RESUMEN
AIM: To evaluate the management and outcome of children with dilating vesico-ureteric reflux diagnosed before 2 y of age. METHODS: This retrospective, multicentre study was part of a programme for quality assurance in Sweden. A total of 2309 unselected children, aged 0-2 y, were investigated after the first urinary tract infection. Voiding cystourethrography was performed in a total of 1953 children, of whom 584 had reflux. Of these children, 303 (119 boys and 184 girls) had reflux with dilatation (grade 3-5). RESULTS: Follow-up after 4-6 y was reported in 272 of the 303 children. Spontaneous regression of dilating reflux occurred in more than half of the patients and was significantly more frequent in boys than in girls (p = 0.047). In children with grade 3 reflux and grade 4-5 reflux, there were pyelonephritic recurrences in 18% and 45% of the boys and 28% and 70% of the girls, respectively (p < 0.001). One hundred and eighty-one children (65%) were managed conservatively, 58 (21%) were treated with subureteric injection and 33 (12%) with ureteric reimplantation. There were considerable differences in treatment strategies between centres. CONCLUSION: This study of an unselected cohort of children with urinary tract infection and dilating reflux showed spontaneous resolution of dilating reflux in more than half of the subjects and more often in boys than in girls. Pyelonephritic recurrences were more common in girls than in boys, and more frequent in grade 4-5 reflux than in grade 3. The results indicate important differences between the sexes and that boys and girls should be assessed separately when treatment strategies are studied.
Asunto(s)
Pielonefritis/tratamiento farmacológico , Garantía de la Calidad de Atención de Salud , Reflujo Vesicoureteral/terapia , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios Multicéntricos como Asunto , Pielonefritis/clasificación , Pielonefritis/etiología , Índice de Severidad de la Enfermedad , Distribución por Sexo , Suecia , Infecciones Urinarias/complicaciones , Reflujo Vesicoureteral/clasificación , Reflujo Vesicoureteral/diagnósticoRESUMEN
UNLABELLED: Bone mineral density (BMD) and content (BMC) were measured in nine children treated with corticosteroids for nephrotic syndrome and in age-matched controls, using dual-energy X-ray absorptiometry (DEXA). The urinary excretion of cross-linked N-telopeptide (NTx) released from collagen type I as a specific marker of bone resorption was also measured. There were no significant differences in body size, BMD results or NTx urinary concentrations between patients and controls, nor could any significant differences be found when the six patients given a cumulative corticosteroid dose of >15 g were analysed separately. The lack of significant differences could be due to the small number of patients included in the study. But when the measured BMD and BMC were analysed according to methods that corrected for body size and puberty stage, values well within the normal range were found in patients as well as in controls. There was, however, a significant, negative correlation between the urinary excretion of NTx and the cumulative dose of corticosteroids. CONCLUSION: Despite treatment for long periods with high, cumulative doses of corticosteroids, the skeletons of the patients had a normal mineral content, which is encouraging for all those in need of steroids for nephrotic syndrome. A negative correlation between urinary collagen degradation products and the cumulative steroid dose might point to a reduced growth velocity in patients on high doses of steroids earlier than an effect on bone mineralization.
Asunto(s)
Densidad Ósea/efectos de los fármacos , Colágeno/metabolismo , Glucocorticoides/uso terapéutico , Síndrome Nefrótico/tratamiento farmacológico , Síndrome Nefrótico/metabolismo , Prednisolona/uso terapéutico , Niño , Preescolar , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVE: To study awareness of urinary tract infections (UTIs) by determining the diagnostic rate of first UTI in children <2 years of age and to estimate the minimum incidence. METHODS: Twenty-six of a total of 43 pediatric centers participated in the study. Sixty-four percent of the total childhood population <2 years of age was covered. The number of all children included in the study was used to calculate the diagnostic rate. Only UTI confirmed by either suprapubic aspiration (any growth) or midstream or bag samples with >/=100 000 bacteria/mL, together with a positive nitrite reaction, was used to estimate the minimum incidence. RESULTS: The mean diagnostic rate was 1.5% for boys (range, 0.7%-3.0%) and 1.7% for girls (range, 0.7%-2.9%). The diagnostic rate was significantly higher in June than in December. The mean incidence was 1.0% for both boys and girls (range, 0.3%-3.0% and 0.4%-2.9%, respectively). The minimum cumulative incidence at 2 years of age was estimated to be 2.2% for boys and 2.1% for girls. CONCLUSION: This study suggests a high UTI awareness in Sweden as indicated by a higher diagnostic rate and, despite stricter diagnostic criteria, a higher incidence of UTI in children <2 years of age than previously reported. It is suggested that a high UTI awareness may reduce chronic renal failure because of pyelonephritic renal scarring.
