amphotericin-b and Abscess

Cryptococcus neoformans is frequently present as an opportunistic pathogen mainly affecting immunocompromised populations. Disseminated C. neoformans infection in immunocompetent population is rare and usually involves lung and central nerve system. Cryptococcus from biologic samples can easily grow on routine fungal and bacterial culture media. Besides, cryptococcal latex agglutination test has been established as a reliable diagnostic tool with overall sensitivities of 93-100%.. We report a rare disseminated cryptococcosis case which presented with chronic recurrent multiple abscess in an immunocompetent male involving skin, lung, spine and iliac fossa without evidence of central nerve system involving. The results of serum cryptococcal latex agglutination tests and standard microbial cultures were negative. The patient underwent empirical anti-bacterial and anti-tuberculosis therapy which turned out to be effectless. Finally, bedside inoculation of the pus was carried out and revealed Cryptococcus neoformans, which was confirmed by polymerase chain reaction. After the administration of anti-fungal drugs including liposomal amphotericin B, the patient recovered from fever and paraplegia.. This case reveals an uncommon pattern of disseminated C. neoformans infection in immunocompetent population presented with chronic multiple abscess and without central nerve system involving. Negative routine microbial cultures may not necessarily rule out cryptococcosis, especially in early stage. Besides, cryptococcal latex agglutination test does have a chance of false negative, which might be related with "capsule-deficiency". Moreover, this phenomenon could be related with low-grade virulence and relative long illness duration.

Topics: Abscess; Aged; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Humans; Immunocompromised Host; Latex Fixation Tests; Male; Spine

We present a case of a patient with hairy cell leukemia and pulmonary aspergillosis who developed a cycotic pulmonary artery aneurysm despite prolonged antifungal therapy. A review of the literature in regards to incidence, etiology, clinical manifestations and treatment options is included.

Topics: Abscess; Acyclovir; Amphotericin B; Aneurysm, Infected; Anti-Bacterial Agents; Antifungal Agents; Antineoplastic Agents; Antiviral Agents; Aspergillus; Caspofungin; Ceftazidime; Clindamycin; Echinocandins; Fluconazole; Humans; Leukemia, Hairy Cell; Lipopeptides; Male; Middle Aged; Mouth; Ofloxacin; Pneumonia; Pulmonary Artery; Pulmonary Aspergillosis; Valacyclovir; Valine; Vancomycin

Pituitary abscess is rare and most of the cases are of bacterial origin. True fungal pituitary abscess is extremely rare only five cases have been reported. In this report, we present a case of aspergillus pituitary abscess. Mortality rate in intracranial aspergillosis is close to 100% especially in immunsuppressed patients when undiagnosed and untreated. In focal CNS aspergillosis total cure can be achieved in approximately 30% of the cases by surgical drainage and intensive antifungal therapy. Although this is the first reported case with magnetic resonance imaging examination the definitive diagnosis was established only by histopathological examination.. A 42 year-old man was referred to our hospital with the diagnosis of sellar suprasellar mass accompanied by frontal headache and decreased visual acuity. His medical history was insignificant. Physical examination was normal and the patient was afebrile. The neurological examination revealed bilateral papilledema and bitemporal hemianopsia but no stiff neck and motor or sensory deficit. In the light of MRI examination, the preoperative diagnosis was pituitary abscess secondary to paranasal sinus infection or hemorrhagic pituitary adenoma.. The patient was successfully treated by transsphenoidal surgery. Histopathological examination of sphenoid sinus mucosa revealed normal mucosal appearance with inflammation and histopathological examination of the intrasellar mass resulted in the diagnosis of aspergillosis. All cultures obtained from sphenoid sinus were reported as having no growth. However in the second week after the operation fungal culture of the intrasellar mass grew aspergillus. After 8 weeks of amphothericine-B treatment, the patient was discharged. At the last follow up examination two years after the operation, the patient was symptom free with normal pituitary function.. Aspergillus pituitary abscess should be considered in the differential diagnosis of a pituitary mass. The correct diagnosis of pituitary aspergillosis can only be achieved by histopathological examination because clinical and radiological findings including MRI are not specific and culture results are obtained later. Immediately after the diagnosis, intensive antifungal therapy should be started for a successful treatment.

Topics: Abscess; Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Humans; Male; Pituitary Diseases

Fungal infections of total joint arthroplasties are extremely rare with only 21 previous reported cases in the literature. In 19 of these cases, the offending organism has been a member of the candida species. In all of these cases, the patients had no clinical evidence of disseminated fungal infection. All previously reported cases of total joint fungal infections required removal of the primary prosthesis to eradicate the infection. There has also been a great reluctance to reimplant these patients. In fact, reimplantation has been successful in only one reported case. We report the first case of successful salvage of an arthroplasty infected with candida.

Topics: Abscess; Amphotericin B; Antifungal Agents; Arthritis, Infectious; Candidiasis; Combined Modality Therapy; Hip Prosthesis; Humans; Male; Middle Aged; Osteoarthritis, Knee; Reoperation; Surgical Wound Infection; Synovectomy; Synovitis

Candidal infection has been associated extensively with serious infections. Its role in genital tract infections has consisted largely of vulvovaginitis, with serious upper genital tract infection a rarity. A 47-year-old woman with an intrauterine device had Candida glabrata in a large tuboovarian abscess and recovered only after removal of the abscess and treatment with amphotericin B.

Topics: Abscess; Amphotericin B; Candidiasis; Combined Modality Therapy; Fallopian Tube Diseases; Female; Humans; Intrauterine Devices, Copper; Middle Aged; Ovarian Diseases

Aspergillus osteomyelitis of the vertebral body and disc space is rare. This report discusses a case that occurred in an immunosuppressed 29-year-old man and reviews the pertinent medical literature.. To review the management and treatment of Aspergillus osteomyelitis of the vertebral body and disc space.. The patient presented with acute neurologic compromise resulting from L5-S1 discitis and a large epidural soft tissue component secondary to the Aspergillus infection.. The patient underwent aggressive surgical debridement along with treatment with amphotericin B and had a complete clinical recovery.. The authors recommend a combined medical-surgical approach in most cases of vertebral Aspergillus osteomyelitis. Early surgery with vigorous surgical debridement along with antifungal treatment seems to yield a good outcome.

Topics: Abscess; Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Debridement; Discitis; Humans; Lumbar Vertebrae; Male; Osteomyelitis; Sacrum

The Candida species account for approximately three-fourths of fungal infections in patients with cancer. Although Candida albicans is the most frequent cause, C. tropicalis is increasingly implicated as an important pathogen. Over a 12 year period 19 children treated for leukemia at our institution developed C. tropicalis infections. We describe their clinical presentation, extent of fungal infection, treatment, and outcome. Fungemia without meningitis in 11 children was treated successfully, whereas C. tropicalis meningitis in 7 children was uniformly fatal. An additional patient had unsuspected, widespread infection detected at autopsy. Multiple sites, including the cerebrospinal fluid yielded C. tropicalis. Previously reported risk factors including neutropenia, broad-spectrum antibiotic usage, corticosteroid therapy, and total parenteral nutrition were observed in our cases. A high index of suspicion and the early use of aggressive antifungal therapy are critical to the successful management of C. tropicalis infections in children with leukemia.

Topics: Abscess; Adolescent; Amphotericin B; Candida; Candidiasis; Cerebrospinal Fluid; Child; Child, Preschool; Combined Modality Therapy; Drainage; Female; Fluconazole; Fungemia; Humans; Infant; Leukemia; Male; Meningitis, Fungal; Neutropenia; Parenteral Nutrition, Total; Retrospective Studies; Risk Factors; Superinfection; Tennessee

A 57-yr-old man with a chronic lung cavity presumed to be related to ankylosing spondylitis and/or old cavitary tuberculosis presented with hemoptysis and rapidly developed lower extremity paresis and hypoesthesia. On chest radiograph he had a left upper lobe lesion suggestive of aspergilloma combined with a large left empyema with bronchopleural fistula. Serologic analysis demonstrated precipitins and very high titer IgG antibodies to Aspergillus fumigatus antigens. Decompressive laminectomy from T1 to T5 was performed, with drainage of A. fumigatus culture-positive material from an epidural abscess compressing the spinal cord. Chest drainage was required for control of the empyema. With a total course of 3 g of intravenously administered amphotericin B, rehabilitative therapy, and chronic empyema drainage, he is now at home and ambulatory with assistance. He is also being followed by regular serum assays of IgG antibodies to Aspergillus proteins. We report the case of an apparent long-term survivor of a formerly lethal and/or nonreversible paraplegic condition. The critical factors compared with previous cases with a poor outcome would appear to be prompt neurosurgical intervention, restoration of a normal number of T-cells, effective long-term chest drainage, and high dose amphotericin treatment.

Topics: Abscess; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Empyema, Pleural; Epidural Space; Humans; Lung Diseases, Fungal; Male; Middle Aged; Spinal Cord Compression

Case 1. A 34-year-old male was admitted in July, 1986 with a diagnosis of AML (M2). Two courses of BHAC-DMP regimen induced complete remission in October, while marked pyrexia resistant to antibiotics remained. An ultrasonography (US) and computed tomography (CT) revealed multiple liver and spleen abscesses suspected of mycotic etiology. Administration of amphotericin B (AMPH-B) by intravenous injection was difficult owing to its severe side effect. Multiple abscesses increased in the size and number despite treatment with Miconazole (MCZ) and Ketoconazole. Exploratory laparotomy was performed with splenectomy, and splenic specimens were found to contain Candida organisms. Soon AMPH-B was administered through a catheter inserted into the portal vein at the same time. A side effect by AMPH-B was tolerable and his fever resolved to normal in 2 weeks after institution of this therapy, and the sizes of abscesses were markedly reduced. The patient remained in remission through 23 months, free of fungal infection. Case 2. A 23-year-old female was admitted for relapse of ALL (L2), in April, 1987. Reinduction therapy with BHAC-L-AVP achieved again in May but fever unresponsive to antibiotics occurred. Since multiple liver-spleen abscesses were showed by US and CT suspected mycotic etiology, antimycotic therapy with Miconazole and AMPH-B was performed but clinical findings were deteriorated. AMPH-B was administered through a catheter inserted into the hepatic artery for two weeks, following into the splenic artery for a week. Splenic abscesses were resolved in a week and liver abscesses were markedly reduced at three weeks after initiation of intra-arterial antifungal treatment. Through the analysis of these case studies we confirmed the usefulness of intraportal and intrahepatosplenic arterial administration of AMPH-B.

