Invasive pulmonary aspergillosis and pulmonary tuberculosis in a patient treated with infliximab for Crohn’s disease

We report a case of concurrent development of active pulmonary tuberculosis and invasive pulmonary aspergillosis (IPA) in a patient who received therapy with infliximab for Crohn’s disease. He has been treated with antitubercular therapy and liposomal amphotericin B for 8 weeks. His clinical course was complicated by paroxysmal atrial fibrillation requiring maintenance therapy with amiodarone, respiratory failure due both to pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamases (ESBL)-producing Klebsiella pneumoniae and pleural effusion requiring chest drainage. At discharge, a maintenance regimen based on the administration of isavuconazole 200 mg daily, moxifloxacin 400 mg daily and isoniazid 300 mg daily was chosen to avoid multiple drug-drug interaction between rifamycins, antifungal triazole agents and antiarrhythmic drugs. At 3 months of follow-up his clinical conditions were dramatically improved, high resolution chest tomography (HRCT) showed reduction of parenchymal lesions and no changes both in sinus rhythm and QTc interval were noticed. Besides the complexity and the peculiarity of the clinical scenario, this case underlines the risk of invasive fungal infections linked to the administration of TNF-α antagonists in gastroenterological setting and the importance of accurate evaluation of drug-drug interactions when choosing the antimicrobial therapies.
Source: IDCases - Category: Infectious Diseases Source Type: research

Related Links:

