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November 1980, Vol 134, No. 11 >
Article | November 1980

Aspergillosis in Chronic Granulomatous Disease: Therapeutic Considerations FREE

MICHAEL L. CORRADO, MD; DENNIS CLERI, MD; SENIH M. FIKRIG, MD; JUANA C. PHILLIPS, MD; Vincent I. Ahonkhai, MD
Am J Dis Child. 1980;134(11):1092-1094. doi:10.1001/archpedi.1980.02130230070021.
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Children with chronic granulomatous disease (CGD) are susceptible to a wide variety of catalase-positive microorganisms.1Aspergillus infections are particularly difficult to diagnose and treat. Aspergilli may invade many tissues, including the lung,1,2 thyroid,3 and bone,4 and diagnosis frequently requires culture of surgical specimens. Therapy for aspergillosis in children with CGD by use of amphotericin B alone is frequently suboptimal, and several patients have required granulocyte transfusions in addition to amphotericin B.1,2 The need for potentially synergistic combinations of antimicrobials is particularly keen in children with CGD. We report a case of aspergillosis involving the ribs, lung, and pleura that was successfully treated with the combination of amphotericin B and rifampin.

Method of Susceptibility Testing.—The clinical isolate of A fumigatus was grown on Sabouraud's ager slants for seven days. The method of harvesting and quantitating the inocula of the aspergillus and the control organism Candida

REFERENCES

1 +
Bujak JS, Kwon-Chung KJ, Chusid MJ:  Osteomyelitis and pneumonia in a boy with chronic granulomatous disease of childhood caused by a mutant strain of Aspergillus nidulans . Am J Clin Pathol 61:361-367, 1974;.
2 +
Raubitschek AA, Levin AS, Stites DP, et al:  Normal granulocyte infusion therapy for aspergillosis in chronic granulomatous disease . Pediatrics 51:230-233, 1973;.
3 +
Halazun JF, Anast CS, Luken JN:  Thyrotoxicosis associated with aspergillus thyroiditis in chronic granulomatous disease . J Pediatr 80:106-108, 1972;.
4 +
Simpson MB, Merz WG, Kurlinski JP, et al:  Opportunistic mycotic osteomyelitis: Bone infections due to Aspergillus and Candida species . Medicine 56:475-482, 1977;.
5 +
Corrado ML, Weitzman I, Stanek A, et al:  Subcutaneous infection with Phialophora richardsiae and its susceptibility to 5-fluorocytosine, amphotericin B, and miconazole . Sabouraudia 18:97-104, 1980;.
6 +
Shadomy S, Espinel-Imgrafo A:  Susceptibility testing of antifungal agents , in Lennette EH, Spaulding EH, Truant JP (eds): Manual of Clinical Microbiology , ed 2. Washington, DC, American Society for Microbiology, 1974;, pp 571-573.
7 +
Maish WL: Chronic Granulomatous Disease: The McLeod Syndrome, and the Kell Blood Group. Birth defects original article series , New York, National Foundation March of Dimes, 1978;, vol 14, no (6a) , pp 9-25.
8 +
Cohen MS, Isturig RE, Malech HL, et al: Fungal infections in chronic granulomatous disease (CGD) (abstract No. 670). Read before the 19th Interscience Conference on Antimicrobial Agents and Chemotherapy, Boston, Oct 4, 1979.
9 +
Kitahara M, Seth VK, Medoff G, et al:  Activity of amphotericin B, 5-fluorocytosine, and rifampin against six clinical isolates of Aspergillus . Antimicrob Agents Chemother 9:915-919, 1976;.
10 +
Arroyo J, Medoff G, Kobayashi GS:  Therapy of murine aspergillosis with amphotericin B in combination with rifampin or 5-FC . Antimicrob Agents Chemother 11:21-25, 1977;.
11 +
Bennett JE, Dismukes WE, Duma RJ, et al:  A comparison of amphotericin B alone and combined with flucytosine in the treatment of crytococcal meningitis . N Engl J Med 301:126-131, 1979;.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Bujak JS, Kwon-Chung KJ, Chusid MJ:  Osteomyelitis and pneumonia in a boy with chronic granulomatous disease of childhood caused by a mutant strain of Aspergillus nidulans . Am J Clin Pathol 61:361-367, 1974;.
2 +
Raubitschek AA, Levin AS, Stites DP, et al:  Normal granulocyte infusion therapy for aspergillosis in chronic granulomatous disease . Pediatrics 51:230-233, 1973;.
3 +
Halazun JF, Anast CS, Luken JN:  Thyrotoxicosis associated with aspergillus thyroiditis in chronic granulomatous disease . J Pediatr 80:106-108, 1972;.
4 +
Simpson MB, Merz WG, Kurlinski JP, et al:  Opportunistic mycotic osteomyelitis: Bone infections due to Aspergillus and Candida species . Medicine 56:475-482, 1977;.
5 +
Corrado ML, Weitzman I, Stanek A, et al:  Subcutaneous infection with Phialophora richardsiae and its susceptibility to 5-fluorocytosine, amphotericin B, and miconazole . Sabouraudia 18:97-104, 1980;.
6 +
Shadomy S, Espinel-Imgrafo A:  Susceptibility testing of antifungal agents , in Lennette EH, Spaulding EH, Truant JP (eds): Manual of Clinical Microbiology , ed 2. Washington, DC, American Society for Microbiology, 1974;, pp 571-573.
7 +
Maish WL: Chronic Granulomatous Disease: The McLeod Syndrome, and the Kell Blood Group. Birth defects original article series , New York, National Foundation March of Dimes, 1978;, vol 14, no (6a) , pp 9-25.
8 +
Cohen MS, Isturig RE, Malech HL, et al: Fungal infections in chronic granulomatous disease (CGD) (abstract No. 670). Read before the 19th Interscience Conference on Antimicrobial Agents and Chemotherapy, Boston, Oct 4, 1979.
9 +
Kitahara M, Seth VK, Medoff G, et al:  Activity of amphotericin B, 5-fluorocytosine, and rifampin against six clinical isolates of Aspergillus . Antimicrob Agents Chemother 9:915-919, 1976;.
10 +
Arroyo J, Medoff G, Kobayashi GS:  Therapy of murine aspergillosis with amphotericin B in combination with rifampin or 5-FC . Antimicrob Agents Chemother 11:21-25, 1977;.
11 +
Bennett JE, Dismukes WE, Duma RJ, et al:  A comparison of amphotericin B alone and combined with flucytosine in the treatment of crytococcal meningitis . N Engl J Med 301:126-131, 1979;.

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