amphotericin-b and Blindness

Effective antifungal therapy must be long-term, nondamaging, penetrating to the eye, and highly active against each patient's fungus. Results of antifungal sensitivity testing of 61 collected ocular fungal pathogens and observations in 25 cases treated with one of the nonpolyene antifungal drugs indicated that infection was rapidly controlled and eradicated with restoration of visual acuity, determined by the degree of disorganization present at the time of commencement of rational specific antifungal therapy. Pimaricin has the widest spectrum, a medium level of activity, and rather poor penetration but is recommended as an antifungal prophylactic and as first-line-therapy for ocular fungal disease while awaiting identification and sensitivity testing of the fungus. Flucytosine combined with amphotericin B, or possibly with clotrimazole or miconazole, is recommended for Candida infections. Clotrimazole is the drug of choice for Aspergillus species although miconazole and econazole are more effective with some isolates. Miconazole and econazole are recommended for miscellaneous filamentous fungi although clotrimazole or thiabendazole are superior in some cases. Each of these drugs may be useful in patients infected with Fusarium who do not respond to primaricin. In these cases, drug use should be guided by the results of antifungal sensitivity testing. In addition to medical antifungal therapy some eyes may require excisional keratoplasty with the lens removal and evacuation of the posterior chamber and anterior vitreous cavity.

Topics: Adrenal Cortex Hormones; Adult; Aged; Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus; Blindness; Candida; Candidiasis; Clotrimazole; Cornea; Eye Diseases; Female; Fusarium; Glaucoma; Humans; Imidazoles; Male; Middle Aged; Mycoses; Natamycin; Polyenes

Topics: Acute Disease; Aged; Amphotericin B; Antifungal Agents; Blindness; Debridement; Diabetes Mellitus, Type 1; Eye Infections, Fungal; Eye Pain; Fatal Outcome; Humans; Intraocular Pressure; Magnetic Resonance Imaging; Male; Mucormycosis; Orbital Diseases; Rhinitis; Slit Lamp Microscopy; Tomography, X-Ray Computed; Visual Acuity

We describe an elderly diabetic patient presenting with sudden onset right-sided proptosis and vision loss secondary to rhino-orbital mucormycosis and central retinal vascular occlusion. He underwent orbital exenteration that was complicated by intraoperative cerebrospinal fluid (CSF) leak from lateral orbital wall. The leak was surgically repaired and the patient recovered well. We postulate the cause of the CSF leak to be twofold: necrotic periorbital tissue due to mucormycosis rendering the thin bones susceptible to damage and second, intraoperative manipulation and dissection at the orbital apex with monopolar cautery and instruments. We describe measures taken to successfully repair the CSF leak and the possible precautions that can be taken to avoid it.

Topics: Administration, Intravenous; Amphotericin B; Antifungal Agents; Blepharoptosis; Blindness; Cerebrospinal Fluid Leak; Debridement; Diabetes Mellitus, Type 2; Endoscopy; Humans; Hyphae; Intraoperative Complications; Magnetic Resonance Angiography; Male; Middle Aged; Mucormycosis; Orbit; Orbit Evisceration; Orbital Diseases; Paranasal Sinuses; Retinal Artery Occlusion; Sinusitis; Treatment Outcome

Topics: Amphotericin B; Antifungal Agents; Blindness; Brain Diseases; Debridement; Exophthalmos; Eye Diseases; Fatal Outcome; Female; Humans; Magnetic Resonance Imaging; Maxillary Sinusitis; Middle Aged; Mucormycosis; Optic Neuritis

In this report, we describe the case of a young, diabetic girl with ketoacidosis who suffered sudden loss of vision of the right eye. The loss of vision was caused by an invasive rhino-orbital-cerebral fungal infection (mucormycosis) with extensive periorbital thrombosis. Despite maximal antifungal and surgical treatment (including exenteration of the right orbit), the clinical situation deteriorated. It was only after overcoming the difficulties of managing her hyperglycaemia that the patient's condition stabilised and her life was saved. Another factor contributing to this girls' survival was the swift diagnosis of mucormycosis, which was made soon after the onset of symptoms. Because of this, treatment could be started almost immediately.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Blindness; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Eye Infections, Fungal; Female; Humans; Medication Adherence; Mucormycosis; Nasal Surgical Procedures; Orbital Diseases; Paranasal Sinus Diseases; Tomography, X-Ray Computed; Treatment Outcome

