amphotericin-b and Agammaglobulinemia

Cryptococcal infection is the most common fungal infection of the central nervous system. More than 50% of the cases of cryptococcal infection are superimposed on an immunosuppressive or other general debilitating condition. Cerebral cryptococcosis usually presents as meningitis or meningoencephalitis, although cerebral granuloma has also been reported. Hydrocephalus is the most common neurosurgical complication of cerebral cryptococcosis. The majority of patients require only medical treatment with antifungal drugs. However, when complications ensue, surgical intervention is mandatory. We suggest that chronic meningitis be ruled out in all patients prior to the placement of shunts. In the two cases reported here treatment of cryptococcal meningitis was a combination of amphotericin B and flucytosine for six weeks. Fluconazole is a new alternative and at least as effective as amphotericin B.

Topics: Adolescent; Adult; Agammaglobulinemia; Amphotericin B; Brain Abscess; Brain Diseases; Cryptococcosis; Female; Flucytosine; HIV Seronegativity; Humans; Hydrocephalus; Magnetic Resonance Imaging; Male; Opportunistic Infections

Visceral leishmaniasis (VL) is becoming endemic in São Paulo state, in the southeastern region of Brazil. Unusual manifestations with non-specific signs and symptoms may make diagnosis difficult and delay treatment, increasing the risk of severity and death, particularly in new endemic areas. There are few studies on patients with these characteristics in Brazil. We describe a case series of unusual manifestations of VL in children and its spatial dispersion in the western region of São Paulo state.. From 2009 to 2014, five clinical cases involving children treated in the Regional Hospital of Presidente Prudente (RH) were selected. Two patients had multiple relapses requiring liposomal amphotericin B; one patient had VL-cytomegalovirus-dengue co-infection and liver injury; one patient was diagnosed with X-linked agammaglobulinemia, a primary immunodeficiency; and one patient was diagnosed with VL-human immunodeficiency virus/acquired immunodeficiency syndrome (VL-HIV/AIDS) co-infection. Primary or secondary immunodeficiencies were found in four children, and associated viral infections were found in three children. Three patients were referred from other hospitals to RH. With regard to the geographic spread of VL, more cases were found in the northern area, in the epicenter of the infection where the first cases were registered, flowing south; a spatial-temporal occurrence was found.. Primary and secondary immunodeficiencies and viral co-infectious should be considered among unusual manifestations of VL, especially in those with multiple relapses. Spatial-temporal occurrence was found. Thus, integrated actions and effective monitoring of the disease are needed to complement curative practices to stem the tide of the epidemic.

Topics: Acquired Immunodeficiency Syndrome; Agammaglobulinemia; Amphotericin B; Animals; Antiprotozoal Agents; Brazil; Child; Child, Preschool; Coinfection; Cytomegalovirus Infections; Dogs; Female; Genetic Diseases, X-Linked; Humans; Immunologic Deficiency Syndromes; Infant; Leishmaniasis, Visceral; Male

Dematiaceous fungi have melanin-like pigment in the cell wall and usually cause a variety of dermal infections in humans. Infections of the central nervous system(cerebral phaeohyphomycosis)are rare but serious, since they commonly occur in immunocompromized patients. A 76-year-old man was admitted with mild motor aphasia and underwent total excision of a mass in the left frontal lobe. With the postoperative diagnosis of brain abscess due to infection with dematiaceous fungi (C. bantiana) associated with hypogammaglobulinemia following gastrectomy, intravenous antifungal drugs including amphotericin B and fluconazole were administered. Regrowth of the abscess with intraventricular rupture was noted at about the 88th day after the initial surgery, and the patient underwent neuroendoscopic aspiration of the pus and placement of a ventricular drain. Following intraventricular administration of miconazole through ventricular drainage or an Ommaya reservoir, neuroradiological findings improved, but general and neurological conditions worsened. Further treatment was discontinued and the patient died 9 months after onset. The poor outcome in this patient is attributed to 1)intractability of dematiaceous fungi, 2)development of ventriculitis and the need for intraventricular administration of antifungal drugs, and 3)untreatable hypogammaglobulinemia following gastrectomy.

Topics: Agammaglobulinemia; Aged; Amphotericin B; Antifungal Agents; Ascomycota; Brain Abscess; Drug Combinations; Fluconazole; Gastrectomy; Humans; Male; Mycoses

We report two immunocompromised infants aged six and four months with invasive gastrointestinal aspergillosis. Both patients presented with weight loss and diarrhea. The underlying disorders were combined immunodeficiency and transient hypogammaglobulinemia of infancy. The diagnosis of gastrointestinal aspergillosis was established by gastrointestinal endoscopy and histopathological examination of the tissue specimens. Both children responded well to Amphotericin B.

