RESUMEN
Invasive aspergillosis (IA) is the most common invasive fungal infection following a hematopoietic cell transplant, with emerging cryptic species exhibiting resistance to commonly used antifungals such as azoles. These species have been increasingly found after the introduction of anti-mold prophylaxis. We report a case of a 56-year-old female with primary myelofibrosis whose allogeneic hematopoietic cell transplant was complicated by disseminated fungal infection (skin, lung) due to Aspergillus calidoustus, a cryptic specie. Treatment of Aspergillus species remains challenging as these cryptic species are usually resistant to azoles including voriconazole which is the first line of treatment of IA. Infection was successfully treated with surgical excision and combination antifungal therapy based on in vitro susceptibility and synergy testing. Therapy included isavuconazole, a drug that has been shown to be non-inferior to voriconazole in the treatment of invasive mold infections.
Asunto(s)
Aspergilosis , Aspergillus , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Infecciones Fúngicas Invasoras , Antifúngicos/uso terapéutico , Aspergilosis/tratamiento farmacológico , Aspergilosis/patología , Aspergillus/aislamiento & purificación , Aspergillus/patogenicidad , Azoles/uso terapéutico , Farmacorresistencia Fúngica , Femenino , Humanos , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Infecciones Fúngicas Invasoras/patología , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Nitrilos/uso terapéutico , Mielofibrosis Primaria/complicaciones , Piridinas/uso terapéutico , Triazoles/uso terapéuticoRESUMEN
New antibiotic options are urgently needed for the treatment of carbapenem-resistant Enterobacteriaceae infections. We report a 64-year-old female with prolonged hospitalization following an intestinal transplant who developed refractory bacteremia due to a serine carbapenemase-producing pandrug-resistant isolate of Klebsiella pneumoniae. After failing multiple antimicrobial regimens, the patient was successfully treated.