Topics: Amphotericin B; Animals; Anti-Inflammatory Agents; Antifungal Agents; Blindness; Cat Diseases; Cats; Fluconazole; Male; Meningitis, Cryptococcal; Prednisolone

Acute vision loss in the post-partum period can occur due to many reasons. Eclampsia, posterior reversible encephalopathy syndrome (PRES), pituitary apoplexy, and central serous retinopathy are some of the important causes. Cryptococcal meningitis as a cause of acute vision loss in the post-partum period has not been mentioned in literature.. A 25-year-old female presented to us with acute bilateral complete vision loss in the post-partum period. Her serum was tested positive for HIV antibodies. Cerebrospinal fluid (CSF) examination revealed cryptococcal meningitis. She was started on amphotericin B, antiretroviral drugs, and steroids. Though symptoms of meningitis resolved after treatment no significant improvement in vision was observed at 3 months.. Cryptococcal meningitis may be considered as one of the causes of acute vision loss in pregnant/post-partum females with human immunodeficiency virus (HIV) positivity.

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Blindness; Female; HIV Antibodies; HIV Seropositivity; Humans; Meningitis, Cryptococcal; Postpartum Period; Pregnancy; Treatment Outcome

Candida albicans osteomyelitis is a rare disease that occurs in immunocompromised individuals, sometimes with a late diagnosis related to the mismatch between symptoms and candidemia. This case refers to a 36-year-old male patient with a history of oesophageal surgery for achalasia with multiple subsequent surgeries and hospitalisation in the intensive care unit for oesophageal fistula complication. Four months after discharge, the patient was admitted to the infectious diseases department with pain in the 10th-12th left ribs, swelling of the 4th-6th costal cartilage and decreased visual acuity. An MRI study showed thickening and diffuse enhancement, with no defined borders in the cartilage and ribs, compatible with infection. After performing a CT-guided bone biopsy, isolated C. albicans sensitive to antifungal agents was detected. The patient started therapy with liposomal amphotericin B and maintenance fluconazole for 6 months and showed clinical and radiological improvement within this time.

Topics: Adult; Amphotericin B; Antifungal Agents; Blindness; Candida albicans; Candidiasis; Chest Pain; Fluconazole; Humans; Male; Osteomyelitis; Ribs

We present a case report of young man with Type 1 diabetes who developed acute visual loss after initially presenting with diabetic ketoacidosis. The diagnosis of invasive paranasal sinusoidal aspergillosis was made following CT and biopsy. Although uncommon, visual loss is a recognised complication of disseminated aspergillosis and is more likely in immune-compromised patients and those with diabetes. Early investigation with appropriate sinus imaging and involvement of the Ear Nose and Throat team in recommended when patients with diabetes develop acute visual loss in the context of a non-specific infective illness.

Topics: Acute Disease; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Biopsy; Blindness; Caspofungin; Diabetes Mellitus, Type 1; Diagnosis, Differential; Echinocandins; Emergency Service, Hospital; Fatal Outcome; Humans; Lipopeptides; Magnetic Resonance Imaging; Male; Meropenem; Middle Aged; Paranasal Sinuses; Thienamycins; Tomography, X-Ray Computed; United Kingdom

