Date: 26 November 2013
Image c. 3 yr old boy with CNS aspergillosis pt TS. MRI scan pre-amphotericin B
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Notes:
A 3 year old boy, quite active and healthy clinically, who has CNS aspergillosis. He was first seen about 4 months ago for a red eye, which turned out to be panophthalmitis; culture yielded Aspergillus spp. He received 2 weeks of iv amphotericin and was sent home by the ophthalmologists. No h/o eye trauma. He returned 2 weeks ago with focal fits, and the MR showed several lesions bilaterally (including ring enhancing lesions) and normal sinuses, and a brain bx showed fungal hyphae (no culture this time). His immune status (normal WCC and neutrophil function so far) was investigated.
He was given conventional amphotericin for 8 weeks, and switched to oral itraconazole. We had to limit the ampho to 0.7 mg/kg owing to toxicity (mainly hypokalaemia).
The MRI scan was repeated at about 6 weeks, and generally showed good improvement (scans e-h). The enhancement/flare were gone but remained in a few lesions, the lesions themselves were all either gone or much smaller. Further investigations revealed the child was immunocompetent.
Patient was switched from amphotericin to oral itraconazole at week 8 essentially on a clinical assessment. Awaiting follow-up.
Images library
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Left= an agar air plate exposed for 2 minutes after the barley had been turned. showing numerous colonies of the fungus following incubation at 26C on 2% malt agar.Right= A sputum sample taken from a maltworker after exposure showing many fungal colonies when cultured on agar. His commensal yeast flora is seen towards the right base as cream/white colonies.
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growing on contaminated barley malt. The deep blue-green heads made up of chains of conidia are seen on the left. On the right, conidiophores from which conidial chains are developed show typical clavate heads. Stain- Cotton blue in Lactophenol.
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Sections of colonised alveoli
On the left, the conidiophores sporulate freely, on the right they are seen to cease development at the phialide stage. Carbon deposits are clearly seen here.A=alveolus, As=alveolar septum, C=conidiophore, P=phialide
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The growth isolated from the aspergilloma in the presence of living cells of the three bacterial species in culture.The most marked inhibition occurred with Pseudomonas aeruginosa(P) and Haemophilus influenzae(H) and to a much lesser extent with Staphylococcus aureus(S). C=control. Inhibitory factors were components of the bacterial slime layers.
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aspergilloma removed from the lung cavity seen in section.Staining was with methenamine/silver and light green. The structure shows zonation probably due to variations in the growth rate of mycelium(deep brown). A mucus layer(stained green) containing cell debris and bacteria is seen shrouding the fungus. Bacterial genera were Staphylococcus, Haemophilus and Pseudodomonas.
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Plugs cultured on agarA young colony of the fungus(AF) has a central patch of sporulation and is surrounded by colonies of bacteria and yeasts.
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A part of the mycelium in a stained sputum plug showing the dichotomously branched hyphae of Aspergillus fumigatus.
