amphotericin-b and Brain-Abscess

Invasive mucormycosis is a refractory fungal infection. Central nervous system (CNS) mucormycosis is a rare complication caused by infiltration from the paranasal sinuses or hematogenous dissemination. Here, we present a case of a brain abscess, due to mucormycosis, diagnosed using burr craniotomy. A 25-year-old Japanese woman with relapsed-refractory acute lymphoblastic leukemia underwent cord blood transplantation (CBT). The patient experienced prolonged and profound neutropenia, and oral voriconazole was administered as primary antifungal prophylaxis. The patient received a conditioning regimen on day -11 and complained of aphasia and right hemiparesis on day -6. Magnetic resonance imaging (MRI) revealed a T2-weighted high-intensity area in the left frontal cortex. A brain abscess was suspected, and liposomal amphotericin B (L-AMB) administration was started. The patient underwent CBT as scheduled and underwent neutrophil engraftment on day 14. Although the patient achieved complete remission on day 28, her consciousness level gradually deteriorated. MRI revealed an enlarged brain lesion with a midline shift sign, suggesting brain herniation. Craniotomy was performed to relieve intracranial pressure and drain the abscess on day 38, and a diagnosis of cerebral mucormycosis was confirmed. The L-AMB dose was increased to 10 mg/kg on day 43. Although the patient's consciousness level improved, she died of hemorrhagic cystitis and aspiration pneumonia. Cerebral mucormycosis should be suspected if neurological symptoms are observed in stem cell transplant recipients. Prompt commencement of antifungal therapy and debridement are crucial because mucormycosis has a poor prognosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Abscess; Central Nervous System; Female; Hematologic Neoplasms; Humans; Mucormycosis; Voriconazole

Cerebral abscesses caused by dark-pigmented Fonsecaea fungi are rare, especially in otherwise healthy individuals. In this case report, we present a 61-year-old man from Moldova, living in the Czech Republic, who had worked as a locksmith on oil platforms in Turkmenistan, Kazakhstan, Sudan, and Iraq since 1999, and was admitted to a neurology ward for a sudden motion disorder of the right leg, dysarthria, and hypomimia. Imaging revealed presence of expansive focus around the left lateral ventricle of the brain and a pronounced peripheral edema. The intracranial infectious focus was excised under intraoperative SonoWand guidance. Tissue samples were histologically positive for dark-pigmented hyphae, suggesting dematiaceous fungi. Therefore, liposomal amphotericin B therapy was initiated immediately. Fonsecaea monophora was provisionally identified using ITS rDNA region sequencing directly from brain tissue. The identification was subsequently confirmed by cultivation and DNA sequencing from culture. The strain exhibited in vitro sensitive to voriconazole (MIC = 0.016 μg/mL) and resistance to amphotericin B (MIC = 4 μg/mL); therefore, the amphotericin B was replaced with voriconazole. Postoperatively, a significant clinical improvement was observed and no additional surgery was required. Based on the literature review, this is the third documented case of cerebral infection due to this pathogen in patients without underlying conditions and the first such case in Europe.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Brain Abscess; Czech Republic; DNA, Ribosomal; Humans; Immunocompetence; Male; Middle Aged; Mycoses; Treatment Outcome

Severely immunocompromised patients such as those with haematological malignancies and haematopoietic stem cell transplant recipients are at an increased risk of acquiring invasive mould infections. Fusarium, a ubiquitous fungus, can cause potentially fatal infections in such hosts. It usually manifests as skin lesions, fevers and sino-pulmonary infections. Brain abscesses have been reported, but are relatively uncommon. We report a case of a 50-year-old patient with acute lymphocytic leukaemia and failed autologous peripheral stem cell transplant that presented with new onset seizures and was found to have Fusarium solani brain abscess. Nasal route was the presumed mode of entry of the fungus into the cerebrum. Treatment comprised surgical excision of the lesion, and antimycotic therapy with liposomal amphotericin B and voriconazole. Despite aggressive therapy, patient succumbed to the disease. We have provided an overview of infections secondary to Fusarium, along with a review of the central nervous system involvement by this pathogenic mould.

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Central Nervous System Fungal Infections; Fatal Outcome; Female; Fusariosis; Fusarium; Humans; Immunocompromised Host; Middle Aged; Peripheral Blood Stem Cell Transplantation; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Radiography; Seizures; Voriconazole

Cerebral aspergillosis is a rare and highly fatal infection that mainly affects immunocompromised patients. We report on a case of a heart transplanted Caucasian man, who arrived at our hospital because of the onset of diplopy. We performed a broad diagnostic work-up: the brain MRI showed a single ring-enhancing thalamo-mesencephalic area suggestive of abscess lesion; cerebrospinal fluid (CSF) analysis disclosed galactomannan and beta-D-glucan antigens. Thus the antifungal therapy was immediately started. We decided to discontinue the therapy 16 months later because of severe hepatic toxicity, given that the patient was persistently asymptomatic, brain imaging showed a progressive resolution of the abscess area and CSF antigen analysis was persistently negative. The follow-up at three months was unchanged.

Topics: Administration, Intravenous; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Brain Abscess; Drug Therapy, Combination; Heart Transplantation; Humans; Immunocompromised Host; Male; Mesencephalon; Thalamus; Time Factors; Treatment Outcome; Voriconazole

Mucormycosis is an invasive fungal infection associated with a high mortality. Cerebral mucor abscesses can result secondary to rhinocerebral or hematogenous spread. Amphotericin B, posaconazole, and aggressive surgical resection are the hallmarks of treatment. While amphotericin is typically administered intravenously, less is known about the use of intrathecal amphotericin B. We describe a 42-year-old man who developed a cerebellar mucor abscess after undergoing hematopoietic stem cell transplant for the treatment of myelodysplastic syndrome. In the post-operative period he was admitted to the neurocritical care unit and received liposomal amphotericin B intravenously and through an external ventricular drain. This patient demonstrates that utilization of an external ventricular drain for intrathecal antifungal therapy in the post-operative period may warrant further study in patients with difficult to treat intracranial fungal abscesses.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain; Brain Abscess; Follow-Up Studies; Hematopoietic Stem Cell Transplantation; Humans; Injections, Spinal; Magnetic Resonance Angiography; Male; Mucormycosis; Myelodysplastic Syndromes; Ventriculostomy

Cerebral abscess caused by Candida spp. is a rare disease, with a nonspecific presentation, little data on treatment, and generally poor outcomes. We present a case of this type of Candida infection in a 57-year-old man with a history of uncontrolled diabetes mellitus and intravenous drug abuse, and review the literature on this disease. Our patient had a good treatment outcome with liposomal amphotericin B and flucytosine, followed by oral fluconazole. Comorbidities include prior antibiotic use (52%), prior surgery (28%), malignancy (28%), stem cell or solid organ transplant (20%), prior corticosteroid use (16%), central venous catheter (CVC) insertion (10%), and burns (7%). Diagnosis requires a high index of suspicion, as clinical presentations and laboratory data can be nonspecific and difficult to differentiate from bacterial cerebral abscesses. In reviewed cases, 55% of blood cultures and 23% of cerebrospinal fluid (CSF) cultures were positive for Candida spp. and outcomes were poor, as the mortality rate of the non-autopsy cases reviewed was 69%.

Topics: Administration, Intravenous; Administration, Oral; Adolescent; Adult; Amphotericin B; Brain Abscess; Candida; Candidiasis; Child, Preschool; Diabetes Complications; Female; Fluconazole; Flucytosine; Humans; Infant; Male; Middle Aged; Substance Abuse, Intravenous; Young Adult

Many victims of the tsunami that occurred following the Great East Japan Earthquake on March 11, 2011 developed systemic disorders owing to aspiration pneumonia. Herein, we report a case of tsunami lung wherein Scedosporium aurantiacum was detected in the respiratory tract. A magnetic resonance image of the patient's head confirmed multiple brain abscesses and lateral right ventricle enlargement. In this case report, we describe a potential refractory multidrug-resistant infection following a tsunami disaster.

Topics: Aged; Amphotericin B; Antifungal Agents; Brain Abscess; Central Nervous System Fungal Infections; Delayed Diagnosis; Female; Humans; Japan; Lung Diseases, Fungal; Magnetic Resonance Imaging; Near Drowning; Pyrimidines; Scedosporium; Survivors; Tomography, X-Ray Computed; Triazoles; Tsunamis; Voriconazole

Topics: Amphotericin B; Antifungal Agents; Brain; Brain Abscess; Diabetes Mellitus; DNA, Fungal; Frontal Sinusitis; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mycoses; Radiography; Schizophyllum

An unusual, but not unique, case of cerebellar aspergillosis associated with autologous peripheral blood stem cell transplantation for breast cancer is presented.. A 45-year-old woman with breast cancer underwent chemotherapy and radiotherapy as well as autologous peripheral blood stem cell transplantation. She developed a cerebellar aspergillosis abscess that was treated successfully with two surgical resections.. After removal of pus and the abscess wall, the patient received local application of amphotericin B (AmB). She received AmB 1 mg/kg/d for 3 months and itraconazole 100 mg/kg/d for 1 year. After 3 months of AmB treatment, magnetic resonance imaging revealed that disease had not recurred.. In cases of central nervous system aspergillosis, to increase the therapeutic efficiency, AmB can also be applied to the abscess cavity. Computed tomographic and contrast-enhanced magnetic resonance imaging scans play an important role in establishing early diagnosis in high-risk, immunocompromised patients.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Brain Abscess; Breast Neoplasms; Cerebellar Diseases; Drainage; Female; Hematopoietic Stem Cell Transplantation; Humans; Transplantation, Autologous

Mucormycosis refers to a group of rapidly progressive infections caused by fungi belonging to the order Mucorales. Infection most often develops in individuals with immunological or metabolic compromise, although patients without underlying abnormalities have been affected. Specific clinical manifestations are associated with various predisposing factors. Rhinocerebral mucormycosis is the most common form and most frequently develops in individuals with poorly controlled diabetes mellitus. The extent of anatomical involvement and clinical course are unpredictable, depending on the intrinsic factors of the host. Over the past 20 years the prognosis for patients with rhinocerebral mucormycosis, once considered to be a uniformly fatal disease, has improved. Coordinated medical and surgical treatment, including rapid diagnosis, the advent of systemic antifungal agents, aggressive surgical debridement, and control of the underlying disease process, have been credited with its successful management. The range of survival rates recorded with the regimen of combined therapies is wide because the number of patients reported is limited and anatomical involvement is diverse. Survival with intracerebral abscess is rare. The authors describe the successful management of a patient who developed a bifrontal fungal abscess during treatment for rhinocerebral mucormycosis associated with ketoacidosis and diabetes mellitus. The patient remains without radiographic or clinical evidence of infection more than 2 years after treatment. The authors review the characteristic clinical, radiographic, and pathological features of previously reported infections and emphasize the importance of early detection and aggressive treatment in the management of this frequently fulminant and fatal disease.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Abscess; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Follow-Up Studies; Humans; Immunocompromised Host; Male; Mucormycosis; Paranasal Sinus Diseases; Prognosis; Risk Factors; Survival Rate; Treatment Outcome

Invasive aspergillosis of the central nervous system is a rare but well-described disease. There have been only a few reported survivors, and mortality exceeds 95% in the immunosuppressed host. We present a 2-year-old boy with acute lymphatic leukemia and multiple Aspergillus brain abscesses who was successfully treated with liposomal amphotericin B, itraconazole, and surgical excision of the abscesses. Liposomal amphotericin B is a new preparation that safely allows the attainment of significantly higher tissue levels with less toxicity than standard amphotericin B. The treatment of patients with invasive central nervous system aspergillosis is reviewed.

Topics: Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Aspergillus fumigatus; Brain Abscess; Child, Preschool; Combined Modality Therapy; Drug Carriers; Drug Therapy, Combination; Humans; Itraconazole; Liposomes; Male; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma

A 68-year-old liver transplant recipient who was being treated with FK 506 and immunosuppressive steroid therapy was admitted to our medical center because of a tonic-clonic seizure. Computed tomography of the head revealed multiple discrete cerebral abscesses, and culture of fluid drained intraoperatively yielded a dematiaceous fungus. The isolate was susceptible to amphotericin B and itraconazole but was resistant to flucytosine and fluconazole. The patient was successfully treated with a prolonged course of amphotericin B colloidal dispersion and itraconazole, as evidenced by both clinical and radiographic resolution of disease over a 2-year follow-up.

Topics: Aged; Amphotericin B; Brain Abscess; Humans; Immunosuppression Therapy; Itraconazole; Liver Transplantation; Male; Mitosporic Fungi; Mycoses

Cerebral mucormycosis (without associated involvement of and invasion from the nasal sinuses and turbinates) is an extremely rare opportunistic infection of the central nervous system. We report the case of an intravenous drug abuser (who was negative for the human immunodeficiency virus) who presented with hemiparesis on the right side, slurred speech, altered mental status, and an unsteady gait. Imaging studies revealed a large left-side basal ganglia lesion. A stereotactic biopsy obtained a tissue sample that revealed wide, nonseptated hyphal fragments with granulomatous inflammation. The patient was treated with 3 gm of amphotericin B during a 5-month period. The patient had no residual neurological dysfunction after treatment. Open surgical resection was not employed. This case suggests that stereotactic biopsy followed by long-term amphotericin B therapy, in lieu of open surgical resection, represents a viable treatment option for this rare disorder.

Topics: Adult; Amphotericin B; Basal Ganglia Diseases; Biopsy, Needle; Brain Abscess; Combined Modality Therapy; Humans; Male; Mucorales; Mucormycosis; Neurologic Examination; Stereotaxic Techniques

Cryptococcal infection is the most common fungal infection of the central nervous system. More than 50% of the cases of cryptococcal infection are superimposed on an immunosuppressive or other general debilitating condition. Cerebral cryptococcosis usually presents as meningitis or meningoencephalitis, although cerebral granuloma has also been reported. Hydrocephalus is the most common neurosurgical complication of cerebral cryptococcosis. The majority of patients require only medical treatment with antifungal drugs. However, when complications ensue, surgical intervention is mandatory. We suggest that chronic meningitis be ruled out in all patients prior to the placement of shunts. In the two cases reported here treatment of cryptococcal meningitis was a combination of amphotericin B and flucytosine for six weeks. Fluconazole is a new alternative and at least as effective as amphotericin B.

Topics: Adolescent; Adult; Agammaglobulinemia; Amphotericin B; Brain Abscess; Brain Diseases; Cryptococcosis; Female; Flucytosine; HIV Seronegativity; Humans; Hydrocephalus; Magnetic Resonance Imaging; Male; Opportunistic Infections

A 76-year-old male with chief complaints of back and right leg sciatica was hospitalized. His abdominal CT scan revealed lumber spondylitic stenosis. A laminectomy was performed. Postoperatively, he became febrile, aphasic and had grand mal seizure. A left craniotomy of the front abscess, seen in the CT scan, was performed. H and E stained smears of drainage revealed dematiaceous, septate hyphae. Cultures of the abscess drainage grew an olivaceous-grey fungus. Based on macro- and micro-morphological characters, growth at 42 degrees C, and exoantigenic analysis, the patient's fungus was identified as Xylohypha bantiana. Treatment with amphotericin B and 5-fluorocytosine was initiated. Despite surgical procedures and antifungal therapy, the patient's condition deteriorated and he died a few weeks later due to cerebral edema. The case reported here is the first microscopically, culturally, histopathologically and exoantigenically proven case of phaeohyphomycosis caused by X. bantiana in the province of Alberta and from Canada. A review of the literature on cases of X. bantiana infections has also been presented.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antibodies, Fungal; Brain Abscess; Child; Cladosporium; Female; Flucytosine; Humans; Male; Middle Aged; Mycoses; Tomography, X-Ray Computed

Aspergillus brain abscess is often a fatal disease, regardless of the mode of therapy. Most often seen in the compromised host, it is notoriously refractory to systemic antifungal agents and intrathecal antimycotics. Even with radical surgical debridement, only 13 patients, including the present case, have survived longer than 3 months after being treated for aspergillus brain abscess or granuloma. Studies have shown poor penetration of amphotericin B into the brain and cerebrospinal fluid. One way to achieve therapeutic levels of the agent near the abscess is through the direct introduction of the agent into the abscess site via an indwelling catheter. In the present case, a woman with an aspergillus abscess of the left temporal lobe was treated by a combination of systemic agents, radical debridement, and local therapy, resulting in a cure with a follow-up of 6 years. This is the first reported instance of the use of long-term, local antifungal therapy delivered to the area of the abscess cavity, using a closed reservoir system, and this patient is only the second renal transplant patient reported to have survived aspergillus brain abscess. This form of treatment produced no untoward long-term side effects or neurological sequelae. Local irrigation with antifungal agents should be considered in conjunction with systemic antifungal drugs and drainage and/or debridement in cases of fungal intracerebral aspergilloma. This technique may also prove useful with other fungal brain lesions.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Brain Abscess; Debridement; Drainage; Female; Humans; Tomography, X-Ray Computed

The clinical course of patients with mucormycosis of the paranasal sinuses can be unpredictable and is often determined by intrinsic host factors. The degree to and mechanism(s) by which these factors influence a patient's ability to survive the disease are poorly understood. Extensions to orbital and intracranial structures occur in some patients with paranasal sinus mucormycosis despite aggressive treatment. Controversies persist over adequate antifungal regimen, the precise role of hyperbaric oxygenation, and the appropriate extent of surgical debridement. We have developed an alloxan-induced immunocompromised murine model of mucormycosis in mice. Deferoxamine iron chelation produced rhinocerebral mucormycosis in these animals when challenged intraethmoidally with Rhizopus spores. The implications of our experimental studies in the content of our clinical experience in managing patients with intracranial extensions of paranasal sinus mucormycosis are discussed.

Topics: Adult; Alloxan; Amphotericin B; Animals; Brain Abscess; Brain Diseases; Child; Deferoxamine; Diabetes Mellitus, Experimental; Disease Susceptibility; Ethmoid Sinus; Female; Humans; Male; Mice; Mice, Inbred Strains; Middle Aged; Mucormycosis; Paranasal Sinus Diseases; Rhizopus

Rhinocladiella mackenziei is a highly neurotropic fungus, mainly reported from the Middle East. However, in recent years, there have been some cases from outside this region. We described an additional fatal case of R. mackenziei cerebral infection for the first time from Turkey and made a literature review of all previously reported cases. During 34 years (1988-2022), there have been 42 R. mackenziei brain abscess cases. Most patients have been reported from Saudi Arabia (n = 14, 33.3%). It is noteworthy that 40.5% of patients, including our case, were immunocompetent at initial diagnosis and mostly presented with a single lesion (n = 10, 23.8%). The most frequent comorbidities were solid organ transplant (n = 9, 21.4%), diabetes mellitus (n = 6, 14.3%), malignancy (n = 6, 14.3%) and prior surgery (n = 3, 7.1%). The most commonly used initial antifungal regimen were amphotericin B together with itraconazole (n = 9, 21.4%), combinations of lipid preparations of amphotericin B, voriconazole and/or posaconazole (n = 9, 21.4%) and amphotericin B alone (n = 8, 19%). Although both surgical procedures and antifungal medication in the majority of patients were performed, mortality rates remained high (90.4%). The area at risk of R. mackenziei cerebral abscess cases extends to other countries. Clinicians should be aware of this emerging disease and take a detailed travel history in patients with atypical and undocumented brain abscesses. Our case confirms the hypothesis that this fungus might spread more widely than previously predicted regions.

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Central Nervous System Fungal Infections; Humans; Turkey

Here we present a case of a poorly controlled diabetic who developed extensive rhinocerebral mucormycosis. Systemic and intrathecal amphotericin were not able to improve his life threatening infection. Therefore, salvage therapy with intracavitary amphotericin B deoxycholate was used to instill antifungal therapy directly into the patient's brain abscess. For proper dosing of intracavitary amphotericin B deoxycholate, we devised a formula which can be theoretically applied for all intracavitary therapies. Unfortunately, the patient's family withdrew care 6 days after starting intracavitary amphotericin and efficacy of this therapy could not be evaluated.

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Humans; Male; Middle Aged; Rhizopus oryzae

Aspergillus infection is a well-known complication of severe influenza and severe acute respiratory syndrome coronavirus (SARS-CoV), and these infections have been related with significant morbidity and mortality even when appropriately diagnosed and treated. Recent studies have indicated that SARS-CoV-2 might increase the risk of invasive pulmonary aspergillosis (IPA). Here, we report the first case of Aspergillus ochraceus in a SARS-CoV-2 positive immunocompetent patient, which is complicated by pulmonary and brain infections. Proven IPA is supported by the positive Galactomannan test, culture-positive, and histopathological evidence. The patient did not respond to voriconazole, and liposomal amphotericin B was added to his anti-fungal regimen. Further studies are needed to evaluate the prevalence of IPA in immunocompetent patients infected with SARS-CoV-2. Consequently, testing for the incidence of Aspergillus species in lower respiratory secretions and Galactomannan test of COVID-19 patients with appropriate therapy and targeted anti-fungal therapy based on the primary clinical suspicion of IPA are highly recommended.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus ochraceus; Biomarkers; Brain Abscess; Bronchoalveolar Lavage Fluid; COVID-19; COVID-19 Nucleic Acid Testing; Fatal Outcome; Galactose; Humans; Immunocompetence; Invasive Fungal Infections; Lung Diseases, Fungal; Male; Mannans; SARS-CoV-2; Voriconazole

Cerebral abscess due to pigmented molds is a rare but usually fatal infection occasionally seen in transplant recipients. A 67-year-old man of Iraqi origin underwent a deceased donation renal transplant for renal failure and 2 months later was diagnosed with an abscess in the left posterior frontal lobe of his brain. Subsequent biopsy proved this to be due to the mold Rhinocladiella mackenziei. Further interventions included two operations to aspirate the lesion, voriconazole, then liposomal amphotericin B, then a combination of posaconazole and flucytosine which he continued for over 4 years. He also suffered from right ankle pain and was diagnosed with septic arthritis; R mackenziei was isolated from pus aspirated from the ankle joint. He responded well to the treatment and has had little loss of function, and on CT, the cerebral lesion has stabilized. Beta-D-glucan, initially at very high levels proved useful to monitor response over the 5 years and the latest sample was negative (38 pg/mL). This case is notable for the first disseminated case of this infection, its favorable outcome on a novel antifungal combination and a new approach to monitoring the course of disease.

