amphotericin-b and Brain-Damage--Chronic

Topics: Amphotericin B; Antibodies, Fungal; Antifungal Agents; Brain Damage, Chronic; Brain Edema; Child; Delayed Diagnosis; Deoxycholic Acid; Diagnostic Errors; Drug Combinations; Histoplasma; Histoplasmosis; Humans; Hydrocephalus; Immunocompetence; Itraconazole; Liposomes; Male; Meningitis; Meningitis, Viral; Prognosis; Stroke, Lacunar; Tuberculosis, Meningeal; Ventriculoperitoneal Shunt

Mucormycosis are opportunist infections occurring usually among predisposed patients. We report a case of an 18-year-old male with a severe thoracic trauma who developed an Absidia infection on his contused pulmonary parenchyma, without presenting the usual risk factors (diabetes mellitus, immunodeficiency). The early diagnosis using bronchoscopy has probably improved the outcome by allowing a faster treatment. After 18-months, the infectious process resolved thanks to a combination of a medical treatment composed of high-dose amphotericin B lipid formulation, itraconazole and a complementary surgical treatment.

Topics: Absidia; Adolescent; Amphotericin B; Antifungal Agents; Bicycling; Brain Damage, Chronic; Brain Injuries; Brain Stem; Cerebral Hemorrhage; Combined Modality Therapy; Drug Therapy, Combination; Humans; Itraconazole; Lung Abscess; Lung Diseases, Fungal; Male; Mucormycosis; Multiple Trauma; Pneumonectomy; Thoracic Injuries; Vancomycin

Aspergillus brain abscess is a rare but frequently fatal disease. Despite the scarcity of reported survivors, a combination of medication and surgical treatment might be effective. We report a 37-year-old man who developed multiple aspergillus brain abscesses after severe bacterial pneumonia. The following strategy was used to treat the patient: diagnostic puncture of one of the abscesses, long-term treatment with medication, excision of chronic granuloma in the occipital lobe and fourth ventricle, surgical treatment of the hydrocephalus. Following various surgical and antifungal treatments, the patient survived. Nearly three years after discharge, he still is in good physical condition and has a moderate neurologic deficit. Only 36 patients have been reported to have survived longer than three months after receiving treatment for brain aspergillosis. A course of medication in combination with various surgical procedures was required to achieve a successful outcome in this otherwise fatal disease.

Topics: Adult; Amphotericin B; Aspergillus niger; Brain Abscess; Brain Damage, Chronic; Combined Modality Therapy; Diagnosis, Differential; Follow-Up Studies; Fourth Ventricle; Frontal Lobe; Humans; Hydrocephalus; Male; Neuroaspergillosis; Neurologic Examination; Postoperative Complications; Punctures; Reoperation; Slovenia; Survivors; Tomography, X-Ray Computed