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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 Garzón1
Estimated H-index: 1
(Universidad de La Sabana)
+ 2 AuthorsAlexander Sanchez
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
Newest
#1Fabio Silvio Taccone (Free University of Brussels)H-Index: 42
Last. Stijn Blot (UGent: Ghent University)H-Index: 61
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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.
123 CitationsSource
#1Mónica M. Toro-Lezcano (UdeA: University of Antioquia)H-Index: 1
#2Francisco Molina Saldarriaga (UPB: Pontifical Bolivarian University)H-Index: 1
Last. Alexander Guerra Villafañe (UdeA: University of Antioquia)H-Index: 1
view all 5 authors...
Invasive aspergilosis (IA) is caused by Aspergillum particles inhalation such as mildew and yeast. They live in the soil as a natural habitat. This infection has been described in patients with a bone marrow transplant and serious neutropenia (<500mm 3 ). Inward patients of intensive care unit (ICU) can be also susceptible to them, and even more with risk factors associated such as chronic obstructive pulmonary disease (COPD), liver cirrhosis, autoimmune diseases with inmunosupressor therapy and...
1 CitationsSource
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...
28 CitationsSource
#1David A. Stevens (Santa Clara Valley Medical Center)H-Index: 86
#2George L. Melikian (Stanford University)H-Index: 5
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...
37 CitationsSource
#1Thomas J. WalshH-Index: 133
#2Elias Anaissie (University of Arkansas for Medical Sciences)H-Index: 98
Last. y Thomas F. Patterson (University of Texas Health Science Center at San Antonio)H-Index: 1
view all 13 authors...
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...
11 CitationsSource
#1Oliver A. CornelyH-Index: 63
#2Johan MaertensH-Index: 58
Last. Raoul HerbrechtH-Index: 66
view all 19 authors...
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...
501 CitationsSource
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...
24 Citations
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...
89 CitationsSource
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...
21 Citations
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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