amphotericin-b and Anemia

Visceral leishmaniasis (also known as kala-azar) is characterized by fever, weight loss, swelling of the spleen and liver, and pancytopenia. If it is not treated, the fatality rate in developing countries can be as high as 100% within 2 years. In a high risk situation for perioperative bleeding due to severe thrombocytopenia/coagulopathy, we present a rare challenge for urgent splenectomy in a patient with previously undiagnosed visceral leishmaniasis. A histologic examination of the spleen revealed a visceral leishmaniasis, and the patient was successfully treated with amphotericin B.

Topics: Amphotericin B; Anemia; Fever; Humans; Leishmaniasis, Visceral; Splenectomy

Amphotericin B (AmB) is a crucial agent in the management of serious systemic fungal infections. In spite of its proven track record, its well-known side effects and toxicity will sometimes require discontinuation of therapy despite a life-threatening systemic fungal infection. The mechanism of action of AmB is based on the binding of the AmB molecule to the fungal cell membrane ergosterol, producing an aggregate that creates a transmembrane channel, allowing the cytoplasmic contents to leak out, leading to cell death. Most of the efforts at improving AmB have been focused on the preparation of AmB with a lipid conjugate. AmB administration is limited by infusion-related toxicity, an effect postulated to result from proinflammatory cytokine production. The principal acute toxicity of AmB deoxycholate includes nausea, vomiting, rigors, fever, hypertension or hypotension, and hypoxia. Its principal chronic adverse effect is nephrotoxicity. AmB probably produces renal injury by a variety of mechanisms. Risk factors for AmB nephrotoxicity include male gender, higher average daily dose of AmB (> or = 35 mg/day), diuretic use, body weight > or = 90 kg, concomitant use of nephrotoxic drugs, and abnormal baseline renal function. Clinical manifestations of AmB nephrotoxicity include renal insufficiency, hypokalemia, hypomagnesemia, metabolic academia, and polyuria due to nephrogenic diabetes insipidus. Human studies show convincingly that sodium loading in excess of the usual dietary intake notably reduces the incidence and severity of AmB-induced nephrotoxicity.

Topics: Amphotericin B; Anemia; Animals; Arrhythmias, Cardiac; Calcium Channel Blockers; Cytokines; Fever; Gastrointestinal Diseases; Humans; Hyperkalemia; Kidney Diseases; Liposomes; Mycoses; Rats; Sodium Chloride

The authors report on a 14-year-old adolescent boy suffering of Hodgkin disease in remission, who developed autoimmune anemia and thrombopenia. He was treated with high-dose steroids and he developed serious invasive lung aspergillosis, which was treated with antifungal agents and surgical intervention. Children suffering from cancer are prone to develop systemic fungal infections secondary to the severe immunosuppression caused by the disease itself and the antineoplastic therapy. Intravenous antifungal medications and, when feasible, surgery are used for treatment of pulmonary aspergillosis. Factors related to better outcome are early diagnosis, remission of underlying disease, aggressive antifungal therapy, and recovery from neutropenia.

Topics: Adolescent; Amphotericin B; Anemia; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis, Allergic Bronchopulmonary; Bleomycin; Etoposide; Hodgkin Disease; Humans; Lung; Male; Prednisone; Purpura, Thrombocytopenic, Idiopathic; Radiography; Vinblastine

The use of pacemakers and implantable cardioverter-defibrillators continues to increase for the management of cardiac dysrhythmias and, more recently, heart failure. Long-term complications associated with their use include infection, lead failure, and spurious shocks. Although the risk of infection with intracardiac devices is well known, the clinical presentation of this complication can be insidious, delayed in onset, and difficult to diagnose. We report a case of Aspergillus fumigatus infection of an implantable cardioverter-defibrillator with right-sided endocarditis in a 55-year-old man. The infection presented as persistent pulmonary infiltrates (due to recurrent septic pulmonary embolism) and anemia more than 2 years after implantation of the device. Clinicians should be aware of the variable manifestations resulting from infection of intracardiac devices.

