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James E Peacock - One of the best experts on this subject based on the ideXlab platform.
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Pseudallescheria boydii Brain Abscess Successfully Treated with Voriconazole and Surgical Drainage: Case Report and Literature Review of Central Nervous
2016Co-Authors: System Pseudallescheriasis, Mark A Nesky, Colin E Mcdougal, James E PeacockAbstract:Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous, saprophytic fungi that commonly cause cutaneous infection. However, in certain circum-stances, P. boydii can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is dif®cult, therapeutic options are lim-ited, and the prognosis is poor. We report a case of Pseudallescheria brain abscess successfully treated with Surgical Drainage and systemic voriconazole, the ®rst such case to be described in the literature. We also review previously reported cases of CNS pseudallescheriasis and evaluate therapeutic options. The fungi that most commonly cause CNS infections are Candida species and Cryptococcus neoformans [1±3]. However, with the increasing prevalence of immunosuppression (in pa-tients who have undergone organ transplantation, who are re-ceiving chemotherapy for neoplasm, who have AIDS, etc.), other opportunistic fungi have recently emerged as important pathogenic organisms [4±6]. Among these emerging agents, P
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pseudallescheria boydii brain abscess successfully treated with voriconazole and Surgical Drainage case report and literature review of central nervous system pseudallescheriasis
Clinical Infectious Diseases, 2000Co-Authors: Mark A Nesky, Colin E Mcdougal, James E PeacockAbstract:Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous, saprophytic fungi that commonly cause cutaneous infection. However, in certain circumstances, P. boydii can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited, and the prognosis is poor. We report a case of Pseudallescheria brain abscess successfully treated with Surgical Drainage and systemic voriconazole, the first such case to be described in the literature. We also review previously reported cases of CNS pseudallescheriasis and evaluate therapeutic options.
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pseudallescheria boydii brain abscess successfully treated with voriconazole and Surgical Drainage case report and literature review of central nervous system pseudallescheriasis
Clinical Infectious Diseases, 2000Co-Authors: Mark A Nesky, Colin E Mcdougal, James E PeacockAbstract:Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous, saprophytic fungi that commonly cause cutaneous infection. However, in certain circumstances, P. boydii can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited, and the prognosis is poor. We report a case of Pseudallescheria brain abscess successfully treated with Surgical Drainage and systemic voriconazole, the first such case to be described in the literature. We also review previously reported cases of CNS pseudallescheriasis and evaluate therapeutic options. The fungi that most commonly cause CNS infections are Candida species and Cryptococcus neoformans [1‐3]. However, with the increasing prevalence of immunosuppression (in patients who have undergone organ transplantation, who are receiving chemotherapy for neoplasm, who have AIDS, etc.), other opportunistic fungi have recently emerged as important pathogenic organisms [4‐6]. Among these emerging agents, P. boydii is a relatively rare but well-documented potential CNS pathogen. P. boydii (previously known as Allescheria boydii and Petriellidium boydii) and its asexual form, Scedosporium apiospermum (previously Monosporium apiospermum), are ubiquitous saprophytic fungi found in soil, manure, decaying vegetation, and polluted streams [7, 8]. Although P. boydii most often causes cutaneous infection (i.e., mycetoma), invasive disease can occur in immunocompromised hosts, in patients with impaired anatomic barriers (trauma, burns, etc.), and in cases of massive inoculation (near-drowning in polluted water). When P. boydii infection with CNS involvement occurs, it most frequently manifests as either multiple or solitary parenchymal brain abscesses. For the vast majority of patients, the outcome is fatal, even when the diagnosis is promptly established and early and aggressive therapeutic intervention is undertaken [9,
Mark A Nesky - One of the best experts on this subject based on the ideXlab platform.
