amphotericin-b and Bronchitis

Fungal infections are a frequent cause of morbidity an mortality in transplant recipients. Aspergillus spp. is an ubiquitous fungus capable of producing diverse clinical entities with varying severity.. To study the incidence and severity of Aspergillus spp. infections in lung transplantation, analysing the different clinical presentations and response to antifungal drugs.. A review was made of the clinical histories of all patients undergoing lung transplantation who developed positive Aspergillus spp. cultures in our centre between June 1991 and December 1996.. Eleven of 49 transplanted patients (22%) developed Aspergillus spp. infections. Four patients presented invasive aspergillosis forms and 7 tracheobronchitis. In spite of antifungal treatment 3 patients (30%) died of invasive aspergillosis as a direct consequence of the infection. Of the 7 patients with tracheobronchitis, 2 were ulcerative and 1 pseudomembranous, all responded to antifungal treatment. Three patients (10.3%) developed Aspergillus spp. infections despite prophylaxis with itraconazole.. Invasive aspergillosis in the immediate posttransplant period was mortal despite treatment. As opposed, aspergillar tracheobronchitis have been overcome using combined treatments of liposomal or lipidic amphotericin, itraconazole and nebulised amphotericin.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Bronchitis; Drug Therapy, Combination; Female; Humans; Immunocompromised Host; Immunosuppression Therapy; Incidence; Itraconazole; Lung Diseases, Fungal; Lung Transplantation; Male; Middle Aged; Postoperative Complications; Premedication; Retrospective Studies; Spain; Tracheitis; Treatment Outcome

Invasive fungal infections are a major cause of mortality among solid organ transplant recipients. Scopulariopsis species and their teleomorph Microascus are molds found in soil and decaying organic matter. We report here the case of a woman who underwent bilateral lung transplantation for severe emphysema. On day 25 after transplantation, endobronchial green-black lesions were detected during routine endoscopy. Endobronchial swabs, biopsies, and bronchoalveolar lavage samples were positive for Microascus cirrosus. This fungal infection developed despite voriconazole given for previous persistent invasive aspergillosis. Treatment consisted of a combination of antifungal medication (voriconazole, terbinafine, amphotericin B, and caspofungin) and endoscopic resection of necrosed bronchial mucosa. A favorable clinical outcome was achieved after 7 weeks of treatment. Seven cases of Scopulariopsis/Microascus infection have been previously described in solid organ transplant recipients. Only two survived after treatment with an antifungal combination therapy including echinocandins, posaconazole, and terbinafine. In immunocompromised patients, infection by Microascus species is a rare but life-threatening event because of innate resistance to most common antifungal drugs. Our patient was successfully cured by combined therapy including intravenous voriconazole and caspofungin, oral terbinafine, and inhaled voriconazole and amphotericin B administered for 7 weeks in association with iterative endoscopic debridement to reduce fungal inoculum.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Bronchi; Bronchitis; Endoscopy; Female; Humans; Immunocompromised Host; Lung Transplantation; Middle Aged; Mycoses; Necrosis; Transplant Recipients; Treatment Outcome; Triazoles

Topics: Adenocarcinoma; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Biopsy; Bronchitis; Bronchoscopy; Chemoradiotherapy; Humans; Immunocompromised Host; Lung Neoplasms; Male; Tomography, X-Ray Computed; Tracheitis; Ulcer

Pseudomembranous aspergillus tracheobronchitis is an uncommon form of invasive pulmonary aspergillosis, and it is generally seen in immunocompromised patients. We report about a mildly immunocompromised case with pseudomembranous aspergillus tracheobronchitis, which caused tracheal perforation, and Horner's syndrome. A 44-year-old female with uncontrolled diabetes mellitus, complaining of fever and dyspnea, was admitted to the hospital. She was hospitalized with community-acquired pneumonia and diabetic ketoacidosis. Insulin infusion and empirical antibiotics were firstly commenced. Bronchoscopy showed left vocal cord paralysis with extensive whitish exudative membranes covering the trachea and the main bronchi. Liposomal amphotericin B was added due to the probability of fungal etiology. Mucosal biopsy revealed aspergillus species. Second bronchoscopic examination demonstrated a large perforation in the tracheobronchial system. Despite all treatments, respiratory failure developed on the 25th day and the patient died within 2 days. Pseudomembranous aspergillus tracheobronchitis is fatal in about 78 % of all cases despite appropriate therapy. Early diagnosis and efficient antifungal therapy may improve the prognosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Biopsy; Bronchitis; Fatal Outcome; Female; Horner Syndrome; Humans; Spontaneous Perforation; Trachea; Tracheitis

