Antigen detection in the diagnosis and management of a patient with probable cerebral aspergillosis treated with voriconazole.
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.
Machetti
M
M
National Institute for Cancer Research, Genoa, Italy.
Zotti
M
M
Veroni
L
L
Mordini
N
N
Van Lint
M T
MT
Bacigalupo
A
A
Paola
D
D
Viscoli
C
C
D000293:Adolescent; D000935:Antifungal Agents / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001228:Aspergillosis / Q000175:diagnosis / Q000188:drug therapy*; D001230:Aspergillus / Q000302:isolation & purification; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000382:microbiology; D020953:Neuroaspergillosis / Q000175:diagnosis / Q000188:drug therapy*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D011743:Pyrimidines / Q000493:pharmacokinetics / Q000627:therapeutic use*; D014230:Triazoles / Q000493:pharmacokinetics / Q000627:therapeutic use*; D065819:Voriconazole
D000935:Antifungal Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole