<i>Aspergillus flavus</i> myositis in a patient after liver transplantation

Li, Dong Ming; Xiu, Dian Rong; Li, Ruo Yu; Samson, Robert A.; Hoog, G.S. de; Wang, Duan Li

doi:10.1111/j.1399-0012.2008.00801.x

Cited by 16 publications

(7 citation statements)

References 18 publications

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“…Additionally, the outcome was not reported for 141 cases, whereas in 174 cases, more than 50% of the characteristics required for the analysis were lacking. Therefore, 116 individual cases in all were analyzed …”

Section: Resultsmentioning

confidence: 99%

Invasive aspergillosis in liver transplant recipients: Epidemiology, clinical characteristics, treatment, and outcomes in 116 cases

et al. 2015

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Invasive aspergillosis (IA) in liver transplant recipients is associated with grave outcomes. We reviewed 116 individual cases reported in the literature from 1985 to 2013. IA was diagnosed after a median of 25 days after transplantation and involved a single organ in 51% of the cases, whereas in the remaining cases, multiple sites were involved. The most common infecting Aspergillus species were Aspergillus fumigatus (73%), Aspergillus flavus (14%), and Aspergillus terreus (8%). Amphotericin B was the drug most frequently used, and it was followed by voriconazole and itraconazole. Combination regimens were used in 51% of the cases. The overall 1-year cumulative survival probability was 35% [95% confidence interval (CI) 5 24.6%-49.6%]. Survival was significantly higher for patients reported from the year 2000 and thereafter (P < 0.001), for those diagnosed with IA more than 30 days after transplantation versus those diagnosed earlier (P 5 0.019), and for patients without renal failure (P 5 0.020). Additionally, the use of voriconazole was significantly associated with a higher probability of survival (P < 0.001). Cox regression analysis showed that subjects with the involvement of multiple sites had a 2.52 times higher risk of a negative outcome (95% CI 5 1.08-5.87) than those with the involvement of a single site. Thus, IA causes life-threatening infections in liver transplant recipients. Predictors associated with poor outcomes may help clinicians to optimize the management of this infection.

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Section: Resultsmentioning

confidence: 99%

Invasive aspergillosis in liver transplant recipients: Epidemiology, clinical characteristics, treatment, and outcomes in 116 cases

et al. 2015

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“…Animal studies have shown that in vivo antifungal efficacy against C. bantiana is consistent with in vitro antifungal susceptibility. [22731] Despite these improved agents, failure with C. Bantiana continue to be reported. [21]…”

Section: Discussionmentioning

confidence: 99%

Fungal brain abscess caused by “Black Mold” (Cladophialophora bantiana) – A case report of successful treatment with an emphasis on how fungal brain abscess may be different from bacterial brain abscess

Aljuboori¹,

Hruska²,

Yaseen³

et al. 2017

Surg Neurol Int

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Background:Central nervous system infection with Cladophialophora bantiana (Black Mold) is rare. It carries a high mortality rate, that is more than 70%, despite multimodal therapy.Case Description:We present a rare case of “black mold” fungal brain abscess that was successfully treated with good patient outcome. The case is unusual because there were two fungal brain abscesses located bilaterally symmetrically in the mesial frontal lobes, and the response to different treatment strategies was well documented by over 25 magnetic resonance imaging (MRI) scans. Initial attempts to treat these lesions by repeated surgical excision and systemic amphotericin B was followed by continued growth rather than resolution. We realized that the application of treatment principles learned from bacterial brain abscess may not transpose intuitively to the treatment of fungal brain abscess. Therefore, a new treatment strategy was adopted that avoided further attempts at resection in favor of long-term oral voriconazole and repeated intracavitary aspiration and instillation of amphotericin B on an outpatient basis. Without further resection, the lesions stabilized and the aspirates eventually sterilized, however, the enhancing capsule never resolved on MRI scans. All treatment was stopped after 1 year. The apparently sterilized lesions have been followed for an additional 3 years without further growth, and the patient remains functionally, intellectually, and behaviorally normal.Conclusion:We conclude that, in the case of fungal abscess, it may be preferable to sterilize the lesion in situ rather than attempting to achieve resolution on imaging studies by repeated surgical resection of the capsule which can be counterproductive. This strategy accepts that the capsule may be important to the patient's immune defense against the fungus. Helping that defense barrier with intracapsular and systemic antifungal agents, rather than capsular removal, may be the better strategy for patients in whom early aggressive resection has failed. The basis for the apparent differences in the response of fungal versus bacterial brain abscess to surgical resection is discussed in the light of pathological findings from this and other cases.

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“…In some rare cases, muscle infection by Treponema pallidum has been reported and some patients had secondary syphilis after HIV infection [74,75]. Because fungal infection is closely related to the immune status of patients, fungal myositis is found mainly in immunocompromised patients after HIV infection or organ transplantation and Aspergillus is a common cause in these cases [76][77][78].…”

Section: Recent Findings On Infectious Myopathymentioning

confidence: 99%