amphotericin-b and Acidosis

We conducted a trial of oral acetazolamide for the treatment of cryptococcal meningitis in 22 Thai adults with headache and an opening cerebrospinal fluid pressure of >/=200 mm H(2)0. The trial was terminated prematurely because patients who received acetazolamide developed significantly lower venous bicarbonate levels and higher chloride levels and had more-frequent serious adverse events than did subjects who received placebo.

Topics: Acetazolamide; Acidosis; Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Diuretics; Double-Blind Method; Female; Headache; Humans; Hypokalemia; Intracranial Hypertension; Male; Meningitis, Cryptococcal; Middle Aged

Topics: Acetaminophen; Acidosis; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Antipyretics; Candida; Candidiasis; Child; Febrile Neutropenia; Humans; Leukemia, Myeloid, Acute; Male; Pyrrolidonecarboxylic Acid

Amphotericin B colloidal dispersion (ABCD) is a novel lipid formulation of amphotericin B designed to diminish toxic effects of the drug. In the following report, nine cases of suspected (n = 4) and proven (n = 5) deep Candida infection, treated sequentially with amphotericin B deoxycholate and ABCD, are presented. The treatment was successful in seven cases. During treatment with amphotericin B deoxycholate, a rise in serum creatinine was observed in seven patients, hypokalemia in five, and metabolic acidosis in four. After replacing amphotericin B deoxycholate with ABCD, laboratory parameters improved in four of the seven patients with increased creatinine, in four of the five patients with hypokalemia, and in two of the four patients with metabolic acidosis. Infusion-related rigors were observed in four patients receiving amphotericin B deoxycholate and in one patient treated with ABCD. Reversible elevation of liver enzymes was found in one patient receiving ABCD. In this study ABCD proved less toxic than amphotericin B deoxycholate. The efficacy of ABCD alone cannot be assessed because of previous treatment with amphotericin B deoxycholate, but sequential treatment of deep Candida infections with amphotericin B deoxycholate and ABCD seems to be an effective therapeutic modality, especially in patients requiring prolonged administration of amphotericin B.

Topics: Acidosis; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candidiasis; Creatinine; Deoxycholic Acid; Drug Combinations; Drug Therapy, Combination; Female; Humans; Hypokalemia; Male; Middle Aged; Treatment Outcome

A 51-year-old, ketoacidotic diabetic with the rare neurological complications of rhinocerebral mucormycosis is reported. The clinical presentation was characterized by initial severe frontal headache, rapid visual loss with complete external ophthalmoplegia and intracranial spread by invasive fungal growth. Its course and fungostatic therapy with amphotericin B and ketoconazole are described and the literature reviewed.

Topics: Acidosis; Amphotericin B; Diabetes Complications; Diabetes Mellitus; Humans; Ketoconazole; Ketone Bodies; Male; Middle Aged; Mucormycosis; Paranasal Sinus Diseases; Tomography, X-Ray Computed

Rhinocerebral mucormycosis is, with few exceptions, only reported in patients with severe metabolic or immunologic imbalances. Factors which may predispose to the development of mucormycosis are reviewed. These factors include ketoacidosis and immunologic deficiency states due either to the primary disease or to the treatment for other diseases. An appreciation for these predisposing factors is very important in order that aggressive diagnosis and therapy be undertaken without delay.

Topics: Acidosis; Adrenal Cortex Hormones; Aged; Amphotericin B; Anemia; Brain Diseases; Diabetes Complications; Humans; Immunologic Deficiency Syndromes; Keto Acids; Leukemia; Male; Mucormycosis; Neutropenia; Nose Diseases; Turbinates; Uremia

The case of a 15 year old white man, diabetic in cetoacidosis, with a orbit-rhino-cerebral phycomycosis is reported. The illness had an acute onset and the treatment was iniciated early with Amphotericin-B and unilateral osteotomy of maxillary and ethmoidal sinus. With this treatment the patient did well with residuals of ophtalmoplegia and amaurosis on the right. Interesting investigation aspects are the occluded internal carotid on the same side of the affected orbit and the CAT-SCAN finding of moderated ventricular dilatation (two months after hospital admission). Mycology, pathophysiology, histopathology, clinical aspects, diagnosis and therapy are discussed, comparing the findings of this case with avaliable literature. An increased number of survivors can be expected with earlier recognition and more aggressive therapy. Treatment of the underlying debilitating disease, Amphotericin-B and surgical debridement of necrotic tissue, are frequently necessary such as observed in the case reported. The favorable results obtained with the proposed managment are stressed.

Topics: Acidosis; Adolescent; Amphotericin B; Brain Diseases; Diabetes Complications; Ethmoid Sinus; Humans; Male; Mucormycosis; Orbit; Respiratory Tract Diseases

Topics: Acidosis; Adolescent; Amphotericin B; Brain Diseases; Female; Humans; Kidney Calculi; Mucormycosis; Nose Diseases

13 cases of deep candidiasis (two or more positive blood cultures or histological evidence) are reported. The patients were hospitalized because of respiratory problems (pneumonia, neuromuscular respiratory failure, bronchial carcinoma, brochiectasis, chronic bronchitis and acute laryngitis). Frequency, clinical signs and symptoms and therapy are discussed. The importance of early diagnosis is stressed.

Topics: Acidosis; Adult; Aged; Amphotericin B; Candidiasis; Drug Synergism; Drug Therapy, Combination; Female; Flucytosine; Humans; Lung Diseases, Fungal; Male; Mannitol; Middle Aged; Respiratory Insufficiency

Mucormycosis is a fulminant fungal infection occurring in debilitated patients with an underlying pathologic condition. The rhinocerebral form of the disease, which comprises nearly one half of recently reported cases, is most often found in uncontrolled diabetics or profoundly dehydrated children. Infection usually begins in the nose and progresses through the paranasal sinuses, invading the orbit and CNS secondarily. Despite the known pathogenesis of this disease, the ophthalmologist is often first to consider the diagnosis, due to inadequate intranasal examination by the primary physician. The delay caused by late occurrence of orbital manifestations has resulted in poor survival rates, despite vigorous therapy. In recent years, increased physician awareness has led to earlier diagnosis of rhinocerebral mucormycosis. This report presents 13 cases with which we have delt since 1963. The long-term survival rate is 85%. Aggressive surgical therapy, with repeated debridement, in combination with intravenous amphotericin B, have led to this high rate of cure.

Topics: Acidosis; Adult; Aged; Amphotericin B; Brain Diseases; Diabetes Complications; Female; Humans; Infant; Male; Middle Aged; Mucormycosis; Nose Diseases

Renal transplant recipients are susceptible to a number of fungal infections amenable to therapy with amphotericin B, but azotaemia is an almost invariable sequel to the use of this agent. As intravenous mannitol has been shown to minimize nephrotoxicity induced by amphotericin B in dogs we treated four kidney transplant recipients who had systemic fungal infections with mannitol and amphotericin B. None showed significant reduction in renal function though a mild metabolic acidosis did develop.

Topics: Acidosis; Adult; Amphotericin B; Candidiasis; Cryptococcosis; Histoplasmosis; Humans; Injections, Intravenous; Kidney Diseases; Kidney Function Tests; Kidney Transplantation; Male; Mannitol; Middle Aged; Postoperative Complications; Transplantation, Homologous; Uremia