amphotericin-b and Brain-Diseases

Patients with diabetes are known as an important high-risk group for cerebral mucormycosis (CM).. We conducted a structured search using PubMed/MEDLINE to collect both case reports and case series case (ie including at least two patients) onto CM in diabetic patient published between 2000 and March 2020.. Forty-five reports of individual cases and eighteen case series articles were included. India accounted for the largest share of reports with 37.7% and 38.8% of individual cases and case series, respectively. Mortality ranged from 0% to 100% in the case series. The overall mortality in the individual cases was 46.3%, and 64.2% of deaths were reported in patients with ketoacidosis diabetes. Facial swelling (53.3%), headache (44.4%), loss of vision (35.5%) and ophthalmoplegia (35.5%) were the most frequently reported clinical symptoms. In all patients except 4 (91.1%), CM was treated surgically; however, in many cases (42%), despite the use of surgery, death occurred. Amphotericin B deoxycholate (AMB) and lipid-based AMB (LAMB) were used as the first lines of treatment for all patients; however, posaconazole, echinocandins, hyperbaric oxygen therapy (HBOT) and deferasirox were used in combination for a number of patients. Posaconazole has been shown to have positive therapeutic effect; however, posaconazole, LAMB and HBOT are not commonly used in low-income and health-challenged countries.. Cerebral mucormycosis is a rapidly progressive infection in diabetic patients and carries immense morbidity despite early diagnosis and treatment. Low-income countries have had the highest number of reports of the disease in recent years, indicating the need to control diabetes in these countries.

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Deoxycholic Acid; Diabetes Complications; Diabetes Mellitus; Drug Combinations; Humans; Mucormycosis; Risk Factors; Triazoles

Rhino-orbito-cerebral mucormycosis is an acute onset and often fatal disease. Risk factors include uncontrolled diabetes mellitus, hematological malignancies, and long-term corticosteroid use. Early diagnosis and treatment are important. The underlying causes should be treated, surgical debridement should be performed and appropriate antifungal drugs should be given. In this article, we report two diabetic ketoacidosis patients who developed rhino-orbito-cerebral mucormycosis and were treated with surgical debridement and amphotericin B therapy.

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Central Nervous System Fungal Infections; Debridement; Diabetic Ketoacidosis; Humans; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases; Risk Factors

Rhinocerebral mucormycosis is an invasive infection caused by filamentous fungi of the Mucoraceae family. The rhinocerebral form of the disease represents the most common form and has two distinct clinical entities. The common presentation consists of a rapidly progressive infection with high mortality rate, while the other presentation is that of a chronic infection with lower mortality. In the present paper we report a rare case of chronic rhinocerebral mucormycosis. An 85-year-old male with a 6-month history of purulent and odorous nasal discharge, and sporadic episodes of epistaxis and anosmia, presented to the outpatient department of our clinic. Initial cultures were positive only for Pseudomonas aeruginosa. The patient was unresponsive to ciprofloxacin treatment, developing necrotic areas of the nasal septum suspicious for rhinocerebral mucormycosis. Admission to the ENT clinic followed, with histopathologic evaluation of the vomer bone confirming the diagnosis. The patient was treated with amphotericin B and was discharged 3 weeks later on oral posaconazole therapy. Chronic rhinocerebral mucormycosis may present with atypical symptoms or coinfection with another agent. A high degree of clinical suspicion is required for correct diagnosis and prompt initiation of appropriate treatment.

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Brain Diseases; Humans; Male; Mucorales; Mucormycosis; Nose Diseases

In this retrospective study, we describe our experience in the diagnosis and management of rhinocerebral mucormycosis (RCM), a rapidly lethal fungal infection.. Between 1997 and 2007, five patients hospitalized for suspicion of RCM. Computed tomography was performed in all cases, and diagnosis was confirmed after anatomopathological or mycological examination. All patients underwent medical and surgical treatment. Follow-up was clinical and radiological with a mean period of 17 months.. All patients were diabetic. Exophthalmia, rhinorrhea, and ophthalmoplegia were the most frequent symptoms observed. One patient had loss of visual acuity and another exhibited peripheral facial palsy. One patient had extensive hemifacial cutaneous necrosis. Nasal endoscopy revealed black necrotic lesions in one case, and another patient had a tumefaction localised in the left middle meatus. Necrotic lesions were most often found in the orbit, the maxillary and the ethmoidal sinuses on computed tomography (four cases for each site). One patient had thrombophlebitis of the cavernous sinus, and another had an intracranial extension. All patients were administered ordinary insulin and intravenous amphotericin B. Surgical debridement of the nasal cavity and the involved sinuses was performed through lateral rhinotomy (four cases) or endoscopy (one case). Unilateral orbital exenteration was associated in two cases. Progression was favourable in four cases; one patient died from sepsis despite aggressive treatment.. Early diagnosis is crucial for the management of RCM. Treatment of underlying disorders, use of intravenous amphotericin B, and aggressive surgical intervention are key in reducing morbidity and mortality rates.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Debridement; Facial Paralysis; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mucormycosis; Nasal Cavity; Necrosis; Nose Diseases; Paranasal Sinus Diseases; Prognosis; Retrospective Studies; Tomography, X-Ray Computed; Visual Acuity; Young Adult

Zygomycosis is an invasive fungal infection with extremely high mortality caused by filamentous fungi which belong to Class Zygomycetes (Rhizopus spp., Mucor spp., Cunninghamella spp., etc). Despite of the similarities of the ecological characteristics and of the patients' backgrounds, zygomycosis is much rarer than invasive aspergillosis. In addition to well known immunosuppressive risk factors (hematological malignancy, hematopoietic stem cell or solid organ transplant, prolonged neutropenia, corticosteroid, etc), diabetic ketoacidosis, iron overload, and administration of deferoxamine are specific factors predisposing zygomycosis. Rhinocerebral, pulmonary and disseminated disease is characteristic forms. The mainstay of the treatment is surgical resection, reversal of immunosuppressive factors, and administration of high-dose amphotericin B or its liposomal formulation. Because of the difficulty of culture detection and the absence of reliable serological diagnostic methods, premortem diagnosis and no delaying of effective treatment remain a challenge to physicians.

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Central Nervous System Fungal Infections; Diabetes Complications; Drug Delivery Systems; Humans; Immunocompromised Host; Iron Overload; Liposomes; Lung Diseases, Fungal; Neutropenia; Prognosis; Risk Factors; Surgical Procedures, Operative; Zygomycosis

Rhino-orbito-cerebral mucormycosis (ROCM) is a rare, fulminant opportunistic fungal infection that is mostly seen in immunocompromised or diabetic patients. The disease should be recognised and treated immediately. We present here MR imaging findings of two patients with histopathologically proven ROCM. One of the cases had a history of corticosteroid treatment and iatrogenic diabetes mellitus and although amphotericin B was started immediately, the disease progressed and surgical debridement was necessary. The second case was a patient with diabetes mellitus type 1 in whom ROCM had occurred following an abdominal surgery; amphotericin B treatment alone was adequate in this patient.

Topics: Adrenal Cortex Hormones; Amphotericin B; Antifungal Agents; Brain Diseases; Diabetes Complications; Diabetes Mellitus, Type 1; Humans; Iatrogenic Disease; Immunocompromised Host; Male; Middle Aged; Mucormycosis; Nose Diseases; Opportunistic Infections; Orbital Diseases; Purpura, Thrombocytopenic, Idiopathic

Rhino-orbitocerebral mucormycosis (ROCM) caused by more common zygomycetes (e.g., Mucor) is known to cause rapidly fatal infections in immunocompromised patients. Apophysomyces elegans is an emerging zygomycete that has been reported to cause invasive cutaneous and rhino-orbitocerebral infections in immunocompetent individuals. Limited data exist describing the syndrome of ROCM caused by A. elegans. We describe a recent case and performed a comprehensive literature review to delineate the clinical characteristics of ROCM caused by A. elegans. Our case is a 50-year-old man with diabetes mellitus who presented with facial pain and right eye proptosis. Endoscopic sinus sampling revealed A. elegans. He was treated with liposomal amphotericin B and multiple debridements, with no disease on 1.5-year follow-up examination. Seven cases were identified on literature review, including the present case. Most patients (86%) were male, with a mean age of 40 years. Most patients (71%) did not have predisposing medical conditions. Three patients had predisposing head trauma. All presented with facial and/or periorbital pain. All had magnetic resonance imaging or computed tomography of the head showing intraorbital and/or sinus inflammation. Diagnosis was confirmed by histopathology and deep tissue culture in all cases. All patients required eye exenteration and extensive surgical debridement, in addition to intravenous amphotericin B. Six of the seven patients (86%) recovered. ROCM caused by A. elegans is rarely reported in the literature. Most such infections occurred in immunocompetent patients, often after facial trauma. Survival in ROCM caused by A. elegans is favorable in reported cases, with prompt surgical debridement and antifungal therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Mucorales; Mucormycosis; Nose Diseases; Orbit Evisceration; Orbital Diseases

Amphotericin B reformulated into the liposomal formulation known as AmBisome (amphotericin B, hydrogenated soy phosphatidylcholine, cholesterol and dimyristoyl phosphatidylglycerol) can be safely administered at dosages 15 times higher than the conventional drug with the same broad spectrum of activity. Increased doses demonstrate non-linear clearance with saturation of the reticuloendothelial system (RES) and redistribution of the drug into non-RES tissues. The efficacy of this liposomal amphotericin B formulation appears to be related both to improved tissue penetration in the lungs, brain, kidneys, liver and spleen along with sustained bioactivity of therapeutic drug levels in these target tissues.

Topics: Amphotericin B; Animals; Antifungal Agents; Brain Diseases; Dermatomycoses; Humans; Liver Diseases; Lung Diseases, Fungal; Mycoses; Splenic Diseases

Topics: Accidents, Traffic; Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Debridement; Humans; Immunocompetence; Male; Mucormycosis; Orbit Evisceration; Orbital Diseases; Paranasal Sinus Diseases; Soft Tissue Infections

A 24-year-old man presented with cerebral aspergillus fungal granuloma involving the left frontal region secondary to pulmonary aspergillosis. He was otherwise healthy with no evidence of immune-suppression. Because of poor penetration of amphotericin B into the brain and cerebrospinal fluid (CSF), this patient was treated by a combination of systemic and local therapy in addition to surgical excision resulting in a cure with follow up for more than three years. This form of treatment produced no untoward long-term side effects or neurological sequel. On review of the literature on aspergillosis of the central nervous system (CNS), we found that six patients, including the present case, have been reported who survived longer than 1 year; their treatment included local administration of antifungal agent in the abscess cavity or into cerebral ventricles in order to control this devastating, treatment-resistant pathological fungal infection.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Brain Diseases; Humans; Immunocompetence; Infusion Pumps, Implantable; Injections, Intraventricular; Lung Diseases, Fungal; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Brain Diseases; Diagnosis, Differential; Humans; Prognosis

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Diagnosis, Differential; Humans; Mucormycosis; Nose Diseases; Prognosis; Rhizopus; Risk Factors

We report a case of cerebral phaeohyphomycosis in a 36-year-old male caused by the neurotropic fungus Ramichloridium obovoideum (Matushima) de Hoog 1977 (Ramichloridium mackenziei Campbell et Al-Hedaithy 1993). This man resided in the Middle East, where the fungus appears to be endemic and, possibly, geographically restricted, since all previous reports of brain abscesses due to this organism have been for patients indigenous to this area. As a servant of the Saudi Arabian royal family, he appeared in the United States seeking treatment for chronic weight loss, fatigue, decreased memory, and a more recent 2-week history of right-hand weakness which worsened to involve the entire right upper extremity. On the day prior to his admission, he had a focal motor seizure with rotation of the head and eyes to the right, followed by secondary generalization. A computerized tomogram showed a ring-enhancing hypodense lesion in the left parietal subcortical region with associated edema and mass effect. Diagnosis of a fungal etiology was made following a parietal craniotomy and excisional biopsy by observation of septate, dematiaceous hyphal elements 2 to 3 microm in width on hematoxylin-and-eosin-stained sections from within areas of inflammation and necrosis. Culture of the excised material grew out a dematiaceous mould which was subsequently identified as R. obovoideum. At two months postsurgery and with a regimen of 200 mg of itraconazole twice a day, the patient was doing well and returned to Saudi Arabia. His condition subsequently deteriorated, however, and following a 7-month course of itraconzole, he expired. We use this case to alert clinicians and personnel in clinical mycology laboratories of the pathogenicity of this organism and its potential occurrence in patients with central nervous system signs and symptoms who have resided in the Middle East and to review and/or compare R. obovoideum with other neurotropic, dematiaceous taxa and similar nonneurotropic, dematiaceous species.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain; Brain Diseases; Female; Humans; Itraconazole; Male; Mitosporic Fungi; Mycoses; Opportunistic Infections; Saudi Arabia; United States

The rhinocerebral mucormycosis is the more common form produced by Rhizopus, a genus of fungi. It's a serious infective disease with high mortality, that needs a precocious medical treatment. Amphotericin B is the choice medical treatment, but liposomal amphotericine B in recent years is a better drug, due to minor renal toxicity and greater tisular diffusion. Even can not to treat all affected areas it's necessary an extensive surgical treatment according to individual characteristics and disease evolution. A 56-year-old man with rhinocerebral mucormycosis, caused by Rhizopus, who was treated with liposomal-amphotericin B and extensive rhino-orbital surgery is presented.

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Cerebral Cortex; Humans; Male; Middle Aged; Mucormycosis; Paranasal Sinus Diseases; Paranasal Sinuses; Rhizopus; Tomography, X-Ray Computed

Rhinocerebral mucormycosis with intracranial involvement has a high mortality. The standard therapy consists of aggressive surgical débridement accompanied by high doses of amphotericin B deoxycholate. Even with this therapy, the mortality rate has been 48% in the series reported since 1980. We treated a 60-year-old diabetic woman with rhinocerebral mucormycosis involving the cavernous sinus whose infection responded to medical therapy with amphotericin B lipid complex. To our knowledge, this is the only well-documented medical cure of a patient with rhinocerebral mucormycosis and intracranial involvement.

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Female; Humans; Middle Aged; Mucormycosis; Sinusitis

A previously healthy 19-year-old man developed rapidly progressive invasive rhinocerebral zygomycosis due to Apophysomyces elegans. He required extensive surgery and prolonged treatment with high-dose i.v. amphotericin B for cure. This is only the third reported case of acute invasive rhinocerebral zygomycosis in an otherwise healthy patient and the first reported case of infection due to A. elegans in any patient. We review the literature and clinical spectrum of rhinocerebral zygomycosis in otherwise healthy patients and discuss the recently recognized association between A. elegans and zygomycosis in immunocompetent patients.

Topics: Adult; Amphotericin B; Brain Diseases; Combined Modality Therapy; Humans; Male; Mucorales; Mucormycosis; Nose Diseases

Phaeohyphomycosis due to Dactylaria (Ochroconis) spp. is a rare infection of man. It was first reported in 1986. All patients have had significant immunosuppression. To our knowledge, this is the second case of phaeohyphomycosis caused by Dactylaria constricta var. gallopava in a liver transplant patient and it developed even though he had been receiving fungal prophylaxis with fluconazole. Moreover, this case may represent nosocomial acquisition. In addition, we have reviewed the English language literature of previously reported patients with phaeohyphomycosis caused by Dactylaria spp.

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Fluconazole; Humans; Immunosuppression Therapy; Liver Transplantation; Male; Middle Aged; Mitosporic Fungi; Mycoses

Isolated central nervous system (CNS) mucormycosis is a rare but life-threatening infection. We report a case of bilateral frontal lobe mucormycosis in a previously healthy woman. Intravenous drug use was the most likely route of infection. After treatment with surgical drainage and amphotericin B, she survived but suffered permanent neurologic deficits. We identified 29 previous reports of isolated CNS mucormycosis in the medical literature. Including our case, the patients averaged 32 years of age and most were male. Intravenous drug use appears to be the most important risk factor, present in 20 patients (67%). Treatment with amphotericin B was the only predictor of survival, reducing mortality from 92% to 41%. Isolated CNS mucormycosis should be considered in the differential diagnosis of brain abscesses, especially in intravenous drug users. Prompt initiation of therapy with amphotericin B may be life-saving.

Topics: Adult; Amphotericin B; Brain Diseases; Female; Frontal Lobe; Humans; Magnetic Resonance Imaging; Male; Mucormycosis; Substance Abuse, Intravenous; Tomography, X-Ray Computed

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

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

Three cases of central nervous system (CNS) aspergillosis in immunocompromised patients are reported. All three had neurological symptoms with normal cerebrospinal fluid (CSF). The CT scan showed poorly defined low density lesions which were not enhanced by contrast medium. They also had pulmonary signs and fever despite antibiotic treatment. Aspergillus fumigatus was isolated from bronchoalveolar lavage fluid. Antifungal therapy was started promptly, associating amphotericin B, itraconazole and flucytosine. Unfortunately, they died within 2 days to 2 weeks after admission in the intensive care unit. Postmortem examinations revealed disseminated aspergillosis with colonization of brain, lung, heart and kidney. The CT scan signs were quite different from those seen with the more usual bacterial ring lesions. In immunocompromised patients, the agents responsible for producing these findings are Aspergillus, Nocardia, Cryptococcus, Toxoplasma and Mycobacterium tuberculosis. Signs involving organs other than the CNS, and an examination of the CSF, should provide elements for establishing a differential diagnosis. Early antifungal treatment is the only chance of survival. Recrudescent fever and pulmonary signs occurring in neutropenic patients after antibacterial antibiotic treatment has been started are sufficient criteria for empirically starting amphotericin B administration unless clinical judgement dictates otherwise.

Topics: Adult; Amphotericin B; Aspergillosis; Brain Diseases; Bronchoalveolar Lavage Fluid; Female; Humans; Immunologic Deficiency Syndromes; Male; Middle Aged; Prognosis; Tomography, X-Ray Computed

The authors report a case of aspergillus granuloma of the brain, in a 28 year old woman, simulating a meningioma. Preoperative diagnosis of aspergilloma is difficult. However, it may be suspected in a patient who has associated pulmonary and paranasal sinus fungal infection. Peroperatively it may be confused with a brain tumour. The lesions usually are in the frontal lobes. Diagnosis can be made only by surgical biopsy with identification of fungal elements. Granuloma induce a good host response, and a high capacity to elaborate antibodies.

Topics: Adult; Aged; Amphotericin B; Aspergillosis; Brain Diseases; Brain Neoplasms; Child; Diagnosis, Differential; Female; Flucytosine; Granuloma; Humans; Male; Meningioma; Middle Aged; Olfaction Disorders; Tomography, X-Ray Computed

Disseminated candidiasis has become an important infection, particularly in immunocompromised and postoperative patients. Although serologic tests may, in some settings, facilitate a premortem diagnosis, the disease is usually diagnosed by comprehensive clinical evaluation. Detection of the relatively newly recognized peripheral manifestations of candidemia may be vital to early diagnosis: endophthalmitis, osteomyelitis, arthritis, myocarditis, meningitis, and macronodular skin lesions. Studies in patients with chronic mucocutaneous candidiasis and in-vitro manipulations have begun to elucidate normal immune defense mechanisms against Candida, including serum factors, phagocytosis, intracellular killing mechanisms, and lymphocyte function (particularly T cell). The primary drugs for the treatment of disseminated candidiasis are still amphotericin B or amphotericin B plus 5-fluorocytosine; the mainstay of therapy for chronic mucocutaneous candidiasis is amphotericin B. Other antifungals and immune system-stimulating modalities (transfer factor, thymosin, thymus epithelial cell transplantation, and levamisol) may be useful for chronic mucocutaneous candidiasis in some settings and deserve further evaluation.

Topics: Amphotericin B; Animals; Antifungal Agents; Arthritis; Brain Diseases; Candidiasis; Candidiasis, Cutaneous; Drug Therapy, Combination; Endophthalmitis; Humans; Immunotherapy; Leukocytes; Lymphocytes; Macrophages; Myocarditis; Osteomyelitis; Phagocytosis; Skin Diseases

Topics: Amphotericin B; Brain Diseases; Candidiasis; Coccidioidomycosis; Cryptococcosis; Herpes Zoster; Humans; Immunity, Cellular; Immunity, Maternally-Acquired; Leprosy; Lymphocyte Activation; Lymphokines; Male; Meningitis; Middle Aged; Subacute Sclerosing Panencephalitis; T-Lymphocytes; Tuberculosis; Wiskott-Aldrich Syndrome

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Child; Child, Preschool; Corticosterone; Diabetes Complications; Female; Humans; Infant; Infant, Newborn; Leukemia; Lung Diseases, Fungal; Male; Meningoencephalitis; Middle Aged; Mucormycosis; Postoperative Complications; Sinusitis; Substance-Related Disorders; Syndrome; Transplantation, Homologous

Continuous awareness of systemic mycosis in immunocompromised patients is important. Early diagnosis is based on (direct) histologal examination and CT scan. Since treatment should start as early as possible, there is usually no time to await results of tissue cultures. Systemic treatment with amphotericin B and aggressive surgical débridement should be performed as soon as possible, while the place of hyperbaric oxygen and G-CSF remains to be established. In addition to routine preventive measures, prophylactic intranasal application of amphotericin B seems to be of value.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Brain Diseases; Child; Debridement; Female; Granulocyte Colony-Stimulating Factor; Humans; Hyperbaric Oxygenation; Immunocompromised Host; Male; Middle Aged; Mucormycosis; Paranasal Sinus Diseases; Treatment Outcome

Amphotericin B (AmB) is used to treat cryptococcal meningoencephalitis. However, the mortality rate remains high. Higher doses of AmB in deoxycholate buffer (AmBd) are toxic to human red blood cells (hRBC) and have no effect on brain organism load in mice. Here we show that while AmBd lysed 96% of hRBC, AmB complexed with gold nanoparticles (AuNP-SA-AmB) lysed only 27% of hRBC. In vitro growth of C. neoformans was inhibited by 0.25 μg/ml AmBd and 0.04 μg/ml of AuNP-SA-AmB. In mice infected with C. neoformans, five daily treatments with AuNP-SA-AmB containing 0.25 mg/kg AmB significantly lowered the fungal burden in the brain tissue compared to either untreated or treatment with 0.25 mg/kg of AmBd. When a single dose of AmBd was injected intravenously into BALB/c mice, 81.61% of AmB cleared in the α-phase and 18.39% cleared in the β-phase at a rate of 0.34% per hour. In contrast, when AuNP-SA-AmB was injected, 49.19% of AmB cleared in the α-phase and 50.81% of AmB cleared in the β-phase at a rate of 0.27% per hour. These results suggest that AmB complexed with gold nanoparticles is less toxic to hRBC, is more effective against C. neoformans and persists longer in blood when injected into mice resulting in more effective clearing of C. neoformans from the brain tissue.. Amphotericin B (AmB) was complexed with gold nanoparticles (AuNP-SA-AmB) to improve brain delivery. AuNP-SA-AmB was more effective than AmB alone in clearing of Cryptococcus neoformans from the brain tissue of infected mice. This may be due to longer plasma half-life of AmB as AuNP-SA-AmB.

Topics: Amphotericin B; Animals; Antifungal Agents; Brain Diseases; Cryptococcosis; Cryptococcus neoformans; Disease Models, Animal; Erythrocytes; Gold; Humans; Mice; Rodent Diseases

Topics: Aged; Amphotericin B; Brain Diseases; Debridement; Eye Infections, Fungal; Fatal Outcome; Female; Humans; Mucorales; Mucormycosis; Nose Diseases; Orbital Diseases

To report the frequency and factors affecting patients', globe and vision survivals in rhino-orbito-cerebral mucormycosis (ROCM).. This is a retrospective study of 63 patients (79 eyes) with biopsy-proven ROCM at a university hospital 2008-2016. Systemic and ophthalmic manifestations, imaging, management and final outcomes were recorded. Globe survival was defined as no exenteration and vision survival as final visual acuity of light perception and more.. Mean age was 55.5 (SD 12.9) years with no gender preference. Diabetes was the most common underlying disease (68.3%). Patient survival was observed in 57.1 % (36/63). Presence of frozen eye (OR 4.6), nasal mucosal involvement (OR 7.3) and shorter duration of antifungal therapy (OR 1.03) were significantly associated with lower patient survival. Exenteration did not significantly change the survival. Globe survival was detected in 43% (34/79). Higher white blood cell (WBC) count was associated with a lower globe survival (p=0.02). Vision survival was observed in 25.3% (20/79) in whom younger age was significantly associated with a worse vision survival.. Patient, globe and vision survivals were 57%, 43% and 25%, respectively. Exenteration did not affect the patients' survival. While frozen eye and nasal mucosal involvement were significantly associated with a lower survival, higher WBC count significantly increased the risk of exenteration.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Combined Modality Therapy; Debridement; Deoxycholic Acid; Eye Infections, Fungal; Female; Humans; Male; Middle Aged; Mucormycosis; Natural Orifice Endoscopic Surgery; Orbital Diseases; Paranasal Sinus Diseases; Retrospective Studies; Treatment Outcome; Triazoles; Young Adult

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

A 17-year-old girl developed invasive rhinocerebral mucormycosis during intensive re-induction chemotherapy for relapsed pre-B acute lymphoblastic leukemia. Due to the high case fatality rate for invasive mucormycosis in profoundly immunosuppressed patients, an aggressive treatment regimen was pursued. In addition to the standard of care treatments with intravenous amphotericin and aggressive surgical debridements, she received intraventricular amphotericin to the brain via an Ommaya reservoir, hyperbaric oxygen treatments, filgrastim, intravenous immunoglobulin and antifungal in vitro synergy testing to allow for more targeted antifungal therapy with the addition of micafungin. After a 3-month treatment course, it was determined that her mucormycosis was under appropriate control, allowing her to continue treatment for her leukemia with hematopoietic stem cell transplant with a plan for continued intravenous antifungal therapy through engraftment.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Brain; Brain Diseases; Combined Modality Therapy; Drug Therapy; Female; Humans; Hyperbaric Oxygenation; Immunocompromised Host; Mucormycosis; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Treatment Outcome

No comprehensive reports have been published on epidemiological status of Rhinocerebral zygomycosis infections and its outcome in our population, Hence, the current study came to address epidemiological characteristics as well as clinical outcome of patients with Rhinocerebral zygomycosis infection referred to a referral hospital in Iran.. This retrospective study was performed at the Rasoul-e-Akram hospital, an 800-bed tertiary care teaching hospital in Tehran, Iran. The pathology recorded charts were reviewed to identify all cases of Rhinocerebral zygomycosis from patients admitted between April 2007 and March 2014. A diagnosis of Rhinocerebral zygomycosis was based on histopathological assessments.. Sixty four patients with Rhinocerebral zygomycosis were assessed. The mean age of the patients was 46.07 ± 22.59 years and 51.6% were female. Among those, 67.2% were diabetic, 26.6% were hypertensive and 29.7% had history of cancer. Different sinuses were infected in 73.4% of the patients. Out of all the patients 26.6% underwent surgical procedures and 17.2% were controlled medically. Extensive debridement was carried out in 40.6%. Neutropenia (<1500 cell/ µl) was revealed in 12.5%. In-hospital mortality rate was 35.9% and prolonged hospital stay (> 14 days) was found in 60.9%. According to the Multivariable logistic regression analysis, the main predictors of in-hospital mortality included female gender, advanced age, the presence of sinus infection, and neutropenia, while higher dosages of amphotericin administered had a protective role in preventing early mortality. In a similar Multivariate model, history of cancer could predict prolonged hospital stay, whereas using higher dose of amphotericin could lead to shortening length of hospital stay.. There is no difference in demographic characteristics between our patients with Rhinocerebral zygomycosis and other nations. The presence of diabetes mellitus is closely associated with the presence of this infection. Sinus involvement is very common in those with Rhinocerebral zygomycosis leading to high mortality and morbidity. Besides female gender, advanced age, and presence of neutropenia was a major risk factor for increasing early mortality. The use of higher doses of antifungal treatment such as amphotericin can prevent both mortality and prolonged hospital stay. The cancer patients may need longer hospital stay because of needing comprehensive in-hospital treatment.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Brain Diseases; Child; Child, Preschool; Debridement; Diabetes Mellitus; Dose-Response Relationship, Drug; Female; Hospital Mortality; Humans; Iran; Length of Stay; Logistic Models; Male; Middle Aged; Nose Diseases; Retrospective Studies; Risk Factors; Young Adult; Zygomycosis

Topics: Amphotericin B; Antifungal Agents; Biopsy; Brain Diseases; Deoxycholic Acid; Diabetes Mellitus, Type 2; Drug Combinations; Eye; Eye Diseases; Fatal Outcome; Female; Humans; Kidney Failure, Chronic; Magnetic Resonance Imaging; Middle Aged; Mucormycosis; Multiple Organ Failure; Paranasal Sinuses; Temporal Lobe

We report the case of a 19-year-old male with possible cerebral mucormycosis following chemotherapy. We detected a Lichtheimia DNA load of 2.0×10(4) copies/ml in cerebrospinal fluid (CSF), although a CSF culture showed no growth. After treatment with intravenous liposomal amphotericin B, the Lichtheimia DNA load fell below the detection limit, and at the same time the patient's headache and imaging findings improved. The quantification of Mucorales DNA in CSF may be useful for evaluating cerebral mucormycosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; DNA, Fungal; Humans; Male; Mucorales; Mucormycosis; Young Adult

Rhinocerebral mucormycosis is a rare, rapidly progressive life threatening opportunistic fungal disease that usually occurs in immunocompromised patients.. The aim of the study is to present a case series of six immunocompromised patients who were diagnosed with rhinocerebral mucormycosis, review the diagnostic criteria and treatment approach.. Six patients were treated in our department between the years 2005-2010. Their diagnostic criteria, surgical treatment and mortality rate are analyzed and discussed.. All six immunocompromised patients suffered from a primary hematological malignancy and received chemotherapy to treat their primary disease. Symptoms such as pain mimicking sinusitis, facial swelling, oral or dental pain, and fever were found in most patients. The diagnosis was based on both clinical signs and a biopsy for microbiological culture and histological examination. All patients underwent aggressive surgical resection and were treated simultaneously with anti fungal therapy. Four patients died from their primary illness. One patient died due to uncontrolled spreading of mucormycosis and one patient, the youngest and with the most extensive form of the disease (brain invasion) survived and clinically recovered with no evidence of recurrent disease following the surgical management.. Rhinocerebral mucormycosis is a rapidly progressing disease with a high mortality rate, which requires immediate surgical and medical intervention. It seems from the data presented that the presence of mucormycosis is an ominous sign in immunocompromised patients. The extent of the disease is of less prognostic value, since the only patients in our series who survived had the most extensive disease, yet his primary haemato-oncological disease was under control. Controlling the underlying disease with early diagnosis and aggressive surgical intervention appears to be the most important factor for survival.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Cause of Death; Combined Modality Therapy; Diagnosis, Differential; Fatal Outcome; Female; Hematologic Neoplasms; Humans; Immunocompromised Host; Male; Maxillary Sinusitis; Middle Aged; Mucormycosis; Nose Diseases; Paranasal Sinus Diseases; Pyrimidines; Triazoles; Voriconazole; Young Adult

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Central Nervous System Fungal Infections; Combined Modality Therapy; Debridement; Diabetes Complications; Early Diagnosis; Endoscopy; Fatal Outcome; Female; Humans; Male; Maxillary Sinus; Middle Aged; Mucormycosis; Nose Diseases; Opportunistic Infections; Oroantral Fistula; Paranasal Sinus Diseases; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pregnancy; Pregnancy Complications, Infectious; Sinusitis; Zygomycosis

Cerebral mucormycosis without systemic foci of involvement is a rare life-threatening fungal infection that is reported to be more common in intravenous drug abusers. We present a case of isolated cerebral mucormycosis in a diabetic patient diagnosed through excision and biopsy and treated with combination of surgery and amphotericin with posaconazole.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Brain Diseases; Combined Modality Therapy; Diabetes Mellitus, Type 2; Diagnosis, Differential; Drug Therapy, Combination; Endoscopy; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mucormycosis; Tomography, X-Ray Computed; Triazoles

Mucormycosis is an opportunist, often lethal fungal infection which occurs in immunocompromised patients. We present our experience in 14 patients with this condition.. A retrospective chart review was conducted for 14 patients treated for rhinocerebral mucormycosis.. Nine patients had diabetes mellitus and six had a haematological malignancy. Nine patients had cutaneous and/or palatal necrosis. Eleven patients were treated with amphotericin B and five with liposomal amphotericin B. Endoscopic sinus surgery was performed in five patients with disease limited to the sinonasal cavity; nine patients underwent more extensive surgery. Five patients with disease limited to the sinonasal cavity survived, while nine patients with widely disseminated disease died. Five of the nine diabetic patients died, as did five of the six patients with haematological malignancy.. Patients with rhinocerebral mucormycosis spreading outside the sinonasal cavity have a poor prognosis.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Child; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Female; Humans; Immunocompromised Host; Magnetic Resonance Imaging; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases; Palate; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome; Young Adult

The objective of this paper is to review a recent case of rhino-orbital-cerebral mucormycosis that involved the successful treatment of an immunocompromised male patient that took place in a deployed military setting. In this interventional case review, a comprehensive evaluation of predisposing factors, presenting signs and symptoms, diagnostic evaluation, and treatment will be discussed in detail. The patient was a 38-yr-old noncompliant insulin-dependent diabetes mellitus Iraqi man whose initial presentation encompassed nonspecific signs and symptoms consistent with sinusitis. Symptoms progressed rapidly including the development of acute visual loss, unilateral facial edema, fixed dilated right pupil, loss of extraocular movements, and oropharyngeal eschar formation. With this progressive clinical picture, a diagnosis of mucormycosis was made in the absence of histological confirmation due to the nature of the deployed environment. Treatment included hospitalization for combined intervention with intravenous antifungal therapy and a series of surgeries which ultimately resulted in orbital exenteration and preservation of life. Successful treatment was attributed to having a high index of suspicion in the clinical presentation of nonspecific otorhinolaryngological and ophthalmological symptoms superimposed with underlying predisposing immunocompromised host conditions.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Debridement; Diabetes Insipidus, Nephrogenic; Diabetes Mellitus, Type 1; Disease Progression; Eye Infections, Fungal; Humans; Immunocompromised Host; Magnetic Resonance Imaging; Male; Mucormycosis; Nose Diseases; Orbital Diseases; Tomography, X-Ray Computed; Triazoles

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Central Nervous System Fungal Infections; Female; Humans; Paracoccidioidomycosis; Tomography, X-Ray Computed

To study the disease spectrum and salient management features of 36 patients with histopathologically-confirmed rhinocerebral zygomycosis seen at our academic center over a 16-year period.. Retrospective review of patients admitted to the Aga Khan University Hospital in Karachi, Pakistan from January 1991 to December 2006 with histopathologically-confirmed zygomycosis of the head and neck.. Mean patient age was 40 +/- 5.0 years (range, 34-63 years), and 23 (64%) patients were male. Thirty-two (89%) patients were referred from clinical services other than otolaryngology. Underlying predisposing conditions included diabetes mellitus (21 patients), haematologic diseases (9), and renal failure (6). Twenty (55%) patients had limited sinonasal disease, ten (28%) had orbital involvement, and six (17%) had intracranial extension. All patients underwent rigid nasal endoscopy and biopsy, and black necrotic tissue was seen in 22 (61%) instances warranting endoscopic or open surgical debridement. Four of 6 patients undergoing open surgery required orbital exenteration. Overall patient survival was 56% (20/36 patients). Diabetic patients had improved survival (17/21, or 81%) compared to patients with haematologic disorders (3/9, or 33%) (p = 0.001). All six patients with intracerebral disease died. Eighteen of the 22 (82%) patients treated with surgery plus amphotericin B survived vs. two of 14 (14%) receiving amphotericin B alone (p < 0.001).. In rhinocerebral zygomycosis, an aggressive, multidisciplinary, diagnostic and therapeutic approach that utilizes CT or MRI staging, and combines endoscopic or open surgical debridement with amphotericin B-based antifungal therapy offers the best chance of recovery.

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; Brain Diseases; Debridement; Endoscopy; Female; Hospitals, Teaching; Humans; Male; Middle Aged; Mucor; Nose Diseases; Pakistan; Retrospective Studies; Rhizopus; Survival Analysis; Treatment Outcome; Zygomycosis

Rhino-orbital-cerebral disease is a significant manifestation of zygomycosis in solid organ transplant (SOT) recipients. However, its characteristics and outcome are not well addressed.. SOT recipients with zygomycosis as per the European Organization for Research and Treatment in Cancer and the Mycoses Study Group criteria in a cohort study at our centers published previously and those identified with a PubMed search from the 1950s to November 2009 were studied. Patients with mycosis involving the sinuses, orbits, or central nervous system (CNS) were included.. Patients comprised a total of 90 SOT recipients with rhino-orbital-cerebral zygomycosis, including 13 in our cohort and 77 in the literature. CNS disease occurred in 57% (51 of 90). Overall mortality was 52.3% (46 of 88), and the mortality in patients with CNS disease was 73.5% (36 of 49). In logistic regression analysis, older age (odds ratio [OR] 1.12, 95% confidence interval [CI] 1.04-1.21, P=0.002) was associated with a higher mortality rate, whereas lipid formulations of amphotericin B compared with amphotericin B deoxycholate (OR 0.09, 95% CI 0.02-0.50, P=0.006) and surgery (OR 0.12, 95% CI 0.01-0.94, P=0.043) were independently associated with an improved survival even when controlled for CNS involvement and the era of diagnosis of disease.. Rhino-orbital-cerebral zygomycosis, particularly CNS disease, is associated with substantial mortality rate in SOT recipients. Older age is a significant risk factor for mortality, whereas lipid formulations of amphotericin B and surgery improved outcomes.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Cohort Studies; Debridement; Female; Humans; Kidney Transplantation; Liver Transplantation; Male; Middle Aged; Mycoses; Organ Transplantation; Regression Analysis; Sinusitis; Zygomycosis

Rhinocerebral mucormycosis is rare, rapidly progressive, potentially life-threatening disease, and it usually occurs in immunocompromised patients. We present our clinical experience with 12 cases and we attempt to identify the prognostic features and proper treatment protocols.. All the cases of mucormycosis were proven by histology or culture. The prognosis was analyzed according to the predisposing factors, including underlying disease, extent of disease and surgical intervention.. The overall mortality rate in our series was 33.3%. 7 of the 10 operated patients recovered, while 1 of the 2 non-operated patients expired. The associated conditions included diabetes mellitus (n=9) and hematological disease (n=3). A poor prognosis was primarily related with uncontrolled underlying disease. Other associated prognostic factors were the extent of disease including orbital or intracranial extension. Surgical debridement is essential for a good prognosis, but timely intervention and complete aggressive debridement are not always needed in all patients. The patient who had slowly progressive disease also survived after conventional medical management and limited surgical debridement, including orbital preservation.. Control of the underlying predisposing illness along with prompt parenteral administration of amphotericin B and aggressive surgical debridement remain the essential treatments even today. Contrary to this, as described in this study, for the patients with slowly progressive disease, the aggressive surgical debridement is spared, and a successful result may be obtained with the conventional management, including medical treatment and timely limited surgical intervention.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Mucormycosis; Orbital Diseases; Prognosis; Rhinitis; Survival Rate

The authors report on a case of intracranial candidiasis in an immunocompetent neonate with a ventriculo-peritoneal shunt. The child was known to be colonized with yeast as she had been treated for oral thrush; however, she did not have systemic candidiasis. Despite initial treatment with antifungal medication, intraventricular fungus balls developed that were visible on imaging and confirmed with pathological analysis. Multiple endoscopic intraventricular operations were required for excision of the initial and recurrent fungus balls, multiple fenestrations of loculations and cysts were performed, and ultimately 3 ventriculoperitoneal shunts were placed. The finding of an intraventricular fungus ball is a unique manifestation of intracranial candidiasis, and to the authors' knowledge has not been previously reported in the English literature.

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Brain Diseases; Candidiasis; Caspofungin; Echinocandins; Endoscopy; Ependyma; Female; Fluconazole; Humans; Immunocompetence; Infant, Newborn; Injections, Spinal; Lipopeptides; Magnetic Resonance Imaging; Postoperative Care; Recurrence; Reoperation; Ventriculoperitoneal Shunt

Fungal infections of the central nervous system (CNS) are almost always a surprising finding. Their presentation is usually subtle, often without any diagnostic characteristics, and they are frequently mistaken for pyogenic abscesses, or brain tumors. Aspergillosis of the central nervous system is an uncommon infection, mainly occurring in immunocompromised patients. It may present in several forms, including meningitis, mycotic aneurysms, infarcts and a tumoral form. We report an intracranial granuloma due to Aspergillus fumigatus involving the anterior cranial fossa and the frontal lobe. The clinical symptoms began one year before admission. Final diagnosis was made after craniotomy. The patient was treated with an extensive excision of the cerebral mass and medical antifungal therapy (intravenous amphotericin B), but she failed to respond to these treatments and died.

Topics: Amphotericin B; Antifungal Agents; Aspergillus fumigatus; Brain Diseases; Craniotomy; Fatal Outcome; Female; Humans; Middle Aged; Neuroaspergillosis

To present a clinical report of palatal zygomycosis, its epidemiological, mycological features, and our treatment experience.. Retrospective report.. This is a 25-year long retrospective trial of clinically and mycologically proven cases of zygomycosis. Some patients underwent a biopsy of the palatal lesion and autopsy. This study reports the treatment experience with amphotericin B alone and in combination with itraconazole and fluconazole.. Twenty-one cases (18.75%) of zygomycosis with palatal involvement were included in the study, from a total of 112 cases screened. Mean age was 36.5 years, with 18 adults and three children. The associated pre-disposing factors were: ketoacidotic diabetes (five type-1 and 15 type-2), and acute leukaemia in one patient. The clinical varieties were as follows: 19 cases of rhinocerebral (RC) involvement and two disseminated cases. Palatal ulcers occurred in 3/21 early cases (14.3%) and in 16/21 cases after the nasal involvement. All patients received amphotericin B; in four patients, it was combined with itraconazole and four with fluconazole. Clinical and mycological cure was achieved in 4/21 patients (19.04%).. Zygomycosis with palatal involvement occurs in around 18% of cases, usually associated with RC modalities; it has an acute and generally lethal course.

Topics: Absidia; Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Child; Diabetic Ketoacidosis; Drug Combinations; Female; Fluconazole; Humans; Itraconazole; Male; Mouth Diseases; Mucormycosis; Nose Diseases; Opportunistic Infections; Oral Ulcer; Palate; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Rhizopus; Treatment Outcome; Zygomycosis

Invasive intracranial aspergillosis remains a disease with high morbidity and mortality. The rapid increase in the incidence of this disease led us to review the literature and formulate a treatment protocol for such patients.. An analysis of 46 patients with invasive intracranial aspergillosis is presented and the subgroups of extradural and intradural variety are evaluated with different treatment strategies.. Patients with extradural form of disease had 100% survival, whereas antifungal chemotherapy preloading tends to provide a better outcome.. Extradural aspergillosis does not need chemotherapy preloading, whereas intradural variant may have improved survival chances after preloading. Liposomal formulation has an advantage of shortened time duration for preloading, because the daily administration dose is 6 times higher than conventional preparation.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Child; Child, Preschool; Cohort Studies; Craniotomy; Debridement; Female; Humans; Infant; Male; Middle Aged; Neuroaspergillosis; Retrospective Studies

Rhinocerebral mucormycosis is a devastating, rapidly progressive and often fatal opportunistic fungal infection predominantly affecting individuals with underlying metabolic and/or immunological compromise. Intracranial extension of the disease has invariably been associated with mortality.We present a review of optimum management of rhinocerebral mucormycosis and a case report of sinonasal mucormycosis with intracranial and orbital extension which was treated successfully with a combination of systemic liposomal amphotericin B therapy and wide surgical debridement.

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Eye Infections, Fungal; Humans; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases; Otorhinolaryngologic Surgical Procedures; Treatment Outcome

A case of cerebral aspergillosis was diagnosed by the detection of Aspergillus flavus-specific DNA in brain biopsy and serum specimens. The diagnosis was also supported by detection of elevated levels of galactomannan and (1-->3)-beta-d-glucan in serum specimens. Despite the presence of dichotomously branched septate hyphae in brain biopsy, the culture remained negative. The inability to isolate the organism in culture suggested that combined therapy of AmBisome and caspofungin was fungicidal for the fungus in the brain abscess.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; beta-Glucans; Brain; Brain Diseases; Caspofungin; Diagnosis, Differential; DNA, Fungal; Echinocandins; Electrophoresis, Agar Gel; Galactose; Humans; Lipopeptides; Male; Mannans; Middle Aged; Peptides, Cyclic; Polymerase Chain Reaction

A 21-year-old man presented with aspergilloma in the prepontine cistern that developed after treatment for cerebellar hematoma following rupture of an arteriovenous malformation. He became bedridden with neurological signs of tetraparesis, disturbed ocular movement, and bulbar palsy, despite alert consciousness. Repeat magnetic resonance imaging 1 year later revealed a space-occupying lesion in the prepontine cistern along the clivus. This multilobular enhanced mass lesion gradually enlarged towards the brainstem over the following 4 years, resulting in loss of spontaneous breathing and dependence on a mechanical respirator. Surgical treatment via a lateral suboccipital approach was selected to reduce the size of the mass lesion and confirm the diagnosis. Histological examination revealed the presence of Aspergillus fumigatus. Treatment with amphotericin B (1 mg/kg/day) and fluconazole (100 mg/kg/day) injected into the peripheral veins was initiated, but was stopped due to the appearance of renal dysfunction. An Ommaya tube was then inserted into the prepontine cistern via a transsylvian approach to provide high concentrations of amphotericin B around the granulomatous lesion. He gradually improved, corresponding to the decreased size of the aspergilloma just after surgery. Surgical reduction of granuloma combined with local administration of antifungal agent is a good treatment option in patients with aspergilloma refractory to systemic administration.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillus fumigatus; Brain Diseases; Cranial Fossa, Posterior; Humans; Infusions, Intralesional; Male; Neuroaspergillosis; Subarachnoid Space

Mucormycosis is an opportunistic, fulminating fungal infection of the sino-nasal region. It tends to affect people with immune suppression. The hard palate is a rare site of the disease and few cases have been reported in the literature. This report discusses the nature of hard palate mucormycosis, with the aim of outlining possible explanations and reviewing associated characteristics.. This was a prospective analysis of four cases of hard palate mucormycosis. The patients were referred from the medical department, with uncontrolled diabetes mellitus. An aggressive treatment protocol was used, i.e. an intensive course of antifungal drugs and frequent debridement of dead tissue.. A painful, dusky red swelling was noticed at the early stages of the hemi-palate lesion. It was eventually followed by deep ulceration and even big perforation. Orbit and intracranial extension was the preceding sign in all instances. The progression of the perforation was not controlled by a full course of treatment. There were two deaths during the treatment course.. Mucormycosis of the hard palate is an ominous sign. Although rare, the lesion is progressive in nature and barely controlled by treatment. Clinicians should maintain a high degree of clinical suspicion in the management of patients with palatal ulcer and debilitating illness.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Biopsy; Brain Diseases; Debridement; Diabetes Complications; Fatal Outcome; Female; Humans; Male; Middle Aged; Mucorales; Mucormycosis; Orbital Diseases; Oroantral Fistula; Palate, Hard; Paranasal Sinus Diseases; Prospective Studies; Tomography, X-Ray Computed; Treatment Outcome

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Brain; Brain Diseases; HIV Infections; Humans; Liposomes; Lymphoproliferative Disorders; Magnetic Resonance Imaging; Male; Middle Aged; Mucormycosis; Radiography; Sphenoid Sinus; Sphenoid Sinusitis; Treatment Outcome

Intracranial aspergillosis is a rare clinical picture, but the mortality rate is very high. In this report, an immunocompetent 43 years old male patient with mortal intracranial aspergillosis was presented. The patient has been admitted to Neurosurgery Clinics of our hospital with the complaints of weakness and walking difficulties. In the cranial tomography a brain mass was detected, and his medical history revealed that he had experienced an operation 18 months ago because of another intracranial tumour. After the operation his fever was high (39 degrees C), the leukocyte count, erythrocyte sedimentation rate and CRP values were increased, and purulent discharge was present in the operation site. As the pathological examination of the operation material have suggested aspergillosis, conventional amphotericin B treatment was started initially, but has changed to liposomal form 18 days later. Aspergillus fumigatus has been grown on the exudate culture collected from flap region. The levels of immunoglobulins and complement components of the patient were found normal. Since his next cranial magnetic resonance result indicated the presence of pansinusitis and destructive lesions in ethmoid sinuses, caspofungin was added to the therapy. The patient has reoperated since there was no clinical and laboratory progress at the 83rd day of amphotericin B, and 10th day of caspofungin therapy. Bacterial and fungal cultures of specimens collected during the second operation yielded negative results, however microabscesses and chronic inflammation focci were detected in histopathological examination. Fever and purulent discharge recurred in the patient after the second operation and visual defect has developed in his left eye. There was no bacterial or fungal growth in the discharge material, but direct microscopy have showed the presence of septate hyphae. The patient was discharged from the hospital by his family request with oral itraconazole treatment, however, he died one month later. Since no immunosuppressive status was detected in our patient, the transmission was thought to occur during the operation which he had experienced one and half year ago. In conclusion, the patients who experience neurosurgery should be followed-up carefully in terms of aspergillosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillus fumigatus; Brain Diseases; Caspofungin; Echinocandins; Fatal Outcome; Humans; Immunocompetence; Itraconazole; Lipopeptides; Male; Neuroaspergillosis; Reoperation; Surgical Wound Infection

An 8-year-old domestic shorthair cat was evaluated because of signs of depression, circling, and visual deficits.. The cat had no cutaneous lesions, and results of an ophthalmologic examination and thoracic radiography were within reference limits. Computed tomography of the brain revealed a mass lesion involving the right parietal, temporal, and occipital lobes; the mass was in broad-based contact with the skull and smoothly marginated and had strong homogenous enhancement after contrast agent administration. During craniectomy, samples of the mass were collected for cytologic and histopathologic evaluations and microbial culture. A diagnosis of Blastomyces dermatitidis-associated meningoencephalitis with secondary pyogranulomatous inflammation was made.. Amphotericin B (0.25 mg/kg [0.11 mg/lb], IV) was administered on alternate days (cumulative dose, 1.75 mg/kg [0.8 mg/lb]). To minimize the risk of nephrotoxicosis, assessments of serum biochemical variables (urea nitrogen and creatinine concentrations) and urinalyses were performed at intervals. The third dose of amphotericin B was postponed 48 hours because the cat became azotemic. The cat subsequently received fluconazole (10 mg/kg [4.5 mg/lb], PO, q 12 h) for 5.5 months. Six months after discontinuation of that treatment, the cat appeared healthy and had no signs of relapse.. Brain infection with B dermatitidis is typically associated with widespread disseminated disease. The cat of this report had no evidence of systemic disease. Blastomycosis of the CNS should be considered as a differential diagnosis for brain lesions in cats from areas in which B dermatitidis is endemic.

Topics: Amphotericin B; Animals; Antifungal Agents; Blastomycosis; Brain Diseases; Cat Diseases; Cats; Diagnosis, Differential; Male; Meningoencephalitis; Tomography, X-Ray Computed; Treatment Outcome

Rhinocerebral mucormycosis is a rapidly progressive and often fatal infection frequently seen in patients with uncontrolled diabetes mellitus and hematologic malignancies. The disease is difficult to diagnose because it often masquerades as bacterial sinusitis. The current report describes a 69-year-old white woman with diabetes mellitus who was prescribed high-dose prednisone therapy for chronic obstructive pulmonary disease. Two weeks after treatment initiation, she presented to the hospital with facial edema on the right side, mouth pain, and general weakness. No black eschars on the nasal mucosae or palates were present on admission. Although bacterial etiology was initially suspected, surgery and tissue samples revealed the presence of rhinocerebral mucormycosis. The patient died at 6 days postadmission despite aggressive medical and surgical intervention. The current report discusses the risk factors associated with rhinocerebral mucormycosis as well as the necessity of early diagnosis and treatment to improve patient outcomes.

Topics: Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Comorbidity; Diabetes Mellitus; Disease Progression; Edema; Fatal Outcome; Female; Glucocorticoids; Humans; Immunocompromised Host; Kidney Failure, Chronic; Mucormycosis; Prednisone; Pulmonary Disease, Chronic Obstructive; Risk Factors; Sinusitis

Topics: Amphotericin B; Antifungal Agents; Barium; Brain Diseases; Catheterization; Child; Contrast Media; Eye Infections, Fungal; Humans; Iohexol; Male; Middle Aged; Mucormycosis; Orbit; Orbital Diseases; Paranasal Sinus Diseases; Silicone Elastomers; Tomography, X-Ray Computed

Extrapulmonary manifestations of tuberculosis involving the central nervous system (CNS) due to haematogenous spread are not a rare entity. It presents as meningitis or tuberculoma. Tuberculoma is a granulomatous inflammatory process mimicking a neoplasm radiologically, so usually a biopsy is performed.. Our study consisted of 23 pathologically proven cases of tuberculomas between 1988 and 2003. Patients were discussed clinically, radiologically and histologically. Headache, fever, weight loss and weakness are the most common clinical manifestations. Our patient's ages vary from 3 to 67 years with a mean of 31.8 years. Ninety-five percent of patients had bad social, economic and nutritional conditions. None of them were infected by human immunodeficiency virus (HIV). All patients had similar contrast-enhancing lesions radiologically. The majority of tuberculomas were located supratentorially. Only one patient presented two foci of (cerebral and cerebellar) tuberculomas. Nineteen tuberculomas were intracerebral; two were located in the cerebellum and one was intramedullary. Among those lesions, one cavernous sinus tuberculoma and one sellar tuberculoma were identified. Only two patients underwent stereotactic biopsy and 21 patients underwent surgical excision. Histopathologic examination revealed granulomatous inflammation with central caseous necrosis in all patients.. Diagnosis of tuberculoma can be difficult, and in most of our cases, the clinical diagnosis was 'neoplasm'. For this reason, clinicians must always be aware of it and consider it in the differential diagnosis of central nervous system mass lesions.

Topics: Adolescent; Adult; Aged; Amphotericin B; Anti-Infective Agents; Brain Diseases; Child; Child, Preschool; Diagnosis, Differential; Female; Fever; Headache; Humans; Magnetic Resonance Imaging; Male; Meningitis; Middle Aged; Necrosis; Retrospective Studies; Socioeconomic Factors; Tuberculoma, Intracranial

A case of rhino-orbito-cerebral mucormycosis is presented showing its aggressive nature and progression of disease. The typical clinical features, neuroimaging and histological findings are highlighted in this report. Amphotericin B and surgical debridement remain the mainstay of treatment. However, associated co-morbidities need to be addressed.

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Debridement; Disease Progression; Eye Infections, Fungal; Humans; Immunocompromised Host; Magnetic Resonance Imaging; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Brain Neoplasms; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Histoplasmosis; Humans; Male; Middle Aged; Pons; Radiography

Two cases of intracranial fungal infection, crippled with the recurrence of the fungal infection even after excisional surgery followed by intravenous Amphotericin B and oral Itraconazole are presented.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Drug Therapy, Combination; Humans; Itraconazole; Male; Middle Aged; Neuroaspergillosis; Recurrence

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

We report on a 36 years-old man that had been at the Amazon forest four years before. Six months before the admission he had developed a progressive quadriparesis, gait ataxia, dysphagia, dysarthria, difficulty in breathing and hiccup. The gadolinium-enhanced T1-weighted MRI showed a lesion into the right parietoccipital area and another into the medulla, that was the largest. There was any evidence of tuberculosis or AIDS. The patient was submitted to microsurgical approach to the medulla. Pathological examination revealed paracoccidioidomycosis. Treatment with anphotericin B till 2100 mg was administered followed by sulfamethoxazole-trimetoprim for three months plus physical therapy. The patient went back to his activities six months after the end of the treatment. Comments are presented about the participation of the immunological system and of the cytokines (interleukines).