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Pseudallescheria boydii Brain Abscess Successfully Treated with Voriconazole and Surgical Drainage: Case Report and Literature Review of Central Nervous
2016Co-Authors: System Pseudallescheriasis, Mark A Nesky, Colin E Mcdougal, James E PeacockAbstract:Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous, saprophytic fungi that commonly cause cutaneous infection. However, in certain circum-stances, P. boydii can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is dif®cult, therapeutic options are lim-ited, and the prognosis is poor. We report a case of Pseudallescheria brain abscess successfully treated with Surgical Drainage and systemic voriconazole, the ®rst such case to be described in the literature. We also review previously reported cases of CNS pseudallescheriasis and evaluate therapeutic options. The fungi that most commonly cause CNS infections are Candida species and Cryptococcus neoformans [1±3]. However, with the increasing prevalence of immunosuppression (in pa-tients who have undergone organ transplantation, who are re-ceiving chemotherapy for neoplasm, who have AIDS, etc.), other opportunistic fungi have recently emerged as important pathogenic organisms [4±6]. Among these emerging agents, P
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pseudallescheria boydii brain abscess successfully treated with voriconazole and Surgical Drainage case report and literature review of central nervous system pseudallescheriasis
Clinical Infectious Diseases, 2000Co-Authors: Mark A Nesky, Colin E Mcdougal, James E PeacockAbstract:Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous, saprophytic fungi that commonly cause cutaneous infection. However, in certain circumstances, P. boydii can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited, and the prognosis is poor. We report a case of Pseudallescheria brain abscess successfully treated with Surgical Drainage and systemic voriconazole, the first such case to be described in the literature. We also review previously reported cases of CNS pseudallescheriasis and evaluate therapeutic options.
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pseudallescheria boydii brain abscess successfully treated with voriconazole and Surgical Drainage case report and literature review of central nervous system pseudallescheriasis
Clinical Infectious Diseases, 2000Co-Authors: Mark A Nesky, Colin E Mcdougal, James E PeacockAbstract:Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous, saprophytic fungi that commonly cause cutaneous infection. However, in certain circumstances, P. boydii can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited, and the prognosis is poor. We report a case of Pseudallescheria brain abscess successfully treated with Surgical Drainage and systemic voriconazole, the first such case to be described in the literature. We also review previously reported cases of CNS pseudallescheriasis and evaluate therapeutic options. The fungi that most commonly cause CNS infections are Candida species and Cryptococcus neoformans [1‐3]. However, with the increasing prevalence of immunosuppression (in patients who have undergone organ transplantation, who are receiving chemotherapy for neoplasm, who have AIDS, etc.), other opportunistic fungi have recently emerged as important pathogenic organisms [4‐6]. Among these emerging agents, P. boydii is a relatively rare but well-documented potential CNS pathogen. P. boydii (previously known as Allescheria boydii and Petriellidium boydii) and its asexual form, Scedosporium apiospermum (previously Monosporium apiospermum), are ubiquitous saprophytic fungi found in soil, manure, decaying vegetation, and polluted streams [7, 8]. Although P. boydii most often causes cutaneous infection (i.e., mycetoma), invasive disease can occur in immunocompromised hosts, in patients with impaired anatomic barriers (trauma, burns, etc.), and in cases of massive inoculation (near-drowning in polluted water). When P. boydii infection with CNS involvement occurs, it most frequently manifests as either multiple or solitary parenchymal brain abscesses. For the vast majority of patients, the outcome is fatal, even when the diagnosis is promptly established and early and aggressive therapeutic intervention is undertaken [9,
Stephen P Pereira - One of the best experts on this subject based on the ideXlab platform.
