Molecular and clinical features of 45 patients with chronic granulomatous disease and invasive aspergillosis in Mexico
| Patient code (P) . | Sex . | Gene . | Events . | IA Classification (EORTC/MSGERC) . | Aspergillus species . | Treatment . | Time of Treatment . | Steroids . | Parallel antituberculosis therapy to antifungal therapy . | Organs involved . | Co-infection to aspergillosis . | Clinical course . | Cause of death . | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| <175 days . | >75 days . | |||||||||||||
| P1(4) | M | CYBB | 2 | Possible | | Voriconazole | * | | ● | | Lung | Enterococcus faecalis, Achromobacter xylosoxidans, and Neisseria subflava | Dead | IA |
| Probable | | Voriconazole | | * | ● | | Lung | |||||||
| P2(4) | M | CYBB | 1 | Probable | | Voriconazole and caspofungin | | * | ● | | Lung | Pseudomonas aeruginosa | Alive | |
| P3(4) | M | CYBB | 4 | Possible | | Voriconazole, caspofungin, and amphotericin B | * | | ● | R, H, Z, and E | Lung, liver, spleen, and kidney | Serratia marcescens | Dead | Cardiogenic shock |
| Possible | | Voriconazole | | * | | | Lung and bone | |||||||
| Possible | | Voriconazole and caspofungin | | * | | | Lung and bone | |||||||
| Possible | | Voriconazole and fluconazole | * | | ● | | Lung | |||||||
| P4(4) | M | NCF2 | 1 | Possible | | Voriconazole and caspofungin | * | | ● | | Lung | | Dead | Septic shock |
| P5(4) | M | CYBB | 4 | Possible | | Voriconazole | | * | ● | R, H, Z, and E | Lung | Exophiala dermatitidis | Alive | |
| Possible | | Voriconazole | | * | ● | | Lung | |||||||
| Probable | | Voriconazole and amphotericin B | * | | ● | | Lung | |||||||
| Probable | | Voriconazole | | * | ● | | Lung | |||||||
| P6(4) | M | CYBB | 2 | Possible | | Voriconazole and caspofungin | | * | | R, H, Z, E, and LVX | Lung | | Alive | |
| Possible | | Voriconazole | * | | | | Lung | |||||||
| P7(4)a | F | NCF2 | 2 | Possible | | Voriconazole and posaconazole | | * | | | Lung and spleen | | Alive | |
| Probable | A. fumigatus | Voriconazole | | * | | H, E, CLR, and LVX | Lung | |||||||
| P8 | M | CYBB | 1 | Probable | | Voriconazole and caspofungin | * | | ● | H, R, E, CIP, and CLR | Lung | | Dead | IA |
| P9(4) | F | CYBA | 3 | Probable | Aspergillus spp | Voriconazole | | * | | | Lung | Salmonella spp., P. aeruginosa, Citrobacter freundii, Klebsiella variicola, and Mycobacterium chimaera | Dead | IA |
| Probable | | Voriconazole | | * | ● | | Lung | |||||||
| Probable | A. niger A. terreus | Voriconazole, caspofungin, and amphotericin B | | * | ● | R, Z, E, and H | Lung | |||||||
| P10 | M | CYBB | 1 | Possible | | Voriconazole, caspofungin, and posaconazole | | * | ● | LVX, H, Z, and E | Lung | | Dead | Septic shock |
| P11(4) | M | NCF2 | 1 | Probable | | Voriconazole, caspofungin, and amphotericin B | * | | ● | H, R, and E | Lung, skin, and CNS | | Dead | IA |
| P12(4) | M | CYBB | 1 | Proven | A. versicolor | Voriconazole | | * | ● | | Lung, liver, spleen, and CNS | S. marcescens and Burkholderia cepacia | Alive | |
| P13(4) | M | CYBB | 2 | Probable | | Voriconazole, caspofungin, and amphotericin B | | * | ● | | Lung and spleen | Pneumocystis jirovecii | Dead | IA |
