amphotericin-b and Bezoars

Candida infection is a relatively common hematogenous nosocomial infection in immunocompromised patients. However, renal disease remains unusual. The mode of presentation in the case reported herein was lumbar pain with fever and hydronephrosis of the left kidney due to a fungal bezoar in the renal pelvis. Clinical and biological suspicion of this disease must quickly lead to ultrasound examination to confirm the diagnosis.

Topics: Amphotericin B; Antifungal Agents; Bezoars; Candidiasis; Child; Diabetes Mellitus, Type 1; Diagnosis, Differential; Female; Flank Pain; Humans; Kidney Pelvis; Opportunistic Infections; Ultrasonography

The incidence of genitourinary fungal infections is increasing, and because of their lethal potential, early diagnosis and treatment is mandatory. Candida is the most common urinary fungus and is manifest as renal involvement from systemic candidiasis, primary renal candidiasis, bezoar formation, cystitis, and as asymptomatic candiduria. The clinical status of the patient, serial urine cultures, excretory urogram, and serum candidal titers help to differentiate between the various disease states. Treatment is specific and is based on the clinical manifestation of the disease. Systemic candidiasis is treated with intravenous amphotericin. Fungal bezoars are best treated with oral flucytosine, ureteral and renal irrigation with amphotericin and, occasionally, operation. Cystitis is treated with oral flucytosine or amphoteric bladder irrigations. Asymptomatic candiduria is left untreated. A systematized evaluation and treatment regimen is presented.

Topics: Amphotericin B; Bezoars; Candidiasis; Flucytosine; Humans; Kidney Diseases; Urologic Diseases

Topics: Amphotericin B; Antifungal Agents; Bezoars; Candida; Humans; Microbial Sensitivity Tests; Urinary Bladder

Primary renal aspergillosis, though a rare entity, is still seen in immune compromised individuals. Renal aspergillosis may lead to formation of focal abscesses, fungal bezoars and may cause ureteric obstruction. Treatment involves stabilization of patient and removal of fungal bezoars along with administration of anti-fungal agents. This report describes the case of localized primary renal aspergillosis with fungal bezoars formation in a 55 years old female, diabetic, hypertensive, who presented with upper urinary tract obstruction and was successfully managed by endoscopic removal of fungal bezoars and intravenous amphotericin followed by oral itraconazole.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Bezoars; Female; Humans; Itraconazole; Kidney; Kidney Diseases; Middle Aged; Treatment Outcome; Ultrasonography; Ureteral Obstruction; Ureteroscopy

In kidney transplant recipients, acute renal failure resulting from a ureteral obstruction by fungus balls is uncommon. We report a 60-year-old man diagnosed with ureteral obstruction caused by Candida albicans fungus balls early after transplant. Diagnosis was made by a T2-weighted magnetic resonance image, which demonstrated fungus balls as a low-intensity mass in the pelvis and microscopic examination findings in the urine. The patient was treated successfully with an antifungal agent and direct irrigation. It should be noted that fungus balls may cause ureteral obstruction of transplanted kidneys, possibly resulting in graft failure. Imaging of the kidneys and collecting system and aggressive debridement that adds to systemic therapy are necessary for early diagnosis and are central to a successful outcome.

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Bezoars; Candida albicans; Candidiasis; Fluconazole; Humans; Kidney Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Therapeutic Irrigation; Treatment Outcome; Ureteral Obstruction

A 67-year-old man developed dysuria and position-dependent obstructive voiding symptoms after undergoing holmium laser ablation of the prostate (HOLAP) for benign prostatic hypertrophy. A large fungal (candidal) ball adherent to the bladder wall was removed by loop excision, but the bezoar recurred in 2 weeks despite systemic fluconazole and intravesical amphotericin B. A second attempt at endoscopic removal with ultrasonic lithotripsy, endoscopic graspers, and fulguration was also unsuccessful. The patient underwent open partial cystectomy to remove his invasive fungal bezoar. Convalescence was unremarkable. Urinalysis, culture, and follow-up cystoscopy after partial cystectomy demonstrated successful definitive treatment of the fungal ball.

Topics: Aged; Amphotericin B; Antifungal Agents; Bezoars; Candidiasis; Combined Modality Therapy; Cystectomy; Cystoscopy; Dysuria; Electrocoagulation; Fluconazole; Humans; Laser Therapy; Lasers, Solid-State; Lithotripsy; Male; Postoperative Complications; Prostatic Hyperplasia; Recurrence; Urinary Bladder; Urinary Tract Infections

Fungal urinary tract infections are commonly encountered in the hospitalized neonate. Although these infections most commonly take the form of cystitis, the infection may be complicated by the formation of fungal bezoars, with subsequent urinary tract obstruction. In certain cases, endosurgical debulking or extraction of the fungal bezoar may be necessary. This is particularly challenging in neonates due to their often-compromised physiologic state and small size. We report a case of a premature infant with bilateral obstructing renal fungal bezoars in whom a percutaneous catheter-based thrombectomy system was used successfully to debulk the fungal burden.

Topics: Amphotericin B; Antifungal Agents; Bezoars; Candida albicans; Candidiasis; Catheterization; Humans; Hydronephrosis; Infant, Newborn; Infant, Premature; Kidney; Nephrostomy, Percutaneous; Thrombectomy; Ultrasonography; Urinary Tract Infections

A voluminous trichobezoar was discovered in an 11-year-old girl without major clinical implications. The diagnosis was made by endoscopy and surgery was performed without complications.

