Successful treatment of Aspergillus ventriculitis through voriconazole adaptive pharmacotherapy, immunomodulation, and therapeutic monitoring of cerebrospinal fluid (1→3)-β-D-glucan.

Autor:	Chen TK; Pediatric Infectious Diseases, Department of Pediatrics, Miller Children's and Women's Hospital, Long Beach, CA, USA.; University of California, Irvine, Irvine, CA, USA., Groncy PK; Hematology-Oncology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA., Javahery R; Neurosurgery, Long Beach Memorial Medical Center, Miller Children's and Women's Hospital, Long Beach, CA, USA., Chai RY; Radiology, Long Beach Memorial Medical Center, Miller Children's and Women's Hospital, Long Beach, CA, USA., Nagpala P; Endocrinology, Department of Pediatrics, Miller Children's and Women's Hospital, Long Beach, CA, USA., Finkelman M; Associates of Cape Cod, Inc., East Falmouth, MA, USA., Petraitiene R; Transplantation-Oncology Infectious Diseases Program and Infectious Diseases Translational Research Laboratory, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA., Walsh TJ; Transplantation-Oncology Infectious Diseases Program and Infectious Diseases Translational Research Laboratory, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA thw2003@med.cornell.edu.; Departments of Pediatrics, and Microbiology & Immunology, Weill Cornell Medicine, New York, NY, USA.
Jazyk:	angličtina
Zdroj:	Medical mycology [Med Mycol] 2017 Jan 01; Vol. 55 (1), pp. 109-117. Date of Electronic Publication: 2016 Nov 12.
DOI:	10.1093/mmy/myw118
Abstrakt:	Aspergillus ventriculitis is an uncommon but often fatal form of invasive aspergillosis of the central nervous system (CNS). As little is known about the diagnosis, treatment, and outcome of this potentially lethal infection, we report the strategies used to successfully treat Aspergillus ventriculitis complicating a pineal and pituitary germinoma with emphasis on the critical role of adaptive pharmacotherapy of voriconazole and serial monitoring of (1→3)-β-D-glucan in cerebrospinal fluid. We describe several rationally based therapeutic modalities, including adaptive pharmacotherapy, combination therapy, sargramostim-based immunomodulation, and biomarker-based therapeutic monitoring of the CNS compartment. Through these strategies, our patient remains in remission from both his germinoma and Aspergillus ventriculitis making him one of the few survivors of Aspergillus ventriculitis. (© The Author 2016. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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