Topics: Abscess; Acute Disease; Adult; Amphotericin B; Catheters, Indwelling; Female; Hepatic Artery; Humans; Leukemia; Liver Abscess; Male; Mycoses; Portal Vein; Splenic Artery; Splenic Diseases

A 42-year-old male post-renal transplantation presented with sudden diminution of vision in the left eye. The right eye was lost following a failed vitreoretinal surgery 5 years ago. The patient had been hospitalized 4 months prior for coronavirus disease 2019 infection with a good recovery. The presenting visual acuity was 20/600 in the right eye and 20/250 in the left eye. Fundus examination revealed a sub-macular sub-retinal abscess in the left eye. Sub-retinal aspiration of the abscess revealed Candida albicans. The patient was managed with repeated intravitreal amphotericin B injections, following which the abscess resolved with scarring and vision improving to 20/60.

Topics: Abscess; Adult; Amphotericin B; Candida albicans; COVID-19; Humans; Intravitreal Injections; Male

Topics: Abscess; Adult; Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Bronchoalveolar Lavage; Drainage; Humans; Male; Scapula; Treatment Outcome

Topics: Abscess; Amphotericin B; Antifungal Agents; Aortic Valve; Aortic Valve Stenosis; Aspergillosis; Aspergillus fumigatus; Azoles; Computed Tomography Angiography; Drug Therapy, Combination; Endocarditis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Intracranial Embolism; Male; Middle Aged; Postoperative Complications; Prosthesis-Related Infections; Treatment Outcome; Voriconazole

Phaeohyphomycosis is a term used to describe a heterogenous group of cutaneous and systemic mycotic infections caused by melanized fungi. Many fungi have been reported as pathogens of this disease. The disease spectrum ranges from superficial cutaneous infections, deep cutaneous infections, to systemic infections with internal organ involvement. We report two cases of deep cutaneous phaeohyphomycosis on the foot clinically presenting as cellulitis with abscess formation. The pathogens were isolated from the lesion and both were identified as Neoscytalidium dimidiatum by their colony morphology, microscopic features, and sequences of internal transcribed spacers of ribosomal DNA. Both patients did not respond to the therapy with voriconazole and itraconazole, but improved after intravenous amphotericin B.

Topics: Abscess; Aged, 80 and over; Amphotericin B; Antifungal Agents; Ascomycota; Cellulitis; Dermatomycoses; DNA, Fungal; DNA, Ribosomal Spacer; Female; Foot; Humans; Male; Microbiological Techniques; Middle Aged; Molecular Diagnostic Techniques; Phaeohyphomycosis; Sequence Analysis, DNA; Treatment Outcome

Opportunistic infections frequently develop in immunocompromised patients, such as those with hematological malignancies, causing significant mortality. Early diagnosis of invasive fungal infections is often important and difficult due to the difficult nature of confirming infection using cytologic and histologic findings. However, we report the first case of candidal infection leading to muscle abscesses in the legs of a patient with leukemia.. A 60-year-old man with acute myeloid leukemia (AML) presented with multifocal muscle abscesses of the legs.. Multifocal muscle candidiasis of the legs was confirmed by fine-needle aspiration biopsy of 2 of the calf lesions.. After treatment with amphotericin B and flucytosine for 1 month, the patient was administered intravenous caspofungin for 3 months.. A CT scan of the abdomen and an MRI of the lower calves showed significant improvement.. This case highlights that fungal infection should be considered when patients present with multiple abscesses, emphasizing the value of early biopsy to confirm diagnosis and facilitate precision treatment.

Topics: Abscess; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Candida tropicalis; Candidiasis; Caspofungin; Flucytosine; Humans; Immunocompromised Host; Leg; Leukemia, Myeloid, Acute; Magnetic Resonance Imaging; Male; Middle Aged; Muscle, Skeletal; Muscular Diseases; Opportunistic Infections; Tomography, X-Ray Computed

A 66-year-old woman with diabetes who was treated with prednisolone (15 mg/day) for autoimmune hepatitis developed multiple erythematous nodules with retention of purulent fluid on her lower right limb. Candida albicans was cultured from the nodules. She was started on oral fluconazole, and the lesions subsided. However, multiple dark-red abscesses and indurations newly appeared on the left crus. Histopathological examination showed numerous branched hyphae, and tissue culture yielded a Rhizopus microsporus-related fungus. She was treated with liposomal amphotericin B combined with drainage and debridement. However, she died because of poor control of the infection and hepatic disorder.

Topics: Abscess; Aged; Amphotericin B; Antifungal Agents; Debridement; Dermatomycoses; Drainage; Fatal Outcome; Female; Hepatitis, Autoimmune; Humans; Immunocompromised Host; Mucormycosis; Prednisolone; Rhizopus

A 7-year-old boy presented with a chronic, indurated, tender left thigh swelling in association with a hypertensive emergency. He had a bilateral moderate degree of hydronephrosis and a left perinephric abscess, and MRI features of posterior reversible encephalopathy syndrome. Histopathological examination of the biopsy specimen demonstrated eosinophilic fasciitis with filamentous fungi. Basidiobolus ranarum was isolated from the culture. The fungus was also isolated from a perinephric fluid aspirate. Computerised tomography of the abdomen demonstrated features consistent with fungal invasion of the pelvic floor muscles and urinary bladder, leading to bilateral hydronephrosis. He required multiple antihypertensive drug therapy and was treated with intravenous amphotericin B, oral itraconazole and potassium iodide. Antihypertensive agents were discontinued after 2 weeks of antifungal therapy. At 6-months follow-up, the hydronephrosis had resolved completely. Perinephric abscess associated with basidiobolomycosis has not been reported previously.

Topics: Abscess; Amphotericin B; Antifungal Agents; Antihypertensive Agents; Biopsy; Child; Entomophthorales; Histocytochemistry; Humans; Hydronephrosis; Hypertension; Itraconazole; Magnetic Resonance Imaging; Male; Microscopy; Perinephritis; Potassium Iodide; Radiography, Abdominal; Tomography, X-Ray Computed; Treatment Outcome; Zygomycosis

Fungal meningitis transmitted through injections of methylprednisolone contaminated with Exserohilum rostratum affected 753 persons and caused 61 deaths in the United States in 2012. We report a case of infection recurrence after 24-months with the unique manifestation of an intradural fungal abscess. Fungal disease should remain on the differential diagnosis list for previously exposed patients.

Topics: Abscess; Aged; Amphotericin B; Antifungal Agents; Ascomycota; Drug Contamination; Female; Humans; Meningitis, Fungal; Methylprednisolone; Recurrence; Voriconazole

Topics: Abscess; Adult; Amphotericin B; Antifungal Agents; Drainage; Humans; Immunocompetence; Leg; Male; Methicillin-Resistant Staphylococcus aureus; Mucormycosis; Postoperative Complications; Skin Diseases; Staphylococcal Infections; Triazoles

The aim of this report was to present the first known case of coccidioidomycosis involving the temporomandibular joint, review the literature regarding dissemination to the mandible, and to provide treatment recommendations for this challenging condition.. Coccidioidomycosis of the mandibular condyle was identified in a 30-year-old Somali male residing in Arizona. Due to the difficulty of surgical access and the anticipated temporomandibular joint morbidity of radical condylar debridement, primary medical management was performed.. Marked symptomatic improvement was observed after 10 days of IV antifungal therapy. Resolution of the abscess with residual bony destruction was observed on CT scan. Based on the results of this patient and review of the literature, an algorithm is presented to help guide management of coccidioidomycosis dissemination to the mandible.. Prolonged antifungal therapy should be attempted for initial management of a Coccidioides abscess involving the condyle with early surgical intervention reserved for the more easily accessible and less functionally compromising portions of the mandible.

Topics: Abscess; Adult; Amphotericin B; Coccidioidomycosis; Drug Therapy, Combination; Fluconazole; Humans; Infusions, Intravenous; Long-Term Care; Male; Osteomyelitis; Temporomandibular Joint Disorders; Tomography, X-Ray Computed

We present a rare case of intraorbital abscess caused by Candida allociferrii, which was described as a new species of Stephanoascus ciferrii complex in 2002, in a patient after enucleation of choroidal melanoma. This strain showed resistance to itraconazole, and fluconazole. After debridement and topical use of amphotericin B, his wound abscess was disappeared. To our knowledge, this is the first C. allociferrii infection case in human.

Topics: Abscess; Administration, Topical; Aged; Amphotericin B; Antifungal Agents; Candida; Debridement; DNA, Fungal; DNA, Ribosomal; Humans; Male; Orbital Diseases; Polymerase Chain Reaction; Treatment Outcome

Topics: Abscess; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Child; Fever; Humans; Immunocompetence; Itraconazole; Low Back Pain; Male; Treatment Outcome

We report a case of Alternaria keratitis and hypopyon following clear-corneal cataract surgery. A 66-year-old woman presented with a painful red left eye several months after uneventful self-sealing clear-corneal phacoemulsification that was unresponsive to prolonged treatment with topical/oral quinolones and topical corticosteroids. A full-thickness stromal white dense infiltrate in the area of the intrastromal tunnel incision and a 2.0 mm hypopyon were observed. Culture from corneal scrapings revealed Alternaria species. Treatment included topical and subconjunctival injections of amphotericin-B (5 mg/mL) and 200 mg of oral ketoconazole. Complete resolution of the corneal infiltration and hypopyon was observed after 30 days of treatment, with no recurrence during 6 years of follow-up. To our knowledge, this is the first report of Alternaria species keratitis complicating self-sealing clear-corneal cataract surgery. Topical and subconjunctival injections of amphotericin-B and oral ketoconazole were effective in resolving the corneal abscess and anterior chamber inflammatory reaction.. No author has a financial or proprietary interest in any material or method mentioned.