Topics: Amphotericin B; Anemia, Hypochromic; Anti-Bacterial Agents; Bezoars; Child; Diagnosis, Differential; Female; Gastroscopy; Humans; Hypoalbuminemia; Madagascar; Stomach; Weight Loss

To describe the renewed interest in Candida infections in general and urinary tract infections in particular, due to a recrudescence of immunodepressed patients and a better knowledge of their clinical and radiological manifestations.. The authors report 2 cases of Candida bezoars diagnosed by IVU, ultrasonography and CT scan in two insulin-dependent diabetics.. The first case presented with right renal involvement, in the form of delayed renal secretion on IVU with the presence of a pelvic filling defect, dilatation of the upper tract cavities on ultrasonography with a dilated renal pelvis occupied by an echogenic formation with no posterior acoustic shadow. CT showed a slightly heterogeneous low-density lesion with no contrast enhancement. The second case presented with right pelvic and vesical involvement. The diagnosis of urinary candidiasis was confirmed, in the first case, by the presence of whitish lumps on catheterization, for which analysis and culture were in favour of candidiasis and, in the second case, by direct examination and urine culture. Treatment with amphotericin B led to improvement followed by disappearance of the signs in both cases.. In addition to laboratory examinations, noninvasive imaging techniques, mainly ultrasonography and CT, but also percutaneous aspiration, constitute a decisive element in the diagnostic and therapeutic management of urinary candidiasis.

Topics: Adult; Amphotericin B; Antifungal Agents; Bezoars; Candidiasis; Female; Humans; Tomography, X-Ray Computed; Ultrasonography; Urinary Tract Infections; Urography

We report two cases of urinary obstruction by fungal bezoars in full-term neonates who presented a uropathy detected antenatally. Early percutaneous urinary diversion was performed to relieve renal impairment secondary to a primary megaureter in the first case and to bilateral pelvi-ureteral obstruction in the second. Acute fungal obstruction occurred first on the side of the primary megaureter and then on the healthy side in the first patient. Symptoms of infection and impaired renal function led to a diagnosis of fungal bezoar. In the second patient the development of the bezoar was more insidious and occurred after surgical correction of the obstructive pelvi-ureteral junction on the left side. Candiduria was the first sign in both cases. Ultrasonography is the best method to visualize fungal masses within the collecting system. In most cases, percutaneous nephrostomy allows relief of the obstruction, sampling of urine for culture and irrigation with amphotericin B. However, additional surgical intervention may be necessary. Systemic antifungal treatment using mainly 5-flucytosine is also given.

Topics: Amphotericin B; Bezoars; Candidiasis; Humans; Infant, Newborn; Male; Nephrostomy, Percutaneous; Postoperative Complications; Ureteral Obstruction

The authors report a case of acute renal failure caused by fungal bezoar in the renal pelvis. The patient was successfully treated with bilateral percutaneous nephrostomy drainage. He had been admitted because of necrotizing enterocolitis, at the age of 26 days. Eventually, his bowel was reduced to 40 cm of small intestine, including 5 cm of terminal ileum. Candida sepsis developed during central total parenteral nutrition, at the age of 76 days. Five weeks after the diagnosis of systemic candidiasis, sudden anuria developed, and ultrasonography showed echogenic material in both renal pelvises. Bilateral percutaneous nephrostomy catheters were placed in the renal pelvises, and local irrigation with amphotericin B was performed for 3 weeks. The renal function of the baby was completely recovered, without systemic antifungal treatment.

Topics: Acute Kidney Injury; Amphotericin B; Antifungal Agents; Bezoars; Candidiasis; Catheterization, Central Venous; Fungemia; Humans; Hydronephrosis; Infant, Newborn; Kidney Pelvis; Male; Parenteral Nutrition, Total; Ultrasonography

We report a case of anuria in a premature neonate secondary to bilateral ureteropelvic junction obstructions related to Candida bezoars. Percutaneous decompression and drainage of both kidneys contributed significantly to the successful management of renal candidiasis in this patient. A review of the literature is presented.

Topics: Amphotericin B; Anuria; Bezoars; Candidiasis; Drainage; Flucytosine; Humans; Infant, Newborn; Infant, Premature, Diseases; Kidney Diseases; Male; Nephrostomy, Percutaneous

A 4 month-old premature infant having received prolonged intensive care for necrotizing enterocolitis and Pseudomonas infection, developed anuria with intrapyelic fungus ball developed in a congenital single kidney. Review of the literature found 19 similar cases and emphasized the difficulty of an early diagnosis and the usefulness of renal ultrasonography for its detection. Moreover the opportunity to treat premature neonates carrying candida albicans with IV amphotericin B and flucytosine before the occurrence of an uneasy treatable urological obstacle in discussed.

Topics: Amphotericin B; Anuria; Bezoars; Candidiasis; Flucytosine; Humans; Infant; Kidney; Kidney Pelvis

Systemic candidiasis with renal involvement is a well recognised complication of intensive care in premature newborns. However, the development of reversible obstructive oliguric acute renal failure has not been well documented. We report a premature infant who developed anuria associated with bilateral candidal bezoar formation in the renal collecting system. The sonographic appearance of the renal fungus balls is described. Treatment by surgical removal of the bezoars, open placement of nephrostomy tubes and intravenous antifungal therapy resulted in apparent complete recovery.

Topics: Amphotericin B; Anuria; Bezoars; Candidiasis; Female; Flucytosine; Follow-Up Studies; Humans; Infant; Infant, Newborn; Infant, Premature, Diseases; Injections, Intravenous; Kidney Diseases; Radiography; Time Factors; Ureteral Diseases