RESUMEN

Invasive fungal infection is a serious complication following allogeneic hematopoietic stem cell transplantation. Pulmonary infection due to Hormographiella aspergillata is an uncommon condition associated with a high mortality rate. The susceptibility of H. aspergillata to available antifungal agents is not well established. We report for the first time a case of H. aspergillata lung infection that responded poorly to conventional treatment with liposomal amphotericin B (LAmB; 3 mg kg-1 of body weight per day) with renal damage at higher posology (5 mg kg-1 of body weight per day), but improved rapidly after addition of nebulized LAmB to intravenous LAmB (3 mg kg-1 of body weight per day). Successful treatment of our patient using nebulized LAmB would be worth evaluating in cases refractory to standard treatment or when the reference treatment may not be extended due to interaction or side effects.

Asunto(s)

Aerosoles/administración & dosificación , Agaricales/aislamiento & purificación , Anfotericina B/administración & dosificación , Antifúngicos/administración & dosificación , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Administración por Inhalación , Administración Intravenosa , Adulto , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Humanos , Enfermedades Pulmonares Fúngicas/microbiología , Masculino , Trasplante Homólogo/efectos adversos , Resultado del Tratamiento

RESUMEN

Mixed fungal infection and acquired echinocandin resistance of Candida spp. remain infrequent. In this study we have reported the case of a patient hospitalized for tuberculosis who experienced multiple infections due to three common Candida species (C. albicans, C. glabrata, C. tropicalis). Furthermore, consecutive isolates from blood cultures and heart valve were found resistant to azoles (C. tropicalis) and to echinocandin with either novel (C. tropicalis) or previously described (C. albicans) missense mutations in the Fks gene.