amphotericin-b and Heart-Defects--Congenital

Trichoderma longibrachiatum is an emerging pathogen in immunocompromised patients. We report a case of Trichoderma post-operative mediastinitis and peritonitis in a child with complex congenital cardiac disease and functional asplenia. The patient was treated unsuccessfully, initially with caspofungin alone followed by a combination of voriconazole (systemic and topical), caspofungin and intraperitoneal amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Caspofungin; Child, Preschool; Echinocandins; Fatal Outcome; Female; Heart Defects, Congenital; Humans; Immunocompromised Host; Lipopeptides; Mediastinitis; Mycoses; Peritoneal Dialysis; Peritonitis; Postoperative Complications; Pyrimidines; Spleen; Triazoles; Trichoderma; Voriconazole

Fungal peritonitis is a rare but serious complication in children on peritoneal dialysis. Clinical presentation of fungal peritonitis is similar to bacterial peritonitis and Candida spp. are the most common agent. Fungal peritonitis has been usually associated with high morbidity, mortality and its treatment is difficult. In this report, we present an infant with Acremonium spp. peritonitis. A 7-month-old boy with Down syndrome, congenital heart disease, pulmonary hypertension and congestive heart failure required peritoneal dialysis for his persistent pulmonary oedema and symptomatic hyponatremia. Acremonium spp. peritonitis developed while he was on extended spectrum antibiotics and fluconazole. The patient was successfully treated with peritoneal dialysis catheter removal and liposomal amphotericin B. The case was presented to draw attention to a rare cause of peritonitis -Acremonium spp. - in a paediatric patient.

Topics: Acremonium; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Down Syndrome; Fluconazole; Heart Defects, Congenital; Humans; Infant; Male; Mycoses; Peritoneal Dialysis; Peritonitis

All cases of infective endocarditis occurring from January 1990 to December 1996 at our institution were reviewed, with a special focus on fungal endocarditis. Five critically ill children with fungal endocarditis and eleven children with bacterial endocarditis were recorded. The proportion of fungal endocarditis in our series was 5/16 (31%) and Candida albicans (4/5) was the most common fungal pathogen. Only one patient required heart surgery because of a loose patch but all the others were treated only by medical management for cure. The hospital survival rate was 80% (4/5) and the overall long-term survival rate was 60% (3/5) with only one death directly related to fungal infection.. Despite the small number of cases, a sole medical approach including amphotericin B and long-term fluconazole prophylaxis for the treatment of fungal endocarditis in critically ill children seems to offer an alternative to surgical treatment which may be kept for failure of medical treatment.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Child; Child, Preschool; Endocarditis; Female; Fungemia; Heart Defects, Congenital; Humans; Male; Postoperative Complications; Retrospective Studies; Switzerland; Treatment Outcome

We present a case of disseminated intracranial infection by Candida albicans in a 5-year-old girl who had fever and a change of consciousness after surgery for complex congenital heart malformation. MR imaging revealed multiple small ring-enhancing hemorrhagic abscesses. One year after antifungal treatment, the abscesses and ventriculomegaly were almost completely resolved. The patient was discharged in a stable but vegetative condition.

Topics: Amphotericin B; Antifungal Agents; Brain; Candidiasis; Child, Preschool; Combined Modality Therapy; Drug Therapy, Combination; Female; Fluconazole; Heart Defects, Congenital; Humans; Hydrocephalus; Meningitis, Fungal; Opportunistic Infections; Postoperative Complications; Ventriculoperitoneal Shunt

Topics: Amphotericin B; Candidiasis; Exchange Transfusion, Whole Blood; Heart Defects, Congenital; Humans; Infant, Newborn; Infant, Premature, Diseases; Jaundice, Neonatal; Sepsis