Rhino-orbital zygomycosis is a life-threatening fungal infection generally occurring in patients with an underlying disorder, such as diabetes mellitus with ketoacidosis or with immunocompromising factors, although it may rarely appear in healthy individuals. The study has been undertaken to discuss the clinical presentation, pathogenesis, diagnostic work up and management of this rapidly progressive disease. Four male patients having uncontrolled diabetes and presenting with signs and symptoms of rhino-orbital zygomycosis were studied to illustrate the serious nature of the disease. All the four patients had rapidly deteriorating vision loss either unilateral or bilateral along with other nasal and orbital signs and symptoms. All the patients were put on liposomal amphotericin B and underwent orbital exenteration and pansinusectomy. One patient died, while the other three were successfully treated. Early diagnosis is critical in the prevention of morbidity and mortality associated with the disease. There is need for a high index of clinical suspicion in immunocompromised patients. Timely medical-surgical treatment proves extremely important for prognosis.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Blindness; Diabetes Complications; Eye Enucleation; Humans; Male; Middle Aged; Nose Diseases; Orbital Diseases; Zygomycosis

Cryptococcus neoformans meningoencephalitis is the most common fungal central nervous system infection, in people affected by the human immunodeficiency virus. It is rare in inmunocompetent children and it is often fatal. It predominates in males at a ratio of 3 to 1. We describe the cases of two school children, one male and one female, with history of contact with pigeons (Columba livea), whose clinical symptoms were fever, headache, photophobia, diplopia, ataxia and meningeal signs, with unilateral involvement of cranial nerve VI. The diagnosis was established by the isolation of Cryptococcus neoformans in culture, staining with India ink and evidence of latex antigen agglutination in the cerebrospinal fluid. The determination of antibodies to human immunodeficiency virus and quantification of CD4, CD8 and T lymphocyte cells, were normal. In the first case, a chest X-ray showed a round mass, circumscribed in the bottom half of the left lung. A brain MRI revealed an image compatible with a nodular cryptococcoma in the parietal region. A pattern of intracranial hypertension was established, with papilledema and bilateral amaurosis, that evolved unsatisfactorily, with the subsequent death of the patient. Both were treated with amphotericin B (1 mg/Kg/day) or fluconazole (6 mg/Kg/day). The second case had a favorable evolution. The Crypotococcus neoformans is not a common fungus in inmunocompetent children. Early detection of the disease and appropriate treatment is essential to achieve a better prognosis ot the disease.

Topics: Amphotericin B; Animals; Animals, Domestic; Antifungal Agents; Blindness; Cerebrospinal Fluid; Child; Columbidae; Cryptococcus neoformans; Fatal Outcome; Female; Fluconazole; Humans; Immunocompetence; Intracranial Hypertension; Lung Diseases, Fungal; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal; Venezuela

HIV infection is the main cause of cryptococcal neuromeningitis but other diseases may be associated with this infection.. We report a case of cryptococcal neuromeningitis in a patient with sarcoidosis and ventriculoatrial shunting. The patient was successfully treated by effective therapy without device withdrawal.. The relationship between cryptococcosis and sarcoïdosis has been already described and may be not fortuitous. However it remains a very rare complication of sarcoidosis. Because of its potential severity (mortality rate of 40%), the diagnosis of cryptococcosis should be evoked as a differential diagnosis of neuro-sarcoidosis.

Topics: Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Blindness; Cerebrospinal Fluid Shunts; Diagnosis, Differential; Drug Therapy, Combination; Eye Infections, Fungal; Fluconazole; Flucytosine; Fludrocortisone; Follow-Up Studies; HIV Seronegativity; Humans; Hydrocephalus; Hydrocortisone; Male; Meningitis, Cryptococcal; Middle Aged; Prednisolone; Sarcoidosis; Time Factors; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Blindness; Brain Diseases; Fatal Outcome; Humans; Male; Mucorales; Mucormycosis; Nose Diseases; Orbit Evisceration; Orbital Diseases; Phycomyces

Orbitocerebral aspergillosis has a very high fatality rate and cure is unusual. We describe the successful management of a child with cereberal aspergillosis who had a dramatic response to therapy with a combination of liposomal amphotericin and voriconazole with adjunctive cytokine therapy during immunosuppresive chemotherapy for acute lymphoblastic leukaemia.

