Management of Aspergillus pleural empyema with combined systemic and intrapleural antifungal therapy in a pediatric patient: Case report

Almuhareb, Alanoud M; Zayeni, Habib

doi:10.1016/j.jiph.2017.04.003

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…There is limited evidence on the use of intrapleural antifungals in children, with only a few case reports published on the treatment of invasive pulmonary aspergillosis. Baquero-Artigao et al [ 41 ] and Almuhareb et al [ 42 ] treated with combined systemic and intrapleural antifungals an empyema caused by Aspergillus fumigatus in two 12-year-old and 8-year-old immunocompromised boys. In particular, the first patient [ 41 ], after debridement surgery and systemic administration of L-amphotericin B, developed pulmonary empyema and a bronchopleural-cutaneous fistula.…”

Section: Resultsmentioning

confidence: 99%

Alternative Antimicrobial Irrigation Strategies for the Treatment of Infections in Children: A Review of the Existing Literature

et al. 2023

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As a synergistic treatment approach with systemic antimicrobial therapy or a systemic antibiotic-sparing strategy, the local administration of antimicrobial agents has been proposed as an alternative route for complicated infections. With the rationale of concentrating the active principle in the desired target site, avoiding potentially toxic systemic levels and bypassing anatomical and physiological barriers, local irrigation or infusion of antibiotics may effectively shorten the antimicrobial therapy course and reduce both infection-related and systemic therapy-related complications. Although evidence from the adult population supports its use in selected patients with an acceptable safety profile, data specifically focused on the pediatric population are limited. To provide a rapid and easily accessible tool for clinical practice, we synthesized the most relevant evidence on the use of local antimicrobial agents in common severe infections in children: meningitis, mediastinitis, pleural infections, recurrent urinary infections, and peritonitis. A literature search was performed using predefined combined keywords through an electronic research database (PubMed). Described molecules, dosages, routes, treated age groups, and related efficacy have been summarized for prompt application to clinical practice. It should, however, be noted that the evidence for the pediatric population remains limited, and the local administration of several molecules remains off-label. A careful multidisciplinary and patient-tailored evaluation, as well as a rational use of available guidelines, should always be the basis of clinical decision making in settings where local administration of antibiotics may be considered.

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Section: Resultsmentioning

confidence: 99%

Alternative Antimicrobial Irrigation Strategies for the Treatment of Infections in Children: A Review of the Existing Literature

et al. 2023

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“…For treatment of refractory abscesses, cavities (eg in the lung) or severe haemoptysis from pulmonary aspergilloma in which surgical intervention is not feasible, a drainage (in particular for fungal empyema) as well as a local drug instillation may be considered 321,322 . Here, antifungal preparations (commonly containing AmB preparation or azoles, eg voriconazole) have been used (CIII) 323‐325 . No change to previous AGIHO recommendations.…”

Section: Resultsmentioning

confidence: 99%

“…321,322 Here, antifungal preparations (commonly containing AmB preparation or azoles, eg voriconazole) have been used (CIII). [323][324][325] No change to previous AGIHO recommendations.…”

Section: Drug Instillationmentioning

confidence: 99%

Treatment of invasive fungal diseases in cancer patients—Revised 2019 Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Ruhnke

Cornely

Schmidt‐Hieber

et al. 2020

Mycoses

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Summary Background Invasive fungal diseases remain a major cause of morbidity and mortality in cancer patients undergoing intensive cytotoxic therapy. The choice of the most appropriate antifungal treatment (AFT) depends on the fungal species suspected or identified, the patient's risk factors (eg length and depth of granulocytopenia) and the expected side effects. Objectives Since the last edition of recommendations for ‘Treatment of invasive fungal infections in cancer patients’ of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO) in 2013, treatment strategies were gradually moving away from solely empirical therapy of presumed or possible invasive fungal diseases (IFDs) towards pre‐emptive therapy of probable IFD. Methods The guideline was prepared by German clinical experts for infections in cancer patients in a stepwise consensus process. MEDLINE was systematically searched for English‐language publications from January 1975 up to September 2019 using the key terms such as ‘invasive fungal infection’ and/or ‘invasive fungal disease’ and at least one of the following: antifungal agents, cancer, haematological malignancy, antifungal therapy, neutropenia, granulocytopenia, mycoses, aspergillosis, candidosis and mucormycosis. Results AFT of IFDs in cancer patients may include not only antifungal agents but also non‐pharmacologic treatment. In addition, the armamentarium of antifungals for treatment of IFDs has been broadened (eg licensing of isavuconazole). Additional antifungals are currently under investigation or in clinical trials. Conclusions Here, updated recommendations for the treatment of proven or probable IFDs are given. All recommendations including the levels of evidence are summarised in tables to give the reader rapid access to key information.

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“…The diagnosis of pleural aspergillosis is made by demonstration of the organism in pleural effusion or in pleural biopsy. [ 2 ] This type of infection is generally lethal if not treated, but very few evidences exist in the literature to guide the clinician towards the best treatment of an Aspergillus fumigatus empyema [ [1] , [2] , [3] , [4] , [5] , [6] ]. Pleural aspergillosis is a rare manifestation of invasive aspergillosis and is not necessary associated with pulmonary manifestations.…”

Section: Introductionmentioning

confidence: 99%

“…Intrapleural therapy of amphotericin B administered by a thoracic drain has been successful in an 8 years old patient [ 3 ]. Furthermore, four adult patients were treated with an intrapleural infusion of amphotericin B [ 2 ], administered by a pleural drain as an instillation [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Successful management of Aspergillus infection of an open window thoracostomy with topical liposomal amphotericin B

Legault-Dupuis

Roy

Giroux

et al. 2021

Medical Mycology Case Reports

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Management of Aspergillus pleural empyema with combined systemic and intrapleural antifungal therapy in a pediatric patient: Case report

Cited by 6 publications

References 9 publications

Alternative Antimicrobial Irrigation Strategies for the Treatment of Infections in Children: A Review of the Existing Literature

Alternative Antimicrobial Irrigation Strategies for the Treatment of Infections in Children: A Review of the Existing Literature

Treatment of invasive fungal diseases in cancer patients—Revised 2019 Recommendations of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO)

Successful management of Aspergillus infection of an open window thoracostomy with topical liposomal amphotericin B

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