Cerebral and pulmonary aspergillosis, treatment and diagnostic challenges of mixed breakthrough invasive fungal infections: case report study.
Antifungal Agents
/ therapeutic use
Antigens, Fungal
/ analysis
Aspergillus fumigatus
/ immunology
Aspergillus niger
/ genetics
Cerebellum
/ microbiology
Child
Coinfection
/ diagnosis
Fatal Outcome
Humans
Induction Chemotherapy
/ adverse effects
Infant
Invasive Pulmonary Aspergillosis
/ blood
Male
Neuroaspergillosis
/ diagnosis
Neutropenia
/ chemically induced
Precursor Cell Lymphoblastic Leukemia-Lymphoma
/ drug therapy
Aspergillus fumigatus
Aspergillus niger
Brain abscess
Breakthrough invasive fungal infections
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
23 Jul 2020
23 Jul 2020
Historique:
received:
28
11
2019
accepted:
17
06
2020
entrez:
25
7
2020
pubmed:
25
7
2020
medline:
22
8
2020
Statut:
epublish
Résumé
Breakthrough invasive fungal infections (bIFIs) are an area of concern in the scarcity of new antifungals. The mixed form of bIFIs is a rare phenomenon but could be potentially a troublesome challenge when caused by azole-resistant strains or non-Aspergillus fumigatus. To raise awareness and emphasize diagnostic challenges, we present a case of mixed bIFIs in a child with acute lymphoblastic leukemia. A newly diagnosed 18-month-old boy with acute lymphoblastic leukemia was complicated with prolonged severe neutropenia after induction chemotherapy. He experienced repeated episodes of fever due to extended-spectrum beta-lactamase-producing Escherichia coli bloodstream infection and pulmonary invasive fungal infection with Aspergillus fumigatus (early-type bIFIs) while receiving antifungal prophylaxis. Shortly after pulmonary involvement, his condition aggravated by abnormal focal movement, loss of consciousness and seizure. Cerebral aspergillosis with Aspergillus niger diagnosed after brain tissue biopsy. The patient finally died despite 108-day antifungal therapy. Mixed bIFIs is a rare condition with high morbidity and mortality in the patients receiving immunosuppressants for hematological malignancies. This case highlights the clinical importance of Aspergillus identification at the species level in invasive fungal infections with multiple site involvement in the patients on antifungal prophylaxis.
Sections du résumé
BACKGROUND
BACKGROUND
Breakthrough invasive fungal infections (bIFIs) are an area of concern in the scarcity of new antifungals. The mixed form of bIFIs is a rare phenomenon but could be potentially a troublesome challenge when caused by azole-resistant strains or non-Aspergillus fumigatus. To raise awareness and emphasize diagnostic challenges, we present a case of mixed bIFIs in a child with acute lymphoblastic leukemia.
CASE PRESENTATION
METHODS
A newly diagnosed 18-month-old boy with acute lymphoblastic leukemia was complicated with prolonged severe neutropenia after induction chemotherapy. He experienced repeated episodes of fever due to extended-spectrum beta-lactamase-producing Escherichia coli bloodstream infection and pulmonary invasive fungal infection with Aspergillus fumigatus (early-type bIFIs) while receiving antifungal prophylaxis. Shortly after pulmonary involvement, his condition aggravated by abnormal focal movement, loss of consciousness and seizure. Cerebral aspergillosis with Aspergillus niger diagnosed after brain tissue biopsy. The patient finally died despite 108-day antifungal therapy.
CONCLUSIONS
CONCLUSIONS
Mixed bIFIs is a rare condition with high morbidity and mortality in the patients receiving immunosuppressants for hematological malignancies. This case highlights the clinical importance of Aspergillus identification at the species level in invasive fungal infections with multiple site involvement in the patients on antifungal prophylaxis.
Identifiants
pubmed: 32703183
doi: 10.1186/s12879-020-05162-9
pii: 10.1186/s12879-020-05162-9
pmc: PMC7376672
doi:
Substances chimiques
Antifungal Agents
0
Antigens, Fungal
0
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
535Références
Clin Infect Dis. 2012 Dec;55(11):1515-21
pubmed: 22955439
Med Mycol. 2011 Apr;49 Suppl 1:S7-S12
pubmed: 20718606
N Engl J Med. 2002 Jan 24;346(4):225-34
pubmed: 11807146
Clin Infect Dis. 2017 Jun 1;64(11):1619-1621
pubmed: 28199491
Clin Infect Dis. 2015 Oct 15;61(8):1263-72
pubmed: 26157047
Clin Microbiol Infect. 2018 May;24 Suppl 1:e1-e38
pubmed: 29544767
J Mycol Med. 2018 Jun;28(2):274-278
pubmed: 29551443
J Infect. 2012 Apr;64(4):424-9
pubmed: 22227384
Appl Environ Microbiol. 1995 Apr;61(4):1323-30
pubmed: 7747954
Mycoses. 2018 Nov;61(11):861-867
pubmed: 30015364
Mycoses. 2015 Jun;58(6):325-36
pubmed: 25808822
J Med Microbiol. 2009 Feb;58(Pt 2):192-195
pubmed: 19141736
Radiographics. 2009 Mar-Apr;29(2):375-9
pubmed: 19325053
Biol Blood Marrow Transplant. 2011 Apr;17(4):507-15
pubmed: 20460163
Int J Infect Dis. 2007 Sep;11(5):381-93
pubmed: 17509921
J Neurol Neurosurg Psychiatry. 1993 Feb;56(2):188-93
pubmed: 8437008
N Engl J Med. 2007 Jan 25;356(4):348-59
pubmed: 17251531
Jundishapur J Microbiol. 2016 Oct 26;9(11):e41573
pubmed: 28138379
Philos Trans R Soc Lond B Biol Sci. 2016 Dec 5;371(1709):
pubmed: 28080986
J Infect Dev Ctries. 2016 Jan 31;10(1):90-5
pubmed: 26829542
Clin Microbiol Infect. 2014 Nov;20(11):O952-9
pubmed: 24861577
Transpl Infect Dis. 2018 Dec;20(6):e12981
pubmed: 30144374
Bone Marrow Transplant. 2003 Feb;31(3):191-6
pubmed: 12621480
Iran J Microbiol. 2015 Feb;7(1):62-6
pubmed: 26644876
J Infect. 2017 Dec;75(6):572-580
pubmed: 28919347
Antimicrob Agents Chemother. 2017 Jul 25;61(8):
pubmed: 28507111
Med Mycol. 2016 Jul 1;54(5):459-70
pubmed: 26773134
Arch Iran Med. 2012 Jul;15(7):429-32
pubmed: 22724880
J Antimicrob Chemother. 2012 Sep;67(9):2268-73
pubmed: 22653819
Clin Infect Dis. 1996 Sep;23(3):628-30
pubmed: 8879790
J Antimicrob Chemother. 2016 Sep;71(9):2634-41
pubmed: 27317443
Clin Infect Dis. 2018 Oct 30;67(10):1621-1630
pubmed: 29860307
PLoS One. 2016 Apr 20;11(4):e0152475
pubmed: 27097323