amphotericin-b and Abdominal-Pain

To investigate whether the use of an antibacterial vaginal pessary containing tetracycline and amphotericin B would reduce complications from large loop excision of the transformation zone (LLETZ).. Prospective randomised controlled trial.. Department of Obstetrics and Gynaecology, University of Hong Kong.. A total of 321 women who underwent LLETZ.. Women were randomised to either receiving an antimicrobial vaginal pessary twice a day for 14 days after LLETZ or no medication. Before LLETZ, endocervical and high vaginal swabs were taken for the detection of Chlamydia and other pathogens. All women were given a diary to record the degree of symptoms, such as vaginal discharge, bleeding and pain for 3 weeks. These were then compared between the two groups.. Bleeding, vaginal discharge and pain after LLETZ.. There was no significant difference in the total bleeding, vaginal discharge and pain scores between the two groups. However, for women who had positive endocervical or high vaginal swabs, the treatment group had significantly less bleeding in the second week (Z=-2.083, P= 0.037) and less overall vaginal discharge (Z=-2.024, P= 0.043).. An antimicrobial vaginal pessary containing tetracycline and amphotericin B did not provide any significant benefit after LLETZ, except for a subgroup of women with positive vaginal or endocervical swabs. Given that this group of women cannot be identified before the procedure since swabs are not routinely taken, the use of routine prophylactic topical antibiotics cannot be recommended for the general population.

Topics: Abdominal Pain; Administration, Intravaginal; Adult; Amphotericin B; Anti-Bacterial Agents; Antibiotic Prophylaxis; Chlamydia Infections; Female; Humans; Pessaries; Postoperative Complications; Prospective Studies; Tetracycline; Treatment Failure; Uterine Cervical Dysplasia; Uterine Cervical Neoplasms; Uterine Hemorrhage; Vaginal Discharge

We describe a case of haemophagocytic lymphohistiocytosis (HLH) secondary to disseminated histoplasmosis, which was treated with chemotherapy in addition to standard antifungal therapy. While HLH in the setting of infections is very well described, its treatment in this setting is controversial, with some physicians treating only the underlying infection, whereas others using immune suppression in addition to antimicrobials. To the best of our knowledge, this is the first report documenting the successful treatment of an adult patient with HLH due to disseminated histoplasmosis using etoposide chemotherapy after initial antifungal therapy failed to show improvement.

Topics: Abdominal Pain; Adult; Amphotericin B; Antifungal Agents; Biopsy; Bone Marrow; Dexamethasone; Diagnosis, Differential; Drug Therapy, Combination; Encephalitis, Viral; Etoposide; Female; Fever; Histoplasma; Histoplasmosis; Humans; Invasive Fungal Infections; Lymphohistiocytosis, Hemophagocytic; Meningitis; Nausea; Treatment Outcome

Mucormycosis is a rare fungal infection often seen in immunocompromised hosts. Isolated renal mucormycosis may however present in immunocompetent children as renal failure and has a uniformly poor prognosis if not detected and treated early into the course of illness. We present a 3-year-old boy with unrelenting pyelonephritis in whom serial urine cultures done were negative. A final diagnosis of isolated renal mucormycosis was made by magnetic resonance imaging and renal biopsy.

Topics: Abdominal Pain; Amphotericin B; Antifungal Agents; Child, Preschool; Dialysis; Fever; Humans; Kidney; Kidney Failure, Chronic; Magnetic Resonance Imaging; Male; Mucorales; Mucormycosis; Pyelonephritis; Treatment Outcome; Triazoles; Urinary Tract Infections; Vomiting

Topics: Abdominal Pain; Aged; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Diarrhea; Female; Fever; Histoplasma; Histoplasmosis; Humans

A 53-year-old man with Crohn's disease treated with adalimumab was hospitalised with abdominal pain, fatigue, fever and chills. CT scan of the abdomen showed chronic thickening of the terminal ileum and cecum and new-onset ascites. Further studies revealed weakly positive urine and serum histoplasma antigen. Laparoscopy revealed metastatic caking of the omentum and abdominal wall; peritoneal biopsy demonstrated organisms morphologically consistent with

Topics: Abdominal Pain; Adalimumab; Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Ascites; Crohn Disease; Histoplasma; Histoplasmosis; Humans; Itraconazole; Laparoscopy; Male; Middle Aged; Peritonitis; Tomography, X-Ray Computed; Treatment Outcome

