14th ICID - Poster Abstracts - International Society for Infectious ...

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When citing these abstracts please use the following reference: Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number. Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1 is available electronically on http://www.sciencedirect.com Final Abstract Number: 30.017 Session: Mycology, Fungal Infections and Antifungal Drugs Date: Wednesday, March 10, 2010 Time: 12:30-13:30 Room: Poster & Exhibition Area/Ground Level Type: Poster Presentation Myocardial infarction caused by aspergillus embolization in a patient with cirrhosis A. Shahzad 1 , B. Nseir 2 1 Ochsner Medica; Center, Kenner, LA, USA, 2 Ochsner Clinic Foundation, New Orleans, LA, USA Background: Patient presented with ST elevation MI and died secondary to multiorgan failure. Autopsy revealed angioinvasive aspergillosis involving several organs. Methods: Case: A 47-year-old African American male with past medical history of alcoholinduced cirrhosis presented with acute midsternal pain of 5 hours duration. Respiratory distress developed and mechanical ventilation was required for airways protection. Results: Initial work up showed markedly elevated cardiac enzymes with CPK 14000 U/L, elevated AST 800 U/L, ALT 210 U/L, total bilirubin 8 mg/dL, direct bilirubin 7 mg/dL, and ST segment elevation on inferior EKG leads. Patient underwent emergent left heart catheterization which revealed patent coronary arteries. Subsequently multiorgan failure resulted in decompensated shock and patient received several vasopressors. Blood, spinal fluid, urine and sputum cultures showed no growth. Patient had negative serology for HIV, acute viral hepatitis, syphilis, dengue fever, tularemia, herpes virus 1&2, CMV, EBV, leptospirosis, Q fever, Lyme disease, brucellosis, and ehrlichiosis. Patient experienced intractable ventricular fibrillation which resulted in death after a 13-day hospital stay. Autopsy report confirmed disseminated angioinvasive aspergillosis involving heart, lungs, bowel, thyroid, kidneys and spleen in addition to complete occlusion of the posterior descending artery with a fungal thrombus and multiple fungal vegetations. Conclusion: Discussion: Aspergillus organisms are ubiquitous and exposure to their conidia must be a frequent event. However, disease due to tissue invasion is uncommon and occurs primarily in the setting of immunosuppression. Risk factors for invasive aspergillosis include prolonged and severe neutropenia, organ transplantation, AIDS and corticosteroid use. Infection of virtually any organ can occur, but most commonly kidney, liver, spleen, and CNS are involved. Aspergillus is second only to Candida as a cause of fungal endocarditis. Patients typically present with fever and embolic phenomena. Blood cultures are rarely positive. Prognosis of Aspergillus endocarditis is poor. Even with combined medical and surgical therapy, the mortality approaches 100 percent. Septic embolization has been occasionally reported as a reason for cerebral, myocardial and pulmonary infarctions. Our report represents rare case of myocardial infarction as a part of aspergillus septic emboli in the setting of hepatic cirrhosis as etiology of the immunocompromised state. Autopsy; however could not identify the original infected source.
When citing these abstracts please use the following reference: Author(s) of abstract. Title of abstract [abstract]. Int J Infect Dis 2010;14S1: Abstract number. Please note that the official publication of the International Journal of Infectious Diseases 2010, Volume 14, Supplement 1 is available electronically on http://www.sciencedirect.com Final Abstract Number: 30.018 Session: Mycology, Fungal Infections and Antifungal Drugs Date: Wednesday, March 10, 2010 Time: 12:30-13:30 Room: Poster & Exhibition Area/Ground Level Type: Poster Presentation Correlation between HIV-1 viral load and cryptococcal capsular polysaccharide concentration: Evaluation in a clinical setting D. CECCHINI, A. M. Cañizal, H. ROJAS, A. Arechavala, R. Negroni, M. B. Bouzas, J. Benetucci Hospital Muñiz , Buenos Aires, Argentina Background: In vitro studies demonstrated that a clinically relevant concentration of cryptococcal polysaccharide enhanced HIV-1 production in peripheral mononuclear cells (Pettoello-Mantovani M, et al. Enhancement of HIV-1 infection by the capsular polysaccharide of Cryptococcus neoformans. Lancet 1992, 339:21-23). However, the correlation between cryptococcal capsular polysaccharide (CCP) concentrations and HIV-1 viral load has never been assessed in a clinical setting. Considering the immunomodulatory properties of CCP and that extrapulmonary cryptococcosis is one of the most frequent HIV-related opportunistic infections in our region, the evaluation of potential pathophysiological interactions between these pathogens are of importance for development of therapeutic strategies. Methods: Prospective collection of pretreatment blood samples from antiretroviral naive HIVinfected patients with culture-confirmed cryptococcal meningitis assisted at the Infectious Diseases Hospital “Francisco Javier Muñiz”, Buenos Aires, Argentina (period 2004-2006). Informed consent was obtained from all patients. HIV plasma viral load was measured by reverse transcriptase-polymerase chain reaction using the Cobas Amplicor HIV-1 Monitor Test 1.5 (Roche). CCP antigen concentration was determined by a standard commercial assay (Latex- Cryptococcus Antigen Detection System-IMMY, Immunomycologics). A linear regression analysis was performed with Statistix 7.0 software. Florencio Fiorini “Estimulo” Scholarship by Florencio Fiorini Foundation and by Asociacion Medica Argentina was obtained for the development of the study, as part of an investigation of HIV-1 related cryptococcosis. Results: During the study, 37 HIV-infected patients with cryptococcal meningitis were enrolled. Data regarding HIV-1 plasma viral load and CCP concentrations were available for 25 patients for the final analysis. Median HIV plasma concentration (copies/mL) was 296000 (range: 1000- 750000). Median serum CCP antigen titer was 100 (range: 0-10000). Linear regression analysis found no evidence of a statistical significant correlation between HIV-1 plasma viral load and CCP concentrations (r = 0.1522; p = 0.4676). Conclusion: In opposition to in vitro findings, HIV-1 plasma viral load has no correlation with CCP concentrations. To the best of our knowledge, this is the first study to assess if there is a relationship between the levels of an opportunistic pathogen in blood and HIV-1 viral load in a real life clinical setting
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