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Combined Modality Therapy; Humans; Magnetic Resonance Imaging; Male; Paracoccidioidomycosis; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

Involvement of the brain by neurotropic, dematiaceous fungi namely Cladosporium bantianum is extremely rare. The disease is very resistant to treatment and prone for frequent relapses despite treatment with amphotericin B and flucytosine, the drugs of choice for the infection. Surgery is often required for resection of the fungal granuloma. Isolation of the fungus from the tissue specimens and its culture, showing dark colored fungal colonies clinches the diagnosis. Animal inoculation studies can provide insights to the portal of entry of the organism. We hereby report a case of fungal granuloma of the brain due to C. bantianum, which responded favorably to intensive antifungal treatment alone, with relevant review of literature.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Cladosporium; Fluconazole; Granuloma; Headache; Humans; Magnetic Resonance Imaging; Male; Review Literature as Topic; Staining and Labeling

We describe the successful medical treatment of invasive aspergillosis in a patient suffering from Weil's disease with a combined therapy based on amphotericin B lipid complex and voriconazole.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Brain Diseases; Drug Therapy, Combination; Humans; Lung Diseases, Fungal; Male; Middle Aged; Pyrimidines; Radiography; Treatment Outcome; Triazoles; Voriconazole; Weil Disease

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

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

A 79-year-old man with myelodysplastic syndrome developed a right optic neuropathy with optic disc edema and intractable periocular pain, one month after undergoing removal of a gangrenous gallbladder. Although results of a temporal artery biopsy were negative, he was treated with prednisone for presumed temporal arteritis. Attempts at tapering the prednisone dose led to recurrence of periocular pain. On neuro-ophthalmologic evaluation six months after the prednisone treatment was begun, he had developed right fourth and sixth cranial nerve palsies, and magnetic resonance imaging demonstrated a right orbital apex mass. Trans-sphenoidal biopsy revealed Aspergillus fumigatus. During treatment of aspergillosis, the patient developed a left hemiparesis. Magnetic resonance imaging disclosed multiple ring-enhancing cerebral masses. Biopsy revealed Nocardia asteroides. The patient was successfully treated for both infections with recovery of neurologic function except for the right optic neuropathy. Although immunocompromised patients are known to be subject to multiple infections, this may be the first reported case of concurrent sino-orbital aspergillosis and cerebral nocardiosis.

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Brain Diseases; Fatal Outcome; Humans; Imipenem; Magnetic Resonance Imaging; Male; Minocycline; Nocardia Infections; Orbital Diseases; Paranasal Sinus Diseases

Until recently, brain aspergillosis was almost always fatal, with a response rate to amphotericin B of < 10%. This study describes a retrospective analysis of eight consecutive cases of brain aspergillosis. All patients were immunosuppressed and five required mechanical ventilation. Antifungal treatment included amphotericin B (n = 7), itraconazole (n = 3), voriconazole (n = 2) and flucytosine (n = 1). Three (38%) patients survived following prolonged azole therapy after initial amphotericin B treatment, combined with a reduction in their immunosuppressive treatment. The prognosis of brain aspergillosis might be improved if immunosuppression could be reduced and prolonged oral azole therapy used.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillus; Brain Diseases; Critical Care; Female; Humans; Immunocompromised Host; Male; Middle Aged; Neuroaspergillosis; Pyrimidines; Retrospective Studies; Triazoles; Voriconazole

The aim of this retrospective study was to analyse the data of patients with rhino-orbital-cerebral mucormycosis for predisposing factors, diagnosis, treatment and survival rate. The role of frozen section in early diagnosis and use of nasal endoscopy in diagnosis, treatment and follow-up of patients has also been examined.. Retrospective case series.. University Teaching Hospital.. The case notes of 9 patients with diagnosis of mucormycosis who presented from 1973 to 2001 were examined. The data for predisposing factors, signs/symptoms, histological diagnosis, radiological intervention, medical and surgical treatment and final outcome was analysed.. There were 9 patients with mucormycoses. Early diagnosis was made by endoscopic examination and frozen section in 5 patients, which was later confirmed by histology. Treatment included parental and/or local amphotericin, hyperbaric oxygen and debridement either by endoscopic or external approach, with or without orbital exenteration. This resulted in an overall survival of 5 patients.. Frozen section diagnosis allows for early therapy since successful treatment depends on systemic amphotericin, surgical debridement and treatment of underlying predisposing factors. Nasal endoscopy is useful in diagnosis, endoscopic debridement and follow up of patients.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Brain Diseases; Debridement; Endoscopy; Female; Humans; Hyperbaric Oxygenation; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases; Retrospective Studies

Cerebral scedosporiosis is a life-threatening infection that is difficult to treat. The aim of this work was to develop a murine model of cerebral infection by Scedosporium apiospermum using intracranial inoculation and to use this model to evaluate the efficacy of amphotericin B deoxycholate and liposomal amphotericin B.. Mice were rendered neutropenic by intraperitoneal cyclophosphamide and intravenous (iv) 5-fluorouracil administration. Animals were infected with iv or intracranial inoculation of 1 x 10(4), 5 x 10(4) or 5 x 10(5) cfu of a clinical strain of S. apiospermum. Tissue burden reduction was determined in kidneys and brain 4 days after the infection. Efficacy of amphotericin B and liposomal amphotericin B (0.8 mg/kg/day intraperitoneally and 40 mg/kg/day iv, respectively) was evaluated in neutropenic mice infected iv or intracranially with 5 x 10(4) cfu. Survival was analysed with the log-rank test. Fungal burden values of different groups were compared using the Mann-Whitney U-test.. In our model, intracranial infection produced a higher fungal load in the brain and a lower fungal load in the kidney than iv inoculation. Survival of animals infected intracranially and treated with amphotericin B or liposomal amphotericin B (mean survival time = 8.3 and 9.2 days, respectively) was not different from the control group (P=0.58 and 0.85, respectively).. We have developed a murine model of cerebral scedosporiosis, which may be useful for studying various pathological aspects of this infection and evaluating new therapeutic approaches. Amphotericin B and liposomal amphotericin B were unable to resolve the infection.

Topics: Amphotericin B; Animals; Antifungal Agents; Brain; Brain Diseases; Disease Models, Animal; Humans; Liposomes; Male; Mice; Mycetoma; Neutropenia; Scedosporium; Treatment Failure

A 32-year-old immunocompetent female presented with sensory aphasia and psychomotor seizure due to aspergillosis in the left temporal lobe spreaded from the left orbita. In spite of oral administration of itraconazole, the symptoms continued to deteriorate due to extension of the lesion to the left temporoparietal white matter. As a result of the stereotactic biopsy of the lesion, she was histologically diagnosed as intracerebral aspergillosis. Intravenous administration of fluconazole and amphotericin B was apparently effective for the lesion, and the symptoms subsided. Ga-67 scintigram could serve as useful adjuncts to magnetic resonance images for evaluation of the therapy. This case is unusual in that an immunocompetent patient suffered from the intracerebral aspergillosis, which invasively spreaded into the parenchyma. We discussed about her pathology, diagnosis, therapy and the route of invasive aspergillosis to the parenchyma.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Brain Diseases; Female; Fluconazole; Humans; Immunocompetence

Cerebral aspergillosis infection is a rare disease in children that carries extremely high morbidity and mortality. Although occurring most commonly in the immunosuppressed patient, cerebral aspergillosis infection has been reported after trauma or neurosurgical procedures. Amphotericin B is the main medical therapy for cerebral aspergillosis. However, surgical treatment is often required for cases of abscess or granuloma formation. Despite aggressive antifungal treatment and surgical intervention, aspergillosis of the central nervous system is often fatal. We present a case report in which a free latissimus dorsi muscle flap was used in conjunction with antifungal medication and surgical debridement to treat intracranial and epidural aspergillosis in a young male following complex craniofacial trauma.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Brain Diseases; Child; Debridement; Humans; Male; Surgical Flaps; Wound Infection

To understand the demographic as well as clinical characteristics, and outcomes of patients with rhinocerebral mucormycosis in Taiwan, we retrospectively analyzed patients with this disease admitted to Chang Gung Memorial Hospital-Kaohsiung from 1988 through 2000. The 21 patients included 8 men (28%) and 13 women (62%). The median age was 60 years (range, 34-82 years). Twenty patients (95%) had underlying diabetes mellitus. The most common clinical feature at admission was ocular lesions, followed by headache, nostril lesions, and consciousness disturbance. Fifteen (94%) of 16 patients who received combined surgical debridement and therapy with amphotericin B survived, while only 1 (20%) of the 5 patients who received amphotericin B alone survived (p=0.004). The diagnosis of rhinocerebral mucormycosis was delayed in 4 patients (19%). Of the 16 patients who survived, 1 (6%) had delayed diagnosis, while of the 5 patients who died, 3 (60%) had delayed diagnoses (p=0.028). This series disclosed a higher proportion of patients with rhinocerebral mucormycosis in Taiwan had underlying diabetes mellitus, and ocular lesions were more frequent than nostril lesions at the time of admission. These results highlight the importance of the timely initiation of a combination of aggressive surgical debridement and treatment with amphotericin B in patients with rhinocerebral mucormycosis. Considering the high rate of delayed diagnosis, improved clinician's awareness of mucormycosis is extremely important and is in urgent need in Taiwan.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Brain Diseases; Community Health Centers; Debridement; Diabetes Complications; Eye; Female; Fever; Headache; Humans; Male; Middle Aged; Mucormycosis; Nose; Nose Diseases; Retrospective Studies; Taiwan; Treatment Outcome; Unconsciousness

In this report we describe a case of cerebral phaeohyphomycosis involving a 56-year-old Egyptian male who worked as a mason in Kuwait for 6 years. Computerized tomography scan of the brain revealed presence of a large abscess in the left occipital lobe. Aspirated pus from the abscess showed branched, septate, hyphae with light brown pigmentation. Cultured pus grew the fungus Ramichloridium mackenziei. Despite amphotericin B (1 mg kg(-1) per day) therapy for 2 weeks, the patient expired. The isolate was later found to be resistant to amphotericin B ( > 32 microg ml(-1)). Antifungal susceptibility testing to other agents was also performed.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Brain Diseases; Drainage; Fatal Outcome; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Middle East; Mycoses

This report describes a patient with intracranial Aspergillus flavus infection in whom it was impossible to remove the fungal mass surgically. Progressive fungal infiltration of the optic nerves was reversed and the extensive intracranial fungal burden was managed successfully with combination antifungal-immunomodulatory therapy alone.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; Brain Diseases; Cytokines; Drug Therapy, Combination; Female; Humans; Liposomes; Magnetic Resonance Imaging

Topics: Acquired Immunodeficiency Syndrome; Adolescent; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Brain Diseases; Female; Histoplasma; Histoplasmosis; HIV-1; Humans; Itraconazole; Transfusion Reaction

Cryptococcal infection is common in immunocompromised patients, often presenting with meningitis or meningoencephalitis. We report an unusual presentation of cryptococcal infection in an immunocompetent patient presenting with headache and hemiplegia. CT demonstrated a large ring-enhancing lesion in the parietal region with intralesional calcification.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Central Nervous System Fungal Infections; Cryptococcosis; Follow-Up Studies; Humans; Male; Parietal Lobe; Tomography, X-Ray Computed

Of the 21 patients with aspergillosis of central nervous system seen during the years 1990-1997, 16 (76%) had aspergillosis of sino-cranial origin. The occupation in patients with sino-cranial aspergillosis was either agricultural or manual work and predisposing risk factors were present in only two (12.5%) patients. Skull-base syndromes were the presenting features in 13 patients and three patients presented with features of intracranial space-occupying lesion. Paranasal sinus mass lesions were seen in all the 16 patients. Computerized tomography showed intracranial extradural-enhancing mass lesions in the anterior, middle or posterior cranial fossa in nine (68%) patients, intracranial and orbital lesions in four and orbital lesions in three. Well-formed granuloma with dense fibrosis was the histological feature. Survival rates were not good even after surgical and antifungal chemotherapy. Surgical treatment was subradical in our series. The majority of cases of sinocranial aspergillosis are reported from countries with temperate climates and the high incidence in these regions is probably related to constant exposure to the high spore content of pathogenic Aspergillus species in the 'mouldy' work environment.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Biopsy; Brain Diseases; Central Nervous System Fungal Infections; Climate; Female; Flucytosine; Granuloma; Humans; India; Male; Middle Aged; Occupational Diseases; Orbital Diseases; Risk Factors; Sinusitis; Tomography, X-Ray Computed

We report our recent experience with two cases of invasive pulmonary aspergillosis in patients who were both undergoing chemotherapy, one for acute myeloid leukaemia and the other for primary amyloidosis. Both patients had bad prognostic factors and were in very poor clinical condition, but both recovered from infection after a prolonged therapy with liposomal amphotericin B (AmBisome) without signs of toxicity.

Topics: Aged; Amphotericin B; Amyloidosis; Antifungal Agents; Antineoplastic Agents; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Brain Diseases; Fatal Outcome; Humans; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Middle Aged

Mucormycosis is a rare opportunistic infection but a fulminant disease. We report the 4 first cases of rhinocerebral mucormycosis diagnosed in Sfax region (Tunisia). They occurred in insulin dependent diabetes and developed varying clinical manifestations from facial cellulites to ocular and cerebral extension. The diagnosis of mucormycosis was not initially evoked, but confirmed tardively by anatomopathologic and mycologic examinations. The evolution was favourable in 2 cases by administration of amphotericine B associated with extensive surgical debridement and correction of the diabetes. Two patients had a fatal outcome. This infection has a severe prognosis and necessitates early diagnosis.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Diabetes Mellitus, Type 1; Eye Diseases; Fatal Outcome; Female; Humans; Male; Middle Aged; Mucormycosis; Nose Diseases; Prognosis; Tunisia

Rhino-orbital-cerebral mucormycosis is usually associated with a poor prognosis and is almost exclusively seen in immunocompromised patients. We report the third documented case of rhino-orbital-cerebral mucormycosis caused by Apophysomyces elegans (a new genus of the family Mucoraceae first isolated in 1979) in an immunocompetent individual. Orbital exenteration and radical debridement of involved adjacent structures combined with intravenous liposomal amphotericin resulted in patient survival.. Interventional case report.. A 59-year-old immunocompetent white man sustained a high-pressure water jet injury to the right inner canthus while cleaning an air conditioner filter. He later had "orbital cellulitis" develop that did not respond to antibiotics and progressed to orbital infarction. Imaging studies and biopsy results led to a diagnosis of mucormycosis. Tissue culture grew Apophysomyces elegans, a new genus of the family Mucoraceae first isolated in 1979. Orbital exenteration and radical debridement of involved adjacent structures, combined with intravenous liposomal amphotericin, resulted in patient survival.. After orbital exenteration and debridement of involved adjacent structures along with intravenous liposomal amphotericin, our patient has remained free from relapse with long-term follow-up.. The agent causing this case of rhino-orbital-cerebral mucormycosis (Apophysomyces elegans) contrasts with the three genera most commonly responsible for mucormycosis (Rhizopus, Mucor, and Absidia) in that infections with this agent tend to occur in warm climates, by means of traumatic inoculation, and in immunocompetent patients. Rhino-orbital-cerebral mucormycosis should be considered in all patients with orbital inflammation associated with multiple cranial nerve palsies and retinal or orbital infarction, regardless of their immunologic status. A team approach to management is recommended for early, appropriate surgery and systemic antifungal agents.

Topics: Amphotericin B; Brain Diseases; Debridement; Eye Infections, Fungal; Humans; Immunocompetence; Magnetic Resonance Imaging; Male; Middle Aged; Mucorales; Mucormycosis; Nose Diseases; Orbit Evisceration; Orbital Diseases; Tomography, X-Ray Computed

Topics: Aged; Amphotericin B; Anticoagulants; Brain Diseases; Debridement; Diabetes Mellitus, Type 2; Humans; Male; Mucormycosis; Paranasal Sinus Diseases; Warfarin

A case of liver and brain mucormycosis in a 73-y-old diabetic patient is described. The patient presented with fever and a moderate, tender hepatomegaly and a C/T scan examination of the abdomen and brain showed multiple hepatic and cerebral nodular lesions. The largest of the liver lesions was aspirated and broad hyphae of mucor were demonstrated in the purulent material obtained. The patient was treated successfully (for 40 d) with intravenous liposomal amphotericin B and then with itraconazole for 3 months. To our knowledge, this is the first case of a diabetic patient with both liver and brain mucormycosis who has been treated successfully.

Topics: Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Diabetes Mellitus, Type 2; Female; Humans; Liver Diseases; Mucormycosis; Opportunistic Infections

Rhinocerebral mucormycosis is a rapidly progressing, often fatal fungal infection that occurs commonly in diabetics and immunocompromised individuals. We present 2 cases of rhinocerebral mucormycosis with a paranasal mass. One patient had an intracranial extension. Nasal scrapings and fine-needle aspiration cytology (FNAC) of the paranasal masses showed fungal hyphae morphologically resembling Mucor. Surgical material showed features of mucormycosis. FNAC and scrape smears can give a conclusive diagnosis of mucormycosis, and the patient can be treated with appropriate antifungal therapy and surgical debridement. Preoperative cytology is an effective technique to establish a diagnosis of mucormycosis and obviates the need for a preoperative biopsy.

Topics: Amphotericin B; Antifungal Agents; Biopsy, Needle; Brain Diseases; Debridement; Diabetes Complications; Humans; Male; Middle Aged; Mucormycosis; Paranasal Sinus Diseases; Rhizopus; Treatment Outcome

This is a report of the use of endoscopic sinus surgery in the management of three patients diagnosed with rhino-orbital or rhino-orbito-cerebral mucormycosis. A retrospective review was performed of the clinical examinations and imaging studies of three patients who underwent endoscopic sinus surgery as part of their therapy for mucormycosis. In addition to endoscopic surgery, all patients had aggressive control of underlying risk factors (diabetes mellitus, immunosuppression) and prolonged intravenous amphotericin B therapy. All three patients survived and avoided orbital exenteration. In selected patients with rhino-orbito-cerebral mucormycosis, endoscopic techniques can play a valuable role in diagnosis and management.

