Aspergillus Nidulans in the CNS
vinscal at ix.netcom.com
Tue Feb 18 01:59:09 EST 1997
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
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
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.
I hope this helps
perhaps a combined drug therapy would be more succesful?
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