amphotericin-b and Pneumonia--Aspiration

Invasive fungal infection (IFI) caused by Lecythophora mutabilis occasionally occurs in patients with impaired host immunity; such patients had eosinophilia at onset, and surviving patients were treated with fungal cell-membrane-targeted drugs. An 18-year-old man with mitochondrial encephalomyopathy accompanied with refractory anaemia and chronic renal failure developed septic shock caused by L. mutabilis, which was detected from a blood culture, and was identified morphologically and genetically. During the course of the infection, he had eosinophilia, although beta-d-glucan levels were within the normal range. He was treated with micafungin, but deteriorated and died, despite his treatment being changed to liposomal amphotericin B. On the basis of this we suggest that IFI caused by L. mutabilis should be suspected when a compromised host develops infection and eosinophilia, and that antifungal drugs that target beta-d-glucan are not advisable.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Ascomycota; Echinocandins; Humans; Insomnia, Fatal Familial; Lipopeptides; Male; Micafungin; Mitochondrial Encephalomyopathies; Mycoses; Pneumonia, Aspiration; Shock, Septic

Aspiration of oropharyngeal bacteria and fungi is occasionally suspected in patients with pneumonia. A patient with oral carcinoma underwent chemoradioimmunotherapy and, about 4 weeks from the start of the therapy, the patient suffered from severe oral mucositis induced by chemoradiotherapy, and candidal pneumonia was subsequently induced. The candidal pneumonia was insufficiently improved by potent antifungal drugs, taking a lethal course. Randomly amplified polymorphic DNA analysis and DNA sequence examination of strains isolated from the oral cavity 1 week before the onset of pneumonia and autopsied lung revealed the identity of both strains as Candida albicans, and the DNA analysis supported aspiration of oral Candida. These results indicate that the pathogen of the pneumonia, C. albicans, was aspirated from the oral cavity and that oral Candida is easily aspirated and becomes the pathogen of pneumonia.

Topics: Aerosols; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Base Sequence; Candida albicans; Candidiasis; Candidiasis, Oral; Carcinoma, Squamous Cell; DNA, Fungal; Fatal Outcome; Female; Fluconazole; Humans; Miconazole; Mouth Neoplasms; Pneumonia, Aspiration; Random Amplified Polymorphic DNA Technique