論文 - 詳細
| RRC ID | 47015 |
|---|---|
| 著者 | Saito T, Shime N, Itoh K, Fujita N, Saito Y, Shinozaki M, Shibuya K, Makimura K, Hashimoto S. |
| タイトル | Disseminated aspergillosis following resolution of Pneumocystis pneumonia with sustained elevation of beta-glucan in an Intensive Care Unit: a case report. |
| ジャーナル | Infection |
| Abstract |
Invasive aspergillosis is a major cause of morbidity and mortality in immunocompromised patients receiving intensive care. The double-sandwich ELISA for galactomannan is reported to have a high sensitivity (96.5%) for the detection of invasive aspergillosis when a cut-off value of 0.8 ng/ml is used. However, we have experienced a case of lethal disseminated aspergillosis in a patient that presented with a negative galactomannan (GM) test and persistent elevation of beta-D glucan (BG) levels. A 63-year-old female was admitted to our Intensive Care Unit (ICU) in acute respiratory failure and elevated BG. She had been receiving medication for Good-pasture syndrome based on anti-glomerular basement membrane antibodies and myeloperoxidase-antineutrophil cytoplasmic antibodies for 9 months and was receiving long-term prednisolone therapy (20 mg/day). On admission, her trachea was immediately intubated, and a PCR analysis of the bronchoalveolar lavage sample revealed Pneumocystis jiroveci. Trimethoprimsulfamethoxazole therapy was started for Pneumocystis pneumonia. The levels of BG remained elevated (> 100 pg/ml) during the treatment period despite the clinical resolution of Pneumocystis pneumonia, raising concerns of another complicated invasive fungal disease; consequently, fosfluconazole was administered empirically. The serum BG levels, however, did not decrease. Blood cultures did not detect a fungal infection. Serum GM levels measured by a double-sandwich ELISA on the 6th, 11th, and 24th days in the ICU were negative (< 0.2 ng/ml). The patient ultimately died of multiple organ failure on the 45th ICU day. Postmortem examination revealed a disseminated fungal infection with aggressive vascular invasion of the lungs, heart, and brain. In situ hybridization with a 568-bp probe of the alkaline proteinase sequence of Aspergillus fumigatus showed specific positive staining within the fungus present in the infected lung tissue, revealing that this patient may have had a systemic infection by A. fumigatus or A. flavus. This is a case of serum GM-negative disseminated aspergillosis pathologically proven by autopsy. Persistent elevated BG levels (> 100 pg/ml) refractory to trimethoprim-sulfamethoxazole and fosfluconazole may suggest possible Aspergillus infection and should prompt the initiation of empiric anti-aspergillosis therapies in patients at risk for fungal infection. |
| 巻・号 | 37(6) |
| ページ | 547-50 |
| 公開日 | 2009-12-1 |
| DOI | 10.1007/s15010-009-8108-5 |
| PMID | 19730788 |
| MeSH | Antifungal Agents / therapeutic use Aspergillosis / diagnosis* Aspergillosis / microbiology Aspergillosis / pathology Aspergillus / isolation & purification Brain / microbiology Fatal Outcome Female Galactose / analogs & derivatives Heart / microbiology Humans Immunosuppressive Agents / adverse effects Immunosuppressive Agents / therapeutic use Intensive Care Units Lung / microbiology Mannans / blood Middle Aged Pneumocystis carinii / isolation & purification Pneumonia, Pneumocystis / diagnosis* Pneumonia, Pneumocystis / drug therapy* Pneumonia, Pneumocystis / microbiology Prednisolone / adverse effects Prednisolone / therapeutic use Trimethoprim, Sulfamethoxazole Drug Combination / therapeutic use beta-Glucans / blood* |
| IF | 3.04 |
| 引用数 | 7 |
| WOS 分野 | INFECTIOUS DISEASES |
| オルトメトリクス指標 |
オルトメトリクス指標項目
|
| 最多言及媒体 | X(Twitter) |
| 各媒体での言及数の合計 | 1 |
| 過去6か月間でのオルトメトリクス指標の変動値 | 0.0 |
| リソース情報 | |
| 病原微生物 | |