Invasive fungal infections are a major cause of morbidity and mortality in allogeneic stem cell transplant recipients. They can occasionally involve the tracheobronchial tree with serious clinical consequences. Tracheobronchial involvement is often an unexpected finding during diagnostic bronchoscopy. Herein, we report a case of pseudomembranous tracheobronchitis caused by Rhizopus sp. in an allogeneic stem cell transplant recipient.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Bronchitis; Bronchoscopy; Fatal Outcome; Graft vs Host Disease; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Mucormycosis; Nausea; Respiratory Insufficiency; Rhizopus; Stem Cell Transplantation; Tracheitis; Transplantation, Homologous

The main problem with using nebulized liposomal amphotericin (n-LAB) as prophylaxis for Aspergillus infection after lung transplantation is the lack of knowledge of its pharmacokinetics and its possible adverse effects. The aim of this study was to measure post-inhalation amphotericin B concentration in the respiratory tract and serum of lung transplant patients and assess the effects of n-LAB on respiratory function.. Thirty-two consecutive bronchoscopies were performed on 27 lung transplant patients at two hospitals. Amphotericin B concentration in the first and third aliquot of bronchoalveolar lavage material was measured in steady state. The first aliquot approximates most closely the true amphotericin B concentrations in the proximal airway, whereas the third aliquot provides an optimum sample from the distal airway.. At 2 days, mean amphotericin B concentrations were 11.1 microg/ml (95% confidence interval [CI]: 16.5 to 5.7 microg/ml) and 9.0 microg/ml (95% CI: 14.3 to 3.8 microg/ml) in the first and third aliquot, respectively. Thereafter, concentrations declined progressively. At 14 days, concentrations were 3.0 microg/ml (95% CI: 4.4 to 1.5 microg/ml) in the first aliquot and 4.1 microg/ml (95% CI: 6.1 to 2.1 microg/ml) in the third aliquot (p = not statistically significant). Traces of amphotericin B (0.1 microg/ml) were found in serum samples from only 1 of 27 patients. Mean value of forced expiratory volume in the first second (FEV(1)) was similar before and after n-LAB.. Amphotericin B concentrations after n-LAB remained high for 14 days, at adequate concentrations for prophylaxis of Aspergillus infection. No significant systemic absorption of amphotericin B was detected and no effect was observed on respiratory function. This promising prophylactic regimen warrants assessment in future clinical studies.

Topics: Aerosols; Amphotericin B; Antifungal Agents; Aspergillosis; Bronchitis; Bronchoalveolar Lavage Fluid; Bronchoscopy; Dose-Response Relationship, Drug; Humans; Liposomes; Lung Transplantation; Nebulizers and Vaporizers; Respiratory Function Tests; Safety; Tissue Distribution

A case of endobronchitis by Scedosporium apiospermum in a child with cystic fibrosis is presented. The bronchial aspirate's cytology showed the presence of a large amount of septated-dichotomized hyphae. The bronchial aspirate's culture showed the presence of Scedosporium apiospermum in a pure culture of three consecutive samples. The scanning electron microscopy study of the mucosal surface revealed scarce mycelia with the presence of abundant conidiae. The transmission electron microscopy of the mucosa revealed inflammatory infiltrates constituted by macrophages, polymorphonuclear leukocytes, a lot of dichotomized mycelia and macrophages with hyphae and conidiae within the phagosomes. The patient was treated with amphotericin B and itraconazole.

Topics: Amphotericin B; Antifungal Agents; Bronchi; Bronchitis; Child; Cystic Fibrosis; Disease Susceptibility; Drug Therapy, Combination; Female; Humans; Itraconazole; Microscopy, Electron; Mycetoma; Respiratory Mucosa; Scedosporium

Localised fungal infection of the larynx and tracheobronchial tree is extremely uncommon. We report the case of a 6-year-old girl with acute lymphocytic leukaemia, who developed symptoms of upper airways obstruction 6 months after a cord blood transplant. Bronchoscopy showed a pale plaque lesion in the larynx and tracheobronchial tree. Aspergillus fumigatus was cultured from a biopsy of the lesion. The patient was treated successfully with a prolonged course of amphotericin B and assessed with multiple surveillance bronchoscopies.

