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

[Belohradsky, Bernd]

Dear YaeJean, it might well be that your patient will overcome his mycobacterial infection only following a successful stemcell transplantation; we and others have seen that in SCID patients with BCGitis;
Bernd H.Belohradsky
(Childrens Hosp.,Univ.Munich)

________________________________
Von: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] Im Auftrag von YaeJean Kim
Gesendet: Montag, 13. Juni 2011 05:23
An: pagid
Betreff: [CIS-PAGID] a question on CGD baby_Tb meds + antifungal prophylaxis

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<mailto:yaejeankim at skku.edu>

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