This report describes the diagnosis and management of a 16-year-old boy who developed neurological signs and symptoms suggestive of cerebral aspergillosis following a haploidentical bone marrow transplant. A new sandwich enzyme-linked immunosorbent assay (ELISA) for the detection of Aspergillus galactomannan circulating antigens (Platelia Aspergillus, Sanofi Diagnostic Pasteur, France) was used on serum and cerebrospinal fluid to obtain a presumptive diagnosis and to monitor the course of the disease. Having failed conventional therapy with amphotericin B, the patient received compassionate treatment with voriconazole for a period of 37 days. High levels of voriconazole were observed in both serum and cerebrospinal fluid (CSF), with a trend toward accumulation. After 7 days a marked improvement in the patient's neurological symptoms was noted, and ELISA data indicated a corresponding decrease in Aspergillus galactomannan levels in both serum and CSF. Voriconazole was well tolerated, with only transient increases in ALT/AST recorded during therapy. Although the patient survived the acute Aspergillus infection, he subsequently died of an unrelated infection.
A remarkable increase in knowledge of fungal biodiversity in Italy has occurred in the last five years. The authors report up-to-date numbers of fungi (Basidiomycota and Ascomycota) by regions together with distributional and ecological data on hypogeous fungi. Specific case studies such as alpine fungi, orchid mycorrhizas symbionts, invasive species, and the use of macrofungi as food by red squirrels are analyzed. In situ conservation strategies carried out on target species and/or taxonomic groups are also indicated.
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