Aspergillus Nidulans in the CNS

[V. Scalo]

PLEASE HELP wrote:
> 
> 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.
I am not an expert, but my mycology text by
bryce Kendrick
has a refernce to a 14 year old who was infected with Aspergillus
flavus. a very resistant strain

He stated it was a colleague that treated the patient
perhaps you can reach Dr. Kendrick
I believe he may still be at the University of Waterloo ?Canada? Ontario

the ref is The Fufth Kingdom 2nd ed. p. 351.

Kendrick gives these as possible treatments:
(KI) potassium iodide
Nystatin for candidiasas
Miconazole side effects nausea and phlebitis 
Amphotericin B and 5-flourcytosine for cryptococcosis
Griseofulvin
Ketoconazole (Nizoral) 1981 side effects adrenal suppresion and aspermia
and imptence in males

Other refernces, which I am sorry to say I don't have are:

Medical Mycology (1977) Emmons
 Medical Mycology (1988) Rippon
Antifungal Chemotherapy (1980) Speller
Aspergillus and Aspergillosis(1987) Vanden Bossche, Mackenzie and G.
Cauwenbergh


I hope this helps
perhaps a combined drug therapy would be more succesful?
-- 
V. Scalo
Signal Station 71
128 Henry Street, East Haven, CT 06512-4757
FAX 1-(203)458-0560    http://pw2.netcom.com/~vinscal/