Asunto(s)
Infecciones Urinarias/epidemiología , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Suecia/epidemiologíaRESUMEN
The objective of this study was to evaluate the basis for diagnosis and assessment of children <2 y of age with urinary tract infections (UTI) and to describe their subsequent management as currently practised in Sweden. The study was a prospective, multicentre project as part of a programme for quality assurance. A total of 2309 children (1111M, 1198F) was studied during a 2-y period. Of the population at risk, 1.6% of both boys and girls were diagnosed with a UTI. This represents a minimum figure. Suprapubic bladder aspiration was mainly used during the first year of life, with the highest frequency in the youngest infants. Adhesive bags were used in half of the children, and the frequency increased with age. Imaging of the urinary tract was performed in 97% of the children. Vesicoureteric reflux was the most common finding, occurring in 36% of the girls and 24% of the boys. The presence of dilatation of the upper urinary tract correlated significantly to the presence and grade of reflux. Initial intravenous therapy was given to 31% of the children and long-term antibacterial prophylaxis to 20%. Major differences were found between centres in diagnostic rate, urine sampling technique and the use of parenteral therapy. In conclusion, this study showed a high diagnostic rate of urinary infections in children below 2 y of age. The urine sampling technique was optimal (suprapubic aspiration) in half of the infants, but less reliable in the children above 1 y of age. The frequency of imaging investigations of the urinary tract was high. The strategies for diagnosis and treatment varied considerably among centres.
Asunto(s)
Pediatría/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Garantía de la Calidad de Atención de Salud/organización & administración , Infecciones Urinarias/diagnóstico , Infecciones Urinarias/terapia , Distribución por Edad , Factores de Edad , Antibacterianos/uso terapéutico , Preescolar , Femenino , Fluidoterapia , Humanos , Lactante , Recién Nacido , Masculino , Pediatría/estadística & datos numéricos , Estudios Prospectivos , Factores de Riesgo , Manejo de Especímenes/métodos , Suecia , Urinálisis/métodos , Infecciones Urinarias/etiología , UrodinámicaAsunto(s)
Servicios de Salud del Adolescente/normas , Servicios de Salud del Niño/normas , Competencia Clínica , Pediatría/normas , Garantía de la Calidad de Atención de Salud , Programas de Autoevaluación , Adolescente , Adulto , Niño , Humanos , Pediatría/educación , Encuestas y Cuestionarios , SueciaRESUMEN
In a national survey, chronic renal failure (CRF) in Swedish children was studied during the period 1986-1994; 118 children (72 boys, 46 girls) with CRF, defined as a glomerular filtration rate below 30 ml/min per 1.73 m2 body surface area, were identified. The median annual incidence of CRF was 7.7 and that of terminal renal failure (TRF) 6.4 per million children. The prevalence of preterminal renal failure decreased from 29 to 21 per million children over the study period, while the prevalence of TRF increased from 17.8 in 1986 to 38 per million children in 1994. The increase in TRF prevalence was due to a lower incidence of deaths due to uremia and a slightly increased incidence of TRF compared with an earlier study period, 1978-1985. The results point to a more active treatment of uremia in Sweden now than during the period 1978-1985. The congenital causes of CRF (renal malformations, obstructive conditions, and hereditary disorders) accounted for 67.5% of all cases, which is high compared with data from other countries. No child with non-obstructive pyelonephritis as a cause of CRF was identified. Age at detection of CRF and time from detection of CRF to TRF were studied. As a high proportion of children, 42%, reached 16 years of age without entering TRF, the value of presenting time from CRF to TRF for the remaining individuals is questionable. There were only minor differences in primary renal disease, age at presentation, and time from CRF to TRF when the study results were compared with those from 1978-1985.
