Treatment of a critically ill child with disseminated Candida glabrata with a recombinant human antibody specific for fungal heat shock protein 90 and liposomal amphotericin B, caspofungin, and voriconazole.
OBJECTIVE
To report a case of fungal sepsis treated prospectively with liposomal amphotericin, caspofungin, and a novel monoclonal antibody specific for candidal heat shock protein 90 (Mycograb, Neutec Pharma, Manchester, UK).


METHODS
Case report.


METHODS
Pediatric intensive care unit in a tertiary care children's hospital.


METHODS
A 7-yr-old male with a history of global developmental delay, epilepsy, and gastroesophageal reflux, who presented to the emergency department with a transdiaphragmatic herniation of bowel and subsequent Candida glabrata infection.


METHODS
Efungumab 1 mg/kg twice daily for 5 days.


RESULTS
C-reactive protein fell from 225 mg/L to 99 mg/L, and physiological monitoring parameters improved when Mycograb was used in conjunction with high-dose antifungals.


CONCLUSIONS
Mycograb therapy was well tolerated, but further experience with this therapy in children is needed.
Royal Hospital for Sick Children, Glasgow, UK. adam.sutherland@ggc.scot.nhs.uk
Adam
A
Sutherland
David
D
Ellis
D000666:Amphotericin B / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000935:Antifungal Agents / Q000627:therapeutic use*; D041221:Candida glabrata; D002177:Candidiasis / Q000188:drug therapy*; D000077336:Caspofungin; D002648:Child; D016638:Critical Illness; D004359:Drug Therapy, Combination; D054714:Echinocandins / Q000627:therapeutic use*; D018841:HSP90 Heat-Shock Proteins / Q000276:immunology; D006548:Hernia, Diaphragmatic / Q000601:surgery; D006801:Humans; D055666:Lipopeptides; D008297:Male; D011183:Postoperative Complications / Q000188:drug therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use; D018805:Sepsis / Q000188:drug therapy*
D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000935:Antifungal Agents; D054714:Echinocandins; D018841:HSP90 Heat-Shock Proteins; D055666:Lipopeptides; D011994:Recombinant Proteins; C068538:liposomal amphotericin B; D000666:Amphotericin B; C512268:efungumab; D000077336:Caspofungin