Topics: Aged; Amphotericin B; Antifungal Agents; Arthritis, Infectious; Ascomycota; Brain Abscess; Central Nervous System Fungal Infections; Humans; Immunocompromised Host; Invasive Fungal Infections; Kidney Transplantation; Male; Treatment Outcome; Triazoles

Clinical worsening or new manifestation of cryptococcal disease following initiation of anti-retroviral therapy (ART) in an HIV patient is a hallmark of cryptococcal immune reconstitution inflammatory syndrome (C-IRIS). However, it can be difficult to distinguish IRIS from worsening or new infection. Here, we present a case of severe C-IRIS involving multiple cerebellar, spinal, and intradural abscesses and spinal arachnoiditis 7 months after ART initiation in an AIDS patient with uncertain prior ART compliance. He had multiple prior episodes of cryptococcal meningitis with complications necessitating ventriculoperitoneal shunt placement and was on suppressive fluconazole when he developed worsening brain manifestations. He received empiric anti-cryptococcal re-induction without improvement. All cerebrospinal fluid cultures remained sterile, with negative

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Anti-Inflammatory Agents; Anti-Retroviral Agents; Antifungal Agents; Arachnoid; Arachnoiditis; Biopsy; Brain; Brain Abscess; Brain Edema; Cerebellar Diseases; Empyema, Subdural; Fluconazole; Flucytosine; HIV Infections; Humans; Immune Reconstitution Inflammatory Syndrome; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal; Middle Aged; Prednisone; Recurrence

Phaeohyphomycosis causes a wide spectrum of systemic manifestations and can affect even the immunocompetent hosts. Involvement of the central nervous system is rare. A 48-year-old farmer presented with chronic headache, fever, and impaired vision and hearing. Serial MRIs of the brain showed enhancing exudates in the basal cisterns, and lesions in the sella and perichiasmatic and cerebellopontine angle regions along with enhancement of the cranial nerves and leptomeninges. Cerebrospinal fluid (CSF) showed lymphocytic pleocytosis with elevated protein and decreased glucose on multiple occasions. Clinical, imaging, and CSF abnormalities persisted despite treatment with antitubercular drugs and steroids for 2 years. Biopsy of the dura mater at the cervicomedullary junction revealed necrotizing granulomatous lesions, neutrophilic abscesses, and giant cells containing slender, pauci-septate, pigmented fungal hyphae. Fungal culture showed growth of

Topics: Amphotericin B; Antifungal Agents; Antitubercular Agents; Ascomycota; Brain; Brain Abscess; Diagnosis, Differential; Humans; Male; Meningitis; Meningitis, Fungal; Middle Aged; Phaeohyphomycosis; Steroids; Tuberculosis, Meningeal; Voriconazole

Cerebral feohifomycosis are severe infections caused by dematiaceous fungi. Cladophialophora bantiana is one of the most commonly isolated species; it has central nervous system tropism and it often manifests as a brain abscess in immunocompetent patients. In immunocompromised patients, it can lead to brain abscesses and disseminated infections.\ Despite the availability of broad-spectrum antifungal drugs, it is a must to perform surgical management, in addition to drug therapy. However, mortality is high. The diagnostic approach must be invasive to establish a timely diagnosis and direct treatment based on culture and susceptibility tests.\ We report a case of brain abscess caused by C. bantiana in an immunosuppressed patient who was treated with surgical resection and voriconazole with an adequate response to therapy and without neurological sequels.. Las feohifomicosis cerebrales son infecciones graves causadas por mohos dematiáceos, entre los cuales Cladophialophora bantiana es una de las especies más comúnmente aislada. Esta tiene tropismo por el sistema nervioso central y frecuentemente produce abscesos cerebrales en pacientes inmunocompetentes; además, en los inmunocomprometidos también puede ocasionar infección diseminada. Pese a la disponibilidad de medicamentos antifúngicos de amplio espectro, a menudo se requiere también la intervención quirúrgica; de todas maneras, la mortalidad es elevada. El diagnóstico debe hacerse interviniendo para tomar la muestra y hacer el cultivo y las pruebas de sensibilidad. Se presenta aquí el caso de un paciente con trasplante renal que presentó un absceso cerebral por C. bantiana, el cual se extrajo mediante resección quirúrgica. El paciente recibió tratamiento con voriconazol, con adecuada respuesta, mejoría y sin secuelas neurológicas.

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Cerebral Phaeohyphomycosis; Combined Modality Therapy; Craniotomy; Graft Rejection; Humans; Hyperoxaluria, Primary; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Nephrolithiasis; Postoperative Complications; Recurrence; Renal Dialysis; Saccharomycetales

Cladophialophora bantiana (C. bantiana) is a life-threatening melanized mycelial fungus causing brain abscess. C. bantiana is usually observed in tropical countries, including India. We report a Japanese case of C. bantiana presenting with myelitis mimicking neuromyelitis optica (NMO) and brain abscess. A 73-year-old man was administered prednisolone (30 mg/day) for antineutrophil cytoplasmic antibody (ANCA)-related vasculitis 100 days before admission. He had right side-dominant paraplegia and sensory loss in the right leg. T2-weighted spinal cord MRI revealed longitudinal high-intensity signals at the T7 to T12 levels. A ring-enhancing lesion at the T10 level was detected on gadolinium (Gd)-enhanced MRI. He was tentatively diagnosed with NMO, and steroid pulse therapy was performed. One month later, an abscess at the right cerebropontine angle was noted on Gd-enhanced brain MRI. Two months later, several subcutaneous intramuscular tumors were detected. Based on the morphological study of the cultured organelle obtained by tumor enucleation and the internal transcribed spacer sequence of ribosomal RNA, the pathogen was identified as C. bantiana. Although he received liposomal amphotericin B treatment, the patient died of respiratory insufficiency. C. bantiana infection should be considered in patients with myelitis presenting with longitudinal lesions and CNS abscess in an immunocompromised state.

Topics: Aged; Amphotericin B; Antifungal Agents; Ascomycota; Brain Abscess; Diagnosis, Differential; Fatal Outcome; Humans; Male; Mycoses; Neuromyelitis Optica

Intracranial aspergillosis is a rare infectious disease of the central nervous system with high mortality rates. Our aim is to present 3 cases of intracranial aspergillosis who were surgically treated with intracavitary amphotericin B administration. First case was a 21-year-old male patient. Allogeneic stem cell transplantation treatment was performed because of aplastic anemia and vocal cord paralysis developed 10 days after treatment. Multiple aspergillosis abscesses were observed in the cranial magnetic resonance imaging (MRI). Cerebral lesions were excised and 0.3 cc of amphotericin B was applied locally. Second case was a 18-year-old male patient treated for acute lymphocytic leukemia. MRI was performed on the development of consciousness change during treatment and right frontal abscess was detected. The abscess was excised and amphotericin B was applied locally. Third case was a 45-year-old woman with mastectomy. She had chemotherapy after surgery and had blood stem cell transplantation because of pancytopenia. Two months after treatments, MRI was performed on the development of ataxia and a cerebellar abscess was detected. The abscess was surgically excised and local amphotericin B was applied. The first case deceased 2 weeks after surgery and the second case died 2.5 years later due to multi-organ failure. The third case is stil alive and neurologically stable after 14 years of surgical treatment. In intracranial aspergillosis, intracavitary amphotericin B therapy may be used as an adjunct after the surgical excision of abscess. This procedure may contributes to the regression of abscess or prevention of the recurrence. But comparative clinical studies are needed for more accurate conclusions.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Aspergillosis; Brain Abscess; Fatal Outcome; Female; Hematopoietic Stem Cell Transplantation; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Treatment Outcome; Young Adult

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Diagnosis, Differential; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Mucormycosis; Rhizomucor; Seizures; Stem Cell Transplantation; Temporal Lobe; Tomography, X-Ray Computed

Dematiaceous fungi have melanin-like pigment in the cell wall and usually cause a variety of dermal infections in humans. Infections of the central nervous system(cerebral phaeohyphomycosis)are rare but serious, since they commonly occur in immunocompromized patients. A 76-year-old man was admitted with mild motor aphasia and underwent total excision of a mass in the left frontal lobe. With the postoperative diagnosis of brain abscess due to infection with dematiaceous fungi (C. bantiana) associated with hypogammaglobulinemia following gastrectomy, intravenous antifungal drugs including amphotericin B and fluconazole were administered. Regrowth of the abscess with intraventricular rupture was noted at about the 88th day after the initial surgery, and the patient underwent neuroendoscopic aspiration of the pus and placement of a ventricular drain. Following intraventricular administration of miconazole through ventricular drainage or an Ommaya reservoir, neuroradiological findings improved, but general and neurological conditions worsened. Further treatment was discontinued and the patient died 9 months after onset. The poor outcome in this patient is attributed to 1)intractability of dematiaceous fungi, 2)development of ventriculitis and the need for intraventricular administration of antifungal drugs, and 3)untreatable hypogammaglobulinemia following gastrectomy.

Topics: Agammaglobulinemia; Aged; Amphotericin B; Antifungal Agents; Ascomycota; Brain Abscess; Drug Combinations; Fluconazole; Gastrectomy; Humans; Male; Mycoses

Invasive cerebral aspergillosis always developed in immunocompromised host. Early diagnosis may save life in this critical condition; however, it is difficult to reach. Herein, we presented an unusual case of invasive cerebral aspergillosis in a cirrhotic patient. A 47-year-old man presented with progressive deterioration of consciousness for three days. The patient had a history of alcoholic liver cirrhosis, Child-Pugh class C. Magnetic resonance imaging (MRI) of brain showed multi-focal parenchymal lesions, which was consistent with multiple brain abscesses. The diagnosis of invasive cerebral aspergillosis was made by molecular based laboratory methods including Aspergillus galactomannan antigen assay and oligonucleotide array. Despite treatment with the antifungal agent, Amphotericin B, the patient died at the ninth day of hospitalization. Our findings suggest that liver cirrhosis can be one of risk factors of invasive cerebral aspergillosis, and support the diagnosing usefulness of MRI, Aspergillus galactomannan antigen assay, and oligonucleotide array.

Topics: Amphotericin B; Antifungal Agents; Antigens, Fungal; Aspergillus fumigatus; Brain Abscess; Fatal Outcome; Humans; Liver Cirrhosis; Magnetic Resonance Imaging; Male; Middle Aged; Oligonucleotide Array Sequence Analysis

Rhinocerebral mucormycosis is a rare, rapidly progressive and potentially lethal disease almost exclusively affecting immunocompromised hosts or patients with metabolic disorders, such as poorly controlled diabetes mellitus.. This work is aimed to describe five cases of rhinocerebral mucormycosis to review and possibly define diagnostic and surgical treatment guidelines. In all the patients, surgical debridement, systemic and local antifungal therapy, and oral rehabilitation using filling prostheses were performed.. None of the patients revealed recurrence of the infection, as confirmed by radiological and clinical long term follow up.. Given the lethal nature of the disease, the authors underline the importance of early diagnosis and of a multidisciplinary approach in order to undertake correct surgical and medical treatments, while keeping the underlying disease under control.

Topics: Adult; Amphotericin B; Antibiotic Prophylaxis; Brain Abscess; Child; Female; Humans; Infectious Encephalitis; Male; Middle Aged; Mucormycosis; Practice Guidelines as Topic; Preoperative Care; Rhinitis

Topics: Adolescent; Amphotericin B; Antifungal Agents; Ascomycota; Benzenesulfonates; Brain Abscess; Central Nervous System Fungal Infections; Chronic Disease; Coloring Agents; Debridement; Epidural Abscess; Frontal Lobe; Frontal Sinus; Humans; Lactic Acid; Male; Phenols; Pyrimidines; Sinusitis; Treatment Outcome; Triazoles; Voriconazole

Dematiaceous, or dark-pigmented, fungi are known to cause infections such as phaeohyphomycosis, chromoblastomycosis, and mycetoma. These fungi are becoming increasingly important opportunistic pathogens in solid organ transplant recipients (SOTR). We present a retrospective chart review of 27 SOTR who developed phaeohyphomycosis infections post transplant from 1988 to 2009.. Cases were reviewed for fungal species isolated, date and source of culture, immunosuppressive and fungal therapy used, and outcome. The majority of isolates obtained were from the skin and soft tissue, with 3 pulmonary and brain abscesses.. The time from transplantation to onset of infection ranged from 2 months to 11 years. The species isolated were Exophiala (11), Ochroconis (3), Alternaria (2), Phoma (2), Wangiella (1), Cladosporium (1), Aureobasidium (1), Chaetomium (1), Coniothyrium (1), and non-sporulating fungi (2). An additional 4 patients had infections confirmed by pathology, but no cultures were done. Most of the affected skin lesions were surgically debrided and treated with itraconazole; 2 patients were treated with voriconazole and 2 with amphotericin D. Death from fungal disease occurred only in patients with pulmonary and brain abscesses.. As the number of SOTR increases, so does the incidence of fungal infections in that population. Surgery, along with antifungal therapy and a reduction in immunosuppression, are the cornerstones of treatment.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Brain Abscess; Debridement; Female; Humans; Immunosuppression Therapy; Itraconazole; Lung Abscess; Male; Middle Aged; Opportunistic Infections; Organ Transplantation; Phaeohyphomycosis; Retrospective Studies; Time Factors; Voriconazole; Young Adult

We present a case of cerebral Scedosporium apiospermum infection presenting with intestinal manifestations in a 64-year-old male patient on immunosuppression for orthotopic liver transplantation. At admission, the patient's chief complaint was chronic watery diarrhea and he was found to have colonic ulcers on endoscopy. His hospital course was complicated by a tonic-clonic seizure caused by a left frontal brain abscess, with the causative agent being identified by culture. He was treated with lobectomy, high-dose intravenous voriconazole, and liposomal amphotericin with clinical, endoscopic, and histologic improvement. To our knowledge, S. apiospermum has not been previously described as a cause of colitis. The septate branching appearance of the Scedosporium species is similar to the more common Aspergillus species. This case of gastrointestinal Scedosporium brings into question previously reported cases of isolated gastrointestinal aspergillosis diagnosed by histopathology. Clinical suspicion for S. apiospermum must be maintained in immunosuppressed patients presenting with neurologic and gastrointestinal symptoms.

