[PAGID] Necrotisin pneumonia in a CGD patient

[Church, Joseph]

Does the patient also have severe adenopathy?  If the pathology is characterized by necrotizing granulomas, consider an infection with a recently described gram negative bacterium Granulibacter bethesdensis (PLoS Pathogens 2006; 2:e28) or a related organism.  It is very hard to grow and very difficult to treat.

 

I suggest you contact Dr. Greenberg at NIH regarding how to optimize culture conditions for this class of organism.  His contact information is dgreenberg at niaid.nih.gov.  

 

Joe Church

Childrens Hospital Los Angeles

 

________________________________

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Chinen, Javier
Sent: Tuesday, July 27, 2010 11:55 AM
To: 'pagid at list.clinimmsoc.org'
Subject: Re: [PAGID] Necrotisin pneumonia in a CGD patient

 

This is an expected clinical scenario in CGD. Consider Fungitell (BDGlucan), and aspergillus galactomannan (platelia). Major problems with sensitivity and specificity, as the tests perform worse in CGD than in neutropenic patients (unpublished experience), but definitive positives are helpful.

Javier

 

________________________________

From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Pere Soler Palacin
Sent: Tuesday, July 27, 2010 12:47 PM
To: pagid at list.clinimmsoc.org
Subject: [PAGID] Necrotisin pneumonia in a CGD patient

 

 

Dear colleagues, 

 

We are actually worried about a 3 yo boy who was diagnosed of CGD 2 years ago due to family history (his brother suffered from disseminated aspergilosis). He has been doing well until May, when he was admitted to another centre in Spain due to a left lung necrotising pneumonia. Despite several antibacterial and antifungal courses, the patient is worsening and a lung CT performed a week ago showed invasion of the 6th rib and pericardium.

The patient is currently receiving meropenem, rifampin, cotrimoxazole, clarithromycin, voriconazole and caspofungin in order to treat Nocardia, Actinomyces, Rhodococcus and IFI.

During admission two BAL and one open lung biopsy have been performed and cultures (bacteria, mycobacteria, fungi) have repeteadly yielded negative results as PCR to Mycobacterium tuberculosis complex and Aspergillus sp. Our pathologist has reported the presence of granulomata and severe necrosis.

We are waiting for surgical resection of the lesion and we wonder what microbiological tests you would consider in order to achieve an aetiological diagnosis if possible.

 

 

Many thanks for your time,

 

Yours,

 

Pere Soler Palacín

Pediatric Infectious Diseases and Immunodeficiencies Unit

Vall d'Hebron University Hospital

Barcelona, Spain

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