Amphotericin-B/caspofungin/voriconazole
- PDF / 175,949 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 26 Downloads / 155 Views
S
Scopulariopsis/Microascus infection: 3 case reports In a retrospective review of 157 patients, who received lung transplantation from March 2017 to December 2018, three men aged 61–68 years were described, who developed Scopulariopsis/Microascus infection while receiving amphotericin B, caspofungin and voriconazole as antifungal treatment [not all dosages, routes and duration of treatments to reactions onsets stated]. Case 1: A 67‐year‐old man, who had chronic hypersensitivity pneumonitis (CHP), underwent left lung transplantation on 09 September 2017. He started receiving caspofungin and inhaled amphotericin B as prophylactic antifungal treatment. He was also receiving other concomitant medications. Subsequently, he was diagnosed with invasive tracheobronchial aspergillosis and started receiving IV voriconazole. On 18 October 2017, bronchoscopy showed improvement, and IV voriconazole was switched to oral administration. On 02 January 2018 (92 days after voriconazole administration), he was admitted to the hospital because of an influenza infection. The culture of bronchoalveolar lavage fluid (BALF) and bronchial mucosa biopsies showed Microascus species and molecular sequencing confirmed it as Microascus gracilis. Following the administration of oseltamivir, his condition improved rapidly. A repeat bronchoscopy revealed smooth bronchial mucosa with no obvious hyperaemia and secretion. A repeated GM and BALF culture were also negative. Treatment with voriconazole was stopped. Thereafter, he was regularly followed‐up. Case 2: A 68‐year‐old man, who had end‐stage chronic obstructive pulmonary disease (COPD), underwent bilateral lung transplantation on 15 June 2018. He started receiving caspofungin and inhaled amphotericin B as prophylactic antifungal treatment. He was also receiving other concomitant medications. On 14 September 2018, his BALF culture detected Enterobacter cloacae, Pseudomonas putida and Aspergillus flavus and he started receiving IV voriconazole along with other drugs. There was no decrease in sticky secretion in the bronchus; hence, caspofungin was added to the therapy on 28 September 2018. A repeat BALF GM and culture were negative. On 30 October 2018, treatment with voriconazole was withdrawn. On 29 September 2018, (10 days after voriconazole administration), a repeat culture of BALF identified Microascus gracilis. Thereafter, he was regularly followed‐up, and during follow-up, his BALF was negative for Microascus gracilis. Case 3: A 61-year-old man, who had end‐stage COPD, was treated with different medications. A culture of sputum showed Aspergillus fumigatus and Mycobacterium avium. Subsequently, he was treated with oral voriconazole along with other drugs. On 04 March 2018, he underwent bilateral lung transplantation. Following transplantation, he was started on caspofungin and inhaled amphotericin B. Concomitantly, he received some other medications. On 10 May 2018, he complained of nocturnal dyspnoea with cough, sticky sputum and lower extr
Data Loading...