Topics: Amphotericin B; Anemia; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Biopsy; Blood Sedimentation; Chronic Disease; Coronary Artery Bypass; Defibrillators, Implantable; Echocardiography, Transesophageal; Endocarditis; Humans; Male; Middle Aged; Prosthesis Failure; Prosthesis-Related Infections; Pulmonary Embolism; Recurrence; Tomography, X-Ray Computed

Since 1955, when amphotericin B was introduced into clinical therapy, a lore has grown up surrounding its use that often lacks evidential basis. Matters such as rate of intravenous injection, periodicity of administration, dosage, and the monitoring of therapy should not be shrouded in a mystique that is passed on from one generation of house officers to another. Factual rationalization of the use of amphotericin B should be pursued and is attempted in this article.

Topics: Amphotericin B; Anemia; Heart; Humans; Kidney; Molecular Structure; Mycoses; Nervous System

Topics: Administration, Oral; Adolescent; Aged; Amphotericin B; Anemia; Anterior Chamber; Blastomycosis; Bronchi; Child; Cryptococcosis; Drug Resistance, Microbial; Fungi; Histoplasmosis; Humans; Injections; Injections, Intravenous; Injections, Spinal; Kidney Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Mycoses; Thrombophlebitis; Water-Electrolyte Balance

Amphotericin B deoxycholate (AmBd) is the recommended induction treatment for HIV-associated cryptococcal meningitis (CM). Its use is hampered by toxicities that include electrolyte abnormalities, nephrotoxicity, and anemia. Protocols to minimize toxicity are applied inconsistently. In a clinical trial cohort of AmBd-based CM induction treatment, a standardized protocol of preemptive hydration and electrolyte supplementation was applied. Changes in blood counts, electrolyte levels, and creatinine levels over 14 days were analyzed in relation to the AmBd dose, treatment duration (short course of 5 to 7 days or standard course of 14 days), addition of flucytosine (5FC), and outcome. In the 368 patients studied, the hemoglobin levels dropped by a mean of 1.5 g/dl (95% confidence interval [CI], 1.0 to 1.9 g/dl) following 7 days of AmBd and by a mean of 2.3 g/dl (95% CI, 1.1 to 3.6 g/dl) after 14 days. Serum creatinine levels increased by 37 μmol/liter (95% CI, 30 to 45 μmol/liter) by day 7 and by 49 μmol/liter (95% CI, 35 to 64μmol/liter) by day 14 of AmBd treatment. Overall, 33% of patients developed grade III/IV anemia, 5.6% developed grade III hypokalemia, 9.5% had creatinine levels that exceeded 220 μmol, and 6% discontinued AmBd prematurely. The addition of 5FC was associated with a slight increase in anemia but not neutropenia. Laboratory abnormalities stabilized or reversed during the second week in patients on short-course induction. Grade III/IV anemia (adjusted odds ratio [aOR], 2.2; 95% CI, 1.1 to 4.3; P = 0.028) and nephrotoxicity (aOR, 4.5; 95% CI, 1.8 to 11; P = 0.001) were risk factors for 10-week mortality. In summary, routine intravenous saline hydration and preemptive electrolyte replacement during AmBd-based induction regimens for HIV-associated CM minimized the incidence of hypokalemia and nephrotoxicity. Anemia remained a concerning adverse effect. The addition of flucytosine was not associated with increased neutropenia. Shorter AmBd courses were less toxic, with rapid reversibility.

Topics: Adult; Amphotericin B; Anemia; Antifungal Agents; Blood Cell Count; Coinfection; Creatinine; Cryptococcus neoformans; Deoxycholic Acid; Drug Combinations; Female; Flucytosine; Hemoglobins; HIV; HIV Infections; Humans; Hypokalemia; Induction Chemotherapy; Kidney; Male; Meningitis, Cryptococcal; Neutropenia; Survival Analysis; Treatment Outcome

