease are recognized: saprophytic infestation of airways, cavities and necrotic tissue; allergic disease including extrinsic allergic alveolitis, asthma, allergic bronchopulmonary aspergillosis, bronchocentric granulomatosis and chronic eosinophilic pneumonia; and airway and tissue invasive disease -- pseudomembranous tracheobronchitis, acute bronchopneumonia, angioinvasive aspergillosis, chronic necrotizing aspergillosis and invasive pleural disease. A broad knowledge of these clinical presentations and a high index of suspicion are required to ensure timely diagnosis and treatment of the potentially lethal manifestations of aspergillus-related pulmonary disease. In the present report, the clinical, radiographic and pathological aspects of the various aspergillus-related lung diseases are briefly reviewed.

  10. Cavernous sinus thrombosis secondary to aspergillus granuloma: A case report and review of the literature.

    Science.gov (United States)

    Brenet, Esteban; Boulagnon-Rombi, Camille; N'guyen, Yohan; Litré, Claude-Fabien

    2016-10-01

    Cavernous sinus thrombosis is a rare but serious complication of sphenoid aspergillosis. The rarity of this pathology makes its diagnostic very difficult on a clinical, biological and radiological sense. The authors present a case of cavernous sinus thrombosis with ipsilateral internal carotid artery thrombosis secondary to a non-invasive sphenoid aspergillosis in an immunocompetent host, responsible of a cavernous syndrome associated to a Claude Bernard Horner syndrome. One year after surgery, the patient is still asymptomatic without recurrence. Diagnostic modalities are detailed and several management of this pathology are compared. Surgery is essential in a diagnostic and therapeutic sense. There is no evidence of the interest of adjuvant therapies such as antibiotic and anticoagulation. Concerning the antifungal treatment, the attitude towards a non-invasive sphenoid aspergillosis in an immunocompetent host is unclear. PMID:26860234

  11. A comparative study of antigens of Aspergillus fumigatus isolates from patients and soil of ornamental plants in the immunodiffusion test.

    Science.gov (United States)

    Staib, F; Folkens, U; Tompak, B; Abel, T; Thiel, D

    1978-11-01

    The strikingly frequent and constant presence of Aspergillus fimigatus in the soil of potted ornamental plants kept in private houses and hospitals has been the reason for studying the antigens of the strains found from the diagnostic and epidemiological angles. Culture-filtrate antigens of A. fumigatus strains isolated from the soil of 4 different ornamental plants, epiphyllum (Epiphyllum truncatum), orange tree (Citrus sinensis), Alpine rose (Azalea indica) and Christmas flower (Euphorbia pulcherrima), were compared, in the immunodiffusion test, with antigens of A. fumigatus strains from aspergillosis patients prepared in an identical way. When tested against 8 different sera from different aspergillosis patients there was a good coincidence of results. Control sera from patients suffering from diseases other than aspergillosis, no false-positive reactions could be observed. The findings are discussed in respect of diagnosis and epidemiology. PMID:83753

  12. Successful Treatment of Fungal Osteomyelitis with Voriconazole in a Patient with CGD

    Directory of Open Access Journals (Sweden)

    Masoud Mohammadpour

    2010-12-01

    Full Text Available Background:Chronic granulomatous disease (CGD is an immunodeficiency affecting phagocytic leukocytes. Defective respiratory burst mechanism renders the affected patients to be susceptible to catalase positive microorganisms. With the great successes in antibacterial prophylaxis and therapy, fungal infections are a persistent problem. Invasive aspergillosis is the most important cause of mortality in CGD. Case Presentation: We describe a nine year-old boy with CGD who presented with aspergillus induced skull osteomyelitis. He was successfully treated with voriconazole after initial failure of amphotericin B therapy.Conclusion: Currently, newer triazoles are recommended as initial therapy for invasive aspergillosis in immunodeficiency states such as CGD.

  13. Successful Treatment of Fungal Osteomyelitis with Voriconazole in a Patient with CGD

    Directory of Open Access Journals (Sweden)

    Mahsa Oaji

    2010-12-01

    Full Text Available Background:Chronic granulomatous disease (CGD is an immunodeficiency affecting phagocytic leukocytes. Defective respiratory burst mechanism renders the affected patients to be susceptible to catalase positive microorganisms. With the great successes in antibacterial prophylaxis and therapy, fungal infections are a persistent problem. Invasive aspergillosis is the most important cause of mortality in CGD. Case Presentation: We describe a nine year-old boy with CGD who presented with aspergillus induced skull osteomyelitis. He was successfully treated with voriconazole after initial failure of amphotericin B therapy. Conclusion: Currently, newer triazoles are recommended as initial therapy for invasive aspergillosis in immunodeficiency states such as CGD.

  14. Aspergillus in the lung: diverse and coincident forms

    International Nuclear Information System (INIS)

    Pulmonary disease caused by the fungus Aspergillus has traditionally been regarded as belonging to one of the following, apparently distinct, entities: saprophytic aspergilloma; allergic bronchopulmonary aspergillosis (ABPA); and invasive aspergillosis (IPA); which may be further categorised as angioinvasive, acute or chronic airway invasive [1]. It is not always obvious that there is overlap between these entities, and that in any given patient more than one Aspergillus-related pathological process can co-exist [2]. The aim of this article is to review the clinical and imaging features of the main categories of Aspergillus-related pulmonary disease and, in particular, to highlight the overlap between them. (orig.)

  15. Septic-Metastasizing Aspergillus-Encephalitis Mimicking Massive Cerebral Infarction in a Heart Transplant Recipient: A Case Report.

    Science.gov (United States)

    Ballázs, Christina; Akhyari, Payam; Mehdiani, Arash; Kamiya, Hiroyuki; Reinecke, Petra; Felsberg, Jörg; Saeed, Diyar; Lichtenberg, Artur; Boeken, Udo

    2016-06-01

    Invasive fungal infection after solid-organ transplantation is known as a severe complication and carries with it a high risk of infection-related mortality. Among patients after heart transplant Aspergillus species most often cause atypical pneumonia. The incidence of invasive aspergillosis after heart transplant has been reported from 3% to 14%. It is the opportunistic pathogen with the highest mortality, ranging from 50% to 80%. Prompt antifungal therapy is crucial, but rapid diagnostic procedures with sufficient sensitivity and specificity are lacking at the moment. We present a rare case of a patient with massive metastasizing invasive aspergillosis within 1 month after heart transplant, undetected before death. PMID:25476237

  16. Epidural mass due to Aspergillus flavus causing spinal cord compression - A case report and brief update

    Directory of Open Access Journals (Sweden)

    Tendolkar U

    2005-01-01

    Full Text Available Aspergillus infection of the central nervous system (CNS is an uncommon disease. Most of the reported cases are of sinocranial spread and cases with contiguous spread to spinal cord from lung and other organs are uncommon. A case of pulmonary aspergillosis with extension to thoracic vertebrae forming a paraspinal mass resulting in neurological deficit due to Aspergillus flavus , is reported. The 43 year old patient did not have any obvious predisposing condition. He presented with loss of motor function and succumbed to the infection despite operative intervention and antifungal therapy. A brief update on CNS aspergillosis is presented along with detailed clinical, radiological and laboratory work up of the patient.

  17. Antifungal prophylaxis during neutropenia and immunodeficiency.

    OpenAIRE

    Lortholary, O; Dupont, B

    1997-01-01

    Fungal infections represent a major source of morbidity and mortality in patients with almost all types of immunodeficiencies. These infections may be nosocomial (aspergillosis) or community acquired (cryptococcosis), or both (candidiasis). Endemic mycoses such as histoplasmosis, coccidioidomycosis, and penicilliosis may infect many immunocompromised hosts in some geographic areas and thereby create major public health problems. With the wide availability of oral azoles, antifungal prophylact...

  18. Immunological characterization of a recombinant 27-kilodalton antigenic protein from Paracoccidioides brasiliensis.

    OpenAIRE

    Ortiz, B L; Garcia, A. M.; A. Restrepo; McEwen, J. G.

    1996-01-01

    We report the expression in Escherichia coli of a 27-kDa antigenic protein from Paracoccidioides brasiliensis. When analyzed by immunoblotting, this recombinant antigenic protein was recognized by antibodies present in the sera of 40 of the 44 paracoccidioidomycosis patients studied. No cross-reactions were observed with sera from patients with other mycoses (histoplasmosis, aspergillosis, cryptococcosis, sporotrichosis, and chromoblastomycosis) or with tuberculosis.

  19. İmmunkompetan bir infantta kısa süreli steroid tedavisi ile ilişkili invaziv pulmoner aspergilloz

    OpenAIRE

    A, Erdemir; A, Babayiğit; D, Olmez; N, Uzuner; Ö, Karaman; B, Makay; Ö, Anal

    2009-01-01

    Invasive aspergillosis occurs very rarely in immunocompetent hosts. We report a case of invasive fungal infection in an infant who was treated with short term of inhaled and systemic steroids although there was no detectable immune deficiency. This case was presented in order to demonstrate the potential risk for opportunistic fungal infections in children treated with short term systemic and inhaled corticosteroids.

  20. Disease: H01328 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H01328 Aspergillosis Infectious disease Aspergillus fumigatus [GN:afm] Aspergillus flavus [GN:afv] Aspergill...us nidulans [GN:ani] Aspergillus niger [GN:ang] ICD-10: B44 MeSH: D001228 MedlinePlus: 001326 ...

  1. Rare and new etiological agents revealed among 178 clinical Aspergillus strains obtained from Czech patients and characterized by molecular sequencing

    Czech Academy of Sciences Publication Activity Database

    Hubka, Vít; Kubátová, A.; Mallátová, N.; Sedláček, P.; Melichar, J.; Skořepová, M.; Mencl, K.; Lysková, P.; Šrámková, B.; Chudíčková, Milada; Hamal, P.; Kolařík, Miroslav

    2012-01-01

    Roč. 50, č. 6 (2012), s. 601-610. ISSN 1369-3786 Institutional research plan: CEZ:AV0Z50200510 Keywords : invasive aspergillosis * non-dermatophytic onychomycosis * otomycosis Subject RIV: EE - Microbiology, Virology Impact factor: 1.979, year: 2012

  2. In Vitro Activities at pH 5.0 and pH 7.0 and In Vivo Efficacy of Flucytosine against Aspergillus fumigatus▿

    OpenAIRE

    Verweij, P. E.; Dorsthorst, D.T.A. te; Janssen, W.H.P.; Meis, J. F. G. M.; Mouton, J. W.

