OBJECTIVESTo study the clinical characteristics of hepatic failure with aspergillosis.

METHODSThe data of hepatic failure patients with fungal infection hospitalized in our hospital form January 1985 to June 2006 were collected. This research mainly focused on the clinical characteristics of the patients co-infected with aspergillosis.

RESULTSThe occurrence of aspergillosis was 20.5% (104 cases) among 507 hepatic failure patients with fungal infection. Compared with other fungal infection in hepatic failure patients, the effective rate of antifungal therapy and the improvement rate of underlying disease were worse in patients with aspergillus infection (36.5% vs 57.8%, P = 0.000; 26.0% vs 36.7%, P = 0.049). Aspergillus fumigatus was the most common species among 108 fungal species. The species next to Aspergillus fumigatus were Aspergillus niger and Aspergillus flavus. The mainly infected organ was lung and its clinical manifestation was atypical. Liver function could be improved with effective anti-fungus therapy.

CONCLUSIONSDiagnosis and treatment of aspergillosis is difficult in hepatic failure patients co-infected with aspergillosis. Early and effective antifungal therapy is helpful to the recovery of liver function in the hepatic failure patients suspected with aspergillosis co-infection.

Antifungal Agents ; therapeutic use ; Aspergillosis ; diagnosis ; drug therapy ; Aspergillus ; isolation & purification ; Humans ; Liver Failure ; diagnosis ; drug therapy ; microbiology

Adolescent ; Aged ; Aspergillosis ; microbiology ; pathology ; Aspergillus ; isolation & purification ; Brain Diseases ; drug therapy ; microbiology ; pathology ; surgery ; Diabetes Complications ; microbiology ; Diagnosis, Differential ; Female ; Humans ; Male ; Mucorales ; isolation & purification ; Mucormycosis ; drug therapy ; pathology ; surgery ; Nose Diseases ; drug therapy ; microbiology ; pathology ; surgery

OBJECTIVE: To discuss the distinctive clinical manifestation of primary aspergillus laryngitis. METHOD: Six cases of primary aspergillus laryngitis in our department were reviewed, among which 3 cases were diabetes patients, and were laryngeal mucosal barrier impairment. 2 cases were smoking, 2 cases were over use of voice and 1 case was gastro-pharyngeal reflux. Refractory hoarseness was the main clinical manifestation of all patients. The prophase treatment with antibiotics and glucocorticoid should breakdown the balance of flora and exacerbate the disease. RESULT: Stop using antibiotics and glucocorticoid and alter to oral administration of itraconazole in 2 to 4 weeks after final diagnosis can effectively cure the disease. No recurrence was found in 6 month to 4 years follow up. CONCLUSION Diffuse hyperemia, pachynsis and scattered lamellar leukasmus of vocal cord were the characteristic physical findings of primary aspergillus laryngitis. Pathology is the major means to get the final diagnosis. Oral administration of itraconazole could be effective.
Adult ; Aged ; Antifungal Agents ; therapeutic use ; Aspergillosis ; diagnosis ; drug therapy ; Aspergillus ; Female ; Humans ; Itraconazole ; therapeutic use ; Laryngitis ; diagnosis ; drug therapy ; microbiology ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

This study was aimed to analyze the clinical features, anti-fungal therapeutic efficacy and safety in hematological malignancy patients with invasive aspergillosis (IA) after hematopoietic stem cell transplantation (HSCT) or chemotherapy. The patients with hematological malignancies received chemotherapy or HSCT were analyzed retrospectively, then the clinical characteristics and diagnosis were analyzed according to the diagnostic criteria for IA. The efficacy and safety of anti- Aspergillus therapy, and the factors influencing therapeutic response were evaluated. The results showed that out of 30 cases with IA, 2 were proven, 19 were probable, 9 were possible, and 19 were diagnosed after HSCT, most in the late period after-HSCT (> 40 d). 8 cases received fluconazol only, 6 received caspofungin only, 7 received combined therapy. The efficacy and time interval from the first day of treatment to successful response (TTR) were 87.5%, 50% and 85.7% and 38, 20 and 36 days, respectively. Combined therapy is better than single drug treatment (p < 0.05) while the TTR was not significantly different between them. The factors influencing the therapeutic efficacy were as follows: age, HSCT, GVHD and CMV, previous IFI and so on (p < 0.05). All the anti- Aspergillus medicines resulted in some injury of hepatic and renal function. However, there were no significant difference between the drugs or between combination and single drug therapy (p > 0.05). It is concluded that IA is also the major and severe complication in the patients with hematological malignancies or received HSCT. Combined therapy for anti- aspergillus is better than single drug in efficacy and safety, without increasing the adverse drug reactions for hepatic and renal function. The efficacy of anti- aspergillus may be related to age, HSCT, GVHD and CMV, previous IFI and so on.
Adolescent ; Adult ; Antifungal Agents ; therapeutic use ; Aspergillosis ; complications ; diagnosis ; drug therapy ; Aspergillus ; Female ; Hematologic Neoplasms ; complications ; drug therapy ; microbiology ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Young Adult

