Arza FS, Coria LJJ, Rosales URE, Gómez BD

Language: Spanish
References: 54
Page: 80-92
PDF size: 235.62 Kb.

ABSTRACT

Introduction: Aspergillus is a ubiquitous filamentous fungus that mainly causes complications, fundamentally in neutropenic patients with cellular defense disorder.
Clinical case: Male, 3 years old, suffering histiocytosis (27-04-01); last chemotherapy 9 days before admittance (methotrexate). He is admitted with epistaxis of 3 hours evolution and hard to control, in spite of previous administration of platelet concentrate and nasal tampon. Since admittance he was neutropenic, with low platelet count, so we began ceftazidime, amikacin, clindamycin and fluconazole (due to suspicion of candidiasis). He remains febrile and neutropenic; E. coli was isolated in urine 16 days after admittance; ceftazidime and fluconazole were withdrawn, initiating cefepime and amphotericin B. The pattern of sensitivity was favorable to meropenem and resistance to the rest of antibiotics determined interruption of cefepime and initiation of meropenem. Thorax X-ray showed a diffuse bilateral infiltrate, that didn´t seem to cause respiratory difficulty. Thorax CT showed a nodular image, suggestive of pulmonary aspergillosis. PCR (serum) was positive for Aspergillus fumigatus. Due to creatinine increase we continued therapy with liposomal amphothericin (7mg/kg/day). Thirty days after admittance, due to unfavorable evolution, resection of superior pulmonary lobe and a portion of right medium lobe was performed. Anatomopathological finding was granuloma, suggestive of Aspergillus. Patient completed two weeks with i.v treatment post-resection surgery, and was released in stable condition with indications to continue ambulatory therapy with itraconazole for 4-6 months and periodic controls.

REFERENCES

1. Rankin NE. Disseminated aspergillosis and moniliasis associated with agranulocytosis and antibiotic therapy. BMJ. 1953; 25:918-919.

2. Samson RA, Pitt JA, eds. Modern Concepts in Penicillium and Aspergillosis Classification. New York: Plenum; 1990.

3. Groll AH, Shah PM, Mentzel, et al. Trends in the post mortem epidemiology of invasive fungal infections at a university hospital. J Infect.1996; 33:23-32.

4. Hall LA, Denning DW. Oxygen requirements of Aspergillus species. J Microbiol.1994; 41:311-315.

5. Tang CM, Cohen J, et al. The alkaline protease of Aspergillus fumigatus is not virulence determinant in two murine models of invasive pulmonary aspergillosis. Infect Immun. 1993; 61:1650-1656.

6. Staib F. Ecological and epidemiological aspects of aspergilli pathogenia for man and animal in Berlin. Zentralbl Bakteriol 1984; 257:240-245.

7. Mullins J, Harvey R, et al. Sources and incidence of airborne Aspergillus fumigatus. Clin Allergy. 1976; 6:209-217.

8. Simmonds EJ, et al. Aspergillus fumigatus colonization and population density of place of residence in cystic fibrosis. Arch Dis Child 1994; 70:139-140.

9. Debeaupuis JP, et al. Genetic diversity among clinical and environmental isolates of Aspergillus fumigatus. Infect Immun. 1997; 19:3080-3085.

10. Latge JP, et al. Longitudinal study of Aspergillus fumigatus strain isolated from cystic fibrosis patients. Eur J Clin Microbiol Infect Dis. 1997; 16:747-750.

11. Gerson SL, et al. Prolonged granulocytopenia: The major risk factor for invasive pulmonary aspergillosis in patients with acute leukemia. Ann Intern Med. 1984; 100:345-351.

12. Martino P, et al. Aspergillus colonization of the nose and pulmonary aspergillosis in neutropenic patients: Retrospective study. Haematologica. 1989; 74:263-265.

13. Gefter WB, et al. Invasive pulmonary aspergillosis: A new look at the spectrum of Aspergillus infections of the lung. Radiology. 1981; 140:313-321.

14. Karim M, et al. Chronic invasive aspergillosis in apparently immunocompetent host. Clin Infect Dis. 1997; 24:723-733.

15. Parta M, Chang Y, et al. HYPI, a hydrophobin gene from Aspergillus nidulans. Infect Immun. 1994; 62: 4380-4395.

16. Monod M, et al. The secreted proteases of pathogenic species of Aspergillus and their possible role in virulence. Can J Bot. 1995; 73(suppl 1) 1081-1086.

17. Markaryam A, et al. Purification and characterization of an elastinolytic metalloprotease from Aspergillus fumigatus and immunoelectron microscopic evidence of secretion of this enzyme by the fungus invading murine lung. Infect Immun 1994; 62:2149-2157.

18. Chris JF, et al. Proteases from Aspergillus fumigatus induce release of proinflamatory cytokines and cell detachment in airway epithelial cell lines. J Infect Dis. 1997; 176:300-303.

19. Birch M, et al. Evidence of multiple phospholipase activities of Aspergillus fumigatus. Infect Immun. 1996; 64:751-755.

20. Denning DW, et al. Risk factors and outcomes from invasive aspergillosis. Presented at the Thirty-sixth ICAAC. New Orleans 1996.

21. Levy H, et al. The value of bronchoalveolar lavage and bronchial washings in the diagnosis of invasive pulmonary aspergillosis. Am J Clin Pathol. 1986; 86:243-248.

22. Denning DW. Invasive aspergillosis. Clin Infect Dis 1998; 26:781-805.

23. Paterson D, Singh N. Invasive aspergillosis in transplant recipients. Medicine 1999; 78:123-138.

24. Lin SJ, Schanz J, Teutsch SM. Aspergillosis case fatality rate: systematic review of the literature. Clin Infect Dis 2001; 32:358-366.

25. Groll AH, Shah PM, Mentzel C, et al. Trends in the post-mortem epidemiology of invasive fungal infections at a University hospital. J Infect 1996; 33:23-32.

26. Vogesen M, Wanders A, Haas A, et al. A four year review of fatal aspergillosis. Eur J Clin Microbiol Infect Dis 1999; 18:42-45.

27. Prentice HG, Kibbler CC, Prentice AG. Towards a targeted, risk based, antifungal strategy in neutropenic patients. Br J Haematol 2000; 110:273-284.

28. Palaio A, Cuetara MS, Ponton J. El diagnóstico de laboratorio de la aspergilosis invasora. Rev Iberoam Micol 2003; 20:90-98.

29. Perferct JR, Cox GM, et al. The impact of culture isolation of Aspergillus sp.: a hospital-based survey of aspergillosis. Clin Infect Dis 2001; 33:1824-1833.

30. Ascioglu S, de Paw B, Bennett JE, et al. Defining opportunistic invasive fungal infections in immunocompromised patients with cancer and hematopoietic stem cell transplants: an international consensus. Clin Infect Dis 2002; 34:7-14.

31. Herbrecht R, Letscher-Bru V, Oprea C, et al. Aspergillosis galactomannan detection in the diagnosis of invasive aspergillosis in cancer patients. L Clin Oncol 2002; 20:1898-1906.

32. Chan C, Woo PCY, et al. Detection of antibodies specific to an antigen all wall galactomannoprotein for serodiagnosis of invasive deep mycosis and fungal febrile episodes. Lancet 1995; 345:17-20.

33. Duthie R, Denning DW. Aspergillus fungemia: reports of two cases and review. Clin Infect Dis 1995; 20:598-605.

34. Obayashi T, Toshida M, Mori T et al. Plasma (1-3)-ß-D glucan measurement in diagnosis of invasive deep mycosis and fungal febrile episodes. Lancet 1995; 345:17-20.

35. Sulahian A, Boutboul, et al. Value of antigen detection using an enzyme immunoassay in the diagnosis and prediction of invasive aspergillosis in two adult and pediatric hematology units during a 4 year prospective study. Cancer 2001; 91:311-318.