    2008-01-01

    The antifungal agent flucytosine was found to be active in vitro against Aspergillus fumigatus isolates when the MIC was determined at pH 5.0 instead of pH 7.0. The in vitro MIC at pH 5.0 corresponded to the in vivo efficacy of flucytosine monotherapy in a murine model of invasive aspergillosis.

  3. International expert opinion on the management of infection caused by azole-resistant Aspergillus fumigatus.

    Science.gov (United States)

    Verweij, Paul E; Ananda-Rajah, Michelle; Andes, David; Arendrup, Maiken C; Brüggemann, Roger J; Chowdhary, Anuradha; Cornely, Oliver A; Denning, David W; Groll, Andreas H; Izumikawa, Koichi; Kullberg, Bart Jan; Lagrou, Katrien; Maertens, Johan; Meis, Jacques F; Newton, Pippa; Page, Iain; Seyedmousavi, Seyedmojtaba; Sheppard, Donald C; Viscoli, Claudio; Warris, Adilia; Donnelly, J Peter

    2015-01-01

    An international expert panel was convened to deliberate the management of azole-resistant aspergillosis. In culture-positive cases, in vitro susceptibility testing should always be performed if antifungal therapy is intended. Different patterns of resistance are seen, with multi-azole and pan-azole resistance more common than resistance to a single triazole. In confirmed invasive pulmonary aspergillosis due to an azole-resistant Aspergillus, the experts recommended a switch from voriconazole to liposomal amphotericin B (L-AmB; Ambisome(®)). In regions with environmental resistance rates of ≥10%, a voriconazole-echinocandin combination or L-AmB were favoured as initial therapy. All experts recommended L-AmB as core therapy for central nervous system aspergillosis suspected to be due to an azole-resistant Aspergillus, and considered the addition of a second agent with the majority favouring flucytosine. Intravenous therapy with either micafungin or L-AmB given as either intermittent or continuous therapy was recommended for chronic pulmonary aspergillosis due to a pan-azole-resistant Aspergillus. Local and national surveillance with identification of clinical and environmental resistance patterns, rapid diagnostics, better quality clinical outcome data, and a greater understanding of the factors driving or minimising environmental resistance are areas where research is urgently needed, as well as the development of new oral agents outside the azole drug class. PMID:26282594

  4. Differential diagnosis of vertebral lesions with paraspinal mass with MRI

    International Nuclear Information System (INIS)

    To assess the characteristic features of MR findings which would be useful for the differentiation of various spinal diseases involving paraspinal soft tissue mass. We retrospectively reviewed MR findings in 31 cases(M : F = 20 : 11) of spinal disease in which paraspinal mass was involved. The breakdown of cases was as follows : spinal tuberculosis, 12; spinal metastasis, 13; multiple myeloma, 3; pyogenic spondylitis, 2; spinal aspergillosis, 1. The pattern of bone marrow invasion in spinal metastasis, multiple myeloma, spinal tuberculosis and aspergillosis was mixed; focal, homogeneously diffuse and inhomogeneously patterns were seen. Pyogenic spondylitis showed inhomogeneously diffuse invasion; an intravertebral abscess was seen in the only five cases of spinal tuberculosis. Vertebral posterior compartment invasion was observed in seven cases of spinal tuberculosis, two of multiple myeloma, the one case of spinal aspergillosis and in all 13 cases of spinal metastasis. This and multiple myeloma showed no disc space invasion, in any case, but all cases of infectious spondylitis showed such invasion. Peripheral rim-enhancement in the paravertebral mass was seen in 11 cases of spinal tuberculosis, one case of pyogenic spondylitis and the case of aspergillosis. Bilobate anterior epidural mass was noted in 60% of spinal tuberculosis cases, 36% of spinal metastasis and one case of pyogenic spondylitis. MR findings of spinal disease involving a paraspinal soft tissue mass were useful for differentiation

  5. Clonal expansion and emergence of environmental multiple-triazole-resistant Aspergillus fumigatus strains carrying the TR(3)(4)/L98H mutations in the cyp51A gene in India.

    NARCIS (Netherlands)

    Chowdhary, A.; Kathuria, S.; Xu, J.; Sharma, C.; Sundar, G.; Singh, P.K.; Gaur, S.N.; Hagen, F.; Klaassen, C.H.; Meis, J.F.G.M.

    2012-01-01

    Azole resistance is an emerging problem in Aspergillus which impacts the management of aspergillosis. Here in we report the emergence and clonal spread of resistance to triazoles in environmental Aspergillus fumigatus isolates in India. A total of 44 (7%) A. fumigatus isolates from 24 environmental

  6. Azole resistance in Aspergillus fumigatus: a side-eff ect of environmental fungicide use?

    NARCIS (Netherlands)

    Verweij, P.A.; Snelders, E.; Kema, G.H.J.; Mellado, E.; Melchers, W.J.G.

    2009-01-01

    Invasive aspergillosis due to multi-azole-resistant Aspergillus fumigatus has emerged in the Netherlands since 1999, with 6·0–12·8% of patients harbouring resistant isolates. The presence of a single resistance mechanism (denoted by TR/L98H), which consists of a substitution at codon 98 of cyp51A an

  7. Genome sequence of Aspergillus flavus NRRL 3357, a strain that causes aflatoxin contamination of food and feed

    Science.gov (United States)

    Aflatoxin contamination of food and livestock feed results in significant annual crop losses internationally. Aspergillus flavus is the major fungus responsible for this loss. Additionally, A. flavus is the second leading cause of aspergillosis in immune compromised human patients. Here we report th...

  8. Enteral voriconazole induced hypoglycemia: A potentially life threatening complication

    Directory of Open Access Journals (Sweden)

    Tanmoy Ghatak

    2012-01-01

    Full Text Available Voriconazole is a newer effective antifungal agent currently available for the treatment of invasive aspergillosis. The case we present describes an episode of serious persistent hypoglycemia after voriconazole therapy and we believe that this strongly contributed to this event. It is a warning to all that voriconazole has a propensity to alter glucose homeostasis in the presence of kidney disturbance.

  9. Plasma concentrations of caspofungin at two different dosage regimens in a patient with hepatic dysfunction

    NARCIS (Netherlands)

    van der Elst, K. C. M.; Bruggemann, R. J. M.; Rodgers, M. G. G.; Alffenaar, J. W. C.

    2012-01-01

    The currently recommended dosage regimen of caspofungin (50 mg/day) was developed for patients with invasive candidiasis. With invasive aspergillosis, successful outcomes occur in less than half the patients. We evaluate the pharmacokinetics in a patient with elevated liver enzyme levels after liver

  10. Increasing fungal infections in the intensive care unit

    NARCIS (Netherlands)

    Pauw, B.E. de

    2006-01-01

    BACKGROUND: Yeasts and molds now rank among the most common pathogens in intensive care units. Whereas the incidence of Candida infections peaked in the late 1970s, aspergillosis is still increasing. METHOD: Review of the pertinent English-language literature. RESULTS: Most factors promoting an inva

  11. Aspergillus Tracheobronchitis Causing Subtotal Tracheal Stenosis in a Liver Transplant Recipient

    Directory of Open Access Journals (Sweden)

    Sonia Radunz

    2013-01-01

    Full Text Available Invasive aspergillosis is recognized as one of the most significant opportunistic infections after liver transplantation. Diagnosis of invasive aspergillosis in transplant recipients has been proven to be challenging, and optimal approach to the treatment of invasive aspergillosis is still controversial. We here present an unusual case of Aspergillus tracheobronchitis in the setting of liver transplantation. A 47-year-old female patient with persistent dry cough after liver transplantation developed respiratory insufficiency and was readmitted to the intensive care unit 55 days after liver transplantation. A CT scan revealed subtotal tracheal stenosis; bronchoscopy was performed, and extended white mucus coverings causative of the tracheal stenosis were removed. Microbiological assessment isolated Aspergillus fumigatus. The diagnosis was obstructive Aspergillus tracheobronchitis. The patient was started on a treatment of voriconazole 200 mg orally twice daily, adjusted to a trough level of 1–4 mg/L. For further airway management, a tracheal stent had to be implanted. The patient is alive and well 28 months after liver transplantation. Invasive aspergillosis should be considered a possible etiology in liver transplant patients presenting with unspecific symptoms such as persistent dry cough. Optimal strategies for improved and early diagnosis as well as prophylaxis need to be defined.

  12. Hospitalized Patients and Fungal Infections

    Science.gov (United States)

    ... Care Med 1998;24:206-16. Alangaden GJ. Nosocomial Fungal Infections: Epidemiology, Infection Control, and Prevention. Infectious Disease Clinics ... 25:201-25. Zilberberg MD, Shorr AF. Fungal infections in the ICU. Infect Dis ... D. Nosocomial aspergillosis and building construction. Med Mycol 2009;47 ...

  13. Evolutionary relationships in Aspergillus section Fumigati inferred from partial beta-tubulin and hydrophobin sequences

    DEFF Research Database (Denmark)

    Geiser, D.M.; Frisvad, Jens Christian; Taylor, J.W.

    1998-01-01

    Members of Aspergillus section Fumigati are important animal pathogens and food contaminants. There is considerable variation among the 16 currently recognized species in this section, particularly in their mating systems: five are known to be strictly mitosporic, nine are homothallic, and two ar....... fischeri was identified as the closest known meiotic relative to the cosmopolitan species most often implicated in human aspergillosis, A. fumigatus....

