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Case 66: Aspergillus invasive skin graft infection in a child suffering from severe burns. Figure 1. Case history number 66
Aspergillus bronchitis and mucoid impaction: PtMK MK is 59 years old and presented with right sided pleuritic chest pain and coughing over 1 week. A chest Xray and then CT scan revealed complete collapse of her right lower lobe and middle lobes. Mucous retention is seen just proximal to the abrupt read more... October 2016, January 2017
October 2016, January 2017 Aspergillus bronchitis and mucoid impaction: PtMK MK is 59 years old and presented with right sided pleuritic chest pain and coughing over 1 week. A chest Xray and then CT scan revealed complete collapse of her right lower lobe and middle lobes. Mucous retention is seen just proximal to the abrupt read more...

A bronchoscopy found large amounts of mucous that was suctioned and removed. Aspergillus was found in the mucous on microscopy and A. fumigatus grown in culture. 

She felt better immediately and a follow up scan shows re-expansion of the right middle and lower lobes. 

A diagnosis of Aspergillus bronchitis was made based on the bronchoscopy findings, microscopy and culture results and supported by an positive Aspergillus IgG of 97mg/L (ImmunoCap). 

Papular rash with CPA Drug rashes: Drug interactions between steroids and anti-fungal drugs - (ecchymosis) Image A: Red skin rash on arms due to effect of inhaled steroids termed ecchymosis., Image B: Red skin rash on arms due to effect of inhaled steroids termed ecchymosis., Image C: Papular rash with blisters on the back, associated with CPA but prior to treatment, rash appeared 2 years previously in October 2007. The rash resolved on treatment with azoles., Image D: Papular rash with blisters on the back, associated with CPA but prior to treatment, rash appeared 2 years previously in October 2007. The rash resolved on treatment with azoles.
Image A: Red skin rash on arms due to effect of inhaled steroids termed ecchymosis., Image B: Red skin rash on arms due to effect of inhaled steroids termed ecchymosis., Image C: Papular rash with blisters on the back, associated with CPA but prior to treatment, rash appeared 2 years previously in October 2007. The rash resolved on treatment with azoles., Image D: Papular rash with blisters on the back, associated with CPA but prior to treatment, rash appeared 2 years previously in October 2007. The rash resolved on treatment with azoles. Papular rash with CPA Drug rashes: Drug interactions between steroids and anti-fungal drugs - (ecchymosis)
Facial erythema: Side effects of anti-fungal drugs - drug rashes Reference: Muco-cutaneous retinoid effects and facial erythema related to the novel triazole antifungal agent voriconazole. Denning, DW & Griffiths, CEM. Clin.Exp Dermatol 2001, 26(8), 648-53.Courtesy of Dr D Denning, Wythenshawe Hospital, read more... Patient AB: Voriconazole rash. Following 8 weeks of Voriconazole, patient had remarkable facial erythema, most consistent with sun exposure because of sparing of her neck., Patient AB: Voriconazole rash. Following 8 weeks of Voriconazole, patient had remarkable facial erythema, most consistent with sun exposure because of sparing of her neck., Patient AB: Discoid lupus erythematosus following 12 months voriconazole therapy. This improved with use of sunblock factor 30 and resolved after discontinuation of voriconazole, 2 months later.
Patient AB: Voriconazole rash. Following 8 weeks of Voriconazole, patient had remarkable facial erythema, most consistent with sun exposure because of sparing of her neck., Patient AB: Voriconazole rash. Following 8 weeks of Voriconazole, patient had remarkable facial erythema, most consistent with sun exposure because of sparing of her neck., Patient AB: Discoid lupus erythematosus following 12 months voriconazole therapy. This improved with use of sunblock factor 30 and resolved after discontinuation of voriconazole, 2 months later. Facial erythema: Side effects of anti-fungal drugs - drug rashes Reference: Muco-cutaneous retinoid effects and facial erythema related to the novel triazole antifungal agent voriconazole. Denning, DW & Griffiths, CEM. Clin.Exp Dermatol 2001, 26(8), 648-53.Courtesy of Dr D Denning, Wythenshawe Hospital, read more...
Cresemba Cresemba (Isavuconazole)
Germinating spores of Aspergillus fumigatus Germinating spores of Aspergillus fumigatus
Germinating spores of Aspergillus fumigatus Germinating spores of Aspergillus fumigatus

Scanning Electron Micrograph of germinating Aspergillus fumigatus spores (provided by KM Lord and ND Read)

Haemofungin
E1210 structure
Patient JSG: Nicotine stained fingers in ABPA with bronchiectasis Patient with chronic productive cough, chest pain and ABPA, unable to take itraconazole or nebulised amphotericin B. Smokes at least 40 roll up cigarettes a day. Nicotine stained fingers - image 1, Nicotine stained fingers - image 2
Nicotine stained fingers - image 1, Nicotine stained fingers - image 2 Patient JSG: Nicotine stained fingers in ABPA with bronchiectasis Patient with chronic productive cough, chest pain and ABPA, unable to take itraconazole or nebulised amphotericin B. Smokes at least 40 roll up cigarettes a day.
T-2307 The chemical structure of the novel arylamidine T-2307 T-2307
T-2307 T-2307 The chemical structure of the novel arylamidine T-2307
Laryngeal Aspergillosis, ptSA Laryngeal aspergillosis, probably related to inhaled corticosteroids. Image A., Image B., Image C., Image D.
Image A., Image B., Image C., Image D. Laryngeal Aspergillosis, ptSA Laryngeal aspergillosis, probably related to inhaled corticosteroids.
VL-2397 (ASP2397) VL-2397 (formerly known as ASP2397) is a novel antifungal drug initially developed by our partner, Astellas Pharma. This drug was isolated from a leaf litter fungus Acremonium species collected in a Malaysian national park. Astellas presented two read more... VL-2397 (ASP2397)
VL-2397 (ASP2397) VL-2397 (ASP2397) VL-2397 (formerly known as ASP2397) is a novel antifungal drug initially developed by our partner, Astellas Pharma. This drug was isolated from a leaf litter fungus Acremonium species collected in a Malaysian national park. Astellas presented two read more...
SCY-078 (MK-3118) SCY-078, new orally available beta-1,3-d-glucan synthase inhibitor, Formely MK-3118. SCY-078, new orally available beta-1,3-d-glucan synthase inhibitor
SCY-078, new orally available beta-1,3-d-glucan synthase inhibitor SCY-078 (MK-3118) SCY-078, new orally available beta-1,3-d-glucan synthase inhibitor, Formely MK-3118.
Biafungin acetate Biafungin acetate, a new echinocandin Biafungin acetate, a new echinocandin
Biafungin acetate, a new echinocandin Biafungin acetate Biafungin acetate, a new echinocandin
Primary Aspergillus pneumonia Pt DSM Community acquired primary Aspergillus pneumonia. Two x-rays taken on 02/02/2010 then 05/03/2010 Pt DSM Community acquired primary Aspergillus pneumonia 05/03/2010, Pt DSM, Community acquired Aspergillus pneumonia 02/02/2010
Pt DSM Community acquired primary Aspergillus pneumonia 05/03/2010, Pt DSM, Community acquired Aspergillus pneumonia 02/02/2010 Primary Aspergillus pneumonia Pt DSM Community acquired primary Aspergillus pneumonia. Two x-rays taken on 02/02/2010 then 05/03/2010

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