Topics: Abscess; Administration, Oral; Aged; Alternaria; Alternariosis; Amphotericin B; Antifungal Agents; Cornea; Corneal Ulcer; Eye Infections, Fungal; Female; Humans; Injections, Intraocular; Ketoconazole; Lens Implantation, Intraocular; Phacoemulsification; Visual Acuity

To report an unusual case of fungal mastoiditis caused by entomophthorales in an immunocompetent patient, and its management.. Case report with a review of the literature.. A 13-year-old girl presented to us with a mastoid abscess. Entomophthoromycotic infection of the mastoid was diagnosed on histopathological examination, and subsequently treated with surgical debridement and amphotericin B injection.. This is the first reported case of mastoid abscess secondary to entomophthoromycosis. Early detection and treatment contributed to this patient's good outcome.

Topics: Abscess; Adolescent; Amphotericin B; Antifungal Agents; Audiometry, Pure-Tone; Debridement; Ear Canal; Entomophthorales; Female; Hearing Loss, Conductive; Humans; Mastoiditis; Temporal Bone; Tomography, X-Ray Computed; Zygomycosis

Topics: Abscess; Aged; Amphotericin B; Ascomycota; Cataract Extraction; Combined Modality Therapy; Drug Therapy, Combination; Endophthalmitis; Eye Enucleation; Eye Infections, Fungal; Female; Humans; Mycoses; Pyrimidines; Recurrence; Triazoles; Vitrectomy; Vitreous Body; Voriconazole

Candida glabrata endophthalmitis following keratoplasty is rare and almost always associated with positive donor rim culture.. A 63-year-old patient, diagnosed Fuch's endothelial dystrophy in both eyes underwent a penetrating keratoplasty in his right eye. He had multiple underlying medical problems, which included diabetes mellitus, hypertension, hypoadrenalism on oral dexamethasone and fatty liver secondary to hypertrigliseridemia. He developed multiple suture abscesses, corneal haziness, retrocorneal white plaques and a level of hypopyon two weeks after an uneventful penetrating keratoplasty in his right eye. Cultures of the donor button and the transport media culture were negative. Candida glabrata was isolated successfully from the aqueous and vitreous taps. He was treated with a combination of topical, intracameral, intravitreal and intravenous Amphotericin B. His final visual acuity remained poor due to the haziness of the corneal button.. Candida glabrata endophthalmitis following penetrating keratoplasty can occur in negative donor rim and transport media cultures. The growth of the organism is facilitated by the patient's immunocompromised status. Awareness by the ophthalmologists and appropriate choice of antibiotics are mandatory in this challenging condition.

Topics: Abscess; Administration, Topical; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Drug Administration Schedule; Endophthalmitis; Eye Diseases; Fuchs' Endothelial Dystrophy; Humans; Injections, Intraocular; Injections, Intravenous; Keratoplasty, Penetrating; Male; Middle Aged; Sutures; Transplants; Ultrasonography; Vitreous Body

Histoplasmosis caused by Histoplasma capsulatum var. duboisii is an endemic mycosis of sub-Saharan Africa that usually affects the skin, subcutaneous tissue, lymph nodes and bones. We present a case of a 10-year-old immunocompetent girl with severe cutaneous and subcutaneous abscesses affecting the head and upper body. Microscopic examination showed polar budding yeasts and short mycelium compatible with H. capsulatum var. duboisii. Cultures were not possible but serology showed antibodies against both H. capsulatum var. duboisii and H. capsulatum var. capsulatum antigens. Presumptive diagnosis of histoplasmosis was done but treatment with itraconazole was inefficacious. After 15 days of treatment with Amphotericin B i/v, improvement was evident and, three months later, the patient was discharged with only residual lesions. Seven months later, no relapses were observed.

Topics: Abscess; Amphotericin B; Antibodies, Fungal; Antifungal Agents; Chad; Child; Dermatomycoses; Female; Histoplasma; Histoplasmosis; Humans; Itraconazole

Nervous system infections by Cryptococcus neoformans may occur not only in congenital or acquired immunodeficiency syndromes, but also in immunocompetent hosts. Neurological manifestations of C. neoformans infection include meningitis and, less commonly, parenchymal CNS granulomatous disease. This paper provides detailed clinical descriptions of highly unusual neurological manifestations of cryptococcal nervous system infections. Medical records and diagnostic data including magnetic resonance imaging, histopathology, serology, and CSF analysis were reviewed. A conus medullaris abscess was found in a patient infected with the human immunodeficiency virus (HIV). A patient with Hodgkin's disease was diagnosed with cryptococcal meningitis and dermatitis mimicking ophthalmic zoster. An immunocompetent patient presented with recurrent cerebral infarctions in the setting of cryptococcal meningitis. Cryptococcal infections of the nervous system can cause severe neurological disability when diagnosis is delayed. Sensitive and specific tests are readily available and should be considered when an unusual clinical presentation is encountered.

Topics: Abscess; Adult; Aged; Amphotericin B; Anticoagulants; Antifungal Agents; Brain; Central Nervous System Fungal Infections; Cryptococcosis; Cryptococcus neoformans; HIV Infections; Hodgkin Disease; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Spinal Diseases; Tomography, X-Ray Computed; Warfarin

A 57-year-old Japanese man complained of pain on micturition. The prostate was of normal size but hard. Transrectal needle biopsy demonstrated granulomatous prostatitis with small focal abscesses. Staining with periodic acid-Schiff, Grocott's methenamine silver and Fontana-Masson revealed yeast-form fungus in the granulomas. The mucoid capsule of the fungus stained with mucicarmine. PCR specific for cryptococcal 18S rDNA using DNA extracted from the pathological specimen was positive, and the sequence was homologous to Cryptococcus neoformans. A diagnosis of cryptococcal granulomatous prostatitis was made. The patient was then found to suffer from meningitis and lung abscess, and was treated with amphotericin B and flucytosine. Careful histological and molecular studies are beneficial to reach the correct diagnosis and to prevent an unfavorable outcome of disseminated cryptococcosis.

Topics: Abscess; Amphotericin B; Antifungal Agents; Carmine; Coloring Agents; Cryptococcosis; Cryptococcus neoformans; DNA, Fungal; DNA, Ribosomal; Drug Therapy, Combination; Flucytosine; Granuloma; Humans; Lung Diseases, Fungal; Male; Meningitis, Cryptococcal; Methenamine; Middle Aged; Periodic Acid-Schiff Reaction; Prostatitis; Ribotyping; RNA, Fungal; RNA, Ribosomal, 18S; Silver Nitrate; Staining and Labeling

We describe a case of sporotrichosis that disseminated to involve multiple nerves after initiation of immunosuppressive therapy and then precipitously worsened after withdrawal of therapy. This case illustrates that multiple mononeuropathies are not always caused by vasculitis, and a correct pathological diagnosis should be established before treatment. Based on clinical and pathological features, the mechanism of neuropathy may have been due to either direct nerve infection or a bystander effect of inflammatory/immune damage or, perhaps more likely, to both mechanisms.

Topics: Abscess; Amphotericin B; Anti-Bacterial Agents; Anti-Inflammatory Agents; Debridement; Dermatitis; Diagnostic Errors; Disease Progression; Forearm; Granulomatous Disease, Chronic; Humans; Immunosuppressive Agents; Inflammation; Male; Middle Aged; Muscle Weakness; Muscle, Skeletal; Pain; Peripheral Nerves; Peripheral Nervous System Diseases; Sporothrix; Sporotrichosis; Treatment Outcome; Wrist Joint

Topics: Abscess; Amphotericin B; Antifungal Agents; Candidiasis; Dermatomycoses; Extremities; Face; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged

Topics: Abscess; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Biopsy, Fine-Needle; Caspofungin; Contraindications; Cyclosporine; Delayed Graft Function; Drug Interactions; Echinocandins; Fever of Unknown Origin; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Lipopeptides; Male; Middle Aged; Mycophenolic Acid; Peptides, Cyclic; Postoperative Complications; Prednisone; Pyrimidines; Radionuclide Imaging; Stenotrophomonas maltophilia; Surgical Wound Infection; Thyroiditis; Triazoles; Ultrasonography; Voriconazole

Although aspergillosis remains the most common mould infection in patients with haematologic malignancies, disseminated Fusarium infection is an emerging problem with a poor prognosis in this patient population. The treatment options are limited due to relative resistance of the fungus to standard antifungals. We present a patient with acute lymphoblastic leukaemia successfully treated with AmBisome for a disseminated Fusarium solani infection that did not respond to first line treatment with voriconazole. Despite the fact that he received additional myelosuppressive chemotherapy and underwent two stem cell transplantations from HLA mismatched donors the Fusarium infection did not recur during the subsequent phases of neutropenia. The clinical presentation, diagnosis, prognosis and therapeutic options of fusariosis in immunocompromised patients are briefly discussed.

Topics: Abscess; Amphotericin B; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Benzamides; Combined Modality Therapy; Cytarabine; Foot Dermatoses; Fusarium; Humans; Imatinib Mesylate; Immunocompromised Host; Liposomes; Male; Middle Aged; Muscular Diseases; Onychomycosis; Peripheral Blood Stem Cell Transplantation; Piperazines; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Recurrence; Remission Induction; Reoperation; Rituximab; Teniposide; Triazoles; Voriconazole

Topics: Abscess; Adrenal Gland Diseases; Amphotericin B; Histoplasmosis; Humans; Immunocompetence; Middle Aged; Tomography, X-Ray Computed

Morphologically atypical Fusarium verticillioides causing a nasal abscess in a severely immunosuppressed child was successfully treated with repeated surgical intervention and liposomal amphotericin B, despite amphotericin B resistance in vitro. Definitive identification was achieved by sequencing the translation elongation factor alpha gene after ribosomal sequencing proved inadequate.

