1.A Case of Disseminated Trichosporon beigelii Infection in a Patient with Myelodysplastic Syndrome after Chemotherapy.
Jong Chul KIM ; Yang Soo KIM ; Chul Sung PARK ; Jae Myung KANG ; Baek Nam KIM ; Jun Hee WOO ; Jiso RYU ; Woo Gun KIM
Journal of Korean Medical Science 2001;16(4):505-508
Trichosporonosis is a potentially life-threatening infection with Trichosporon beigelii, the causative agent of white piedra. The systemic infection by this fungus has been most frequently described in immunocompromised hosts with neutropenia. Here, we report the first patient with disseminated infection by T. beigelii in Korea, acquired during a period of severe neutropenia after chemo-therapy for myelodysplastic syndrome. The patient recovered from the infection after an early-intensified treatment with amphotericin B and a rapid neutrophil recovery. The disseminated infection by T. beigelii is still rare, however, is an emerging fatal mycosis in immunocompromised patients with severe neutropenia.
Adult
;
Amphotericin B/therapeutic use
;
Human
;
Male
;
Mycoses/drug therapy/*etiology
;
Myelodysplastic Syndromes/*complications/drug therapy
2.Invasive fungal infections in the pediatric intensive care unit: a clinical analysis of 38 cases.
Xiao-Fang CAI ; Ji-Min SUN ; Zong-Qi DONG ; Wen-Bin LI
Chinese Journal of Contemporary Pediatrics 2013;15(8):644-648
OBJECTIVETo investigate the clinical features of invasive fungal infections (IFI) in the pediatric intensive care unit (PICU) and, to provide a basis for the effective prevention and treatment of IFI.
METHODSRetrospective analysis was performed on the clinical features and treatment outcomes of 38 children with IFI who were admitted to the PICU of Wuhan Children's Hospital between January 2009 and August 2012.
RESULTSPulmonary fungal infection (89%) was the most common among the 38 cases. Before diagnosis of IFI, all patients had severe underlying diseases and received several broad-spectrum antibiotics, including carbapenems, which were used in 95% of cases; 47% of all cases had been treated with corticosteroids systemically; all patients had received invasive operations, and 47% of them had undergone endotracheal intubation and mechanical ventilation. None of these cases had either typical clinical symptoms and signs or specific imaging findings. Fifty-six strains of fungi were isolated, with Candida albicans (41%), Aspergilli (25%), and Mucor (20%) being the most common ones. All patients received timely antifungal therapies, 15 cases were cured and 16 cases showed improvements, with a response rate of 82%, and the rate of adverse events was 16%.
CONCLUSIONSIn the PICU, the respiratory tract is the most common site of IFI infection, and Candida albicans is the leading pathogen. Severe underlying diseases, use of broad-spectrum antibiotics and corticosteroids, and invasive operations are the main risk factors for IFI in the PICU. Early diagnosis and timely treatment with high-performance antifungal drugs can improve the prognosis in children with IFI.
Female ; Humans ; Infant ; Intensive Care Units, Pediatric ; Male ; Mycoses ; diagnosis ; drug therapy ; etiology ; Retrospective Studies
4.Clinical characteristics and pathogens of invasive fungal infections in children.
Li CHANG ; Hua SHI ; Wei ZHOU ; Zheng-Qiang HU ; Li-Yuan MU ; Min SU ; Ling-Han KUANG ; Yong-Mei JIANG
Chinese Journal of Contemporary Pediatrics 2012;14(12):933-937
OBJECTIVETo study the clinical characteristics and pathogens of invasive fungal infection in children.
METHODSThe clinical data of 104 children who suffered from invasive fungal infections between 2008 and 2012 was retrospectively reviewed.
