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Eventos trombóticos asociados a infección invasiva por Aspergillus: reporte de un caso

Published on Jul 1, 2017in Acta Colombiana de Cuidado Intensivo
· DOI :10.1016/j.acci.2017.02.004
Felipe Barragán (Universidad de La Sabana), Diana Garzón (Universidad de La Sabana)+ 2 AuthorsAlexander Sanchez
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Abstract
Resumen La aspergilosis invasiva es causada por cualquiera de los generos de Aspergillus; su desarrollo dependera del propio hongo y naturalmente del estado inmunologico del paciente; la mortalidad de esta patologia supera el 50%. Se presenta el caso de una paciente adulta, sin antecedentes patologicos previos, con cuadro progresivo de edema en miembros inferiores y superior derecho, adicionalmente con coloracion violacea de este, asociado a disnea de pequenos esfuerzos, al ingreso con anemia severa que requirio transfusion de hemoderivados; se realiza Doppler arterio-venoso de extremidades, que evidencia trombosis de todo el sistema venoso profundo del brazo derecho; se inicia anticoagulacion plena. Paciente con deterioro progresivo requiere traslado a Unidad de Cuidado Intensivo, donde presenta deterioro neurologico. Realizan una tomografia cerebral que mostro evento isquemico y hemorragico agudo; la paciente fallece y se envia a autopsia. La aspergilosis invasiva es mas comun en paciente con inmunocompromiso; sin embargo, se han reportado casos en pacientes inmunocompetentes, El proceso de angioinvasion de la hifa aumenta la produccion de factor tisular, lo que desencadena activacion de la cascada de coagulacion. Una de las caracteristicas importantes de esta infeccion es la trombosis intravascular extensa desde el foco de infeccion; el tratamiento con voriconazol ha demostrado alta efectividad y se ha de iniciar ante la sospecha clinica de la patologia, pues sin tratamiento la mortalidad de la misma llega al 90%.
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References11
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Published on Jan 1, 2015in Infectio
Mónica M. Toro-Lezcano1
Estimated H-index: 1
(UdeA: University of Antioquia),
Francisco Molina Saldarriaga1
Estimated H-index: 1
(UPB: Pontifical Bolivarian University)
+ 2 AuthorsAlexander Guerra Villafañe1
Estimated H-index: 1
(UdeA: University of Antioquia)
Resumen La aspergilosis invasiva (AI) es causada por la inhalacion de conidias del moho Aspergillus spp. , el cual tiene como habitat el suelo. Ha sido descrita en pacientes con trasplante de medula osea y neutropenia grave ( 3 ). Los pacientes que ingresan a la unidad de cuidado intensivo (UCI) tambien pueden ser susceptibles a la AI, con otros factores de riesgo tales como: enfermedad pulmonar obstructiva cronica (EPOC), cirrosis hepatica, enfermedades autoinmunes en manejo inmunosupresor y tr...
Published on Jan 1, 2015in Critical Care6.96
Fabio Silvio Taccone41
Estimated H-index: 41
(Free University of Brussels),
Anne-Marie Van den Abeele9
Estimated H-index: 9
+ 10 AuthorsGeorge Dimopoulos38
Estimated H-index: 38
(UoA: National and Kapodistrian University of Athens)
Introduction Invasive aspergillosis (IA) is a fungal infection that particularly affects immunocompromised hosts. Recently, several studies have indicated a high incidence of IA in intensive care unit (ICU) patients. However, few data are available on the epidemiology and outcome of patients with IA in this setting.
Jesús Fortún42
Estimated H-index: 42
,
Y. Meije12
Estimated H-index: 12
+ 1 AuthorsSantiago Moreno Guillén53
Estimated H-index: 53
Resumen La aspergilosis invasiva junto con la aspergilosis cronica pulmonar y la aspergilosis broncopulmonar alergica, constituyen las formas clinicas de aspergilosis. Aunque el numero de especies de Aspergillus spp. es muy numeroso, Aspergillus fumigatus -complex es el agente etiologico mas frecuente, independientemente de la forma clinica y la afeccion de base del paciente. El incremento de los diferentes tratamientos inmunosupresores y el mayor uso de corticoides en pacientes con enfermedad o...
