In 1999 leukemia patient Abby Rosen received news that was difficult to take, she had developed an invasive aspergillus infection that had spread to her brain. The infection was so serious that she had to endure the removal of part of her skull (craniectomy) to prevent damage caused by swelling of her brain – it essentially gives the swollen tissue somewhere to go to and prevents the brain tissue being crushed by the buildup of pressure.
Treatment for leukemia causes a severe reduction in the effectiveness of the patients’ immune system until it recovers from the first stage of chemotherapy treatment. This gives infectious agents including aspergillus fungi a ‘window of opportunity’ that they are more than happy to climb through.
Bacterial infections are common in this situation but antibiotic treatments are so effective and plentiful these do not normally cause too much of a problem. Fungal infections such as aspergillus are a different story.
Fungal infections have to be treated using one of a limited number of antifungal drugs. Some of these are quite toxic and cannot be used for some patients e.g. those with impaired kidney or liver function. This cuts the choice down further. More modern antifungals tend to be very expensive which can make then unattractive to use! On top of all this there is difficulty getting antifungals into the brain as there is a blood/brain barrier that prevents easy passage of drugs into the brain. How do fungi cross this barrier? It isn’t really known for sure but one possibility is that it simply grows across it using the ability of its hyphae to ‘push’ through tissue.
All of this sounds like there is no hope, surely any patient faced with these odds might as well give up?! The happy answer is NO not at all. 12 years after suffering from cancer and this major infection Abby is back at work as an accountant and has been for the last 6 years. Thanks to the treatment she received she recovered, regaining so much of what was lost that on November 21st 2010 Abby was married to Andy and has spent the last few weeks on honeymoon in Hawaii.
Abby’s mum Sandra commented:
- When my husband first contacted Dr. Denning in 1999 and he told him about a five year old boy that had survived aspergillus that was a great deal of encouragement for me. I hope Abby’s story of hope and success will help other families who are in need of that encouragement. It is an amazing story to be told.
- I have to say that it was a long journey to get to where she is today. One can’t imagine how delighted we all are that she is with us and how much progress she has made after her brain injury. She is still improving daily. There definitely is a life after cancer and a brain injury.