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Central Nervous System Fungal Infections; Colitis, Ulcerative; Histocytochemistry; Humans; Male; Microscopy; Middle Aged; Psychosurgery; Pyrimidines; Scedosporium; Triazoles; Voriconazole

Fungal infection is a severe problem in children suffering from cancer. We report a case of a four-year-old girl who was diagnosed with acute lymphoblastic leukemia and multiple Aspergillus niger abscesses at the induction phase of the treatment. She was treated with granulocyte transfusions, liposomal amphotericin B with a combination of voriconazole for four months, followed by oral variconazole alone for 17 months. She was successfully treated with this combination without any sequel, and the planned chemotherapy was also completed. Our experience revealed that antifungal treatment including intravenous amphotericin B and variconazole augmented by granulocyte transfusion is an alternative option for the management of this catastrophic complication.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus niger; Brain Abscess; Child, Preschool; Female; Humans; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Triazoles; Voriconazole

Immunosuppressive agents increase the vulnerability of solid organ transplant patients to opportunistic infections. An atypical clinical presentation of a bacterial and fungal co-infection makes diagnosis and treatment even more challenging in this population. A 54-year-old hypertensive woman underwent a cadaveric kidney transplant after years on hemodialysis. Her treatment included mycophenolate, tacrolimus, and prednisone. By post-transplant week 8, she had pneumonia followed by progressive visual changes and seizures. Diagnostic work-up, consisting of magnetic resonance imaging of the brain and chest x-ray, showed several cerebral ring-enhancing lesions, and a pulmonary cavitary lesion. Disseminated nocardiosis was suspected and therapy was started. Skin biopsy was taken from a nodular lesion and culture confirmed Nocardia species infection. During hospitalization, neurological deficit persisted with worsening of brain lesions. She underwent excision of a brain abscess and the final pathologic report showed mucormycosis, revealing the patient's co-infection by 2 different pathogens. After therapy with liposomal amphotericin B and posaconazole, she has remained stable for more than 1 year. Disseminated nocardiosis masked and delayed the diagnosis and treatment of a more aggressive and worrisome organism. Mucormycosis, as a non-fatal isolated brain abscess without rhinal involvement, is an atypical presentation, and only a few cases have been reported.

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Coinfection; Female; Humans; Kidney Transplantation; Middle Aged; Nocardia; Nocardia Infections; Opportunistic Infections; Pneumonia, Bacterial; Radiography; Triazoles; Zygomycosis

A case of a 38-year-old male farmer with a brain abscess caused by Cladophialophora bantiana is described. He had a 2 year history of non-insulin-dependent diabetes and myelodysplastic syndrome. A cranial computed tomography scan demonstrated a hypodense ring lesion with peripheral oedema and a midline shift in the left frontal lobe. A darkly pigmented mould was isolated from the brain abscess. The isolate was identified as C. bantiana based on its morphological features and DNA sequence analysis. The patient was unresponsive to burr hole aspiration and irrigation, as well as liposomal amphotericin B infusion, and died after discharge from the hospital. This is believed to be the first case of a cerebral abscess due to C. bantiana in China.

Topics: Adult; Amphotericin B; Antifungal Agents; Ascomycota; Brain Abscess; Central Nervous System Fungal Infections; China; Cladosporium; Diabetes Mellitus, Type 2; Fatal Outcome; Humans; Male; Molecular Sequence Data; Myelodysplastic Syndromes

Candida parapsilosis is a very rare cause of meningitis. Though several cases have now been reported in neonates and children, only one has been described in an adult. We report on a 55-year-old male that was admitted due to altered mental status. He had recent sinus drainage and polypectomy, craniotomy with drainage of brain abscess, and ventriculo-peritoneal shunt placement. On admission, imaging studies showed no evidence of shunt dysfunction but did reveal extensive white matter decreased attenuation. Microscopic examination of the first 10 daily cerebrospinal fluid (CSF) cultures revealed yeast. Flucytosine and liposomal amphotericin B were started and externalization of shunt was performed on day 3. On day 8, CSF culture from admission grew C. parapsilosis; fluconazole was added. On day 10, daily CSF still showed yeast and cultures consistently grew C. parapsilosis. Shunt was removed and bilateral ventriculostomy drains were inserted. CSF after procedure as well as at follow-up examinations throughout his 3-month hospitalization were negative for yeast. Extended treatment with flucytosine and fluconazole was initiated. At 8-month follow-up, successful treatment of C. parapsilosis infection without recurrence was confirmed. This case underscores the need for suspicion of C. parapsilosis as a cause of meningitis after invasive surgeries in adults.

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Candida; Candidiasis; Drainage; Fluconazole; Flucytosine; Follow-Up Studies; Humans; Injections, Intravenous; Male; Meningitis, Bacterial; Middle Aged; Recurrence; Treatment Outcome; Ventriculoperitoneal Shunt

Intracranial fungal masses are uncommon diseases, but their incidence is increasing, most often due to the prolonged survival of patients with different immunodeficiencies. The management of patients with intracranial fungal masses included stereotactic biopsy for diagnosis, partial or radical surgery excision and prolonged antifungal therapy.. We report the case of a 51-year-old diabetic man with a history of psoas abscess due to Candida albicans 1 year before the onset of neurological symptoms, including headache and generalized tonoclonic seizures.. Magnetic resonance imaging showed a single lesion located in the right parietal lobe with mass effect, surrounding edema and enhancement after injection of gadolinium. The material was purulent.. Direct microscopic examination showed hyaline, branched and septate hyphae compatible with fungal elements.. Fungal infections, especially due to Candida species, should be considered in diabetic patients with parenchymal brain abscesses. Radical excision followed by prolonged antifungal therapy based on fluconazole or amphotericin B is necessary to improve the prognosis of this type of patients.

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Candida albicans; Candidiasis; Combined Modality Therapy; Craniotomy; Deoxycholic Acid; Diabetes Mellitus, Type 2; Drug Combinations; Drug Therapy, Combination; Fluconazole; Humans; Hyphae; Magnetic Resonance Imaging; Male; Mannitol; Middle Aged; Parietal Lobe; Psoas Abscess

Brain abscesses are uncommon in children. We report a 3-year-old, previously healthy and immunocompetent boy, with an Absidia brain abscess. He presented with decreased sensorium and status epilepticus. The brain abscess was detected using cranial computed tomography and magnetic resonance imaging, and the diagnosis was confirmed with pus and brain tissue cultures. The patient responded to surgical drainage with concomitant intravenous and intraventricular amphotericin B.

Topics: Absidia; Amphotericin B; Antifungal Agents; Brain Abscess; Child, Preschool; Drainage; Humans; Immunocompetence; Injections, Intraventricular; Male; Mucormycosis

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Brain; Brain Abscess; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mood Disorders; Myelodysplastic Syndromes; Personality; Pyrimidines; Stem Cell Transplantation; Transplantation, Homologous; Triazoles; Voriconazole

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Brain Abscess; Caspofungin; Deoxycholic Acid; Drug Combinations; Drug Therapy, Combination; Echinocandins; Fatal Outcome; Humans; Leukoencephalopathy, Progressive Multifocal; Lipopeptides; Male; Middle Aged; Pulmonary Aspergillosis; Pyrimidines; Triazoles; Voriconazole

Topics: Amphotericin B; Antifungal Agents; Brain; Brain Abscess; Candidiasis; Deoxycholic Acid; Drug Combinations; Drug Therapy, Combination; Echoencephalography; Female; Flucytosine; Follow-Up Studies; Fungemia; Humans; Infant; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Magnetic Resonance Imaging

The objective of this study was to determine if the preoperative use of antifungal therapy positively influences clinical outcome in patients with Aspergillus brain abscess.. We studied 25 patients with confirmed diagnosis of cerebral aspergillosis. We compared baseline characteristics and outcomes of patients treated with either amphotericin B or itraconazole either pre-operatively (n=11) or post-operatively (n=14) at a tertiary care hospital in Karachi.. Twenty-five patients were included in the study. Cerebral aspergillosis was largely a disease of immune competent people (80%). Baseline clinical characteristics between the two treatment groups were comparable i.e., age (P>0.896), gender (P>0.999), coma at presentation (P>0.999), immunosuppression (P>0.623), number of abscesses (P>0.999) and interval between presentation and surgery (P>0.447). Overall mortality was 40%. The overall outcome was significantly better (P<0.001) in patients treated with antifungal therapy before surgery. All 11 patients who received antifungal therapy before surgery survived, but only preoperative itraconazole treatment was statistically associated with an improved survival compared to delayed treatment.. Cerebral aspergillosis was largely a disease of immune competent people (80%). Overall mortality was 40%. The outcome was significantly better in patients treated with antifungal therapy (especially itraconazole) before surgery suggesting a possible beneficial effect of pre-surgical treatment with antifungal therapy.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Brain Abscess; Female; Humans; Itraconazole; Male; Middle Aged; Retrospective Studies; Treatment Outcome

Primary cerebral phaeohyphomycosis is caused by pigmented fungi that exhibit distinct neurotropism often in immunocompetent individuals. A 20-yr-old male presented with multiple brain abscess which was subsequently proven microbiologically to be due to Cladophialophora Bantiana. In spite of near total excision and appropriate antifungal agents succumbed to his illness. We report this case to highlight its rarity and high mortality in an immunocompetent host. There is no initial clinical or laboratory feature that makes a preoperative diagnosis possible and relies on microbiological confirmation.

Topics: Adult; Amphotericin B; Antifungal Agents; Ascomycota; Brain Abscess; Central Nervous System Fungal Infections; Cladosporium; Craniotomy; Drug Therapy, Combination; Fatal Outcome; Flucytosine; Humans; Itraconazole; Male

Cerebral mucormycosis without rhino-orbital or systemic involvement is an extremely rare condition mostly associated with parenteral drug abuse.. We report the case of a 42-year-old woman who presented with hemiparesis of the left side and altered mental status. Neuroradiologic workup demonstrated an inflammatory lesion involving the right basal ganglia. Proton magnetic resonance spectroscopy demonstrated features consistent with a pyogenic abscess. Computed tomography-guided stereotactic biopsy led to the diagnosis of cerebral mucormycosis. Parenteral AMB-L treatment was conducted, but the patient worsened clinically, presenting with a complete hemiplegia, and cerebral magnetic resonance imaging (MRI) scans demonstrated a voluminous abscess formation. Then, under stereotactic guidance, a surgical endoscopic debridement of the abscess cavity associated with the placement of an Ommaya reservoir was performed. Systemic and intralesional treatment with AmB associated with an adjunctive immune therapy was conducted. At 3-year follow-up, the patient had recovered partially from her left hemiplegia, allowing her to walk without help, and cerebral MRI scans showed complete resorption of the abscess.. Our good results suggest that surgical endoscopic debridement associated with intravenous and intracavitary antifungal therapy might be valuable in treating voluminous deep-seated mucormycotic lesions.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Abscess; Central Nervous System Fungal Infections; Debridement; Endoscopy; Female; Humans; Mucormycosis

Aspergillosis of the central nervous system (CNS) is a rare, but well described disease in immuno-competent patients. We present a 65-year-old patient who developed neuro-aspergillosis 10 months after severe cranio-facial trauma (Le Fort III). He was treated successfully with surgery including stereotactic drainage and, with Amphotericin B, Liposomal Amphotericin B, and Itraconazol.

