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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These colonies were isolated from a BAL, (also with bacterial qrowth of S.aureus and S.maltophilia) from a patient with a VAP (undergoing corticosteroid treatment). The growth medium used is sabouraud dextrose agar , incubated at 37° C
The identification is made by microscopic/macroscopic observation criteria.
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Microscopic morphology of A. flavus. Conidial heads are radiate, splitting to form loose columns, biseriate but having some heads with phialides borne directly on the vesicle.