36. Siemann N, Koch-Dorfler M, et al. False positive results in premature infants with the Platelia®Aspergillus sandwich enzyme-linked immunosorbent assay. Mycoses 1998; 41:373-377.

37. Loffler J, Hebart H et al. Polimerase chain reaction detection of Aspergillus DNA in experimental models of invasive aspergillosis. J Infect Dis 2002; 185:1203-1206.

38. Jones ME, Fox AJ, Barnes AJ, et al. PCR-ELISA for the early diagnosis of invasive pulmonary Aspergillus infection in neutropenic patients. J Clin Pathol 1998; 51:652-656. Gómez BD 92

39. Kami M, Fukui T, Ogawa S, et al. Use of real time PCR on blood samples for diagnosis of invasive aspergillosis. Clin Infect Dis 2001; 33:1504-1512.

40. Spiess B, Buchheidt D, et al. Development of a Light Cycler PCR assay for detection and quantification of Aspergillus fumigatus DNA in clinical samples from neutropenic patients. J Clin Microbiol 2003; 41:1811-1818.

41. Costa C, Costa JM, et al. Real time PCR coupled with automatic DNA extraction and detection of antigen in serum by Enzyme-Linked Immunosorbent assay for the diagnosis of invasive aspergillosis. J Clin Microbiol 2002; 40:2224-2227.

42. Hebart H, Loffler J, Meisner C, et al. Early detection of Aspergillus infection after allogenic stem cell transplantation by polymerase chain reaction screening. J Infect Dis 2000; 181:1203-1206.

43. Verweij PE, Weemaes CM, Curfs Jo et al. Failure to detect circulating Aspergillus markers in a patient with chronic granulomatous disease and invasive aspergillosis. J Clin Microbiol 2000; 38:3900-3901.

44. Severens JL, Donnelly JP, et al. Two strategies for managing invasive aspergillosis: a decision analysis. Clin Infect Dis 1997; 25:1148-1154.

45. Wingard JR, Kubulis P, Lee L, et al. Clinical significance of nephrotoxicity in patients treated with amphothericin B for suspected or proven aspergillosis. Clin Infect Dis 1999; 29:1402-1407.

46. Bowden R, Chandrasekar P, White M, et al. A double blind randomized controlled trial of amphothericin B colloidal dispersion versus amphothericin B for the treatment of invasive aspergillosis in immunocompromised patients. Clin Infect Dis 2002; 35:359-66.

47. Arikan S, Rex JH. Lipid based antifungal agents: Current status. Curr Pharmaceutical Design 2001; 7:393-415.

48. Herbrecht R, Denning DW, et al. Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 2002; 347:408-15.

49. Denning DW, Ribaud P, et al. Efficacy and safety of voriconazole in the treatment of acute invasive aspergillosis. Clin Infect Dis 2002; 34:563-71.

50. Gavalda J, López P, Martin M, Gomis X, Pahissa A. Activity of amphotericin B (Ab)+voriconazole(V)or terfinabine(T) and V+Tagainst Aspergillus fumigatus (AF) strains by using chitin quantification. Program and Abstracts in 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy. San Diego. 2002. Washington: American Society for Microbiology 2000: Abs. M-1817; p.416.

51. Perea S, González G, et al. In vitro interaction of caspofungin acetate with voriconazole against clinical isolates of Aspergillus spp. Antimicrobial Agents Chemother 2002; 46:3039-41.

52. Arikan S, Lozano-Chiu M, Paetznick V, Rex J. In vitro synergy of caspofungin and amphotericin B against Aspergillus and Fusarium spp. Antimicrob Agents Chemother 2002; 46:2564-68.

53. Lum LR, Turco TF, Leone J. Combination therapy with caspofungin and amphotericin B lipid complex. Am J Health Syst Pharm 2002; 59:80-1.

54. Mosquera J, Sharp A, et al. In vitro interaction of terfinabine with itraconazole, fluconazole, amphotericin B and 5-fluocytosine against Aspergillus spp. J-124 Abstract of the 41srt ICAAC. Chicago. 2001. Washington: American Society for Microbiology. 2001; Abstract. J-124; p.363.