Topics: Aged; Amphotericin B; Antifungal Agents; Brain Abscess; Cerebral Ventricles; Cerebrospinal Fluid Shunts; Combined Modality Therapy; Drug Administration Schedule; Facial Injuries; Humans; Hydrocephalus; Immunocompetence; Itraconazole; Male; Maxillary Fractures; Meningitis, Fungal; Microsurgery; Motor Cortex; Neuroaspergillosis; Neuronavigation; Osteotomy, Le Fort; Postoperative Complications; Reoperation; Skull Fractures; Tomography, X-Ray Computed

The variable forms of clinical complaints, findings and time interval of presentation in 27 cases of mucormycosis have been described, which were encountered over a span of 8 years. The previous concept about this fungal infection attacking chronic, debilitated, immunocompromised patients does not appear to hold true. Seven of the 27 patients (22.2%) did not reveal any predisposing factors and their outcome of 42.9% survival seems to be poorer than the total outcome (66.7%). 'Chronic form' of disease presentation, the definition of which is still not delineated, was encountered in four patients (14.8%). Again, the outcome was not significantly different from the total survival. Burr-hole tap of an intracranial abscess revealing mucor in a 2-month-old infant has been described. Even in the present era, extranasal exenteration of sinuses along with disfiguring orbital exenteration is required to ensure satisfactory surgical debridement. Control of the underlying predisposing illness, along with the aggressive surgical debridement and the parenteral administration of amphotericin B, remains the treatment essentials even today.

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Abscess; Child, Preschool; Female; Head; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mucor; Mucormycosis; Radiography

Ramichloridium mackenziei is a dematiaceous fungus that usually causes cerebral phaeohyphomycosis. We describe the aspiration cytology findings of a case of cerebral abscess caused by R. mackenziei in a 66-yr-old Saudi woman who had a long standing history of diabetes mellitus and a recent diagnosis of systemic lupus erythematosus. She was on long-term corticosteroid therapy. The patient developed rapidly progressive multiple brain abscesses and died despite aspiration of the abscess and administration of intravenous amphotericin B lipid complex and voriconazole.

Topics: Aged; Amphotericin B; Antifungal Agents; Ascomycota; Biopsy, Needle; Brain Abscess; Central Nervous System Fungal Infections; Combined Modality Therapy; Diabetes Complications; Diabetes Mellitus; Fatal Outcome; Female; Humans; Lupus Erythematosus, Systemic; Pyrimidines; Triazoles; Voriconazole

Conidiobolus coronatus is recognized as a human pathogen causing subcutaneous fungal infection of the face in immunocompetent patients. The disease process is usually benign. We report, what we believe to be the first case of intracranial extension of C. coronatus producing rhino-orbitocerebral syndrome, and subsequent dissemination of C. coronatus in an immunocompetent patient.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Abscess; Conidiobolus; Fatal Outcome; Female; Humans; Lung Diseases, Fungal; Nose Diseases; Orbital Diseases; Zygomycosis

Invasive aspergillosis is a devastating infection in immunocompromised hosts. The lung is the most common site of primary infection, and the central nervous system is the most common secondary site of invasive disease. Invasive aspergillosis in autoimmunopathies treated with corticosteroids has rarely been reported in the literature. Herein, we report the case of a 48-year-old female patient with idiopathic thrombocytopenic purpura complicated with fatal invasive pulmonary and cerebral aspergillosis. She had been given 1,016 g intravenous amphotericin B empirically for lung infection during a previous admission. At presentation, she had fever, cough, and shortness of breath for 4 weeks. Chest radiography revealed a huge cavity over the left upper lung field. Bronchoscopic biopsy and culture showed Aspergillus species. She was initially treated with intravenous amphotericin B (0.9 mg/kg/day), and intravenous hydrocortisone for her idiopathic thrombocytopenic purpura. However, deterioration of consciousness occurred 12 days after hospitalization. Computed tomography of the brain showed ring-like cystic mass lesions in the right side basal ganglion. Stereotactic aspiration of the brain revealed Aspergillus species. Her condition exacerbated despite combination treatment with high-dose amphotericin B (1.2 mg/kg/day) and itraconazole (400 mg/day). She died 24 days after admission. This case suggests that treatment with corticosteroids and premature discontinuation of antifungal drugs bear the risk of fatal cerebral involvement in patients with invasive pulmonary aspergillosis.

Topics: Amphotericin B; Antigens, Fungal; Aspergillosis; Brain Abscess; Drug Therapy, Combination; Female; Humans; Lung Diseases, Fungal; Middle Aged; Purpura, Thrombocytopenic, Idiopathic

Invasive aspergillosis of the central nervous system has a mortality rate exceeding 90%. We describe a 29-year-old woman with a medical history of chronic polyarthritis who developed a proven rhinocerebral Aspergillus fumigatus infection refractory to first-line treatment with liposomal amphotericin B. The patient responded successfully to salvage combination treatment with voriconazole and caspofungin. Furthermore, for the first time, voriconazole levels in an intracerebral abscess were measured in this patient undergoing voriconazole oral therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Arthritis; Aspergillus fumigatus; Brain; Brain Abscess; Caspofungin; Chromatography, Liquid; Echinocandins; Female; Humans; Lipopeptides; Magnetic Resonance Imaging; Mass Spectrometry; Neuroaspergillosis; Paranasal Sinus Diseases; Peptides, Cyclic; Pyrimidines; Staphylococcus aureus; Triazoles; Voriconazole

A 28-year-old woman with acute lymphoblastic leukemia developed fever and unilateral pleural based pulmonary infiltrate during prolonged chemotherapy induced neutropenia. CT-guided lung biopsy confirmed the diagnosis of pulmonary mucormycosis and liposomal amphotericin B therapy was started. A few days after the initial symptoms, the patient developed convulsions and a brain abscess was detected in computerized tomography and magnetic resonance imaging. Fungal hyphae detected in histopathological examination of a brain biopsy had identical morphology with those seen in previous lung biopsies. The patient was treated with liposomal amphotericin B for five months and cytotoxic chemotherapy was successfully completed during antifungal therapy. Pulmonary infiltrates and the brain abscess resolved and the patient received an allogeneic bone marrow transplantation from a matched, unrelated donor. Antifungal therapy was continued for one additional month after bone marrow transplantation to prevent a relapse of invasive mucormycosis. Follow-up of the patient revealed no signs of relapse of invasive mucormycosis but two months after successful bone marrow transplantation the patient developed lethal cytomegalovirus pneumonitis which was confirmed by autopsy. No signs of mucormycosis were detected at post-mortem.

Topics: Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Bone Marrow Transplantation; Brain Abscess; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Cytomegalovirus Infections; Daunorubicin; Dexamethasone; Etoposide; Fatal Outcome; Female; Humans; Immunocompromised Host; Liposomes; Lung Diseases, Fungal; Mercaptopurine; Mitoxantrone; Mucormycosis; Pneumonia, Viral; Postoperative Complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction; Transplantation, Homologous; Vincristine

Topics: Abdomen, Acute; Adult; Amphotericin B; Amyloidosis, Familial; Antifungal Agents; Ascomycota; Brain Abscess; Cefazolin; Coma; Combined Modality Therapy; Craniotomy; Drainage; Enterococcus faecalis; Fatal Outcome; Female; Frontal Lobe; Gram-Positive Bacterial Infections; Humans; Immunocompromised Host; Liver Transplantation; Postoperative Complications; Pseudomonas Infections; Reoperation; Spain

Invasive fungal infection continues to pose a significant threat to immunocompromised patients, with cerebral aspergillosis being among the most feared ones. The authors describe an adolescent girl with acute lymphoblastic leukemia (ALL) with subsequent acute liver failure, who developed an aspergillus brain abscess. The patient was treated with combined antifungal therapy using amphotericin B local instillation, prolonged systemic amphotericin B colloidal dispersion along with vinca alkaloids-containing chemotherapy, followed by neurosurgical débridement and oral voriconazole in the setting of ongoing antileukemic maintenance chemotherapy. Her ALL remains now in complete remission 30 months from diagnosis, with no evidence of fungal infection.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Brain Abscess; Combined Modality Therapy; Drug Therapy, Combination; Female; Humans; Liver Failure, Acute; Magnetic Resonance Imaging; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Remission Induction; Triazoles; Voriconazole

We report a case of a large intracerebral CSF collection formed along the course of the catheter of an ommaya-type reservoir (Medtronic 12 mm), implanted in a patient suffered from cryptococcal meningitis in the frame of CLL. This collection was at first diagnosed as intracerebral abscess but emergency craniotomy proves clear CSF collection with no signs of infection. We describe the case and we discuss the issue of CSF pressure pathophysiology and changes in flow dynamics, to patients with cryptococcal meningitis.

Topics: Acyclovir; Aged; Amphotericin B; Anti-Infective Agents; Brain Abscess; Ceftriaxone; Cerebrospinal Fluid; Cerebrospinal Fluid Pressure; Diagnosis, Differential; Drainage; Fluconazole; Humans; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal; Metronidazole; Spinal Puncture; Teicoplanin

We report an unusual case of brain aspergillosis with multiple recurrent abscess in a 40 year-old immunocompetent woman, with good therapeutical outcome. The patient presented a subarachnoid hemorrhage caused by a ruptured pericallosal artery aneurysm and was submitted to a craniotomy for aneurysm surgery. Five months later, she developed multiple Aspergillus cerebral abscess. Two craniotomies and amphotericin B became necessary during treatment. Fourteen years later, she is asymptomatic. Treatment of brain aspergillosis abscess implied the combination of both surgical and drug therapy with amphotericin B.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillus; Brain Abscess; Female; Fluconazole; Follow-Up Studies; Humans; Immunocompetence; Intracranial Aneurysm; Neuroaspergillosis; Postoperative Complications; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Abscess; Candida albicans; Candidiasis; Caspofungin; Echinocandins; Endocarditis; Fluconazole; Heart Valve Prosthesis; Humans; Lipopeptides; Male; Peptides, Cyclic; Treatment Failure

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Brain Abscess; Caspofungin; Combined Modality Therapy; Contraindications; Craniotomy; Diabetes Complications; Diabetes Mellitus; Drug Hypersensitivity; Echinocandins; Female; Follow-Up Studies; Humans; Lipopeptides; Magnetic Resonance Imaging; Peptides; Peptides, Cyclic; Risk Assessment; Treatment Outcome

An 11-year-old boy with alveolar rhabdomyosarcoma of the thigh experienced three instances of catheter-related bacteremia resulting from After two episodes of seizures, two low-density lesions in the right parietal lobe and the left corpus callosum with enhanced pericavitary opacity were detected. The catheter was removed. A brain biopsy sample grew and revealed dichotomously branched septate hyphae compatible with The patient was treated with ceftriaxone and liposomal amphotericin B for 12 and 52 weeks, respectively, until biopsy-confirmed resolution of the infections.

Topics: Amphotericin B; Aspergillus; Bacillus cereus; Brain Abscess; Child; Humans; Magnetic Resonance Imaging; Male; Rhabdomyosarcoma, Alveolar

We report on a case of cryptococcal intramedullary abscess, which occurred three years after a disseminated cryptococcosis and two years after a lymph node cryptococcal recurrence in a HIV-infected patient who exhibited a long-standing immune restoration. At the time of diagnosis, CD4(+) lymphocyte-count was 640x10(6)/l and HIV viral load was undetectable. Spinal involvement is rare during cryptococcosis of the central nervous system. As far as we are aware, there is only one case of proven intramedullary cryptococcal abscess reported in the literature and this case is then the second one. The significant and sustained increase in CD4 count following effective antiretroviral therapy was probably associated with only a partial immune restitution that did not allow to avoid the occurrence of the cryptococcal medullar abscess. Finally, this case raises the question of when to stop secondary prophylaxis of cryptococcal disease after increase in CD4 cell count under antiretroviral therapy.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Brain Abscess; Cryptococcosis; Cryptococcus neoformans; Fluconazole; Flucytosine; Humans; Male

Aspergillus brain abscess is a rare but frequently fatal disease. Despite the scarcity of reported survivors, a combination of medication and surgical treatment might be effective. We report a 37-year-old man who developed multiple aspergillus brain abscesses after severe bacterial pneumonia. The following strategy was used to treat the patient: diagnostic puncture of one of the abscesses, long-term treatment with medication, excision of chronic granuloma in the occipital lobe and fourth ventricle, surgical treatment of the hydrocephalus. Following various surgical and antifungal treatments, the patient survived. Nearly three years after discharge, he still is in good physical condition and has a moderate neurologic deficit. Only 36 patients have been reported to have survived longer than three months after receiving treatment for brain aspergillosis. A course of medication in combination with various surgical procedures was required to achieve a successful outcome in this otherwise fatal disease.