OBJECTIVE: To analyze the clinical features of invasive fungal infection in patients with hematological malignancies and to compare the the therapeutic effect of fluconazole and intraconazole. METHODS: The clinical manifestations, mycological features, and the therapeutic results of 47 patients were retrospectively analyzed. Fluconazole was given to 17 paitents, intraconazole was given to 21 patients, and intraconazole to the other 9 patients after they had no effect with fluconazole. RESULTS: All patients had fever. The lung and the mouth cavity were the main locations of infection (53.2% and 21.3%, respectively). Fungi were found in 23 (48.9%) patients, in which the majority were Candida albicans and Aspergillus (56.5% and 26.1%, respectively). Intraconazole was more effective than fluconazole (63.3% vs. 34.6%, P<0.05) with no serious side effect. CONCLUSION The most common clinical features of IFI are fever, lung infection, and oral infection in patients with hematological malignancies. Candida albicans and Aspergillus infection are common. Intraconazole is safe and effective for invasive fungal infection.
Adolescent ; Adult ; Aged ; Antifungal Agents ; therapeutic use ; Aspergillosis ; complications ; diagnosis ; drug therapy ; Candidiasis ; complications ; diagnosis ; drug therapy ; Female ; Fluconazole ; therapeutic use ; Hematologic Neoplasms ; microbiology ; Humans ; Itraconazole ; therapeutic use ; Lung Diseases, Fungal ; complications ; diagnosis ; drug therapy ; Male ; Middle Aged

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

Invasive aspergillosis (IA), generally considered an opportunistic infection in immunocompromised hosts, is associated with high morbidity and mortality. IA commonly occurs in the respiratory tract with isolated reports of aspergillosis infection in the nasal sinuses, central nervous system, skin, liver, and urinary tract. Extra-pulmonary aspergillosis is usually observed in disseminated disease. To date, there are a few studies regarding primary and disseminated gastrointestinal (GI) aspergillosis in immunocompromised hosts. Only a few cases of primary GI aspergillosis in non-immunocompromised hosts have been reported; of these, almost all of them involved the upper GI tract. We describe a very rare case of IA involving the lower GI tract in the patient without classical risk factors that presented as multiple colon perforations and was successfully treated by surgery and antifungal treatment. We also review related literature and discuss the characteristics and risk factors of IA in the immunocompetent hosts without classical risk factors. This case that shows IA should be considered in critically ill patients, and that primary lower GI aspergillosis may also occur in the immunocompetent hosts without classical risk factors.
Amphotericin B/administration & dosage/therapeutic use ; Antifungal Agents/administration & dosage/*therapeutic use ; Aspergillosis/*diagnosis/drug therapy/microbiology/surgery ; Aspergillus/*isolation & purification ; Colon/microbiology/radiography/*surgery ; Colonic Diseases/diagnosis/therapy ; Combined Modality Therapy ; Humans ; *Immunocompetence ; Laparotomy ; Male ; Middle Aged ; Treatment Outcome ; Voriconazole/administration & dosage/therapeutic use

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

Monitoring the response to therapy for invasive aspergillosis (IA) is essential for the management of patients with hematologic diseases. We evaluated the correlation between the outcome of real-time nucleic acid sequence-based amplification (RTi-NASBA) for Aspergillus 18S rRNA and the clinical outcome of IA. A total of 157 serum samples from 29 patients with IA were tested for RTi-NASBA. The treatment response and mortality were compared with the NASBA outcome (whether the NASBA value was converted to negative or not) at 12 weeks after the start of antifungal therapy. At 12 weeks, there was a moderate correlation between the treatment failure and persistently positive NASBA (kappa = 0.482; P = 0.019). Deaths attributable to IA were more prevalent in patients without negative conversion of NASBA than in those with negative conversion (50% vs 5%; P = 0.013). Significant factors of treatment failure at 12 weeks were the status of hematologic disease (nonremission; P = 0.041) and the NASBA outcome (failure of negative conversion; P = 0.024). Survival was significantly better in patients with negative conversion of NASBA than those with persistently positive values (P = 0.036). This study suggests that the serial monitoring of RTi-NASBA could be useful for prediction of the clinical outcome in hematologic patients with IA.
Adolescent ; Adult ; Aged ; Antifungal Agents/therapeutic use ; Aspergillosis/*diagnosis/drug therapy/microbiology/mortality ; Aspergillus/*genetics/isolation & purification ; Base Sequence ; Female ; Humans ; Lung/microbiology ; Male ; Middle Aged ; Predictive Value of Tests ; RNA, Ribosomal, 18S/analysis ; *Real-Time Polymerase Chain Reaction ; Retrospective Studies ; Sputum/microbiology ; Survival Rate

Systemic infection with Aspergillus is an opportunistic disease that affects mainly immunocompromised hosts, and is associated with a high mortality rate. It typically occurs in patients with several predisposing factors, but Aspergillus endocarditis of native valves is rare and experience in diagnosis and treatment is limited. We report a case of native valve endocarditis caused by Aspergillus. A 35-yr-old male patient who underwent pericardiocentesis four months previously for pericardial effusion of unknown etiology presented with right leg pain and absence of the right femoral artery pulse. Cardiac echocardiography revealed severe mitral insufficiency with large mobile vegetations, and computed tomographic angiography showed embolic occlusion of both common iliac arteries. We performed mitral valve replacement and thromoembolectomy, and Aspergillus was identified as the vegetation. We started intravenous amphotericin B and oral itraconazole, but systemic complications developed including superior mesenteric artery aneurysm and gastrointestinal bleeding. After aggressive management, the patient was discharged 78 days post surgery on oral itraconazole. He was well at 12 months post discharge but died in a traffic accident 13 months after discharge.
Administration, Oral ; Adult ; Amphotericin B/administration & dosage ; Antifungal Agents/administration & dosage ; Aspergillosis/complications/*diagnosis/drug therapy ; Aspergillus/isolation & purification ; Endocarditis/*diagnosis/surgery/ultrasonography ; Heart Valve Diseases/*diagnosis/microbiology/surgery ; Humans ; Itraconazole/administration & dosage ; Male ; Postoperative Complications/microbiology ; Tomography, X-Ray Computed