amphotericin-b and Autoimmune-Diseases

Leishmaniasis is a neglected disease that is prevalent in tropical and subtropical regions of the world. Even though cutaneous leishmaniasis is the most common form, visceral leishmaniasis is associated with high mortality. The case presented herein is a 39 year-old bed-ridden female who presented with fever of unknown origin, tachypnea and pancytopenia. She was initially misdiagnosed as having autoimmune pancytopenia elsewhere and treated with corticosteroids and intravenous immunoglobulin. She had also received wide-spectrum antibiotics for febrile neutropenia. We performed a leishmania rK39 dipstick test which turned out to be positive along with visualisation of amastigote forms of leishmania on bone marrow biopsy. Thus, we made a diagnosis of visceral leishmaniasis and treated her with liposomal amphotericin B. Her clinical course was complicated by respiratory failure necessitating invasive mechanical ventilation. She responded well to treatment and was later extubated, shortly before being discharged. At 6 months of follow-up, no sign of recurrence was observed.

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Autoimmune Diseases; Biopsy; Bone Marrow; Cerebral Palsy; Chromatography, Affinity; Diagnosis, Differential; Female; Fever of Unknown Origin; Humans; Leishmaniasis, Visceral; Pancytopenia; Recurrence; Respiration, Artificial; Respiratory Insufficiency; Tachypnea; Turkey

The isolation frequency and susceptibility to antifungal agents of oral Candida isolates from patients with oral candidiasis (OC) were compared between studies conducted in 2006-2007 and 2012-2013.. A total158 strains was isolated from 112 patients who visited Kagoshima University Hospital for the treatment of OC during the 14-month period from February 2012 and March 2013, and evaluated on the isolation frequency of each Candida strain and the susceptibility against antifungal drugs as compared to those evaluated in 2006-2007.. There was a higher frequency of xerostomia as a chief complaint and of autoimmune disease in the 2012-2013 study than in the 2006-2007 study. More than 95% of Candida isolates were C. albicans and C. glabrata. In addition, the proportion of the latter increased from 12.3% in the 2006-2007 study to 23.4% in the 2012-2013 study, while the proportion of the former decreased from 86.2% to 72.8%, respectively. C. albicans was isolated in almost all patients, while C. glabrata was only isolated concomitantly with C. albicans. Minimal inhibitory concentrations (MICs) were not significantly different between groups with a few exceptions. Candida isolates, of which MICs surpassed break points, apparently increased for miconazole and itraconazole against C. glabrata in the 2012-2013 study, but this was not statistically significant. As a result, more cases of autoimmune disease, a greater number of C. glabrata isolates, and higher resistance to azoles were seen in the 2012-2013 study than in the 2006-2007 study.. These data indicate that with recent increases in C. glabrata infection, a causative fungus of OC, and in C. glabrata resistance to azoles, caution is needed in the selection of antifungal drugs for the treatment of OC.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Autoimmune Diseases; Bacterial Load; Candida; Candida albicans; Candida glabrata; Candidiasis, Oral; Coinfection; Drug Resistance, Fungal; Echinocandins; Female; Fluconazole; Flucytosine; Humans; Itraconazole; Japan; Lipopeptides; Male; Micafungin; Miconazole; Microbial Sensitivity Tests; Middle Aged; Xerostomia

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Autoimmune Diseases; Azathioprine; Fatal Outcome; Female; Humans; Hydrocephalus; Immunocompromised Host; Immunosuppressive Agents; Leukopenia; Lung Diseases, Fungal; Neuroaspergillosis; Prednisone; Thrombocytopenia

A woman of 75 years old was admitted at our hospital for evaluation of worsening and weakness in inferior limbs. Several vertebral fractures by crushing, one doubtful discitis, an infiltrate with cavitation in the right superior lobe and one infiltrate in the left superior lobe were detected. In the biopsy of the consolidation a filamentous fungus was watched and in the bronchial washing specimen culture grew Aspergillus terreus. The infiltrates disappeared with liposomal Amphotericin B remaining with oral Itraconazol during three months more. The clinical and analytical data demonstrate the existence of a Overlap syndrome associate to antiphospholipid-antibody syndrome. We comment the peculiarity of the infection by Aspergillus terreus in patients who have not been in critical care and the good response at treatment with liposomal Amphotericin B. It contrasts with the high mortality referred in a recent review. Other aspects to comment are the coexistence with a collagen vascular and an antiphospholipid-antibody syndrome with the higher titles of IgM ACA that we have found in literature.

Topics: Aged; Amphotericin B; Antifungal Agents; Antiphospholipid Syndrome; Aspergillosis; Aspergillus; Autoimmune Diseases; Drug Therapy, Combination; Female; Gastritis, Atrophic; Helicobacter Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Itraconazole; Liposomes; Lung Diseases, Fungal; Opportunistic Infections; Prednisone; Purpura, Thrombocytopenic, Idiopathic