Topics: Adult; Amphotericin B; Aspergillus niger; Brain Abscess; Brain Damage, Chronic; Combined Modality Therapy; Diagnosis, Differential; Follow-Up Studies; Fourth Ventricle; Frontal Lobe; Humans; Hydrocephalus; Male; Neuroaspergillosis; Neurologic Examination; Postoperative Complications; Punctures; Reoperation; Slovenia; Survivors; Tomography, X-Ray Computed

We describe in detail a 67-yr-old woman who was treated with a cytostatic combination chemotherapy for newly diagnosed common-acute lymphoblastic leukaemia. At the end of induction therapy, the patient acquired invasive mould infection affecting lung and brain. The patient entered complete remission of her leukaemia. Treatment with liposomal amphotericin B was initiated along with surgical excision of the fungal brain abscess. Intrathecal instillation of amphotericin B deoxycholate was started using an Ommaya reservoir because of an anatomical connection between the postoperative cavity and the ventricle. Full dose cytostatic chemotherapy was continued with little delay. A computerised tomography scan of the chest performed 2 months later revealed no fungal abscesses. Magnetic resonance imaging of the brain did not reveal any fungal manifestation. During maintenance therapy/week 69, the patient relapsed from leukaemia. High doses of intravenous liposomal amphotericin B were administered prophylactically. The patient's leukaemia proved refractory to reinduction chemotherapy and the patient died from pneumonia 8 wk later. Post mortem microbiological investigation and histopathological examination of lung and brain tissue did not reveal any macroscopical or microscopical fungal manifestations. This case underlines the feasibility and successful application of combined antileukaemic, antifungal and surgical therapy in a patient with acute leukaemia.

Topics: Aged; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Brain Abscess; Combined Modality Therapy; Craniotomy; Deoxycholic Acid; Drug Combinations; Fatal Outcome; Female; Humans; Immunocompromised Host; Infusions, Intravenous; Injections, Spinal; Liposomes; Lung Abscess; Lung Diseases, Fungal; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Neuroaspergillosis; Pneumonia, Pneumococcal; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction; Tomography, X-Ray Computed

We report the first documented case of brain abscess due to the dematiaceous fungus Microascus cinereus, an organism common in soil and stored grain. M. cinereus was isolated from brain abscess material from a bone marrow transplant recipient. The patient responded well to treatment by amphotericin B lipid complex, itraconazole, and a craniotomy but later died from secondary complications caused by graft-versus-host disease.

Topics: Adult; Amphotericin B; Ascomycota; Bone Marrow Transplantation; Brain Abscess; Central Nervous System Fungal Infections; Craniotomy; Drug Combinations; Female; Graft vs Host Disease; Humans; Itraconazole; Phosphatidylcholines; Phosphatidylglycerols

Cerebral aspergillosis carries a high mortality in immunocompromised patients. However, favorable outcome can be achieved by the prolonged use of antifungal agents and the maintenance of adequate drug levels. The authors report a 2-year-old girl who developed an aspergillus brain abscess during treatment for acute lymphoblastic leukemia. Predisposing factors for the fungal infection and details of the antifungal therapy are described. Prolonged treatment with AmBisome and 5-flucytosine successfully eradicated the lesion, but the girl's antileukemic therapy was compromised due to the infection. She developed a central nervous system and bone marrow relapse 9 and 15 months, respectively, after the initial presentation. The report emphasizes the need for further consideration of effective, long-term antifungal prophylaxis and a careful balance between aggressive treatment for severe infection and antileukemic therapy.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Agents; Aspergillosis; Aspergillus fumigatus; Brain Abscess; Cerebral Cortex; Child, Preschool; Female; Flucytosine; Humans; Immunosuppression Therapy; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Brain Abscess; Granulomatous Disease, Chronic; Humans; Male; Recurrence

Although abundant in nature, fungi are infrequently pathogenic in humans. CNS fungal infections in non-immunocompromised individuals are uncommon. We discuss here the case of an otherwise healthy black woman with an isolated mass of the cerebellopontine angle identified as Blastomyces dermatitidis, successfully treated with surgical resection of the mass and intravenous amphotericin B therapy.

Topics: Adult; Amphotericin B; Blastomyces; Brain Abscess; Cerebellar Diseases; Combined Modality Therapy; Female; Humans; Magnetic Resonance Imaging

Rhinocerebral mucormycosis is extremely difficult to treat. Approximately 70% of patients are poorly controlled diabetics, and many of the remainder are immunocompromised as a consequence of cytotoxic drugs, burn injuries, or end-stage renal disease. Despite standard treatment consisting of surgical debridement and the intravenous administration of amphotericin B, rhinocerebral mucormycosis is usually a fatal disease.. We describe the case of a 16-year-old male patient with juvenile onset diabetes mellitus who presented with fever, right-sided hemiparesis, and dysarthria. Axial view computed tomography revealed abscess formation in the left basal ganglia and frontal lobe, which was proven by stereotactic biopsy to contain Rhizopus oryzae.. Intravenous administration of amphotericin B (30-280 mg/dose) was begun on the day of admission. On hospital Day 20, after the occurrence of frank abscess formation, the lesion was aggressively debrided. Despite these therapies, there was neurological deterioration characterized by the development of hemiplegia and aphasia. Sequential computed tomographic scans enhanced with contrast medium demonstrated progressively enlarging lesions. Ommaya reservoirs were placed into the abscess cavity and the frontal horn of the contralateral lateral ventricle. The patient was then treated with intracavitary/interstitial injections of amphotericin B during the course of 80 days and three doses of intraventricular amphotericin B. Clinical and radiographic improvement was achieved after treatment. Two years after the initial diagnosis, magnetic resonance imaging of the brain showed no evidence of disease and an examination revealed a neurologically intact and fully functional patient.. We conclude that with an infection as morbid as rhinocerebral mucormycosis, it is advisable to use surgical debridement and all available routes for delivering amphotericin B to infected cerebral parenchyma, which include intravenous, intracavitary/interstitial, and cerebrospinal fluid perfusion pathways.

Topics: Adolescent; Amphotericin B; Brain Abscess; Brain Diseases; Debridement; Humans; Injections, Intravenous; Injections, Intraventricular; Male; Mucormycosis; Nose Diseases; Tomography, X-Ray Computed

Topics: Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Brain Abscess; Female; Hematopoietic Stem Cell Transplantation; Humans; Itraconazole; Liposomes; Lung Diseases, Fungal; Tomography, X-Ray Computed

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Brain; Brain Abscess; Drug Carriers; Humans; Kidney Transplantation; Liposomes; Male; Postoperative Complications; Tomography, X-Ray Computed

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Brain Abscess; Drug Carriers; Follow-Up Studies; Humans; Kidney Transplantation; Liposomes; Magnetic Resonance Imaging; Male; Middle Aged; Opportunistic Infections; Safety

We describe an unusual case of a late presentation of a fungal brain abscess in a non-neutropenic child 1 year after completing chemotherapy for M5 acute myeloid leukaemia (AML). Biopsy of the mass identified candidal hyphae and the patient was treated with 5 mg/kg of liposomal amphotericin B for 6 weeks. The lesion resolved completely and the child remains well 2 years later. Invasive fungal infection should be included in the differential diagnosis of unexplained symptoms in patients who have previously received intensive chemotherapy.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Agents; Brain Abscess; Candidiasis; Child, Preschool; Female; Humans; Leukemia, Monocytic, Acute

Invasive opportunistic mycoses are common complications in patients suffering from hematological disorders. Brain abscesses in the immunocompromised host are known to be most frequently caused by fungi of the Aspergillus species and are often associated with concomitant pulmonary disease. As the penetration of the currently available antifungal agents into the brain tissue is limited, only very few patients have been described to survive this life-threatening condition. We report the case of a 62 year old female patient who presented with multiple aspergillus brain abscesses during prolonged neutropenia following induction chemotherapy for acute myeloblastic leukemia and was successfully treated with high dose (8 mg/kg/day) liposomal amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Brain Abscess; Female; Humans; Leukemia, Myeloid, Acute; Liposomes; Middle Aged

Gas-containing brain abscesses are rare, and the vast majority are caused by Clostridium perfringens. Significant simultaneous fungal infection in a bacterial abscess is even rarer. We present such a case and review the literature.. A 21-month-old male patient sustained a penetrating head injury in a barnyard, developed a gas-containing left parietal brain abscess, and presented with high fever, galeal swelling, and seizure.. The patient initially underwent debridement of his wound and then repeated aspirations. The initial cultures revealed pure growth of Clostridium perfringens. Despite appropriate antibiotic therapy, serial neuroimaging did not demonstrate a decrease in the size of the cavity. An excision had to be undertaken 6 weeks after the injury. The culture from the excised specimen revealed an unexpected growth of a saprophytic and opportunistic fungus, Myceliophthora thermophila. Antifungal treatment consisting of the administration of liposomal amphotericin B and itraconazole was then performed. The child was well and neurologically intact 6 months after the excision.. Our review revealed 38 cases of clostridial brain abscess in the literature. Despite the reputation of the organism, the outcome with clostridial brain abscesses was relatively benign. The main characteristics of clostridial brain abscesses are highlighted, with reference to their optimal treatment. Our review also revealed that fungal infection after a penetrating head injury is extremely rare and often fatal. Our case seems to be the first in the medical literature with growth of M. thermophila as a causative agent for intracranial suppuration.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Brain Abscess; Craniocerebral Trauma; Gas Gangrene; Humans; Infant; Itraconazole; Male; Mycoses; Tomography, X-Ray Computed

A case of cerebral aspergillosis during induction chemotherapy for acute lymphoblastic leukemia was described. A 5-year-old boy complained of headache and left homonymous hemianopsia during induction chemotherapy for acute lymphoblastic leukemia. CT scan and MR imaging survey demonstrated cerebral fungal lesion as well as multifocal lung lesions. A cerebral lesion appeared as a low density mass in right occipital lobe with marginal enhancement on CT scan, and iso- and high-signal intensity appeared with marginal gadolinium enhancement on T1- and T2-weighted MR imaging. Although fungus balls in the lung responded well to daily intravenous administration of amphotericin-B for 2 months, the cerebral lesion showed a rather expansive character as invading into neighbouring falx, opposite occipital lobe, meninges, and occipital bone. Extensive removal of the brain lesion from the parenchyma, falx, invaded dura, and skull was surgically performed. The lesion was confirmed as aspergillosis by Grocott's methenamine histological stain. Surgical intervention and concomitant use of amphotericin-B for a month resulted in complete remission of the aspergillosis. After 6 years, a cranioplasty was successfully completed for the occipital bone defect.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Aspergillosis; Brain Abscess; Child, Preschool; Cyclophosphamide; Humans; Magnetic Resonance Imaging; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Tomography, X-Ray Computed; Vincristine

We describe a patient who developed Candida albicans brain abscess associated with prominent vascular invasion following an episode of central venous catheter-related fungemia. The increasing population of immunosuppressed patients and the frequent use of broad-spectrum antimicrobials, corticosteroids, chemotherapeutics, organ transplantation, and prolonged supportive measures are responsible for an increasing incidence of candidal infections. Brain abscess is a rare complication of candidemia but may be expected to become more common as venous catheter-related fungemia is encountered more frequently.