RESULTSOf the 104 cases, 20 occurred in neonates, 48 in infants and 36 in preschool and school-aged children (old-aged children). Prematurity (70%), hyaline membrane disease (45%) and pneumonia (30%) were commonly comorbid in the neonate group. In addition, the percentage of cases receiving total parenteral nutrition was higher in the neonate group than in the other two age groups (P<0.01). Mechanical ventilation was more frequent in neonate and infant groups than in the old-aged children (P<0.01). Hematological malignancy was the most common underlying disease, and the percentage of children who had neutropenia and accepted chemotherapy was higher in the old-aged children than in the other two age groups (P<0.05). Lung infection was the most common (61.5%), followed by sepsis (14.4%) and intestinal tract infection (12.5%), while nervous system infections were found only in old-aged children. A total of 105 strains of fungi were isolated from the 104 patients, including Candida (n=90, 85.7%), Cryptococcus (n=6) and others (n=9). The most commonly isolated species was Candida albicans (n=52, 49.5%). Non-Candida albicans Candida accounted for 36.2% (n=38). The rate of susceptibility of Candida species to 5-fluorocytosine and amphotericin B was higher than fluconazole.
CONCLUSIONSInvasive fungal infections can occur in children at various ages. There are differences in the risk factors for invasive fungal infections between age groups. Candida species are the main pathogens of childhood invasive fungal infections, and both Candida albicans and non-Candida albicans Candida are common. Fluorocytosine and amphotericin B are sensitive antifungal agents for infections caused by Candida species.
Adolescent ; Child ; Child, Preschool ; Female ; Fungi ; drug effects ; isolation & purification ; Humans ; Infant ; Infant, Newborn ; Male ; Microbial Sensitivity Tests ; Mycoses ; drug therapy ; etiology ; microbiology ; Prognosis ; Risk Factors
5.Clinical analysis of invasive laryngeal mycosis.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery 2013;27(21):1174-1176
OBJECTIVE:
To summarize the clinical datas of thepatients with invasive laryngeal fungal infections in, discuss pathogenesis and treatment methods.
METHOD:
Eleven cases of invasive laryngeal fmycosis who were collected from September 2006 to February 2010 with electronic laryngoscopy, aspirate smear and culture and tissue biopsy for pathological diagnosis, were restrospectively analyzed. Those patients were received iv fluconazole, treatment of Oxygen Atomization of amphotericin B solution and taking itraconazole orally. The hepatic and renal functions of the patients were monitored in the course of treatment.
RESULT:
All the cases were diagnosed of invasive laryngeal mycosis. 1 patient showed liver dysfunction in the second week during treatment. And continuing the treatment after using liver protection drugs. All symptoms of the patients were improved and no recurrence happened during the 1-6 years of follow-up.
CONCLUSION
Invasive laryngeal fmycosis was correlated with occupation exposure, abusing of antibiotics and low immunity. Laryngeal mycosis was Diagnosised mainly depended on the pathological examination. The positive rates of the secretion smear was low. The effects of iv fluconazole, Oxygen Atomization of amphotericin B 2-4 weeks, and 4 weeks of taking itraconazole orally were safety and reliable.
Administration, Oral
;
Amphotericin B
;
therapeutic use
;
Antifungal Agents
;
therapeutic use
;
Chemical and Drug Induced Liver Injury
;
prevention & control
;
Fluconazole
;
therapeutic use
;
Humans
;
Itraconazole
;
therapeutic use
;
Laryngeal Diseases
;
drug therapy
;
etiology
;
pathology
;
Mycoses
;
drug therapy
;
etiology
;
pathology
6.Acquired immunodeficiency syndrome associated disseminated Penicillium Marneffei infection: report of 8 cases.
Pu-xuan LU ; Wen-ke ZHU ; Yan LIU ; Xin-chun CHEN ; Neng-yong ZHAN ; Jin-qing LIU ; Jian ZANG ; Gen-dong YANG ; Ru-xin YE ; Li-sheng CAI
Chinese Medical Journal 2005;118(16):1395-1399
AIDS-Related Opportunistic Infections
;
diagnostic imaging
;
drug therapy
;
etiology
;
Adult
;
Bone Marrow Examination
;
CD4 Lymphocyte Count
;
Female
;
Humans
;
Male
;
Middle Aged
;
Mycoses
;
diagnostic imaging
;
drug therapy
;
etiology
;
Penicillium
;
isolation & purification
;
Prognosis
;
Radiography
7.Prospective audit of post-chemotherapy febrile neutropenia in patients with solid cancer and lymphoma in two Singaporean cancer centres.
Mabel WONG ; Jing JIN ; Min Han TAN ; Yee Mei LEE ; Ten Eng LEE ; Ying DING ; Hong Chan YONG ; Siew Eng LIM ; Louis Ya CHAI ; Noan Minh CHAU ; Li Yang HSU
Annals of the Academy of Medicine, Singapore 2012;41(7):287-293
INTRODUCTIONFebrile neutropenia (FN) is a significant cause of mortality and morbidity in oncology and haematology units worldwide. The overall mortality in hospital surveys in Singapore surveys on post-chemotherapy FN has ranged between 3.0% and 8.8%. However, recent evidence indicates that outpatient management of patients with low-risk FN is safe and cost-effective.
MATERIALS AND METHODSWe conducted a prospective audit on a cohort of adult patients with post-chemotherapy FN seen at 2 local public sector cancer centres over a 1-year period in order to define their epidemiological characteristics and outcomes, and also to assess the uptake of early discharge/outpatient management strategies for these patients.
RESULTSWe reviewed 306 FN episodes from 248 patients. Patient characteristics and outcomes were similar between both institutions. Eleven (3.7%) FN episodes were managed as outpatient and none developed complications. Overall 30-day mortality was 6.6%, while the median length of stay (LOS) was 7 days (IQR: 4 to 11 days). The only independent risk factor for mortality was severe sepsis (OR:13.19; 95% CI: 1.98 to 87.7; P = 0.008). Factors independently associated with a longer LOS were vancomycin prescription (coefficient: 0.25; 95% CI: 0.08 to 0.41; P = 0.003), longer duration of intravenous antibiotics (coefficient: 0.08; 95% CI: 0.06 to 0.10; P <0.001), and prior review by an infectious diseases physician (coefficient: 0.16; 95% CI: 0.01 to 0.31; P = 0.034).
CONCLUSIONThis audit demonstrated that mortality from FN in our 2 cancer centres is low and comparable to international institutions. It also demonstrates that outpatient management of FN is safe in selected patients, and can be further expanded for right-siting of resources.
Adult ; Anti-Bacterial Agents ; therapeutic use ; Antineoplastic Agents ; adverse effects ; Bacterial Infections ; epidemiology ; Cohort Studies ; Female ; Fever ; epidemiology ; etiology ; Humans ; Male ; Middle Aged ; Mycoses ; epidemiology ; Neoplasms ; complications ; drug therapy ; Neutropenia ; epidemiology ; etiology ; Prospective Studies ; Singapore ; epidemiology
8.Prophylaxis of invasive fungal infection with different administration regimens of itraconazole in patients with acute myeloid leukemia: a report from a randomized, controlled trial.
Xin LIU ; Yong HUANG ; Dong-lin YANG ; Jia-lin WEI ; Yi HE ; Qiao-ling MA ; Ai-ming PANG ; Si-zhou FENG ; Ming-zhe HAN
Chinese Journal of Hematology 2013;34(6):502-506
OBJECTIVETo evaluate the efficacy and safety of antifungal prophylaxis of itraconazole in patients with acute myeloid leukemia (AML) to probe the relationship of the antifungal effect and the adverse events with serum concentration.
METHODSFrom April 2009 to May 2011, a total of 310 courses from 112 patients referred to our institute were enrolled in this study; of them, 297 courses were eligible for analysis. Eligible cases were randomized into oral group and injection/oral group according to different chemotherapy of induction and consolidation. Blood samples were collected at different time points for measurements of serum itraconazole levels. The morbidity of IFI and the adverse events were analyzed.
RESULTSThe morbidities of IFI in injection/oral and oral groups were 10.1% and 20.9%, respectively (P=0.010). 7 and 9 cases in injection/oral and oral groups, respectively were withdrawn from the study because of adverse events, and the difference between these two groups was of no significance. Serum itraconazole levels of injection/oral and oral groups were 672(299-1097) μg/L and 534(210-936) μg/L, respectively (P<0.01).
