Trichosporon asahii is a rare opportunistic fungal pathogen that causes fatal systemic infection in immunocompromised patients. Neutropenia developing due to malignancies is an important risk factor for fungal infection. Invasive infections due to T. asahii can be divided into disseminated and localized forms. The disseminated form is more common and usually occurs in neutropenic patients. The patient typically has an acute febrile illness that progresses rapidly to multiorgan failure. Here, we are presenting a case of fungal sepsis by invasive T. asahii in a 1-year-old child with Wilms Tumor. To the best of our knowledge, this is the first time that fungal sepsis due to T. asahii has been reported in a Wilms tumor patient. The incidence of rare invasive fungal infections is increasing in immunocompromised patients in whom management becomes difficult due to their heterogenous antifungal susceptibility pattern and intrinsic resistance to the standard antifungal agents that are routinely given. The patient was admitted with high spiking fever, and his laboratory investigations suggested neutropenia. T. asahii was isolated from the blood culture, for which he was started on inj. voriconozole. After 14 days of treatment, the fungus was cleared out from the patient’s blood.
Background:
Hepatocellular carcinoma (HCC) is the most prevalent kind of primary liver cancer and a significant cause of cancer-related mortality across the world.Sorafenib is considered as the approved drug of choice in advanced HCC, which is an oral multikinase inhibitor with effective antiproliferative and antiangiogenic effects.In India, there is currently insufficient data on the safety and efficacy of sorafenib in the treatment of HCC.
Objective:
The study aims to evaluate the safety and effectiveness of sorafenib therapy in advanced HCC.
Methods:
A prospective study of 66 patients administered with sorafenib for advanced HCC between June 2016- May 2017 was carried out in a single center with a mean follow-up of 3 months. The adverse events (AEs) were graded using the Common Terminology Criteria for Adverse Events (CTCAE), version 4.0. Effectiveness was analyzed based on Alpha- Fetoprotein (AFP) levels from laboratory findings. The median age was 63 years (range 61-70) with the male to female ratio of 16:1.
Results:
The most commonly observed adverse events were fatigue (31.81%), hand foot syndrome (24.24%), and diarrhea(24.24%). A statistically significant decline
in AFP levels was observed with sorafenib treatment (p=<0.001).
Conclusion:
Sorafenib appears to be beneficial for individuals with advanced HCC, regardless of the baseline condition.
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