Asunto(s)
Fallo Renal Crónico/epidemiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Suecia/epidemiología , Factores de TiempoRESUMEN
BACKGROUND: In Orebro County a 2.5-fold increase in the incidence of Haemophilus influenzae (HI) meningitis was found between 1970 and 1980, an observation that initiated the present study. MATERIALS AND METHODS: In order to search for associations between morbidity in invasive HI infection and possible risk factors, a case-control study was conducted over a 6-year period from 1987 to 1992, before general Hib vaccination was introduced in Sweden. Fifty-four cases with invasive HI infection 139 matched controls were studied for possible risk factors such as day-care outside the home, short duration of breastfeeding, passive smoking, low socioeconomic level of the household, many siblings in the family, allergy, frequent, infections, repeated antibiotic treatments and immunoglobulin deficiency. RESULTS: Multivariate analysis showed a significant association between invasive HI infection and two independent factors, i.e. short duration (< 13 weeks) of exclusive breastfeeding, odds ratio (OR) 3.79 (95% confidence interval [CI] 1.6-8.8) and history of frequent infections, OR 4.49 (95% CI : 1.0-21.0). For the age at onset 12 months or older, the associations were stronger, OR 7.79 (95% CI : 2.4-26.6) and 5.86 (95% CI : 1.1-30.6), respectively. When breastfeeding duration in weeks was analysed as a continuous variable the OR was 0.95 (95% CI : 0.92-0.99), indicating a decreased risk with each additional week. Increased OR were observed for other risk factors as well but not of the magnitude found for short duration of breastfeeding. DISCUSSION: The association of decreased risk for invasive HI infection and long duration of breastfeeding was persisting beyond the period of breastfeeding itself. This finding supports the hypothesis of a long-lasting protective effect of breastfeeding on the risk for invasive HI infection. CONCLUSION: A decreased risk for invasive HI infection with long duration of breastfeeding was found. Our results do have implications for strategies in breastfeeding promotion, especially in countries where Hib vaccination is too costly and not yet implemented.
Asunto(s)
Bacteriemia/inmunología , Lactancia Materna , Infecciones por Haemophilus/epidemiología , Infecciones por Haemophilus/inmunología , Haemophilus influenzae/inmunología , Leche Humana/inmunología , Edad de Inicio , Análisis de Varianza , Bacteriemia/epidemiología , Estudios de Casos y Controles , Preescolar , Femenino , Humanos , Incidencia , Lactante , Modelos Logísticos , Masculino , Estudios Prospectivos , Factores de Riesgo , Distribución por Sexo , Suecia/epidemiologíaRESUMEN
We report on a 6-year-old boy with Xanthogranulomatous pyelonephritis. This unusual type of renal inflammation has a typical clinical picture that is important to bear in mind. The affected child is often seriously ill with a palpable flank mass leading to initial suspicion of malignancy. Modern imaging procedures help in obtaining a pre-operative diagnosis.
Asunto(s)
Riñón/fisiopatología , Pielonefritis Xantogranulomatosa/diagnóstico , Pielonefritis Xantogranulomatosa/fisiopatología , Niño , Enfermedad Crónica , Humanos , Riñón/microbiología , Riñón/cirugía , Masculino , Proteus vulgaris/aislamiento & purificación , Pielonefritis Xantogranulomatosa/cirugía , Tomografía Computarizada por Rayos XRESUMEN
Urinary calcium excretion was measured in an unselected population of 153 healthy Swedish children aged 2-18 years. Urine was collected after an ordinary meal. Urinary calcium excretion was measured as the calcium/creatinine concentration ratio (UCa/Cr) and expressed in mmol/l per mmol/l. UCa/Cr was 0.44 +/- 0.379 (mean +/- SD). As the UCa/Cr in this childhood population was not distributed in a normal manner, the results are more correctly presented as the 50th (0.33) and 97th (1.5) centiles. There was a weak but significant correlation between UCa/Cr and age, with higher values in the lower age groups. There was no correlation between UCa/Cr and the anamnestic intake of cow's milk. Repeated samples from some children showed a coefficient of variation between days of 30-40%. The upper limits of normal UCa/Cr (97th centile = 1.5; +2 SD = 1.2) in this investigation were higher than what is considered normal by others. In spite of this, none of the children had a history of renal stone disease or any other symptoms of hypercalciuria. Renal stone disease is thought to be rare in Swedish children although the real incidence is not known. The diagnosis of hypercalciuria should be based on repeated samples from an individual with symptoms and related to age-related reference values from the same population group.
