Successful Treatment of Aspergillus Brain Abscess in a Child With Acute Lymphoblastic Leukemia

Ng, Andrea K.; Gadong, Nimze; Kelsey, Anna; Denning, David W.; Leggate, J.; Eden, O. B.

doi:10.1080/08880010050120863

Cited by 22 publications

(11 citation statements)

References 7 publications

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“…Itraconazole, posaconazole, or liposomal amphotericin B are recommended for patients who are intolerant or refractory to voriconazole. Among the amphotericins, liposomal amphotericin B showed favorable responses in some case reports [ 33 – 35 ], in agreement with the current study.…”

Section: Discussionsupporting

confidence: 92%

Cerebral aspergillosis in a patient with leprosy and diabetes: a case report

et al. 2014

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BackgroundOpportunistic fungi are dispersed as airborne, ground and decaying matter. The second most frequent extra-pulmonary disease by Aspergillus is in the central nervous system.Case presentationThe case subject was 55 years old, male, mulatto, and an assistant surveyor residing in Teresina, Piauí. He presented with headache, seizures, confusion, fever and left hemiparesis upon hospitalization in 2006 at Hospital São Marcos. Five years previously, he was diagnosed with diabetes mellitus, and 17 months previously he had acne margined by hyperpigmented areas and was diagnosed with leprosy. Laboratory tests indicated leukocytosis and magnetic resonance imaging showed an infarction in the right cerebral hemisphere. Cerebrospinal fluid examination showed 120 cells/mm3 and was alcohol-resistant bacilli negative. Trans-sphenoidal surgery with biopsy showed inflammation was caused by infection with Aspergillus fumigatus. We initiated use of parenteral amphotericin B, but his condition worsened. He underwent another surgery to implant a reservoir of Ommaya–Hickmann, a subcutaneous catheter. We started liposomal amphotericin B 5 mg/kg in the reservoir on alternate days. He was discharged with a prescription of tegretol and fluconazole.ConclusionThis report has scientific interest because of the occurrence of angioinvasive cerebral aspergillosis in a diabetic patient, which is rarely reported. In conclusion, we suggest a definitive diagnosis of cerebral aspergillosis should not postpone quick effective treatment.

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Section: Discussionsupporting

confidence: 92%

Cerebral aspergillosis in a patient with leprosy and diabetes: a case report

et al. 2014

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“…In one study (117), micafungin-itraconazole was a more effective combination regimen compared to micafungin-amphotericin B in clearing cerebral aspergillosis but was similar to itraconazole alone. In another study, however, caspofungin combined with amphotericin B produced a trend towards decreased fungal burden in the kidneys (C. M. Douglas, J. C. Bowman, K. (54,93,137,159,163). However, the potential hematologic toxicity of flucytosine, the lack of a widely available intravenous formulation, and the drug interaction profile of rifampin have limited the widespread use of these agents in combination therapy of Aspergillus infections (57).…”

Section: (D) Other Combinationsmentioning

confidence: 99%

Combination Antifungal Therapy

Johnson

MacDougall

Ostrosky-Zeichner

et al. 2004

Antimicrob Agents Chemother

491

368

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5 RATIONALEThe availability of new antifungal agents with novel mechanisms of action has stimulated renewed interest in combination antifungal therapies. In particular, and despite the limited clinical data, the high mortality of mold infections and the relatively limited efficacy of current agents have produced significant interest in polyene-, extended-spectrum azole-, and echinocandin-based combinations for these difficult-to-treat infections. With the recent publication of the first large randomized trial of antifungal combination therapy to be conducted in two decades (166) and the rapid proliferation of new in vitro and in vivo data on antifungal combinations, we have sought to review the recent work and future challenges in this area.The focus of this review is on the efficacy of antifungal drugs in combination with respect to the extent or rate of killing of the fungal pathogen, although other potential interactions (such as pharmacokinetic drug interactions) can impact efficacy when these agents are used together. The value of giving two drugs because each is separately effective against a group of organisms exhibiting a variety of types of resistance is not specifically discussed, but this also is an obvious and straightforward reason to use a combination of agents.It cannot be simply assumed that the use of two or more effective drugs with different mechanisms of action will produce an improved outcome compared to the results seen with a single agent. Combination antifungal therapy could reduce antifungal killing and clinical efficacy, increase potential for drug interactions and drug toxicities, and carry a much higher cost for antifungal drug expenditures without proven clinical benefit (106). Thus, it is important to critically evaluate the role of combination therapy as new data become available.Conceptual models and terminology. Methods for studying antifungal combinations in vitro and in vivo have differed considerably over time and among investigators. These tools do not differ with respect to their application to combination antibacterial or antiviral therapies and have been discussed extensively and elegantly in the landmark 1995 review by Greco (79). In brief, all approaches to evaluating combinations can be reduced to two elements: (i) a conceptual model for predicting the expected result for a combination and (ii) a set of phrases used to categorize results that are better than expected, worse than expected, or as expected. Although many subtle variations are possible, the underlying mathematical model is based on either the assumption of additive interactions or the assumption of probabilistic (multiplicative) interactions. On the basis of the terminology employed by the author who first carefully described each of these models, the two models can be usefully referred to as the Loewe additivity model and the Bliss independence model (79).The terminology used to place results into interpretive categories is often the subject of debate and confusion. Greco et al. (79) have proposed a set ...

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“…The mortality rates due to fungal abscesses range from 75 to 100%, despite intensive treatment with amphotericin B. 26,68,69 There continues to be a strong representation of anaerobes (30-50%) in patients with brain abscesses. Additionally, atypical bacteria such as Nocardia and Actinomyces spp may occur in immunocompromised patients.…”

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confidence: 99%

Pyogenic brain abscess

Erdoğan

Cansever²

2008

FOC

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✓ Brain abscesses have been one of the most challenging lesions, both for surgeons and internists. From the beginning of the computed tomography (CT) era, the diagnosis and treatment of these entities have become easier and less invasive. The outcomes have become better with the improvement of diagnostic techniques, neurosurgery, and broad-spectrum antibiotics. Atypical bacterial abscesses are more often due to chemotherapy usage in oncology, long life expectancy in patients with human immunodeficiency virus (HIV) infection, and immunosuppression in conjunction with organ transplantation. Surgical treatment options showed no significant difference with respect to mortality levels, but lower morbidity rates were achieved with stereotactically guided aspiration. Decompression with stereotactically guided aspiration, antibiotic therapy based on results of pus culture, and repeated aspirations if indicated from results of periodic CT follow-up scans seem to be the most appropriate treatment modality for brain abscesses. Immunosuppression and comorbidities, initial neurological status, and intraventricular rupture were significant factors influencing the outcomes of patients. The pitfalls and evolution in the diagnosis and treatment of brain abscesses are discussed in this study.

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Successful Treatment of Aspergillus Brain Abscess in a Child With Acute Lymphoblastic Leukemia

Cited by 22 publications

References 7 publications

Cerebral aspergillosis in a patient with leprosy and diabetes: a case report

Cerebral aspergillosis in a patient with leprosy and diabetes: a case report

Combination Antifungal Therapy

Pyogenic brain abscess

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