Topics: Abscess; Amphotericin B; Antifungal Agents; Child; Fusarium; Humans; Immunocompromised Host; Liposomes; Male; Microbial Sensitivity Tests; Molecular Sequence Data; Mycoses; Nasal Septum; Sequence Analysis, DNA

A case of Pott's puffy tumour in a diabetic patient with renal failure is reported. The patient did not respond to intravenous antibiotics and further investigation revealed that the patient had mucormycosis. As far as we are aware, this is the first case of Pott's puffy tumour due to mucormycosis to be reported in the literature.

Topics: Abscess; Amphotericin B; Antifungal Agents; Female; Frontal Bone; Humans; Immunocompromised Host; Middle Aged; Mucormycosis; Orbital Diseases; Osteomyelitis; Paranasal Sinus Diseases; Tomography, X-Ray Computed

Cryptococcosis is the third most common invasive fungal infection in organ transplant recipients after candidiasis and aspergillosis. It occurs almost exclusively in the late posttransplantation period (>6 months after the initiation of immunosuppression). Subclinical onset of meningitis is the usual clinical presentation. Despite initiation of therapy, the mortality rate associated with this infection in this patient population remains high. To the best of our knowledge, this report describes one of the first cases of a rare entity: a primary cutaneous cryptococcosis in a renal transplant recipient disclosed by skull osteomyelitis and pseudotumoral intracranial extension. Surgical debridement and azole antifungal therapy were performed. Ten months after the onset of treatment, the patient feels good, clinical examination findings are normal, and no sign of evolutive cryptococcosis is noted.

Topics: Abscess; Amphotericin B; Animals; Antifungal Agents; Combined Modality Therapy; Cryptococcosis; Debridement; Diagnosis, Differential; Ducks; Environmental Exposure; Facial Injuries; Fluconazole; Graft Rejection; Granuloma; Granulomatosis with Polyangiitis; Humans; Immunocompromised Host; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Opportunistic Infections; Osteitis; Osteolysis; Parietal Bone; Postoperative Complications; Remission Induction; Seminoma; Skull Neoplasms; Subcutaneous Tissue; Testicular Neoplasms

To report the unusual occurrence of a recurrent scleral abscess after uncomplicated cataract extraction.. Case report of a 77-year-old healthy woman.. Multiple cultures and antibiotic treatments failed to resolve presenting symptoms. Gram stain, Gomori methenamine silver (GMS) stain, and all cultures were negative. After drainage of the abscess, the patient's symptoms cleared briefly, then returned 6 months later showing a positive GMS stain consistent with Candida. The patient was treated with amphotericin, natamycin, and fluconazole at this time, and a return in visual acuity occurred along with a resolution of symptoms. No re-occurrence has been noted with 2.5 years of follow-up.. Cataract extraction, although generally a safe procedure, can still result in unusual complications such as scleral abscesses. Excellent outcomes are possible once the infections are identified and treated.

Topics: Abscess; Aged; Amphotericin B; Antifungal Agents; Candidiasis; Cataract Extraction; Drug Therapy, Combination; Female; Fluconazole; Humans; Natamycin; Recurrence; Scleral Diseases

One month after penetrating keratoplasty, a male patient suffered recurrent abscess and endophthalmitis caused by mixed bacteria (Staphylococcus aureus and Candida Albicans).. Two samples of vitreous and aqueous were taken, and a combination of systemic Vancomycin and Amphotericin B were injected intravitreally. The patient was asymptomatic for a month, but the abscess reactivated and was treated with Vancomycin and Ciprofloxacin administered intravenously. Fifteen days after withdrawing the treatment endophthalmitis returned and was treated with vitrectomy and additional systemic/intravitreal antibiotics and antifungal therapy. The final visual acuity was 20/40.. The delayed vitrectomy proved to be necessary to remove established germs and to eliminate recurrent infections.

Topics: Abscess; Adult; Amphotericin B; Aqueous Humor; Candida albicans; Candidiasis; Ciprofloxacin; Drug Therapy, Combination; Endophthalmitis; Eye Infections, Bacterial; Eye Infections, Fungal; Humans; Keratoplasty, Penetrating; Male; Postoperative Complications; Recurrence; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome; Vancomycin; Vitreous Body

This case emphasizes that aggressive neurosurgical management may benefit patients with disseminated coccidioidomycosis and skull abscesses. Disseminated infection due to Coccidioides immitis, the causative agent of coccidioidomycosis, is difficult to treat and often requires prolonged antifungal therapy in addition to surgical debridement. We present a case of a young woman with disseminated coccidioidomycosis who had multiple skull lesions, two of which penetrated the skull and invaded the subgaleal and epidural spaces. Despite prolonged aggressive medical management, these lesions failed to resolve until they were surgically drained.

Topics: Abscess; Adult; Amphotericin B; Antifungal Agents; Coccidioidomycosis; Combined Modality Therapy; Drug Therapy, Combination; Female; Fluconazole; Humans; Liposomes; Osteomyelitis; Skull

Topics: Abscess; Amikacin; Amphotericin B; Cefotaxime; Choroid Diseases; Drug Therapy, Combination; Eye Infections, Bacterial; Fluorescein Angiography; Humans; Kidney Transplantation; Male; Middle Aged; Nocardia asteroides; Nocardia Infections; Transplantation, Homologous; Trimethoprim, Sulfamethoxazole Drug Combination; Vitreous Body

Topics: Abscess; Amphotericin B; Antifungal Agents; Candidiasis; Cataract Extraction; Eye Infections, Fungal; Female; Fluconazole; Fungemia; Humans; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Lens Diseases; Male; Vitrectomy

Hepatosplenic microabscesses secondary to invasion by various organisms may result in life-threatening conditions, especially in patients with cancer. Whether these patients should continue ongoing cytotoxic therapy, which might result in neutropenia, with the risk of progressive abscess formation or fungemia, remains a dilemma. We report five cases of pediatric acute leukemia with hepatosplenic microabscesses in children aged 4 years to 18 years. These patients presented with prolonged fever and neutropenia after antineoplastic chemotherapy, followed by abdominal pain, hepatosplenomegaly and hepatic dysfunction. Abdominal ultrasound and computed tomography (CT) or magnetic resonance imaging (MRI) demonstrated multiple small lesions compatible with hepatosplenic candidiasis in all of the patients. Cultures, including blood or stool cultures, were positive in only two cases. Treatment with intravenous antifungal agents, including amphotericin B, liposomal amphotericin B, and/or fluconazole were successful in two cases. These two patients remained event-free and survived for more than 24 months (20 months and 22 months after infection was diagnosed). The duration of systemic antifungal medication administration ranged from 3 months to 22 months. The serial image examinations revealed drastic reductions in small residual lesions in the two patients who survived the longest. The major issues for these patients were how long the antifungal therapy should be administered for, and how to select the optimal drug and dosage to avoid hepatic and renal toxicity. Among our patients, alternative therapy with amphotericin B, liposomal amphotericin B, and fluconazole was used according to the patients' conditions, and the duration of antifungal therapy was determined by clinical manifestations and imaging study changes.

Topics: Abscess; Acute Disease; Adolescent; Amphotericin B; Antifungal Agents; Candidiasis; Child; Child, Preschool; Drug Administration Schedule; Humans; Leukemia; Liver Abscess; Male; Splenic Diseases

Paecilomyces lilacinus was the causal agent of a case of subcutaneous infection in a patient with liver cirrhosis. Surgical treatment in combination with systemic amphotericin B therapy led to complete recovery. Retrospectively performed microdilution testing revealed dose dependent in vitro susceptibility of the isolate to voriconazole (MIC = 2 g/ml) and terbinafine (MIC = 1 microg/ml).

Topics: Abscess; Adult; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Dermatomycoses; Germany; Humans; Liver Cirrhosis; Male; Microbial Sensitivity Tests; Paecilomyces

Deep-seated Candida infections are strongly associated with mortality and morbidity of patients, and need early diagnosis. The frequency of deep-seated fungal infection has recently been growing. We encountered a tuboovarian abscess caused by Candida glabrata after chemotherapy with an anticancer drug, methotrexate, in a febrile neutropenic patient. The susceptibilities to fluconazole and amphotericin B were 16 and 0.5 micro g/ml, respectively. Although combination therapy of fluconazole and amphotericin B was effective, left salpingectomy was laparoscopically performed because the left adnexal tumor continued to exist asymptomatically after 1 month.

Topics: Abscess; Adult; Amphotericin B; Antifungal Agents; Antimetabolites, Antineoplastic; Candida glabrata; Candidiasis; Diagnosis, Differential; Fallopian Tubes; Female; Fever; Fluconazole; Genital Diseases, Female; Granulocyte Colony-Stimulating Factor; Humans; Hydatidiform Mole; Magnetic Resonance Imaging; Methotrexate; Neutropenia; Pregnancy

In this report, we review the case of a candidal lens abscess in a premature infant girl who was 28 weeks' gestational age at birth. The culture obtained from the lens abscess grew Candida albicans sensitive to amphotericin B but resistant to flucytosine. This case is unique in that the infant developed a fungal lens cataract at 34 weeks' postconceptional age during the last week of a 30-day course of amphotericin B. The embryonic hyaloid artery system, which perfuses the developing lens, regresses between 29 and 32 weeks of gestation; thus, the mechanism for an infection of the lens may be inoculation of the lens by Candida before hyaloid artery system regression, followed by developmental loss of this blood supply, which makes the lens inaccessible to antimicrobial penetration. Candidal endophthalmitis with lens abscess is an uncommon morbidity that requires prompt recognition and surgical intervention for effective management.

Topics: Abscess; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Cataract Extraction; Endophthalmitis; Eye Infections, Fungal; Female; Flucytosine; Gestational Age; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Lens Diseases; Lens, Crystalline; Ophthalmic Artery

Coccidioidomycosis, a fungal infection endemic in the southwestern United States, can cause life-threatening infections in immunosuppressed patients. We report the contrasting cases of two adolescents with lupus nephritis, treated with intravenous pulse cyclophosphamide and daily oral corticosteroids, who developed pulmonary coccidioidomycosis. One patient developed a fatal form of fulminant disseminated coccidioidomycosis, while the other patient developed a solitary pulmonary Coccidioides immitis abscess which was responsive to intravenous liposomal amphotericin and fluconazole therapy. Because serologies and initial X-ray studies can be negative, definitive diagnostic studies including bronchoaveolar lavage and needle aspiration should be performed when there is clinical suspicion of coccidioidomycosis in an immunocompromised patient. Immunosuppressed patients with coccidioidomycosis should receive early intravenous amphotericin therapy and may benefit from long-term suppressive antifungal therapy to prevent relapse.

