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Number of Allogeneic BMT Cases done at KFSH & RC 1984-2003

Invasive Fungal Infections Encountered in Saudi Arabia Hail M. Al-Abdely, MD Section of Infectious Diseases Department of Medicine King Faisal Specialist Hospital & Research Center Riyadh, Saudi Arabia. Number of Allogeneic BMT Cases done at KFSH & RC 1984-2003. Cases. Total cases: 1407.

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Number of Allogeneic BMT Cases done at KFSH & RC 1984-2003

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  1. Invasive Fungal Infections Encountered in Saudi ArabiaHail M. Al-Abdely, MDSection of Infectious DiseasesDepartment of MedicineKing Faisal Specialist Hospital & Research CenterRiyadh, Saudi Arabia

  2. Number of Allogeneic BMT Cases done at KFSH & RC 1984-2003 Cases Total cases: 1407

  3. “Common” Invasive Fungal Infections Encountered at KFSH&RC

  4. Candidemia

  5. Cases of Candidemia from 1990 to 2003

  6. Adult compared to pediatric cases

  7. Prevalence of C. albicans isolates compared to non-albicans Candida species

  8. Distribution of non-albicans Candida species over the years

  9. Distribution of cases of candidemia to medical units

  10. Distribution of Candidemia Cases in adults by Clinical Service

  11. Antifungal Prophylaxis and Candida species from blood

  12. Aspergillosis

  13. Aspergillosis at KFSH & RC 2001 - 2003 Cases

  14. Distribution of Aspergillus species in Sinus and Invasive Disease %

  15. Zygomycosis

  16. Distribution of Mucormycosis Cases over the Years

  17. Underlying Conditions in Patients with Mucormycosis

  18. Site of Infection Related to Underlying Condition

  19. Outcome of Patients with Mucormycosis

  20. Outcome Related to Underlying Condition

  21. Fusariosis

  22. Fusarium Isolates at KFSH & RC 1992 - 2003

  23. Cryptococcosis

  24. Cryptococcosis • Rare infection in Saudi Arabia • Only 6 cases from 1985 to 2003 • Two of the cases were courtesy of John Perfect visit 1995 • 4 HIVs, 1 brain tumor on steroids and 1 with idiopathic CD4 cytopenia

  25. “Unique Cases”

  26. “Survivor of the Middle-East Fungus”

  27. History • 62 y/o male from AlAhasa with Type II DM on insulin • DM complications with retinopathy and nephropathy leading to ESRD  HD • February 12, 2000: NRLKTx in Iran. • Uneventful perioperative course and normal graft function.

  28. History • 22/4/2000: • Presented to ARAMCO hosp. With 2 days h/o left sided hemiparesis and hemisensory loss. • No h/o fever, seizures or synchope. • Meds • Cyclosporin, prednisone, Amlodipine.

  29. Clinical • Alert and oriented • Afebrile. BP 170/90 • Left sided hemiparesis, power 4/5 • Marked left hemisensory loss. • Chest, CVS and abdomen: unremarkable

  30. WBC= 6.2 HgB= 118 Plt= 250 Creatinine=104 ALP= 168 ALT= 30 ALB= 31 Labs/imaging • PPD= negative • CXR= unremarkable • USS abd.= normal • CT brain

  31. Ramichloridium mackenziei

  32. Hospital Course • 25/4/2000: • Started on Amphotericin B Lipid Complex (ABLC) 5 mg/kg/day and Itraconazole 200 mg BID. • 13/5/2000: • Neurologically the same. • MRI brain

  33. 13 May 2000

  34. Case 2- Hospital Course • 23/5/2000 (ARAMCO): • Slightly worse. More weak. • On same meds. • MRI brain

  35. 23 May 2000

  36. Hospital Course • 31/5/2000:Transfer to KFSH. • Clinically the same • Started on • AmBisome 5mg/kg/day, • Itraconazole 250mg IV Q12hrs • 5-Flucytosine 20mg/kg IV Q8hrs.

  37. KFSH Course • 13/6/2000: • Clinically the same • MRI brain

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