Cerebral aspergillosis and pulmonary tuberculosis in a child with chronic granulomatous disease

Abstract

Background:Chronic granulomatous disease (CGD) is an immune disorder that affects phagocytes. It is characterized by recurrent or persistent bacterial and fungal infections. Reports of tuberculosis (TB) in patients with CGD are rare. In developing countries, where TB is endemic, possibility of other chronic infections is often overlooked by physicians.Case Description:We report the case of a 4-year-old boy who had recurrent respiratory infections and episodes of headache. He was put on antituberculosis (ATT) drugs without microbiological or pathological evidence 2 months prior to presentation. The child did not improve and was brought to our hospital where a computed tomography scan revealed multiple cerebral abscesses. These abscesses were excised. The microbiological specimen was determined to be positive for Aspergillus fumigatus. His tracheal aspirate was positive for Mycobacterium tuberculosis polymerase chain reaction assay. Further work-up confirmed the diagnosis of CGD in the child.Conclusion:This report describes the course of the patient's illness in order to highlight the challenges associated with the management of these infections. We also aim to stress on the importance of pathological diagnosis before starting a therapy.

Granulomas del encéfalo. A propósito de un caso

“…En general se presentan como lesiones oportunistas, pero se han descrito también en pacientes inmunocompetentes; pueden alcanzar el encéfalo por continuidad o contigüidad, previa colonización de senos perinasales, o por vía hematógena como en el caso de la infección pulmonar. Son más frecuentes los causados por Aspergirus 10,26 , Blastomicosis 24 , Paracoccidioidomicosis 12 , entre otras. Como ocurre en las otras causas infecciosas, el diagnóstico se sustenta en la titulación de anticuerpos plasmáticos hacia las diferentes especies, cultivos en medios apropiados, técnicas de amplificación y reconocimiento del DNA (PCR) y examen histopatológico; en los cuales, aplicando tinciones adecuadas, pue-den detectarse las hifas o levaduras, según corresponda; la sensibilidad de dicho examen mejora si se practica en tejido fresco, antes de la aplicación de las técnicas de fijación.…”

Chronic granulomatous disease may be an underlying cause for invasive nocardiosis

“…Children who present with invasive aspergillosis and TB may have CGD as reported recently from Pakistan. [5] In general, X-linked patients have more severe disease, especially in those with lower residual superoxide production. [3] Antibiotic (trimethoprim-sulfamethoxazole), antifungal (itraconazole, voriconazole) prophylaxis are the mainstay of treatment and immunomodulation with IFNγ reduces frequency and severity of infections.…”