ABSTRACT
Disseminated infection by Hormographiella aspergillata is extremely rare and small intestine involvement has not been reported previously. A 51-year-old man with myelodysplastic syndrome developed pneumonia after cord blood cell transplantation. Fungal growth from the biopsied lung was identified as H. aspergillata by morphology and the gene analysis. Although antifungal agents including voriconazole and liposomal amphotericin B were administered, he died of disseminated H. aspergillata infection. We review the literature and discuss the treatment and prognosis.
Subject(s)
Agaricales/pathogenicity , Antifungal Agents/therapeutic use , Hematopoietic Stem Cell Transplantation/adverse effects , Immunosuppression Therapy/adverse effects , Invasive Fungal Infections/microbiology , Rare Diseases/microbiology , Agaricales/genetics , Agaricales/isolation & purification , Antifungal Agents/administration & dosage , Brain/diagnostic imaging , Brain/pathology , Central Nervous System Fungal Infections/blood , Central Nervous System Fungal Infections/drug therapy , Central Nervous System Fungal Infections/etiology , Central Nervous System Fungal Infections/pathology , DNA, Fungal , Graft vs Host Disease/prevention & control , Humans , Immunosuppression Therapy/methods , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/therapeutic use , Intestinal Diseases/blood , Intestinal Diseases/drug therapy , Intestinal Diseases/etiology , Intestinal Diseases/pathology , Intestine, Small/pathology , Invasive Fungal Infections/blood , Invasive Fungal Infections/drug therapy , Lung Diseases, Fungal/blood , Lung Diseases, Fungal/drug therapy , Lung Diseases, Fungal/etiology , Lung Diseases, Fungal/pathology , Magnetic Resonance Imaging , Male , Middle Aged , Myelodysplastic Syndromes/surgery , Neutropenia/drug therapy , Neutropenia/etiology , Neutropenia/microbiology , Rare Diseases/blood , Rare Diseases/drug therapy , Sequence Analysis, DNA , Tomography, X-Ray Computed , Transplantation Conditioning/adverse effects , Transplantation Conditioning/methods , Transplantation, Homologous/adverse effectsABSTRACT
BACKGROUND: Late-onset sepsis (LOS) is an important cause of morbidity and mortality in very low birth weight (VLBW) infants. AIM: To determine the incidence, risk factors and etiology of LOS. METHODS: LOS was investigated in a multicenter prospective cohort of infants at eight public university neonatal intensive care units (NICUs). Inclusion criteria included inborn, 23-33 weeks of gestational age, 400-1499 g birth weight, who survived >3 days. RESULTS: Of 1507 infants, 357 (24%) had proven LOS and 345 (23%) had clinical LOS. Infants with LOS were more likely to die. The majority of infections (76%) were caused by Gram-positive organisms. Independent risk factors for proven LOS were use of central venous catheter and mechanical ventilation, age at the first feeding and number of days on parenteral nutrition and on mechanical ventilation. CONCLUSION: LOS incidence and mortality are high in Brazilian VLBW infants. Most risk factors are associated with routine practices at NICU.
Subject(s)
Infant, Premature, Diseases/microbiology , Infant, Very Low Birth Weight , Intensive Care Units, Neonatal , Sepsis/mortality , Age of Onset , Brazil/epidemiology , Central Nervous System Fungal Infections/blood , Central Nervous System Fungal Infections/mortality , Child , Female , Gestational Age , Gram-Positive Bacterial Infections/blood , Gram-Positive Bacterial Infections/microbiology , Gram-Positive Bacterial Infections/mortality , Humans , Incidence , Infant, Newborn , Infant, Premature , Logistic Models , Male , Population Surveillance , Prospective Studies , Risk Factors , Sepsis/blood , Sepsis/microbiologySubject(s)
Central Nervous System Fungal Infections/cerebrospinal fluid , beta-Glucans/cerebrospinal fluid , Adult , Biomarkers/blood , Biomarkers/cerebrospinal fluid , Central Nervous System Fungal Infections/blood , Central Nervous System Fungal Infections/microbiology , Female , Humans , Male , Middle Aged , beta-Glucans/bloodABSTRACT
The central nervous system (CNS) distribution and antifungal efficacy of all 4 approved formulations of amphotericin B (AmB) were investigated in a rabbit model of hematogenous Candida albicans meningoencephalitis. Treatment with AmB deoxycholate (1 mg/kg/day) or liposomal AmB (5 mg/kg/day) yielded the highest peak plasma concentration (C(max)), area under concentration versus time curve from zero to 24 h (AUC(0-24)), and time during dosing level tau Ttau>minimum inhibitory complex (MIC) values and led to complete eradication of C. albicans from brain tissue (P<.05 vs. untreated controls). By comparison, AmB colloidal dispersion and AmB lipid complex (5 mg/kg/day each) were only partially effective (not significant vs. untreated controls). There was a strong correlation of C(max), AUC(0-24), C(max)/MIC, AUC(0-24)/MIC, and Ttau>MIC with clearance of C. albicans from brain tissue (P
