Date: 7 February 2014
Image B
Copyright:
Dr D Denning, Wythenshawe Hospital, Manchester.(© Fungal Infection Trust)
Notes:
Patient BC
A petite women in her 50’s with severe asthma and fungal sensitization (SAFS) had been unable to tolerate either itraconazole or voriconazole for any length of time, and was severely disabled with her symptoms. One treatment option which is occasionally helpful is to give nebulised amphotericin B (link to video of Helen). She was given 10mg of amphotericin B deoxycholate in water through a Pari LC nebulizer, supervised by a senior physiotherapist. Shortly after starting this, she felt much more breathless and the nebulizer was stopped. Salbutamol rescue was administered. After about 40 minutes she recovered.
The spirometer readings show a starting FEV1 of 2.35 L/sec. This fell to 1.05 L/sec, a dramatic fall with amphotericin B nebulisation. (Image A) She recovered with salbutamol to 2.25 L/sec. (Image B)
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Light microscopical appearance of hepatic tissue in outbreak of aflatoxicosis showing centrilobular degeneration of hepatocytes with vacuolated cytoplasm and apoptoses (top right abnormal)(Haematoxylin and eosin).
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Aspergillus terreus Thom. A Colonies on MEA after one week; B detail of colony showing columnar conidial heads x 44 ; C conidial heads and tip x 920; D conidia x2330
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Aspergillus terreus Thom. Conidial head of Aspergillus terreus. Conidial heads are compact, columnar and biseriate. Conidiophores are hyaline to slightly yellow and smooth walled.