| Probable | A. fumigatus | Voriconazole | * | | | | Lung | |||||||
| P14(4) | F | NCF2 | 4 | Possible | | Voriconazole | | * | ● | CLR, R, H, and E | Lung | E. coli BLEE, Klebsiella pneumoniae BLEE, P. aeruginosa, Pseudomonas rhodesiae, Streptococcus oralis, Streptococcus salivarius, Penicillium spp., and Campylobacter spp. | Alive | |
| Possible | | Voriconazole, caspofungin, and amphotericin B | | * | ● | | Lung, liver, and spleen | |||||||
| Proven | A. ustus | Voriconazole | * | | | CLR, R, H, and E | Lung | |||||||
| Probable | | Voriconazole | | * | ● | | Lung | |||||||
| P15(4) | M | CYBB | 1 | Probable | | Voriconazole | | * | ● | | Lung | | Alive | |
| P16 | M | CYBB | 1 | Possible | | Voriconazole | | * | | | Lung | | Dead | IA |
| P17b | M | CYBB | 1 | Probable | A. terreus | Voriconazole and caspofungin | * | | ● | | Lung | Actinomyces israelii and Staphylococcus aureus | Dead | IA |
| A. flavus | | |||||||||||||
| P18(4) | M | CYBB | 2 | Possible | | Voriconazole | * | | | | Lung | Salmonella spp. | Dead | IA |
| Probable | A. fumigatus | Voriconazole, caspofungin, amphotericin B, and posaconazole | | * | ● | | Lung and CNS | |||||||
| P19(4) | M | CYBB | 1 | Probable | | Voriconazole and caspofungin | * | | ● | | Lung | | Dead | IA |
| P20(4) | M | CYBA | 3 | Possible | | Voriconazole | * | | | | Lung | S. marcescens, Burkholderia multivorans, P. aeruginosa, and K. pneumoniae BLEE | Dead | Pneumonia K. pneumoniae |
| Possible | | Voriconazole | | * | | | Lung and spleen | |||||||
| Proven | A. flavus | Voriconazole, caspofungin, and amphotericin B | | * | ● | | Lung and CNS | |||||||
| P21(4) | F | NCF2 | 2 | Possible | | Voriconazole and caspofungin | | * | ● | | Lung | Salmonella spp., Streptococcus pneumoniae, P. aureginosa, and Hormographiella aspergillata | Alive | |
| Probable | | Voriconazole | * | | ● | | Lung | |||||||
| P22(4) | M | NCF1 | 3 | Possible | | Voriconazole | * | | ● | | Lung | K. pneumoniae and Enterobacter cloacae | Alive | |
| Possible | | Voriconazole | | * | | H, E, LZD, and LVX | Lung | |||||||
| Probable | | Voriconazole, caspofungin, and amphotericin B | | * | | H, E | Lung and CNS | |||||||
| P23(4) | M | CYBB | 1 | Probable | | Voriconazole and caspofungin | | * | ● | | Lung | E. coli | Dead | Septic shock |
| P24 | M | CYBB | 1 | Probable | Aspergillus spp | Voriconazole | * | | ● | | Lung | Staphylococcushominis | Alive | |
| P25(4) | M | CYBB | 1 | Possible | | Voriconazole, caspofungin, and amphotericin B | | * | ● | | Lung | Staphylococcus haemolyticus and Stenotrophomonas maltophilia | Dead | IA |
| P26(4) | M | NCF1 | 3 | Possible | | Voriconazole | * | | | | Lung | Candida guilliermondii | Alive | |
| Proven | A. fumigatus | Voriconazole | | * | ● | | Lung | |||||||
| Proven | A. nidulans A. fumigatus A. versicolor | Voriconazole and amphotericin B | | * | ● | | Lung | |||||||
| P27(24) | M | CYBB | 1 | Probable | Aspergillus spp | Voriconazole, caspofungin, amphotericin B, and posaconazole | | * | ● | H, E, and LVX | Lung, skin, and CNS | | Dead | IA |
| P28 | M | CYBB | 1 | Probable | | Voriconazole, caspofungin, and amphotericin | | * | ● | H, R, Z, and E | Lung | | Alive | |
| P29(4) | M | CYBB | 3 | Possible | | Voriconazole | * | | | | Lung | | Alive | |
| Possible | | Voriconazole | | * | | | Lung | |||||||
| Possible | | Voriconazole | | * | ● | | Lung | |||||||
| P30(4) | M | CYBB | 1 | Possible | | Voriconazole and caspofungin | | * | ● | | Lung | | Alive | |
| P31(16)c | M | CYBB | 2 | Probable | Aspergillus spp | Voriconazole | * | | | | Lung, bone, and skin | E. faecalis | Dead | IA |
| Probable | A. fumigatus | Voriconazole | * | | | | Lung | |||||||
| P32(4) | M | CYBB | 1 | Proven | Aspergillus spp | None | | | ● | | Lung | B. cepacia | Dead | IA |
| P33 | M | CYBB | 1 | Proven | A. fumigatus | Fluconazole | | * | ● | | Lung | Mycobacterium tuberculosis and K. pneumoniae | Dead | IA |
| P34(4) | F | CYBB | 1 | Probable | | Voriconazole and amphotericin B | * | | ● | | Lung | | Alive | |
| P35(4) | M | CYBB | 1 | Proven | A. versicolor | Voriconazole | | * | ● | H, R, Z, and E | Lung | | Alive | |
| P36(4) | M | CYBB | 2 | Possible | | Voriconazole | | * | ● | | Lung and liver | | Alive | |
| Probable | A. fumigatus | Voriconazole | | * | ● | | Lung and skin | |||||||
| P37(4) | M | NCF2 | 4 | Possible | | Voriconazole, caspofungin, and amphotericin B | | * | | | Lung | S. marcescens | Alive | |
| Probable | | Voriconazole and caspofungin | | * | | R, H, Z, and E | Lung | |||||||
| Proven | A. versicolor | Voriconazole | | * | ● | | Lung | |||||||
| Proven | A. fumigatus | Voriconazole | | * | ● | | Lung and skin | |||||||
| P38(4) | F | CYBA | 1 | Probable | A. fumigatus | Voriconazole | * | | | | Lung | | Dead | Accident |
| P39 | M | CYBB | 2 | Possible | | Voriconazole | | * | | | Lung | Pseudomonas putida and K. pneumoniae BLEE | Alive | |
| Probable | A. versicolor | Voriconazole | | * | | | Lung | |||||||
| P40 | M | CYBB | 1 | Probable | | Amphotericin B | * | | ● | | Lung | S. aureus and S. maltophilia | Dead | Septic shock |
| P41 | M | CYBB | 1 | Proven | A. nidulans | Voriconazole, caspofungin, and amphotericin B | * | | ● | | Lung | B. cepacia, Penicillium spp., and Pseudomonas spp. | Dead | IA |
| P42 | M | CYBB | 1 | Probable | A. fumigatus A. versicolor | Voriconazole | * | | | | Lung and bone | A. lwoffi and P. aeruginosa | Dead | IA |
| P43 | M | CYBB | 1 | Proven | A. versicolor | Voriconazole, caspofungin, amphotericin B, and posaconazole | | * | ● | | Lung and pericardium | S. aureus and S. hominis | Dead | IA |
| P44 | M | CYBB | 1 | Proven | Aspergillus spp | Voriconazole, caspofungin, and amphotericin B | | * | ● | | Lung and bone | Streptococcus mitis, K. pneumoniae, P. aeruginosa, S. hominis, and Candida albicans | Dead | IA |
| P45(4) | M | NCF1 | 4 | Possible | | Voriconazole, itraconazole, and anidulafungin | * | | | | Lung | | Dead | Cerebral cryptococcosis |
| Probable | A. fumigatus A. flavus | Itraconazole | | * | ● | | Lung | |||||||
| Probable | A. fumigatus | Voriconazole, amphotericin B, itraconazole, fluconazole, and anidulafungin | * | | | | Lung | |||||||
| Probable | A. flavus | Voriconazole, caspofungin, and amphotericin B | * | | ● | | Lung | |||||||
