scholarly journals Influenza-Associated Disseminated Aspergillosis in a 9-Year-Old Girl Requiring ECMO Support

2021 ◽  
Vol 7 (9) ◽  
pp. 726
Author(s):  
Natalia Mendoza-Palomar ◽  
Susana Melendo-Pérez ◽  
Joan Balcells ◽  
Jaume Izquierdo-Blasco ◽  
Maria Teresa Martín-Gómez ◽  
...  
Keyword(s):  
Aspergillus Fumigatus ◽  
Amphotericin B ◽  
Influenza A ◽  
Ecmo Support ◽  
Fulminant Myocarditis ◽  
Therapeutic Drug ◽  
Immunological Study ◽  
Pulmonary Aspergillosis ◽  
Severe Influenza ◽  
Disseminated Aspergillosis

A previously healthy 9-year-old girl developed fulminant myocarditis due to severe influenza A infection complicated with methicillin-resistant Staphylococcus aureus pneumonia, requiring extracorporeal membrane oxygenation (ECMO) support. Twelve days after admission, Aspergillus fumigatus was isolated in tracheal aspirate, and 12 h later she suddenly developed anisocoria. Computed tomography (CT) of the head showed fungal brain lesions. Urgent decompressive craniectomy with lesion drainage was performed; histopathology found hyphae in surgical samples, culture-positive for Aspergillus fumigatus (susceptible to azoles, echinocandins, and amphotericin B). Extension workup showed disseminated aspergillosis. After multiple surgeries and combined antifungal therapy (isavuconazole plus liposomal amphotericin B), her clinical course was favorable. Isavuconazole therapeutic drug monitoring was performed weekly. Extensive immunological study ruled out primary immunodeficiencies. Fluorine-18 fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) follow-up showed a gradual decrease in fungal lesions. Influenza-associated pulmonary aspergillosis is well-recognized in critically ill adult patients, but pediatric data are scant. Clinical features described in adults concur with those of our case. Isavuconazole, an off-label drug in children, was chosen because our patient had severe renal failure. To conclude, influenza-associated pulmonary aspergillosis is uncommon in children admitted to intensive care for severe influenza, but pediatricians should be highly aware of this condition to enable prompt diagnosis and treatment.

scholarly journals Invasive pulmonary aspergillosisas a complication of severe influenza (case report)

2020 ◽  
Vol 12 (1) ◽  
pp. 96-103
Author(s):  
Yu. E. Melekhina ◽  
O. V. Shadrivova ◽  
E. V. Frolova ◽  
Yu. V. Borzova ◽  
E. V. Shagdileeva ◽  
...  
Keyword(s):  
Case Report ◽  
Influenza A ◽  
Clinical Case ◽  
Influenza Infection ◽  
Invasive Pulmonary Aspergillosis ◽  
Pulmonary Aspergillosis ◽  
Severe Influenza ◽  
Influenza A H1n1 ◽  
Influenza Case ◽  
Immunocompetent Patients

During  last  years  the  frequency  of  invasive  pulmonary aspergillosis  (IPA)  in  immunocompetent  patients  has  increased. Clinical case report of successful treatment invasive aspergillosis  with  influenza  A(H1N1)  presented  in  the  article. We analyzed the special literature of patients with IPA following influenza infection. The timely identification and treatment of these patients are necessary.

scholarly journals 1639. Efficacy of Voriconazole Prophylaxis Followed by Therapeutic Liposomal Amphotericin B for the Treatment of Murine Pulmonary Aspergillosis Caused by Azole-Resistant Aspergillus fumigatus Strains

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S45-S45
Author(s):  
Jon Olson ◽  
Matthew Slarve ◽  
Jill Adler-Moore
Keyword(s):  
Aspergillus Fumigatus ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Therapeutic Option ◽  
The Other ◽  
Liposomal Amphotericin B ◽  
Post Challenge ◽  
Pulmonary Aspergillosis ◽  
Fungal Burden ◽  
Buffer Control

