acyclovir and Aspergillosis

Topics: Acyclovir; Aged; Amphotericin B; Antifungal Agents; Antiviral Agents; Aspergillosis; Fatal Outcome; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Mouth Diseases; Paranasal Sinus Diseases; Pyrimidines; Triazoles; Voriconazole

We describe a case of isolated acute appendicitis due to Aspergillus carneus in a neutropenic child with acute myeloid leukemia (AML) treated according to the AIEOP AML 2002/01 protocol. Despite prophylaxis with acyclovir, ciprofloxacin and fluconazole administered during the neutropenic phase, 16 days after the end of chemotherapy the child developed fever without identified infective foci, which prompted a therapy shift to meropenem and liposomial amphotericin B. After five days of persisting fever he developed ingravescent abdominal lower right quadrant pain. Abdominal ultrasound was consistent with acute appendicitis and he underwent appendectomy with prompt defervescence. PAS+ fungal elements were found at histopathology examination of the resected vermiform appendix, and galactomannan was low positive. A. carneus, a rare species of Aspergillus formerly placed in section Flavipedes and recently considered a member of section Terrei, was identified in the specimen. Treatment with voriconazole was promptly started with success. No other site of Aspergillus localization was detected. Appendicitis is rarely caused by fungal organisms and isolated intestinal aspergillosis without pulmonary infection is unusual. To our knowledge, this is the first report of infection due to A. carneus in a child and in a primary gastrointestinal infection.

Topics: Acute Disease; Acyclovir; Amphotericin B; Antifungal Agents; Appendicitis; Aspergillosis; Aspergillus; Child; Ciprofloxacin; Fluconazole; Humans; Leukemia, Myeloid, Acute; Male; Neutropenia; Pyrimidines; Voriconazole

Treatment of chronic lymphocytic leukaemia (CLL) is rapidly evolving, with emerging new drugs. Alemtuzumab is a monoclonal antibody recognizing CD52 antigen approved in the treatment of relapsing-refractory CLL. A frequent side effect is the immunosuppression and patients treated with alemtuzumab risk to develop fungal infections such as aspergillosis.. This case report is about a patient who developed an uncommon localization of aspergillosis: prostatic and renal, after a treatment by alemtuzumab monotherapy. During the week 8 of alemtuzumab, the patient presented fever, urinary frequency and urologic symptoms. Persistance of fever with common antibiotherapy led to realize a tomography that showed prostatic and renal abscess (70mm and 29mm). It was decided to realize a prostatic biopsy.. Histological findings showed suppurative abscess with ischemic necrosis and fungal proliferation, with branched fungal hyphae. Direct examination was negative. Culture on Sabouraud's agar revealed a mould identified as Aspergillus fumigatus. The organism was susceptible to voriconazole (MIC: voriconazole 0,25ug/mL).. Because of the main side effect of alemtuzumab is immunosuppression, we have to research fungal infections such as Aspergillosis, particularly in patients with fever resistant to common antibiotherapy.

Topics: Abscess; Acyclovir; Alemtuzumab; Anti-Bacterial Agents; Antibiotic Prophylaxis; Antibodies, Monoclonal, Humanized; Antifungal Agents; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Aspergillus fumigatus; Drug Resistance, Fungal; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Nephritis; Prostatitis; Salvage Therapy; Valacyclovir; Valine; Voriconazole

Topics: Acyclovir; Adolescent; Antiviral Agents; Aspergillosis; Azathioprine; Brain; Chickenpox; Disseminated Intravascular Coagulation; Fatal Outcome; Female; Humans; Immunosuppressive Agents; Lung; Lupus Erythematosus, Systemic; Lymphohistiocytosis, Hemophagocytic; Meninges; Multiple Organ Failure; Myocardium; Opportunistic Infections; Prednisolone