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trial based cost effectiveness analysis comparing Surgical and endoscopic Drainage in patients with obstructive chronic pancreatitis
BMJ Open, 2013Co-Authors: Philippe Laramee, Djuna L Cahen, Dirk J Gouma, Marcel G W Dijkgraaf, David Wonderling, Marco J Bruno, Stephen P PereiraAbstract:Objective: Published evidence indicates that Surgical Drainage of the pancreatic duct was more effective than endoscopic Drainage for patients with chronic pancreatitis. This analysis assessed the costeffectiveness of Surgical versus endoscopic Drainage in obstructive chronic pancreatitis. Design: This trial-based cost-utility analysis (ISRCTN04572410) was conducted from a UK National Health Service (NHS) perspective and during a 79-month time horizon. During the trial the details of the diagnostic and therapeutic procedures, and pancreatic insufficiency were collected. The resource use was varied in the sensitivity analysis based on a review of the literature. The health outcome was the Quality-Adjusted Life Year (QALY), generated using EQ-5D data collected during the trial. There were no pancreas-related deaths in the trial. All-cause mortality from the trial was incorporated into the QALY estimates in the sensitivity analysis. Setting: Hospital. Participants: Patients with obstructive chronic pancreatitis. Primary and secondary outcome measures: Costs, QALYs and cost-effectiveness. Results: The result of the base-case analysis was that Surgical Drainage dominated endoscopic Drainage, being both more effective and less costly. The sensitivity analysis varied mortality and resource use and showed that the Surgical option remained dominant in all scenarios. The probability of costeffectiveness for Surgical Drainage was 100% for the base case and 82% in the assessed most conservative case scenario. Conclusions: In obstructive chronic pancreatitis, Surgical Drainage is highly cost-effective compared with endoscopic Drainage from a UK NHS perspective.
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long term outcomes of endoscopic vs Surgical Drainage of the pancreatic duct in patients with chronic pancreatitis
Gastroenterology, 2011Co-Authors: Djuna L Cahen, Dirk J Gouma, Yung Nio, Erik A J Rauws, Marja A Boermeester, Olivier R Busch, Philippe Laramee, Paul Fockens, Ernst J Kuipers, Stephen P PereiraAbstract:Background & Aims A randomized trial that compared endoscopic and Surgical Drainage of the pancreatic duct in patients with advanced chronic pancreatitis reported a significant benefit of surgery after a 2-year follow-up period. We evaluated the long-term outcome of these patients after 5 years. Methods Between 2000 and 2004, 39 symptomatic patients were randomly assigned to groups that underwent endoscopic Drainage or operative pancreaticojejunostomy. In 2009, information was collected regarding pain, quality of life, morbidity, mortality, length of hospital stay, number of procedures undergone, changes in pancreatic function, and costs. Analysis was performed according to an intention-to-treat principle. Results During the 79-month follow-up period, one patient was lost and 7 died from unrelated causes. Of the patients treated by endoscopy, 68% required additional Drainage compared with 5% in the surgery group ( P = .001). Hospital stay and costs were comparable, but overall, patients assigned to endoscopy underwent more procedures (median, 12 vs 4; P = .001). Moreover, 47% of the patients in the endoscopy group eventually underwent surgery. Although the mean difference in Izbicki pain scores was no longer significant (39 vs 22; P = .12), surgery was still superior in terms of pain relief (80% vs 38%; P = .042). Levels of quality of life and pancreatic function were comparable. Conclusions In the long term, symptomatic patients with advanced chronic pancreatitis who underwent surgery as the initial treatment for pancreatic duct obstruction had more relief from pain, with fewer procedures, than patients who were treated endoscopically. Importantly, almost half of the patients who were treated with endoscopy eventually underwent surgery.
Colin E Mcdougal - One of the best experts on this subject based on the ideXlab platform.