CONCLUSIONAntifungal prophylaxis with itraconazole in AML patients was effective and safe. Prophylactic effect with injection/oral itraconazole was superior to oral itraconazole solution; moreover, prophylactic effect of itraconazole was highly correlated with its serum level.
Adolescent ; Adult ; Antibiotic Prophylaxis ; Antifungal Agents ; therapeutic use ; Female ; Humans ; Itraconazole ; blood ; therapeutic use ; Leukemia, Myeloid, Acute ; drug therapy ; microbiology ; Male ; Middle Aged ; Mycoses ; etiology ; prevention & control ; Young Adult
9.Diagnosis and treatment of fungal infection after liver transplantation.
Xian-Jie SHI ; Shao-Cheng LÜ ; Lei HE ; Fang LU ; Yu-Rong LIANG ; Ying LUO ; Wen-Bin JI ; Zhi-Ming ZHAO
Chinese Medical Journal 2011;124(7):1015-1017
BACKGROUNDLiver transplantation is the most effective treatment for end-stage liver diseases; however, infections after transplantation can seriously affect the patient's health. The aim of this research was to investigate the diagnosis and treatment of fungal infection following liver transplantation.
METHODSClinical data for 232 liver transplant patients at risk of fungal infection were examined for the presence of fungus in the blood, fluid, sputum, urine and stools of patients and by chest or abdominal CT scans. Patients diagnosed with a fungal infection were treated with Fluconazole or, if this was not effective, Voriconazole or Amphotericin B. Immunosuppressive therapy was also reviewed.
RESULTSThirty-seven of 232 (15.9%) patients were diagnosed with a fungal infection, which occurred 4 to 34 days post-transplantation. Candida infections were diagnosed in 23 cases (62.2%) and Aspergillus infections in 12 cases (32.4%). Twenty-one cases were effectively treated with Fluconazole, 11 cases with Voriconazole, and two cases with Amphotericin B; however, three cases were not effectively treated with any of the antifungal agents. Overall, treatment was effective in 91.9% of patients.
CONCLUSIONSFungal infection has a significant influence on survival rate after liver transplantation. Imaging studies, and pathogenic and biopsy examinations can diagnose fungal infections, which can be effectively treated with antifungal agents such as Fluconazole, Voriconazole or Amphotericin B.
Adult ; Amphotericin B ; therapeutic use ; Antifungal Agents ; therapeutic use ; Female ; Fluconazole ; therapeutic use ; Humans ; Liver Transplantation ; adverse effects ; Male ; Mycoses ; diagnosis ; drug therapy ; etiology ; Pyrimidines ; therapeutic use ; Triazoles ; therapeutic use ; Voriconazole
10.Bilateral Peripheral Infiltrative Keratitis After LASIK.
Sung Woon MOON ; Yong Hwan KIM ; Seung Chan LEE ; Mi Ae LEE ; Kyung Hyun JIN
Korean Journal of Ophthalmology 2007;21(3):172-174
PURPOSE: To present a case of peripheral infiltrative keratitis mimicking infectious keratitis on the flap margin and limbus, which appeared on the first postoperative day after the laser in situ keratomileusis (LASIK). METHODS: A 36-year-old woman who underwent uneventful bilateral simultaneous LASIK developed multiple round infiltrate along the flap margin reaching to limbus from the 11 o'clock to 6 o'clock area in both eyes. RESULTS: The flap was lifted and irrigation was performed with antibiotics. but infiltration seemed to appear again. The infiltrate was more concentrated at the periphery and was extended to the limbus. Direct smear and culture for bacteria and fungus were negative. Topical prednisolone acetate 1% eye drops was added, infiltrative condition was resolved. CONCLUSIONS: LASIK induced peripheral infiltrative keratitis, in which infectious origin was ruled out, is reported.
Adult
;
Anti-Inflammatory Agents/therapeutic use
;
Bacterial Infections
;
Diagnosis, Differential
;
Female
;
Humans
;
Keratitis/diagnosis/drug therapy/*etiology/microbiology
;
Keratomileusis, Laser In Situ/*adverse effects
;
Mycoses
;
Prednisolone/analogs & derivatives/therapeutic use
;
Surgical Flaps/adverse effects