  14. ANTİFUNGALLERİN SİSTEMİK MANTAR İNFEKSİYONLARINDA KULLANIMI VE DUYARLILIK DENEYLERİ: GENEL YÖNLENDİRME

    OpenAIRE

    YÜCEL, AYHAN; KANTARCIOĞLU, A. Serda

    2014-01-01

    Background.- This paper outlines major distinctive features of conventional antifungal agents and their common practice, and also reviews various reports related to systemic antifungal prophylaxis and therapy administrations. Furthermore, general therapeutic approaches in some special situations such as certain types of candidiasis, aspergillosis, cryptococcosis, pregnancy, and nosocomial mycoses are summarized. The significance of susceptibility tests in antifungal therapy is discussed.* Ana...

  15. Meningitis following relapsing painful ophthalmoplegia in aspergillus sphenoidal sinusitis: a case report.

    Science.gov (United States)

    Botturi, A; Salmaggi, A; Pollo, B; Lamperti, E; Erbetta, A; Boiardi, A

    2006-09-01

    We report the case of a 58-year-old woman in whom relapsing painful ophthalmoplegia related to a mycetoma of the sphenoid sinus gave origin to meningitis with markedly depressed glucose levels in the cerebrospinal fluid. Surgical exeresis of the mycetoma allowed aetiological diagnosis (aspergillosis) and--together with antimycotic therapy--led to durable clinical response. PMID:16998735

  16. A polysaccharide virulence factor from Aspergillus fumigatus elicits anti-inflammatory effects through induction of Interleukin-1 receptor antagonist.

    Directory of Open Access Journals (Sweden)

    Mark S Gresnigt

    2014-03-01

    Full Text Available The galactosaminogalactan (GAG is a cell wall component of Aspergillus fumigatus that has potent anti-inflammatory effects in mice. However, the mechanisms responsible for the anti-inflammatory property of GAG remain to be elucidated. In the present study we used in vitro PBMC stimulation assays to demonstrate, that GAG inhibits proinflammatory T-helper (Th1 and Th17 cytokine production in human PBMCs by inducing Interleukin-1 receptor antagonist (IL-1Ra, a potent anti-inflammatory cytokine that blocks IL-1 signalling. GAG cannot suppress human T-helper cytokine production in the presence of neutralizing antibodies against IL-1Ra. In a mouse model of invasive aspergillosis, GAG induces IL-1Ra in vivo, and the increased susceptibility to invasive aspergillosis in the presence of GAG in wild type mice is not observed in mice deficient for IL-1Ra. Additionally, we demonstrate that the capacity of GAG to induce IL-1Ra could also be used for treatment of inflammatory diseases, as GAG was able to reduce severity of an experimental model of allergic aspergillosis, and in a murine DSS-induced colitis model. In the setting of invasive aspergillosis, GAG has a significant immunomodulatory function by inducing IL-1Ra and notably IL-1Ra knockout mice are completely protected to invasive pulmonary aspergillosis. This opens new treatment strategies that target IL-1Ra in the setting of acute invasive fungal infection. However, the observation that GAG can also protect mice from allergy and colitis makes GAG or a derivative structure of GAG a potential treatment compound for IL-1 driven inflammatory diseases.

  17. P67-phox (NCF2 lacking exons 11 and 12 is functionally active and leads to an extremely late diagnosis of chronic granulomatous disease (CGD.

    Directory of Open Access Journals (Sweden)

    Joachim Roesler

    Full Text Available Two brothers in their fifties presented with a medical history of suspected fungal allergy, allergic bronchopulmonary aspergillosis, alveolitis, and invasive aspergillosis and pulmonary fistula, respectively. Eventually, after a delay of 50 years, chronic granulomatous disease (CGD was diagnosed in the index patient. We found a new splice mutation in the NCF2 (p67-phox gene, c.1000 + 2T → G, that led to several splice products one of which lacked exons 11 and 12. This deletion was in frame and allowed for remarkable residual NADPH oxidase activity as determined by transduction experiments using a retroviral vector. We conclude that p67-phox which lacks the 34 amino acids encoded by the two exons can still exert considerable functional activity. This activity can partially explain the long-term survival of the patients without adequate diagnosis and treatment, but could not prevent progressing lung damage.

  18. Simultaneous Chronic Invasive Fungal Infection and Tracheal Fungus Ball Mimicking Cancer in an Immunocompetent Patient

    Science.gov (United States)

    Çetinkaya, Erdoğan; Gül, Şule; Mert, Ali; Boyacı, Hilal; Çam, Ertan; Dincer, H. Erhan

    2016-01-01

    Fungal infections of the lung are uncommon and mainly affect people with immune deficiency. There are crucial problems in the diagnosis and treatment of this condition. Invasive pulmonary aspergillosis and candidiasis are the most common opportunistic fungal infections. Aspergillus species (spp.) are saprophytes molds that exist in nature as spores and rarely cause disease in immunocompetent individuals. In patients with immune deficiency or chronic lung disease, such as cavitary lung disease or bronchiectasis, Aspergillus may cause a variety of aspergillosis infections. Here we present a case of a 57-year-old patient without immunodeficiency or chronic lung disease who was diagnosed with endotracheal fungus ball and chronic fungal infection, possibly due to Aspergillus. Bronchoscopic examination showed a paralyzed right vocal cord and vegetating mass that was yellow in color, at the posterior wall of tracheal lumen. After 3 months, both the parenchymal and tracheal lesions were completely resolved. PMID:27418930

  19. Update on the optimal use of voriconazole for invasive fungal infections

    Directory of Open Access Journals (Sweden)

    Asma Lat George R Thompson III

    2011-02-01

    Full Text Available Asma Lat1 George R Thompson III21Department of Pharmacy, New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA; 2Department of Medical Microbiology and Immunology, Coccidioidomycosis Serology Laboratory, and the Department of Medicine, Division of Infectious Diseases, University of California-Davis, Sacramento, CA, USAAbstract: Voriconazole is an extended-spectrum triazole with excellent bioavailability that has now become the treatment of choice for aspergillosis. It has a unique side effect profile compared with other azoles, as well as a number of clinically important drug–drug interactions. These factors, along with a correlation between increased serum levels and improved outcomes, have prompted an interest in therapeutic drug monitoring of this agent. The pharmacology and clinical outcomes data of voriconazole are presented in this review.Keywords: therapeutic drug monitoring, aspergillosis, candidiasis, voriconazole

  20. Isavuconazonium sulfate for the treatment of fungal infection.

    Science.gov (United States)

    Walker, R C; Zeuli, J D; Temesgen, Z

    2016-01-01

    Isavuconazole is a new azole antifungal drug with a broad antifungal spectrum that includes yeasts, molds and dimorphic fungi. Its prodrug, isavuconazonium sulfate, is currently approved in the United States and Europe for the treatment of the two of the most common and most challenging invasive fungal infections in clinical practice, invasive aspergillosis and invasive mucormycosis. It is available in both oral and intravenous formulations for once-a-day dosing and has favorable safety profile and drug interaction potential in comparison to voriconazole. Its role in the treatment of other fungal infections, besides aspergillosis and mucormycosis, remains to be determined. Similarly, its efficacy in prophylaxis against invasive fungal infections or its utility in patients with prior azole exposure is yet to be elucidated in clinical studies. PMID:26937491

  1. Aspergillus sellar abscess: Case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Hao Li

    2008-01-01

    Full Text Available Aspergillus sellar abscess is a very rare form of fungal infections of the central nervous system (CNS. In this report, we describe the successful treatment of a patient with aspergillus sellar abscess. A 65-year-old woman presented with headache, nasal discharge and decreased visual acuity. The diagnosis of sellar mass was made on the basis of magnetic resonance imaging (MRI examination. The computed tomography (CT scan revealed sellar enlargement and sellar floor bony destruction. After hospitalization the patient underwent transsphenoidal surgery. Histopathological examination of the sellar mass revealed aspergillosis. Postoperatively, amphotericine-B and itraconazole therapy was started. During a six-month follow-up, the patient′s headache and inertia disappeared, visual acuity improved. Aspergillus sellar abscess must be considered in the differential diagnosis of a sellar mass. The correct diagnosis of pituitary aspergillosis can only be achieved by histopathological examination. Surgical intervention and antifungal therapy should be considered the optimal treatment.

  2. Cerebral aspergillus infection in pediatric acute lymphoblastic leukemia induction therapy

    Directory of Open Access Journals (Sweden)

    Gaurav Prakash

    2012-01-01

    Full Text Available Angioinvasive pulmonary infection from filamentous fungi is not an uncommon occurrence in immunocompromised patients like acute lymphoblastic leukemia (ALL. Rarely, these lesions can spread via the hematogenous route and involve multiple visceral organs. We report a case of a 14-year-old boy with ALL who developed angioinvasive pulmonary aspergillosis early in the course of induction therapy, which was followed by hematogenous dissemination and formation of multiple brain abscesses. The patient was treated with intravenous amphotericin B. There was no response to the therapy and the patient succumbed to disseminated infection. Postmortem lung biopsy confirmed angioinvasive pulmonary aspergillosis. Poor penetration of amphotericin B across the blood-brain barrier could be one of the contributory factors for poor response to antifungal therapy. We discuss the various antifungal agents with respect to their penetration in brain.

