1/191. Fatal disseminated trichoderma longibrachiatum infection in an adult bone marrow transplant patient: species identification and review of the literature.trichoderma longibrachiatum was recovered from stool surveillance cultures and a perirectal ulcer biopsy specimen from a 29-year-old male who had received an allogeneic bone marrow transplant for acute lymphoblastic leukemia. The amphotericin b (2.0 microgram/ml) and itraconazole (1.0 microgram/ml) MICs for the organism were elevated. Therapy with these agents was unsuccessful, and the patient died on day 58 posttransplantation. At autopsy, histologic sections from the lungs, liver, brain, and intestinal wall showed infiltration by branching septate hyphae. Cultures were positive for trichoderma longibrachiatum. While trichoderma species have been recognized to be pathogenic in profoundly immunosuppressed hosts with increasing frequency, this is the first report of probable acquisition through the gastrointestinal tract. Salient features regarding the identification of molds in the trichoderma longibrachiatum species aggregate are presented.- - - - - - - - - - ranking = 1keywords = plant (Clic here for more details about this article) |
2/191. fusarium infections in patients with severe aplastic anemia: review and implications for management.BACKGROUND AND OBJECTIVE: The prognosis of severe fungal infections, such as fusarium infections, in patients with aplastic anemia is directly related to the recovery of bone marrow functions. In this study, in vitro anti-fusarium activity of granulocytes was investigated, the case of disseminated infection in a child with very severe aplastic anemia is reported, and implications for management of such infective complications are discussed. DESIGN AND methods: The in vitro efficiency of PMNL from three untreated, normal blood donors and from two G-CSF-treated WBC donors in contrasting the growth of the fusarium sp strain isolated from the patient we present was measured by a 3H-glucose uptake inhibition assay and confirmed by microscopic examination. RESULTS: Basic growth inhibitory activity of unstimulated PMNL on fusarium cells was significantly enhanced in the presence of GM-CSF in all three blood donors tested. In one of the two G-CSF-treated donors, in vitro efficiency of PMNL in contrasting the growth of the fungus increased notably after G-CSF treatment. We report the case of a 3-year-old girl with very severe aplastic anemia unresponsive to conventional immunosuppressant therapy who developed a disseminated fusarium infection. The child initially responded to liposomal amphotericin b and granulocyte transfusions from G-CSF stimulated donors. Subsequently she was given a cord blood stem cell transplantation but died of disseminated infection. INTERPRETATION AND CONCLUSIONS: Including the present case, there are only ten reports of invasive infections caused by the genus fusarium in aplastic anemia patients and only two of the patients survived. in vitro data seem to suggest that in vivo treatment with rh-G-CSF could have a stimulatory effect on the anti-fusarium activity of neutrophils. Despite the efficacy of granulocyte transfusions by G-CSF-stimulated donors in the temporary control of fusarium infection, treatment of the underlying hematologic disease is required to cure the infection in patients with severe aplastic anemia. Granulocyte transfusions by G-CSF-stimulated donors while awaiting bone marrow recovery following the blood stem cell transplant should be considered.- - - - - - - - - - ranking = 0.33333333333333keywords = plant (Clic here for more details about this article) |
3/191. Subcutaneous phaeohyphomycosis caused by Phaeoacremonium rubrigenum in an immunosuppressed patient.BACKGROUND: phaeohyphomycosis refers to infection by dematiaceous fungi with pigmented hyphae or yeast-like cells in the tissue. In humans, this disease is usually considered to be an opportunistic infection. The causal agents of phaeohyphomycosis include numerous species belonging to different genera and they are increasing as a result of the development of intensive medical therapy. observation: We report the case of a 61-year-old Japanese female under corticosteroid treatment for malignant rheumatoid arthritis. An asymptomatic subcutaneous tumor developed on the back of her left foot. Histological examination of the excised material revealed mixed cell granuloma (H&E) and the presence of branched hyphal elements (periodic acid-Schiff). A fungus grown in pure culture was identified as Phaeoacremonium rubrigenum. CONCLUSION: The hyphomycete genus, Phaeoacremonium, was proposed in 1996 by Crous et al. Three species belonging to this genus have been isolated from clinical specimens: P. inflatipes, from a human toenail, human synovial fluid and human mycetoma of the foot, P. parasiticum, from a subcutaneous lesion on a kidney transplant patient and several other sources, and P. rubrigenum, from a human patient with pneumonia. To our knowledge, however, this is the first report of phaeohyphomycosis caused by Phaeoacremonium rubrigenum.- - - - - - - - - - ranking = 0.16666666666667keywords = plant (Clic here for more details about this article) |
4/191. Systemic mycoses during prophylactical use of liposomal amphotericin b (Ambisome) after liver transplantation.We investigated the prophylactical administration of liposomal amphotericin b (Ambisome) in the early phase after liver transplantation (LTx). Fifty-eight patients received Ambisome prophylactically after LTx. Ambisome (1 mg kg-1 day-1) was given intravenously for 7 days after LTx. Immunosuppressive prophylaxis was cyclosporin A (CsA) based in 11 patients. Forty-seven patients had a tacrolimus-based immunosuppressive regimen. CsA and tacrolimus dosages were adjusted to trough levels of 150-250 ng ml-1 (EMIT) and 5-15 ng ml-1 (MEIA II) respectively. Three patients died from sepsis due to aspergillus fumigatus infection. Reasons for a fatal outcome were foudroyant Aspergillus pneumonia in a patient transplanted for fulminant hepatic failure on post-operative day (pod) 8; Aspergillus sepsis with severe endocardidtis in a patient with two retransplantations for graft non/dysfunction on pod 24; and disseminated aspergillosis due to aspergillus fumigatus in a patient retransplanted for primary non-function (pod 19). All three patients underwent haemofiltration for renal failure. One patient with candida albicans sepsis (pod 4) recovered under increased dosage of Ambisome (3 mg kg-1 per day). Ambisome (1 mg kg-1 per day) seems to be beneficial against systemic Candida infections. However, the onset of systemic Aspergillus infections could not be prevented. Obviously, higher Ambisome doses appear to be necessary against Aspergillus. We recommend the use of Ambisome (3 mg kg-1 per day) for patients with risk factors such as graft dys-/non-function, retransplantation, haemofiltration and complicated acute liver failure to prevent invasive aspergillosis.- - - - - - - - - - ranking = 1.5keywords = plant (Clic here for more details about this article) |