The standard therapy for human immunodeficiency virus (HIV)-associated cryptococcal meningitis of amphotericin B (AmB; 0.7 mg/kg per day) plus flucytosine frequently takes >2 weeks to sterilize the cerebral spinal fluid, and acute mortality remains high. A dosage range for AmB of 0.7-1 mg/kg per day is noted in current guidelines, but there are no data comparing 0.7 mg/kg per day with 1 mg/kg per day.. Sixty-four HIV-seropositive, antiretroviral therapy-naive patients in Cape Town, South Africa, who experienced their first episode of cryptococcal meningitis during the period May 2005-June 2006 were randomized to receive either (1) AmB, 0.7 mg/kg per day, plus flucytosine, 25 mg/kg 4 times per day (group 1; 30 patients); or (2) AmB, 1 mg/kg per day, plus flucytosine, 25 mg/kg 4 times per day (group 2; 34 patients). Regimens were given for 2 weeks, followed by treatment with oral fluconazole. The primary outcome measure was early fungicidal activity, as determined by results of serial, quantitative cerebral spinal fluid cryptococcal cultures. Secondary outcome measures were safety and mortality. The median duration of follow-up was 1 year.. Early fungicidal activity was significantly greater for group 2 than for group 1 (mean +/- SD, -0.56 +/- 0.24 vs. -0.45 +/- 0.16 log cfu/mL of cerebral spinal fluid per day; P = .02). The incidence of renal impairment did not significantly differ between the 2 groups. Anemia was associated with female sex and, less strongly, with membership in group 2. Renal impairment and anemia reversed after the regimen was switched to fluconazole. Two- and 10-week mortality rates were 6% and 24%, respectively, with no difference between groups.. AmB, 1 mg/kg per day, plus flucytosine is more rapidly fungicidal than is standard-dose AmB plus flucytosine. Because of its size, this study provides limited data on any difference in toxicity between the regimens, but toxicities were manageable and reversible.. ISRCTN68133435 (http://www.controlled-trials.com).

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Anemia; Antifungal Agents; Cerebrospinal Fluid; Creatinine; Cryptococcus neoformans; Female; Flucytosine; Follow-Up Studies; Hemoglobins; Humans; Male; Meningitis, Cryptococcal; Renal Insufficiency; Sex Factors; South Africa; Treatment Outcome

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Anemia; Erythropoietin; Histoplasmosis; Humans; Recombinant Proteins; Zidovudine

This study's objective was to investigate the predictors for severe anemia, severe leukopenia, and severe thrombocytopenia when amphotericin B deoxycholate-based induction therapy is used in HIV-infected patients with talaromycosis.. A total of 170 HIV-infected patients with talaromycosis were enrolled from January 1st, 2019, to September 30th, 2020.. The preceding findings reveal risk factors for severe anemia, severe leukopenia, and severe thrombocytopenia. After treatment with Amphotericin B, these severe adverse events are likely unrelated to fungal clearance at 2 weeks. Starting amphotericin B deoxycholate at a dose of 10 mg on the first day may increase the risk of severe anemia but can lead to earlier fungal clearance.. ChiCTR1900021195. Registered 1 February 2019.

Topics: Amphotericin B; Anemia; Antifungal Agents; HIV Infections; Humans; Induction Chemotherapy; Leukopenia; Prospective Studies; Thrombocytopenia

Anaemia represents a common toxicity with amphotericin B-based induction therapy in HIV-infected persons with cryptococcal meningitis. We sought to examine the impact of amphotericin-related anaemia on survival.. We used data from Ugandan and South African trial participants to characterize the variation of haemoglobin concentrations from diagnosis to 12 weeks post-diagnosis. Anaemia severity was classified based on the haemoglobin concentration at cryptococcal meningitis diagnosis, and nadir haemoglobin values during amphotericin induction. Cox proportional hazard models were used to estimate 2- and 10-week mortality risk. We also estimated 10-week mortality risk among participants with nadir haemoglobin < 8.5 g/dL during amphotericin induction and who survived ≥ 2 weeks post-enrolment.. The median haemoglobin concentration at meningitis diagnosis was 11.5 g/dL [interquartile range (IQR) 9.7-13 g/dL; n = 311] with a mean decline of 4.2 g/dL [95% confidence interval (CI) -4.6 to -3.8; P < 0.001; n = 148] from diagnosis to nadir value among participants with baseline haemoglobin ≥ 8.5 g/dL. The median haemoglobin concentration was 8.1 g/dL (IQR 6.5-9.5 g/dL) at 2 weeks, increasing to 9.4 g/dL (IQR 8.2-10.9 g/dL) by 4 weeks and continuing to increase to 12 weeks. Among participants with haemoglobin < 8.5 g/dL at diagnosis, mortality risk was elevated at 2 weeks [hazard ratio (HR) 2.7; 95% CI 1.5-4.9; P < 0.01] and 10 weeks (HR 1.8; 95% CI 1.1-2.2; P = 0.03), relative to those with haemoglobin ≥ 8.5 g/dL. New-onset anaemia occurring with amphotericin therapy did not have a statistically significant association with 10-week mortality (HR 2.0; 95% CI 0.5-9.1; P = 0.4).. Amphotericin induced significant haemoglobin declines, which were mostly transient and did not impact 10-week mortality. Individuals with moderate to life-threatening anaemia at baseline had a higher mortality risk at 2 and 10 weeks post-enrolment.

