RESUMEN
Disseminated infection by Hormographiella aspergillata is extremely rare and small intestine involvement has not been reported previously. A 51-year-old man with myelodysplastic syndrome developed pneumonia after cord blood cell transplantation. Fungal growth from the biopsied lung was identified as H. aspergillata by morphology and the gene analysis. Although antifungal agents including voriconazole and liposomal amphotericin B were administered, he died of disseminated H. aspergillata infection. We review the literature and discuss the treatment and prognosis.
Asunto(s)
Agaricales/patogenicidad , Antifúngicos/uso terapéutico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Terapia de Inmunosupresión/efectos adversos , Infecciones Fúngicas Invasoras/microbiología , Enfermedades Raras/microbiología , Agaricales/genética , Agaricales/aislamiento & purificación , Antifúngicos/administración & dosificación , Encéfalo/diagnóstico por imagen , Encéfalo/patología , Infecciones Fúngicas del Sistema Nervioso Central/sangre , Infecciones Fúngicas del Sistema Nervioso Central/tratamiento farmacológico , Infecciones Fúngicas del Sistema Nervioso Central/etiología , Infecciones Fúngicas del Sistema Nervioso Central/patología , ADN de Hongos , Enfermedad Injerto contra Huésped/prevención & control , Humanos , Terapia de Inmunosupresión/métodos , Inmunosupresores/administración & dosificación , Inmunosupresores/uso terapéutico , Enfermedades Intestinales/sangre , Enfermedades Intestinales/tratamiento farmacológico , Enfermedades Intestinales/etiología , Enfermedades Intestinales/patología , Intestino Delgado/patología , Infecciones Fúngicas Invasoras/sangre , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/sangre , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/etiología , Enfermedades Pulmonares Fúngicas/patología , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Síndromes Mielodisplásicos/cirugía , Neutropenia/tratamiento farmacológico , Neutropenia/etiología , Neutropenia/microbiología , Enfermedades Raras/sangre , Enfermedades Raras/tratamiento farmacológico , Análisis de Secuencia de ADN , Tomografía Computarizada por Rayos X , Acondicionamiento Pretrasplante/efectos adversos , Acondicionamiento Pretrasplante/métodos , Trasplante Homólogo/efectos adversosRESUMEN
Fifteen double-blind placebo-controlled studies in pollen and mould asthma have been carried out, the majority with grass pollen immunotherapy. Despite certain methodological limitations, the clinical efficacy was demonstrated in all studies performed. A decrease in specific immediate skin reactivity is relatively common during pollen and mould immunotherapy. In several studies the efficacy of immunotherapy was further indicated by the change in some functional parameters of the airways that sometimes seem to be related to the clinical results. At the moment available data do not indicate that IgG subclasses are useful in predicting the clinical outcome of immunotherapy. Currently the only methods which truly reflect the efficacy of immunotherapy are clinical evaluations. The effectiveness of this treatment is influenced by the quality of allergens used for immunotherapy and better results will probably be achieved in the future after further allergen purification and standardization.