Topics: Amphotericin B; Antifungal Agents; Blindness; Brain Diseases; Child, Preschool; Cytokines; Drug Therapy, Combination; Female; Humans; Neuroaspergillosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Remission Induction; Tomography, X-Ray Computed; Treatment Outcome; Triazoles; Voriconazole

A 59-year-old woman was referred to our clinic with sudden visual loss in her right eye after she was treated with 40 mg/day of oral prednisolone for 2 weeks under the diagnosis of idiopathic optic neuritis. At that time, computerized tomography (CT) of the brain showed no evidence of optic nerve or brain pathology. However, there was progressive diminution of right visual acuity associated with a limitation of adduction and abduction in the right eye. On magnetic resonance imaging and repeated CT, a malignant lesion was suggested, and was confirmed as an Aspergillus fungus colony by histopathologic examination. Postoperatively, she was treated with intravenous administration of amphotericin B for 13 weeks. However, her condition continued to deteriorate. She developed ptosis and total ophthalmoplegia in the right eye and blindness in both eyes. After discharge, she was given itraconazole for 20 weeks. She has shown no recovery of visual acuity or extraocular motion during a two-year follow-up period. The clinical features of our case suggest that early diagnosis in a case of aspergilloma presenting with visual loss is difficult and that a high index of suspicion, repeated radiological examination and adequate biopsy may be required for diagnosis.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Blindness; Diagnosis, Differential; Eye Infections, Fungal; Female; Humans; Itraconazole; Magnetic Resonance Imaging; Middle Aged; Optic Neuritis; Visual Acuity

The management of Candida albicans endophthalmitis in intravenous drug abusers (IVDAs) has yet to be established. Early vitrectomy was previously reported as a promising treatment for C. albicans endophthalmitis. In our series, C. albicans endophthalmitis was diagnosed for 15 IVDAs. Funduscopic examinations confirmed severe vitritis in 12 patients and chorioretinitis in three. Blood and vitreal cultures were positive for C. albicans for seven and eight patients, respectively. Patients with vitritis received antifungal therapy before and after vitrectomy. Amphotericin B or fluconazole therapy was given according to the physician's preference. Vitrectomy was defined as early if it was performed within 1 week after the diagnosis of vitritis. All seven patients who underwent early vitrectomy had a favorable response without complications. Two of three patients who underwent late vitrectomy developed blindness or scotoma. Blindness was also described in two patients with vitritis who did not undergo vitrectomy. Early vitrectomy preceded and followed by antifungal therapy seems to be appropriate management of vitritis in IVDAs.

Topics: Adult; Amphotericin B; Antifungal Agents; Blindness; Candidiasis; Combined Modality Therapy; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Heroin Dependence; Humans; Injections, Intravenous; Male; Visual Acuity; Vitrectomy

Cryptococcal meningitis is a common cause of chronic meningitis in Papua New Guinea, affecting apparently immunocompetent people. The majority of infections are believed to be due to Cryptococcus neoformans var. gattii. We have reviewed the records of 49 Melanesian adults who presented with proven cryptococcal meningitis to the University teaching hospital in Port Moresby, and compare our findings with other published studies of cryptococcal meningitis in the tropics and sub-tropics. None of the patients had an obvious cause of immunosuppression. Visual disturbances and fundoscopic changes of papilloedema or papillitis were particularly common. The in-hospital case fatality rate for patients treated with amphotericin B and flucytosine was 22.4%. Of the fully treated patients, 31% became completely blind before being discharged from hospital. Therapy directly aimed at reducing intracranial pressure may improve outcome.