Topics: Adolescent; Adult; Amphotericin B; Anemia; Antifungal Agents; Female; Hemoglobins; Humans; Male; Meningitis, Cryptococcal; Middle Aged; South Africa; Survival Analysis; Treatment Outcome; Uganda; Young Adult

Non-alcoholic fatty liver disease (NAFLD), defined as excessive fat accumulation in hepatocytes when no other pathologic causes are present, is an increasingly common obesity-related disorder. We sought to describe the prevalence of elevated liver enzymes, a marker of liver damage, among New Zealand adults, and high-risk subgroups including those with an elevated body mass index and those with pre-diabetes or diabetes, to gain a better understanding of the burden of liver disease.. A total of 4,721 New Zealanders aged 15+ years participated in a nationally representative nutrition survey. Liver enzymes, alanine transaminase (ALT) and gamma glutamyl transpeptidase (GGT) were measured in serum. Results were available for 3,035 participants, of whom 10.8% were Māori and 4.5% Pacific.. Obesity-related liver disease is likely to increasingly burden the New Zealand health sector and contribute to health disparities unless effective obesity treatment and prevention measures are given high priority. © 2015 The Authors. Obesity Science & Practice published by John Wiley & Sons Ltd, World Obesity and The Obesity Society.. LVADs are an important therapeutic alternative to heart transplantation in the context of a developing heart transplant programme with outcomes that are comparable to those reported by other centres.. 3D graphene-nanowall-decorated carbon felts (CF) are synthesized via an in situ microwave plasma enhanced chemical vapor deposition method and used as positive electrode for vanadium redox flow battery (VRFB). The carbon fibers in CF are successfully wrapped by vertically grown graphene nanowalls, which not only increase the electrode specific area, but also expose a high density of sharp graphene edges with good catalytic activities to the vanadium ions. As a result, the VRFB with this novel electrode shows three times higher reaction rate toward VO

Topics: Acetylglucosaminidase; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Anemia; Animals; Antifungal Agents; Area Under Curve; Biomarkers; Blotting, Western; Body Mass Index; C-Reactive Protein; Cardiovascular Diseases; Carotenoids; Cell Line; Chemistry, Pharmaceutical; Child; Child Health Services; Child, Preschool; Clinical Decision-Making; Colitis, Ulcerative; Colonoscopy; Conjugation, Genetic; Crohn Disease; Cross-Sectional Studies; Cytokines; Diet Records; Drug Administration Schedule; Drug Carriers; Drug Resistance, Bacterial; Epithelial Cells; Escherichia coli; Feces; Female; Gene Transfer, Horizontal; Genetic Loci; Hemoglobins; Host-Pathogen Interactions; Humans; Interspersed Repetitive Sequences; Kidney; Leukocyte L1 Antigen Complex; Magnetic Resonance Imaging; Male; Micelles; Microscopy, Confocal; Middle Aged; Models, Biological; Nutrition Surveys; Pediatric Obesity; Physical Fitness; Polyesters; Polyethylene Glycols; Rats; Rats, Sprague-Dawley; Recombination, Genetic; Sedentary Behavior; Sequence Analysis, DNA; Serum Albumin; Signal Transduction; Streptococcus; Surveys and Questionnaires; Tissue Distribution; Tomography, X-Ray Computed; United States; Young Adult

Visceral leishmaniasis or kala-azar is an endemic parasitic disease in some parts of the world which is characterized by fever, splenomegaly, and pancytopenia in most of the cases. Herein we report an 11 month-old male infant with diagnosis of kala-azar who presented with pallor, hepatosplenomegaly, failure to gain weight, and no history of fever. Surprisingly, fever started after beginning of meglumine antimoniate treatment in this patient. As far as we are aware of, this is a rare presentation of visceral leishmaniasis. Therefore, clinicians especially in endemic areas are highly recommended to include kala-azar among differential diagnosis of unexplained anemia without fever to prevent misdiagnosis of this potentially fatal, but treatable condition.

