Airway Obstruction ; diagnosis ; etiology ; Aspergillosis ; complications ; diagnosis ; Humans ; Laryngeal Diseases ; complications ; diagnosis ; microbiology ; Larynx

Pacemaker lead infection is a rare but a dangerous complication. Diagnosis can usually be established by the clinical picture and blood cultures. Transesophageal two dimensional echocardiography might be crucial in the diagnosis by visualizing pacing lead vegetations. Medical treatment alone is rarely successful, and several studies have suggested the infected pacemaker systems should be removed quickly for optimal management. We describe a case of Aspergillus infection in a permanent ventricular pacing lead, which appears to be the first reported case in Korea. A 30-yr-old man was evaluated for the symptoms and signs of congestive heart failure 3 yr after DDD pacemaker implantation. The transthoracic and transesophageal echocardiogram showed a large movable round shaggy mass attached to a ventricular lead in the right atrium. The atrial and ventricular leads were removed during cardiopulmonary bypass, and a new epicardial pacing system was implanted. The functional ventricular pacemaker lead was encased in a large organized thrombus. Histological findings were consistent with Aspergillus infection in a large thrombus attached to a pacemaker lead.
Adult ; Aspergillosis/diagnosis/*etiology/microbiology ; Echocardiography ; Echocardiography, Transesophageal ; Heart Atria/microbiology ; Humans ; Male ; Pacemaker, Artificial/*adverse effects/microbiology ; Thrombosis/diagnosis/*etiology/microbiology

Adult ; Aspergillosis ; diagnosis ; etiology ; Diagnostic Errors ; Humans ; Lung Diseases, Fungal ; diagnosis ; etiology ; Male ; Silicosis ; diagnosis ; microbiology ; Silicotuberculosis ; diagnosis ; etiology ; Tuberculosis, Pulmonary ; diagnosis ; etiology

OBJECTIVETo determine risk factors of invasive fungal infections (IFI) in patients admitted to non-hematological oncology department and pediatric intensive care unit (PICU), in order to improve diagnostic level of invasive fungal infections.

METHODWe retrospectively assessed 85 hospitalized pediatric patients with invasive fungal infections in Beijing Children's Hospital Affiliated to Capital Medical University from Jan.2007 to Nov.2012. All the cases were either from non-hematological oncology department or the PICU.We reviewed risk factors of invasive fungal infections.

RESULTAmong 85 patients, 42 had invasive candida infection, 20 invasive aspergillus infection, 21 cryptococcus infection, 1 Histoplasma capsulatum infection and 1 Mucor mucedo infection.In the 42 patients with invasive candida infection, 5 were young infants, 3 had combined immunodeficiency, 1 cellular immunodeficiency, 25 secondary infection due to long term use of corticosteroids and/or combined use of more than 2 kinds of antibiotics with primary disease, 5 prior intestinal tract surgery or chronic diarrheal disease, 1 reflux gastritis.In the 20 patients with invasive aspergillosis infection, 10 patients had chronic granulomatous disease, 5 long term use of corticosteroids ≥ 1 month, 3 long term use of corticosteroids and combined use of more than 2 kinds of antibiotics, 2 had no apparent host factors.In the 21 patients with cryptococcus infection, 2 patients had used corticosteroids ≥ 1 month, 2 had immunodeficiency mainly for lack of antibodies, while others had no apparent host factors. The child with Mucor mucedo infection had diabetes mellitus. And the one with Histoplasma capsulatum infection had immunodeficiency.

CONCLUSIONHigh risk factors for IFI in patients admitted to non-hematological oncology department and PICU are primary immunodeficiency disease and long term use of corticosteroids and/or long term combined use of more than 2 kinds of antibiotics. Besides, young infant is also a high risk factor for invasive candida infection. Most of the cryptococcus infections and certain aspergillosis had no obvious host factors.