Topics: Adult; Amphotericin B; Brain Diseases; Endoscopy; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mucormycosis; Orbital Diseases; Paranasal Sinuses; Sinusitis

Only a few cerebral infections with the dark-walled mold Ramichloridium obovoideum (Ramichloridium mackenziei) have been reported in the literature. Central nervous system infections caused by this fungus have poor prognoses; the optimal medical and surgical treatments have not yet been established. We report a case of cerebral R. obovoideum infection for which a combination of medical and surgical treatments failed.. A 58-year-old Kuwaiti woman, with a history of chronic renal failure requiring hemodialysis, presented with a 3-day history of left frontal headache, blurry vision, dizziness, and right-sided clumsiness. Computed tomography demonstrated multiple, ring-enhancing, cerebral lesions (the largest of which measured 2-3 cm) in the deep left parieto-occipital region.. A computed tomography-guided needle biopsy of the parieto-occipital lesion yielded 10 ml of dark caseous fluid. Stains demonstrated long, branching, septate hyphae. Fungal cultures grew R. obovoideum. The patient was treated with a combination of amphotericin B and itraconazole. The condition of the patient continued to deteriorate, and stereotactic aspiration of the largest lesion was performed. Despite this approach, the lesion progressed and the patient died.. R. obovoideum is being increasingly recognized as a cause of cerebral abscesses in patients residing in the Middle East. Prognoses are poor, and responses to antifungal therapy are generally short-lived. Until more effective therapies are found, the greatest chance for adequate treatment involves early recognition, prompt treatment with antifungal agents, and attempts at complete resection.

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Drainage; Fatal Outcome; Female; Humans; Itraconazole; Magnetic Resonance Imaging; Middle Aged; Mitosporic Fungi; Mycoses

Topics: Adolescent; Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Brain Diseases; Drug Carriers; Humans; Immunosuppressive Agents; Liposomes; Male

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: Adolescent; Amphotericin B; Antifungal Agents; Brain Diseases; Fatal Outcome; Humans; Leukemia; Male; Mucormycosis; Orbital Diseases; Paranasal Sinus Diseases

Cerebral aspergillosis is a life-threatening complication in liver transplant recipients, with mortality rates approaching 100%; treatment with amphotericin B is of limited efficacy because of its poor distribution in the cerebrospinal fluid and its systemic side effects. We report the case of a liver transplant recipient who developed recurrent cerebral Aspergillus fumigatus infection, and was successfully treated by combined surgical excision of the lesion and administration of liposomal amphotericin B. This first report of long-term complication-free survival in a liver transplant recipient suggests that therapy with liposomal amphotericin B may reduce the risk of recurrence of cerebral aspergillosis in these immunocompromised patients.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Brain; Brain Diseases; Drug Carriers; Humans; Liposomes; Liver Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Postoperative Complications; Time Factors; Tomography, X-Ray Computed

To describe ocular findings in 2 patients with disseminated coccidioidomycosis diagnosed by skin biopsy.. The clinical and histopathologic findings of the 2 patients were reviewed retrospectively.. One patient had a unilateral, granulomatous iridocyclitis with multiple iris nodules and a large vascularized anterior chamber mass, in the setting of pulmonary, cutaneous, and skeletal infection by Coccidioides immitis. The second patient developed papilledema and multifocal chorioretinitis accompanied by pulmonary, cutaneous, and meningeal C immitis infection. In each case, examination of the skin biopsy specimen revealed C immitis spherules. Treatments included local and systemic amphotericin B and oral fluconazole.. Although rare, intraocular involvement can occur in the setting of disseminated coccidioidomycosis. A thorough systemic evaluation and biopsy of suspicious skin lesions can aid in the diagnosis.

Topics: Adult; Amphotericin B; Biopsy; Bone Diseases; Brain Diseases; Chorioretinitis; Coccidioidomycosis; Dermatomycoses; Eye Infections, Fungal; Female; Fluconazole; Humans; Iridocyclitis; Lung Diseases, Fungal; Male; Radiography; Radionuclide Imaging; Retrospective Studies; Skin; Technetium Tc 99m Pyrophosphate

A 24-year-old male developed cytogenetic relapse of chronic myeloid leukemia (CML) four years after allogeneic BMT. After a year of treatment with IFN-alpha, he achieved a partial cytogenetic response. Treatment with donor leukocyte infusions (DLI) was given (total dose 1 x 10(8) T lymphocytes/kg). Two months later, he developed acute GVHD (skin and liver), that improved with CsA and methylprednisolone and resulted in cytogenetic remission with complete donor chimerism. One month later he developed rhinocerebral mucormycosis and was successfully treated with surgical debridement and liposomal amphotericin B (total dose 12 g). This is the first case of mucormycosis described after DLI.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Drug Carriers; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukocyte Transfusion; Liposomes; Male; Mucormycosis; Transplantation, Homologous

A new member of the polyene family, N-dimethylaminoacetyl-partricin A 2-dimethylaminoethylamide diaspartate (SPA), was investigated and was found to be more effective than amphotericin B (i) in vivo by enhancing mouse resistance to cryptococcal meningoencephalitis and (ii) in vitro by potentiating the anticryptococcal activity of murine microglial cells.

Topics: Amphotericin B; Animals; Antifungal Agents; Brain; Brain Diseases; Colony Count, Microbial; Dose-Response Relationship, Drug; Female; Meningitis, Cryptococcal; Mice; Polyenes

A renal transplant recipient with isolated cerebral aspergilloma 4 months after allograft transplantation is reported. On admission cerebral computed tomography showed a ring-enhancing mass in the left frontal hemisphere and aspirated purulent material revealed A. fumigatus hyphae. He was cured by short-term antifungal therapy and neurosurgical removal of the well demarcated lesion. He is still alive more than two years later and the renal transplant is well functioning. This is the first report of a renal transplant recipient with isolated cerebral aspergillosis without any relapse and only the third patient who has survived longer than 3 months. Early diagnostic procedures with rapid confirmation of aspergillus infection are pivotal for a benign clinical course.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Brain Diseases; Combined Modality Therapy; Craniotomy; Drainage; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged

Rhinocerebral mucormycosis is recognized as a potentially aggressive and commonly fatal fungal infection. The classic presentation is involvement of nasal mucosa with invasion of the paranasal sinuses and orbit. Mucormycosis is most commonly seen in association with diabetic ketoacidosis, but disease demographics have changed with the onset of AIDS and the advent of powerful immunosuppressive drugs. Treatment includes aggressive debridement, systemic antifungal therapy, and control of underlying comorbid factors. Although surgical intervention remains essential, advances in medical therapy have permitted a more limited surgical approach to minimize functional loss without compromising survival. We present the UCLA experience with rhinocerebral mucormycosis from 1955 to 1995, with emphasis on the evolution of disease presentation and alternative treatment options.

Topics: Adolescent; Adult; Aged; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Brain Diseases; Child; Combined Modality Therapy; Debridement; Diabetic Ketoacidosis; Female; Follow-Up Studies; Humans; Immunocompromised Host; Immunosuppressive Agents; Male; Middle Aged; Mucormycosis; Nasal Mucosa; Nose Diseases; Opportunistic Infections; Orbital Diseases; Paranasal Sinus Diseases; Retrospective Studies; Survival Rate; Treatment Outcome

Well-recognized risk factors for zygomycosis include diabetic ketoacidosis, immunocompromise, and deferoxamine therapy for iron or aluminum overload, usually in patients undergoing kidney dialysis. We report a case of fatal nasal-orbital-cerebral zygomycosis in an 82-year-old man with known myelodysplasia and well-controlled diabetes. He was not receiving deferoxamine. Despite radical surgery and amphotericin B therapy, he died; primary hemochromatosis with gross iron overload was found post mortem. Experimental evidence suggests iron overload without deferoxamine therapy may be a risk factor for zygomycosis; the findings in this case would support this hypothesis.

Topics: Aged; Amphotericin B; Antifungal Agents; Biopsy; Brain Diseases; Eye Infections, Fungal; Fatal Outcome; Follow-Up Studies; Humans; Iron; Iron Overload; Male; Mucor; Mucormycosis; Orbit Evisceration; Orbital Diseases; Paranasal Sinus Diseases; Risk Factors; Tomography, X-Ray Computed

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Bone Marrow Transplantation; Brain Diseases; Female; Humans; Rifampin; Transplantation, Homologous

Topics: Aged; Amphotericin B; Brain Diseases; Eye Diseases; Fatal Outcome; Female; Humans; Mucormycosis; Nose Diseases

In a murine model of intracerebral infection by Cryptococcus neoformans the therapeutic effects of pentoxifylline or dexamethasone were studied alone and in combination with amphotericin B. Assessed parameters were mean survival time, brain histopathology index, amounts of glutamate and gamma-aminobutyric acid in the brain, and yeast CFU per brain. Survival increased significantly in mice treated with dexamethasone, amphotericin B, amphotericin B plus dexamethasone, and amphotericin B plus pentoxifylline; the latter had significantly longer survival than other treated groups. Indices of histopathological damage were similar in all treated groups. In infected untreated mice, the amounts of glutamate in the brain were decreased, presumably by depletion. In mice treated with amphotericin B plus dexamethasone, glutamate levels returned to the range of control mice. No differences in the amounts of gamma-aminobutyric acid were found between control and treatment groups. Brain fungal counts were significantly lower in mice treated with amphotericin B, amphotericin B plus dexamethasone, and amphotericin B plus pentoxifylline than in untreated animals. In this model, pentoxifylline in combination with amphotericin B improved survival, decreasing the fungal burden, and has potential as adjuvant therapy in cerebral cryptococcosis.

Topics: Amphotericin B; Animals; Antifungal Agents; Brain; Brain Chemistry; Brain Diseases; Cryptococcosis; Dexamethasone; Drug Therapy, Combination; Female; gamma-Aminobutyric Acid; Glutamic Acid; Mice; Pentoxifylline; Survival Analysis

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Humans; Itraconazole; Mitosporic Fungi; Mycoses

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Drug Combinations; Humans; Mucormycosis; Phosphatidylcholines; Phosphatidylglycerols; Sinusitis

A 65 year old man was found to have mucormycosis cerebri during immunosuppression after treatment of hairy cell leukaemia with 2-chlorodeoxyadenosine. Although mucormycosis cerebri has a poor prognosis, the patient survived after systemic administration of high dose amphotericin B, extensive excision of the abscess, and additional local application of amphotericin B with the help of an absorbable gelatin sponge.

Topics: Administration, Topical; Aged; Amphotericin B; Animals; Antifungal Agents; Brain Diseases; Gelatin; Humans; Immunocompromised Host; Male; Mucormycosis; Treatment Outcome

A 43-year-old male was diagnosed as having cryptococcal meningitis based on his clinical condition, cerebrospinal fluid (CSF) profile and high titer CSF cryptococcal antigen. The patient received intravenous amphotericin B at a total dose of 91 mg over 5 days. The therapy was then abandoned due to acute hepatorenal failure. The patient's neurologic status remained stable for 2 months, after which he began experiencing somnolence, confusion and a personality change. Cranial computed tomography revealed multifocal white matter lesions, and a brain biopsy showed a demyelination change with concurrent IgM and C1q deposition. A clinical diagnosis of amphotericin B-induced leukoencephalopathy was made. The patient's clinical condition was partially reversed after low-dose steroid therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Humans; Male; Meningitis, Cryptococcal

To review the presentation and course of choroidal blastomycosis, a rare chorioretinal mycotic infection, which results from disseminated blastomycosis.. Two cases of disseminated blastomycosis with ocular infection limited to the choroid are presented. Each patient was diagnosed through biopsy of skin lesions demonstrating the characteristic histologic features and the budding yeast.. Systemic evaluation revealed extensive disseminated disease with involvement of the eye, lung, skin, bone and joint, central nervous system, and genitourinary system. Both patients were successfully treated with intravenous amphotericin B with elimination of ocular and systemic disease.. Although rare, blastomycosis can result in choroidal mycotic infection in immune competent individuals. Tissue biopsy to confirm the diagnosis and extensive systemic evaluation are required.

Topics: Adult; Amphotericin B; Blastomyces; Blastomycosis; Brain Diseases; Choroid; Choroid Diseases; Dermatomycoses; Eye Infections, Fungal; Female; Fundus Oculi; Hand; Humans; Infusions, Intravenous; Male; Middle Aged; Osteomyelitis; Radionuclide Imaging; Skin; Tomography, X-Ray Computed

Disseminated infection with Histoplasma capsulatum frequently involves the nervous system, but the CNS process is generally not clinically apparent. We report an unusual case of a renal transplant recipient with long-standing immunosuppression who presented with clinical evidence of mass lesions in both his cerebral cortex and his spinal cord. Findings of CSF examination were normal, but stereotaxic biopsies of his cortical lesions demonstrated yeast forms and cultures of biopsy specimens yielded H. capsulatum. Clinical defects referable to both the cortical and spinal lesions decreased in severity after the patient received antifungal therapy. Our case illustrates that disseminated histoplasmosis can present in myriad ways and that widespread disease in the CNS can be occult in immunocompromised patients.

Topics: Aged; Amphotericin B; Anorexia; Brain Diseases; Follow-Up Studies; Histoplasmosis; Humans; Immunocompromised Host; Kidney Transplantation; Magnetic Resonance Imaging; Male; Postoperative Complications; Spinal Cord Diseases; Weight Loss

Encephalopathy, leukoencephalopathy, and secondary parkinsonism occurred in 3 children with refractory leukemia undergoing allogenic bone marrow transplantation (BMT) who were treated with high-dose amphotericin B for pulmonary aspergillosis or sinus aspergillosis that did not involve the nervous system. Treatment included high-dose cytosine arabinoside, cyclophosphamide, and total body irradiation prior to the BMT. The children developed a progressively worsening encephalopathy and parkinsonian features, characterized by resting tremor, cogwheel rigidity, and masklike facies. Neuroimaging studies showed cerebellar, cerebral, and basal ganglia atrophy, as well as frontal and temporal lobe white matter involvement. Two of the 3 patients recovered, although 1 has residual intellectual impairment. The third succumbed to non-central nervous system Epstein-Barr virus-lymphoproliferative disease and had autopsy-confirmed leukoenephalopathy.

Topics: Adolescent; Amphotericin B; Antineoplastic Agents; Aspergillosis; Bone Marrow Transplantation; Brain Diseases; Child; Cyclophosphamide; Cytarabine; Humans; Leukemia, Myeloid, Acute; Lung Diseases; Male; Methotrexate; Parkinson Disease; Radiation Injuries

Topics: Amphotericin B; Antifungal Agents; Brain Diseases; Humans; Injections, Spinal; Mucormycosis

Cerebral aspergillosis has a very poor prognosis. When this complication occurs in the immunocompromised host, evolution is virtually fatal in all cases despite surgical and medical treatment. We describe in this report the case of a child with acute lymphoblastic leukaemia who developed pulmonary aspergillosis, and subsequent cerebral dissemination during therapeutic induction. Due to multifocal cerebral lesions, surgery was impossible. The patient was administered long term treatment including amphotericin B, flucytosine and itraconazole for 9 months, during which time a neutropenic period occurred with reactivation of cerebral mycotic lesions, in spite of modification of antileukaemic therapy. Seven years later, he nevertheless remains in complete remission without any neurological sequelae. Thus cerebral aspergillosis requires early diagnosis and can be treated using a strong combination of antimycotic drugs (amphotericin B, flucytosine and itraconazole) on a long term basis, even when aspergillomas cannot be removed surgically. Antileukaemic therapy must be concomitantly adapted to avoid or limit neutropenia.

Topics: Amphotericin B; Aspergillosis; Brain Diseases; Child; Flucytosine; Humans; Immunocompromised Host; Itraconazole; Lung Diseases, Fungal; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma

The case is reported of a 70-year-old man with decompensated non-acidotic type-2 diabetes mellitus and with rhinocerebral mucormycosis, manifested by inflammatory infiltration of the left nasal, paranasal, maxillary, and orbital bone structures with left ophthalmoplegia. The patient was cured after amphotericin B treatment (total dose 2.7 g) and 30 sessions of hyperbaric oxygen (2.8 atmospheres). Cure was confirmed by follow-up over more than 2 years. It is concluded that rhinocerebral mucormycosis must be treated, in addition to control of predisposing factors, and especially by restoring endocrine-metabolic balance, by adequate surgical revision, with specific high-dose amphotericin B treatment and adjunctive hyperbaric oxygen. Further studies are desirable in order to define the advantages of these therapeutic measures.

Topics: Aged; Amphotericin B; Brain Diseases; Diabetes Mellitus, Type 2; Follow-Up Studies; Humans; Male; Mucormycosis; Nose Diseases; Time Factors; Tomography, X-Ray Computed

Topics: Aged; Amphotericin B; Brain Diseases; Combined Modality Therapy; Diabetes Complications; Drug Carriers; Humans; Liposomes; Male; Mucormycosis; Nose Diseases

Rhinocerebral aspergillosis (RA) is becoming increasingly common in patients undergoing bone marrow transplantation (BMT). The disease can involve nearly all major head and neck structures, including the nose, paranasal sinuses, and orbits. Intracranial extension of the infection is of major concern, since this is usually a fatal complication. Our study population comprised 423 consecutive BMT patients at Hadassah University Hospital from January 1986 to August 1992. Eight patients (1.9%) developed RA, 5 of whom had underlying hematologic malignancies, and 3 of whom had severe aplastic anemia. Only 2 of the 8 patients responded completely to therapy, with a follow-up of 15 months. It appears that RA is a fatal complication in immunocompromised patients post-BMT. Early diagnosis followed by extensive surgical debridement of necrotic tissue and systemic, as well as topical, antifungal therapy with amphotericin B or its new formulations and the patient's recovery of bone marrow function may improve the outcome of this life-threatening complication.

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Aspergillus flavus; Bone Marrow Transplantation; Brain Diseases; Female; Humans; Infant; Male; Middle Aged; Opportunistic Infections; Paranasal Sinus Diseases; Retrospective Studies; Treatment Outcome

Topics: Amphotericin B; Brain Diseases; Candidiasis; Female; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Liver Diseases; Middle Aged; Splenic Diseases

Topics: Adult; Amphotericin B; Brain Diseases; Female; Humans; Parkinson Disease, Secondary

Six months after an attack of pyelonephritis, adnexitis and candida colpitis an 18-year-old girl developed some clouding of consciousness. On neurological examination she showed organic behavioural changes, discrete anisocoria and possible meningism. Computed tomography revealed hydrocephalus and signs of increased cerebrospinal fluid (CSF) pressure. CSF contained 2336/3 cells, while total protein was raised to 7.0 g/l and lactate concentration to 6.85 mmol/l. Glucose concentration in CSF was 51 mg/dl and 75 mg/dl in serum. As tuberculous meningitis was suspected, treatment was started with four tuberculostatic drugs, but there was no improvement. Five weeks later microscopic CSF examination showed fungal spores and nonbranching hyphae. The maximal candida haemagglutination titre in CSF was 1:2048. CSF culture grew Candida albicans. The further course was complicated by side effects to the antimycotic drugs (amphotericin B between 4.5 and 45 mg daily; flucytosine 1.7 g four times daily) and recurrent obstruction in the ventricular system requiring repeated neurosurgical interventions. However, full cure was achieved after seven months' hospital treatment.