| Patient code (P) . | Sex . | Gene . | Events . | IA Classification (EORTC/MSGERC) . | Aspergillus species . | Treatment . | Time of Treatment . | Steroids . | Parallel antituberculosis therapy to antifungal therapy . | Organs involved . | Co-infection to aspergillosis . | Clinical course . | Cause of death . | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| <175 days . | >75 days . | |||||||||||||
| P1(4) | M | CYBB | 2 | Possible | | Voriconazole | * | | ● | | Lung | Enterococcus faecalis, Achromobacter xylosoxidans, and Neisseria subflava | Dead | IA |
| Probable | | Voriconazole | | * | ● | | Lung | |||||||
| P2(4) | M | CYBB | 1 | Probable | | Voriconazole and caspofungin | | * | ● | | Lung | Pseudomonas aeruginosa | Alive | |
| P3(4) | M | CYBB | 4 | Possible | | Voriconazole, caspofungin, and amphotericin B | * | | ● | R, H, Z, and E | Lung, liver, spleen, and kidney | Serratia marcescens | Dead | Cardiogenic shock |
| Possible | | Voriconazole | | * | | | Lung and bone | |||||||
| Possible | | Voriconazole and caspofungin | | * | | | Lung and bone | |||||||
| Possible | | Voriconazole and fluconazole | * | | ● | | Lung | |||||||
| P4(4) | M | NCF2 | 1 | Possible | | Voriconazole and caspofungin | * | | ● | | Lung | | Dead | Septic shock |
| P5(4) | M | CYBB | 4 | Possible | | Voriconazole | | * | ● | R, H, Z, and E | Lung | Exophiala dermatitidis | Alive | |
| Possible | | Voriconazole | | * | ● | | Lung | |||||||
| Probable | | Voriconazole and amphotericin B | * | | ● | | Lung | |||||||
| Probable | | Voriconazole | | * | ● | | Lung | |||||||
| P6(4) | M | CYBB | 2 | Possible | | Voriconazole and caspofungin | | * | | R, H, Z, E, and LVX | Lung | | Alive | |
| Possible | | Voriconazole | * | | | | Lung | |||||||
| P7(4)a | F | NCF2 | 2 | Possible | | Voriconazole and posaconazole | | * | | | Lung and spleen | | Alive | |
| Probable | A. fumigatus | Voriconazole | | * | | H, E, CLR, and LVX | Lung | |||||||
| P8 | M | CYBB | 1 | Probable | | Voriconazole and caspofungin | * | | ● | H, R, E, CIP, and CLR | Lung | | Dead | IA |
| P9(4) | F | CYBA | 3 | Probable | Aspergillus spp | Voriconazole | | * | | | Lung | Salmonella spp., P. aeruginosa, Citrobacter freundii, Klebsiella variicola, and Mycobacterium chimaera | Dead | IA |
| Probable | | Voriconazole | | * | ● | | Lung | |||||||
| Probable | A. niger A. terreus | Voriconazole, caspofungin, and amphotericin B | | * | ● | R, Z, E, and H | Lung | |||||||
| P10 | M | CYBB | 1 | Possible | | Voriconazole, caspofungin, and posaconazole | | * | ● | LVX, H, Z, and E | Lung | | Dead | Septic shock |
| P11(4) | M | NCF2 | 1 | Probable | | Voriconazole, caspofungin, and amphotericin B | * | | ● | H, R, and E | Lung, skin, and CNS | | Dead | IA |
| P12(4) | M | CYBB | 1 | Proven | A. versicolor | Voriconazole | | * | ● | | Lung, liver, spleen, and CNS | S. marcescens and Burkholderia cepacia | Alive | |
| P13(4) | M | CYBB | 2 | Probable | | Voriconazole, caspofungin, and amphotericin B | | * | ● | | Lung and spleen | Pneumocystis jirovecii | Dead | IA |
| Probable | A. fumigatus | Voriconazole | * | | | | Lung | |||||||
| P14(4) | F | NCF2 | 4 | Possible | | Voriconazole | | * | ● | CLR, R, H, and E | Lung | E. coli BLEE, Klebsiella pneumoniae BLEE, P. aeruginosa, Pseudomonas rhodesiae, Streptococcus oralis, Streptococcus salivarius, Penicillium spp., and Campylobacter spp. | Alive | |
