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Antigen detection in the diagnosis and management of a patient with probable cerebral aspergillosis treated with voriconazole
Author(s) -
Machetti M.,
Zotti M.,
Veroni L.,
Mordini N.,
Lint M.T.,
Bacigalupo A.,
Paola D.,
Viscoli C.
Publication year - 2000
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1034/j.1399-3062.2000.020307.x
Subject(s) - voriconazole , galactomannan , medicine , aspergillosis , cerebrospinal fluid , aspergillus , amphotericin b , immunology , gastroenterology , dermatology , antifungal , microbiology and biotechnology , biology
This report describes the diagnosis and management of a 16‐year‐old boy who developed neurological signs and symptoms suggestive of cerebral aspergillosis following a haploidentical bone marrow transplant. A new sandwich enzyme‐linked immunosorbent assay (ELISA) for the detection of Aspergillus galactomannan circulating antigens (Platelia Aspergillus , Sanofi Diagnostic Pasteur, France) was used on serum and cerebrospinal fluid to obtain a presumptive diagnosis and to monitor the course of the disease. Having failed conventional therapy with amphotericin B, the patient received compassionate treatment with voriconazole for a period of 37 days. High levels of voriconazole were observed in both serum and cerebrospinal fluid (CSF), with a trend toward accumulation. After 7 days a marked improvement in the patient’s neurological symptoms was noted, and ELISA data indicated a corresponding decrease in Aspergillus galactomannan levels in both serum and CSF. Voriconazole was well tolerated, with only transient increases in ALT/AST recorded during therapy. Although the patient survived the acute Aspergillus infection, he subsequently died of an unrelated infection.