5/191. phaeohyphomycosis from Exphiala jeanselmei with concomitant nocardia asteroides infection in a renal transplant recipient: case report and review of the literature.A 59-year-old black man who received a cadaveric renal transplant 15 months earlier developed subcutaneous nodules on his right upper extremity that were identified as phaeohyphomycosis caused by exophiala jeanselmei. The man was admitted 4 weeks later with a swollen left arm and had nocardia asteroides in this area and in the apex of his left lung. He was treated with surgical excision, and itraconazole, imipenem-cilastatin, and trimethoprim-sulfamethoxazole. With the potential presence of more than one microorganism in an immunocompromised patient, it is important to identify and differentiate them correctly to direct appropriate therapy.- - - - - - - - - - ranking = 0.83333333333333keywords = plant (Clic here for more details about this article) |
6/191. Disseminated fusarium infection identified by the immunohistochemical staining in a patient with a refractory leukemia.The difficulty and uncertainty encountered in diagnosing a systemic mycosis often lead to a delay in starting antifungal therapy. We reported a disseminated infection of multiple fungal isolates including fusarium species during donor leukocyte transfusion (DLT) after allogeneic bone marrow transplantation in a 20-year-old woman with a refractory leukemia. skin lesions are the feature of fusarium and occur in the early period of the infection. In this case, during immunosuppression state after DLT, she presented with the whole body ache and erythematous lesions which appeared rapidly on her trunk and extremities. While administration of amphotericin b was started, her condition was further deteriorated and she died. autopsy materials revealed that she had multiple fungal infection with different isolates, including Aspergillus and Candida in the brain, lung and liver, but not in the skin. With the immunohistochemical staining with specific antibody, fusarium or Aspergillus infection was identified from the biopsy skin or autopsy brain, respectively. This rapid and specific immunohistochemical method may be useful for the diagnosis and treatment of invasive fungal infection without delay.- - - - - - - - - - ranking = 0.16666666666667keywords = plant (Clic here for more details about this article) |
7/191. Fatal case of trichoderma harzianum infection in a renal transplant recipient.We describe the second known case of human infection by trichoderma harzianum. A disseminated fungal infection was detected in the postmortem examination of a renal transplant recipient and confirmed in culture. The only other reported infection by this fungus caused peritonitis in a diabetic patient. The in vitro antifungal susceptibilities of the clinical strain and three other strains of trichoderma species to six antifungal drugs are provided. This case illustrates the widening spectrum of opportunistic trichoderma spp. in immunocompromised patients and emphasizes the problems in diagnosing invasive fungal diseases.- - - - - - - - - - ranking = 0.83333333333333keywords = plant (Clic here for more details about this article) |
8/191. paecilomyces fungus infection of the paranasal sinuses.Fungal infections caused by paecilomyces species are very rare and occur in adult patients with impaired host defences or following foreign body implants. They are found worldwide in soil and decaying vegetation. We describe a case of an 8 year old child who came with complaints of left sided nasal obstruction and discharge, telecanthus, diplopia and epiphora. On examination and investigation he had pansinusitis caused by P. lilacinus. An endoscopic sinus surgery was done and the patient was on oral itraconazole for 6 months. To our knowledge, this is the first case reported in the paediatric age group.- - - - - - - - - - ranking = 0.16666666666667keywords = plant (Clic here for more details about this article) |
9/191. Cutaneous infection caused by paecilomyces lilacinus in a renal transplant patient: treatment with voriconazole.Moulds belonging to the genus paecilomyces are rare opportunistic pathogens. About 100 cases have been reported in immunocompromised hosts or in relation to surgical procedures. We describe here a cutaneous infection due to P. lilacinus in a renal transplant patient, which responded to voriconazole treatment.- - - - - - - - - - ranking = 0.83333333333333keywords = plant (Clic here for more details about this article) |
10/191. Disseminated infection by scedosporium prolificans: an emerging fatality among haematology patients. Case report and review.We describe a case of proven disseminated infection by scedosporium prolificans in a profoundly neutropenic patient. The patient presented with a fever unresponsive to broad-spectrum antibiotics, endophthalmitis, respiratory failure and a renal abscess. The organism was isolated from bronchoalveolar lavage fluid and from pus obtained through a sterile puncture. review of the English-language literature identified 28 additional cases; these occurred exclusively in severely neutropenic patients (predominantly leukaemia) and in transplant recipients. Apart from two or possibly three cases, dissemination was uniformly fatal due to persistent neutropenia and inherited resistance of these pathogens to currently available antifungal drugs. At present, the optimal treatment of S. prolificans infections is unknown, but reversal of the underlying deficient immune status appears of great importance.- - - - - - - - - - ranking = 0.16666666666667keywords = plant (Clic here for more details about this article) |
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