Aspergillus Nidulans in the CNS

PLEASE HELP domflag at istar.ca
Mon Feb 17 09:04:25 EST 1997


PLEASE HELP!

We are the parents of a nineteen month old Baby Boy with a life threatening
disease.   To our knowledge this is the first case of a fungal infection of
this type known anywhere in the world.   If you can provide any suggestions
for helping our little boy we would be most grateful.

Infection:  Aspergillus Nidulans in the Central Nervous System.   The
fungus surrounds the base of the brain and is present in other locations on
the covering of the meninges.  This was diagnosed following a biopsy taken
from his lumbar region.   Biopsy was taken September 13, 1996.

Cause of Infection:  Unknown

Patient's Present Condition:  Beginning to show signs of Hydrocephalus. 
Vomiting is becoming more frequent, fevers and pain becoming more frequent
and severe.   He is developing a little trouble walking.

Course of Treatment:   Began treatment in September on Amphotericin B and
5FC given by IV.  Treatment was determined to be unsuccessful.   After one
month MRI showed disease had progressed.
The next treatment was Amphotericin Liposomal given by IV and Oral
Itraconazole.   An MRI taken one month after this treatment was started,
appeared to show a slight reduction in the size of the fungal growths,
however a followup MRI taken thirty days later showed the fungus was once
again growing.   At this point the decision was made to put in a reservoir
to administer Ampho B directly into his CSF.   On January 9, 1997 a second
biopsy was taken from his spine.   The biopsy confirmed the fungus was
Aspergillus, but the cultures would not grow so it could not be confirmed
the fungus was Nidulans.
An MRI taken February 3, 1997 has shown that the fungus increased in size
considerably even with this treatment and there are new lesions.
The therapy is now going to be double the dose of Oral Itraconazole
(10mg/kg) and the Itrathecal Amphotericin therapy has been discontinued.  
He is going to be given Gamma Interferon Sub-cutaneously to boose immune
function though no immune deficiency has ever been detected.  He had a
negative result when tested for CGD.





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