1887

Abstract

Fungal infection of the kidneys is a rare condition that has been reported in premature babies and in diabetic or immunocompromised adult patients. spp. is the most frequent micro-organism involved. This paper reports a case of an immunocompetent newborn with a bladder exstrophy who suffered from an acute renal failure caused by bilateral renal aspergilloma (). The newborn was treated with amphotericin B urinary tract irrigation through bilateral nephrostomy catheters, combined with liposomal amphotericin B and voriconazole therapy, which improved his renal function. However, due to persistent fungal colonization, a long antifungal treatment and permanent ureterostomies were necessary to deal with new episodes of ureterorenal obstruction. As of November 2009, despite the renal injuries, renal function had been conserved. The management of the mechanical obstruction and the choice of antifungal drugs are discussed in this unusual case.

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2010-03-01
2024-03-28
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References

  1. Andes D. 2006; Pharmacokinetics and pharmacodynamics of antifungals. Infect Dis Clin North Am 20:679–697 [CrossRef]
    [Google Scholar]
  2. Bell D. A., Rose S. C., Starr N. K., Jaffe R. B., Miller F. J. Jr 1993; Percutaneous nephrostomy for nonoperative management of fungal urinary tract infections. J Vasc Interv Radiol 4:311–315 [CrossRef]
    [Google Scholar]
  3. Blyth C. C., Palasanthiran P., O'Brien T. A. 2007; Antifungal therapy in children with invasive fungal infections: a systematic review. Pediatrics 119:772–784 [CrossRef]
    [Google Scholar]
  4. Burgos A., Zaoutis T. E., Dvorak C. C., Hoffman J. A., Knapp K. M., Nania J. J., Prasad P., Steinbach W. J. 2008; Pediatric invasive aspergillosis: a multicenter retrospective analysis of 139 contemporary cases. Pediatrics 121:e1286–e1294 [CrossRef]
    [Google Scholar]
  5. Gadea I., Cuenca-Estrella M., Martin E., Peman J., Ponton J., Rodriguez-Tudela J. L. 2007; Microbiological procedures for diagnosing mycoses and for antifungal susceptibility testing. Enferm Infecc Microbiol Clin 25:336–340 [CrossRef]
    [Google Scholar]
  6. Groll A. H., Jaeger G., Allendorf A., Herrmann G., Schloesser G., Loewenich V. 1998; Invasive pulmonary aspergillosis in a critically ill neonate: case report and review of invasive aspergillosis during the first 3 months of life. Clin Infect Dis 27:437–452 [CrossRef]
    [Google Scholar]
  7. Hari P., Srivastava A., Gupta A. K., Srivastava R. N. 1997; Neonatal renal failure due to obstructive candidal bezoars. Pediatr Nephrol 11:497–498 [CrossRef]
    [Google Scholar]
  8. Hedayati M. T., Pasqualotto A. C., Warn P. A., Bowyer P., Denning D. W. 2007; Aspergillus flavus : human pathogen, allergen and mycotoxin producer. Microbiology 153:1677–1692 [CrossRef]
    [Google Scholar]
  9. Kueter J. C., MacDiarmid S. A., Redman J. F. 2002; Anuria due to bilateral ureteral obstruction by Aspergillus flavus in an adult male. Urology 59:601
    [Google Scholar]
  10. Lass-Flörl C., Cuenca-Estrella M., Denning D. W., Rodriguez-Tudela J. L. 2006; Antifungal susceptibility testing in Aspergillus spp. according to EUCAST methodology. Med Mycol 44 (Suppl. 1):319–325 [CrossRef]
    [Google Scholar]
  11. O'Shaughnessy E. M., Meletiadis J., Stergiopoulou T., Demchok J. P., Walsh T. J. 2006; Antifungal interactions within the triple combination of amphotericin B, caspofungin and voriconazole against Aspergillus species. J Antimicrob Chemother 58:1168–1176 [CrossRef]
    [Google Scholar]
  12. Perez-Arellano J. L., Angel-Moreno A., Belon E., Frances A., Santana O. E., Martin-Sanchez A. M. 2001; Isolated renoureteric aspergilloma due to Aspergillus flavus : case report and review of the literature. J Infect 42:163–165 [CrossRef]
    [Google Scholar]
  13. Smaldone M. C., Cannon G. M., Benoit R. M. 2006; Case report: bilateral ureteral obstruction secondary to aspergillus bezoar. J Endourol 20:318–320 [CrossRef]
    [Google Scholar]
  14. Steinbach W. J., Stevens D. A., Denning D. W. 2003; Combination and sequential antifungal therapy for invasive aspergillosis: review of published in vitro and in vivo interactions and 6281 clinical cases from 1966 to 2001. Clin Infect Dis 37 (Suppl. 3):S188–S224 [CrossRef]
    [Google Scholar]
  15. Stuck K. J., Silver T. M., Jaffe M. H., Bowerman R. A. 1982; Sonographic demonstration of renal fungus balls. Radiology 142:473 [CrossRef]
    [Google Scholar]
  16. Vazquez-Tsuji O., Campos-Rivera T., Ahumada-Mendoza H., Rondan-Zarate A., Martinez-Barbosa I. 2005; Renal ultrasonography and detection of pseudomycelium in urine as means of diagnosis of renal fungus balls in neonates. Mycopathologia 159:331–337 [CrossRef]
    [Google Scholar]
  17. Walsh T. J., Anaissie E. J., Denning D. W., Herbrecht R., Kontoyiannis D. P., Marr K. A., Morrison V. A., Segal B. H., Steinbach W. J. other authors 2008; Treatment of aspergillosis: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 46:327–360 [CrossRef]
    [Google Scholar]
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