amphotericin-b and Abdominal-Abscess

Cryptococcus spp. is a rare cause of ventriculoperitoneal shunt (VPS) infection, with a variable clinical presentation. Diagnosis and treatment of this entity are challenging.. A cryptococcal VPS infection occurred in a human immunodeficiency virus-infected patient with an excellent immunovirologic status, with an abdominal mass as the only clinical sign at presentation. Microbiologic diagnosis was confirmed when Cryptococcus neoformans was isolated in 4 cerebrospinal fluid samples on different days. The patient was treated with dual antifungal therapy (liposomal amphotericin B plus flucytosine). The VPS was initially externalized and then removed. At 12-month follow-up, the patient remained asymptomatic, and no replacement VPS was required.. This is the first reported case of cryptococcal VPS infection in a patient with human immunodeficiency virus infection. Clinical outcome was excellent after dual antifungal therapy plus device withdrawal. Diagnosis and treatment of this entity remain a challenge for clinicians.

Topics: Abdominal Abscess; Adult; Amphotericin B; Antifungal Agents; Antiretroviral Therapy, Highly Active; Catheter-Related Infections; Device Removal; Flucytosine; HIV Infections; Humans; Male; Meningitis, Cryptococcal; Ventriculoperitoneal Shunt

A 42-year-old man, with a history of immunoglobulin A nephropathy, underwent a living-related kidney transplant. Allograft function progressively deteriorated secondary to chronic rejection and recurrence of IgA nephropathy, and he returned to peritoneal dialysis after 5 years of the transplant. Fifteen months after the discontinuation of immunosuppressive therapy, Eschericia coli peritonitis developed, which was treated with ceftazidime intraperitoneally; he received fluconazole as prophylactic antifungal therapy during this period. After completing his course of treatment, abdominal pain occurred with an increased peritoneal fluid white blood cell count. Peritoneal fluid cultures were negative. He received broad-spectrum antibiotics and fluconazole with no appreciable response. After removal of the Tenckoff catheter, peritoneal fluid cultures grew a zygomycete. The patient was treated with liposomal amphotericin B (AmBisome) intravenously for 6 weeks. He had episodes of recurrent intraabdominal abscesses requiring surgical drainage and antibiotics. A second course of liposomal amphotericin B was administered for histopathologic evidence of filamentous fungal recurrence. After 5 months, the patient remains well without any evidence of infection.

Topics: Abdominal Abscess; Amphotericin B; Antifungal Agents; Bacteroides fragilis; Combined Modality Therapy; Drug Therapy, Combination; Fluconazole; Glomerulonephritis, IGA; Graft Rejection; Gram-Negative Bacterial Infections; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Mucormycosis; Peritoneal Dialysis; Peritonitis; Recurrence

The aim of the present study was to assess the influence of immunomodulation of host defense with recombinant murine granulocyte colony-stimulating factor (rmG-CSF) on intra-abdominal abscesses caused by Candida albicans. Mice received prophylaxis or therapy with 1 microg of rmG-CSF/day in the presence or absence of antifungal treatment consisting of amphotericin B (0.75 mg/kg of body weight/day) or fluconazole (50 mg/kg/day). The number of Candida CFU in abscesses was significantly reduced (P<0.05) in mice receiving rmG-CSF prophylaxis (day -1 or day -1 through 2) compared with controls on day 8 of infection. Administration of rmG-CSF therapy alone (for 5 days starting on day 4 of infection) had no influence on the number of Candida CFU in abscesses. Amphotericin B treatment was significantly more effective than fluconazole treatment (3.41 log CFU/abscesses; 95% confidence interval [CI], 3.17 log CFU/abscesses; 3.65 versus 3.90 log CFU/abscesses; 95% CI, 3.66 log CFU/abscesses, 4.16 log CFU/abscesses; P<0.05). Therapeutic administration of rmG-CSF in conjunction with an antifungal agent showed a tendency towards a further reduction of Candida CFU in abscesses than antifungal treatment only. In conclusion, in this experimental model of intra-abdominal Candida abscesses, rmG-CSF administration did not have a detrimental influence on the course of infection. Amphotericin B treatment was most effective, and additional rmG-CSF therapy did not antagonize the effect of antifungal treatment. In contrast, addition of rmG-CSF therapy to antifungal treatment might further enhance the beneficial effect of the antifungal agent.

Topics: Abdominal Abscess; Adjuvants, Immunologic; Amphotericin B; Animals; Antifungal Agents; Candida albicans; Cytokines; Female; Fluconazole; Granulocyte Colony-Stimulating Factor; Lymphocytes; Mice; Mice, Inbred CBA; Microbial Sensitivity Tests; Recombinant Proteins; Spleen; Treatment Outcome

Topics: Abdominal Abscess; Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida tropicalis; Candidiasis; Child, Preschool; Digestive System Surgical Procedures; Female; Fluconazole; Gastrins; Humans; Peritonitis; Reoperation; Rupture, Spontaneous; Stomach Rupture; Treatment Outcome

There are few reports of severe infections caused by Candida norvegensis. We here describe a case of C. norvegensis-associated intraabdominal abscess and Gore-Tex mesh-associated infection, successfully treated with liposomal amphotericin B and removal of the mesh. This is, to our knowledge, the first report of C. norvegensis causing this type of infection.

Topics: Abdominal Abscess; Aged; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Drug Combinations; Female; Humans; Phosphatidylcholines; Phosphatidylglycerols; Polytetrafluoroethylene; Surgical Mesh