Asunto(s)
Calcio/orina , Adolescente , Adulto , Factores de Edad , Animales , Niño , Preescolar , Creatinina/orina , Dieta , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Leche , Valores de Referencia , SueciaRESUMEN
In a prospective study between January 1987 and December 1992, 103 patients with invasive Haemophilus influenzae (Hi) infection were identified in a well-defined population before large-scale Haemophilus influenzae type b (Hib) vaccination was introduced. The incidence (case/100,000/year) of invasive Hi infection was 5.9 for the whole population, 55 for children 0-4 years old and as high as 2.8 for adults. Hib was the predominant cause of the infection (83 cases) in children but, in adults, 13/39 (30%) cases were caused by non-typable Hi and 6/39 (19%) by Hi serotype f. Three patients (3%) died and 6 (5.8%) suffered a permanent sequel from the infection. All patients with such a sequel had invasive Hib infection. No significant difference between patients 0-6 years old and matched controls regarding the frequency of subnormal serum levels of immunoglobulins was found.
Asunto(s)
Infecciones por Haemophilus/epidemiología , Vacunas contra Haemophilus , Haemophilus influenzae , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Niño , Preescolar , Epiglotitis/epidemiología , Epiglotitis/microbiología , Epiglotitis/prevención & control , Femenino , Infecciones por Haemophilus/microbiología , Infecciones por Haemophilus/prevención & control , Haemophilus influenzae/clasificación , Haemophilus influenzae/efectos de los fármacos , Haemophilus influenzae/aislamiento & purificación , Humanos , Inmunoglobulinas/sangre , Incidencia , Lactante , Recién Nacido , Masculino , Meningitis por Haemophilus/epidemiología , Meningitis por Haemophilus/microbiología , Meningitis por Haemophilus/prevención & control , Persona de Mediana Edad , Estudios Prospectivos , Serotipificación , Suecia/epidemiologíaRESUMEN
The standard diagnostic methods for pertussis have several shortcomings. With the increased knowledge of the Bordetella pertussis genome a specific and conserved DNA sequence, present in about 70-80 copies in each genome, was selected for amplification with the polymerase chain reaction (PCR) technique in order to evaluate its diagnostic potential in children with suspected pertussis. The 400 basepair DNA sequence chosen was present and amplified in all 112 B. pertussis strains and in no other bacterial species examined. The specificity of the amplified material was documented by restriction enzyme cleavage. In nasopharyngeal aspirates a B. pertussis specific PCR product was visualized in 19/25 culture positive and in 5/50 culture negative children. In conclusion the present PCR assay for B. pertussis can be clinically useful and permit a specific diagnosis within 1 day after sampling. Further studies are requested to document its sensitivity, specificity and predictive value for positive and negative results.
Asunto(s)
Bordetella pertussis/genética , ADN Bacteriano/genética , Reacción en Cadena de la Polimerasa , Tos Ferina/diagnóstico , Secuencia de Bases , Bordetella pertussis/aislamiento & purificación , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Datos de Secuencia Molecular , SueciaRESUMEN
Auditory brainstem evoked responses (ABR) were recorded in 9 neonates with hyperbilirubinaemia. Pathological recordings were found in two children showing absence of waves and prolonged latencies. There was no correlation between latencies to waves and the total serum bilirubin concentration. The serum reserve albumin concentration for monoacetyldiaminodiphenyl sulphone (MADDS) was, however, inversely related to the latencies in the ABR recordings. Our findings suggest that the binding properties of serum albumin contribute to the risk of bilirubin toxicity and that, in this study, the reserve albumin concentration for MADDS seemed to be of greater significance than the total bilirubin concentration.
