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)
Image 1. The chest x-ray shows extensive bilateral nodular disease, most consistent with a fungal infection, or possibly tuberculosis. He was treated with a bucket face mask with 80% oxygen and voriconazole.
A Colonies on MEA +20 % sucrose after 2 weeks; B ascomata, x 40; C conidiophore of Aspergillus glaucus x 920;D conidiophore of Aspergillus glaucus x920 E. portion of ascoma with asci x 920. F ascospores x2330.
, 
, 
, 
, 
, 
, 
