RESUMEN
We report a case of cerebral phaeohyphomycosis, a fungal brain infection due to a dark (dematiaceous) fungi in a 6-year-old French Guyanese boy. The child presented fever and drowsiness due to several paraventricular brain abscesses. Neurological surgeries were performed to reduce intracranial hypertension and to obtain abscess biopsies. Mycological cultures of intraoperative samples led to the diagnosis of cerebral phaeohyphomycosis due to Cladophialophora bantiana. The patient neurological status deteriorated and remained critical after several weeks of combination antifungal therapy with voriconazole 8mg/kg/day, liposomal amphotericin B 10mg/kg/day and flucytosine 200mg/kg/day. A complete surgical resection was not possible because of multiple small abscesses. A multidisciplinary ethical staff decided on home medical care with palliative ventriculoperitoneal shunt, nasogastric feeding and analgesics. One year later, the patient's neurological condition had improved and cerebral lesions had regressed, while he had not received any antifungal treatment but only traditional medicines. Cerebral phaeohyphomycosis are rare diseases affecting immunocompromised but also apparently non-immunocompromised patients, as in this case. A complete surgical resection is not always possible and mortality rates are high in spite of treatments with a combination of antifungals. The diagnosis may be difficult because of these dematiaceous fungi's slowly growing and their potential pathogenicity for laboratory staff.
Asunto(s)
Ascomicetos/aislamiento & purificación , Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico , Feohifomicosis Cerebral/diagnóstico , Antifúngicos/uso terapéutico , Ascomicetos/fisiología , Absceso Encefálico/diagnóstico , Absceso Encefálico/microbiología , Absceso Encefálico/terapia , Infecciones Fúngicas del Sistema Nervioso Central/microbiología , Infecciones Fúngicas del Sistema Nervioso Central/terapia , Feohifomicosis Cerebral/microbiología , Feohifomicosis Cerebral/terapia , Niño , Terapia Combinada , Nutrición Enteral , Guyana Francesa , Humanos , Inmunocompetencia , Intubación Gastrointestinal , Masculino , Procedimientos Neuroquirúrgicos , Derivación VentriculoperitonealRESUMEN
The in vitro stability of archaeosomes made from novel synthetic membrane-spanning tetraether lipids was evaluated in conditions mimicking those of oral route application in terms of bile salts, serum and low pH..