Abstract Background Antifungal treatment for pulmonary aspergillosis is more difficult if the fungal strain causing the infection is azole resistant. To investigate this problem, we used a murine model of pulmonary aspergillosis caused by azole-resistant Aspergillus fumigatus strains V29 and V45, and compared treatment with voriconazole (Vr, oral 40 mg/kg, bid) or liposomal amphotericin B (L-AmB, 5 mg/kg, IV) used alone or in combination. Methods Mice (n = 14/gp) were immunosuppressed with 24 mg/kg triamcinolone acetonide, IP, d-3, d-1, and d+1 relative to fungal challenge (d0). For 2 groups, Vr was given prophylactically (proph) d-3, d-2, d-1 followed by L-AmB or buffer, d+1, d+2, and d+3. The other groups were given Vr, L-AmB, Vr+L-AmB, or buffer d+1, d+2, and d+3. On d0, mice were given 1.3 to 1.6 × 107A. fumigatus spores intranasally (Vr MIC = 64 μg/mL, V29; Vr MIC = 8 μg/mL, V45). On d+3, lungs were collected from 7 mice/gp and fungal burden determined by plating for colony forming units; 7 mice/gp were then monitored for morbidity to d+21. Results Optimum treatment was observed when Vr was given proph, followed by L-AmB post-challenge (Vr/L-AmB), with better survival (100%) for both fungal strains vs. buffer or Vr post-challenge (P ≤ 0.04); for V29, significantly better survival was also seen with Vr/L-AmB vs. L-AmB or Vr+L-AmB post-challenge (P ≤ 0.01). For strain V45, lung fungal burden was significantly lower for Vr/L-AmB versus all other treatments (P ≤ 0.04), while for strain V29, fungal burden was lower for the Vf/L-AmB and L-AmB post-challenge groups versus the other groups, but the differences were not significant. Notably, although the lung fungal burden with Vr proph and Vr postchallenge were both similar to the buffer control, Vr proph yielded significantly better survival than Vr post-challenge (P ≤ 0.001). Conclusion These preclinical observations demonstrate that combining L-AmB with Vr for the postchallenge treatment of pulmonary aspergillosis caused by azole-resistant strains is not an effective therapeutic option. However, the results do show that Vr proph, but not Vr postchallenge, can have some limited antifungal activity, and can significantly enhance the antifungal effects of post-challenge L-AmB. This regimen could be considered in areas where there is a high incidence of azole-resistant A. fumigatus. Disclosures All authors: No reported disclosures.

scholarly journals Liposomal Amphotericin B and Echinocandins as Monotherapy or Sequential or Concomitant Therapy in Murine Disseminated and Pulmonary Aspergillus fumigatus Infections

2010 ◽  
Vol 54 (9) ◽  
pp. 3884-3894 ◽  
Author(s):  
Jon A. Olson ◽  
Ancy George ◽  
David Constable ◽  
Peter Smith ◽  
Richard T. Proffitt ◽  
...  
Keyword(s):  
Aspergillus Fumigatus ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Sequential Therapy ◽  
Liposomal Amphotericin B ◽  
Concomitant Therapy ◽  
Fungal Burden ◽  
Drug Levels ◽  
Drug Concentrations ◽  
Disseminated Aspergillosis

ABSTRACT Monotherapy and combination therapy were compared using optimal doses of liposomal amphotericin B, micafungin, or caspofungin in Aspergillus fumigatus pulmonary and disseminated infections. Mice were challenged intravenously (2.8 × 104 to 5.7 × 104 conidia) or intranasally (5.8 × 107 conidia) with A. fumigatus. Drugs (5, 10, or 15 mg/kg of body weight) were given for 3 or 6 days as single, concomitant, or sequential therapy (i.e., days 1 to 3 and then days 4 to 6). Mice were monitored for survival, and tissues were assayed for fungal burden and drug concentrations. Treatments starting 24 h postchallenge significantly prolonged survival in disseminated aspergillosis (P < 0.002), but only liposomal amphotericin B treatments or treatments beginning with liposomal amphotericin B increased survival to 100% in the pulmonary aspergillosis model. Fungi in kidneys and spleens (disseminated) and lungs (pulmonary) were significantly decreased (P ≤ 0.04) by liposomal amphotericin B, liposomal amphotericin B plus echinocandin, or liposomal amphotericin B prior to echinocandin. In the disseminated infection, liposomal amphotericin B and micafungin (10 or 15 mg/kg) had similar kidney drug levels, while in the spleen, 5 and 15 mg/kg liposomal amphotericin B gave higher drug levels than micafungin (P < 0.02). In the pulmonary infection, drug levels in lungs and spleen with 5-mg/kg dosing were significantly higher with liposomal amphotericin B than with caspofungin (P ≤ 0.002). In summary, treatment of A. fumigatus infections with liposomal amphotericin B plus echinocandin or liposomal amphotericin B prior to echinocandin was as effective as liposomal amphotericin B alone, and a greater decrease in the fungal burden with liposomal amphotericin B supports using liposomal amphotericin B prior to echinocandin.