Adolescent ; Adrenal Cortex Hormones ; administration & dosage ; adverse effects ; Age Factors ; Anti-Bacterial Agents ; administration & dosage ; adverse effects ; Aspergillosis ; diagnosis ; etiology ; microbiology ; Aspergillus ; isolation & purification ; Candida ; isolation & purification ; Child ; Child, Preschool ; Cross Infection ; epidemiology ; microbiology ; Female ; Humans ; Immunologic Deficiency Syndromes ; complications ; Infant ; Infant, Newborn ; Male ; Multivariate Analysis ; Mycoses ; diagnosis ; etiology ; microbiology ; Retrospective Studies ; Risk Factors

A 59-year-old woman was referred to our clinic with sudden visual loss in her right eye after she was treated with 40 mg/day of oral prednisolone for 2 weeks under the diagnosis of idiopathic optic neuritis. At that time, computerized tomography (CT) of the brain showed no evidence of optic nerve or brain pathology. However, there was progressive diminution of right visual acuity associated with a limitation of adduction and abduction in the right eye. On magnetic resonance imaging and repeated CT, a malignant lesion was suggested, and was confirmed as an Aspergillus fungus colony by histopathologic examination. Postoperatively, she was treated with intravenous administration of amphotericin B for 13 weeks. However, her condition continued to deteriorate. She developed ptosis and total ophthalmoplegia in the right eye and blindness in both eyes. After discharge, she was given itraconazole for 20 weeks. She has shown no recovery of visual acuity or extraocular motion during a two-year follow-up period. The clinical features of our case suggest that early diagnosis in a case of aspergilloma presenting with visual loss is difficult and that a high index of suspicion, repeated radiological examination and adequate biopsy may be required for diagnosis.
Amphotericin B/therapeutic use ; Antifungal Agents/therapeutic use ; Aspergillosis/diagnosis/drug therapy/*microbiology ; Blindness/etiology ; Diagnosis, Differential ; Eye Infections, Fungal/diagnosis/drug therapy/*microbiology ; Female ; Human ; Itraconazole/therapeutic use ; Magnetic Resonance Imaging ; Middle Aged ; Optic Neuritis/diagnosis/drug therapy/*microbiology ; Visual Acuity

OBJECTIVETo explore the relationship between the optical density index of serum aspergillus galactomannan (GM) assay and invasive aspergillosis (IA).

METHODSFrom Jan 2008 to Dec 2011, 825 hematological diseases patients with neutrophil count <0.5×10⁹/L⁹ by continuous blood count tests were admitted into our hospital. The optical density index of GM assay was ≥0.5 at least once. Of 825 patients, 247 cases were manifested as fever during hospitalization. The optical density index of GM antigen was detected by enzyme-linked immunosorbent assay, and the sensitivity and specificity of optical density ranged in 0.5-1.5.

RESULTSIn this study, the sensitivity and specificity of GM assay with continuous twice samples (73% and 93%, respectively) were higher than single sample (66% and 80%, respectively) when optical density index ≥1.0. 69 cases were diagnosed as proven IA with the incidence rate of 8.36%.

CONCLUSIONThe cut-off level for serum GM antigen assay should be decided as optical density index in two continuous samples of ≥1.0.

Adolescent ; Adult ; Aged ; Antigens, Fungal ; blood ; Aspergillosis ; blood ; diagnosis ; etiology ; Enzyme-Linked Immunosorbent Assay ; Female ; Hematologic Diseases ; blood ; microbiology ; Humans ; Male ; Mannans ; blood ; immunology ; Middle Aged ; Sensitivity and Specificity ; Young Adult

This study was aimed to investigate the clinical features and therapy of Ph(+) acute lymphoblastic leukemia (Ph(+)ALL) combined with invasive aspergillosis. A series of examination, including routine blood and bone marrow picture analysis, chest roentgenography, cranial computerized tomography and detection of cell genetics etc were carried out for a Ph(+)ALL patient combined with invasive aspergillosis. This patient received chemotherapy with DVCP, idarubicin and imatinib mesylate and was treated with sporanox and amphotericin B (Amb; including Amb-L) and cerebrotomy for drainage because the invasive aspergillosis occurred during myelosuppression. The results showed that patient gained complete remission and the invasive aspergillosis was controlled successfully. It is concluded that patient with Ph(+)ALL has poor prognosis despite intensive conventional chemotherapy, imatinib mesylate may prove to be an effective treatment for Ph(+)ALL. Because detection rate of the fungus is very low, itraconazole in combination with surgical excision of focus is the best treatment of lung and brain invasive aspergillosis.
Antifungal Agents ; therapeutic use ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Aspergillosis ; diagnosis ; drug therapy ; Benzamides ; Brain Diseases ; complications ; microbiology ; Humans ; Imatinib Mesylate ; Itraconazole ; therapeutic use ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive ; complications ; Lung Diseases, Fungal ; drug therapy ; etiology ; Piperazines ; administration & dosage ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; complications ; genetics ; microbiology ; Pyrimidines ; administration & dosage