| Possible | | Voriconazole, caspofungin, and amphotericin B | | * | ● | | Lung, liver, and spleen | |||||||
| Proven | A. ustus | Voriconazole | * | | | CLR, R, H, and E | Lung | |||||||
| Probable | | Voriconazole | | * | ● | | Lung | |||||||
| P15(4) | M | CYBB | 1 | Probable | | Voriconazole | | * | ● | | Lung | | Alive | |
| P16 | M | CYBB | 1 | Possible | | Voriconazole | | * | | | Lung | | Dead | IA |
| P17b | M | CYBB | 1 | Probable | A. terreus | Voriconazole and caspofungin | * | | ● | | Lung | Actinomyces israelii and Staphylococcus aureus | Dead | IA |
| A. flavus | | |||||||||||||
| P18(4) | M | CYBB | 2 | Possible | | Voriconazole | * | | | | Lung | Salmonella spp. | Dead | IA |
| Probable | A. fumigatus | Voriconazole, caspofungin, amphotericin B, and posaconazole | | * | ● | | Lung and CNS | |||||||
| P19(4) | M | CYBB | 1 | Probable | | Voriconazole and caspofungin | * | | ● | | Lung | | Dead | IA |
| P20(4) | M | CYBA | 3 | Possible | | Voriconazole | * | | | | Lung | S. marcescens, Burkholderia multivorans, P. aeruginosa, and K. pneumoniae BLEE | Dead | Pneumonia K. pneumoniae |
| Possible | | Voriconazole | | * | | | Lung and spleen | |||||||
| Proven | A. flavus | Voriconazole, caspofungin, and amphotericin B | | * | ● | | Lung and CNS | |||||||
| P21(4) | F | NCF2 | 2 | Possible | | Voriconazole and caspofungin | | * | ● | | Lung | Salmonella spp., Streptococcus pneumoniae, P. aureginosa, and Hormographiella aspergillata | Alive | |
| Probable | | Voriconazole | * | | ● | | Lung | |||||||
| P22(4) | M | NCF1 | 3 | Possible | | Voriconazole | * | | ● | | Lung | K. pneumoniae and Enterobacter cloacae | Alive | |
| Possible | | Voriconazole | | * | | H, E, LZD, and LVX | Lung | |||||||
| Probable | | Voriconazole, caspofungin, and amphotericin B | | * | | H, E | Lung and CNS | |||||||
| P23(4) | M | CYBB | 1 | Probable | | Voriconazole and caspofungin | | * | ● | | Lung | E. coli | Dead | Septic shock |
| P24 | M | CYBB | 1 | Probable | Aspergillus spp | Voriconazole | * | | ● | | Lung | Staphylococcushominis | Alive | |
| P25(4) | M | CYBB | 1 | Possible | | Voriconazole, caspofungin, and amphotericin B | | * | ● | | Lung | Staphylococcus haemolyticus and Stenotrophomonas maltophilia | Dead | IA |
| P26(4) | M | NCF1 | 3 | Possible | | Voriconazole | * | | | | Lung | Candida guilliermondii | Alive | |
| Proven | A. fumigatus | Voriconazole | | * | ● | | Lung | |||||||
| Proven | A. nidulans A. fumigatus A. versicolor | Voriconazole and amphotericin B | | * | ● | | Lung | |||||||
| P27(24) | M | CYBB | 1 | Probable | Aspergillus spp | Voriconazole, caspofungin, amphotericin B, and posaconazole | | * | ● | H, E, and LVX | Lung, skin, and CNS | | Dead | IA |
| P28 | M | CYBB | 1 | Probable | | Voriconazole, caspofungin, and amphotericin | | * | ● | H, R, Z, and E | Lung | | Alive | |
| P29(4) | M | CYBB | 3 | Possible | | Voriconazole | * | | | | Lung | | Alive | |
| Possible | | Voriconazole | | * | | | Lung | |||||||
| Possible | | Voriconazole | | * | ● | | Lung | |||||||
| P30(4) | M | CYBB | 1 | Possible | | Voriconazole and caspofungin | | * | ● | | Lung | | Alive | |
