RESUMEN
Aspergillus species are a major cause of life-threatening infections in immunocompromised hosts, and the most common pathogen of invasive aspergillosis is Aspergillus fumigatus. Recently, the development of molecular identification has revealed cryptic Aspergillus species, and A. felis is one such species within the Aspergillus section Fumigati reported in 2013. We describe a case of invasive pulmonary aspergillosis caused by A. felis in a 41-year-old Japanese woman diagnosed with myelodysplastic syndrome. She presented with fever 19 days after undergoing autologous peripheral blood stem cell transplantation and was clinically diagnosed with invasive pulmonary aspergillosis. Bronchoscopy and bronchoalveolar lavage were performed for definitive diagnosis. The ß-tubulin genes of the mold isolated from the bronchoalveolar lavage fluid, and sequenced directly from the PCR products using a primer pair were found to have 100% homology with A. felis. We successfully treated the patient with echinocandin following careful susceptibility testing. To the best of our knowledge, this is the first published case reporting the clinical course for diagnosis and successful treatment of invasive aspergillosis by A. felis.
Asunto(s)
Antifúngicos/uso terapéutico , Aspergillus fumigatus/aislamiento & purificación , Huésped Inmunocomprometido/inmunología , Aspergilosis Pulmonar Invasiva/microbiología , Administración Intravenosa , Adulto , Antifúngicos/farmacología , Aspergillus fumigatus/efectos de los fármacos , Líquido del Lavado Bronquioalveolar/microbiología , Quimioterapia Combinada/métodos , Femenino , Humanos , Aspergilosis Pulmonar Invasiva/tratamiento farmacológico , Aspergilosis Pulmonar Invasiva/inmunología , Pruebas de Sensibilidad Microbiana , Síndromes Mielodisplásicos/inmunología , Síndromes Mielodisplásicos/terapia , Trasplante de Células Madre de Sangre Periférica/efectos adversosRESUMEN
Invasive aspergillosis is one of the most important and fatal complications after liver transplant, especially in patients with involvement of the central nervous system. We present a case of a patient who developed cerebral and pulmonary aspergillosis, coinfected with cytomegalovirus, after liver transplant for toxic fulminant hepatitis. The patient was treated successfully with neurosurgical intervention and voriconazole. Voriconazole is considered more effective in cerebral aspergillosis than other anti-fungal agents due to the greater penetration into central nervous system and higher cerebrospinal fluid and brain tissue levels.