Topics: Abscess; Administration, Oral; Adolescent; Adrenal Cortex Hormones; Amphotericin B; Child; Coccidioidomycosis; Cyclophosphamide; Drug Therapy, Combination; Fatal Outcome; Female; Fluconazole; Humans; Immunosuppressive Agents; Injections, Intravenous; Liposomes; Lung Diseases; Lupus Nephritis; Radiography, Thoracic; Tomography, X-Ray Computed

We report a case of Candida glabrata perinephric abscess in a patient with diabetes mellitus who recently underwent ureteropelvic surgery for lithiasic urinary tract obstruction. Surgical drainage and amphotericin B treatment led to resolution of the infection. C. glabrata urinary infection has become more prevalent over the last decade in immunocompromised patients. Drainage is indicated for development of a fungal abscess in the perinephric area. Most authors recommend administration of an antifungal adjuvant treatment.

Topics: Abscess; Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candida; Candidiasis; Combined Modality Therapy; Diabetes Mellitus, Type 1; Drainage; Escherichia coli Infections; Female; Humans; Hypertension; Immunocompromised Host; Kidney Diseases; Postoperative Complications; Risk Factors; Serotyping; Urinary Calculi; Urinary Tract Infections

A case of lethal invasive mucormycosis (IM), a rare fungal infection which predominantly affects immunocompromised patients, is reported in a 73-year-old female patient who presented with a cervical abscess. The patient had asthma treated with steroids and had previously undiagnosed diabetes mellitus. Despite surgical treatment and parenteral antibiotic therapy, there was fatal progression of the condition. The pathogenesis, histological appearances and treatment of mucormycosis are discussed, particularly the importance of urgent histological examination of debrided tissue to distinguish this condition from necrotizing fasciitis (NF) earlier than microbiological culture alone would allow, thus permitting the early introduction of appropriate antifungal therapy.

Topics: Abscess; Absidia; Aged; Amphotericin B; Antifungal Agents; Asthma; Dermatomycoses; Diabetes Complications; Diagnosis, Differential; Drug Therapy, Combination; Fasciitis, Necrotizing; Fatal Outcome; Female; Humans; Immunocompromised Host; Mucormycosis; Neck

Blastomycosis is an unusual fungal infection in children. It is often a chronic infection characterized by granulomatous and suppurative lesions. Clinical manifestations include either pulmonary findings or disseminated disease. Disseminated blastomycosis usually begins with a lung infection that spreads to the skin, bones, and central nervous system. This is a case report of a child with chronic blastomycosis presenting with chronic paronychia, fever, cough, malaise, and back pain. The child underwent surgical drainage of a paravertebral abscess and administration of intravenous amphotericin B. He was discharged in good condition on oral therapy with ketoconazole. The literature on blastomycosis, with particular emphasis on clinical presentations and management, is reviewed. When the history and physical examination suggest a chronic granulomatous or disseminated disease, such as tuberculosis, the physician must include blastomycosis in the differential.

Topics: Abscess; Amphotericin B; Antifungal Agents; Blastomycosis; Child; Chronic Disease; Humans; Ketoconazole; Male; Osteomyelitis; Paronychia; Spinal Diseases

Topics: Abscess; Aged; Amphotericin B; Antifungal Agents; Eye Infections, Fungal; Humans; Itraconazole; Male; Maxillary Sinusitis; Mycetoma; Orbital Diseases; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pseudallescheria; Tomography, X-Ray Computed

Pancreatic infection by Candida is an infrequent entity. We report two cases and review literature. A 67 year-old woman who was admitted for severe acute pancreatitis of biliary origin developed high fever during fourth week of stay; it was secondary to a pancreatic abscess due to Candida. On the other hand, a 67 year-old man with severe acute biliary pancreatitis and renal insufficiency showed an abscess of similar characteristics that was identified during fourth week of evolution. Both of them recovered completely after surgical drainage and antifungical parenteral treatment. The use of broad spectrum antibiotics recently recommended for prophylaxis of pancreatic infection in patients with necrotizing acute pancreatitis, can favour opportunistic infection by several agents. Pancreatic abscesses by Candida often occurs in patients receiving broad spectrum antibiotics, although it isn't an essential condition. The fact that Candida could be only a contaminant may delay diagnosis and early treatment, and then it can determine a poor outcome. Adequate treatment is urgent surgical drainage associated with antifungical parenteral therapy. Usefulness of antifungic drugs in patients undergoing long term antibiotic prophylaxis for secondary infection must be evaluated.

Topics: Abscess; Acute Disease; Aged; Amphotericin B; Antifungal Agents; Candidiasis; Drainage; Female; Humans; Imipenem; Male; Pancreatic Diseases; Pancreatitis; Radiography; Thienamycins

A case of Candida abscess of the thyroid in a patient with acute lymphoblastic leukemia is described. The patient developed this rare complication after treatment with steroids and combination chemotherapy, during therapy with broad spectrum antibiotics for febrile neutropenia. Prior to the thyroiditis the patient had pulmonary aspergillosis. The abscess developed during treatment with high dose Amphotericin B. Unlike previous cases, the Candida was isolated to the thyroid, with no evidence of Candidemia or Candida infection in other sites.

Topics: Abscess; Adolescent; Amphotericin B; Aspergillosis; Candidiasis; Humans; Lung Diseases, Fungal; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Thyroid Gland; Thyroiditis, Suppurative

Topics: Abscess; Amphotericin B; Analgesia, Epidural; Antifungal Agents; Epidural Space; Equipment Contamination; Exophiala; Female; Humans; Middle Aged; Mycoses; Spinal Diseases

A destructive granulomatous lesion of the temporal bone caused by Coccidioides immitis disseminated from a pulmonary lesion was found in a 4-year-old immunocompetent child. To our knowledge, it is the first case of coccidioidomycosis of the temporal bone reported in the world literature. The child presented with pain in her right ear and a 6-month history of intermittent fever, which partially responded to multiple courses of antibiotics. A tender erythematous postauricular swelling consistent with a subperiosteal abscess subsequently developed over 1 month. A mastoidectomy showed granulation tissue with pockets of purulence, and histologic evaluation of the specimen revealed spherules of C immitis, later verified by culture. The patient responded to intravenous amphotericin B therapy, without evidence of disease recurrence. Coccidioides immitis is endemic in regions of the Southwestern United States, with extremely infectious characteristics and relative resistance to medical therapy. Coccidioidomycosis should be considered in the differential diagnosis of a granulomatous lesion of the temporal bone.

Topics: Abscess; Amphotericin B; Antifungal Agents; Chemotherapy, Adjuvant; Child, Preschool; Coccidioidomycosis; Diagnosis, Differential; Female; Humans; Immunocompromised Host; Lung Diseases, Fungal; Periostitis; Temporal Bone

Topics: Abscess; Amphotericin B; Antifungal Agents; Aspergillosis; Dermatomycoses; Diagnosis, Differential; Female; Flucytosine; Humans; Infant, Newborn

A patient with AIDS was hospitalized with a left-sided face swelling and protrusion of the bulbus. After cranial computed tomography and fine-needle aspiration biopsy of the fossa temporalis we diagnosed a mycetoma; localisation and histology made an aspergilloma most probable. Antimycotic therapy led to complete remission of the symptoms. Post mortem we only could culture Candida albicans out of the abscess cavity.

Topics: Abscess; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspergillosis; Biopsy, Needle; Candidiasis; Diagnosis, Differential; Flucytosine; Humans; Male; Maxillary Sinus; Maxillary Sinusitis; Mycetoma; Orbit; Tomography, X-Ray Computed

The recovery of Candida albicans along with bacteria from the abdomen in the setting of peritonitis is becoming increasingly common. It is not known whether the interactions between the fungal and bacterial elements of these infections are synergistic, competitive, or neutral. To study this question, we have examined the effects of both the addition of C. albicans to a solely bacterial infection caused by Escherichia coli and Bacteroides fragilis, and the deletion of various components of this system using directed antimicrobial therapy. In a mixed infection, both C. albicans and bacteria contributed to mortality, since only the combination of cefoxitin and amphotericin B improved survival (from 50% to 90%). The addition of C. albicans to the bacterial inoculum increased the recovery of abscesses, but only to the number seen with fungal infection alone, implying two fairly independent processes. Although the number of bacteria recovered from abscesses at 10 days postinfection was unchanged with the addition of fungi, the deletion of the bacterial component of mixed infections led to the overgrowth of C. albicans. We conclude that this model of mixed C. albicans/E. coli/B. fragilis peritonitis is best characterized as two nonsynergistic, parallel infections with incomplete competition, allowing the survival of all three organisms to eventual abscess formation.

Topics: Abscess; Amphotericin B; Animals; Bacteroides fragilis; Bacteroides Infections; Candida albicans; Candidiasis; Cefotetan; Cefoxitin; Clindamycin; Colony Count, Microbial; Drug Combinations; Escherichia coli; Escherichia coli Infections; Male; Mice; Mice, Inbred BALB C; Peritoneal Diseases; Peritonitis; Survival Rate

We present the clinical, serological, and radiological features of a patient with a spinal intramedullary abscess caused by Candida albicans. Antimycotic treatment was successful, and no neurosurgical approach was necessary.