Topics: Agammaglobulinemia; Amphotericin B; Aspergillosis; Gastrointestinal Diseases; Gastrointestinal Tract; Humans; Immunocompromised Host; Infant; Male; Risk Factors

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

Topics: Agammaglobulinemia; Amphotericin B; Child, Preschool; Cryptococcosis; Drug Therapy, Combination; Fluconazole; Flucytosine; Genetic Linkage; Humans; Immunoglobulin M; Male; X Chromosome

Histoplasma meningitis (HM) has been reported to occur primarily in association with disseminated histoplasmosis (DH). We report a case of histoplasma meningitis occurring in a patient with common variable hypogammaglobulinemia (CVH) in which no manifestations of DH were observed. L. L., a 66-year-old Caucasian male, clerical worker, developed occasional episodes of dizziness and tinnitus in mid-1971. During 1972, increasing frequency of these episodes and gradually progressive confusion were noted. In January 1973, vomiting, forther confusion, obnubilation, and a left central facial paresis developed and he was hospitalized. Physical examination revealed no pulmonary abnormalities, lymphadenopathy or hepatosplenomegaly. Over the ensuing 6-week evaluation, there was occasional fever to 38.5 degrees C. Chest roentgenogram was normal. Cerebral angiography suggested a mass in the left cerebellar hemisphere. EEG was diffusely slow. Multiple CSF examinations revealed: Glucose 7-18 mg/with a normal blood glucose, protein 109-256 mg/and cells 66-140 (95 + % mononuclear). Histoplasma capsulatum was cultured from CSF but not from sputum, urine, blood or bone marrow. Skin tests for PPD, histoplasmosis, coccidiodomycosis, blastomycosis, mumps, dinitrochlorobenzene and streptokinase-streptodornase were negative then and 6 months later. Histoplasma serum antibody was absent. Immunoglobulin analysis revealed IgG 430 mg %, IgA 46 mg %, and IgM 35 mg %, which with the history and skin test results suggested CVH. Treatment with 2.51 gm of amphotericin B given intravenously over a 3-month period resulted in complete reversal of all neurologic signs and clearing of the confusion. The remission has been maintained for two years. This case represents a primary infection of the CNS by histoplasma. The relationship between the HM and the CVH will be discussed.

Topics: Agammaglobulinemia; Aged; Amphotericin B; Cerebrospinal Fluid; Diagnosis, Differential; Histoplasma; Histoplasmosis; Humans; Immunoglobulin A; Immunoglobulin G; Immunoglobulin M; Lymphocytes; Male; Meningitis; Skin Tests

Topics: Adolescent; Adult; Agammaglobulinemia; Amphotericin B; Anuria; Azathioprine; Biopsy; Bis-Trimethylammonium Compounds; Busulfan; Child; Child, Preschool; Chlorambucil; Cyclophosphamide; Female; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Leukemia, Lymphoid; Lymphoma, Non-Hodgkin; Male; Methotrexate; Middle Aged; Mycosis Fungoides; Pneumonia, Pneumocystis; Prednisone; Transplantation, Homologous; Vincristine

Topics: Adrenal Glands; Agammaglobulinemia; Amphotericin B; Brain; Carcinoma; Carcinoma, Hepatocellular; Cryptococcosis; Cryptococcus; Diabetes Complications; Granuloma; Humans; Immunologic Deficiency Syndromes; Kidney Neoplasms; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged

Topics: Agammaglobulinemia; Amphotericin B; Biopsy; Blood Protein Electrophoresis; Drug Therapy; Histoplasmosis; Humans; Intestinal Diseases; Intestinal Mucosa; Intestine, Small; Pathology; Protein-Losing Enteropathies; Radiography; Serum Albumin; Serum Albumin, Radio-Iodinated; Serum Globulins; South Africa

Topics: Agammaglobulinemia; Amphotericin B; Anti-Bacterial Agents; Blood Protein Electrophoresis; Cycloheximide; Drug Therapy; Fusarium; Humans; Iodides; Keratitis; Mycoses; Toxicology

Topics: Agammaglobulinemia; Amphotericin B; Antifungal Agents; Candidiasis; Dermabrasion; Granuloma; Humans; Hypergammaglobulinemia; Plastics; Surgery, Plastic