Topics: Amphotericin B; Arterial Occlusive Diseases; Brain; Brain Abscess; Candida albicans; Candidiasis; Carotid Artery Diseases; Carotid Artery, Internal; Catheterization, Central Venous; Cerebral Arteries; Craniotomy; Drug Therapy, Combination; Flucytosine; Fungemia; Humans; Magnetic Resonance Angiography; Male; Middle Aged; Tomography, X-Ray Computed

Topics: Amphotericin B; Brain Abscess; Candidiasis; Drug Therapy, Combination; Female; Fluconazole; Flucytosine; Fungemia; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Tomography, X-Ray Computed

A 53-year-old male with normal immunity presented with Aspergillus brain abscess manifesting as frontal headache. T2-weighted magnetic resonance imaging revealed a hypointense lesion in the left frontal lobe extending into the right frontal lobe. The hypointense appearance on T2-weighted images appears to be characteristic of aspergillosis. Bifrontal craniotomy exposed an elastic-hard mass in the base of the left frontal lobe extending into the right frontal lobe, and into the left ethmoid sinus. The mass contained a cavity with white fluid. The abscess was removed almost totally. The histological diagnosis was Aspergillus abscess. Antibiotic treatment with amphotericin B and fluconazole was given for 2 months postoperatively. No recurrence was identified during 15-month follow-up.

Topics: Amphotericin B; Aspergillosis; Brain Abscess; Combined Modality Therapy; Fluconazole; Frontal Lobe; Humans; Lymphocyte Activation; Male; Middle Aged; Tomography, X-Ray Computed

Lumbar puncture in a premature newborn undergoing therapy for sepsis revealed meningitis. Contrast-enhanced cranial tomography revealed multiple, homogeneously or ring-like enhanced lesions with peripheral edema. Cerebrospinal fluid culture showed growth of candida. Significant clinical recovery after Amphotericin-B treatment was noted. Follow-up CT examination showed regression of the lesions. Five months later no pathology was reported except small calcified granulomas and an area of encephalomalacia.

Topics: Amphotericin B; Brain Abscess; Candidiasis; Humans; Infant, Newborn; Infant, Premature; Male; Meningitis, Fungal; Tomography, X-Ray Computed

Topics: Adult; Amphotericin B; Antibodies, Fungal; Aspergillosis, Allergic Bronchopulmonary; Aspergillus fumigatus; Brain Abscess; Combined Modality Therapy; Humans; Hypersensitivity; Immunoglobulin A; Male; Sinusitis

Topics: Amphotericin B; Brain Abscess; Debridement; Humans; Male; Middle Aged; Mucormycosis; Rhizopus

Intrathecal administration of amphotericin B is the best method of eradicating intracranial fungal infections. The Ommaya reservoir provides an easy and practical method for fungicidal medication administration. Treatment of coccidioidomycosis with amphotericin B may be accomplished via an Ommaya reservoir. Astute nursing care is essential to prevent complications associated with this procedure.

Topics: Amphotericin B; Brain Abscess; Catheters, Indwelling; Cerebral Ventricles; Coccidioidomycosis; Humans; Injections, Spinal; Male; Meningitis; Middle Aged; Patient Care Planning

Primary amoebic meningoencephalitis due to Naegleria fowleri was found in a 38-year-old Chinese man living in Hong Kong who presumably acquired the infection from swimming in a hot spring in neighbouring China. Amoebic cysts were identified in tissue taken from a brain abscess. The patient responded to surgical drainage and a 6-week course of amphotericin B, rifampicin and chloramphenicol. This is one of 6 cases of successful treatment of primary amoebic meningoencephalitis documented in the medical literature.

Topics: Adult; Amebiasis; Amphotericin B; Animals; Brain Abscess; Chloramphenicol; Combined Modality Therapy; Craniotomy; Drainage; Drug Therapy, Combination; Hong Kong; Humans; Male; Meningoencephalitis; Naegleria fowleri; Rifampin

A unique case of Candida albicans ventriculitis and hydrocephalus in the absence of any evidence of systemic candidiasis or immunosuppression is reported. Initial treatment with CSF shunting and intravenous antimycotic therapy appeared to have eradicated the infection. Recurrence occurred 5 months after discharge and this was treated by intravenous and intrathecal antimycotic therapy in addition to removal of the shunt system, external ventricular drainage and then replacement of the shunt. A concomitant pyogenic brain abscess responded to burrhole aspiration and antibiotics. The role of mannan antigen monitoring is discussed.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Brain Abscess; Candidiasis; Cerebral Ventricles; Cerebrospinal Fluid; Combined Modality Therapy; Drug Therapy, Combination; Female; Flucytosine; Humans; Hydrocephalus; Itraconazole; Ketoconazole; Ventriculoperitoneal Shunt

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Brain Abscess; Dexamethasone; Diagnosis, Differential; Humans; Male; Meningitis, Aseptic; Middle Aged; Prednisone

Rhinocerebral mucormycosis is a rare but often fatal condition characterized by an aggressive necrotizing infection spreading from the nose to the paranasal sinuses, orbit and hence to the central nervous system. A case is reported in which a diabetic male with advanced mucormycosis was successfully treated by a combination of surgery, supportive therapy and liposomal amphotericin B. Liposomal delivery allows the drug to be both less toxic and more effective, and this is the first reported case of its use in rhinocerebral mucormycosis.

Topics: Amphotericin B; Brain Abscess; Brain Diseases; Combined Modality Therapy; Drug Carriers; Humans; Liposomes; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases; Paranasal Sinus Diseases; Pharmaceutical Vehicles

A 60-year-old man with a 9-year history of malignant lymphoma developed an initial pulmonary infection with Nocardia asteroides which later disseminated to the central nervous system with multiple brain abscesses. He was treated successfully with intravenous trimethoprim-sulfamethoxazole for 6 weeks. A follow-up computed tomography (CT) scan showed complete resolution of the abscesses. Two years later, he returned to the hospital with a 2-week history of confusion, loss of concentration, ataxia, and leaning to the left. A CT scan revealed an enhancing multiloculated complex right frontal lesion. Craniotomy revealed a large right frontal lobe abscess, which was totally resected. Histopathologic examination of the resected tissue revealed multiple, lightly pigmented, septate, branched hyphal elements typical of phaeohyphomycosis. The fungal isolate cultured from the tissue was a dematiaceous, thermotolerant fungus that was identified as Ochroconis gallopavum. Despite treatment with amphotericin B, flucytosine and fluconazole, the patient gradually deteriorated and died. This case represents the third fatal infection, the second from the southeastern United States, due to O. gallopavum.

Topics: Amphotericin B; Brain; Brain Abscess; Fluconazole; Flucytosine; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Middle Aged; Mitosporic Fungi; Mycoses; United States

We report on a case of a 26-year-old intravenous narcotic abuser with a primary cerebral mucormycotic abscess caused by Rhizopus oryzae. He was treated with a combination of intravenous and intraventricular amphotericin B and surgical drainage with a successful outcome. There was no evidence that his infection was acquired by the rhinocerebral route, it seems likely that he injected himself with a contaminated batch of narcotic or amphetamine. Mucormycosis presenting in this way has been described previously but this is only the second such case to survive. Early diagnosis and treatment is essential for a favourable outcome in this condition.

Topics: Adult; Amphotericin B; Brain Abscess; Humans; Infusions, Intravenous; Injections, Intraventricular; Male; Mucormycosis; Substance Abuse, Intravenous; Tomography, X-Ray Computed

A 24-year-old man with an 11-year history of i.v. drug use rapidly developed parkinsonism clinically indistinguishable from MPTP toxicity and Parkinson's disease. Although tests were negative for the human immunodeficiency virus, radiologic evaluation revealed bilateral striatal lesions. Stereotactic biopsy demonstrated septate hyphae consistent with either aspergillosis or mucormycosis. Gradual improvement followed systemic therapy with amphotericin B.

Topics: Adult; Amphotericin B; Brain Abscess; Brain Diseases; Corpus Striatum; Humans; Male; Mycoses; Parkinson Disease, Secondary; Substance Abuse, Intravenous

A boy with newly diagnosed acute lymphoblastic leukaemia developed mycotic cerebral abscesses despite treatment with amphotericin. He survived this episode on combination antifungal treatment.

Topics: Adolescent; Amphotericin B; Brain Abscess; Candidiasis; Humans; Leukemia, Lymphoid; Male

Rhinocerebral mucormycosis is a devastating fungal disease with a high mortality rate. Extensive surgical débridement and amphotericin B are currently the mainstays of therapy. When cerebral extension of the fungus occurs, the disease is almost invariably fatal. Two patients with rhinocerebral mucormycosis had progression of their infection to brain abscesses despite aggressive débridement surgery and amphotericin B therapy. Both patients showed marked clinical improvement with the addition of adjunctive hyperbaric oxygen therapy. Both patients remained free of their disease 21 months after hospital discharge.

Topics: Adult; Amphotericin B; Brain Abscess; Brain Diseases; Combined Modality Therapy; Debridement; Female; Humans; Hyperbaric Oxygenation; Ketoconazole; Middle Aged; Mucormycosis; Nose Diseases; Prognosis; Time Factors; Tomography, X-Ray Computed

Multiple phaeohyphomycotic brain abscesses caused by Cladosporium species occurred in a 55 year old woman. No immunological abnormality could be detected. The disease ran a protracted course for a total of 20 months before she died from sudden rupture of an abscess loculus into the ventricular system. Course was characterised by spontaneous remissions and relapses totally independent of adequate doses and prolonged regimes of all the three available anti-fungal chemotherapeutic agents, namely amphotericin B, flucytosine and ketoconazole. Three surgical procedures were carried out; and surgical intervention appeared to be the only modality of treatment capable of prolonging the life or altering the course of the disease. An interesting transitory pulmonary phase of phaeohyphomycosis resembling miliary tuberculosis was noticed. This may help to explain the portal of entry and mole of spread of the fungus to the brain. A dematiaceous fungus was isolated from these abscesses. Mycologic features and histology of brain lesions are described.

Topics: Amphotericin B; Brain Abscess; Cladosporium; Drug Therapy, Combination; Female; Flucytosine; Humans; Ketoconazole; Middle Aged; Mycoses

A case of aspergillotic abscess with granuloma is reported. A 45-year-old man was admitted to our hospital on Apr. 10, 1984 due to the rupture of an aneurysm of the anterior communicating artery. Neck clipping of the aneurysm was proposed on Apr. 12, 1984, but was not performed because of cardiac arrest with unknown etiology during the operation. Neck clipping was performed on Apr. 23, 1984. Antibiotic therapy was prolonged for about three weeks. About 6 months after surgery, he was readmitted on Oct. 12, 1984 with the chief complaint of general fatigue and headache. On readmission, laboratory examinations were normal except for leukocytosis, elevated ESR and positive CRP. Neurological examination revealed left papilledema, disorientation and memory disturbance. On lumbar puncture, the cerebrospinal fluid showed 2 lymphocytes, 71 mg percent protein, 94 mg percent glucose. The skull and chest X-ray findings were normal. The CT scan revealed an irregular low density area in the left frontal lobe with abnormal enhancement. Steroids and antibiotic therapy were initiated. Since mass signs on CT scan increased gradually, partial removal of abscess and granuloma was performed on Nov. 5, 1984. From the necrotic granuloma, Aspergillus was microscopically recognized and Aspergillus fumigatus was cultured on Sabouraud's medium. Immunologically, serum immunoglobulin levels and the subset of lymphocytes were normal. Tuberculin reaction was negative. After the operation, amphotericin-B and 5-fluorocytosine (5-FC) were administered. Nevertheless mass signs on CT scan increased again. The fourth operation was performed on Dec. 6, 1984.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Brain Abscess; Circle of Willis; Combined Modality Therapy; Drug Therapy, Combination; Flucytosine; Humans; Intracranial Aneurysm; Male; Middle Aged; Tomography, X-Ray Computed

The case of a solitary cerebellar abscess in a 36-year-old Rwandese male is described. First it was considered to be tuberculosis, but at microscopal examination of the lesion after neurosurgical excision the true germ was found: Blastomyces dermatitidis. This solitary intracerebellar blastomycosis abscess is only the fifth case reported worldwide and the first in African medical annals.

