1. Antigen detection in the diagnosis and management of a patient with probable cerebral aspergillosis treated with voriconazole.
- Author
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Machetti M, Zotti M, Veroni L, Mordini N, Van Lint MT, Bacigalupo A, Paola D, and Viscoli C
- Subjects
- Adolescent, Antifungal Agents pharmacokinetics, Aspergillosis diagnosis, Aspergillus isolation & purification, Drug Therapy, Combination, Humans, Male, Maxillary Sinus microbiology, Neuroaspergillosis diagnosis, Precursor Cell Lymphoblastic Leukemia-Lymphoma therapy, Pyrimidines pharmacokinetics, Triazoles pharmacokinetics, Voriconazole, Antifungal Agents therapeutic use, Aspergillosis drug therapy, Bone Marrow Transplantation adverse effects, Neuroaspergillosis drug therapy, Pyrimidines therapeutic use, Triazoles therapeutic use
- Abstract
This report describes the diagnosis and management of a 16-year-old boy who developed neurological signs and symptoms suggestive of cerebral aspergillosis following a haploidentical bone marrow transplant. A new sandwich enzyme-linked immunosorbent assay (ELISA) for the detection of Aspergillus galactomannan circulating antigens (Platelia Aspergillus, Sanofi Diagnostic Pasteur, France) was used on serum and cerebrospinal fluid to obtain a presumptive diagnosis and to monitor the course of the disease. Having failed conventional therapy with amphotericin B, the patient received compassionate treatment with voriconazole for a period of 37 days. High levels of voriconazole were observed in both serum and cerebrospinal fluid (CSF), with a trend toward accumulation. After 7 days a marked improvement in the patient's neurological symptoms was noted, and ELISA data indicated a corresponding decrease in Aspergillus galactomannan levels in both serum and CSF. Voriconazole was well tolerated, with only transient increases in ALT/AST recorded during therapy. Although the patient survived the acute Aspergillus infection, he subsequently died of an unrelated infection.
- Published
- 2000
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