[prayingrbc]

My father has been treated empirically for Aspergillus and has we have tried Voriconazole, however, it only showed promise of working for the initial first few days. - We really need an infectious disease specialists’ opinion. The current doctors can’t seem to figure it out.

Facts:
-He has an underline diagnosis for Aplastic Anemia, currently WBC’s generally 2+, Plts 12, HGB 6.5 (on cyclosporine 200 BID)
-Ongoing infection issues since initial immune suppression and original low WBC.
-CT showed fungal ball in lung
- bronchial washing showed CMV and Non MRSA Staph. (currently treating both)
-blood test was positive for*the Aspergillus antigen.
-skin test positive for TB (has always been that way since he was a kid.)

Symptoms of infection:
weakness/fatigue/lethargy
confusion (at times)
difficulty breathing
drooping eyelid (new symptom)
fever
chills
constant sleeping
lower back pain (said he had it before illness but is significantly worse now - at times)
despite 2000 calories of ensure and boost (blood tests showing malnourishment)

The most pressing is what appear to be a fungal infection. Twice in the last two months he has spiked high temps accompanied by weakness and difficulty breathing and confusion, constant sleeping and fever. He has been treated empirically for Aspergillus with Voriconazole, however it doesn’t seem to be working and it appears he may be intolerant to it.

Mid March he started Voriconazole and within 36 hours of being on the drug he seemed to snap back to “normal” walking, no shortness of breath, appetite back, clear mental state, staying awake. Within a week his weakness was returning and it was if the Voriconazole was no longer helping. If anything was worsening. He was becoming severely jaundice, vomiting, severe weakness in addition to all the other symptoms returning (except the fever). We stopped all drugs, including Immunosupressives for his Aplastic Anemia. After 10 days of being off all drugs he seemed to improve. He started to eat a little, was staying awake more, the jaundice went away and he wasn’t confused nearly as much.

We started Immunosupressives again for the Aplastic Anemia and within about a 4-5 days his symptoms were slowly returning - fever, weakness, shortness of breath, confusion. We resumed Voriconazole.

Again, within 36 hours he was showing significant improvement, but again within 4-5 days his symptoms are returning, so far the sleeping and confusion.
I feel like there is something to this - somehow, somewhere we are missing something. I realize they are treating empirically, but to me, seeing the dramatic improvement within 36 hours of being on the Voriconazole (twice) and seeing the decline after a few days (twice) means something. Somewhere there is a missing link or puzzle piece.

Is it a resistant strain of Aspergillus? Not a sufficient dose of Voriconazole? Another fungal infection that needs another drug? Should he be off the cyclosporine Immunosupressive drug to treat the Aplastic Anemia during the course of the Voriconazole treatment?

Any help or direction would be greatly appreciated.