Topics: Abscess; Amphotericin B; Candidiasis; Flucytosine; Humans; Magnetic Resonance Imaging; Male; Medulla Oblongata; Middle Aged; Spinal Cord Diseases

A 54-year-old man with dermatomyositis initially responsive to corticosteroids and methotrexate developed severe myalgias, increasing weakness, and fevers. Laboratory studies were suggestive of disseminated histoplasmosis, and muscle biopsy revealed myositis, fasciitis, and yeast in the perimysial connective tissue. Histoplasma capsulatum was cultured from skeletal muscle. Despite antifungal therapy, necrotizing fasciitis progressed to gluteal abscess formation. Disseminated histoplasmosis may present atypically in immunocompromised hosts as fasciitis and myositis. Patients with dermatomyositis could be particularly vulnerable to soft tissue invasion by fungi due to their underlying microangiopathy.

Topics: Abscess; Amphotericin B; Buttocks; Dermatomyositis; Diagnosis, Differential; Fasciitis; Histoplasmosis; Humans; Immunosuppression Therapy; Itraconazole; Magnetic Resonance Imaging; Male; Middle Aged; Muscles; Myositis

Topics: Abscess; Amphotericin B; Antifungal Agents; Child; Humans; Itraconazole; Male; Mycoses; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Thoracic Vertebrae; Trichosporon

We describe here a case of cryptococcal empyema thoracis and periauricular pyogenic abscess in a child with Bruton's agammaglobulinaemia. The cryptococcal empyema thoracis was treated with intravenous amphotericin B and intravenous fluconazole for six weeks followed by oral fluconazole. The pyogenic periauricular abscess was surgically drained and treated with intravenous ceftazidime and cloxacillin for two weeks. He also received monthly intravenous immunoglobulin.

Topics: Abscess; Agammaglobulinemia; Amphotericin B; Ceftazidime; Child, Preschool; Cloxacillin; Combined Modality Therapy; Cryptococcosis; Empyema, Pleural; Fluconazole; Humans; Immunization, Passive; Male; Opportunistic Infections; Otitis Externa

We report successful palliative treatment of an Aspergillus fumigatus orbital mass in a patient with acquired immunodeficiency syndrome by direct injection of amphotericin B into the abscess cavity. This case presents intraorbital injection of amphotericin B as an alternative to surgical debridement of Aspergillus orbital infection. In patients who are unable or unwilling to undergo more aggressive treatment, this procedure appears to limit morbidity while still providing effective palliative therapy.

Topics: Abscess; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Aspergillosis; Eye Infections, Fungal; Humans; Injections; Male; Orbital Diseases; Palliative Care

We reported three consecutive cases of severe fungal keratitis initially undiagnosed by corneal scrapping. Corneal biopsy showed fungal elements of Paecilomyces lilacinus, Fusarium solani, Scedosporium apiospermum. Most cases of fungal keratitis could be treated successfully if adequate antifungal therapy were started early. Early and accurate diagnosis is of major importance. The results of our cases confirm the superiority of corneal biopsy over corneal scrapping. Corneal biopsy is a procedure of choice in suspected cases of keratomycosis in which corneal scrapings fail.

Topics: Abscess; Aged; Amphotericin B; Biopsy; Contact Lenses; Cornea; Corneal Ulcer; Female; Humans; Keratitis; Male; Mycoses; Time Factors

A 44-year-old man was admitted with symptoms compatible with Addison crisis. Abdominal computer tomography revealed extensive bilateral adrenal abscesses. Histoplasma capsulatum was cultured from a needle aspirate. The patient was HIV-seronegative and had no underlying malignancy. He may have acquired the infection during several stays in endemic areas in the United States, South America and Asia. The case was also remarkable for moderate brain atrophy, thrombosis of the portal and splenic veins and liver cirrhosis caused by alpha-1-antitrypsin deficiency (phenotype MZ). The patient recovered fully under substitution of adrenal hormones and antifungal treatment. He received intravenous amphotericin B (75 mg q24h) for 10 days, followed subsequently by oral treatment with itraconazole (400 mg q24h) over several months. Radiologic follow-up 9 and 18 months later showed a pronounced decrease of the inflammatory adrenal lesions.

Topics: Abscess; Acute Disease; Addison Disease; Adrenal Gland Diseases; Adult; alpha 1-Antitrypsin Deficiency; Amphotericin B; Histoplasmosis; Humans; Itraconazole; Liver Cirrhosis; Male; Tomography, X-Ray Computed

Serious infections caused by Torulopsis glabrata, once rarely encountered, have become common over the last 3 decades. The most frequent manifestations of serious fungal infections include septicemia, endocarditis, hepatosplenic infections, and meningitis. We report a case of fungemia and pelvic abscess caused by T glabrata following gynecologic surgery.. A 43-year-old woman developed fever, abdominal pain, and abdominal distention following a total abdominal hysterectomy and right salpingo-oophorectomy. Empirical treatment with broad-spectrum antimicrobial agents was not successful. Three sets of blood cultures were positive for T glabrata, and radiologic investigations revealed pelvic and lesser sac fluid collections. Cultures of the pelvic abscess grew T glabrata. Treatment was changed to amphotericin B, with complete clinical recovery.. Serious T glabrata infections are rare following gynecologic surgery, especially in immunocompetent patients. Given the morbidity and mortality associated with these infections, aggressive treatment with amphotericin B and drainage of abscesses is warranted.

Topics: Abscess; Adult; Amphotericin B; Candidiasis; Female; Fungemia; Humans; Hysterectomy; Pelvis; Postoperative Complications; Uterine Neoplasms

A report is presented of a patient who developed multiple abscesses of the pancreas due to Candida albicans following an Endoscopic retrograde chole-pancreatography (ERCP) for acute pancreatitis. He was not immunocompromised, debilitated and had not had recent surgery. There was complete radiological and clinical resolution of the abscess on prolonged treatment with amphotericin alone. Only a few cases of candidal abscess of the pancreas have been reported, none of them having occurred after an ERCP.

Topics: Abscess; Aged; Amphotericin B; Antifungal Agents; Candidiasis; Cholangiopancreatography, Endoscopic Retrograde; Humans; Male; Pancreatic Diseases; Tomography, X-Ray Computed

A rare case of protothecosis in a 40-year-old Japanese woman with systemic lupus erythematosus, under long-term prednisolone treatment is presented. The patient developed extensive ulcerative skin lesions after injury. The characteristic histopathological findings and biochemical sugar assimilation tests indicated infection by Prototheca wicherhamii. The lesions improved following treatment with amphotericin B. The immunodeficient state of this patient seemed to contribute to the infection with Prototheca.

Topics: Abscess; Adult; Amphotericin B; Elbow Injuries; Female; Humans; Immunity, Cellular; Immunocompromised Host; Infections; Lupus Erythematosus, Systemic; Prednisolone; Prototheca; Skin Diseases, Infectious; Skin Ulcer

Although development of resistance in Candida albicans to amphotericin B is considered rare, C. albicans was persistently recovered from a 28-year-old man after a prolonged course of broad-spectrum antimicrobial therapy for a pancreatic abscess. Determination of the MICs of drugs for C. albicans in Sabouraud broth revealed MICs of 2.5 mg/l amphotericin B, greater than 40 mg/l ketoconazole, 2.5 mg/l miconazole, and greater than 40 mg/l 5-fluorocytosine. Synergy testing revealed a MIC of 0.3 mg/l amphotericin B in the presence of 2.5 mg/l 5-fluorocytosine. When intravenous 5-fluorocytosine was added to the patient's antifungal regimen, achieving levels of 125 mg/l, negative blood cultures resulted for the first time. This suggests there may be a clinical use for in vitro synergy testing as an adjunct to guide antifungal therapy for fungemia due to amphotericin B-resistant C. albicans.

Topics: Abscess; Adult; Amphotericin B; Candida albicans; Candidiasis; Drug Resistance, Microbial; Flucytosine; Humans; Male; Microbial Sensitivity Tests; Pancreatic Diseases

A 40-year-old female was admitted in August 1989 with a diagnosis of acute promyelocytic leukemia (AML; M3). One course of modified-DCMP regimen induced complete remission in September, but she developed spiking fever at a nadir period of WBC after induction chemotherapy. CT revealed multiple hepato-splenic abscesses presumably due to candida infection. She was treated with intravenous administration of amphotericin B (AMPH-B) and other antifungal agents. Despite the hematological remission and prolonged use of these antifungal agents, high fever persisted. A catheter was inserted into the portal vein under ultrasonic-guidance. AMPH-B was administered through the catheter: the initial dose was 3 mg/day and was soon increased to 20 mg/day. Her fever subsided in 1 week, and the sizes of liver abscesses on CT reduced markedly. Chill and hypokalemia were observed during this therapy. The catheter was removed from the portal vein after 29 days. Partial portal vein thrombosis was noted around the catheter tip. This case suggests the usefulness of intraportal administration of AMPH-B in patients with hematological malignancy developing multiple liver abscesses.

Topics: Abscess; Adult; Amphotericin B; Catheterization; Female; Humans; Leukemia, Promyelocytic, Acute; Liver Abscess; Portal Vein; Splenic Diseases

Chronic granulomatous disease (CGD) is a rare inherited disorder in which neutrophils do not appropriately generate cytotoxic superoxide anion, the respiratory burst, in response to invading bacteria or fungi as a part of normal host defence. We report the case of a child with CGD who had two abdominal wall abscesses caused by Paecilomyces lilacinus, an organism not previously known to cause infections in patients with CGD. The abdominal wall is a location that is rarely associated with Paecilomyces infections. Parenteral amphotericin B eradicated the infection in an immunocompromised child whereas this regimen has heretofore largely been unsuccessful in the treatment of this infection. Paecilomyces species and other fungi from immunocompromised hosts and thought to be laboratory contaminants, need to be carefully investigated for they may become pathogens in this clinical setting.

Topics: Abdominal Muscles; Abscess; Amphotericin B; Child, Preschool; Granulomatous Disease, Chronic; Humans; Male; Mycoses; Paecilomyces; Recurrence

Perirenal candidial abscesses are rare, with few well-documented cases in the literature. We describe a case of a perinephric abscess treated with amphotericin B and nephrectomy.

Topics: Abscess; Aged; Amphotericin B; Candidiasis; Drainage; Humans; Kidney Diseases; Male; Nephrectomy

Topics: Abscess; Adult; Amphotericin B; Candidiasis; Dextrans; Endometriosis; Female; Humans; Miconazole; Pelvis; Postoperative Complications; Tissue Adhesions

Over a 2-year period, all surgical patients from whom Candida was isolated from intra-abdominal specimens were evaluated. All but 1 of the 49 evaluable patients had either a spontaneous perforation (57%) or a surgical opening of the gastrointestinal tract (41%). Candida caused infection in 19 patients (39%), of whom 7 had an intra-abdominal abscess and 12 peritonitis. In the other 30 patients (61%), there were no signs of infection and specific surgical or medical treatment was not required. Candida was more likely to cause infection when isolated in patients having surgery for acute pancreatitis than in those with either gastrointestinal perforations or other surgical conditions. The development of a clinical infection was significantly associated with a high initial or increasing amount of Candida in the semiquantitative culture. Surgery alone failed in 16 of 19 patients (84%), of whom 7 died and 9 recovered after combined antifungal and surgical treatment. The overall mortality and the mortality related to infections were significantly higher in the patients with intraabdominal candidal infections than in those without such infections.

Topics: Abscess; Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Candida; Candidiasis; Child; Child, Preschool; Combined Modality Therapy; Drainage; Female; Humans; Infant; Intestinal Perforation; Male; Middle Aged; Pancreatitis; Peritoneum; Peritonitis; Postoperative Complications; Prospective Studies; Retrospective Studies; Time Factors

We report a case of neonatal infection with rhizopus, one of the Mucoraceae family. Human infection is rare but the mortality is high without prompt, correct treatment. The infant had a simultaneous candida septicaemia secondary to colonisation of a central venous line. Serial C reactive protein estimations are valuable in monitoring treatment.

Topics: Abscess; Amphotericin B; Candidiasis; Drainage; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Mucormycosis; Rhizopus

Despite the large number of organ transplants performed yearly, to date there have been no reports of candidal splenic abscess. We describe here the first case of candidal splenic abscess in a renal transplant recipient treated successfully by splenectomy and amphotericin B. Despite a lengthy illness, the patient recovered with preservation of renal function.

Topics: Abscess; Amphotericin B; Candidiasis; Humans; Kidney Transplantation; Male; Middle Aged; Postoperative Complications; Splenic Diseases

Although abdominal candidiasis in critically ill surgical patients is becoming increasingly common, optimal management has not been defined. We treated 16 patients with abdominal candidiasis over a 36 month period. Violation of the gastrointestinal tract mucosa was the most common precipitating event (13 patients). Predisposing factors included: CVP catheters, broad spectrum antibiotics, and parenteral hyperalimentation in all patients, H2-blockers/antacids in 14 patients, as well as malnutrition (7 patients), DM (3 patients), alcoholism (3 patients), and steroids/chemotherapy (3 patients). Candida was isolated from an abscess in seven patients, peritoneal fluid in six patients and both in three patients. In four patients abdominal candidiasis was preceded by positive cultures from blood or two peripheral sites which had not been treated. All patients were treated with amphotericin B (146-4000 mg) without any major adverse effects. Fungal infection was eradicated in ten patients; three patients succumbed to candidiasis. Patients treated within seven days required less Amphotericin B and appeared to have a better outcome than those having delayed treatment. The authors conclude that abdominal candidiasis is a potentially lethal infection in critically ill surgical patients that should be aggressively treated. Amphotericin B can be safely administered and concurrent antibiotics need not be stopped.

Topics: Abdomen; Abscess; Adult; Aged; Aged, 80 and over; Amphotericin B; Candidiasis; Digestive System Surgical Procedures; Female; Humans; Male; Middle Aged; Peritonitis; Postoperative Complications

Aspergillus nidulans var. echinulatus was the sole agent cultured from the left lung, a paraspinal abscess, left ribs, and thoracic vertebral bodies from a patient with chronic granulomatous disease. Hyphal elements were present in histologic sections of lung, vertebral bodies, and infected ribs along with granuloma formation. The patient was treated with two debridement procedures and insertion of a Harrington rod followed by a long course of amphotericin B, flucytosine, and daily white blood cell transfusions.

Topics: Abscess; Amphotericin B; Aspergillosis; Aspergillus nidulans; Blood Transfusion; Child, Preschool; Flucytosine; Granulomatous Disease, Chronic; Humans; Leukocyte Transfusion; Lung Diseases, Fungal; Male; Spinal Diseases; Thoracic Vertebrae

Topics: Abscess; Adrenal Gland Diseases; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Diagnosis, Differential; Drainage; Drug Therapy, Combination; Humans; Ketoconazole; Male; Middle Aged; Opportunistic Infections; Rifampin; Sarcoidosis

Topics: Abscess; Amphotericin B; Candidiasis; Combined Modality Therapy; Drug Therapy, Combination; Erectile Dysfunction; Humans; Ketoconazole; Male; Middle Aged; Penile Diseases; Prostheses and Implants

In an 18-month period candidal splenic abscesses were diagnosed and treated in eight patients. Predisposing factors consisted of recent exposure to cytotoxic chemotherapy, long-term use of prednisone, neutropenia, antibiotic therapy for greater than three weeks, and gastrointestinal tract colonization with Candida. The patients had a clinical profile of nontoxic appearance with a temperature of more than 38.5 degrees C that was unresponsive to antibiotics, pain and tenderness over the upper abdominal quadrants, focal defects visualized on ultrasound and/or computed tomographic scans, and an elevated alkaline phosphatase level. Candida infection was confirmed by histologic examination of the liver and/or spleen in all patients. Diagnosis was made by percutaneous biopsy in one patient and exploratory laparotomy in seven. Five patients had splenectomy and antifungal drugs. In three patients the fungal abscesses resolved with amphotericin B therapy alone. Seven of eight patients were cured of their splenic abscesses, and five of eight were long-term survivors.

Topics: Abscess; Adolescent; Adult; Amphotericin B; Candidiasis; Child, Preschool; Diagnosis, Differential; Female; Flucytosine; Follow-Up Studies; Humans; Immunosuppression Therapy; Liver Abscess; Male; Middle Aged; Splenic Diseases; Tomography, X-Ray Computed; Ultrasonography

We have reported a case of fungal splenic abscess caused by Blastomyces dermatitidis. Splenic abscess is an uncommon disorder, and fungus as the causative organism is rare. The diagnosis of splenic abscess can be rapidly made with radionuclide and CT scanning and ultrasonography. Splenectomy with appropriate antifungal chemotherapy is the currently recommended therapy.

Topics: Abscess; Adult; Amphotericin B; Blastomyces; Blastomycosis; Humans; Male; Spleen; Splenectomy; Splenic Diseases; Splenic Rupture

The pathogenicity of Candida species cultured from peritoneal fluid or from an intra-abdominal abscess is unknown. A review of cultures at NCMH from 1978 to 1983 showed that Candida species were cultured from the peritoneal fluid of 39 patients and from intra-abdominal abscesses in 24 patients. The average age was 49 (range 6 months to 102 years); there were 38 men and 25 women. None of the 39 patients with Candida species grown from the peritoneal fluid was treated with Amphotericin B and only 1 (2.6%) subsequently developed an abscess. This patient was treated by surgical drainage without Amphotericin B and recovered. Twenty-four patients had Candida cultured from an intra-abdominal abscess. Of these, 21 (87.5%) also grew other bacterial organisms. Twenty of these 24 patients were treated with surgical drainage and antibacterial antibiotics without Amphotericin B. Six (30%) died, but only one death was felt to be directly related to the Candida infection. The remaining four were treated with surgical drainage, appropriate antibacterial antibiotics, and Amphotericin B. Two of these four (50%) died; one of the two deaths was related to Candida infection. Candida species grown from the peritoneum were not related to later Candida infection. Treatment of patients with contamination of the peritoneum by Candida with Amphotericin B appears unnecessary and because of Amphotericin renal toxicity, may be potentially harmful. Patients with polymicrobial intra-abdominal abscesses that contain Candida species should be treated with surgical drainage and appropriate antibacterial antibiotics. The value of adding Amphotericin B therapy in patients with polymicrobial abscess containing Candida was not demonstrated in this study, and its role is unclear.

Topics: Abdomen; Abscess; Adolescent; Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Ascitic Fluid; Candida; Candidiasis; Child; Child, Preschool; Drainage; Female; Humans; Infant; Male; Middle Aged

A thrush-like oral infection with subsequent alveolar abscess formation and a positive blood culture due to Trichosporon capitatum developed in a patient with acute myelogenous leukaemia. Later T. capitatum was identified by indirect immunofluorescence in multiple splenic abscesses. The infection was controlled by immediate aggressive treatment with amphotericin B, flucytosine and rifampicin and by splenectomy. This case of systemic T. capitatum infection resembles somewhat the invasive mycosis due to candida.

Topics: Abscess; Adult; Amphotericin B; Blood; Female; Flucytosine; Humans; Leukemia, Myeloid, Acute; Mitosporic Fungi; Mycoses; Rifampin; Splenic Diseases

Rhizopus rhizopodiformis has seldom been isolated from human mucormycosis. We report the first subcutaneous abscess to be caused by this fungus. It occurred in a diabetic man and presented as an inguinal mass, suggestive of a hernia, superficial to his cadaveric renal transplant. The fungus was readily isolated from pus inoculated onto blood and chocolate agars after a short incubation. The patient was cured by surgical drainage and treatment with 2.0 g of intravenous amphotericin B. Complete identification of such isolates is recommended.

Topics: Abscess; Adult; Amphotericin B; Combined Modality Therapy; Diagnostic Errors; Hernia, Inguinal; Humans; Inguinal Canal; Male; Mucormycosis; Rhizopus

Mucormycosis is encountered in patients with diabetes mellitus, as well as other debilitating diseases. The fungus is ubiquitous, but only certain types of patients become afflicted with this disease. Early diagnosis, control of the underlying disease, drug therapy, and surgical treatment can save the lives of patients with this infection. One should not be reluctant to think of mucormycosis in a differential diagnosis. Mucormycosis is becoming more frequently diagnosed.

