amphotericin-b and Appendicitis

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

Topics: Acute Disease; Adult; Amphotericin B; Antifungal Agents; Appendicitis; Candidiasis; Female; Fluconazole; Humans; Leukemia, Myeloid, Acute; Liver Diseases; Lymphoma, Large B-Cell, Diffuse; Middle Aged; Splenic Diseases

Topics: Adult; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Appendicitis; Appendix; Aspergillosis; Combined Modality Therapy; Cytarabine; Daunorubicin; Humans; Ileal Diseases; Iliac Vein; Intestinal Perforation; Ischemia; Leukemia, Myeloid, Acute; Male; Mitoxantrone; Neutropenia; Thrombosis

Three children with the rare occurrence of zygomycosis are descibed: two had involvement of a solitary lesion of gangrenous cellulitis on the buttocks, and th third was a neonate with gastric performation and a gangrenous appendicitis. All three patients were compromised hosts (two with leukemia and one a premature infant with respiratory distress syndrome). All three patients appeared to have acquired the same organism. Rhizopus oryzae, from the same fomites, elastic bondages (Elastoplast). The Center for Disease Control has received several other reports of zygomycosis traceable to the same material. Alll three of our patients were cured of their infections. Early diagnosis and a combined surgical and chemotherapeutic approach appear to prevent death from zygomycosis.

Topics: Amphotericin B; Appendicitis; Bandages; Cellulitis; Child; Female; Humans; Infant, Newborn; Leukemia, Lymphoid; Male; Mucormycosis; Peptic Ulcer Perforation; Respiratory Distress Syndrome, Newborn; Rhizopus; Stomach Ulcer

Gastrointestinal mucormycosis has been a uniformly fatal disease in children. Diagnosis has been difficult, resulting in inadequate therapy. Histologic and bacteriologic confirmation of invasive infection, followed by systemically administered amphotericin B and surgical excision, are the hallmarks of effective treatment.

Topics: Amphotericin B; Appendicitis; Child; Gastroenteritis; Humans; Infant, Newborn; Mucormycosis; Stomach