To report the case of a patient developing fungal keratitis in the context of uncontrolled ocular cicatricial pemphigoid (OCP), which, despite intravenous immunoglobulin (IVIg) and other immunomodulatory therapy, progressed to end-stage pemphigoid, with corneal opacification, ankyloblepharon, and xerosis. Keratoprosthesis (KPro) restored functional vision for the patient.. A 39-year-old man presented with uncontrolled CP and corneal ulcer in the left eye. Conjunctival biopsy diagnosed OCP; corneal scraping and biopsy diagnosed the cause of the corneal ulcer. OCP was treated with systemic steroids, immunosuppressive drugs, and IVIg. Visual rehabilitation was accomplished with Ahmed valve and a type II Dohlman KPro.. Immunohistology of the biopsied conjunctiva showed IgG at the epithelial basement membrane zone, confirming the clinical diagnosis of OCP. Microbiologic studies of the corneal biopsy specimen were negative for Acanthamoeba and herpes but positive for Aspergillus niger. The patient's keratomycosis resolved with topical antifungal therapy. Treatment with Dapsone, intravenous-pulse steroid, oral cyclophosphamide, and intravenous immunoglobulin (IVIg) failed to control the OCP, with resultant complete conjunctivization of the cornea. Keratoprosthesis improved the patient's visual acuity from hand movements to 20/20.. Patients with uncontrolled OCP are at increased risk of corneal infection. The difficulty in diagnosing keratomycosis and the relatively rare occurrence of OCP explain the uniqueness of our reported case. OCP may progress to "end-stage" disease despite therapy. Keratoprosthesis can restore vision in selected otherwise seemingly hopeless cases.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus niger; Autoimmune Diseases; Conjunctivitis; Cornea; Corneal Opacity; Corneal Ulcer; Eye Infections, Fungal; Glucocorticoids; Humans; Immunoglobulins, Intravenous; Immunosuppressive Agents; Male; Pemphigoid, Benign Mucous Membrane; Prostheses and Implants; Prosthesis Implantation

A 12 year old boy suffering from p67-phox deficient chronic granulomatous disease presented with a bullous skin disease and a lung infection with paecilomyces species. The histopathology of a bullous lesion showed subepidermal blister formation and microabcesses containing eosinophils in the dermal papillae. By direct immunofluorescence, linear staining of IgA at the dermal-epidermal junction was detected which confirmed the clinical diagnosis of chronic bullous disease of childhood (linear IgA dermatosis).

Topics: Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Autoimmune Diseases; Child; Drug Therapy, Combination; Granulomatous Disease, Chronic; Humans; Itraconazole; Lung Diseases, Fungal; Male; Paecilomyces; Phosphoproteins; Prednisolone; Skin Diseases, Vesiculobullous

We reviewed the clinical course in 43 patients from eight medical centers who were given the diagnosis of chronic mucocutaneous candidiasis, a rare disorder of unknown cause that may occur in childhood. Recurrent or severe infections with organisms other than Candida were seen in 80% of the patients. There were nine cases of septicemia. Seven patients have died; six of these deaths were directly related to non-Candida infectious complications. Endocrine dysfunction, including Addison disease (11 patients) and hypothyroidism (9 patients), was seen in 19 of 43 patients. Immunologic studies failed to reveal a consistent abnormality, although two of five patients with reversed T4/T8 ratios are among those who have died. Ketoconazole was effective in controlling symptoms of candidiasis in most patients. The findings from this study indicate that non-Candida infections cause serious morbidity and may result in death in patients with chronic mucocutaneous candidiasis.

Topics: Adolescent; Amphotericin B; Autoimmune Diseases; Candidiasis; Candidiasis, Chronic Mucocutaneous; Child; Child, Preschool; Endocrine System Diseases; Family; Female; Flucytosine; Humans; Immunoglobulin A; Immunoglobulin G; Incidence; Infant; Infections; Ketoconazole; Lung Diseases; Male; Survival Rate

Among 3,501 individuals receiving endoscopic examination for the upper digestive tract, 41 were found to have esophageal candidiasis including 17 malignancies, 14 immunological disorders, 4 diabetes mellitus, 7 other underlying diseases and 7 apparently healthy subjects. The diagnosis was made either by brushing of the esophagus or by histological examination of the biopsied specimen. Systemic invasion of fungi was observed mainly in patients with malignancy involving the hematopoietic system, and most of them had been treated by corticosteroids, antibiotics or anticancer agents. Although complications associated with esophageal candidiasis are rare, it is emphasized that those patients with malignancy as well as impared immunity should be carefully examined for esophageal candidiasis, in order to prevent the fungi from developing invasive candidiasis. It should be noted that a few cases of gastric ulcer treated by H2 blocker revealed esophageal candidiasis, suggesting that decrease of gastric acidity might be one of the factors involved in this pathological condition.

Topics: Amphotericin B; Autoimmune Diseases; Candidiasis; Esophageal Diseases; Esophagoscopy; Female; Humans; Immune Tolerance; Ketoconazole; Male; Middle Aged; Neoplasms; Prospective Studies

Topics: Amphotericin B; Antibody Formation; Antigens, Fungal; Autoimmune Diseases; Candidiasis, Cutaneous; Child; Diphtheria Toxoid; Female; Humans; Hypersensitivity, Delayed; Immunoglobulin A; Immunologic Deficiency Syndromes; Lymphocyte Activation; Lymphopenia; Macrophage Migration-Inhibitory Factors; Muscle, Smooth; Nitrobenzenes; Pertussis Vaccine; Skin Tests; Tetanus Antitoxin; Tetanus Toxoid; Thymidine; Typhoid-Paratyphoid Vaccines