Published on Jan 1, 2011in Immunological Investigations2.69
David A. Stevens85
Estimated H-index: 85
(Santa Clara Valley Medical Center),
George L. Melikian5
Estimated H-index: 5
(Stanford University)
Invasive aspergillosis has been classically associated with certain risk factors: cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation, AIDS. However, the literature is growing that this mycosis, particularly pulmonary aspergillosis, can be seen in patients lacking these factors. Many of the latter patients are in the intensive care unit. Other associated conditions include influenza, nonfungal pneumonia, chronic obstructive lung disease, immaturity, sepsis, liver fail...
Published on Feb 1, 2008in Clinical Infectious Diseases9.05
Thomas J. Walsh111
Estimated H-index: 111
,
Elias Anaissie90
Estimated H-index: 90
(University of Arkansas for Medical Sciences)
+ 10 AuthorsDavid A. Stevens85
Estimated H-index: 85
(Stanford University)
Thomas J. Walsh, Elias J. Anaissie, David W. Denning, Raoul Herbrecht, Dimitrios P. Kontoyiannis, Kieren A. Marr, Vicki A. Morrison, Brahm H Segal, William J. Steinbach, David A. Stevens, Jo-Anne van Burik, John R. Wingard, y Thomas F. Patterson Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland; University of Arkansas for Medical Sciences, Little Rock; The University of Texas M. D. Anderson Cancer Center, Houston, and The University of Texas Health Science Center at San An...
Published on May 15, 2007in Clinical Infectious Diseases9.05
Oliver A. Cornely60
Estimated H-index: 60
,
Johan Maertens49
Estimated H-index: 49
+ 16 AuthorsAngelika Boehme1
Estimated H-index: 1
a(See the editorial commentary by Anaissie on pages 1298–1306) Background. Treatment of invasive mold infection in immunocompromised patients remains challenging. Voriconazole has been shown to have efficacy and survival benefits over amphotericin B deoxycholate, but its utility is limited by drug interactions. Liposomal amphotericin B achieves maximum plasma levels at a dosage of 10 mg/kg per day, but clinical efficacy data for higher doses are lacking. Methods. In a double-blind trial, patient...
Nadeem Sajjad Raja9
Estimated H-index: 9
(UM: University of Malaya),
Nishi Nihar Singh2
Estimated H-index: 2
Aspergillosis is a spectrum of diseases caused by members of the genus Aspergillus that continues to pose a significant threat to immunocompromised, organ transplant, neutropenic and cancer patients. In view of increasing risk factors leading to invasive aspergillosis, it is imperative for clinicians to be familiar with the clinical presentation, diagnostic methods and management of the disease. We describe a 34-year-old immunocompetent male patient receiving chemotherapy for Aspergillus fumigat...
Published on Mar 15, 2004in Blood16.56
Leila M. Lopes Bezerra1
Estimated H-index: 1
,
Scott G. Filler63
Estimated H-index: 63
Invasive aspergillosis causes significant mortality among patients with hematologic malignancies. This infection is characterized by vascular invasion and thrombosis. To study the pathogenesis of invasive aspergillosis, we investigated the interactions of Aspergillus fumigatus conidia and hyphae with endothelial cells in vitro. We found that both forms of the organism induced endothelial cell microfilament rearrangement and subsequent endocytosis. Conidia were endocytosed 2-fold more avidly than...
Published on Sep 1, 2003in Revista Iberoamericana De Micologia1.60
Carlos Lumbreras31
Estimated H-index: 31
,
Joan Gavaldà30
Estimated H-index: 30
During the last decade the incidence of invasive aspergillosis has substantially grown due to the increasing use of powerful immunosupressive drugs in more patients. Unfortunately, the associated mortality with this infection is still very high and has not decreased in recent years. Pulmonary aspergillosis is by far the most frequent clinical picture of this infection, followed by sinus, tracheo-bronchial and central nervous system disease. The degree of immunosupression is the main factor influ...
Published on May 1, 1994in Journal of Computer Assisted Tomography1.30
Hiromitsu Hayashi25
Estimated H-index: 25
,
Ryo Takagi8
Estimated H-index: 8
+ 1 AuthorsTatsuko Kumazaki24
Estimated H-index: 24
Invasive pulmonary aspergillosis (IPA) has been recognized as an infectious complication in immunocompromised patients. We present a case of IPA, which occluded the descending aorta and left pulmonary artery and led to death after antileukemic chemotherapy. Contrast-enhanced CT demonstrated thrombi in the great vessels as low attenuation areas. These thrombi became extensive despite intensive antibiotic and antifungal therapy. Microscopic examination revealed that the thrombi contained aspergill...
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