micafungin and Liver-Abscess

We report the first case of liver abscess due to Sterigmatomyces halophilus. Because this pathogen grows poorly in culture medium without added salts, it was identified by sequencing analysis targeting the rRNA gene internal transcribed spacer (ITS) region. This method could be useful for pathogens that cannot be cultured using standard methods.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Agents; Basidiomycota; Biopsy; Bone Marrow Transplantation; Cefozopran; Cephalosporins; Chemotherapy-Induced Febrile Neutropenia; Child; Hematopoietic Stem Cell Transplantation; Humans; Liver; Liver Abscess; Male; Micafungin; Mycoses; Neoplasm Recurrence, Local; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Treatment Outcome

We report the case of a 31-week gestational age neonate with Candida albicans sepsis and a hepatic abscess. Diagnosis relied on clinical and radiological signs of sepsis, liver function impairment and culture isolation of Candida spp. from sterile sites. Liver ultrasound documented the presence of a multiloculated abscess. Treatment with micafungin (3 mg/kg/day) resulted in normalization of liver function and inflammatory laboratory values and improvement of clinical condition. After 30 days of treatment, the liver abscess resolved and at the 8-month follow up the infant is doing well. Prompt diagnosis and antifungal treatment avoided surgical drainage and liver surgery in this high-risk neonate.

Topics: Antifungal Agents; Candidiasis; Echinocandins; Gestational Age; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Lipopeptides; Liver; Liver Abscess; Male; Micafungin; Treatment Outcome; Ultrasonography

While anti-cancer chemotherapy has improved the survival of patients with hematologic malignancies, it has also exposed such patients to the risk of life-threatening infection due to neutropenia. In intensive chemotherapy for leukemia, invasive aspergillosis resulting in death is infrequently observed. In such cases, aggressive diagnostic and therapeutic intervention is required. Herein, we report a case of Aspergillus liver abscesses in a patient with acute monoblastic leukemia. The patient presented with febrile neutropenia and concomitantly with an elevated serum beta-D: -glucan level during chemotherapy. The abscesses were finally diagnosed by liver biopsy. Although antifungal monotherapy of voriconazole or liposomal amphotericin B, both of which are recommended for invasive aspergillosis, showed a poor response, when combined with micafungin, an echinocandin, both had a highly favorable effect against the infection. Therefore, our clinical experience suggests that the serum test is useful for the rapid diagnosis of invasive aspergillosis, especially in deep tissues, and that combination antifungal therapy with micafungin should be considered when initial monotherapy for fungal infection shows an insufficient effect.

Topics: Antifungal Agents; Aspergillosis; Drug Therapy, Combination; Echinocandins; Hepatitis; Humans; Leukemia, Monocytic, Acute; Lipopeptides; Liver Abscess; Male; Micafungin; Middle Aged