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Pseudallescheria boydii Brain Abscess Successfully Treated with Voriconazole and Surgical Drainage: Case Report and Literature Review of Central Nervous
2016Co-Authors: System Pseudallescheriasis, Mark A Nesky, Colin E Mcdougal, James E PeacockAbstract:Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous, saprophytic fungi that commonly cause cutaneous infection. However, in certain circum-stances, P. boydii can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is dif®cult, therapeutic options are lim-ited, and the prognosis is poor. We report a case of Pseudallescheria brain abscess successfully treated with Surgical Drainage and systemic voriconazole, the ®rst such case to be described in the literature. We also review previously reported cases of CNS pseudallescheriasis and evaluate therapeutic options. The fungi that most commonly cause CNS infections are Candida species and Cryptococcus neoformans [1±3]. However, with the increasing prevalence of immunosuppression (in pa-tients who have undergone organ transplantation, who are re-ceiving chemotherapy for neoplasm, who have AIDS, etc.), other opportunistic fungi have recently emerged as important pathogenic organisms [4±6]. Among these emerging agents, P
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pseudallescheria boydii brain abscess successfully treated with voriconazole and Surgical Drainage case report and literature review of central nervous system pseudallescheriasis
Clinical Infectious Diseases, 2000Co-Authors: Mark A Nesky, Colin E Mcdougal, James E PeacockAbstract:Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous, saprophytic fungi that commonly cause cutaneous infection. However, in certain circumstances, P. boydii can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited, and the prognosis is poor. We report a case of Pseudallescheria brain abscess successfully treated with Surgical Drainage and systemic voriconazole, the first such case to be described in the literature. We also review previously reported cases of CNS pseudallescheriasis and evaluate therapeutic options.
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pseudallescheria boydii brain abscess successfully treated with voriconazole and Surgical Drainage case report and literature review of central nervous system pseudallescheriasis
Clinical Infectious Diseases, 2000Co-Authors: Mark A Nesky, Colin E Mcdougal, James E PeacockAbstract:Pseudallescheria boydii and its asexual form, Scedosporium apiospermum, are ubiquitous, saprophytic fungi that commonly cause cutaneous infection. However, in certain circumstances, P. boydii can also cause invasive disease, which can involve the central nervous system (CNS). When the CNS becomes involved, treatment is difficult, therapeutic options are limited, and the prognosis is poor. We report a case of Pseudallescheria brain abscess successfully treated with Surgical Drainage and systemic voriconazole, the first such case to be described in the literature. We also review previously reported cases of CNS pseudallescheriasis and evaluate therapeutic options. The fungi that most commonly cause CNS infections are Candida species and Cryptococcus neoformans [1‐3]. However, with the increasing prevalence of immunosuppression (in patients who have undergone organ transplantation, who are receiving chemotherapy for neoplasm, who have AIDS, etc.), other opportunistic fungi have recently emerged as important pathogenic organisms [4‐6]. Among these emerging agents, P. boydii is a relatively rare but well-documented potential CNS pathogen. P. boydii (previously known as Allescheria boydii and Petriellidium boydii) and its asexual form, Scedosporium apiospermum (previously Monosporium apiospermum), are ubiquitous saprophytic fungi found in soil, manure, decaying vegetation, and polluted streams [7, 8]. Although P. boydii most often causes cutaneous infection (i.e., mycetoma), invasive disease can occur in immunocompromised hosts, in patients with impaired anatomic barriers (trauma, burns, etc.), and in cases of massive inoculation (near-drowning in polluted water). When P. boydii infection with CNS involvement occurs, it most frequently manifests as either multiple or solitary parenchymal brain abscesses. For the vast majority of patients, the outcome is fatal, even when the diagnosis is promptly established and early and aggressive therapeutic intervention is undertaken [9,
Djuna L Cahen - One of the best experts on this subject based on the ideXlab platform.