Invasive Pulmonary Aspergillosis in Adults With Avian Influenza A (H7N9) Pneumonia in China: A Retrospective Study

2020 ◽  
Vol 221 (Supplement_2) ◽  
pp. S193-S197 ◽  
Author(s):  
Pengfei Zou ◽  
Chen Wang ◽  
Shufa Zheng ◽  
Feifei Guo ◽  
Li Yang ◽  
...  
Keyword(s):  
Avian Influenza ◽  
Influenza A ◽  
Invasive Pulmonary Aspergillosis ◽  
Antibiotic Use ◽  
Study Data ◽  
Pulmonary Aspergillosis ◽  
Multicenter Cohort Study ◽  
Severe Influenza ◽  
H7n9 Infection ◽  
Hospital Stays

Abstract Cases of severe influenza with Aspergillus infection are commonly reported in patients with severe influenza. However, the epidemiology, risk factors, and outcomes of invasive pulmonary aspergillosis (IPA) in patients with avian influenza A (H7N9) infection remain unclear. We performed a retrospective multicenter cohort study. Data were collected from patients with avian influenza A (H7N9) infection admitted to 17 hospitals across China from February 2013 through February 2018. We found that IPA was diagnosed in 18 (5.4%) of 335 patients; 61.1% of patients with IPA (11 of 18) were identified before or within 2 days after an H7N9 virus–negative result. The median hospital stays in patients with or without IPA were 23.5 and 18 days, respectively (P &lt; .01), and the median intensive care unit stays, respectively, were 22 and 12 days (P &lt; .01). Smoking in the past year and antibiotic use for &gt;7 days before admission were independently associated with IPA (adjusted odds ratio [95% confidence interval], 6.2 [1.7–26] for smoking and 4.89 [1.0–89] for antibiotic use). These findings provided important insights into the epidemiology and outcomes of IPA in patients with H7N9 infection in China.

scholarly journals Influenza- and COVID-19-associated pulmonary aspergillosis: are the pictures different?

2021 ◽  
Author(s):  
florian reizine ◽  
Kieran Pinceaux ◽  
Mathieu Lederlin ◽  
Brice Autier ◽  
Hélène Guegan ◽  
...  
Keyword(s):  
Distress Syndrome ◽  
Therapeutic Drug ◽  
Radiological Findings ◽  
Pulmonary Aspergillosis ◽  
High Burden ◽  
Severe Influenza ◽  
Kaplan Meier ◽  
Increased Sensitivity ◽  
Influenza Pneumonia ◽  
New Criteria

Abstract BackgroundInvasive pulmonary aspergillosis (IPA) in intensive care unit patients is a major concern, in particular for those with acute respiratory distress syndrome (ARDS). As observed previously for influenza-associated ARDS, the SARS-CoV-2 pandemic has shown a high proportion of COVID-19 patients with ARDS to be at risk of developing invasive fungal diseases.MethodsWe used the new international definitions of influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) to compare the demographic, clinical, biological and radiological aspects of IAPA and CAPA in a monocentric retrospective study.ResultsAmong the 120 ARDS patients included, we observed equivalent prevalence of IPA in Influenza and COVID-19 populations: 17 IAPA (23.9%) and 10 CAPA (20.4%). There were no significant differences in demographic or admission characteristics between patients with and without IPA. Kaplan-Meier curves showed significantly higher 90-day mortality for IPA patients overall (p = 0.032), whereas mortality did not differ between CAPA and IAPA. The duration of mechanical ventilation was higher for IPA patients (23 days [IQR 17–40] than those without (17 days [IQR 9–25], p = 0.038). Patients with COVID-19 and influenza associated ARDS treated with corticosteroids were more likely to develop IPA. Radiological findings of IPA in both populations using the new criteria increased sensitivity but with still poor specificity. Nonetheless, they also showed interesting differences between IAPA and CAPA with a higher proportion of features suggestive of IPA in IAPA patients. Lastly, therapeutic drug monitoring also appeared challenging since a wide proportion of IPA patients had low plasma voriconazole concentrations, with a significant higher delay to reach voriconazole concentrations > 2mg/L in CAPA versus IAPA patients (p = 0.045).ConclusionsICU patients presenting with ARDS during COVID-19 are very similar to those with severe influenza pneumonia in terms of prevalence of IPA and outcome, while CAPA is mainly favored by advanced age irrespective of the background. The dramatic consequences on the patients' prognosis emphasize the need for a better awareness in these particular populations. Larger prospective studies may help in designing the most well-adapted personalized management to prevent IPA, which represents a high burden of death in severe COVID-19 and Influenza pneumonia.

