1. 5/23/2013
hammoud

2. Disseminated fungal infection
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hammoud

3. Amir Ali soultani
A 4 year old boy who was admitted in , 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

4. 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

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

6. 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

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

8. BEFORE AMPHO +CASPHO
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19. AFTER AMPHO +CASPHO
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27. Is there any relation between bacterial sepsis and IFI?
What is the preferred anti fungal therapy?
5/23/2013
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30. 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

31. 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

32. 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