To compare clinical features, diagnosis and therapeutic effect between pulmonary histoplasmosis and progressive disseminated histoplasmosis.
 Methods: A retrospective analysis for 12 cases of hospitalized patients with histoplasmosis, who was admitted in Xiangya Hospital, Central South University during the time from February 2009 to October 2015, was carried out. Four cases of pulmonary histoplasmosis and 8 cases of progressive disseminated histoplasmosis were included. The differences of clinical features, imaging tests, means for diagnosis and prognosis were analyzed between the two types of histoplasmosis.
 Results: The clinical manifestations of pulmonary histoplasmosis were mild, such as dry cough. However, the main clinical symptoms of progressive disseminated histoplasmosis were severe, including recurrence of high fever, superficial lymph node enlargement over the whole body, hepatosplenomegaly, accompanied by cough, abdominal pain, joint pain, skin changes, etc.Laboratory examination showed pancytopenia, abnormal liver function and abnormal coagulation function. One pulmonary case received the operation of left lower lung lobectomy, 3 cases of pulmonary histoplasmosis and 6 cases of progressive disseminated histoplasmosis patients were given deoxycholate amphotericin B, itraconazole, voriconazole or fluconazole for antifungal therapy. One disseminated case discharged from the hospital without treatment after diagnosis of histoplasmosis, and 1 disseminated case combined with severe pneumonia and active tuberculosis died ultimately.
 Conclusion: As a rare fungal infection, histoplasmosis is easily to be misdiagnosed. The diagnostic criteria depends on etiology through bone marrow smear and tissues biopsy. Liposomeal amphotericin B, deoxycholate amphotericin B and itraconazole are recommended to treat infection for histoplasma capsulatum.. 目的：比较肺型与进展播散型组织胞浆菌病的临床特点、诊断及预后差异。 方法：回顾性分析中南大学湘雅医院2009年2月至2015年10月期间收治的组织胞浆菌病住院患者12例，其中肺型4例，进展播散型8例。从临床表现、影像学、确诊途径及预后等方面分析两者之间的差异性。 结果：肺型组织胞浆菌病临床表现轻微，干咳多见。进展播散型患者全身症状明显，极易出现反复高热、全身浅表淋巴结肿大、肝脾肿大，可合并咳嗽、腹痛、关节痛、皮肤改变等。实验室检查示全血细胞减少、肝功能异常、凝血功能异常等。1例肺型患者给予了左下肺切除术，其余3例肺型及6例进展播散型患者分别给予两性霉素B脱氧胆酸盐、伊曲康唑、伏立康唑或氟康唑抗真菌感染治疗，好转出院，1例播散型确诊后暂未治疗即出院，1例播散型因合并重症肺炎及活动性肺结核治疗无效死亡。结论：组织胞浆菌病临床少见，极易漏诊或误诊，依靠骨髓涂片、病理组织切片特殊染色明确病原学是目前确诊的主要依据，推荐两性霉素B脂质体、两性霉素B脱氧胆酸盐及伊曲康唑抗感染治疗。.

Topics: Abdominal Pain; Amphotericin B; Antifungal Agents; Biopsy; Cough; Death; Deoxycholic Acid; Diagnostic Errors; Drug Combinations; Fever; Hepatomegaly; Histoplasma; Histoplasmosis; Humans; Invasive Fungal Infections; Itraconazole; Lung; Lung Diseases, Fungal; Pneumonia; Recurrence; Retrospective Studies; Splenomegaly; Treatment Outcome; Tuberculosis

Topics: Abdominal Pain; Amphotericin B; Antibodies, Fungal; Antifungal Agents; Cerebrospinal Fluid; Child; Diagnosis, Differential; Fever of Unknown Origin; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Nausea

Topics: Abdominal Pain; Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Anti-HIV Agents; Histoplasma; Histoplasmosis; Humans; Ileal Diseases; Ileocecal Valve; Infusions, Intravenous; Intestinal Fistula; Itraconazole; Male; Opportunistic Infections; Rare Diseases; Risk Assessment; Treatment Outcome

We report 2 cases of visceral leishmaniasis in Dutch patients after a stay in Greece and the former Yugoslavia, respectively. Patient A, a 69-year-old woman, was referred to our department with abdominal pain. Additional examinations were suggestive of chronic liver disease. After a liver biopsy, which demonstrated hepatic granulomas, we admitted the patient due to a sudden onset of cyclic fever. Patient B, a 50-year-old woman, was admitted with cyclic fever and abdominal pain. We treated the patient with IV antibiotics and discontinued the methotrexate treatment for her rheumatoid arthritis. Both patients were diagnosed with visceral leishmaniasis and treated with liposomal amphotericin-B. Patient A, an immunocompetent patient, had stayed in Greece for prolonged periods. Patient B had lived in the former Yugoslavia until 1999, and her methotrexate use had likely activated an asymptomatic Leishmania infection. Visceral leishmaniasis, a potentially lethal protozoan disease, should be considered in patients who have travelled in Southern Europe.

