Aspergillus

Question

I have been treated for several weeks with inhalative vancomycin due to a sudden finding of MRSA germs in the sputum, additionally with oral dosages of rifampicin and cotrimoxazole. At the moment, the germ is not detectable anymore, instead masses of Aspergillus have been found. I have realized during this time a worsening of my FEV1, what can assumably be due to the high dosage of vancomycin. But also Aspergillus can cause those symtoms, to my knowledge that the lung function declines markedly within the shortest time. Now of course the Aspergillus should be fought with Sempera® (itraconazole), after the above mentioned antibiotic dosages have been finished.
My question is now, did the mould fungus occur due to the 3-fold antibioitic treatment? And is it possible that, if the fungus is fought, the MRSA wins again through?

Until now, my main germ has always been the Stenotrophomonas, which I have "born" almost unproblematically.

Many thanks for your answer

Answer

Dear questioner,

with your suspicion, you are certainly right. As studies have shown that in case of the finding of MRSA in the airways of CF-patients lung function declines, one tries to eradicate this germ with an antibiotic therapy. Probably this was successful in your case. Unfortunately, consecutively other germs can be detected in the airways then. Furthermore, only several follow-up investigations can indeed demonstrate that the MRSA has been eradicated with certainty. It cannot be predicted, which germ will be detectable in your airways after the therapy with itraconazole. Therefore it is important to go on observing the bacteria or fungi that colonize your airways and probably infect them and to react on this with respecitve therapies.

Yours sincerely,
Barbara Kahl

01.07.2013