Sánchez-Olivo N, Rojas-Zavala CLC, Saldaña-Marroquín LR, Chalita-Joanny H, Perales-Martínez DE

Language: Spanish
References: 12
Page: 160-162
PDF size: 160.31 Kb.

ABSTRACT

Invasive aspergillosis is a severe fungal infection that primarily affects immunocompromised patients. The case of a 49-year-old male patient with rheumatoid arthritis diagnosed six years ago, who had abandoned treatment, is described. He has a febrile syndrome and acute neurological deterioration due to viral encephalitis, which was later complicated by multiple brain abscesses resulting from the regional extension of severe fungal sinusitis.
Microbiological studies confirmed herpes simplex virus type 1 (HSV-1) infection in cerebrospinal fluid (CSF) through PCR molecular panel testing. Additionally, in nasosinusal tissue culture was identified Aspergillus fumigatus, along with bacterial superinfection caused by multidrug-resistant Enterobacteriaceae.
Despite timely management with the antiviral of choice, antifungal agents, targeted antibiotics, and hemodynamic support, the patient developed multiple organ failure (renal, hematologic, neurological, and respiratory). He received palliative care due to the poor prognosis, with a fatal outcome.

REFERENCES

1. Patterson, T.F. et al., “Practice guidelines for the diagnosisand management of aspergillosis: 2016 update bythe Infectious Diseases Society of America”, Clin InfectDis, 2016, 63 (4): e60.

2. Kousha, M., Tadi, R. y Soubani, A.O., “Pulmonary aspergillosis:a clinical review”, Eur Respir Rev, 2011, 20(121): 156-174.

3. Denning, D.W. et al., “Aspergillosis: diagnosis and treatment”,Clinical Microbiology and Infection, 2021, 27 (3):e36-e39.

4. Latgé, J.P. y Chamilos, G., “Aspergillus fumigatus and aspergillosisin 2019”, Clin Microbiology Rev, 2020, 33 (1).

5. Walsh, T.J., Anaissie, E.J., Denning, D.W. et al., “Treatmentof aspergillosis: clinical practice guidelines of theInfectious Diseases Society of America”, Clin Infect Dis,2008, 46 (3): 327-360.

6. Segal, B.H., “Aspergillosis”, N Engl J Med, 2009, 360(18): 1870-1884.

7. Marr, K.A., Schlamm, H.T., Herbrecht, R. et al., “Combinationantifungal therapy for invasive aspergillosis: arandomized trial”, Ann Intern Med, 2015, 162 (2): 81-89.

8. Hoenigl, M., Salmanton-García, J., Walsh, T.J. et al.,“Global guideline for the diagnosis and management ofrare mold infections: an initiative of the European Confederationof Medical Mycology and the InternationalSociety for Human and Animal Mycology”, Lancet InfectDis, 2021, 21 (8): e246-e257.

9. Herbrecht, R., Patterson, T.F., Slavin, M.A. et al., “Isavuconazoleversus voriconazole for primary treatment ofinvasive mould disease caused by Aspergillus and otherfilamentous fungi (secure): a phase 3, randomised-controlled,non-inferiority trial”, Lancet, 2016, 387 (10020):760-772.

10. Baddley, J.W., Thompson, G.R., Chen, S.C. et al., “Isavuconazolein the treatment of invasive aspergillosis andmucormycosis: clinical experience with new antifungaltherapies”, Mycoses, 2020, 63 (3): 102-111.

11. Herbrecht, R. et al., “Voriconazole versus amphotericinb for primary therapy of invasive aspergillosis”, N Engl JMed, 2002, 347 (6): 408-415.

12. Hedayati, M.T., Pasqualotto, A.C., Warn, P.A. et al.,“Aspergillus flavus: human pathogen, allergen andmycotoxin producer”, Microbiology, 2007, 153 (Pt 6):1677-1692.