Topics: Amphotericin B; Anemia; Antiprotozoal Agents; Deoxycholic Acid; Diagnosis, Differential; Drug Combinations; Endemic Diseases; Fever; Humans; Infant; Iran; Leishmania infantum; Leishmaniasis, Visceral; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Splenomegaly

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

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

Older patients referred for further investigation of anaemia are common in a geriatric medicine clinic and it is important to consider a wide range of underlying diagnoses. We present an unusual case of anaemia in an octogenarian in whom a diagnosis of visceral leishmaniasis was made. This is a rare and unusual diagnosis in this cohort of patients, especially within the UK; however, it is important to identify it, given its high mortality if left untreated. Our case, presumably contracted while in Andalucia, Spain, highlights the need for awareness in this group of patients, especially when travel within Europe is becoming commonplace.

Topics: Aged, 80 and over; Amphotericin B; Anemia; Antiprotozoal Agents; Female; Humans; Leishmaniasis, Visceral; Treatment Outcome

Liposomal amphotericin B (L-AmB), which was developed to reduce side effects, has been shown to have a better safety profile than both the deoxycholate and lipid complex forms of amphotericin B; however, the frequency of major side effects is still unclear. Thus, the aim of the present study was to assess retrospectively the frequency of L-AmB-induced anaemia, thrombocytopenia, nephrotoxicity, hepatotoxicity and hypokalaemia as well as the relationship between daily dose of L-AmB and these side effects. A low red blood cell (RBC) count (post-/pre-treatment) and anaemia were observed in 7 and 10 of 21 adult patients, respectively. Thrombocytopenia was observed in 11 of 19 adult patients. Doses of L-AmB that are estimated to cause side effects of a low RBC count, anaemia and thrombocytopenia with 50% probability are 4.0, 3.3 and 3.0mg/kg/day, respectively. Nephrotoxicity was observed in 6 of 22 patients. Variations of total bilirubin, γ-glutamyl transpeptidase, aspartate aminotransferase and alanine aminotransferase used as indices of hepatotoxicity were observed in 6, 7, 8 and 8 of 22 patients, respectively. Hypokalaemia was observed in 4 of 9 patients; however, nephrotoxicity, hepatotoxicity and hypokalaemia were not caused in a dose-dependent manner. In conclusion, the present analyses showed that L-AmB dose-dependently induced anaemia and thrombocytopenia in adult patients. It is important to pay attention to causing anaemia and thrombocytopenia when patients are receiving L-AmB at doses of >3.3mg/kg/day and >3.0mg/kg/day, respectively.

Topics: Aged; Amphotericin B; Anemia; Antifungal Agents; Chemical and Drug Induced Liver Injury; Female; Humans; Hypokalemia; Kidney Diseases; Male; Middle Aged; Thrombocytopenia

Leishmaniases are parasitic diseases due to a flagellate protozoan of the genus Leishmania. They are transmitted from mammal to mammal by the bite of an arthropod vector: a female sandfly. Among the different clinical presentations, the zoonotic visceral leishmaniasis (ZVL) is due to Leishmania infantum. Dogs are the reservoir and can develop a deadly disease. ZVL is described in China, Pakistan, Latin America and in the Mediterranean region, particularly in the South of France. In recent years, many asymptomatic carriers have been described. Despite the fact that cases in immunocompromised adults are the majority, the classic Mediterranean ZVL in young children is still observed. The classic triad of symptoms is: fever, pallor, splenomegaly and hepatomegaly in half of the cases. The biological orientation is a low blood count (anemia, leuconeutropenia, and thrombocytopenia) and an inflammatory syndrome. Serological tests are useful, but the diagnosis is made by the identification of the parasite in a bone marrow sample. Today, the treatment is done by the liposomal amphotericin B (AmBisome) and the total dose must to be 20 mg/kg.