Authors: Kaur P, Kumar P, Randev S, Guglani V Abstract Allergic bronchopulmonary aspergillosis (ABPA) is an immunological disease complicating asthma or cystic fibrosis. An 8-year-old girl with no previous respiratory morbidity was diagnosed with ABPA on the basis of a raised eosinophil count and total and specific serum IgE levels combined with a positive skin-prick test for aspergillus and typical CT images of finger-in-glove hilar opacities and hyperattenuating mucous. She responded to treatment with itraconazole and corticosteroids and remains well. As far as we are aware, she is only the second child to be dia...
Source: Paediatrics and international child health - Category: Pediatrics Tags: Paediatr Int Child Health Source Type: research
Authors: Godman B, McCabe H, D Leong T, Mueller D, Martin AP, Hoxha I, Mwita JC, Rwegerera GM, Massele A, Costa JO, do Nascimento RCRM, Lemos LLP, Tachkov K, Milushewa P, Patrick O, Niba LL, Laius O, Sefah I, Abdulsalim S, Soleymani F, Guantai AN, Achieng L, Oluka M, Jakupi A, Logviss K, Hassali MA, Kibuule D, Kalemeera F, Mubita M, Fadare J, Ogunleye OO, Saleem Z, Hussain S, Bochenek T, Mardare I, Alrasheedy AA, Furst J, Tomek D, Markovic-Pekovic V, Rampamba EM, Alfadl A, Amu AA, Matsebula Z, Phuong TNT, Thanh BN, Chichonyi Kalungia A, Zaranyika T, Masuka N, Olaru ID, Wale J, Hill R, Kurdi A, Timoney A, Campbell S, Meyer ...
Source: Expert Review of Pharmacoeconomics and Outcomes Research - Category: Health Management Tags: Expert Rev Pharmacoecon Outcomes Res Source Type: research
Abstract In Brazil, rabies occurs mainly within an urban cycle, in which dogs and bats are reservoirs. This paper aims to report the occurrence of rabies in Callithrix sp. in Niter ói, Rio de Janeiro, Brazil. In June 2019 a hybrid specimen was referred for diagnosis. The Direct Fluorescent Antibody, Mouse Inoculation, and Polymerase Chain Reaction tests were positive. A phylogenetic analysis was compatible with antigenic variant 3, characteristic of Desmodus rotundus. New stu dies should be undertaken to elucidate the real role of callitrichids in the urban rabies cycle.
Source: Revista da Sociedade Brasileira de Medicina Tropical - Category: Tropical Medicine Source Type: research
Authors: Bastida C, Soy D, Torres A Abstract Introduction: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide, and its prevalence continues to increase. Despite the efficacy of antimicrobials, their safety and tolerability remain topics of interest and concern for clinicians and patients alike.Areas covered: This review outlines the main antimicrobial classes recommended for the empirical treatment of CAP in current guidelines, together with a potential new class. Each pharmacological group underwent a safety evaluation based on all available data about drug-related toxicitie...
Source: Expert Opinion on Drug Safety - Category: Drugs & Pharmacology Tags: Expert Opin Drug Saf Source Type: research
Abstract SUMMARYCaseum, the central necrotic material of tuberculous lesions, is a reservoir of drug-recalcitrant persisting mycobacteria. Caseum is found in closed nodules and in open cavities connecting with an airway. Several commonly accepted characteristics of caseum were established during the preantibiotic era, when autopsies of deceased tuberculosis (TB) patients were common but methodologies were limited. These pioneering studies generated concepts such as acidic pH, low oxygen tension, and paucity of nutrients being the drivers of nonreplication and persistence in caseum. Here we review widely accepted b...
Source: Clinical Microbiology Reviews - Category: Microbiology Authors: Tags: Clin Microbiol Rev Source Type: research
Authors: Wu JJ, Jia X, Zhao Y, Carrico J, Brodtkorb TH, Mendelsohn A, Lowry S, Feldman SR, Armstrong A Abstract Objectives: To compare the cost-effectiveness of tildrakizumab with other commonly used biologics and apremilast as the first-line treatment for moderate-to-severe plaque psoriasis from a US health plan's perspective.Methods: A 10-year cost-effectiveness model was developed to compare the incremental cost per extra month with a Psoriasis Area and Severity Index (PASI) 75 response. Patients were assumed to receive one of the treatments evaluated as their first-line treatment at the outset of the analysis. Nonresponders (PASI
Source: Journal of Dermatological Treatment - Category: Dermatology Tags: J Dermatolog Treat Source Type: research
Authors: Saghazadeh A, Rezaei N Abstract Introduction: At the end of 2019, Wuhan, a city in China with a population of about 11 million, witnessed the outbreak of unusual pneumonia. As of March 29, 2020, the disease has spread to more 199 countries and territories worldwide. The 2019 novel coronavirus, 2019-nCoV, is known as the probable causative agent of the illness.Areas covered: Here, the epidemiological dynamics of the disease that stand in close relation to distinct immunogenetic characters of the pathogen are discussed, to understand the ability and inability of the immune system in combatting the 2019-nCoV ...
Source: Expert Review of Clinical Immunology - Category: Allergy & Immunology Tags: Expert Rev Clin Immunol Source Type: research
Publication date: Available online 2 April 2020Source: The Journal of Foot and Ankle SurgeryAuthor(s): Changgui Zhang, Yangjing Lin, Chengchang Zhang, Jin Cao, Liu Yang, Xiaojun Duan
Source: The Journal of Foot and Ankle Surgery - Category: Orthopaedics Source Type: research
Publication date: Available online 2 April 2020Source: Journal of the Formosan Medical AssociationAuthor(s): Beuy joob, Viroj Wiwanitkit
Source: Journal of the Formosan Medical Association - Category: General Medicine Source Type: research
John Prine was hospitalized last month with COVID-19 and has been on a ventilator. The singer-songwriter, 73, now has pneumonia in both lungs, his wife says.
Source: L.A. Times - Health - Category: Consumer Health News Authors: Source Type: news
More News: Abelcet | Amiodarone | Antibiotic Therapy | Aspergillosis | Atrial Fibrillation | Avelox | Fungal Infections | Gastroenterology | Infectious Diseases | Moxifloxacin | MRSA | Pneumonia | Remicade | Respiratory Medicine | Staphylococcus Aureus | Superbugs | Tuberculosis