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

[Michael Albert]

Dear Yae-Jean,
I think your little patient should undergo reduced intensitiy BM or PBSC
transplant as soon as possible. He might not recover from his BCG infection
unless engrafted succesfully.
Sincerely,
Michael


*Michael Albert, MD***

Assistant Professor

Department of Pediatric Hematology/Oncology

Head SCT Program

Dr. von Haunersches Kinderspital der LMU

Lindwurmstr.4

80337 München

Germany

Tel: +49 89 5160 2811
Fax: +49 89 5160 4719

On Mon, Jun 13, 2011 at 5:23 AM, YaeJean Kim <yaejeankim at skku.edu> wrote:


> 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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