  3. Prevention and treatment of fungal infections in bone marrow transplantation.

    Science.gov (United States)

    Mossad, Sherif B

    2003-07-01

    There has not been as much success in the prevention and treatment of invasive fungal infections, particularly aspergillosis, compared to the prevention and treatment of cytomegalovirus infection and graft-versus-host disease in bone marrow transplant (BMT) recipients. Allogeneic BMT recipients who develop graft-versus-host disease and remain immunosuppressed for long periods are at major risk for development of these infections. Prevention of environmental exposure, antifungal chemoprophylaxis, and attempts at early diagnosis are essential for the reduction of mortality from invasive fungal infections. Chest computerized axial tomography is extremely useful in diagnosing pulmonary aspergillosis. However, microbiologic or histologic identification of infection remains essential. Unfortunately, the response to therapy in BMT recipients remains suboptimal. With the development of the lipid formulations of amphotericin B, the newer azoles, and the echinocandins, safer and more efficacious options have become available. The optimal use of antifungal agents or their combinations remains to be determined. PMID:12901327

  4. Aspergillus vertebral osteomyelitis in a child with a primary monocyte killing defect: response to GM-CSF therapy.

    Science.gov (United States)

    Abu Jawdeh, L; Haidar, R; Bitar, F; Mroueh, S; Akel, S; Nuwayri-Salti, N; Dbaibo, G S

    2000-07-01

    We report the first case of vertebral aspergillosis in a child with a primary defect in monocyte killing, an extremely rare immunodeficiency The diagnosis of defective monocyte killing was made by an in vitro assay that showed normal killing of Staphylococcus aureus by the patient's neutrophils but impaired killing by his monocytes. Importantly, the extensive granulomatous infection that involved the vertebral column, posterior mediastinum, pleura, and lung was not responsive to aggressive treatment with a combination of liposomal amphotericin B. intralesional amphotericin B. itraconazole, and granulocyte transfusions. Dramatic clinical and radiological improvement was only seen after the addition of granulocyte macrophage-colony stimulating factor (GM-CSF) to his treatment regimen. The use of GM-CSF in the treatment of invasive aspergillosis in immunocompromised patients requires further evaluation. PMID:11041713

  5. Aspergillus pragensis sp nov discovered during molecular reidentification of clinical isolates belonging to Aspergillus section Candidi

    DEFF Research Database (Denmark)

    Lyskova, Pavlina; Hubka, Vit; Kolarik, Miroslav;

    2014-01-01

    The identity of nine clinical isolates recovered from Czech patients and presumptively identified as Aspergillus sp. section Candidi based on colony morphology was revised using sequences of beta-tubulin, calmodulin gene sequence, and internal transcribed spacer rDNA. Six isolates were from...... secondary metabolite analysis was also provided with comparison of metabolite spectrum to other species. Section Candidi now encompasses five species for which a dichotomous key based on colony characteristics is provided. All clinical isolates were tested for susceptibilities to selected antifungal agents...... suspected and proven onychomycosis, one from otitis externa, and two associated with probable invasive aspergillosis. The results showed that one Aspergillus candidus isolate was the cause of otitis externa, and both isolates obtained from sputa of patients with probable invasive aspergillosis were...

  6. The burden of serious fungal diseases in Russia.

    Science.gov (United States)

    Klimko, N; Kozlova, Y; Khostelidi, S; Shadrivova, O; Borzova, Y; Burygina, E; Vasilieva, N; Denning, D W

    2015-10-01

    The incidence and prevalence of fungal infections in Russia is unknown. We estimated the burden of fungal infections in Russia according to the methodology of the LIFE program (www.LIFE-worldwide.org). The total number of patients with serious and chronic mycoses in Russia in 2011 was three million. Most of these patients (2,607,494) had superficial fungal infections (recurrent vulvovaginal candidiasis, oral and oesophageal candidiasis with HIV infection and tinea capitis). Invasive and chronic fungal infections (invasive candidiasis, invasive and chronic aspergillosis, cryptococcal meningitis, mucormycosis and Pneumocystis pneumonia) affected 69,331 patients. The total number of adults with allergic bronchopulmonary aspergillosis and severe asthma with fungal sensitisation was 406,082. PMID:26449508

  7. Human Leukocytes Kill Aspergillus nidulans by Reactive Oxygen Species-Independent Mechanisms▿

    OpenAIRE

    Henriet, Stefanie S. V.; Hermans, Peter W. M.; Verweij, Paul E.; Simonetti, Elles; Holland, Steven M.; Sugui, Janyce A.; Kwon-Chung, Kyung J.; Warris, Adilia

    2010-01-01

    Invasive aspergillosis is a major threat for patients suffering from chronic granulomatous disease (CGD). Although Aspergillus fumigatus is the most commonly encountered Aspergillus species, the presence of A. nidulans appears to be disproportionately high in CGD patients. The purpose of this study was to investigate the involvement of the NADPH oxidase and the resulting reactive oxygen species (ROS) in host defense against fungi and to clarify their relationship toward A. nidulans. Murine CG...

  8. Successful Treatment of Fungal Osteomyelitis with Voriconazole in a Patient with Chronic Granulomatous Disease

    OpenAIRE

    Mohammadpour, Masoud; MAMISHI, Setareh; Oaji, Mahsa; POURPAK, Zahra; Parvaneh, Nima

    2010-01-01

    Background Chronic granulomatous disease (CGD) is an immunodeficiency affecting phagocytic leukocytes. Defective respiratory burst mechanism renders the affected patients to be susceptible to catalase positive microorganisms. With the great successes in antibacterial prophylaxis and therapy, fungal infections are a persistent problem. Invasive aspergillosis is the most important cause of mortality in CGD. Case Presentation We describe a nine year-old boy with CGD who presented with aspergillu...

  9. Successful Treatment of Fungal Osteomyelitis with Voriconazole in a Patient with CGD

    OpenAIRE

    Mahsa Oaji; Setareh Mamishi; Masoud Mohammadpour; Zahra Pourpak; Nima Parvaneh

    2010-01-01

    Background:Chronic granulomatous disease (CGD) is an immunodeficiency affecting phagocytic leukocytes. Defective respiratory burst mechanism renders the affected patients to be susceptible to catalase positive microorganisms. With the great successes in antibacterial prophylaxis and therapy, fungal infections are a persistent problem. Invasive aspergillosis is the most important cause of mortality in CGD. Case Presentation: We describe a nine year-old boy with CGD who presented with aspergill...

  10. Difficult diagnosis of invasive fungal infection predominantly involving the lower gastrointestinal tract in acute lymphoblastic leukaemia

    Directory of Open Access Journals (Sweden)

    Gulhadiye Avcu

    2016-03-01

    Full Text Available Invasive fungal infections are most commonly seen in immunocompromised patients and usually affect the respiratory system. Gastrointestinal system involvement of mucormycosis and invasive aspergillosis is rarely reported in childhood. Here we describe a 5 year old boy with acute lymphoblastic leukaemia who developed invasive fungal infection particularly affecting the lower gastrointestinal system to emphasise the difficulties in diagnosis and management of invasive fungal infections in immunocompromised patients.

  11. Death of a SARS case from secondary aspergillus infection

    Institute of Scientific and Technical Information of China (English)

    王慧君; 丁彦青; 徐军; 李欣; 李学锋; 杨磊; 张文丽; 耿健; 申洪; 蔡俊杰; 康伟; 吴正容; 赵菲; 钟南山

    2004-01-01

    @@ Severe acute respiratory syndrome (SARS) is an acute infectious disease which has been found to spread mainly via respiration. The first case was idnetified in Guangdong, southem China in November 2002. This disease has resulted in a severe epidemic outbreak in 27 countries and regions. In order to investigate the etiology and clinicopathologic characteristics of SARS, we reported here a patient with SARS who died of aspergillosis after prolonged treatment with corticosteroids.

  12. Le médicament du mois Le voriconazole (Vfend).

    OpenAIRE

    Pierard, Gérald; Arrese Estrada, Jorge; Quatresooz, Pascale; Pierard, Claudine

    2003-01-01

    Invasive fungal infections are a rare but important cause of morbidity and mortality among patients with severely compromised host defenses. Despite considerable advances in antifungal therapies over the past years, invasive mycoses remain a stubborn and dramatic problem. Voriconazole is a new triazole antifungal agent which confers a relative survival benefit in fluconazole-resistant invasive candidiasis, and in invasive aspergillosis, fusariosis and Scedosporium infections as well.

  13. Epidemiology of Visceral Mycoses: Analysis of Data in Annual of the Pathological Autopsy Cases in Japan

    OpenAIRE

    Yamazaki, Toshikazu; Kume, Hikaru; Murase, Setsuko; Yamashita, Eriko; Arisawa, Mikio

    1999-01-01

    The data on visceral mycoses that had been reported in the Annual of the Pathological Autopsy Cases in Japan from 1969 to 1994 by the Japanese Society of Pathology were analyzed epidemiologically. The frequency of visceral mycoses among the annual total number of pathological autopsy cases increased noticeably from 1.60% in 1969 to a peak of 4.66% in 1990. Among them, the incidences of candidiasis and aspergillosis increased the most. After 1990, however, the frequency of visceral mycoses dec...

  14. Mortality due to systemic mycoses as a primary cause of death or in association with AIDS in Brazil: a review from 1996 to 2006

    OpenAIRE

    Marli Prado; Marcelo Barbosa da Silva; Ruy Laurenti; Luiz R Travassos; Carlos P Taborda

    2009-01-01

    Deaths caused by systemic mycoses such as paracoccidioidomycosis, cryptococcosis, histoplasmosis, candidiasis, aspergillosis, coccidioidomycosis and zygomycosis amounted to 3,583 between 1996-2006 in Brazil. When analysed as the underlying cause of death, paracoccidioidomycosis represented the most important cause of deaths among systemic mycoses (~ 51.2%). When considering AIDS as the underlying cause of death and the systemic mycoses as associated conditions, cryptococcosis (50.9%) appeared...

  15. Fungal Disease in Britain and the United States 1850–2000 : Mycoses and Modernity

    OpenAIRE

    Homei, Aya; Worboys, Michael

    2013-01-01

    In this book, we discuss the changing medical and public profile of fungal infections in the period 1850–2000. We consider four sets of diseases: ringworm and athlete’s foot (dermatophytosis); thrush or candidiasis (infection with Candida albicans); endemic, geographically specific infections in North America (coccidioidomycosis, blastomycosis and histoplasmosis) and mycotoxins; and aspergillosis (infection with Aspergillus fumigatus). We discuss each disease in relation to developing medical...

  16. Pathogens spectrum of deep human mycosis

    Directory of Open Access Journals (Sweden)

    A. B. Kulko

    2012-01-01

    Full Text Available The article describes characteristics of two different etiology groups of deep human mycosis — extremely dangerous endemic deep mycoses (histoplasmosis, coccidioidomycosis, blastomycosis, paracoccidioidomycosis, penicilliosis due to Penicillium marneffei and opportunistic deep mycosis (candidiasis, cryptococcosis, aspergillosis, mucormycosis. Information on fungal pathogens and antifungal agents is presented. The own results of cultural studies obtained during pneumomycosis diagnosis in patients with tuberculosis are shown.