Topics: Adolescent; Adult; Amphotericin B; Blindness; Child; Cryptococcus neoformans; Female; Flucytosine; Humans; Leukocyte Count; Male; Meningitis, Cryptococcal; Middle Aged; Papua New Guinea; Recurrence; Treatment Outcome

The clinical course of cryptococcal meningitis in AIDS shows some important differences from the features of the illness in non-AIDS patients. Complications such as raised intracranial pressure and visual impairment that are recognised in non-AIDS patients may be less frequent in those with AIDS. Persistent intracranial hypertension should be managed actively to prevent visual impairment. In AIDS patients, in whom ventriculo-peritoneal shunts carry additional risks, acetazolamide can be used successfully to lower the CSF pressure and prevent visual loss.. 2 AIDS patients are described who had cryptococcal meningitis accompanied by increased intracranial pressure (ICP) and visual complications, a finding thought to be relatively rare in AIDS. Of the 2-6% of AIDS patients who develop cryptococcal meningitis, many have disseminated and recurrent infections. The 1st case was a 45-year old Ugandan woman who presented with stiff neck, and right VIth cranial nerve palsy. She was treated with amphotericin B and flucytosine with some improvement, but on the 9th day she awoke with headache, drowsiness, and total blindness, although no papilledema. Her CSF pressure was 40 cm H20. She recovered after a month of intravenous chemotherapy and acetazolamide, but remained blind. Her sudden blindness was thought to be due to bilateral optic nerve infarction. The 2nd case was a 32-year old male homosexual, admitted with headache, vomiting, confusion, and drowsiness. He had stiff neck, and a CSF of 40 cm containing Cryptococcus neoformans. He was given amphotericin B, flucytosine, and has CSF drained every other day. On day 21 papilledema was seen in the right eye, and acetazolamide was started to lower CSF pressure. This patient recovered without loss of vision. 3 published series of cryptococcus meningitis in AIDS patients remarked about the low incidence of raised ICP, while 1 reported 9 of 27 with neurological and ophthalmic complications. The visual complications and increased ICP in these patients was thought to be due to inflammatory arachnoiditis or direct cryptococcal infiltration.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Blindness; Cranial Nerve Diseases; Cryptococcus neoformans; Female; Flucytosine; Humans; Intracranial Pressure; Male; Meningitis, Cryptococcal; Middle Aged; Papilledema; Uganda

We report a case of acute visual loss after a test dose (1 mg) of intravenous amphotericin B administered to a patient with systemic lupus erythematosus and with cryptococcal meningitis. Her visual acuity was normal prior to the injection of amphotericin B. The meningitis subsequently responded to miconazole and flucytosine treatment. Our findings suggest that amphotericin B should be withheld in the treatment of cryptococcal meningitis if disease of the optic nerve is strongly suspected.

Topics: Adult; Amphotericin B; Blindness; Cryptococcosis; Female; Humans; Lupus Erythematosus, Systemic; Meningitis

Topics: Aged; Amphotericin B; Blindness; Eye Diseases; Female; Humans; Inflammation; Intraocular Pressure; Male; Mycoses; Peptic Ulcer; Postoperative Complications; Sudan; Visual Acuity

Topics: Adult; Amphotericin B; Blepharoptosis; Blindness; Central Nervous System Diseases; Chronic Disease; Diabetes Complications; Follow-Up Studies; Fungi; Humans; Male; Mycoses; Ophthalmoplegia; Orbit

Topics: Agglutination Tests; Amphotericin B; Antigens; Blindness; Cataract; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus; Culture Media; Humans; Hypertonic Solutions; Male; Methods; Middle Aged; Retinal Detachment; Rubber; Sucrose; Triamcinolone; Uveitis

Topics: Amphotericin B; Blindness; Brain Diseases; Diabetic Ketoacidosis; Humans; Male; Middle Aged; Mucormycosis; Nose Diseases; Paranasal Sinuses; Turbinates

Topics: Adrenal Cortex Hormones; Amphotericin B; Biopsy; Blepharoptosis; Blindness; Brain Diseases; Child; Child, Preschool; Conjunctiva; Edema; Exophthalmos; Eye Diseases; Humans; Inflammation; Male; Mucormycosis; Paranasal Sinuses; Penicillins; Sinusitis

Topics: Adult; Amphotericin B; Blepharoptosis; Blindness; Contact Lenses; Diabetes Complications; Eye Diseases; Female; Humans; Middle Aged; Mucormycosis

Topics: Amphotericin B; Blindness; Cataract Extraction; Eye Diseases; Humans; Mycoses; Postoperative Complications