Topics: Amphotericin B; Anemia; Animals; Anti-Bacterial Agents; Child; Dogs; Female; Fever; Hepatomegaly; Humans; Leishmania infantum; Leishmaniasis; Leishmaniasis, Visceral; Leukopenia; Neutropenia; Splenomegaly; Thrombocytopenia; Zoonoses

The purpose of this study was to evaluate in a retrospective analysis, cases of Mediterranean visceral leishmaniasis (VL) diagnosed in adults during a 20-year period in a department of infectious diseases. Demographic data, clinical and laboratory features and therapeutic findings were considered. During the study period, 22 cases of VL were diagnosed, and 6 (27%) were associated with HIV infection. Fever and splenomegaly were observed in all cases. Anaemia was constant. The anti-leishmanial IF titer was positive among 21 patients (95%). Smears from bone marrow aspiration were positive at microscopy in 95% of cases. Zymodeme analysis was carried out in nine isolates. L. infantum zymodeme MON-1 was characterized in all cases. Seventeen patients (77%) received meglumine antimoniate (MA) (20 mg SbV/kg per day) and 5 (23%) patients amphotericin B (AB) (0.5-1 mg/kg per day) for an average period of 25 days (10-49 days). Adverse events occurred in 7 patients (32%), among them 4 received AB. Clinical cure was achieved with success in 21 patients (95%). After a successful MA treatment of the initial episode, VL relapse was observed in one HIV-positive patient. Only one HIV-positive patient died from neurological disorders. VL is rare in adults. However, its incidence is increasing everywhere in the world, because of HIV-related cases. Its prognosis depends on the precocity of diagnosis and treatment.

Topics: Adult; Amphotericin B; Anemia; Animals; Antimony; Antiprotozoal Agents; Fever; HIV Infections; Humans; Leishmania infantum; Leishmaniasis, Visceral; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Recurrence; Retrospective Studies; Splenomegaly; Treatment Outcome; Tunisia

Amphotericin B (AmB) is widely used for treating severe systemic fungal infections. However, long-term AmB treatment is invariably associated with adverse effects such as anemia. The erythropoietin (EPO) suppression by AmB has been proposed to contribute to the development of anemia. However, the mechanism whereby EPO is suppressed remains obscure. In this study, we investigated the possibility that AmB inhibits the transcription of the EPO gene by inactivating HIF-1, which is a known key transcription factor and regulator of EPO expression. EPO mRNA levels were markedly attenuated by AmB treatment both in rat kidneys and in Hep3B cells. AmB inactivated the transcriptional activity of HIF-1alpha, but did not affect the expression or localization of HIF-1 subunits. Moreover, AmB was found to specifically repress the C-terminal transactivation domain (CAD) of HIF-1alpha, and this repression by AmB required Asn803, a target site of the factor-inhibiting HIF-1 (FIH); moreover, this repressive effect was reversed by FIH inhibitors. Furthermore, AmB stimulated CAD-FIH interaction and inhibited the p300 recruitment by CAD. We propose that this mechanism underlies the unexplained anemia associated with AmB therapy.

Topics: Amphotericin B; Anemia; Animals; Antifungal Agents; Cell Line; Down-Regulation; E1A-Associated p300 Protein; Erythropoietin; Humans; Hypoxia; Hypoxia-Inducible Factor 1, alpha Subunit; Kidney; Male; Mycoses; Protein Structure, Tertiary; Rats; Rats, Sprague-Dawley; Repressor Proteins; Transcription, Genetic

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Anemia; Animals; Blood Cell Count; Bone Marrow Examination; Canada; Diagnosis, Differential; Fever; Guyana; HIV Infections; Humans; Leishmania; Leishmaniasis, Visceral; Male; Middle Aged; Physical Examination; Splenomegaly; Thrombocytopenia; Trypanocidal Agents

A 73-y-old female with a history of adenocarcinoma of colon and refractory anemia developed febrile neutropenia following chemotherapy. Therapy with iv infusion of amphotericin B deoxycholate (AmBd) was initiated on day 8 of hospital admission. Premedications included acetaminophen, diphenhydramine and meperidine. Patient developed rigor, chill and elevated temperature approximately 100 min into the infusion. The infusion was temporarily discontinued and rigors subsided following administration of 25 mg meperidine im. Infusion was continued after cessation of the rigors with no further sequelae. During each infusion of AmBd over the next 3 d, the patient developed rigor, chill and elevated temperature which was managed with meperidine. However, on day 4 she developed respiratory distress, bronchospasm and visible cyanosis with oxygen saturation of 88% while on 2 L oxygen. The infusion was stopped and the symptoms subsided with administration of albuterol via nebulizer. Amphotericin lipid formulation infusion was reinstituted after 3 d because of the patient's worsening clinical status. However, the patient developed severe respiratory distress approximately 130 min into the infusion. The infusion was discontinued and she was treated with albuterol via nebulizer. Itraconazole therapy was instituted without any adverse sequelae. Clinicians should be aware of this potential adverse event since it can occur with all formulation of amphotericin.