  17. Bimodular Peptide Synthetase SidE Produces Fumarylalanine in the Human Pathogen Aspergillus fumigatus

    OpenAIRE

    Steinchen, Wieland; Lackner, Gerald; Yasmin, Sabiha; Schrettl, Markus; Dahse, Hans-Martin; Haas, Hubertus; Hoffmeister, Dirk

    2013-01-01

    The filamentous mold Aspergillus fumigatus causes invasive aspergillosis, a potentially life-threatening infectious disease, in humans. The sidE gene encodes a bimodular peptide synthetase and was shown previously to be strongly upregulated during initiation of murine lung infection. In this study, we characterized the two adenylation domains of SidE with the ATP-[32P]pyrophosphate exchange assay in vitro, which identified fumarate and l-alanine, respectively, as the preferred substrates. Usi...

  18. Pulmonary fungal infections after bone marrow transplantation: the value of high-resolution computed tomography in predicting their etiology

    Institute of Scientific and Technical Information of China (English)

    LI Xiang-sheng; ZHU Hong-xian; FAN Hong-xia; ZHU Ling; WANG Heng-xiang; SONG Yun-long

    2011-01-01

    Background The correct diagnosis of etiology of fungal infection after bone marrow transplantation is very important to the choice of antifungal drugs and a premise for improvement of therapeutic efficacy.This study aimed to compare high-resolution computed tomography (HRCT) findings of the pulmonary fungal infections to determine whether the etiology of various fungal infections could be diagnosed with HRCT.Methods Eighty-five cases were enrolled.According to the pathogens responsible for fungal infections,the patients were classified into three groups including invasive aspergillosis (n=52),candidiasis (n=19) and cryptococcosis (n=14)groups.All the patients underwent HRCT scans.Two independent radiologists retrospectively analyzed the HRCT scans regarding CT patterns and distribution of lung abnormality.Results Most fungal infections in the three groups occurred in the neutropenic phase.There was no significant difference in the constituent ratio of fungal infections at different phases after bone marrow transplantation among the three groups.Agreement between the two observers for all the CT characteristics of fungal infections was excellent (k>0.75).There was a significant difference in occurrence ratio of mass among the three groups (P=0.02).Occurrence ratio of mass (43.3%,13/30) in the group with invasive aspergillosis was higher than in each of other two groups (20.0%,2/10;14.3%,1/7).There was no significant difference in other CT characteristics of nodules or masses; including number,margin,halo sign,cavitation and air-crescent sign.There was no significant difference in number,margin,air bronchogram and distribution of air-space consolidation.Conclusions The HRCT appearance of various pulmonary fungal infections has a great deal of overlap and is nonspecific.Mass is more common in invasive aspergillosis,which is helpful to the diagnosis of invasive aspergillosis after bone marrow transplantation.

  19. In vitro interactions between amphotericin B, itraconazole, and flucytosine against 21 clinical Aspergillus isolates determined by two drug interaction models.

    OpenAIRE

    Dorsthorst, D.T.A. te; Verweij, P E; Meis, J.F.G.M.; Punt, N. C.; Mouton, J. W.

    2004-01-01

    Combination therapy of flucytosine (5FC) with other antifungal agents could be of use for the treatment of invasive aspergillosis. However, interpretation of the results of in vitro interactions is problematic. The fractional inhibitory concentration (FIC) index is the most commonly used method, but it has several major drawbacks in characterizing antifungal drug interaction. Alternatively, a response surface approach using the concentration-effect relationship over the whole concentration ra...

  20. Aspergillus spinal epidural abscess

    International Nuclear Information System (INIS)

    A spinal epidural abscess developed in a renal transplant recipient; results of a serum radioimmunoassay for Aspergillus antigen were positive. Laminectomy disclosed an abscess of the L4-5 interspace and L-5 vertebral body that contained hyphal forms and from which Aspergillus species was cultured. Serum Aspergillus antigen radioimmunoassay may be a valuable, specific early diagnostic test when systemic aspergillosis is a consideration in an immunosuppressed host

  1. Calcineurin Controls Growth, Morphology, and Pathogenicity in Aspergillus fumigatus

    OpenAIRE

    Steinbach, William J.; Cramer, Robert A; Perfect, B. Zachary; Asfaw, Yohannes G.; Sauer, Theodor C.; Najvar, Laura K.; Kirkpatrick, William R.; Thomas F. Patterson; Benjamin, Daniel K., Jr.; Heitman, Joseph; Perfect, John R.

    2006-01-01

    Calcineurin is implicated in a myriad of human diseases as well as homeostasis and virulence in several major human pathogenic microorganisms. The fungus Aspergillus fumigatus is a leading cause of infectious death in the rapidly expanding immunocompromised patient population. Current antifungal treatments for invasive aspergillosis are often ineffective, and novel therapeutic approaches are urgently needed. We demonstrate that a mutant of A. fumigatus lacking the calcineurin A (cnaA) catalyt...

  2. Aspergillus fumigatus-induced Interleukin-8 Synthesis by Respiratory Epithelial Cells Is Controlled by the Phosphatidylinositol 3-Kinase, p38 MAPK, and ERK1/2 Pathways and Not by the Toll-like Receptor-MyD88 Pathway*

    OpenAIRE

    Balloy, Viviane; Sallenave, Jean-Michel; Wu, Yongzheng; Touqui, Lhousseine; Latgé, Jean-Paul; Si-Tahar, Mustapha; Chignard, Michel

    2008-01-01

    Previous studies have established that phagocytes are key cells of the pulmonary innate immune defense against A. fumigatus, an opportunistic fungus responsible of invasive pulmonary aspergillosis. Macrophages detect A. fumigatus via Toll-like receptors 2 and 4 (TLR2 and -4) and respond by the MyD88-NF-κB-dependent synthesis of inflammatory mediators. In the present study, we demonstrate that respiratory epithelial cells also sense A. fumigatus and participate in the h...

  3. Aspergillus fumigatus-induced IL-8 synthesis by respiratory epithelial cells is controlled by the PI3 kinase, p38 MAPK and ERK1/2 pathways and not by the TLR-MYD88 pathway.

    OpenAIRE

    Balloy, Viviane; Sallenave, Jean-Michel; Wu, Yongzheng; Touqui, Lhousseine; Latgé, Jean-Paul; Si-Tahar, Mustapha; Chignard, Michel

    2008-01-01

    Previous studies have established that phagocytes are key cells of the pulmonary innate immune defense against A. fumigatus, an opportunistic fungus responsible of invasive pulmonary aspergillosis. Macrophages detect A. fumigatus via Toll-like receptors (TLR) 2 and 4, and respond by the MyD88-NF-B-dependent synthesis of inflammatory mediators. In the present study, we demonstrate that respiratory epithelial cells also sense A. fumigatus and participate to the host defense. Thus, the interacti...

  4. Aspergillus infection in pulmonary cavitating lesions with right atrial myxoma.

    Science.gov (United States)

    Sharma, Divyesh; Dorgan, Eileen; Douglas, Hannah; Trouton, Tom; McMullan, Ronan; Parissis, Haralabos

    2014-11-01

    Cardiac myxomas are rare primary tumors with varied clinical presentations that may pose a diagnostic challenge. Here, we describe the case of a 21-year-old man with multiple cavitating lung lesions with aspergillosis and underlying right atrial myxoma, who presented with hemoptysis and weight loss. He was successfully treated with right atrial myxoma resection and antifungal agents, with no recurrence or complications after one year of follow-up. PMID:24887845

  5. Genetic and structural validation of Aspergillus fumigatus N-acetylphosphoglucosamine mutase as an antifungal target

    OpenAIRE

    Fang, Wenxia; Du, Ting; Raimi, Olawale G.; Hurtado-Guerrero, Ramón; Mariño, Karina; Ibrahim, Adel F. M.; Albarbarawi, Osama; Ferguson, Michael A. J.; Jin, Cheng; Van Aalten, Daan M. F.

    2013-01-01

    Aspergillus fumigatus is the causative agent of IA (invasive aspergillosis) in immunocompromised patients. It possesses a cell wall composed of chitin, glucan and galactomannan, polymeric carbohydrates synthesized by processive glycosyltransferases from intracellular sugar nucleotide donors. Here we demonstrate that A. fumigatus possesses an active AfAGM1 (A. fumigatus N-acetylphosphoglucosamine mutase), a key enzyme in the biosynthesis of UDP (uridine diphosphate)–GlcNAc (N-acetylglucosamine...

  6. Steady-State Plasma Pharmacokinetics of Oral Voriconazole in Obese Adults▿

    OpenAIRE

    Pai, Manjunath P.; Lodise, Thomas P.

    2011-01-01

    Voriconazole is an antifungal agent that is currently used as primary therapy for invasive aspergillosis and as a potential treatment for systemic candidiasis. Data on the dosing of voriconazole in obese patients are not available, which is problematic given the increased prevalence of this special population. To address this limitation, we evaluated the steady-state plasma pharmacokinetics of voriconazole through a two-way, crossover design in a cohort of eight healthy volunteers with class ...

  7. Intravenous Voriconazole after Toxic Oral Administration▿

    OpenAIRE

    Alffenaar, J. W. C.; Van Assen, S.; de Monchy, J G R; Uges, D. R. A.; Kosterink, J. G. W.; VAN DER WERF, T S

    2009-01-01

    In a male patient with rhinocerebral invasive aspergillosis, prolonged high-dosage oral administration of voriconazole led to hepatotoxicity combined with a severe cutaneous reaction while intravenous administration in the same patient did not. High concentrations in the portal blood precipitate liver enzyme abnormalities, and therefore, oral administration of voriconazole may have a hepatotoxicity profile different from that of intravenous (i.v.) administration. Intravenously administered vo...

  8. Population Pharmacokinetics of Voriconazole in Adults

    OpenAIRE

    Hope, William W.

    2012-01-01

    Voriconazole is a first-line agent for the treatment of invasive fungal infections. The pharmacology of voriconazole is characterized by extensive interindividual variability and nonlinear pharmacokinetics. The population pharmacokinetics of voriconazole in 64 adults is described. The patient population consisted of 21 healthy volunteers, who received a range of intravenous (i.v.) and oral voriconazole regimens, and 43 patients with proven or probable invasive aspergillosis, who received the ...

