Case Report Fatal Disseminated Aspergillosis in a Previously Well Young Adult with Cystic Fibrosis

Guidotti, Tee L.; Agnese, Paul A. di Sant'; Luetzeler, Josef; Escaro, Danilo U.

doi:10.1097/00000441-198205000-00007

Cited by 18 publications

(5 citation statements)

References 9 publications

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“…The catalase antigen is strongly immunogenic [23] and it has been identified as an important diagnostic antigen in non-CF pa tients with a spectrum of Aspergillus-rdated disorders (Aspergillus lung infiltrate, aspergilloma, or chronic necrotizing pulmonary aspergillosis) [13]. Our present findings add ABPA associated with CF to this list; the occurrence of catalase antibodies in CF patients not affected by ABPA may indicate that a symptom-poor form of pulmonary aspergillosis exists in these pa tients [24].…”

Section: Discussionmentioning

confidence: 52%

Clinical and Serological Survey of Pulmonary Aspergillosis in Patients with Cystic Fibrosis

Schønheyder

Jensen²,

Høiby³

et al. 1988

Int Arch Allergy Immunol

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A 5.5-year survey revealed 9 patients with allergic bronchopulmonary aspergillosis (ABPA) and 1 patient with a highly probable diagnosis among 200 Danish patients with cystic fibrosis (CF). The incidence of ABPA was 0.9 (0.4–1.7, 95% confidence limits) per 100 patients per year. All the patients with definite or probable ABPA had serum antibodies to the Aspergillus fumigatus catalase antigen, and in 5 patients the appearance of catalase antibodies during the incipient phase of ABPA was documented. 29 patients without ABPA also had catalase antibodies, but in lower levels than ABPA patients (p = 0.006). The 6-month prevalence rate of A. fumigatus in sputum was 80 and 72% in the 2 groups, respectively. The finding of catalase antibodies in some CF patients without ABPA may indicate the occurrence of a symptom-poor form of pulmonary aspergillosis.

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Section: Discussionmentioning

confidence: 52%

Clinical and Serological Survey of Pulmonary Aspergillosis in Patients with Cystic Fibrosis

Schønheyder

Jensen²,

Høiby³

et al. 1988

Int Arch Allergy Immunol

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“…One patient may have had heavy exposure to Aspergillus spores from frequent contact with rotting timber (76). The patient with cystic fibrosis had minimal disease but may have inhalted Aspergillus spores from contaminated marijuana (2,79). Several patients presmnably injected spores into their skin secondary to trauma.…”

Section: Major Organ and Disseminated Infectionmentioning

confidence: 99%

Aspergillosis

Bodey

Vartivarian

1989

Eur. J. Clin. Microbiol. Infect. Dis.

303

228

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Aspergillus spores are ubiquitous in the environment and may become concentrated in hospital ventilation systems. Colonization in normal hosts can lead to allergic diseases ranging from asthma to allergic bronchopulmonary aspergillosis. Normal hosts rarely develop invasive disease, which is primarily an infection of severely immunocompromised patients. The major predisposing factors for infection include prolonged neutropenia, chronic administration of adrenal corticosteroids, the insertion of prosthetic devices, and tissue damage due to prior infection or trauma. Since Aspergillus spp. are respiratory pathogens, the most common form of infection is pneumonia followed by sinusitis. Patients with preexistant cavitary disease may develop noninvasive aspergillomas. Most infections are caused by Aspergillus fumigatus. The organism is capable of invading across all natural barriers, including cartilage and bone. It has a propensity for invading blood vessels causing thrombosis and infarction. The diagnosis of pulmonary infection is usually difficult to establish because the organism is seldom cultured from sputum and can represent contamination in some cases. Therapy is immunocompromised hosts is less than satisfactory and amphotericin B is the only agent with significant activity. There is anecdotal evidence to suggest that the addition of 5-fluorocytosine to amphotericin B may be beneficial.

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“…True invasive infection, although very rare, has been reported. Fatal disseminated aspergillosis in a previously well young adult with cystic fibrosis was reported by Guidotti et al (36). The patient was thought to represent an exceptional manifestation of immunodeficiency related to cystic fibrosis.…”

Section: Acquired Defects In Host Response To Aspergiltosismentioning

confidence: 87%

Host-parasite interaction in fungal infections

Khardori

1989

Eur. J. Clin. Microbiol. Infect. Dis.

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The outcome of host-parasite interactions in fungal infections is determined by the balance between pathogenicity of the organism and the adequacy of the host defenses. A wide variety of host defense mechanisms are involved in protection against fungal infections. These include nonspecific mechanisms such as intact skin and mucus membranes, indigenous microbial flora, and the fungicidal activity of neutrophils and monocytes. Such mechanisms constitute the major host defense against opportunistic fungal infections caused by ubiquitous organisms of low virulence. The effective role of immunoglobulins and complement as opsonins varies with the fungal pathogen involved. Specific immune responses of both the humoral and cell-mediated type develop in response to infections by pathogenic fungi. Antibodies, in general, are not of major importance in protection against these infections. Specifically sensitized T lymphocytes produce lymphokines that activate macrophages. Activated macrophages are the major line of defense against systemic fungal pathogens. The type and degree of impairment in immune responses determines the susceptibility and severity of diseases. The type of immune response also determines the tissue reactions in these diseases and sometimes may be involved in the pathogenesis of the disease process. The role of natural killer cell activity, antibody-dependent cellular cytotoxicity, and biological response modifiers in various fungal infections has been described recently. The microbial factors of importance in fungal infections are adherence, invasion, presence of an antiphagocytic capsule, and ability to grow under altered physiological states of the host. The differences in the virulence of fungal strains is of minor importance in determining the outcome in general. The seriousness of the alteration of the host state rather than the pathogenic properties of the fungus determine the severity of the disease.

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Case Report Fatal Disseminated Aspergillosis in a Previously Well Young Adult with Cystic Fibrosis

Cited by 18 publications

References 9 publications

Clinical and Serological Survey of Pulmonary Aspergillosis in Patients with Cystic Fibrosis

Clinical and Serological Survey of Pulmonary Aspergillosis in Patients with Cystic Fibrosis

Aspergillosis

Host-parasite interaction in fungal infections

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