5232013 hammoud Amir Ali soultani A 4 year old boy who was admitted in 7192 due to fever abdominal pain and anorexia since 3 weeks CBC WBC350010 blastHb8PLT BMA full blast ALL ID: 934594
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Slide2Disseminated fungal infection
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Slide3Amir Ali
soultani
A 4 year old boy who was admitted in 7-1-92 , due to fever ,abdominal pain , and anorexia since 3 weeks.CBC: WBC:3500(10% blast)-Hb:8-PLT:BMA: full blast- ALL CD10,19,22: +
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Slide4During the last days of induction (prednisone tapering) he had signs of septic shock and was transferred to ICU:
Hypotension
FeverARDSPleural effusion
DIC
Respiratory distress
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Slide5B/C:
klebsiella
pneumonia S: Tazosin-Cipro-Amika R: Meropnem
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Slide6After clinical and lab recovery, the patient had fever and cough
CT: disseminated pulmonary nodules and hypo dense lesions in spleen and kidney compatible with IFI
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Slide7Since the patient was on
voriconazole
for 2 weaks , he was treated with Ampho+ caspoGalactomannan: 0.9 before sepsis
2.4-2.5 (BAL-blood)
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Slide8BEFORE
AMPHO +CASPHO
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Slide19AFTER
AMPHO +CASPHO
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Slide27Is there any relation between bacterial sepsis and IFI?
What is the preferred anti fungal therapy?
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Slide30UP TO DATE
Caspofungin
: Caspofungin, an echinocandin
, has been approved by the US FDA for the treatment of invasive aspergillosis in patients who cannot tolerate or who are refractory to standard therapy
.
It
is not utilized for primary therapy of invasive
aspergillosis
because of a lack of data in this setting; it is used for salvage therapy, often in combination with another antifungal drug
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Slide31UP TO DATE
Liposomal amphotericin B and
caspofungin : Prior to the availability of
voriconazole, there was substantial interest in combination regimens of liposomal amphotericin B (AmBisome
) and
caspofungin
for invasive
aspergillosis
.
This
combination has shown some benefit compared with liposomal amphotericin
monotherapy
, but has not been compared with
voriconazole
monotherapy
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Slide32FEIGIN
GALACTOMANNAN ANTIGEN
TESTING:Galactomannan (GM) is a
major cell wall component of Aspergillus, and
the highest concentrations of GM are always released in the terminal phases of the
diseas
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