Topics: Abdominal Pain; Aged; Amphotericin B; Antiprotozoal Agents; Arthritis, Rheumatoid; Female; Greece; Humans; Leishmania infantum; Leishmaniasis, Visceral; Methotrexate; Middle Aged; Netherlands; Travel; Treatment Outcome; Yugoslavia

Clinicians have usually considered malignancies during follow up of patients who have infectious diseases as a pre-diagnosis. However, malignancy and an infectious disease are seen together more rarely, with the exception of immunosuppressed patients. This presentation is a case report followed up for fever of unknown origin. The patient was admitted to the hospital with the symptoms of fever, weight loss, abdominal pain and weakness. Anemia and hypergamaglobulinemia by biochemical analyses and splenomegaly by total body computed tomography were detected. Amastigotes were seen in bone marrow aspiration smears and promastigotes were isolated in NNN medium. At the end of the Liposomal Amphotericin B treatment, control bone marrow aspiration was applied. Leishmania amastigotes were not seen, while patient was diagnosed as diffuse B cell lymphoma pathologically.

Topics: Abdominal Pain; Amphotericin B; Anemia; Anticestodal Agents; Bone Marrow; Female; Fever of Unknown Origin; Humans; Hypergammaglobulinemia; Leishmania; Leishmaniasis, Visceral; Lymphoma, Large B-Cell, Diffuse; Middle Aged; Splenomegaly; Tomography, X-Ray Computed; Weight Loss

Topics: Abdominal Pain; Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Antifungal Agents; CD4 Lymphocyte Count; Cerebrospinal Fluid; Constipation; Cryptococcosis; Cryptococcus neoformans; Flucytosine; Headache; Humans; Male; Microscopy; Viral Load

Topics: Abdominal Pain; Adult; Amphotericin B; Antifungal Agents; Chills; Diagnosis, Differential; Female; Fever; Fluconazole; Flucytosine; Fungemia; Headache; Humans; Nausea; Pyrimidines; Recurrence; Saccharomyces cerevisiae; Triazoles; Voriconazole

Topics: Abdominal Pain; Amphotericin B; Biopsy, Needle; Color; Follow-Up Studies; Gastroscopy; Humans; Immunohistochemistry; Male; Middle Aged; Mucormycosis; Risk Assessment; Severity of Illness Index; Stomach Ulcer; Tomography, X-Ray Computed; Treatment Outcome

Topics: Abdominal Pain; Adrenal Cortex Hormones; Adult; Amphotericin B; Antibodies, Monoclonal; Antifungal Agents; Biopsy; Colon; Colonoscopy; Crohn Disease; Diagnosis, Differential; Diagnostic Errors; Diarrhea; Hematologic Tests; Histoplasma; Histoplasmosis; Humans; Infliximab; Male; Necrosis

We investigated the clinical characteristics and treatment of patients with a distinctive triad of acute infusion-related reactions (AIRRs) to liposomal amphotericin B (L-AMB) via single-center and multicenter analyses. AIRRs occurred alone or in combination within 1 of 3 symptom complexes: (1) chest pain, dyspnea, and hypoxia; (2) severe abdomen, flank, or leg pain; and (3) flushing and urticaria. The frequency of AIRRs in the single-center analysis increased over time. Most AIRRs (86%) occurred within the first 5 min of infusion. All patients experienced rapid resolution of symptoms after intravenous diphenhydramine was administered. The multicenter analysis demonstrated a mean overall frequency of 20% (range, 0%-100%) of AIRRs among 64 centers. A triad of severe AIRRs to L-AMB may occur in some centers; most of these reactions may be effectively managed by diphenhydramine administration and interruption of L-AMB infusion.

Topics: Abdominal Pain; Adult; Amphotericin B; Antifungal Agents; Chest Pain; Drug Combinations; Dyspnea; Female; Flushing; Humans; Hypoxia; Liposomes; Male; Phosphatidylcholines; Phosphatidylglycerols; Risk Factors