Topics: Adolescent; Amphotericin B; Antitubercular Agents; Brain Diseases; Candida albicans; Candidiasis; Candidiasis, Vulvovaginal; Cerebrospinal Fluid; Diagnosis, Differential; Female; Flucytosine; Humans; Hydrocephalus; Pelvic Inflammatory Disease; Pyelonephritis; Tomography, X-Ray Computed; Tuberculosis, Meningeal

A rare case of rhinocerebral mucormycosis occurred in a 74-year-old diabetic male with gradually progressive right visual loss and total ophthalmoplegia. Computed tomography and magnetic resonance imaging revealed an invasive right orbital apex mass, destroying the medial wall of the orbit and extending into the right cavernous sinus and right middle fossa. Laboratory data demonstrated no signs of inflammation. A carcinomatous lesion originating in the paranasal sinuses and extending into the intracranial space was diagnosed. The mass was totally removed through a subfrontal approach to confirm the histological diagnosis and decompress the optic nerve. The histological diagnosis was mucormycosis. Despite aggressive medical therapy, dissemination resulted in mucor pleuritis and mucor encephalitis or meningitis. He died of septic shock and acute renal failure.

Topics: Aged; Amphotericin B; Brain Diseases; Cavernous Sinus; Diagnosis, Differential; Ethmoid Sinus; Humans; Magnetic Resonance Imaging; Male; Mucormycosis; Orbital Diseases; Paranasal Sinus Neoplasms; Tomography, X-Ray Computed

Amphotericin is a powerful antifungal agent of high toxicity. Encapsulation in liposomes has led to new perspectives although clinical experience is still slight. Four patients, who were neither carriers of antibodies against the human immunodeficiency virus nor neutropenic, diagnosed of meningeal cryptococcosis, pleural aspergillosis, cerebral aspergillosis and ophthalmic candidiasis, respectively and treated with liposomal amphotericin are reported. The treatment was effective and well tolerated. Clinical improvement was observed in the patient with cerebral aspergillosis but magnetic resonance demonstrated persistence of the lesions. Only slight deterioration in renal function was observed in one case and in the other two renal failure improved upon substitution of conventional amphotericin by liposomal amphotericin. The slight systemic toxicity and the absence of local intolerance allowed the administration of high doses and shortening of the therapeutic schedule.

Topics: Adult; Aged; Amphotericin B; Aspergillosis; Brain Diseases; Candidiasis; Drug Carriers; Eye Infections, Fungal; Humans; Immunosuppression Therapy; Liposomes; Male; Meningitis, Cryptococcal; Middle Aged; Pleural Diseases

The intracisternal administration of amphotericin B (AmB) and its mono-methyl ester derivative (AME), via direct intraventricular injection (0.01 to 5 mg/ml, 6 microliters) in adult female Wistar rats, revealed that AmB was significantly more toxic than AME, as measured by weight loss, lethargy, death, and central nervous system histopathology. Light and electron microscopy confirmed a greater neurotoxicity for AmB, manifested as edema and modest gliosis extending along and beyond the injection tract. Neuronal degeneration and myelin damage were present in AmB-treated (1 mg/ml) animals but were present only modestly in animals treated with AME at a fivefold greater concentration. Intravenous administration of AmB to adult female Wistar rats as five daily doses of 5 mg/kg of body weight resulted in significant weight loss and some deaths. Histopathologic examination of the brains, spinal cords, and sural nerves of surviving animals revealed neurotoxicity manifested by neuronal degeneration, gliosis, and myelin edema. In sharp contrast, similar treatment with AME at a 10-fold greater dose resulted in neither death nor significant neurotoxicity. The administration of five daily doses of a mixture of AME-AmB (9:1; wt/wt) at 50 mg/kg of body weight resulted in neurotoxicity. These results indicate that AmB exhibits significantly greater in vivo neurotoxicity than AME.

Topics: Amphotericin B; Animals; Antifungal Agents; Body Weight; Brain Diseases; Drug Combinations; Female; Injections, Intravenous; Injections, Intraventricular; Nerve Degeneration; Neurons; Peripheral Nervous System Diseases; Rats; Rats, Wistar

Mucormycosis is known to cause rhinocerebral and pulmonary disease in patients with diabetes, leukemia, and lymphoma. However, the characteristics and outcome of these infections have not been well described in the BMT population. In a 17-year consecutive series of BMT patients, 13 of 1500 patients (0.9%) developed mucormycosis. Ten of the transplants were allogeneic and three autologous. Six infections occurred within 90 days of transplant, and six occurred at or within several days of autopsy. Seven patients were neutropenic and another patient had just engrafted at diagnosis of infection. Sites of infection were lung-brain (n = 4), sinonasal region (n = 3), lung (n = 2), disseminated (n = 2), lung-kidney (n = 1), and bone-muscle (n = 1). All patients were treated with prolonged amphotericin B therapy. Surgical debridement was employed in the three sinonasal infections. Death from mucormycosis occurred in ten of 13 (77%) patients. Two patients are alive, including one who had resolution of sinonasal infection. Mucormycosis may occur in both neutropenic and non-neutropenic patients, and may occur long after hospital discharge for BMT. These infections are often fatal, although patients with limited sinonasal disease may have a better prognosis, especially with early diagnosis and aggressive antifungal therapy.

Topics: Adolescent; Adult; Amphotericin B; Bone Marrow Transplantation; Brain Diseases; Child; Child, Preschool; Female; Humans; Immunocompromised Host; Leukemia; Lung Diseases; Male; Mucormycosis; Paranasal Sinuses; Prospective Studies; Treatment Outcome

We report instances of fatal leukoencephalopathy associated with the intravenous administration of the antifungal agent amphotericin B (AmB) to a 16-year-old girl treated for acute lymphoblastic leukemia and a 22-year-old man who underwent bone marrow transplantation for a myelodysplastic syndrome. Both received AmB in association with cranial irradiation and developed a subacutely evolving neurologic disorder characterized by personality change and confusion rapidly progressing to akinetic mutism. Neuroimaging studies disclosed diffuse nonenhancing abnormalities of the cerebral, particularly frontal, white matter that included hypodensity on CT and increased signal on T2-weighted MRI. Postmortem examinations demonstrated a diffuse, noninflammatory leukoencephalopathy with florid astrogliosis, demyelination, and infiltration of the hemispheric white matter by foamy macrophages. In neither case was there evidence of opportunistic infection or neoplastic infiltration of the nervous system. We review the evidence that polyene macrolide antibiotics such as AmB are potential leukotoxins.

Topics: Adolescent; Adult; Amphotericin B; Bone Marrow Transplantation; Brain; Brain Diseases; Female; Humans; Magnetic Resonance Imaging; Male; Myelodysplastic Syndromes; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Rhinocerebral mucormycosis was diagnosed in a 75-year-old woman with a history of type II diabetes mellitus. This rare opportunistic infection is caused by fungi belonging to the order of Mucorales. The patient had a severe osteomyelitis of the base of the skull, resulting in complaints of headache and diplopia. She was treated with intravenous colloidal amphotericin B, surgical excision, and later with liposomal amphotericin B. She died of respiratory failure. Mucormycosis is usually a rapidly fulminant infection. This patient showed a remarkably chronic course.

Topics: Aged; Amphotericin B; Brain Diseases; Chronic Disease; Ethmoid Bone; Female; Humans; Mucormycosis; Osteomyelitis; Rhizopus; Tomography, X-Ray Computed

We report the treatment of cerebral aspergillosis with amphotericin B, flucytosine, surgery, and liposomal amphotericin B (L-AmB) after a liver transplant. The patient died 2 months after cessation of antifungal therapy, as a consequence of multiple-system organ failure. The only relevant postmortem finding in the brain was a small, encapsulated abscess containing hyphae. This case indicates that L-AmB is an effective alternative drug for cerebral aspergillosis.

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Brain Diseases; Combined Modality Therapy; Flucytosine; Humans; Liver Transplantation; Male; Middle Aged; Opportunistic Infections

Survival is uncommon in bilateral cerebro-rhino-orbital mucormycosis treated surgically and medically. A 66-year-old man in previously good health had bilateral cerebro-rhino-orbital mucormycosis and newly diagnosed nonketotic diabetes mellitus at initial examination. Total loss of vision, proptosis, and ophthalmoplegia of both eyes were present. The patient was treated with aggressive surgical and medical therapies that included bilateral orbital exenteration, intravenous and local amphotericin B, hyperbaric oxygen, and control of the diabetes mellitus. One and one-half years after onset of the illness, the patient is alert and clinically stable. The importance of prompt diagnosis and aggressive treatment of this disease is emphasized by this case. Additionally, we suggest that adjunctive hyperbaric oxygen is a reasonable modality in the treatment of this often fatal disease.

Topics: Aged; Amphotericin B; Brain Diseases; Combined Modality Therapy; Eye Infections, Fungal; Humans; Hyperbaric Oxygenation; Male; Maxillary Diseases; Mucormycosis; Orbital Diseases; Tomography, X-Ray Computed

Topics: Adult; Amphotericin B; Brain Diseases; Granulocyte Colony-Stimulating Factor; Humans; Male; Mucormycosis; Nose Diseases; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recombinant Proteins

Topics: Amphotericin B; Brain Diseases; Deferoxamine; Humans; Male; Middle Aged; Mucormycosis; Nasal Mucosa; Postoperative Complications; Renal Dialysis

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

Mucormycosis (phycomycosis) is an acute and often fatal infection, mostly seen in diabetics and immunocompromised patients, and seldom in healthy people. Therapy includes aggressive surgical debridement, amphotericin B and control of underlying predisposing condition (diabetes, immunosuppression or immunodeficiency). The rhino-sinuso-orbital presentation is typically observed in insulin-dependent diabetes mellitus with ketoacidosis. This metabolic condition may impair the polymorphonuclear function in a reversible way and this may favour infection by a mucoral. These spores germinate into hyphae, which invade local arteries and arterioles, causing thrombosis, vascular insufficiency and tissue hypoxia and acidosis, conditions which further enhance fungal growth. Hyperbaric oxygen has theoretical value in treating mucormycosis, since it reduces tissue hypoxia caused by the vascular insufficiency. We report an insulin-dependent diabetic patient with rhino-sinuso-orbital mucormycosis, who after being treated with amphotericin B and surgical debridement on two occasions, maintained clinical and tomographic evidence of active infection, and mucoral persistence in the lesion. An aggressive surgical debridement, using microsurgical techniques, was performed. Amphotericin B was increased up to a total dose of 3900 mg. (he had previously received 2900 mg) and hyperbaric oxygen was added as adjunctive treatment. The outcome was successful. There was no evidence of relapse after a 16-month follow-up. This observation would confirm the usefulness of hyperbaric oxygen as adjunctive therapy in mucormycosis.

Topics: Adult; Amphotericin B; Brain Diseases; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 1; Follow-Up Studies; Humans; Hyperbaric Oxygenation; Male; Mucormycosis; Nose Diseases

Rhinocerebral mucormycosis (RCM) is a rare, fulminant fungal infection that usually occurs in diabetic or immunocompromised patients. The mortality rate has been reduced recently with the advent of amphotericin B combined with aggressive surgery. Eleven RCM patients have been treated over the past five years at Srinagarind Hospital. Eight had underlying diabetes, five had renal failure and three of them had both. In eight patients, the diagnosis was established by KOH preparation before histological confirmation. Only two cases revealed positive cultures for Rhizopus spp and Cunninghamella spp. All patients underwent surgical treatments (extensive debridement, 8 cases; sphenoidectomy, 7 cases; ethmoidectomy 8 cases; maxillectomy 5 cases and orbital exenteration, 6 cases). Amphotericin B was administered to all patients as soon as the diagnosis of RCM was made. Only three patients survived. Early diagnosis and cooperation among ophthalmologist, otolaryngologist and physician are the most important factors for the survival of patients with mucormycosis.

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Diabetes Complications; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Mucorales; Mucormycosis; Paranasal Sinus Diseases; Patient Care Team; Rhizopus

Rhinocerebral mucormycosis developed in two poorly controlled diabetic patients with clinical manifestations of frontal headache, ophthalmoplegia, ptosis, proptosis, epistaxis and facial numbness. Early computed tomography (CT) of the head revealed fluid accumulation in paranasal sinuses. The diagnosis of this disease relied upon CT of the head, and biopsy or culture of the mucosa of sinuses. Remarkable improvement was noted following prompt surgical debridement and amphotericin-B therapy. We conclude that early diagnosis and aggressive treatment is the only way to save patient's life.

Topics: Aged; Amphotericin B; Brain Diseases; Combined Modality Therapy; Female; Humans; Male; Mucormycosis; Nose Diseases; Tomography, X-Ray Computed

Immediately after induction therapy for acute lymphoblastic leukemia, a 2 1/2-year-old child developed invasive pulmonary aspergillosis revealed by pneumothorax, an unusual manifestation. Despite treatment with amphotericin B, status epilepticus occurred; this manifestation was related to diffuse ischemic cerebral lesions probably caused by cerebral aspergillosis. Outcome was fatal. Early invasive pulmonary aspergillosis is responsible for non-specific pneumonia. Thoracic CT scan and fiberoptic bronchoscopy are informative investigations. At recovery of bone marrow aplasia, the occurrence of hemoptysis and the discovery of excavated lesions on roentgenograms are suggestive of the diagnosis. Cerebral aspergillosis should be routinely considered whenever neurologic symptoms develop in a patient with agranulocytosis, fever, and pneumonia. The prognosis of invasive aspergillosis depends above all on the promptness of treatment; amphotericin B should be given intravenously whenever broad spectrum antimicrobial therapy fails to induce apyrexia in a patient with agranulocytosis.

Topics: Amphotericin B; Aspergillosis; Brain Diseases; Child, Preschool; Female; Humans; Lung Diseases, Fungal; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prognosis

Cerebral mucormycosis is a rare disorder caused by several genera of the family Mucoraceae. The genera Rhizopus, Absidia, and Mucor are the predominant pathogenic groups. Disease caused by these organisms usually complicates an underlying chronic illness, such as diabetes mellitus or malignancy. Cerebral involvement usually occurs from an ascending infection from the paranasal sinuses via the orbit and is usually associated with poorly controlled diabetes. The pulmonary system is the most common site of infection in patients with leukemia. Isolated cerebral mucormycosis not associated with head trauma or intravenous drug abuse is a rare disorder. We report what we believe to be the first successfully treated case of isolated cerebral mucormycosis in a patient with acute lymphocytic leukemia in remission.

Topics: Adolescent; Amphotericin B; Brain Diseases; Drug Therapy, Combination; Female; Flucytosine; Humans; Mucormycosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; 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

Topics: Amphotericin B; Animals; Antifungal Agents; Brain Diseases; Cryptococcosis; Female; Granuloma, Giant Cell; Itraconazole; Ketoconazole; Lung Diseases, Fungal; Male; Polyethylene Glycols; Rats; Rats, Inbred Strains

Cerebral phycomycosis is a rare disease. We describe two patients with unusual features of focal intracranial phycomycosis: a diabetic patient with chronic epidural abscess and a healthy individual with an isolated intracerebral abscess. Biopsy established the diagnosis in both patients. Treatment was successful in the patient with intracerebral abscess.

Topics: Adult; Amphotericin B; Biopsy; Brain Diseases; Female; Flucytosine; Humans; Male; Middle Aged; Mycoses; Tomography, X-Ray Computed

A rare case of primary cerebral zygomycosis in an Italian drug addict is described. The diagnosis was based on the histologic detection of broad, aseptate, hyaline mycelium in fluid aspirated from a brain mass detected by computerized axial tomography. The zygomycete isolated from the clinical specimen was identified as Rhizopus arrhizus var arrhizus. The patient had no known predisposing condition that would have suppressed his immunological defenses. Once the diagnosis was established, treatment with amphotericin B was initiated, but the patient died during the first day of treatment.

Topics: Adult; Amphotericin B; Brain Diseases; Humans; Italy; Male; Mucormycosis; Rhizopus; Substance-Related Disorders

Rhinocerebral mucormycosis is a fulminant, devastating fungal disease. The use of amphotericin B, combined with aggressive surgical debridement, has increased survival rates from approximately 20% to 70%. Eleven patients with this rare disease have been treated over the past 6 years. Therapy with amphotericin B was begun in all patients as soon as the diagnosis of mucormycosis was suspected. Seven patients underwent aggressive surgical debridement; all seven had disease involving the sphenoethmoidal complex, requiring external ethmoidectomy with or without sphenoidotomy. Six patients had maxillary sinus disease, requiring Caldwell-Luc antrostomy or maxillectomy. Three patients required orbital exenteration. Surgery was performed within 24 hours of diagnosis on all but two of our patients. Despite prompt diagnosis, aggressive surgical debridement, therapy with amphotericin B, and correction of metabolic acidosis, our mortality rate was 82%. Rhinocerebral mucormycosis remains a rapidly progressive, frequently fatal disease.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Brain Diseases; Child; Ethmoid Bone; Female; Humans; Male; Maxillary Sinus; Middle Aged; Mucormycosis; Nose Diseases; Sphenoid Bone

A 25-year-old man with juvenile onset diabetes presented with rhinoorbital mucormycosis. He was treated aggressively with orbital extirpation and amphotericin B. Six months later, he presented with posterior fossa extension of the mucormycosis.

Topics: Adult; Amphotericin B; Brain Diseases; Cranial Fossa, Posterior; Diabetes Mellitus, Type 1; Humans; Male; Mucormycosis

Topics: Amphotericin B; Aspergillosis; Aspergillosis, Allergic Bronchopulmonary; Brain Diseases; Diagnosis, Differential; Flucytosine; Humans

Topics: Amphotericin B; Brain Diseases; Child; Female; Fungi; Humans; Mycoses; Nasopharyngeal Diseases

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

The efficacy of fluconazole, a new bis-triazole antifungal agent, was compared with that of orally administered ketoconazole and parenterally administered amphotericin B against aspergillus and cryptococcus infections in mice. Fluconazole was 5-20-fold more active than ketoconazole against systemic aspergillosis and against systemic, intracranial and pulmonary cryptococcosis but was less active than amphotericin B.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Brain Diseases; Cryptococcosis; Female; Fluconazole; Ketoconazole; Lung Diseases, Fungal; Mice; Opportunistic Infections; Triazoles

The authors report three cases of central nervous system cryptococcosis in children in the first decade of life, from Rio Grande do Sul State, Brazil. Diagnosis was supported by demonstration of Cryptococcus neoformans with India-ink preparations of the spinal fluid and Sabouraud's media culture. Clinical presentation included acute, subacute and chronic forms. Increased intracranial pressure and hydrocephalus were the complications during the course of the disease, and a ventriculoperitoneal shunt was used in one case. Undernutrition was associated with all cases and tubercle bacillus infection with one. Specific therapy was administered to the three patients. One patient was cured and the other two died.

