Clinical case of invasive aspergillosis in child after kidney transplantation

Abstract

Fungal infections occur in 2.1% of cases of infectious complications after kidney transplantation. Invasive aspergillosis is second in frequency among fungal infections and the most often reason of mortality caused by complications of fungal etiology after kidney transplantation. More than 80% of cases of invasive aspergillosis were diagnosed during the first year after surgery. Due to the use of voriconazole, the mortality of patients in this group decreased from 40-70% to 19%. A clinical case of invasive aspergillosis in a child after kidney transplantation is presented. The time course of the patient's clinical condition is described: the development of severe leukopenia, the addition of obstructive pneumonia, the long-term persistence of tracheitis with outcome in stenosis. The immunosuppressive therapy was corrected depending on hematological disorders; tacrolimus dose was reduced significantly (in 10 times) while the patient was treated with voriconazole. The early differential diagnosis between inflammatory processes of viral, bacterial and fungal etiology in developing the systemic inflammatory response syndrome in the postoperative period allowed us to diagnose and treat this desease. A significant increase in the level of C-reactive protein with normal or slightly elevated values of procalcitonin may indicate the accession of an infection of fungal etiology.