Topics: Abscess; Amphotericin B; Female; Humans; Mucormycosis; Orbital Diseases

We reviewed the clinical courses of 63 surgical patients who had experienced one or more days of fungemia, to determine the clinical setting for such infections and to define indications for systemic therapy. Fifty-one patients experienced fungemia as a late complication of intraperitoneal infection. Candida was identified as part of a polymicrobial flora in 70%. If untreated, the mortality was 83% (30 of 36). No untreated patients with fungemia for more than one day survived. Adequate therapy with amphotericin B (total dose, greater than 3 mg/kg) improved survival to 67% (ten of 15). Autopsies performed in 20 cases revealed visceral Candida microabscesses in seven, with the gastrointestinal tract (12) and intraabdominal abscess (five) as the most common sources of fungi. These data support the concept of Candida as an important participant in polymicrobial infection and recommend therapy with amphotericin B for patients with intraperitoneal infection experiencing fungemia.

Topics: Abdomen; Abscess; Adolescent; Adult; Aged; Amphotericin B; Candidiasis; Child; Female; Gastrointestinal Diseases; Hospitalization; Humans; Male; Middle Aged; Peritoneal Diseases; Postoperative Complications; Retrospective Studies; Time Factors

Two patients with acute leukemia were found to have candidal splenic abscesses. Both patients were in remission and had normal granulocyte counts at the time the abscesses became evident. Both patients were treated with splenectomy and antifungal therapy with a definite response. The incidence and treatment of fungal splenic abscesses in leukemia patients is discussed with emphasis on the role of splenectomy.

Topics: Abscess; Acute Disease; Amphotericin B; Candidiasis; Humans; Infant; Leukemia; Leukemia, Lymphoid; Male; Splenectomy; Splenic Diseases

A 9-month-old patient developed a Candida albicans skin abscess at the repair site of a lumbar myelomeningocele. There was no evidence of C. albicans infection elsewhere in the body. The infection may have been acquired at the time of the original myelomeningocele repair at 2 days of age. The abscess was cured by surgical drainage and amphotericin B therapy. This case indicates that laboratories should be aware of C. albicans as an unusual cause of abscess.

Topics: Abscess; Amphotericin B; Candida albicans; Candidiasis, Cutaneous; Humans; Infant; Male; Meningomyelocele; Postoperative Complications; Skin Diseases, Infectious

Between January 1974 and July 1976, three adult patients with leukemia, therapy-associated granulocytopenia and febrile courses unresponsive to broad spectrum antibiotic therapy were operated upon for a preoperative diagnosis of candidal abscess of the spleen. The diagnosis was based upon a high index of suspicion of invasive candidiasis in this immunosuppressed group of patients; the failure of the patients to respond to the empiric administration of broad spectrum antibiotics, salicylates and steroids, and the presence of discrete scintiscan defects on liver-spleen scan with both 99Tc sulfur colloid and 67Ga citrate. Multiple splenic abscesses containing candidal organisms were confirmed in all three patients, and two of the three also had multiple small abscesses of the liver. The fourth patient, whose liver-spleen scintiscans were abnormal only in showing splenomegaly and whose febrile course responded to aspirin, did not have a candidal abscess of the spleen at the time of celiotomy which was undertaken for fever of unknown cause. The antemortem diagnosis and treatment of candidal splenic abscess in patients with leukemia is dependent upon a high index of suspicion and appropriate clinical correlation with diagnostic tests. Although the prophylactic oral administration of mycostatin to patients at high risk may prevent this once fatal complication, only prompt and aggressive treatment can cure it.

Topics: Abscess; Acute Disease; Adult; Amphotericin B; Antineoplastic Agents; Candidiasis; Female; Humans; Leukemia; Male; Middle Aged; Splenic Diseases

For ten years, a 25-year-old immune-competent man experienced a progressive disseminated infection with the saprophytic soil fungus, Curvularia lunata, following presumptive cutaneous inoculation while playing football. Deep, soft tissue abscesses, pulmonary suppuration, paravertebral abscess, and cerebral abscess all followed leg ulcers from neglected abrasions. The patient's delay in obtaining treatment was partially responsible for the paravertebral-mediastinal-pleural-cutaneous fistula that resulted. The importance of prompt and aggressive surgical drainage procedures is clear. Infection was arrested only by surgery. The fungus was inhibited by miconazole nitrate and amphotericin B but it developed resistance to flucytosine. Miconazole appeared to cause resolution of the cerebral abscess. Amphotericin B (1 mg/kg/day) clearly was beneficial but only after effective drainage procedures were done. The patient refused to continue amphotericin B after 5.4 g had been given in two treatments. He became bedridden one year later from back pain that was caused by recurrent disease.

Topics: Abscess; Adult; Amphotericin B; Athletic Injuries; Brain Abscess; Drainage; Football; Humans; Leg Ulcer; Male; Miconazole; Mitosporic Fungi; Mycoses

Cardiac toxic reactions and pulmonary consolidation in the left lower lobe developed in a patient who was receiving amphotericin B therapy for cryptococcal meningitis. Following surgical resection of the lobe, multiple subcutaneous cryptococcal abscesses appeared. Flucytosine administered intravenously failed to eradicate the lesions. Transfer factor therapy and multiple drainage procedures elimniated the skin abscesses. Transfer factor therapy was administered for one year; the patient was asymptomatic 16 months after therapy was discontinued.

Topics: Abscess; Aged; Amphotericin B; Cryptococcosis; Flucytosine; Heart; Humans; Lung Abscess; Male; Remission, Spontaneous; Skin Diseases, Infectious; Transfer Factor

Reports in the literature of patients surviving mucormycosis involving the craniofacial structures are exceedingly rare. The necessity for early diagnosis by recognition of any of the six key signs and symptoms is emphasized. The futility of standard diagnostic tools, other than biopsy, is noted. An underlying debilitating condition such as diabetic ketoacidosis can predispose the patient to an acute infection by this usually nonpathogenic organism. The requirement for prompt treatment of the debilitating condition together with treatment to eradicate the fungus is stressed.

Topics: Abscess; Adult; Amphotericin B; Cavernous Sinus; Cranial Nerves; Dental Caries; Diabetes Complications; Diabetic Coma; Diabetic Neuropathies; Diagnosis, Differential; Face; Humans; Insulin; Lung Diseases; Male; Mucormycosis; Ophthalmoplegia; Pneumonia; Sinus Thrombosis, Intracranial; Skull; Tooth Diseases; Urinary Tract Infections

A 48-year old, retired mounted policeman was followed for 4 years through 4 hospitalizations for progression of his bilateral, cavitary lung disease. His sputum was always negative for acid-fast bacilli and fungi. Subsequently, a painful perianal swelling appeared that was incised and drained of purulent material. Five years after first seen, sputum and rectal drainage revealed Sporothrichum schenckii in many cultures. Serologic evidence of sporotrichosis was also present. With amphotericin B therapy, the patient showed marked clinical improvement. Unfortunately, he died from an episode of acute respiratory failure. Although most patients with primary cutaneous or primary pulmonary sporotrichosis are horticulturists, the writers believe that this disease should be considered in any undiagnosed, chronic, cavitary lung disease, even in the absence of this occupational history.

Topics: Abscess; Amphotericin B; Environmental Exposure; Humans; Lung Diseases, Fungal; Male; Middle Aged; Occupational Diseases; Radiography; Rectal Diseases; Sporotrichosis; Sputum

Topics: Abscess; Administration, Topical; Adult; Amphotericin B; Anti-Bacterial Agents; Anti-Inflammatory Agents; Atropine; Cornea; Ethylmercury Compounds; Eye Diseases; Eye Injuries; Glucocorticoids; Humans; Male; Mitosporic Fungi; Mycoses; Ointments; Ophthalmic Solutions; Phenylephrine

Topics: Abscess; Amphotericin B; Black or African American; Blastomyces; Blastomycosis; Drainage; Exophthalmos; Eye Diseases; Humans; Louisiana; Lung Diseases, Fungal; Male; Middle Aged; North America; Orbit

Topics: Abscess; Adult; Amphotericin B; Coccidioidomycosis; Dermatomycoses; Humans; Lung Diseases, Fungal; Male; Thoracic Diseases

Topics: Abscess; Amphotericin B; Animals; Candida albicans; Candidiasis; Disease Models, Animal; Eye Diseases; Injections; Rabbits; Time Factors; Vitreous Body

Topics: Abscess; Amphotericin B; Child; Coccidioides; Coccidioidomycosis; Complement Fixation Tests; Environmental Exposure; Humans; Male; Skin Diseases, Infectious; Time Factors

Topics: Abscess; Adrenal Cortex Hormones; Adult; Amphotericin B; Aspergillosis; Aspergillus; Chloramphenicol; Cornea; Corneal Transplantation; Dexamethasone; Eye Diseases; Eye Injuries; Humans; Male; Natamycin; Nystatin; Ophthalmic Solutions; Oxacillin; Sulfacetamide; Transplantation, Homologous

Topics: Abscess; Adolescent; Adult; Amphotericin B; Candida; Candidiasis; Diabetes Mellitus, Type 1; Female; Humans; Kidney Diseases; Male; Middle Aged; Perinephritis; Urine; Urography

Topics: Abscess; Adolescent; Amphotericin B; Blastomyces; Blastomycosis; Bone Diseases; Foot Diseases; Humans; Leprosy; Lung Diseases; Male; Mozambique; Prostatic Diseases; Skin Diseases; Sputum

Topics: Abscess; Amphotericin B; Brain Abscess; Candidiasis; Carrier State; Child; Chloramphenicol; Colistin; Deoxyribonucleases; DNA; Empyema; Enteritis; Humans; Kanamycin; Meningitis; Methicillin; Penicillins; Peritonitis; Phlebitis; Pneumonia; Pneumothorax; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Sulfadiazine; Troleandomycin

Topics: Abscess; Amphotericin B; Chronic Disease; Histoplasmosis; Humans; Lung Abscess; Pulmonary Surgical Procedures; Respiratory Tract Infections