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trial based cost effectiveness analysis comparing Surgical and endoscopic Drainage in patients with obstructive chronic pancreatitis
BMJ Open, 2013Co-Authors: Philippe Laramee, Djuna L Cahen, Dirk J Gouma, Marcel G W Dijkgraaf, David Wonderling, Marco J Bruno, Stephen P PereiraAbstract:Objective: Published evidence indicates that Surgical Drainage of the pancreatic duct was more effective than endoscopic Drainage for patients with chronic pancreatitis. This analysis assessed the costeffectiveness of Surgical versus endoscopic Drainage in obstructive chronic pancreatitis. Design: This trial-based cost-utility analysis (ISRCTN04572410) was conducted from a UK National Health Service (NHS) perspective and during a 79-month time horizon. During the trial the details of the diagnostic and therapeutic procedures, and pancreatic insufficiency were collected. The resource use was varied in the sensitivity analysis based on a review of the literature. The health outcome was the Quality-Adjusted Life Year (QALY), generated using EQ-5D data collected during the trial. There were no pancreas-related deaths in the trial. All-cause mortality from the trial was incorporated into the QALY estimates in the sensitivity analysis. Setting: Hospital. Participants: Patients with obstructive chronic pancreatitis. Primary and secondary outcome measures: Costs, QALYs and cost-effectiveness. Results: The result of the base-case analysis was that Surgical Drainage dominated endoscopic Drainage, being both more effective and less costly. The sensitivity analysis varied mortality and resource use and showed that the Surgical option remained dominant in all scenarios. The probability of costeffectiveness for Surgical Drainage was 100% for the base case and 82% in the assessed most conservative case scenario. Conclusions: In obstructive chronic pancreatitis, Surgical Drainage is highly cost-effective compared with endoscopic Drainage from a UK NHS perspective.
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long term outcomes of endoscopic vs Surgical Drainage of the pancreatic duct in patients with chronic pancreatitis
Gastroenterology, 2011Co-Authors: Djuna L Cahen, Dirk J Gouma, Yung Nio, Erik A J Rauws, Marja A Boermeester, Olivier R Busch, Philippe Laramee, Paul Fockens, Ernst J Kuipers, Stephen P PereiraAbstract:Background & Aims A randomized trial that compared endoscopic and Surgical Drainage of the pancreatic duct in patients with advanced chronic pancreatitis reported a significant benefit of surgery after a 2-year follow-up period. We evaluated the long-term outcome of these patients after 5 years. Methods Between 2000 and 2004, 39 symptomatic patients were randomly assigned to groups that underwent endoscopic Drainage or operative pancreaticojejunostomy. In 2009, information was collected regarding pain, quality of life, morbidity, mortality, length of hospital stay, number of procedures undergone, changes in pancreatic function, and costs. Analysis was performed according to an intention-to-treat principle. Results During the 79-month follow-up period, one patient was lost and 7 died from unrelated causes. Of the patients treated by endoscopy, 68% required additional Drainage compared with 5% in the surgery group ( P = .001). Hospital stay and costs were comparable, but overall, patients assigned to endoscopy underwent more procedures (median, 12 vs 4; P = .001). Moreover, 47% of the patients in the endoscopy group eventually underwent surgery. Although the mean difference in Izbicki pain scores was no longer significant (39 vs 22; P = .12), surgery was still superior in terms of pain relief (80% vs 38%; P = .042). Levels of quality of life and pancreatic function were comparable. Conclusions In the long term, symptomatic patients with advanced chronic pancreatitis who underwent surgery as the initial treatment for pancreatic duct obstruction had more relief from pain, with fewer procedures, than patients who were treated endoscopically. Importantly, almost half of the patients who were treated with endoscopy eventually underwent surgery.
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endoscopic versus Surgical Drainage of the pancreatic duct in chronic pancreatitis
The New England Journal of Medicine, 2007Co-Authors: Djuna L Cahen, Dirk J Gouma, Yung Nio, Erik A J Rauws, Marja A Boermeester, Olivier R Busch, Jaap Stoker, Johan S Lameris, Marcel G W Dijkgraaf, K HuibregtseAbstract:From the Departments of Gastroenterology and Hepatology (D.L.C., E.A.J.R., K.H., M.J.B.), Surgery (D.J.G., M.A.B., O.R.B.), Radiology (Y.N., J.S., J.S.L.), and Clinical Epidemiology, Biostatistics, and Bioinformatics (M.G.W.D.), Academic Medical Center, Amsterdam. Address reprint requests to Dr. Cahen at the Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands, or
