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Suggest Treatment For Aspergillosis Flavus

Posted on Tue, 13 May 2014

Question: Dear Dr. I have daigonised with Aspergillosis Flavus and advised Intraconazole BD for 14 days as of now. The available drug in the area of my Residence is Candiforce-100 (Make Mankind). Is the coposition same as of Sporonox and/or Canditral 100 and/or any other fungal drug. Could the medicine be continued and/or should I go for other alternative.

Answered by Dr. Rakesh Madhyastha (7 hours later)

Brief Answer: Candiforce/Canditral/Spronox Detailed Answer: Hello Thanks for the query Thank you for taking time and uploading the reports, I have gone through them and it looks like you are suffering from Aspergillosis. Your doctors have done a wonderful job, XXXXXXX reports as well as the blood reports is indicative of Aspergillosis so willl have to be put on treatment. Your lumpnodes must have got enlarged secondary to the infection, that is why the reports says reactive lymphadenitis, no treatment is required for that. Candiforce/Canditral/Spronox all of these drugs have itraconazole, you can take any of these medications. The disease is curable with these antifungal agents. Candiforce is a safe drug except when you are allergic to it. Most of my patients do well on candiforce except a few who get gastritis and vomiting. I give anti fungal agents for 3 weeks, please continue candiforce for a total treatment duaration of 3 weeks. At the end of 3 weeks repeat your x ray to know if the condition has improved I advice you not to take Methyprednisolone until you are cured of aspergillosis as steroids are known to flare up fungal infections. I hope I was of help, if you have any further queries please get back to me. I wish you good health and a speedy recovery Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (1 hour later)

Thanks for the kind suggestion, but I cannot immediately stop Methylprednisolon it had to be tapered from 40 Mg least in next 12 days before stopping. More over the Dear Dr. your response was expected on the 1st enclosed report about Gram Stain: 1,. Pus Cells, 2. Gram Positive cocci in pairs in few numbers, 3. Gram Cocci negative few .etc. However I trust the antibiotic also pushes fungal infection. Further advice if any food prevention is necessitated. Kind Regards, XXXX

Answered by Dr. Rakesh Madhyastha (13 hours later)

Brief Answer: Hello Detailed Answer: Thanks for getting back XXXX The first report mentions that there are few gram positive and gram negative cocci, however the sputum culture report has failed to grow any significant organisms, which means that these organisms might be commensals ( part of your system) and does not require antibiotic for treatment. It is true, antibiotics when used for a prolonged period of time will cause fungal growth. However it is mostly seen in immunocompromised patients. Are you sure you are on Methylprednisolone? because as per your records you are on Omnacortil which is prednisolone. Continue taking them as prescribed, and taper them down 10 mg per week. My suggestions on diet are 1. Avoid milk and milk products for the time being 2. Avoid cold beverages and cold food items 3. Abstain from smoking and alcohol 4. Avoid oily food I hope I was of help, if you have any further queries please get back to me I wish you good health and a speedy recovery Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (12 hours later)

Dear Dr. Many thanks for the details, please let me learn how fast can I taper the dosages from 40 Mg to 5 mg to and final to zero. If possible please brief what the major difference between Methylpredinisolone and Prednisone. To me both are Steroids the same drug. Any how I have started tapering to 30 mg since 2 days followed by 20, 15, 10 and 5 mg for every 3 days kindly advise. Further I shall be obliged if you confirm from my reference report 1. Whether I was really suffering with ABPA as commented by Dr. XXXXXXX of XXXXXXX Hosp. 2. The fungal elements could not be finally eliminated and are the root cause of Chronic sinusitis. 3. What precautions and regular drugs be taken to avoid sinusitis in future since I can't change my profession and between every 20 to 30 days my cough grows with chest congestion. There is no check with PND since last 7 years despite every effort. 4. I have tried every available option, steam inhaling, Nebulise either with 0.63 livolin, combination of Budecort N Livolin, combination of Budecort N Duonase, combibnation of Inhalex and Duonase, etc. but not relief. But every expert advise is avoid Steroids. But there is no relief from cough untill I take steroids after thick sputum and chest congestion. Even local Auryuvedic, Naturopathy and Homeopathy were of no help. I know I have developed weak structure of my back pain due to use of steroids and even had to be operated for Cataract. May be I had developed osteoporosis too. What I feel there is no escape root and while I do feel fit why not go with drugs that support lifestyle instead of on bed for no fault. Your suggestions/counselling will be highly appreciable. Regards, XXXX

Answered by Dr. Rakesh Madhyastha (19 hours later)

Brief Answer: Hello Detailed Answer: Thanks for getting back I will answer your questions one by one as there are several questions this time 1. I usually recommend my patients to taper 10 mg every week till zero, then once they reach 10 mg I recommend 5 mg for a week and then stop. Tapering once in 3 days is too fast and it might trigger the basix problem 2. Methyl predinsolone is given as injections for very severe issues like cancer, respiratory compromise, indunction agent before transplant, etc. Prednisolone is a weaker steroid and is taken oral 3. Yes you are suffering from ABPA. You have confirmed reports suggesting the same 4. Fungal elements can be eliminated with treatment. But sinusitis is difficult to treat and are known to recur 5. Precautionary measures are i. To avoid crowded places, and to wear a mask ii. To avoid dust iii. There are no prophylactic medications however otrivin nasal drops helps relieve congestion 6. I recommend you to avoid steroids as well, the alternatives for steroids are levocet, cetrizine, fexofenadine 7. Long term steroid use does goes osteoporosis. You can take Tab Osteophos once a week for this, please approach your doctor for prescription and instructions I hope I was of help Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar