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Disseminated fungal infection 5/23/2013 hammoud

Amir Ali soultani A 4 year old boy who was admitted in 7-1- 92 , due to fever ,abdominal pain , and anorexia since 3 weeks. CBC: WBC:3500(10% blast)-Hb:8-PLT: BMA: full blast- ALL CD10,19,22: + 5/23/2013 hammoud

During the last days of induction (prednisone tapering) he had signs of septic shock and was transferred to ICU: Hypotension Fever ARDS Pleural effusion DIC Respiratory distress 5/23/2013 hammoud

B/C: klebsiella pneumonia S: Tazosin-Cipro-Amika R: Meropnem 5/23/2013 hammoud

After clinical and lab recovery, the patient had fever and cough CT: disseminated pulmonary nodules and hypo dense lesions in spleen and kidney compatible with IFI 5/23/2013 hammoud

Since the patient was on voriconazole for 2 weaks , he was treated with Ampho+ caspo Galactomannan: 0.9 before sepsis 2.4-2.5 (BAL-blood) 5/23/2013 hammoud

BEFORE AMPHO +CASPHO 5/23/2013 hammoud

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AFTER AMPHO +CASPHO 5/23/2013 hammoud

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Is there any relation between bacterial sepsis and IFI? What is the preferred anti fungal therapy? 5/23/2013 hammoud

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UP TO DATE Caspofungin: Caspofungin, an echinocandin, has been approved by the US FDA for the treatment of invasive aspergillosis in patients who cannot tolerate or who are refractory to standard therapy . It is not utilized for primary therapy of invasive aspergillosis because of a lack of data in this setting; it is used for salvage therapy, often in combination with another antifungal drug 5/23/2013 hammoud

UP TO DATE Liposomal amphotericin B and caspofungin : Prior to the availability of voriconazole, there was substantial interest in combination regimens of liposomal amphotericin B (AmBisome) and caspofungin for invasive aspergillosis. This combination has shown some benefit compared with liposomal amphotericin monotherapy, but has not been compared with voriconazole monotherapy 5/23/2013 hammoud

FEIGIN GALACTOMANNAN ANTIGEN TESTING: Galactomannan (GM) is a major cell wall component of Aspergillus, and the highest concentrations of GM are always released in the terminal phases of the diseas 5/23/2013 hammoud