Topics: Age Factors; Amphotericin B; Brain Diseases; Brazil; Cerebrospinal Fluid; Child; Child, Preschool; Cryptococcosis; Cryptococcus neoformans; Female; Humans; Male; Meningoencephalitis

Topics: Amphotericin B; Brain Diseases; Histoplasmosis; Humans; Male; Middle Aged

Four patients with aspergillosis of the central nervous system collected in less than two years are reported. Three patients had hematologic malignancies (acute myelogenous leukemia, Hodgkin's disease) and were treated with corticosteroids and chemotherapy. One patient received antimicrobial agents fort a post operative meningitis (after acoustic neuroma surgery). Analysis of these cases and review of literature available us to point out the increased frequency of invasive and cerebral aspergillosis particularly in immunocompromised hosts treated by cytotoxic drugs or broad spectrum antibiotic therapy. Diagnosis is very difficult because: --there are non specific radiologic features for aspergillus granuloma, abscess, aneurysm or meningitis, --blood and cerebrospinal fluid cultures are invariably negative, --serologic tests have limited value in immunosuppressed patients (poor capacity to elaborate antibodies). Diagnosis can be made only by surgical biopsy who isolate fungal elements. However diagnosis in greatest cases is only made at autopsy. Treatment consist by antifungal drugs administered intravenously and surgery when it is possible. Prognosis of cerebral aspergillosis is very poor and mortality rate very high about 70%.

Topics: Adult; Amphotericin B; Aspergillosis; Brain Diseases; Combined Modality Therapy; Female; Flucytosine; Humans; Male; Middle Aged

A 32-year-old Chinese woman with bilateral occipital aspergilloma was treated successfully with high dose ketoconazole (1200 mg/day) for six months in conjunction with amphotericin B and 5-fluorocytosine. No unacceptable side effects occurred. The use of high dose ketoconazole could be considered in CNS aspergillosis unresponsive to conventional anti-fungal therapy.

Topics: Adult; Amphotericin B; Aspergillosis; Brain Diseases; Drug Therapy, Combination; Female; Flucytosine; Hong Kong; Humans; Ketoconazole; Tomography, X-Ray Computed

We report a case of disseminated aspergillosis involving both lung and brain in an adult female patient affected with bronchiectasis. Immunological follow-up was conducted before the clinical diagnosis and during the illness and revealed an excessively high helper-inducer/cytotoxic-suppressor (T4/T8) ratio. Peripheral granulocyte function was normal. A progressive reduction of lung and brain localizations was obtained with antifungal therapy and Imuthiol, an immunopotentiator which regulates the ratio of T-cell subsets. T4/T8 ratio returned to average values. The patient is alive 12 months after the diagnosis.

Topics: Adult; Amphotericin B; Aspergillosis; Brain Diseases; Bronchiectasis; Ditiocarb; Drug Therapy, Combination; Female; Flucytosine; Humans; Lung Diseases, Fungal; T-Lymphocytes

An alcoholic man with uncontrolled diabetes mellitus had right conjunctivitis, facial numbness, and periorbital edema progressing to bilateral visual loss, and left ptosis in association with a large necrotic palatal ulcer due to zygomycosis. The infection progressed to bilateral retinal vein engorgement; left-sided ophthalmoplegia, fixed dilated pupil, and absent corneal reflex; and right-sided ophthalmoplegia, ptosis, and facial nerve paralysis. Work-up revealed disease of both ethmoid sinuses and the right maxillary sinus, with bilateral thromboses of the cavernous sinuses. An aggressive combined therapeutic attack (three Caldwell-Luc procedures, exploration of orbit walls, control of diabetes, systemic and local amphotericin therapy) led to survival with a three-year follow-up thus far.

Topics: Amphotericin B; Brain Diseases; Cavernous Sinus; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 1; Fungi; Humans; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases; Sinus Thrombosis, Intracranial

Topics: Amphotericin B; Brain Diseases; Humans; Lung Diseases, Fungal; Mitosporic Fungi; Mycoses

A previously reported case of cerebral infection due to Curvularia lunata is more fully described. Medical cure was apparently achieved after 30 months' treatment with amphotericin B. Success was achieved only when the drug was given in a dose of 40 mg, three times per week, and was continued for six months after enhanced computed tomographic scans no longer showed cerebral lesions. Immunologic studies suggested the infection was accompanied by an unexplained defect in cell-mediated immunity.

Topics: Adult; Amphotericin B; Brain Diseases; Creatinine; Follow-Up Studies; Humans; Immunity, Cellular; Immunoglobulins; Lung Diseases, Fungal; Male; Mitosporic Fungi; Mycoses; Radiography

Between 1 January 1981 and 1 December 1984, 34 of 396 patients with the acquired immunodeficiency syndrome (AIDS) developed cryptococcal infections. Twenty-six cases are reviewed. Twenty-two patients had brain or meningeal disease; the others had pulmonary disease (2 patients), pericarditis (1 patient), and antigenemia (1 patient). During treatment, 3 patients died of cryptococcosis and 3 died of other causes. Fifteen patients were followed for more than 6 weeks after treatment. Of 8 patients who received no additional amphotericin B, 4 had relapses and died of cryptococcosis within 6 months, 3 died of other causes, and 1 survived. Of 7 patients who received maintenance therapy with amphotericin B, none had relapses, 3 died of other causes, and 4 survived. Our data suggest that maintenance therapy with amphotericin may be needed to prevent relapse in patients with AIDS.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Brain Diseases; Cryptococcosis; Drug Therapy, Combination; Female; Flucytosine; Humans; Injections, Intravenous; Injections, Intraventricular; Male; Meningitis; Middle Aged; Prognosis; Recurrence; Retrospective Studies; Tomography, X-Ray Computed

Curvularia is a saprophyte that rarely causes infection, and then usually occurs in immunocompromised patients. A 41-year-old man, previously in good health, developed pulmonary and cerebral infection with Curvularia lunata. With surgery and amphotericin B therapy, he recovered and was free of infection one year later.

Topics: Adult; Amphotericin B; Brain Diseases; Humans; Lung Diseases, Fungal; Male; Mitosporic Fungi; Mycoses

Two patients with cryptococcal infection of the central nervous system are described. These cases illustrate the variability in mode of presentation of this disease. Upon diagnosis, both patients were initially treated with a combination of amphotericin B and 5-fluorocytosine. Despite an early clinical and serological response, limiting side effects occurred in both cases and 5-fluorocytosine treatment was terminated. In Case 2, 5-fluorocytosine therapy was reinstituted at lower dosages later in the course of the illness, with good results. Combination therapy is superior to amphotericin B alone. However, to circumvent significant toxicity problems close monitoring of renal function, peripheral blood counts and serum 5-fluorocytosine levels are essential. Treatment is usually administered for a minimum of six weeks and remission is assessed on clinical, mycological and serological grounds. Thereafter, adequate follow-up is mandatory.

Topics: Adult; Amphotericin B; Brain; Brain Diseases; Cryptococcosis; Flucytosine; Humans; Lung Diseases, Fungal; Male; Middle Aged; Tomography, X-Ray Computed

Two fatal cases of rhinocerebral mucormycosis with fungal invasion and occlusion of the internal carotid artery are described. Review of the literature reveals 35 similar cases of whom only 6 survived. Emphasis is placed on the need for early diagnosis and prompt therapy which consists of correction of the underlying disease, aggressive surgical debridement, and amphotericin B.

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Carotid Artery Diseases; Child; Child, Preschool; Debridement; Female; Humans; Infant; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases; Paranasal Sinus Diseases

Cryptococcus neoformans (Torula histolytica) is an uncommon cause of infection in the central nervous system. We review 15 cases from all over Queensland which have presented in the last 6 years. Computed tomography (CT) studies were abnormal in 73.5%, with mass lesions and hydrocephalus being the commonest findings. Notable findings were: the disproportionate severity of clinical signs and symptoms as compared with the CT findings, which often were either normal or demonstrated only small granulomas without significant mass effect, absence of enhancement in granulomas in two cases and observation of calcification during treatment in one patient.

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Brain Neoplasms; Cryptococcosis; Diagnosis, Differential; Female; Humans; Immune Tolerance; Male; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Tomography, X-Ray Computed; Tuberculosis, Meningeal

Candida has become the most prevalent cerebral mycosis at autopsy, indicating a significant incidence coupled with inadequate eradication. Of 29 patients with systemic candidiasis, 48 percent (14 of 29) also had central nervous system involvement. Of these patients, however, only 21 percent (three of 14) had antemortem diagnosis, and only one of these three patients remains alive; the two patients with antemortem diagnosis who died had a meningeal form that, although easier to document on the basis of cerebrospinal fluid examination, is now distinctly rarer than other forms of the disease in adults. The lone surviving patient was treated with amphotericin B for endocarditis and mycotic aneurysms of the cerebral vessels. One clue to central nervous system candidal infection was the striking correlation between cardiac and cerebral involvement; 80 percent of patients with myocardial or valve infection also had central nervous system candidiasis. Most forms of immunosuppression represent a risk factor for both the systemic and cerebral mycoses. Neuropathologically, there is a spectrum of disease entities associated with Candida, including two previously unrecognized lesions reported herein: fungus balls of both white and gray matter and mycotic aneurysms secondary to Candida parapsilosis. Other parenchymal presentations include thrombosis, vasculitis, abscess, hemorrhage, and demyelination. For drug therapy such as amphotericin B to be more effective, earlier diagnosis of these parenchymal infections must be sought.

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Candidiasis; Central Nervous System Diseases; Female; Heart Diseases; Heart Valve Diseases; Humans; Male; Middle Aged

Mucormycosis is an acute fungal disease with high mortality exhibiting craniofacial, pulmonary, cutaneous, gastrointestinal and disseminated forms. Cerebro-rhino-orbital (CRO) mucormycosis is the type that most frequently involves the structures of the head and neck. While usually non-pathogenic, these saprophytic organisms can be particularly lethal in chronically debilitated patients. Between the years 1957 and 1982, 18 cases of CRO mucormycosis were seen at the Medical College of Virginia Hospital and the McGuire VA Medical Center. Four illustrative cases of CRO mucormycosis are presented to emphasize: the importance of clinical awareness of the disease, the necessity of tissue biopsy for diagnosis, the need of appropriate management of any underlying disorder, administration of amphotericin-B, and the performance of adequate surgery.

Topics: Adult; Aged; Amphotericin B; Brain Diseases; Combined Modality Therapy; Female; Humans; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases

In immunocompromised renal transplant patients, aspergillosis can be a life-threatening opportunistic infection. During an 8-year period, 25 renal transplant recipients at the University of Minnesota Hospitals developed unequivocal invasive aspergillosis that occurred in epidemic-like patterns in immunocompromised patients throughout the hospital. The premortem diagnosis was made in only 14 of the 25 patients. Seventeen patients died, and three of the eight survivors lost their allografts. The prognosis was dependent upon the clinical pattern of illness: three clinical patterns emerged: (1) cavitary lung disease, (2) diffuse pulmonary disease, and (3) central nervous system disease. All patients in the latter two categories died. The best results were with those patients treated with both amphotericin B and excision of cavitary lung lesions. All three patients treated in this manner survived with functioning grafts. Traditionally, sputum cultures have been thought to be unreliable because Aspergillus is a common colonizer of the upper respiratory tract and a contaminant in laboratories. In this study, false positive sputum cultures were common. A positive sputum culture can be helpful, however, all patients with two positive sputum cultures proved to have invasive aspergillosis. In addition, 86% of patients with positive sputum cultures who were clinically ill proved to have invasive infection. Bronchoscopy is a useful technique to follow up a positive sputum culture or investigate negative sputum cultures with typical clinical patterns. Routine bronchoscopy, unfortunately, also yields a high incidence of false positive cultures. Since the use of covered brush bronchoscopy technique, however, no false positive transbronchial cultures have been found. Transbronchial biopsy is a useful adjunct and is proof of the presence of invasive disease when the results are positive. However, false negative results are also found. Overall, the highest diagnostic yield is obtained both with transbronchial lung biopsy and covered brush bronchoscopy culture. All eight patients with both these procedures were correctly identified as having invasive pulmonary aspergillosis.

Topics: Adult; Amphotericin B; Aspergillosis; Brain Diseases; Bronchoscopy; Female; Graft Rejection; Humans; Immunosuppression Therapy; Kidney Transplantation; Lung Diseases, Fungal; Male; Postoperative Complications; Risk

Mucormycosis is the most acutely fatal fungus infection of man. The disease causes a characteristic pattern of clinical symptoms and signs, prompt recognition of which will permit immediate institution of antifungal therapy. Personal experience with 16 cases of the rhino-orbitocerebral form of mucormycosis is the basis of this report. The first of these patients was seen in 1959, and the last in 1981. All of the patients had one or more preexisting diseases, as follows: (1) diabetes mellitus, 13; (2) acute leukemia, 3; (3) terminal carcinomatosis, 1; and (4) chronic sinusitis, 1. The most common initial symptoms and signs were sinusitis, pharyngitis, nasal discharge, and orbital/periorbital pain. Proptosis and formation of a black eschar were only seldom among the initially apparent features. Hyphas were demonstrated in tissue sections in 14 of the 16 patients in whom biopsy was done. Rhizopus species were cultured in 11 of the 13 patients from whom material for culture had been obtained clinically. Five of the 16 patients survived. All of them had been treated with surgical debridement and with intravenous amphotericin B.

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Debridement; Female; Humans; Male; Middle Aged; Mucorales; Mucormycosis; Nose Diseases; Orbital Diseases

A patient with South American blastomycosis (paracoccidioidomycosis) was studied using computed tomography (CT), which showed six granulomas in the brain. The patient was treated with amphotericin B and observed by repeated CT scans. Two of the lesions disappeared completely after the first cycle of treatment, and residual images, probably representing granulomas in the cicatricial stage, remained after completion of the treatment.

Topics: Amphotericin B; Brain Diseases; Granuloma; Humans; Male; Middle Aged; Paracoccidioidomycosis; Tomography, X-Ray Computed

Phycomycosis is the preferred terminology to define a fungal disease which may be devastating and fatal. It is caused by a nonseptate hyphae, class phycomycetes and genus (Rhizopus, Mucor, Absidia). Phycomycosis in man is usually associated with debilitating diseases such as: diabetes mellitus, leukemia and immunosuppressive conditions. The cephalic phycomycosis has two forms: 1. rhino-orbital cerebral which may be fatal, and 2. rhino-paranasal sinuses form which usually has a benign clinical course. From 1943 to 1967, only 45 cases of the cephalic form were described with a mortality rate of 50%. Since then several series have been added to the literature with improved survival, probably due to the addition of amphotericin B to the therapy. Even with modern therapy, the mortality rate is still about 30%. Modern technology C.T. scan is very helpful to establish orbital and intracranial extension. When intracranial involvement is present, the prognosis is dismal. Our series of 8 patients is reported.

Topics: Adult; Aged; Amphotericin B; Brain Diseases; Diabetes Complications; Female; Humans; Leukemia; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases; Paranasal Sinus Diseases; Tomography, X-Ray Computed

Clinical and autopsy studies of 14 patients treated with amphotericin B methyl ester (AME) for focal, disseminated, and nervous system mycotic infections revealed a high incidence of progressive neurologic dysfunction (dementia, akinesia, mutism, hyperreflexia, and tremor) and diffuse white matter degeneration. All of seven patients who received greater than 9.8 g of AME intravenously developed severe neurologic and neuropathologic changes. Two of three patients given 5-7.2 g of AME developed less severe neurologic symptoms; all three had mild diffuse white matter gliosis. Four patients given less than 1.5 g of AME had no bran abnormalities except those related to coccidioidal meningitis. Thirty-one control patients who died on untreated or amphotericin B-treated coccidioidal meningitis showed no diffuse white matter abnormalities. These findings indicate that prolonged administration of AME and/or other contaminating polyenes injures human white matter. Long-term animal studies, with particular attention to nervous system histology, must precede human use of other polyene derivatives.

Topics: Adolescent; Adult; Aged; Amphotericin B; Aspergillosis; Astrocytes; Brain; Brain Diseases; Child; Coccidioidomycosis; Demyelinating Diseases; Gliosis; Humans; Lung Diseases, Fungal; Middle Aged; Myelin Sheath

Topics: Amphotericin B; Animals; Brain Diseases; Coccidioidomycosis; Dogs; Humans; Macaca mulatta; Mycoses; Nervous System Diseases

Rhinocerebral mucormycosis is, with few exceptions, only reported in patients with severe metabolic or immunologic imbalances. Factors which may predispose to the development of mucormycosis are reviewed. These factors include ketoacidosis and immunologic deficiency states due either to the primary disease or to the treatment for other diseases. An appreciation for these predisposing factors is very important in order that aggressive diagnosis and therapy be undertaken without delay.

Topics: Acidosis; Adrenal Cortex Hormones; Aged; Amphotericin B; Anemia; Brain Diseases; Diabetes Complications; Humans; Immunologic Deficiency Syndromes; Keto Acids; Leukemia; Male; Mucormycosis; Neutropenia; Nose Diseases; Turbinates; Uremia

Topics: Adult; Amphotericin B; Brain Diseases; Cryptococcosis; Cytosine; Flucytosine; Humans; Male; Meningitis

Topics: Amphotericin B; Brain Diseases; Debridement; Diabetic Ketoacidosis; Female; Humans; Middle Aged; Mucormycosis; Nose Diseases; Orbital Diseases

Patients with rhinocerebral mucormycosis and rhinocerebral aspergillosis had computed tomography (CT) as well as other studies. Characteristic sinus involvement was demonstrated by CT and conventional tomography, but the latter produced a better image of bone destruction. CT was clearly superior in demonstrating orbital involvement, the most common of which included lateral displacement of a thickened medial rectus muscle, increased density of the orbital apex, and often enlargement of the optic nerve. Orbital venography and carotid arteriography were diagnostically helpful. Recognition of the characteristic pattern of sinus and orbital involvement should be helpful in leading to early biopsy and treatment.