Asunto(s)
Dapsona/análogos & derivados , Potenciales Evocados Auditivos , Ictericia Neonatal/metabolismo , Albúmina Sérica/metabolismo , Bilirrubina/sangre , Dapsona/metabolismo , Humanos , Recién Nacido , Ictericia Neonatal/fisiopatología , Ligandos , Valor Predictivo de las Pruebas , Unión ProteicaRESUMEN
In 19 non-jaundiced and 22 jaundiced neonates, the serum albumin and bilirubin concentrations were measured during the first week of life. Some of the neonates were followed longitudinally. The albumin binding properties were evaluated by determining the reserve albumin concentration for monoacetyldiaminodiphenyl sulphone (MADDS), a deputy ligand for bilirubin. The reserve albumin concentration for MADDS increased with postnatal age. The reason for this increase is still unexplained. There was an inverse relation between the bilirubin and the reserve albumin concentrations, but when the bilirubin concentration increased by 1 mumol/l, the reserve albumin concentration for MADDS decreased by only 0.2 mumol/l. This shows that the reserve albumin concentration for MADDS does not give a direct measure of the bilirubin binding ability of the serum albumin molecule. In spite of this, it is still possible that a low reserve albumin concentration for MADDS is a risk factor for bilirubin encephalopathy.
Asunto(s)
Bilirrubina/sangre , Recién Nacido/metabolismo , Ictericia Neonatal/metabolismo , Albúmina Sérica/metabolismo , Sitios de Unión , Dapsona/análogos & derivados , Dapsona/metabolismo , Femenino , Humanos , Ligandos , Embarazo , Unión ProteicaRESUMEN
A survey of chronic renal failure (CRF) in Swedish children was carried out for the period 1978-1985, using age-related cut-off levels for creatinine concentrations corresponding approximately to a glomerular filtration rate of 30 ml/min per 1.73 m2. The mean annual incidence of CRF was 6.9 and of terminal renal failure (TRF) 4.4/million children. The prevalence increased during the study period, for preterminal renal failure from 14.1 (1978) to 26.1 (1985) and for TRF from 12.4 to 16/million children. The main groups of primary renal disease were malformations (42%), hereditary disorders (27%), and glomerular diseases (14%), while pyelonephritis with vesico-ureteral reflux only made up 5%.
Asunto(s)
Fallo Renal Crónico/epidemiología , Adolescente , Niño , Preescolar , Femenino , Humanos , Fallo Renal Crónico/etiología , Fallo Renal Crónico/genética , Masculino , SueciaRESUMEN
The concentrations of serum albumin and albumin reserve for bilirubin binding were studied in 24 healthy women during and after pregnancy, using monoacetyl-4,4'-diamino-diphenylsulphone as a deputy ligand for bilirubin. In the first trimester, the serum albumin concentration was already diminished. Likewise, the serum reserve albumin for bilirubin binding was reduced gradually during pregnancy. These reductions were evident as early as the 20th week of gestation, and at delivery the level averaged 53% of the nonpregnant level. The reduction in bilirubin binding capacity was partly dependent on the decreasing serum albumin concentration, but a reduction in the albumin molecule's binding capability was also shown. This binding defect, which is also present in neonates, is not fully explained. The reduction in bilirubin binding capability probably reflects a reduced degree of protein binding for many protein-bound drugs during pregnancy, which may contribute to pharmacokinetic alterations in pregnancy.
Asunto(s)
Bilirrubina/sangre , Embarazo/sangre , Albúmina Sérica/metabolismo , Femenino , Humanos , Unión Proteica , Ensayo de Unión RadioliganteRESUMEN
Serum concentrations of sulphasalazine and sulphapyridine were measured during the first week of life in 15 children whose mothers had been on sulphasalazine during pregnancy. The serum concentrations of sulphapyridine and sulphasalazine were similar in the children and their mothers at delivery. The elimination rate of the drugs in the newborn children was slow but the concentrations were not so high that a bilirubin displacing effect could be expected. In eight mothers who were breast-feeding and taking sulphasalazine, analyses were done of mothers' serum, breast-milk and serum from their children. The results showed that the amount of sulphasalazine and sulphapyridine transferred to the child via the breast-milk is negligible with regard to the risk of kernicterus. It is concluded that a woman in need of sulphasalazine treatment can continue the medication throughout pregnancy and lactation without risk of development of kernicterus in her child. Only term infants without haemolytic disease were included in the study. Thus our conclusion is not necessarily valid for the prematurely born child or the child with haemolytic disease.