Topics: Adult; Amphotericin B; Blastomycosis; Brain Abscess; Cerebellar Diseases; Cerebellum; Humans; Male; Microscopy, Electron; Rwanda; Tomography, X-Ray Computed

In addition to the well-known infectious complications of intravenous narcotic abuse, a much rarer and more recently recognized association between intravenous narcotic addiction and mucormycotic abscesses of the central nervous system has been described. Only four cases have been cited in the literature, with a mortality rate of 100 percent in this group. This report describes a narcotic abuser who presented with obstructive hydrocephalus and a mucormycotic abscess of the brain stem, and recovered. Central nervous system mucormycosis should be included in the differential diagnosis of drug abusers who present with a rapid deterioration in neurologic status.

Topics: Adult; Amphotericin B; Brain Abscess; Brain Stem; Female; Humans; Hydrocephalus; Mucormycosis; Pentazocine; Substance-Related Disorders; Tripelennamine

A 22 year-old man died from multiple cerebral abscesses due to Petriellidium boydii 4 1/2 months after an episode of near drowning. The autopsy showed dissemination to heart and kidney. This patient had no immunocompromising disease but was treated with corticosteroids. The treatment of this condition with ventricular shunting and amphotericin B is discussed and compared with the experience of ten other cases reported in the literature.

Topics: Adult; Amphotericin B; Brain; Brain Abscess; Cerebrospinal Fluid Shunts; Humans; Hydrocortisone; Male; Mycoses; Xylariales

A brain abscess caused by a new variety of Cladosporium trichoides occurred in a previously healthy man. A reversed T-suppressor/helper cell ratio was noted as the only immunologic abnormality. He required three surgical procedures, the last an occipital lobectomy, and antifungal chemotherapy to control his disease. He received 2,068 mg of amphotericin B and one year of flucytosine at 6 g per day. Ten months after the last surgery he is without evidence of disease. C. trichoides var. chlamydosporum was isolated from the abscess. It differed from C. trichoides by producing chlamydospores in vitro and only hyphae in the brain abscess. On modified Sabouraud agar, the fungus did not grow at 25 degrees C and grew poorly at 30 degrees C and 37 degrees C. Histologic sections revealed necrosis, no encapsulation, and no epitheliod cells.

Topics: Amphotericin B; Brain Abscess; Cladosporium; Flucytosine; Humans; Male; Middle Aged; Mitosporic Fungi; Mycoses; T-Lymphocytes, Helper-Inducer; T-Lymphocytes, Regulatory

A case of extensive rhinocerebral mucormycosis, with associated bilateral brain abscesses, occurred in a man with diabetes. A Rhizopus sp grew from the initial nasal biopsy specimens. Successful therapy consisted of correcting metabolic acidosis, using serial computed tomographic (CT) scans to follow the progressive course of brain involvement from cerebritis to encapsulated abscesses, and performing successive biopsies to determine the adequacy of treatment. On 18-month follow-up, the patient had returned to full-time employment with minimal neurologic impairment. With CT scanning and aggressive therapy, rhinocerebral mucormycosis with bilateral brain involvement can be cured.

Topics: Adult; Amphotericin B; Brain Abscess; Diabetes Complications; Humans; Male; Mucormycosis

A favourable outcome was observed in a 12 year-old boy who developed invasive pulmonary and cerebral aspergillosis during antineoplastic treatment for central nervous system relapse of acute lymphoblastic leukemia. Combination therapy with amphotericin B and 5-Fluorocytosine led to complete regression of pulmonary infiltrates. Despite enlargement of the cerebral lesion monitored by computerized tomography, no viable fungi were found in the completely resected abscess after a 4 weeks' course of antifungal treatment preceding neurosurgery. Histological examination confirmed the diagnosis of an aspergillotic abscess. The initially severe neurological symptoms disappeared after successful surgery. Aspergillus fumigatus was detected in the soil of a potted ornamental plant in the mother's living room, suggesting that this might have been the source of the infectious agent.

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Brain Abscess; Child; Flucytosine; Humans; Immunosuppression Therapy; Leukemia, Lymphoid; Lung Diseases, Fungal; Male; Meningeal Neoplasms

A case is presented of a cerebral abscess in a 59-yr-old woman caused by the dematiaceous fungus Cladosporium bantianum (Sacc.) Borelli (= Cladosporium trichoides Emmons). The morphological and physiological properties of the isolate and its pathogenicity for experimental animals were investigated and compared with some other Cladosporium species. The neurotropism exhibited by C. bantianum in human infections was found also in the test animals. Despite surgical excision and therapy with the antifungal drugs amphotericin B and flucytosine, the case had a fatal outcome, the patient dying from a pulmonary embolism 6 mth after the onset of symptoms. The clinical entity of central nervous system infections by dematiaceous fungi is discussed in relation to the present case.

Topics: Amphotericin B; Brain Abscess; Cladosporium; Female; Flucytosine; Humans; Hydrocephalus; Microbiological Techniques; Middle Aged; Mitosporic Fungi; Mycoses; Pulmonary Embolism

The CT features of a young female patient suffering from systemic candidiasis with intracerebral manifestation are reported. The definite diagnosis was made by spinal fluid cultures. The diffuse granulomatous lesions as well as an abscess formation remitted after specific therapy with 5-fluorocytosine and amphotericin B for now more than 1 year. In contrast to reports of other cases with mycosis of the central nervous system this case of candidiasis shows lesions of primarily increased attenuation coefficients.

Topics: Adult; Amphotericin B; Brain Abscess; Candidiasis; Female; Flucytosine; Granuloma; Humans; Tomography, X-Ray Computed

Pituitary abscess is an unusual cause of sella turcica enlargement. Because its presentation closely mimics that of a pituitary tumor, the condition is seldom recognized preoperatively. Most cases have been of bacterial etiology; however, a single patient with a primary mycotic pituitary abscess secondary to Aspergillus species has been reported. That patient died of diffuse Aspergillus meningoencephalitis following a transfrontal craniotomy. In the present case, a woman with primary pituitary aspergillosis survived her infection with virtually intact pituitary function following a transsphenoidal approach which avoided contamination of cerebrospinal fluid. Postoperative amphotericin-B and 5-fluorocytosine therapy probably contributed greatly to her survival. Factors that should alert the clinician to the presence of a pituitary abscess in a patient with sella turcica enlargement are prior episodes of meningitis, sinusitis, or cerebrospinal fluid abnormalities, including pleocytosis, depressed glucose, and elevated protein.

Topics: Amphotericin B; Aspergillosis; Brain Abscess; Cytosine; Drug Therapy, Combination; Female; Flucytosine; Humans; Middle Aged; Pituitary Diseases; Postoperative Period

For ten years, a 25-year-old immune-competent man experienced a progressive disseminated infection with the saprophytic soil fungus, Curvularia lunata, following presumptive cutaneous inoculation while playing football. Deep, soft tissue abscesses, pulmonary suppuration, paravertebral abscess, and cerebral abscess all followed leg ulcers from neglected abrasions. The patient's delay in obtaining treatment was partially responsible for the paravertebral-mediastinal-pleural-cutaneous fistula that resulted. The importance of prompt and aggressive surgical drainage procedures is clear. Infection was arrested only by surgery. The fungus was inhibited by miconazole nitrate and amphotericin B but it developed resistance to flucytosine. Miconazole appeared to cause resolution of the cerebral abscess. Amphotericin B (1 mg/kg/day) clearly was beneficial but only after effective drainage procedures were done. The patient refused to continue amphotericin B after 5.4 g had been given in two treatments. He became bedridden one year later from back pain that was caused by recurrent disease.

Topics: Abscess; Adult; Amphotericin B; Athletic Injuries; Brain Abscess; Drainage; Football; Humans; Leg Ulcer; Male; Miconazole; Mitosporic Fungi; Mycoses

A 3-year-old boy with acute lymphoblastic leukemia developed a right frontal lobe abscess from which Allescheria (Petriellidium) boydii was cultured. The mycotic infection complicating his underlying disease appeared to be confined to the brain. Surgical drainage and therapy with amphotericin B were followed by eventual recovery with no neurologic deficits.

Topics: Amphotericin B; Ascomycota; Brain Abscess; Child, Preschool; Drainage; Humans; Leukemia, Lymphoid; Male; Mycoses

Two patients with rhinocerebral phycomycosis associated with diabetes are presented. The chronic nature of the illness in these two cases in emphasized in contrast to the more fulminant course of most previously reported patients. A high index of suspicion is needed to establish the diagnosis as rapidly as possible. Treatment of the underlying disease combined with amphotericin B therapy and radical surgical excision of all infected tissue is important to establish cure of these patients.

Topics: Adult; Amphotericin B; Brain Abscess; Diabetes Complications; Female; Fungi; Humans; Male; Middle Aged; Mycoses; Nose Diseases

Topics: Amphotericin B; Ampicillin; Brain Abscess; Candidiasis; Cryptococcosis; Enterobacteriaceae Infections; Esophagitis; Herpes Simplex; Humans; Infections; Meningitis; Meningitis, Listeria; Mucormycosis; Neoplasms; Pharyngitis; Stomatitis; Toxoplasmosis

The third reported case of prosthetic valvular endocarditis caused by the fungus Paecilomyces is presented. The clinical course of the patient is discussed. The distinctive morphology of the fungus is described, together with the histologic and cytologic features found in the excised prosthetic valve and in the tissues at autopsy. Prosthetic valvular endocarditis presents a serious antibiotic and surgical problem in therapy. Despite antifungal antibiotics and valve replacement this patient died as a result of metastatic cerebral microabscesses and subarachnoid hemorrhage.

Topics: Amphotericin B; Autopsy; Brain Abscess; Candidiasis; Cytosine; Endocarditis; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitosporic Fungi; Subarachnoid Hemorrhage

A case of cerebellar abscess due to Blastomyces dermatitidis is reported and the literature of central nervous system blastomycosis is reviewed. The case is of interest for two reasons: 1. No obvious site of primary blastomycotic infection was found, despite an extensive search. 2. The focal blastomycotic involvement of the CNS was not associated with meningitis. Only two other such cases are explicitly reported in the literature.

Topics: Amphotericin B; Ampicillin; Animals; Autopsy; Biopsy; Blastomyces; Blastomycosis; Brain Abscess; Cerebellar Diseases; Cerebellum; Humans; Male; Mice; Middle Aged

Topics: Amphotericin B; Anticonvulsants; Blood Sedimentation; Brain Abscess; Cerebral Cortex; Chromoblastomycosis; Electroencephalography; Humans; Immunoglobulin G; Immunoglobulin M; Male; Middle Aged; Phialophora; Postoperative Complications; Radionuclide Imaging; Sulfonamides

Topics: Adult; Amphotericin B; Bacteriological Techniques; Biopsy; Brain Abscess; Cerebrospinal Fluid Proteins; Hemiplegia; Humans; Isoniazid; Joint Diseases; Lung Diseases; Male; Meningitis; Nocardia Infections; Polymyxins; Prednisone; Pseudomonas Infections; Sarcoidosis; Skin Diseases; Sporotrichosis; Tetracycline

Topics: Adolescent; Adult; Amphotericin B; Brain Abscess; Brain Neoplasms; Cerebral Ventriculography; Chronic Disease; Coccidioidomycosis; Complement Fixation Tests; Diagnosis, Differential; Female; Humans; Male; Meningitis; Skin Tests

Topics: Abscess; Amphotericin B; Brain Abscess; Candidiasis; Carrier State; Child; Chloramphenicol; Colistin; Deoxyribonucleases; DNA; Empyema; Enteritis; Humans; Kanamycin; Meningitis; Methicillin; Penicillins; Peritonitis; Phlebitis; Pneumonia; Pneumothorax; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Sulfadiazine; Troleandomycin