  9. Comparative Pharmacokinetics of Voriconazole Administered Orally as either Crushed or Whole Tablets▿

    OpenAIRE

    Dodds Ashley, E. S.; Zaas, A. K.; Fang, A. F.; Damle, B.; Perfect, J.R.

    2006-01-01

    Voriconazole is a triazole antifungal agent used to treat serious, invasive fungal infections including aspergillosis and candidemia. Limitations with existing formulations of voriconazole including restricted utility in patients with renal dysfunction (intravenous preparation) and the unavailability of an oral suspension in some countries make the administration of crushed tablets desirable in many clinical scenarios. However, concerns that this approach may alter the systemic absorption of ...

  10. Difficult diagnosis of invasive fungal infection predominantly involving the lower gastrointestinal tract in acute lymphoblastic leukaemia

    OpenAIRE

    Avcu, Gulhadiye; Karapinar, Deniz Yilmaz; Yazici, Pinar; Duyu, Muhterem; Polat, Suleyha Hilmioglu; Atabay, Berna; Doganavsargil, Basak; Karapinar, Bulent

    2016-01-01

    Invasive fungal infections are most commonly seen in immunocompromised patients and usually affect the respiratory system. Gastrointestinal system involvement of mucormycosis and invasive aspergillosis is rarely reported in childhood. Here we describe a 5 year old boy with acute lymphoblastic leukaemia who developed invasive fungal infection particularly affecting the lower gastrointestinal system to emphasise the difficulties in diagnosis and management of invasive fungal infections in immun...

  11. Evaluation of mRNA Expression Levels of cyp51A and mdr1, Candidate Genes for Voriconazole Resistance in Aspergillus flavus

    OpenAIRE

    Fattahi, Azam; Zaini, Farideh; Kordbacheh, Parivash; Rezaie, Sasan; Safara, Mahin; Fateh, Roohollah; Farahyar, Shirin; Kanani, Ali; Heidari, Mansour

    2015-01-01

    Background: Voriconazole Resistance (VRC-R) in Aspergillus flavus isolates impacts the management of aspergillosis, since azoles are the first choice for prophylaxis and therapy. However, to the best of our knowledge, the mechanisms underlying voriconazole resistance are poorly understood. Objectives: The present study was designed to evaluate mRNA expression levels of cyp51A and mdr1 genes in voriconazole resistant A. flavus by a Real-Time Reverse Transcriptase Polymerase Chain Reaction (RT-...

  12. Interrogation of Related Clinical Pan-Azole-Resistant Aspergillus fumigatus Strains: G138C, Y431C, and G434C Single Nucleotide Polymorphisms in cyp51A, Upregulation of cyp51A, and Integration and Activation of Transposon Atf1 in the cyp51A Promoter ▿ †

    OpenAIRE

    Albarrag, Ahmed M.; Anderson, Michael J.; Howard, Susan J.; Robson, Geoff D.; Warn, Peter A.; Sanglard, Dominique; David W Denning

    2011-01-01

    Multiple Aspergillus fumigatus isolates from a patient with two aspergillomas complicating chronic pulmonary aspergillosis were pan-azole resistant. Microsatellite typing was identical for all isolates despite major phenotypic and some growth rate differences. Three different cyp51A mutations were found (G138C, Y431C, and G434C), of which the first two were demonstrated by heterologous expression in a hypersusceptible Saccharomyces cerevisiae strain to be at least partly responsible for eleva...

  13. Activity and Safety of Inhaled Itraconazole Nanosuspension in a Model Pulmonary Aspergillus fumigatus Infection in Inoculated Young Quails

    OpenAIRE

    Wlaź, Piotr; Knaga, Sebastian; Kasperek, Kornel; Wlaź, Aleksandra; Poleszak, Ewa; Jeżewska-Witkowska, Grażyna; Winiarczyk, Stanisław; Wyska, Elżbieta; Heinekamp, Thorsten; Rundfeldt, Chris

    2015-01-01

    Pulmonary aspergillosis is frequently reported in parrots, falcons, and other birds held in captivity. Inhalation is the main route of infection for Aspergillus fumigatus, resulting in both acute and chronic disease conditions. Itraconazole (ITRA) is an antifungal commonly used in birds, but its administration requires repeated oral dosing, and the safety margin is narrow. To investigate the efficacy of inhaled ITRA, six groups of ten young quails (Coturnix japonica) were inoculated intratrac...

  14. In Vitro Interactions between Antifungals and Immunosuppressants against Aspergillus fumigatus

    OpenAIRE

    Steinbach, William J.; Schell, Wiley A.; Blankenship, Jill R.; Onyewu, Chiatogu; Heitman, Joseph; Perfect, John R.

    2004-01-01

    The optimal treatment for invasive aspergillosis remains elusive, despite the increased efficacy of newer agents. The immunosuppressants cyclosporine (CY), tacrolimus (FK506), and sirolimus (formerly called rapamycin) exhibit in vitro and in vivo activity against Candida albicans, Cryptococcus neoformans, and Saccharomyces cerevisiae, including fungicidal synergy with azole antifungals. We report here that both FK506 and CY exhibit a clear in vitro positive interaction with caspofungin agains...

  15. Aspergilloma in the frontal sinus expanding into the orbit.

    OpenAIRE

    Swoboda, H.; Ullrich, R

    1992-01-01

    A case of primary frontal sinus aspergilloma in a 79 year old non-immunocompromised woman, who presented with a right sided pyocele expanding into the orbit, is presented. The low susceptibility of the frontal sinus is probably related to the brachycephalic shape of the human skull which locates this sinus far anterosuperiorly to the nasal cavity. In human frontal sinus aspergillosis nasal symptoms are absent; the clinical manifestation of this rare disease is initiated by complications, espe...

  16. Prevalence and mechanism of triazole resistance in Aspergillus fumigatus in a referral chest hospital in Delhi, India and an update of the situation in Asia

    Directory of Open Access Journals (Sweden)

    Anuradha eChowdhary

    2015-05-01

    Full Text Available Aspergillus fumigatus causes varied clinical syndromes ranging from colonization to deep infections. The mainstay of therapy of Aspergillus diseases is triazoles but several studies globally highlighted variable prevalence of triazole resistance, which hampers the management of aspergillosis. We studied the prevalence of resistance in clinical A. fumigatus isolates during 4 years in a referral Chest Hospital in Delhi, India and reviewed the scenario in Asia and the Middle East. Aspergillus species (n=2117 were screened with selective plates for azole resistance. The isolates included 45.4% A. flavus, followed by 32.4% A. fumigatus, 15.6% Aspergillus species and 6.6% A. terreus. Azole resistance was found in only 12 (1.7% A. fumigatus isolates.These triazole resistant A. fumigatus (TRAF isolates were subjected to (a calmodulin and β tubulin gene sequencing (b in vitro antifungal susceptibility testing against triazoles using CLSI M38-A2 (c sequencing of cyp51A gene and real-time PCR assay for detection of mutations and (d microsatellite typing of the resistant isolates. TRAF harbored TR34/L98H mutation in 10 (83.3% isolates with a pan-azole resistant phenotype. Among the remaining 2 TRAF isolates, one had G54E and the other had three non-synonymous point mutations. The majority of patients were diagnosed as invasive aspergillosis followed by allergic bronchopulmonary aspergillosis and chronic pulmonary aspergillosis. The Indian TR34/L98H isolates had a unique genotype and were distinct from the Chinese, Middle East and European TR34/L98H strains. This resistance mechanism has been linked to the use of fungicide azoles in agricultural practices in Europe as it has been mainly reported from azole naïve patients. Reports published from Asia demonstrate the same environmental resistance mechanism in A. fumigatus isolates from two highly populated countries in Asia i.e., China and India and also from the neighboring Middle East.

  17. Molecular Epidemiology of Aspergillus fumigatus Isolates Recovered from Water, Air, and Patients Shows Two Clusters of Genetically Distinct Strains

    OpenAIRE

    Warris, Adilia; Klaassen, Corné H. W.; Meis, Jacques F. G. M.; de Ruiter, Maaike T.; de Valk, Hanneke A.; Abrahamsen, Tore G.; Gaustad, Peter; Verweij, Paul E.

    2003-01-01

    There has been an increase in data suggesting that besides air, hospital water is a potential source of transmission of filamentous fungi, and in particular Aspergillus fumigatus. Molecular characterization of environmental and clinical A. fumigatus isolates, collected prospectively during an 18-month period, was performed to establish if waterborne fungi play a role in the pathogenesis of invasive aspergillosis. Isolates recovered from water (n = 54) and air (n = 21) at various locations ins...

  18. Voriconazole-induced periostitis in a patient with overlap syndromes

    OpenAIRE

    Hirota, Keisho; Yasoda, Akihiro; Fujii, Toshihito; Inagaki, Nobuya

    2014-01-01

    A 52-year-old woman with overlap syndrome and interstitial pneumonia underwent immunosuppressive therapy and she was suspected to suffer from pulmonary aspergillosis. Oral voriconazole was initiated, and a rapid elevation of alkaline phosphatase (ALP) occurred after 4 weeks. After 2 months, the patient presented diffuse pain in bilateral skeletal regions, and bone scintigraphy revealed bilateral multiple areas of increased radiotracer uptake. We suspected the skeletal involvement as voriconaz...

  19. Modelling Aspergillus fumigatus infections in racing pigeons (Columba livia domestica)

    OpenAIRE

    Beernaert, Lies Angèle; Pasmans, Frank; Haesebrouck, Freddy; Martel, An

    2008-01-01

    Abstract In vivo modelling of aspergillosis in birds allows the evaluation of control measures and the study of host-pathogen interactions. In this study the impact of the use of different inoculation routes and immunosuppression on the course of an infection with Aspergillus fumigatus in racing pigeons (Columba livia domestica) was examined. A. fumigatus conidia were inoculated in the thoracic air sac, lung or trachea in immunocompetent or immunosuppressed pigeon squabs. Immunosup...

