1/10. Fungal discitis due to Aspergillus terreus in a patient with acute lymphoblastic leukemia.We report a case of Aspergillus terreus discitis which developed in a patient with acute lymphoblastic leukemia following induction chemotherapy. A. terreus was isolated from sputum, one month earlier, but the physician did not consider it significant at the time. magnetic resonance imaging study showed the involvement of L3-4, L4-5 and L5-S1 intervertebral discs. Etiology was established by means of histology and culturing a surgical specimen of disc materials. Our patient survived after a surgical debridement and amphotericin b administration with a total dose of 2.0 g. discitis caused by Aspergillus terreus is a very rare event. A. terreus is one of the invasive Aspergillus species. The pathogenetic mechanism is discussed and the literature is reviewed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. aspergillus fumigatus infection in a mega prosthetic total knee arthroplasty: salvage by staged reimplantation with 5-year follow-up.Fungal infection after total joint arthroplasty is an extremely serious complication and a challenge to the treating physician. When a fungal infection is compounded by a massive allograft or a metallic segmental replacement of the femur or other long bone, treatment options become increasingly limited and commonly have led to arthrodesis or amputation of the infected limb. We present the first case report of a low-grade osteosarcoma treated with a segmental distal femoral allograft prosthetic composite knee arthroplasty, which was complicated by infection with aspergillus fumigatus. This complication was treated successfully with a staged reimplantation procedure, intravenous amphotericin, and oral fluconazole suppression. At 5 years after reimplantation, the patient has had no evidence of infection, no pain, and excellent range of motion without extensor lag. The knee Society knee score improved from 50 to 100, and the function score improved from 40 to 100 (for both scores, 100 is the maximum).- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. Disseminated aspergillosis following infliximab therapy in an immunosuppressed patient with Crohn's disease and chronic hepatitis c: a case study and review of the literature.A 55-year-old white woman with a greater than 25-year history of Crohn's disease developed disseminated aspergillosis following combination therapy with methylprednisolone, azathioprine, and infliximab. The patient was hospitalized 11 days after initiation of infliximab for respiratory symptoms and developed respiratory failure, coma, and died. Postmortem examination revealed disseminated aspergillus fumigatus involving multiple organs. This case demonstrates that combined treatment with infliximab, methylprednisone, and azathioprine may induce severe immunosuppression and depressed cellular immunity, leading to severe opportunistic infections. Given the increasing use of antitumor necrosis factor agents, physicians should be aware of the risk of opportunistic infections and be vigilant about diagnosing and aggressively treating these infections to reduce the risk of disseminated disease.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. Pleural aspergillosis with bronchopleurocutaneous fistula and costal bone destruction: a case report.A 65-year-old man who, when young, had had tuberculosis treated by therapeutic pneumothorax, consulted his family physician for a constitutional syndrome and dyspnea. At this time radiologic studies showed left pleural effusion with bilateral calcified plaques, an infiltrate in the upper left lobe, and a picture compatible with aspergilloma, all suggesting semi-invasive aspergillosis. The patient failed to show up for his followup visit, so no therapy could be started or further diagnostic tests ordered. One month later he was admitted to this hospital for a bronchopleural fistula (empyema necessitatis) with subsequent spontaneous hydropneumothorax and costal bone involvement. The patient underwent surgery because of his rapid worsening condition. biopsy examination revealed a large pleural aspergilloma. Despite immediate antifungal therapy, the patient died. We believe this to be the first report of pleural Aspergillus with a bronchopleurocutaneous fistula and costal bone destruction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. aspergillus flavus endocarditis--to prevaricate is to posture.Fungal endocarditis represents both a diagnostic and therapeutic challenge to the treating team. The critical care physician will see a rising incidence as older and more immuno-compromised patients are being supported in their intensive care units. Aspergillus sp. endocarditis represents less than 25% of all cases of fungal endocarditis and is associated with a mortality of around 80%. early diagnosis may assist with definitive management. We review a case of Aspergillus endocarditis, and review the literature as to optimal methods of detection, imaging modalities of choice, and management, both surgical and medical.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. Invasive Aspergillus infections complicating coronary artery bypass grafting.Endovascular infection with Aspergillus species results in unacceptably high mortality of greater than 80% in most series. Failure to recognize the infection early during its clinical course contributes to its formidable lethality. blood cultures almost never reveal organisms, as in our Cases 1 and 2. When considering a patient with fever, changing murmur, major systemic emboli, or splenomegaly, and with blood cultures negative for organisms months or even years after cardiac surgery, therefore, the physician should maintain a high index of suspicion for fungal endocarditis. The best opportunity to establish the diagnosis antemortem rests in careful histopathologic and microbiologic examination of infected emboli and vegetations. Most authors agree that a combined approach employing early valve replacement and aggressive antifungal chemotherapy with amphotericin b and perhaps flucytosine or rifampin represents the best option for treatment of endovascular Aspergillus infections.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. epidural abscess, vertebral destruction, and paraplegia caused by extending infection from an aspergilloma.An aspergilloma developed in a lung cyst in a 53-year-old man. Aspergillus infection then contiguously spread to the epidural space, causing an abscess, vertebral destruction, and paraplegia at the level of T4. Chronic alcoholism, liver cirrhosis, and corticosteroid treatment may have been predisposing factors in this patient. Although Aspergillus epidural abscess has been described infrequently, this complication has not been described in association with an aspergilloma. Symptoms, signs, or roentgenographic or laboratory findings suggestive of vertebral or meningeal pathologic lesions in patients with aspergilloma should alert the physician to the possibility of contiguous spread of infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. Invasive aspergillosis of the central nervous system.Advancing technology permits aggressive medical interventions that are often lifesaving, yet place the patient's immune system in temporary jeopardy. During the interval of immunocompromise, physicians must maintain vigilance for opportunistic infection by saprophytic organisms such as Aspergillus. Although the lung is the most common site of infection by this fungus, subsequent hematogenous dissemination with central nervous system involvement may occur. Currently, the majority of Aspergillus infections of the central nervous system remain unrecognized until the patient's demise. The clinical and pathological features of aspergillosis of the central nervous system are reviewed in order to promote earlier diagnosis and treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. cystic fibrosis in an elderly woman.cystic fibrosis (CF) is thought of by most physicians as a disease of children. Advances in therapy have extended the life span of patients so that many pulmonary internists have responsibility for the care of young adults with CF. Nevertheless, the initial diagnosis of CF after the age of 30 years is unusual, and a diagnosis after the age of 60 years is rare. Such a case is reported here.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. Acute community-acquired pneumonia due to Aspergillus in presumably immunocompetent hosts: clues for recognition of a rare but fatal disease.This article reports a case of acute community-acquired pneumonia due to aspergillus fumigatus in a healthy patient and reviews 11 previously reported cases occurring in presumably immunocompetent hosts. The diagnosis was delayed for all patients; mortality was 100%. Clues that might suggest Aspergillus as a pathogen in community-acquired pneumonia include a chest radiograph revealing diffuse infiltrates or new cavitation; lack of bacterial or viral cause; a preceding influenza A infection; and respiratory secretion cultures positive for Aspergillus. When these clues are present, the physician should consider an early biopsy of lung tissue. Increased recognition and more timely diagnosis in future cases will improve the outcome of this rare but fatal infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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