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2018 | 8 | 2 | 33-37
Article title

Multiple debulking surgery and triple antifungal therapy in abdominal-cardiac-pulmonary invasive aspergillosis

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EN
Abstracts
EN
Children with acute leukemia are at a high risk of invasive fungal disease, which might manifest itself as clinically-resistant entity. The objective of this paper is to present an unusual clinical case of 17-year-old patient treated for acute lymphoblastic leukemia, with early development of disseminated invasive aspergillosis, involving the abdominal, pulmonary and cardiac structures. The patient was subjected to a combined targeted double, and later triple, antifungal therapy together with several debulking surgical interventions. The clinical course indicated a highly clinically-resistant invasive fungal disease, and the treatment was unsuccessful in this case. Limited current experience in triple antifungal therapy, abdominal aspergillosis, Aspergillus endocarditis, and possible causes of failure of antifungal therapy are discussed in the paper.
Discipline
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Journal
Year
Volume
8
Issue
2
Pages
33-37
Physical description
Contributors
  • Clinical Ward of General and Oncological Surgery for Children and Adolescents, Collegium Medicum, Nicolaus Copernicus University, A. Jurasz University Hospital No. 1, Bydgoszcz
  • Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, A. Jurasz University Hospital No. 1, Bydgoszcz
  • Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, A. Jurasz University Hospital No. 1, Bydgoszcz
  • Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, A. Jurasz University Hospital No. 1, Bydgoszcz
  • Department of Radiology and Imaging Diagnostics, Collegium Medicum, Nicolaus Copernicus University, A. Jurasz University Hospital No. 1, Bydgoszcz
  • Department of Microbiology, Collegium Medicum, Nicolaus Copernicus University, A. Jurasz University Hospital No. 1, Bydgoszcz
  • Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University, A. Jurasz University Hospital No. 1, Bydgoszcz, jstyczynski@cm.umk.pl
References
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  • 2. Styczynski J, Czyzewski K, Wysocki M et al. Increased risk of infections and infection-related mortality in children undergoing haematopoietic stem cell transplantation compared to conventional anticancer therapy: a multicentre nationwide study. Clin Microbiol Infect 2016; 22: 179.e1-179.e10.
  • 3. Groll AH, Castagnola E, Cesaro S et al. Fourth European Conference on Infections in Leukaemia (ECIL-4): guidelines for diagnosis, prevention, and treatment of invasive fungal diseases in paediatric patients with cancer or allogeneic haemopoietic stem-cell transplantation. Lancet Oncol 2014; 15: e327-340.
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  • 5. Marr KA, Schlamm HT, Herbrecht R et al. Combination antifungal therapy for invasive aspergillosis: a randomized trial. Ann Intern Med 2015; 162: 81-89.
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  • 7. Petraitiene R, Petraitis V, Groll AH et al. Antifungal efficacy of caspofungin (MK-0991) in experimental pulmonary aspergillosis in persistently neutropenic rabbits: pharmacokinetics, drug disposition, and relationship to galactomannan antigenemia. Antimicrob Agents Chemother 2002; 46: 12-23.
  • 8. Sims-McCallum RP. Triple antifungal therapy for the treatment of invasive aspergillosis in a neutropenic pediatric patient. Am J Health Syst Pharm 2003; 60: 2352-2356.
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  • 11. Demchok JP, Meletiadis J, Roilides E et al. Comparative pharmacodynamic interaction analysis of triple combinations of caspofungin and voriconazole or ravuconazole with subinhibitory concentrations of amphotericin B against Aspergillus spp. Mycoses 2010; 53: 239-245.
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article
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bwmeta1.element.psjd-b550c762-c82e-4641-ba85-4f5c3f21a1f5
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