  20. ISOLATION AND IDENTIFICATION OF Aspergillus spp. FROM THE WATER USED FOR REHABILITATION OF MAGELLANIC PENGUINS

    OpenAIRE

    Vanice Rodrigues Poester; Gabriel Baracy Klafke; Ângela Leitzke Cabana; Andréa Corrado Adornes; Rodolfo Pinho da Silva Filho; Melissa Orzechowski Xavier

    2015-01-01

    Aspergillosis is the main cause of mortality in captivity penguins. The infection occurs mainly by conidia inhalation of the Aspergillus genus, however, the fungus can also be dispersed by water. Therefore, this study aimed to evaluate water quality of the pool where the rehabilitated penguins remain at Centro de Recuperação de Animais Marinhos in Rio Grande city, Brazil, searching for the presence of the fungus Aspergillus spp. Water samples were collected weekly during a ten-month period an...

  1. Serological monitoring of antibodies for an early diagnosis ofaspergillosis in captive penguins

    OpenAIRE

    Ângela L. Cabana; Xavier, Melissa O.; Vanice Poester; Gabriel B. Klafke; Pedro L. B.Filho; Aryse Martins; Rodolfo P. S.Filho; Meireles, Mário C. A.

    2015-01-01

    Abstract: This study aimed to evaluate the efficacy of detection of anti-Aspergillus fumigatus antibodies in captive penguins by double radial agar gel immunodiffusion (AGID) for the aspergillosis diagnosis. We included 134 Magellanic penguins (Spheniscus magellanicus) in rehabilitation at the Center for Recovery of Marine Animals (CRAM / FURG). All of them were monitored by AGID weekly until its final destination (death or release), totalizing 660 serum samples studied. All animals were clin...

  2. A complementary tool for management of disseminated Histoplasma capsulatum var. capsulatum infections in AIDS patients. : A complementary tool for histoplasmosis management

    OpenAIRE

    Iriart, Xavier; Blanchet, Denis; Menard, Sandie; Lavergne, Rose-Anne; Chauvin, Pamela; Adenis, Antoine; Cassaing, Sophie; Fillaux, Judith; Magnaval, Jean-François; Demar, Magalie; Carme, Bernard; Bessieres, Marie-Hélène; Couppie, Pierre; Nacher, Mathieu; Berry, Antoine

    2014-01-01

    : In South America, disseminated histoplasmosis due to Histoplasma capsulatum var. capsulatum (H. capsulatum), is a severe and frequent opportunistic infection in AIDS patients. In areas outside the USA where specific-Histoplasma antigen detection is not available, the diagnosis is difficult. With the galactomannan antigen (GM) detection, a test commonly used for invasive aspergillosis diagnosis, there is a cross-reactivity with H. capsulatum that can be helpful for the diagnosis of histoplas...

  3. Impact of Aspergillus fumigatus in allergic airway diseases

    OpenAIRE

    Chaudhary Neelkamal; Marr Kieren A

    2011-01-01

    Abstract For decades, fungi have been recognized as associated with asthma and other reactive airway diseases. In contrast to type I-mediated allergies caused by pollen, fungi cause a large number of allergic diseases such as allergic bronchopulmonary mycoses, rhinitis, allergic sinusitis and hypersensitivity pneumonitis. Amongst the fungi, Aspergillus fumigatus is the most prevalent cause of severe pulmonary allergic disease, including allergic bronchopulmonary aspergillosis (ABPA), known to...

  4. Imaging of Asthma.

    Science.gov (United States)

    Richards, John Caleb; Lynch, David; Koelsch, Tilman; Dyer, Debra

    2016-08-01

    Asthma is one of the most common diseases of the lung. Asthma manifests with common, although often subjective and nonspecific, imaging features at radiography and high-resolution computed tomography. The primary role of imaging is not to make a diagnosis of asthma but to identify complications, such as allergic bronchopulmonary aspergillosis, or mimics of asthma, such as hypersensitivity pneumonitis. This article reviews the imaging features of asthma as well as common complications and mimics. PMID:27401624

  5. Differentiation between Isolates of Aspergillus fumigatus from Breeding Turkeys and Their Environment by Genotyping with Microsatellite Markers

    Science.gov (United States)

    Lair-Fulleringer, Sybille; Guillot, Jacques; Desterke, Christophe; Seguin, Dominique; Warin, Stephan; Bezille, Arnaud; Chermette, René; Bretagne, Stéphane

    2003-01-01

    To elucidate the epidemiology of the different forms of avian aspergillosis, 114 Aspergillus fumigatus isolates from sacrificed turkeys and 134 A. fumigatus isolates from air samples were collected and genotyped by microsatellite polymorphism marker analysis. Air sampling confirmed the huge diversity of A. fumigatus populations. Whereas older animals harbored several combinations of genotypes, 1-day-old chicks carried a unique genotype, suggesting a unique source of contamination. PMID:12682192

  6. MR imaging with pathologic correlation of central nervous system manifestations of AIDS

    International Nuclear Information System (INIS)

    This paper presents the MR findings with the pathologic correlation of various examples of the opportunistic infection and other related conditions of head and neck involvement in patients with AIDS. Included in this exhibit are cryptococcal meningitis, tuberculous meningitis, tuberculoma, demyelinating white matter disease, aspergillosis, cervical osteomyelitis, transverse myelitis, primary central nervous system lymphoma, metastatic lymphoma, progressive multifocal leukoencephalopathy, parotid cysts, AIDS-related otomastoiditis, and severe nasopharyngeal lymphadenopathy. The basis pathology and MR findings of each entity are described

  7. Iatrogenic Pulmonary Nodule in a Heart Transplant Recipient

    OpenAIRE

    Mehta, Atul C.; Juan Wang; Jarmanjeet Singh; Joseph Cicenia

    2014-01-01

    A 58-year-old female with a history of non-Hodgkin lymphoma and end-stage nonischemic cardiomyopathy from Adriamycin toxicity underwent orthotic heart transplantation during June 2013. She developed shortness of breath in September 2013 and was suspected to have invasive pulmonary aspergillosis. A flexible bronchoscopy (FB) with a transbronchial biopsy (TBBx) was performed. She was found to have a focal lung nodule in the same location at the site of the TBBx on day 13 after the FB. Spontaneo...

  8. Twin airway abnormalities complicating the management of acute asthma: a case report

    OpenAIRE

    Krishnaswamy, Uma Maheswari; Pasha, Md Majeed; Aneja, Anshum; Mantha, Satya Padmaja; Moideen, Riyaz

    2015-01-01

    The term ‘refractory asthma’ includes patients with severe asthma, steroid-dependent and/or resistant asthma, difficult-to-treat asthma and irreversible asthma. In patients with to difficult to treat asthma, exclusion of other causes of persistent wheeze like vocal cord dysfunction, upper airway obstruction and allergic bronchopulmonary aspergillosis is important. Besides, the presence of anatomical abnormalities that could affect effective medication delivery could also result in sub-optimal...

  9. New cause for false-positive results with the Pastorex Aspergillus antigen latex agglutination test.

    OpenAIRE

    Kappe, R; Schulze-Berge, A

    1993-01-01

    The Pastorex Aspergillus antigen test for detection of Aspergillus galactomannan antigen in the sera of patients with invasive aspergillosis is used in many clinical laboratories. A serum sample contaminated with Penicillium chrysogenum gave a strongly positive reaction (1:128) which was heat stable, was not eliminated by pronase treatment, and was not detected by a normal rabbit globulin control. This observation was shown to be due to cross-reactions of the monoclonal antibody EB-A2 used by...

  10. The Volatome of Aspergillus fumigatus

    OpenAIRE

    Heddergott, C.; Calvo, A. M.; Latgé, J P

    2014-01-01

    Early detection of invasive aspergillosis is absolutely required for efficient therapy of this fungal infection. The identification of fungal volatiles in patient breath can be an alternative for the detection of Aspergillus fumigatus that still remains problematic. In this work, we investigated the production of volatile organic compounds (VOCs) by A. fumigatus in vitro, and we show that volatile production depends on the nutritional environment. A. fumigatus produces a multiplicity of VO...

  11. Burden of fungal disease in Ireland.

    Science.gov (United States)

    Dorgan, Eileen; Denning, David W; McMullan, Ronan

    2015-04-01

    Our objective was to estimate the burden of fungal disease on the island of Ireland, as part of a coordinated project estimating the global burden. Published epidemiology data describing fungal infection in Ireland were identified. Population and underlying disease data were collected for 2010 and a structured set of assumptions were applied to estimate burden of fungal disease based on immunosuppression, chronic disease, and other demographic information indicating predisposition to fungal infection. From Ireland's population of 6.4 million, we estimate 117, 000 patients develop significant fungal disease each year. By far the most common fungal disease is recurrent Candida vaginitis, with an estimated 95, 000 episodes annually (3000 per 100 000 women). Other fungal diseases which may be less well recognized are severe asthma with fungal sensitization and allergic bronchopulmonary aspergillosis, with estimated episodes per year of 11, 700 and 9000, respectively (182 and 140 per 100, 000 population, respectively). The model also estimates 450 episodes of invasive aspergillosis, 200 of chronic pulmonary aspergillosis, 600 of oesophageal candidiasis and 450 of candidaemia per year (7, 3, 9 and 6 episodes per 100, 000 population, respectively). This is, we believe, the first attempt to estimate the burden of fungal disease in our population and provides a basis for estimating its impact on human health and resource use. PMID:25596121

  12. Mycological Microscopic and Culture Examination of 400 Bronchoalveolar Lavage (BAL Samples

    Directory of Open Access Journals (Sweden)

    M Geramishoar

    2012-07-01

    Full Text Available Background: The frequency of invasive opportunistic mycoses has increased significantly over the past decades especially in immunocompromised patients. Invasive aspergillosis (IA has become a major cause of morbidity and mortality among these patients. As bronchoalveolar lavage (BAL fluid samples are generally useful specimens in the diagnosis of invasive pulmonary aspergillosis (IPA, this study was designed to evaluate the incidence of fungal elements in at-risk patients by direct microscopy and culture of BAL samples.Methods: In a 16-month period, 400 BAL samples were obtained from several groups of different patients with pulmonary and respiratory disorders and examined by using both direct microscopy and culture.Results: Of the 400 samples, 16 (4% were positive direct examination with branching septate hyphae and 46 (11.5% were positive culture: 25 (54% Aspergillus flavus, 6 (13% A. fumigatus, 5 (10.9% A. niger, 1 (2.2% A. terreus, 3 (6.5% Penicillium spp. and 6 (13% mixed A. flavus/A. niger. A. flavus was the most common cause of Aspergillus infection or colonization. Bone marrow transplant (BMT recipients were the most susceptible group to fungal infection and/or colonization.Conclusion: Among Aspergillus species, A. flavus was the most common isolate in both infections and colonization in Iran. More studies are needed to clarify the epidemiological aspect of aspergillosis in Iran.

