[CIS-PAGID] a question on CGD baby_Tb meds + antifungal prophylaxis

[YaeJean Kim]

Dear all,


Thanks to you all, I could save the 4 month old boy with CGD early this
year. (I diagnosed CGD because of a hx of liver abscess due to Serratia when
HO people was suspecting hepatoblastoma).
He is doing well now but I have additional question.

He has had inflammation/abscess like lesions at the BCG site and neck LN...I
continued Tb meds (which I started in Feb when he developed ADRS, at that
time we did not have any evidence)
Now since last month, the LN got inflammed more and pus from the operated LN
is AFB positive...we are culturing the organism now.

So, I think this child has Mycobacterium bovis infection due to BCG
immunization and I will continue current meds (INH, Rifampin, Ethambutol)..
 It seems that the response is slow...but IFN-r is not available in Korea so
I can't use it.

I initially started ampho when his condition was serious but then switched
to itraconzole prophylaxis.
But there is a significant drug infection between Tb meds and
itraconazole...the level of itraconazole is undetectable...I currenly
discontinued itraconzole.
My worry at this moment is that I am not giving him any antifungal
prophylaxis.

I think he may need stem cell transplant since he is suffering from serious
infections since young ages (2 months) but his conidtion would be only ready
when I control this mycobacterium infection and protect him from any
serious fungal infection...

 I would appreciate any suggestion regarding this situation.

Thanks.

YaeJean



-- 
Yae-Jean Kim, MD
Assistant Professor
Division of Infectious Diseases
Department of Pediatrics
Sungkyunkwan University School of Medicine
Samsung Medical Center
50 Irwon-dong Gangnam-gu
Seoul, Korea
Tel)  +82-2-3410-0987  Fax) +82-2-3410-0043
yaejeankim at skku.edu
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