Asunto(s)
Lactancia , Intercambio Materno-Fetal , Sulfanilamidas/sangre , Sulfapiridina/sangre , Sulfasalazina/sangre , Colitis Ulcerosa/tratamiento farmacológico , Enfermedad de Crohn/tratamiento farmacológico , Femenino , Humanos , Recién Nacido , Leche Humana/metabolismo , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Sulfapiridina/administración & dosificación , Sulfasalazina/administración & dosificaciónRESUMEN
In eleven pregnant patients with ulcerative colitis or Crohn's disease who were treated with sulphasalazine (SASP) the serum concentrations of SASP and sulphapyridine (SP) were measured at delivery. The concentrations of SASP and SP were almost identical in the cord serum and the maternal serum. In seven of the women the same concentrations were measured at a later occasion when they were not pregnant. The serum SASP concentration remained the same, but the SP concentration was higher in the non-pregnant women. This probably reflects the different degree of protein binding of SASP and SP, respectively, and the change of distribution volume that occurs in pregnancy. In the newborn the concentrations of SASP and SP were 4.6 +/- 3.1 microgram/ml and 18.2 +/- 8.7 microgram/ml, respectively. Current studies have shown that neither SASP nor SP in these concentrations causes significant displacement of bilirubin from albumin. Thus, SASP can be given to the pregnant patient up to delivery without risks for the newborn full-term infant.
Asunto(s)
Placenta/metabolismo , Sulfanilamidas/metabolismo , Sulfapiridina/metabolismo , Sulfasalazina/metabolismo , Colitis/tratamiento farmacológico , Colitis Ulcerosa/tratamiento farmacológico , Enfermedad de Crohn/tratamiento farmacológico , Femenino , Humanos , Recién Nacido , Intercambio Materno-Fetal , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Sulfapiridina/uso terapéutico , Sulfasalazina/uso terapéuticoRESUMEN
Twelve pregnant patients with ulcerative colitis or Crohn's disease who were being treated with sulphasalazine (SASP) were studied together with their newborn, full-term babies. An earlier study had shown almost identical concentrations of SASP and its metabolic sulphapyridine (SP) in maternal and cord serum. As controls, blood samples were collected from 25 healthy women and their newborn infants. Sera from mothers and infants were analysed for the vacant amount of high-affinity bilirubin binding site on albumin (reserve albumin) by the MADDS method. The mean reserve albumin concentration of the SASP-treated mothers was 9% lower than that of the controls, which is probably insignificant. No difference was observed in the corresponding two groups of infants. In vitro studies showed that neither SASP nor SP in therapeutic plasma concentrations had a significant bilirubin-displacing capacity. It seems that SASP preferentially is bound to other sites on albumin than to the high-affinity binding site for bilirubin. The risk of kernicterus in the full-term newborn does not seem to be increased by treatment of the mother with sulphasalazine.
Asunto(s)
Albúminas/metabolismo , Bilirrubina/sangre , Sangre Fetal/metabolismo , Sulfasalazina/uso terapéutico , Adulto , Colitis Ulcerosa/tratamiento farmacológico , Enfermedad de Crohn/tratamiento farmacológico , Femenino , Humanos , Recién Nacido , Intercambio Materno-Fetal , Embarazo , Complicaciones del Embarazo/tratamiento farmacológico , Unión Proteica/efectos de los fármacos , Sulfapiridina/sangre , Sulfasalazina/sangreRESUMEN
A case of systemic infection caused by Aspergillus fumigatus in a seven-year-old boy suffering from chronic granulomatous disease is described. The fungus had infiltrated his lungs, his left foot and the popliteal and inguinal lymph nodes. Amphotericin B, 1 mg/kg daily, was given for three months via a central venous catheter, Progressive anaemia made amputation of his left leg necessary. The bone tissue was heavily infiltrated with fungal elements. The regional lymph nodes were also resected because of fungal growth. After six months no fungi were found in liver aspirates taken on account of liver abscesses due to Staphylococcus aureus. The combined medical and surgical approach resulted in complete eradication of the Aspergillus infection, as verified by the disappearance of Aspergillus precipitins.