Topics: Adolescent; Adult; Aged; Amphotericin B; Aspergillosis; Brain Diseases; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Mucormycosis; Nasal Cavity; Nose Diseases; Prognosis; Tomography, X-Ray Computed

Ninety-one patients with documented invasive infections due to an Aspergillus species were identified at Memorial Sloan-Kettering Cancer Center from July 1, 1971, through December 31, 1976. Of the 29 patients in whom the diagnosis was made during life, 10 had successful treatment and survived the Aspergillus infection by two to 17 months. An immunodiffusion test was useful in the early diagnosis of invasive aspergillosis, and in 11 patients in whom the diagnosis was supported by seroconversion and who underwent treatment, the survival rate was 64 percent. Cultures of respiratory secretions were not reliable because they often reflected only colonization. In one year, only 9 percent of he patients with Aspergillus species isolated from the sputum had an invasive infection. The lung was the commonest site of involvement, 91 percent of the patients having pulmonary lesions. The most frequently affected extrapulmonary organ was the brain (18.3 percent). Eight patients had nonpulmonary aspergillosis as the only manifestation of this infection. Most of the 91 patients had hematologic neoplasms as the underlying disease, and neutropenia and antibacterial therapy preceded the diagnosis of aspergillosis in the majority of cases.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antibodies, Fungal; Aspergillosis; Aspergillus; Brain Diseases; Child; Female; Humans; Lung Diseases, Fungal; Male; Middle Aged; Sputum

Mucormycosis in infants is exceedingly rare, and over 90% of reported cases have been fatal. A case of a dehydrated three-week-old infant with involvement of the palate, maxilla, orbit, and brain is described with extensive laboratory and radiological investigation. This infant survived after surgical debridement and therapy with amphotericin B.

Topics: Amphotericin B; Brain Diseases; Combined Modality Therapy; Debridement; Dehydration; Humans; Infant, Newborn; Male; Maxillary Diseases; Mucormycosis; Orbital Diseases; Palate

Topics: Amphotericin B; Brain Diseases; Central Nervous System Diseases; Cryptococcosis; Flucytosine; Humans

The case of a 15 year old white man, diabetic in cetoacidosis, with a orbit-rhino-cerebral phycomycosis is reported. The illness had an acute onset and the treatment was iniciated early with Amphotericin-B and unilateral osteotomy of maxillary and ethmoidal sinus. With this treatment the patient did well with residuals of ophtalmoplegia and amaurosis on the right. Interesting investigation aspects are the occluded internal carotid on the same side of the affected orbit and the CAT-SCAN finding of moderated ventricular dilatation (two months after hospital admission). Mycology, pathophysiology, histopathology, clinical aspects, diagnosis and therapy are discussed, comparing the findings of this case with avaliable literature. An increased number of survivors can be expected with earlier recognition and more aggressive therapy. Treatment of the underlying debilitating disease, Amphotericin-B and surgical debridement of necrotic tissue, are frequently necessary such as observed in the case reported. The favorable results obtained with the proposed managment are stressed.

Topics: Acidosis; Adolescent; Amphotericin B; Brain Diseases; Diabetes Complications; Ethmoid Sinus; Humans; Male; Mucormycosis; Orbit; Respiratory Tract Diseases

A 51-year-old diabetic woman developed bilateral rhinoorbitocerebral phycomycosis. Successful treatment was accomplished by correction of the ketoacidosis, surgical debridement, and amphotericin B therapy. Rhinoorbitocerebral phycomycosis is a fulminant and frequently fatal disease most often seen in debilitated hosts. This survival suggests that aggressive therapy is indicated in patients with extensive fungal involvement.

Topics: Amphotericin B; Brain Diseases; Diabetic Ketoacidosis; Female; Humans; Middle Aged; Mucormycosis; Nose Diseases; Rhizopus

The diagnosis of rhinocerebral mucormycosis is most often made at autopsy. We report a series of nine patients in whom the diagnosis was established premortem. Six of the patients had underlying diabetes mellitus and three had acute leukemia. Facial or ocular pain was the complaint found in all patients, and frequently was the initial symptom. The diagnosis was established by examination and culture of infected tissue obtained by biopsy. In seven patients, identification of hyphal elements in smears of biopsy material allowed the immediate institution of amphotericin B therapy. Four of the seven patients treated with amphotericin B survived. All surviving patients had underlying diabetes mellitus and had undergone surgical debridement. Early diagnosis leading to immediate institution of appropriate therapy is most important for survival of patients with mucormycosis.

Topics: Acute Disease; Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Diabetes Complications; Female; Humans; Leukemia; Male; Middle Aged; Mucormycosis; Nose Diseases

This report describes a case in which an intracranial histoplasmoma was successfully treated with surgical removal and amphotericin B. This is the third reported case of its kind. The authors discuss problems of preoperative diagnosis in a patient with depressed cell-mediated immunity, and no evidence of extracerebral dissemination.

Topics: Adult; Amphotericin B; Brain Diseases; Female; Histoplasmosis; Humans; Meningitis

We present a patient with a recurrent intracerebral blastomycotic granuloma. The computerized tomographic scan appearance of this lesion is illustrated. Of the 81 reported cases of intracranial blastomycosis, only 35 have represented solid intracerebral lesions; the other patients have had spinal lesions or meningitis. This patient represents the first reported recurrence of an intracerebral blastomycotic granuloma. The treatment utilized, surgical resection combined with intravenous and intraventricular amphotericin B, represents a unique approach to this problem. The diagnosis and currently advocated treatment of intracranial blastomycosis is reviewed, particularly in regard to the potential for recurrence of blastomycosis.

Topics: Adult; Amphotericin B; Blastomycosis; Brain Diseases; Granuloma; Humans; Injections, Intravenous; Male; Recurrence

Topics: Amphotericin B; Brain Diseases; Candidiasis; Humans; Infant; Male

Rhinocerebral zygomycosis is a rare, often fatal opportunistic fungal infection involving the cranial tissues. A diabetic patient with normal humoral and cellular immunity who was successfully treated with amphotericin B and surgery is reported.

Topics: Adult; Amphotericin B; Brain Diseases; Diabetes Complications; Female; Fungi; Humans; Mycoses; Nose Diseases

Two patients with cryptococcal infection of the central nervous system are described. The first presented with signs of an intracranial mass and was subsequently shown to have two lesions within the brain which were later identified as cryptococcal granulomata. Antifungal therapy did not eradicate the lesions; following their excision and continued therapy, the CSF became sterile however. The other patient had signs of a fulminant meningoencephalitis which initially were thought to represent the pathophysiological expression of an expanding brain tumor. These reports are used as a basis to review the various aspects of central nervous system cryptococcosis, particularly as they may relate to the neurosurgeon and the therapy of the disease.

Topics: Aged; Amphotericin B; Brain Diseases; Cryptococcosis; Humans; Male

Topics: Acidosis; Adolescent; Amphotericin B; Brain Diseases; Female; Humans; Kidney Calculi; Mucormycosis; Nose Diseases

Rhinocerebral mucormycosis is a fungal diseases that has a 50% mortality. Its occurrence has increased, possibly because of greater use of chemotherapeutic agents that mya compromise the immunologic defenses of the host or alter the normal flora. The earliest signs, ulceration and pain, may appear in the mouth. In the patient described in this report, the autopsy showed that mucormycosis had entered the brain cells.

Topics: Amphotericin B; Brain Diseases; Female; Humans; Middle Aged; Mouth Diseases; Mucormycosis; Necrosis; Nose Diseases; Prognosis; Ulcer

An ominous prognosis is associated with combined pulmonary and rhinocerebral mucormycosis (phycomycosis). We report the case of a diabetic patient with ketoacidosis who had extensive pulmonary and rhinocerebral mucormycosis that responded satisfactorily to amphotericin B and griseofulvin therapy. The affected lung is completely atelectatic and has remained so for 12 months without evidence of necrosis or abscess formation.

Topics: Adult; Amphotericin B; Brain Diseases; Diabetic Ketoacidosis; Female; Griseofulvin; Humans; Lung Diseases, Fungal; Mucormycosis; Nose Diseases; Prognosis

A previously healthy youth who had sustained severe head trauma and had received steroids and broad-spectrum antimicrobial agents developed a cranial zygomycotic infection with Saksenaea vasiformis. This is the first time this zygomycete has been implicated as a disease agent. Early identification of the fungal infection and subsequent vigorous medical and surgical therapy led to recovery.

Topics: Adult; Amphotericin B; Brain Diseases; Brain Injuries; Fungi; Humans; Male; Mycoses

Topics: Adolescent; Amphotericin B; Brain Diseases; Cryptococcosis; Female; Granuloma; Humans; Male

Topics: Adult; Amphotericin B; Brain Diseases; Diagnosis, Differential; Humans; Male; Mucormycosis; Nose Diseases

Mucormycosis is a fulminant fungal infection occurring in debilitated patients with an underlying pathologic condition. The rhinocerebral form of the disease, which comprises nearly one half of recently reported cases, is most often found in uncontrolled diabetics or profoundly dehydrated children. Infection usually begins in the nose and progresses through the paranasal sinuses, invading the orbit and CNS secondarily. Despite the known pathogenesis of this disease, the ophthalmologist is often first to consider the diagnosis, due to inadequate intranasal examination by the primary physician. The delay caused by late occurrence of orbital manifestations has resulted in poor survival rates, despite vigorous therapy. In recent years, increased physician awareness has led to earlier diagnosis of rhinocerebral mucormycosis. This report presents 13 cases with which we have delt since 1963. The long-term survival rate is 85%. Aggressive surgical therapy, with repeated debridement, in combination with intravenous amphotericin B, have led to this high rate of cure.

Topics: Acidosis; Adult; Aged; Amphotericin B; Brain Diseases; Diabetes Complications; Female; Humans; Infant; Male; Middle Aged; Mucormycosis; Nose Diseases

Ten cases of cryptococcosis have been identified in a 13 year experience with more than 650 renal transplants. Eight patients had meningitis, one patient had a cerebral granuloma, and in one patient the infection appeared to be limited to the lungs. The central nervous system infection often masqueraded as brain tumor and was not suspected initially. The most useful diagnostic test was cerebrospinal fluid examination including India ink preparation. Various ther apeutic regimens with amphotericin B and 5-fluorocytosine were effective in suppressing the infection. A combination of low doses of amphotericin B, not affecting kidney function, with 5-fluorocytosine for at least 3 months was associated with remission of disease in five patients who still are alive, including three patients without recurrence for longer than one year. Five deaths 3 weeks to 4 years after the beginning of treatment were not due to cryptococcosis; death resulted from vascular disease and septiciemia in three of the four patients with known causes of death. Central nervous system cryptococcosis, with the exception of the rare cerebral granuloma, is associated with little inflammation. If early death from increased intracranial pressure or cerebral edema is prevented, prolonged therapy with amphotericin B and 5-fluorocytosine may be expected to control the infection, even in immunosuppressed patients.

Topics: Adult; Amphotericin B; Brain Diseases; Child; Cryptococcosis; Drug Administration Schedule; Female; Flucytosine; Humans; Immunosuppression Therapy; Kidney Transplantation; Lung Diseases, Fungal; Meningitis; Middle Aged; Postoperative Complications; Pseudotumor Cerebri; Transplantation, Homologous

Disseminated cryptococcal infection is described in eight patients, seven of them with verified meningeal involvement. Six of the eight patients were recipients of a renal homograft and submitted to the classical immunosuppressive treatment. Consideration is given to predisposing factors and to problems in the clinical, biological and mycological diagnosis. Some comments are presented on the often disappointing results of antifungal therapy of cryptococcal meningitis.

Topics: Adult; Amphotericin B; Brain Diseases; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus neoformans; Female; Flucytosine; Humans; Immunosuppressive Agents; Kidney Transplantation; Lymphoma, Non-Hodgkin; Male; Meningitis; Middle Aged; Postoperative Complications; Sarcoidosis; Transplantation, Homologous

Mucormycosis classically occurs in patients who have uncontrolled diabetes who develop rhinocerebral disease. A fatal case of rhinocerebral infection caused by Rhizopus arrhizus in a 53-year-old man who had received a renal homograft three years previously is reported. Only five similar cases have been documented, all since 1970. Although direct smears of the purulent nasal exudate revealed the presence of numerous Gram-negative bacilli, later identified as Haemophilus influenzae, the diagnosis of mucormycosis was made by demonstrating the typical broad, nonseptate branched hyphae in the necrotic tissue obtained by surgical debridement of the paranasal sinuses. Culture of this material revealed growth of mold-like fungus which, upon direct microscopic examination, showed sporangiophores bearing spherical sporangia arising directly from a cluster of root-like structures of rhizoids. Despite the immediate institution of therapy with amphotericin B postoperatively, the patient died 48 hours later. Subsequently, the Rhizopus isolated was shown to be resistant to both amphotericin B and 5-fluorocytosine. The present case and two others stress the importance of an aggressive diagnostic approach to patients suspected of having mucormycosis, because the usual microbiologic technics are frequently, inexplicably, unsuccessful, and possibly even misleading in this disease.

Topics: Adult; Aged; Amphotericin B; Azathioprine; Brain Diseases; Drug Resistance, Microbial; Female; Flucytosine; Humans; Kidney Transplantation; Male; Middle Aged; Mucormycosis; Nose Diseases; Postoperative Complications; Prednisone; Transplantation, Homologous

This is a report of a case of internal carotid artery occlusion associated with rhinocerebral phycomycosis. In 18 autopsied similar cases that have been reported previously, hyphae were described in the walls of the internal carotid artery. Four survivors have been reported even though arteriograms demonstrated internal carotid artery occlusion, and a high index of suspicion for this complication should be maintained in all patients with rhinocerebral phycomycosis.

Topics: Adolescent; Adult; Aged; Amphotericin B; Angiography; Brain Diseases; Carotid Artery Thrombosis; Child; Child, Preschool; Diabetes Complications; Female; Humans; Infant; Male; Middle Aged; Mucormycosis; Nose Diseases

The authors describe a case of human cerebral mucormycosis following open head trauma and craniotomy, and discuss possible roles of steroids and antibiotic therapy in its pathogenesis. They suggest that the common usage of prolonged broad-spectrum chemoprophylaxis in head trauma may require critical review.

Topics: Amphotericin B; Anti-Bacterial Agents; Brain Diseases; Cerebrospinal Fluid; Child; Craniocerebral Trauma; Craniotomy; Fungi; Humans; Male; Mucormycosis; Postoperative Complications; Steroids

Topics: Adult; Amphotericin B; Aspergillosis; Brain; Brain Diseases; Female; Humans; Male

Topics: Administration, Oral; Amphotericin B; Arrhythmias, Cardiac; Brain Diseases; Cytosine; Flucytosine; Gastrointestinal Diseases; Humans; Hypokalemia; Injections, Intravenous; Injections, Spinal; Intestinal Perforation; Kidney Diseases; Meningitis; Mycoses; Paralysis; Radiculopathy; Vision Disorders

Topics: Adult; Amphotericin B; Brain Diseases; Cryptococcosis; Humans; Injections, Intravenous; Injections, Spinal; Lung; Lung Diseases; Male; Pneumonectomy

Topics: Adult; Amphotericin B; Brain Diseases; Central Nervous System Diseases; Cryptococcosis; Cytosine; Fluorine; Granuloma; Humans; Male; Meningitis; Microscopy, Phase-Contrast; Middle Aged; Spinal Cord Diseases; Temporal Lobe

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Blood Vessels; Brain Diseases; Fungi; Heroin Dependence; Humans; Kidney Diseases; Male; Mucormycosis; Necrosis; Urography

Topics: Adult; Aged; Amphotericin B; Brain Diseases; Cryptococcosis; Female; Follow-Up Studies; Humans; Indium; Injections, Spinal; Male; Middle Aged; Radionuclide Imaging; Serum Albumin, Radio-Iodinated; Subarachnoid Space; Technetium; Ytterbium

Topics: Adult; Amphotericin B; Brain Diseases; Cerebral Angiography; Cryptococcosis; Follow-Up Studies; Granuloma; Humans; Injections, Intravenous; Injections, Spinal; Male; Motor Cortex; Recurrence

Topics: Adult; Aged; Amphotericin B; Brain; Brain Diseases; Cerebral Angiography; Cerebral Arteries; Cerebrovascular Disorders; Diabetes Complications; Diabetic Ketoacidosis; Female; Fungi; Humans; Intracranial Aneurysm; Kidney Failure, Chronic; Male; Middle Aged; Mycoses

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

Topics: Adult; Amphotericin B; Brain Diseases; Diabetes Complications; Eye Manifestations; Female; Humans; Mucor; Mucormycosis; Nose Diseases; Orbit; Paranasal Sinuses

Topics: Amphotericin B; Bone Diseases; Brain Diseases; Cryptococcosis; Female; Humans; India; Middle Aged; Skin Diseases, Infectious; Skin Ulcer

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

Topics: Amphotericin B; Brain; Brain Diseases; Cryptococcosis; Humans; Male; Middle Aged

Topics: Adult; Amphotericin B; Brain Diseases; Chromoblastomycosis; Diagnosis, Differential; Female; Humans; Isoniazid; Liver; Lymph Nodes; Mitosporic Fungi; Multiple Sclerosis; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Angiography; Brain Diseases; Diabetes Complications; Female; Humans; Mucormycosis; Ophthalmoplegia; Rhizopus

Topics: Adult; Amphotericin B; Brain Diseases; Diabetic Ketoacidosis; Diagnosis, Differential; Female; Fungi; Humans; Male; Mycoses; Nose Diseases

Topics: Adult; Amphotericin B; Brain Diseases; Cerebral Ventriculography; Electroencephalography; Histoplasmosis; Humans; Liver Cirrhosis; Male

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

Topics: Adrenal Cortex Hormones; Amphotericin B; Brain Diseases; Cryptococcosis; Cryptococcus; Diagnosis, Differential; Humans; Lung Diseases, Fungal; Male; Middle Aged; Radiography, Thoracic; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Blastomycosis; Brain Diseases; Female; Humans; Male; Middle Aged

Topics: Amphotericin B; Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Antifungal Agents; Brain Diseases; Candida; Candidiasis; Kidney Diseases; Lung Diseases; Lung Diseases, Fungal; Mice; Nystatin; Pharmacology; Research; Spleen; Virulence

Topics: Adrenal Gland Diseases; Amphotericin B; Brain Diseases; Cerebrospinal Fluid; Cryptococcosis; Dermatomycoses; Diagnosis; Gastroenterology; Geriatrics; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Meningitis; Pathology

Topics: Amphotericin B; Brain Diseases; Cryptococcosis; Cryptococcus; Diagnosis; Diagnosis, Differential; Humans; Lung Diseases; Lung Diseases, Fungal; Meninges; Pathology; Physiology; Sepsis

Topics: Amphotericin B; Brain Diseases; Cryptococcosis; Hodgkin Disease; Humans; Leukemia; Leukemia, Lymphoid; Lymphocytes; Meningitis

Topics: Amphotericin B; Brain Diseases; Cryptococcosis; Hematologic Diseases; Hodgkin Disease; Humans; Leukemia; Leukemia, Lymphoid; Meningitis

Topics: Amphotericin B; Brain Diseases; Humans; Mucormycosis; Zygomycosis

Topics: Amphotericin B; Antifungal Agents; Brain; Brain Diseases; Child; Cycloheximide; Humans; Mucormycosis; Mycoses; Zygomycosis