| P31(16)c | M | CYBB | 2 | Probable | Aspergillus spp | Voriconazole | * | | | | Lung, bone, and skin | E. faecalis | Dead | IA |
| Probable | A. fumigatus | Voriconazole | * | | | | Lung | |||||||
| P32(4) | M | CYBB | 1 | Proven | Aspergillus spp | None | | | ● | | Lung | B. cepacia | Dead | IA |
| P33 | M | CYBB | 1 | Proven | A. fumigatus | Fluconazole | | * | ● | | Lung | Mycobacterium tuberculosis and K. pneumoniae | Dead | IA |
| P34(4) | F | CYBB | 1 | Probable | | Voriconazole and amphotericin B | * | | ● | | Lung | | Alive | |
| P35(4) | M | CYBB | 1 | Proven | A. versicolor | Voriconazole | | * | ● | H, R, Z, and E | Lung | | Alive | |
| P36(4) | M | CYBB | 2 | Possible | | Voriconazole | | * | ● | | Lung and liver | | Alive | |
| Probable | A. fumigatus | Voriconazole | | * | ● | | Lung and skin | |||||||
| P37(4) | M | NCF2 | 4 | Possible | | Voriconazole, caspofungin, and amphotericin B | | * | | | Lung | S. marcescens | Alive | |
| Probable | | Voriconazole and caspofungin | | * | | R, H, Z, and E | Lung | |||||||
| Proven | A. versicolor | Voriconazole | | * | ● | | Lung | |||||||
| Proven | A. fumigatus | Voriconazole | | * | ● | | Lung and skin | |||||||
| P38(4) | F | CYBA | 1 | Probable | A. fumigatus | Voriconazole | * | | | | Lung | | Dead | Accident |
| P39 | M | CYBB | 2 | Possible | | Voriconazole | | * | | | Lung | Pseudomonas putida and K. pneumoniae BLEE | Alive | |
| Probable | A. versicolor | Voriconazole | | * | | | Lung | |||||||
| P40 | M | CYBB | 1 | Probable | | Amphotericin B | * | | ● | | Lung | S. aureus and S. maltophilia | Dead | Septic shock |
| P41 | M | CYBB | 1 | Proven | A. nidulans | Voriconazole, caspofungin, and amphotericin B | * | | ● | | Lung | B. cepacia, Penicillium spp., and Pseudomonas spp. | Dead | IA |
| P42 | M | CYBB | 1 | Probable | A. fumigatus A. versicolor | Voriconazole | * | | | | Lung and bone | A. lwoffi and P. aeruginosa | Dead | IA |
| P43 | M | CYBB | 1 | Proven | A. versicolor | Voriconazole, caspofungin, amphotericin B, and posaconazole | | * | ● | | Lung and pericardium | S. aureus and S. hominis | Dead | IA |
| P44 | M | CYBB | 1 | Proven | Aspergillus spp | Voriconazole, caspofungin, and amphotericin B | | * | ● | | Lung and bone | Streptococcus mitis, K. pneumoniae, P. aeruginosa, S. hominis, and Candida albicans | Dead | IA |
| P45(4) | M | NCF1 | 4 | Possible | | Voriconazole, itraconazole, and anidulafungin | * | | | | Lung | | Dead | Cerebral cryptococcosis |
| Probable | A. fumigatus A. flavus | Itraconazole | | * | ● | | Lung | |||||||
| Probable | A. fumigatus | Voriconazole, amphotericin B, itraconazole, fluconazole, and anidulafungin | * | | | | Lung | |||||||
| Probable | A. flavus | Voriconazole, caspofungin, and amphotericin B | * | | ● | | Lung | |||||||
M, Male; F, Female; H, isoniazid; R, rifampicin; E, ethambutol; Z, pyrazinamide; CLR, clarithromycin; LVX, levofloxacin; CIP, ciprofloxacin; LZD, linezolid. Superscript numbers in column one indicate bibliographic citations if patient previously published. * time of antifungal treatment; ● the patient received steroids.
The patient was exposed to mulch.
The patient visited a cave.
The patient lived in jail after birth.