Topics: Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Aspergillus fumigatus; Biopsy; Bone Marrow Transplantation; Bronchitis; Child; Female; Humans; Laryngitis; Larynx; Postoperative Complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Respiratory Tract Infections; Tracheitis

A case of aspergillus tracheobronchitis following influenza A infection in an immunocompetent 35 year old woman is described that required prolonged mechanical ventilation for airways obstruction. Treatment included liposomal amphotericin, inhaled amphotericin, gamma interferon and GM-CSF. Liposomal amphotericin therapy was associated with reversible hepatosplenomegaly. Inhaled corticosteroids with continued antifungal therapy were used for the management of severe recurrent airway obstruction. After a prolonged course of treatment she survived with fixed airways obstruction unresponsive to corticosteroids.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus niger; Bronchitis; Female; Humans; Influenza, Human; Interferon-gamma; Tracheitis

Topics: Adult; Aerosols; Amphotericin B; Anastomosis, Surgical; Antifungal Agents; Aspergillosis; Bronchitis; Female; Follow-Up Studies; Humans; Itraconazole; Lung Transplantation; Male; Middle Aged; Surgical Wound Infection; Tracheitis; Ulcer

Invasive aspergillosis is a serious opportunistic infection in immunocompromised patients. The case history is described of a 44 year old patient with peripheral T cell lymphoma who developed hoarseness and stridor after chemotherapy. Aspergillus fumigatus was isolated repeatedly from the sputum. Bronchoscopic examination showed symmetrical creamy-white exophytic lesions involving both vocal cords and the supraglottic area. There was diffuse tracheobronchitis with multiple raised cream-coloured plaques in the trachea which histologically consisted of numerous septate branching hyphae consistent with Aspergillus species. The lesions responded to systemic treatment with amphotericin B.

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Bronchitis; Humans; Itraconazole; Laryngitis; Lymphoma, T-Cell, Peripheral; Male; Respiratory Sounds; Respiratory Tract Infections; Tracheitis

A case of invasive broncopulmonar aspergillosis caused by Aspergillus terreus successfully treated with itraconazole is reported in a patient undergoing autologous bone marrow transplantation for acute lymphoblastic leukaemia. Although the patient was on prophylaxis with fluconazole and she did not respond to amphotericin B, there was an excellent response to itraconazole which allowed the transplant without any Aspergillus infection during both the transplant and the post-transplant periods. Due to its oral administration, good tolerance and low toxicity, itraconazole is a promising drug for the treatment of invasive broncopulmonar aspergillosis.

Topics: Agranulocytosis; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Bone Marrow Transplantation; Bronchitis; Combined Modality Therapy; Female; Fluconazole; Humans; Incidence; Itraconazole; Lung Diseases, Fungal; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Remission Induction

In a pilot study, a prophylactic regimen including ciprofloxacin and amphotericin B was applied in 102 consecutive patients on artificial respiration for greater than or equal to 5 days to prevent respiratory tract infection with aerobic Gram-negative bacilli. Ciprofloxacin was given twice a day, as 500 mg through a gastric tube or 200 mg intravenously, and both applications led to negative cultures for aerobic Gram-negative bacilli from faeces and throat, except for a few periods of carriage lasting only a few days. No patient acquired respiratory tract infection with one of the Enterobacteriaceae or Pseudomonadaceae after 4 days of artificial respiration. In contrast to other prophylactic regimens in intensive care patients, this regimen is relatively simple and effective. These preliminary data suggest that this regimen should be studied further with special emphasis on the induction of resistance in Intensive Care Units using prospective, double-blind study designs.

Topics: Amphotericin B; Bronchitis; Ciprofloxacin; Cross Infection; Drug Therapy, Combination; Feces; Female; Gram-Negative Bacteria; Humans; Male; Middle Aged; Pharynx; Pilot Projects; Respiration, Artificial; Respiratory Tract Infections; Sputum

Among 1 161 patients with chronic bronchitis and 172 patients with bronchiectasis treated for a longer time with antibiotics or with antibiotics and corticosteroids and examined all for fungi in bronchial secretion, 34 = 0.9% showed a secondary infection with fungi (32 Candida, 2 Aspergillus fumigatus).

Topics: Amphotericin B; Anti-Bacterial Agents; Aspergillus fumigatus; Bronchiectasis; Bronchitis; Candida albicans; Glucocorticoids; Humans; Risk; Sputum

Topics: Aerosols; Air Sacs; Amphotericin B; Animal Nutritional Physiological Phenomena; Animals; Bird Diseases; Birds; Blood Proteins; Bronchitis; Canaries; Enteral Nutrition; Hematocrit; Incubators; Mite Infestations; Respiratory Tract Diseases; Sinusitis; Sneezing; Thyroid Diseases; Vocalization, Animal

Topics: Adolescent; Adult; Amphotericin B; Bronchitis; Drug Synergism; Female; Humans; Male; Recurrence; Tetracycline