Topics: Adenocarcinoma; Aged; Amphotericin B; Anemia; Antifungal Agents; Colonic Neoplasms; Drug Combinations; Female; Fever; Humans; Infusions, Intravenous; Leukemia, Myeloid, Acute; Neutropenia; Phosphatidylcholines; Phosphatidylglycerols; Respiratory Distress Syndrome

Leishmaniasis in a patient with Wegenerís disease raises the problem of amphotericin toxicity further compromising the pre-existing renal disorder.. An anemic patient treated for Wegenerís disease developed visceral leishmaniasis. This renal failure patient was treated with lipid complex amphotericin B and liposomal amphotericin B. We report outcome at 10 months follow-up.. The new formulations of amphotericin B allow effective treatment of visceral leishmaniasis in renal failure patients. Long-lasting results are probably favored by the interruption of immuno-suppressive therapy.

Topics: Acute Kidney Injury; Aged; Amphotericin B; Anemia; Anti-Bacterial Agents; Female; Follow-Up Studies; Granulomatosis with Polyangiitis; Humans; Leishmaniasis, Visceral; Liposomes; Male; Treatment Outcome

Amphotericin B causes a normochromic, normocytic anemia thought to be mediated by direct marrow toxicity or suppression of erythropoietin production. Serial hemoglobin, hematocrit, amphotericin B, and erythropoietin levels were determined before, during, and after completion of amphotericin B therapy for three patients without significant renal disease or active hematologic malignancy. Patients with systemic fungal diseases treated with itraconazole served as controls. Serum erythropoietin levels were determined by radioimmunoassay and amphotericin B by high-performance liquid chromatography. Despite anemia in all amphotericin B-treated patients, erythropoietin levels declined or remained relatively constant during therapy while erythropoietin levels in controls were appropriate for the degree of anemia. Within 2 weeks of completion of amphotericin B treatment, two patients had increasing erythropoietin levels in response to anemia. Amphotericin B appears to suppress but not abolish the erythropoietin response to anemia; this effect disappears quickly after discontinuation of the drug.

Topics: Amphotericin B; Anemia; Chromatography, High Pressure Liquid; Creatinine; Erythropoietin; Hematocrit; Hemoglobins; Humans; Radioimmunoassay

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 pattern of amphotericin B toxicity was assessed retrospectively in a group of 20 children with cancer who had received one or more courses of the drug for treatment of systemic fungal infection. Azotemia was the most frequent complication, developing during 23 of 24 treatment courses. Other major toxic effects, in decreasing order of frequency, were anemia, hypokalemia, thrombocytopenia, and neutropenia. Infusion side effects, including drug-related fever, chills, and nausea, were also frequently seen. Seventeen of 20 patients were treated for disseminated histoplasmosis. Nineteen of 20 patients had acute leukemia. Although interaction with other agents could not be excluded, amphotericin B appeared to be the major causative agent for the toxic reactions noted. In no patient, however, was administration of amphotericin B stopped because of drug toxicity.

Topics: Adolescent; Amphotericin B; Anemia; Child; Child, Preschool; Female; Heart; Humans; Hypokalemia; Infant; Kidney; Liver; Male; Mycoses; Neoplasms; Neutropenia; Thrombocytopenia

Amphotericin B was given to six patients with systemic fungal infections. A dose averaging 1.78 g, administered from 42 to 144 days, was associated with a fall in hematocrit to a mean value of 25.8%. Despite this degree of anemia, no elevation of erythropoietin concentrations in urine or serum could be detected. Thus, amphotericin appears to cause anemia by inhibiting erythropoietin production rather than by suppressing bone marrow activity directly.

