amphotericin-b and Alternariosis

Orbital apex syndrome as a result of invasive fungal sinusitis is a disease entity most commonly found in immunocompromised patients. Infectious invasion affecting the orbital apex can have devastating visual and life-threatening consequences.

Topics: Aged; Alternaria; Alternariosis; Amphotericin B; Combined Modality Therapy; Debridement; Eye Infections, Fungal; Follow-Up Studies; Fungemia; Humans; Immunocompromised Host; Injections, Intralesional; Male; Orbital Diseases; Risk Assessment; Sinusitis; Syndrome; Tomography, X-Ray Computed; Treatment Outcome

Rhino-sinusal infections are serious diseases and possibly lethal. When they are invasive, we easily discuss apergilloses and mucormycoses. The confirmation of the diagnosis of mucormycosis need an extensive surgery for precise histopathological and mycological evaluation. The pathologist may be faced to other rare mycoses such as phaeohyphomycoses, which present different morphological features than mucormycoses and Aspergillus. Once the diagnosis is established, an appropriate antifungal treatment is quickly started. The aim of our work is to report two observations of phaeohyphomycoses, to describe their histopathological features, to discuss complementary diagnostic methods and to present the main differential diagnoses.

Topics: Adult; Alternaria; Alternariosis; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diagnosis, Differential; Early Diagnosis; Fatal Outcome; Female; Humans; Liposomes; Mastoiditis; Phaeohyphomycosis; Postoperative Complications; Retrospective Studies; Rhinitis; Shock, Septic; Sinusitis

A 28-year-old man presented at our clinic with 1-month history of an ulcer covered with crust on his left anterior tibia. Based on the morphological features and molecular identification, the patient was diagnosed as cutaneous alternariosis caused by Alternaria arborescens. He was successfully cured by oral itraconazole and topical use of 0.25% liposomal amphotericin B. A review of published studies revealed 29 cases of cutaneous alternariosis. Most cases (90%) occurred in immunosuppressed patients; itraconazole (59%) and voriconazole (24%) are the most effective treatments of choices.

Topics: Adolescent; Adult; Aged; Alternaria; Alternariosis; Amphotericin B; Antifungal Agents; Drug Therapy, Combination; Female; Humans; Itraconazole; Male; Middle Aged; Opportunistic Infections; Skin; Treatment Outcome

Topics: Alternaria; Alternariosis; Amphotericin B; Antifungal Agents; Ascomycota; Fatal Outcome; Humans; Immunocompromised Host; Invasive Fungal Infections; Kidney Transplantation; Knee; Lung Diseases, Fungal; Male; Middle Aged; Pneumonia; Risk Factors; Voriconazole

A 61-year-old woman with pulmonary alternariosis and aspergillosis was reported. The patient presented with recurrent hemoptysis and cough for 3 years. Alternaria was identified by fungal culture. Biopsy specimen showed pulmonary aspergillosis. The patient had been treated with voriconazole at 400 mg/d through intravenous guttae for 7 days, and then switched amphotericin B at 25 mg/d through intravenous guttae for 11 days. The patient was treated with voriconazole at 
400 mg through oral when she was discharged from hospital. After the treatment, the clinical symptoms of hemoptysis and cough were recovered, and the lung CT examinations showed normal.. 1例61岁女性肺部链格孢霉合并曲霉菌感染，反复咯血、咳嗽、咳痰3年。真菌培养鉴定为链格孢霉。组织病理活检结果提示肺曲霉病。患者接受伏立康唑400 mg/d静脉滴注治疗7 d后改为两性霉素B 25 mg/d静脉滴注治疗
11 d，患者出院时改为伏立康唑口服400 mg/d治疗。目前患者无咯血、咳嗽、咳痰症状，复查肺部CT结果显示正常。.

Topics: Alternariosis; Amphotericin B; Antifungal Agents; Aspergillosis; Female; Humans; Lung Diseases, Fungal; Middle Aged; Treatment Outcome; Voriconazole

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