  13. Molecular sub-typing suggests that the environment of rehabilitation centers may be a potential source of Aspergillus fumigatus infecting rehabilitating seabirds.

    Science.gov (United States)

    Burco, Julia D; Etienne, Kizee A; Massey, J Gregory; Ziccardi, Michael H; Balajee, S Arunmozhi

    2012-01-01

    Aspergillosis remains a major cause of infection-related avian mortality in birds that are debilitated and undergoing rehabilitation for release into the wild. This study was designed to understand the source of avian aspergillosis in seabirds undergoing rehabilitation at selected northern California aquatic bird rehabilitation centers. Air, surface and water sampling was performed between August 2007 and July 2008 in three such centers and selected natural seabird loafing sites. Average air Aspergillus fumigatus counts were at least nine times higher in samples obtained from the rehabilitation sites (M = 7.34, SD = 9.78 CFU/m(3)), when compared to those found at natural sites (M = 0.76, SD = 2.24 CFU/m(3)), t (205) = -5.99, P < 0.001. A total of 37 A. fumigatus isolates from birds with confirmed aspergillosis and 42 isolates from environmental samples were identified using both morphological and molecular methods, and subsequently sub-typed using an eight-locus microsatellite panel with the neighbor joining algorithm. Results of the study demonstrated the presence of five clonal groups, 13 genotypically related clusters, and 59 distinct genotypes. Six of the 13 genotypically related clusters contained matching genotypes between clinical isolates and local environmental isolates from the rehabilitation center in which these birds were housed. We present evidence that the environment of rehabilitation centers may be a source for A. fumigatus infection in rehabilitated seabirds. PMID:21756021

  14. Fungus infection in immunocompromised rabbits: correlation of thin-section CT findings and histopathology

    International Nuclear Information System (INIS)

    Objective: To compare the thin-section CT findings of pulmonary candidiasis, aspergillosis and cryptococcosis with histopathology in immunocompromised rabbits and improve the diagnostic accuracy of fungus infection. Methods: Healthy New Zealand white rabbits were used for immunocompromised animal models. Thin-section CT scan was performed before and 2, 4, 6, 8, 10, 12, 14 d after inoculation. The pattern and distribution of the pulmonary abnormalities were retrospectively assessed by two thoracic radiologists and compared with histopathology. The granulocyte count was compared before and after administration of immunosuppressive agents. The paired t test, chi square test and the Fisher's exact test were used for the statistics. Results: Fourteen rabbits had candidiasis, 16 rabbits had eryptococcosis, 15 rabbits had aspergillosis. The granulocyte counts before and after administration of immunosuppressive agents were (2.91±0.92) and (0.35±0.19) x 109/L respectively in candidiasis group, there was a significant difference (t=12.484, P9/L in aspergillosis group, there was a significant difference (t=5.792, P9/L in cryptococcosis group, there was a significant difference (t=8.199, P0.05). Ground glass opacity (GGO) and consolidation were the two most common findings in immunocompromised rabbits with three fungus infections, areas of GGO was correlated with the congestion, hemorrhage, inflammatory cell infiltration and interstitial hyperplasia in pathology. Consolidation was correlated with the severe congestion, hemorrhage, inflammatory cell infiltration, interstitial hyperplasia, necrosis and vascular embolism in pathology. Conclusion: GGO and consolidation are the two most common findings of fungus infections in immunocompromised animal models and thin-section CT findings can reflect the pathological changes. (authors)

  15. Activity and Safety of Inhaled Itraconazole Nanosuspension in a Model Pulmonary Aspergillus fumigatus Infection in Inoculated Young Quails.

    Science.gov (United States)

    Wlaź, Piotr; Knaga, Sebastian; Kasperek, Kornel; Wlaź, Aleksandra; Poleszak, Ewa; Jeżewska-Witkowska, Grażyna; Winiarczyk, Stanisław; Wyska, Elżbieta; Heinekamp, Thorsten; Rundfeldt, Chris

    2015-08-01

    Pulmonary aspergillosis is frequently reported in parrots, falcons, and other birds held in captivity. Inhalation is the main route of infection for Aspergillus fumigatus, resulting in both acute and chronic disease conditions. Itraconazole (ITRA) is an antifungal commonly used in birds, but its administration requires repeated oral dosing, and the safety margin is narrow. To investigate the efficacy of inhaled ITRA, six groups of ten young quails (Coturnix japonica) were inoculated intratracheally with 5 × 10(6) spores (3 groups) or 5 × 10(7) spores (3 groups). Animals were exposed to nebulized ITRA nanosuspension as 10 % suspension or 4 % suspension, once daily for 30 min, starting 2 h after inoculation for 6 days. Control groups were exposed to nebulized saline for the same period of time. Survival and clinical scores were evaluated, and animals were subjected to gross pathology. In control animals, aspergillosis resulted in systemic disease without pulmonary or air sac granulomas. Animals died from multiple organ failure. Inhalation of 10 % ITRA nanosuspension blocked lethality and prevented disease-related symptoms in the quails exposed to the low dose of spores, while the disease course in quails inoculated with the high-spore dose was retarded. Inhalation of 4 % ITRA nanosuspension was less effective. Both inhalations were well tolerated, and gross pathology did not reveal signs of local toxicity. The data indicate that inhaled administration of 10 % ITRA nanosuspension is capable of alleviating an acute A. fumigatus infection in quails. A lower ITRA concentration may be only active in chronic pulmonary aspergillosis. PMID:25790942

  16. A rare case of spontaneous Aspergillus spondylodiscitis with epidural abscess in a 45-year-old immunocompetent female

    Directory of Open Access Journals (Sweden)

    K Ambedkar Raj

    2013-01-01

    Full Text Available Vertebral osteomyelitis and discitis are mainly due to bacterial infections though fungal infections are one of the important causes of morbidity and mortality in immunocompromised patients. Aspergillus involving intervertebral disc space is extremely rare. We report a case of aspergillosis of intervertebral L5-S1 disc space with spinal epidural abscess in an immunocompetent 45-year-old female which can add on to a few case reports described in literature as well as an insight for clinicians regarding this rare spontaneous infection in an immunocompetent patient.

  17. Differential diagnosis of infections in a patient with Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Paolo Ghiringhelli

    2008-12-01

    Full Text Available We describe a case of a 65-years-old patient with Chronic Obstructive Pulmonary Disease (COPD, receiving oxygen therapy and resistant to antibiotic therapy. He was admitted with high fever, productive cough, marked leukocytosis, and chest X-ray findings of infiltration and fluid levels within lung cysts. A differential diagnosis was essential to start an adequate treatment and avoid the rapid worsening of patients respiratory status. In patients with chronic pulmonary diseases under immunotherapy, micotic infections should be considered. Aspergillus fumigatus was cultured from bronchial washing fluid and we diagnosed chronic necrotizing pulmonary aspergillosis (CNPA. Oral itraconazole was started and his symptoms and laboratory data markedly improved.

  18. Immunohistochemical diagnosis of systemic bovine zygomycosis by murine monoclonal antibodies

    DEFF Research Database (Denmark)

    Jensen, H.E.; Aalbaek, B.; Lind, Peter; Krogh, H.V.

    1996-01-01

    97%]) the Mab and the polyclonal antibodies reacted in a similar pattern, i.e., positively for zygomycosis in 89 lesions, negatively in 41 aspergillosis lesions, and negatively in 10 undiagnosed lesions. Hyphae within two of four lesions in lymph nodes, which were not stained by the polyclonal...... antibodies, reacted with the specific Mab. However, in another three lesions of lymph nodes stained by the polyclonal antibodies no reactivity was seen with the Mab-WSSA-RA-1. The immunoreactivity of the Mabs (Mab-WSSA-RA-1 through Mab-WSSA-RA-4) raised against WSSA of R. arrhizus justify their application...... for the in situ diagnosis of systemic bovine zygomycosis....

  19. Single Nodula opacity of granulomatous Pneumocystis jirovecii pneumoniain an asymptomatic lymphoma patient

    International Nuclear Information System (INIS)

    The radiologic findings of a single nodule from Pneumocystis jirovecii pneumonia (PJP) have been rarely reported. We described a case of granulomatous PJP manifesting as a solitary pulmonary nodule with a halo sign in a 69-year-old woman with diffuse large B cell lymphoma during chemotherapy. The radiologic appearance of the patient suggested an infectious lesion such as angioinvasive pulmonary aspergillosis or lymphoma involvement of the lung; however, clinical manifestations were not compatible with the diseases. The nodule was confirmed as granulomatous PJP by video-assisted thoracoscopic surgery biopsy.

  20. THE PROBLEM OF INVASIVE MYCOSES IN RHEUMATOLOGY(Part I

    Directory of Open Access Journals (Sweden)

    Boris Sergeyevich Belov

    2009-12-01

    Full Text Available The problem of invasive mycoses is becoming ever more urgent in modern rheumatology. The fact that physicians are unalert to mycoses in patients with systemic rheumatic diseases and that there are difficulties in their lifetime diagnosis and treatment is noteworthy. The significance of this problem substantially increases with the active clinical introduction of biologicals, primarily tumor necrosis factor а inhibitors (infliximab, adalimumab, etanercept, which goes on concurrently with the increasing risk for opportunistic infections. Part I presents information on different aspects of systemic aspergillosis, including the tactics of its diagnosis and rational therapy