Topics: Adult; Aged; Amphotericin B; Anemia; Erythropoietin; Humans; Male; Middle Aged

Topics: Amphotericin B; Anemia; Blood Transfusion; Blood Urea Nitrogen; Candida albicans; Candidiasis; Female; Humans; Infant; Iron; Leg Ulcer; Leukocyte Count; Meningitis; Uremia

Topics: Adolescent; Adult; Aged; Amphotericin B; Anemia; Child; Endocarditis; Female; Histoplasma; Histoplasmosis; Humans; Infant; Larynx; Liver; Male; Meningitis; Middle Aged; Mouth; Prospective Studies; Thrombocytopenia; Urine

Topics: Adult; Amphotericin B; Anemia; Cell Membrane Permeability; Culture Media; Erythrocytes; Humans; Hydrogen-Ion Concentration; Male; Mycoses; Osmotic Fragility; Ouabain; Plasma; Potassium; Sodium Chloride; Stimulation, Chemical; Temperature

Topics: Adult; Amphotericin B; Anemia; Female; Folic Acid Deficiency; Histoplasmosis; Humans; Mononuclear Phagocyte System; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Complications, Infectious; Radiography; Sternum

Topics: Adolescent; Aged; Amphotericin B; Anemia; Blastomycosis; Chemical Phenomena; Chemistry; Humans; Hypokalemia; Kidney Diseases; Male; Microbial Sensitivity Tests

Topics: Amidines; Amphotericin B; Anemia; Animals; Antimony; Blood Protein Electrophoresis; Child, Preschool; Chloroquine; Complement Fixation Tests; Diagnosis, Differential; Dogs; Haplorhini; Hepatomegaly; Humans; Leishmaniasis, Mucocutaneous; Leishmaniasis, Visceral; Leukopenia; Liver Function Tests; Metronidazole; Rodentia; Skin Tests; Splenomegaly

Topics: Adult; Age Factors; Aged; Amphotericin B; Anemia; Blood Urea Nitrogen; Creatinine; Female; Follow-Up Studies; Hematocrit; Humans; Hypokalemia; Kidney; Male; Middle Aged

Topics: Adolescent; Adult; Aged; Amphotericin B; Anemia; Animals; Cote d'Ivoire; Cricetinae; Dyspnea; Electrocardiography; Female; Hepatomegaly; Histoplasma; Histoplasmosis; Humans; Male; Splenomegaly; Tachycardia; Time Factors

Topics: Amphotericin B; Anemia; Blood Urea Nitrogen; Coccidioidomycosis; Drug Therapy; Fungi; Hypokalemia; Lung Diseases, Fungal; Toxicology; Urea

Topics: Amphotericin B; Anemia; Anemia, Aplastic; Bone Marrow Examination; Diagnosis, Differential; Histoplasmosis; Humans; Leukemia; Pancytopenia; Prednisolone

Topics: Adenoidectomy; Amphotericin B; Anemia; Anti-Bacterial Agents; Ear, Inner; Hemorrhage; Hydrocarbons; Meningitis; Mycoses; Nystatin; Otitis Media; Otolaryngology; Pediatrics; Pharynx; Streptomycin; Tonsillectomy; Toxicology; Vitamins

Topics: Amphotericin B; Anemia; Anemia, Aplastic; Blood; Blood Transfusion; Erythrocytes; Hematocrit; Hemolysis; Humans; Iron; Nitrogen; Toxicology; Uremia

Topics: Amphotericin B; Anaphylaxis; Anemia; Anuria; Blushing; Feeding and Eating Disorders; Fever; Headache; Heart Failure; Humans; Hypokalemia; Kidney Diseases; Liver Diseases; Meningitis; Nausea; Pain; Paralysis; Paresthesia; Phlebitis; Seizures; Thrombocytopenia; Toxicology; Ventricular Fibrillation; Vertigo; Vomiting

Topics: Amphotericin B; Anemia; Blood Urea Nitrogen; Bone Marrow Examination; Drug Therapy; Hematocrit; Humans; Toxicology; Uremia; Urologic Diseases

Studies of 47 patients with intravenous amphotericin B revealed some impairment of renal function in all cases. Azotemia developed in 46 cases. Microscopic examination in eight cases showed damage to the distal renal tubule. Profound hypokalemia was recognized in two cases; and symptoms suggesting hypokalemia, which were generally ameliorated by potassium administration, were noted in most cases. It is postulated that the initial potassium loss is due to a "tubular leak" and that subsequent potassium depletion leads to further tubular damage. Mild to severe anemia developed in all cases during therapy. Serial red cell indices, bone marrow examinations and red cell survival studies indicated that hemolysis, rather than bone marrow depression, was responsible.The decision to treat, to modify therapy or to terminate treatment must be made on the basis of severity of disease, probability of progression, and renal status.

Topics: Amphotericin B; Anemia; Anemia, Hemolytic; Humans; Hypokalemia; Kidney; Kidney Tubules; Kidney Tubules, Distal; Male