Use of Posaconazole in the Management of Invasive Orbital Aspergillosis in a Cat

2006 ◽  
Vol 42 (4) ◽  
pp. 302-307 ◽  
Author(s):  
Gillian J. McLellan ◽  
Susette M. Aquino ◽  
David R. Mason ◽  
Joann M. Kinyon ◽  
Ronald K. Myers
Keyword(s):  
Oral Cavity ◽  
Aspergillus Fumigatus ◽  
Amphotericin B ◽  
Oral Therapy ◽  
Surgical Excision ◽  
Parenteral Therapy ◽  
Orbital Exenteration ◽  
Nasal Sinus ◽  
Complete Surgical Excision ◽  
Disseminated Aspergillosis

Orbital infection with Aspergillus fumigatus was diagnosed in a Persian cat that was presented with chronic third eyelid protrusion and exophthalmos. Evidence of nasal, sinus, or disseminated aspergillosis was not detected in this cat. Complete surgical excision of diseased tissues was not possible during orbital exenteration, and infection subsequently extended into the tissues of the oral cavity. Oral therapy with itraconazole and parenteral therapy with amphotericin B were ineffective in resolving the infection. Oral therapy with a novel triazole, posaconazole, was curative.

scholarly journals Inhaled Voriconazole for Prevention of Invasive Pulmonary Aspergillosis

2009 ◽  
Vol 53 (6) ◽  
pp. 2613-2615 ◽  
Author(s):  
Justin A. Tolman ◽  
Nathan P. Wiederhold ◽  
Jason T. McConville ◽  
Laura K. Najvar ◽  
Rosie Bocanegra ◽  
...  
Keyword(s):  
Invasive Aspergillosis ◽  
Aspergillus Fumigatus ◽  
Amphotericin B ◽  
Murine Model ◽  
Invasive Pulmonary Aspergillosis ◽  
Invasive Disease ◽  
Pulmonary Aspergillosis ◽  
Drug Concentrations ◽  
Intravenous Formulation

ABSTRACT Targeted airway delivery of antifungals as prophylaxis against invasive aspergillosis may lead to high lung drug concentrations while avoiding toxicities associated with systemically administered agents. We evaluated the effectiveness of aerosolizing the intravenous formulation of voriconazole as prophylaxis against invasive pulmonary aspergillosis caused by Aspergillus fumigatus in an established murine model. Inhaled voriconazole significantly improved survival and limited the extent of invasive disease, as assessed by histopathology, compared to control and amphotericin B treatments.

scholarly journals In Vivo Resistance of a Laboratory-Selected Aspergillus fumigatus Isolate to Amphotericin B

2005 ◽  
Vol 49 (1) ◽  
pp. 428-430 ◽  
Author(s):  
Elias K. Manavathu ◽  
Jessica L. Cutright ◽  
Pranatharthi H. Chandrasekar
Keyword(s):  
Aspergillus Fumigatus ◽  
Amphotericin B ◽  
Susceptible Parent ◽  
Pulmonary Aspergillosis

ABSTRACT The fungal burdens (number of CFU per pair of lungs) in mice infected with Aspergillus fumigatus AB16.4 (for which the amphotericin B [AMB] MIC was elevated) and W73355 (drug-susceptible parent) were reduced by 21 and 81%, respectively, after 5 days of AMB treatment (2 mg/kg/day), indicating that AB16.4 also shows reduced susceptibility to AMB in a murine pulmonary aspergillosis model.

Sign in / Sign up

Export Citation Format

Share Document