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Haematology oncology patient – continued

Adilia Warris continues the case of an 8 year old boy diagnosed with high risk acute lymphatic leukaemia and developed fever (38.7°C).
© BSAC

In step 3.3, we introduced the case of an 8-year-old boy who was previously diagnosed with high risk acute lymphatic leukaemia and had developed a fever while being neutropenic during the induction phase of his treatment. Read below for the next part of the case and share your thoughts in the comments section.

The HRCT-thorax showed characteristic signs of a possible fungal infection, e.g. the dense nodule in the left lung on HRCT demonstrates the radiological ‘halo sign’, consistent with invasive pulmonary aspergillosis.

HRCT-thorax showing a dense nodule in periphery of left lung

Due to the high likelihood of an invasive fungal infection, presumed to be caused by Aspergillus species due to positive GM in serum, a BAL was performed.

Direct microscopy of the BAL-fluid showed septated hyphae compatible with Aspergillus species but the culture remained negative. GM index in BAL fluid was 1.6.

Answer the following questions in the comment section below:

  1. What does the GM test result in the BAL fluid tell you?
  2. What is your diagnosis using the EORTC-MSG definition guidelines?
  3. Which antifungal(s) would you prescribe?
  4. Is there an indication to perform any additional diagnostic test(s)?
© BSAC
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Fungal Diagnostics in Critically Ill Patients

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