amphotericin-b and Cardiomyopathies

Disseminated acanthamoebiasis is a rare, often fatal, infection most commonly affecting immunocompromised patients. We report a case involving sinuses, skin, and bone in a 60-year-old woman 5 months after heart transplantation. She improved with a combination of flucytosine, fluconazole, miltefosine, and decreased immunosuppression. To our knowledge, this is the first case of successfully treated disseminated acanthamoebiasis in a heart transplant recipient and only the second successful use of miltefosine for this infection among solid organ transplant recipients. Acanthamoeba infection should be considered in transplant recipients with evidence of skin, central nervous system, and sinus infections that are unresponsive to antibiotics. Miltefosine may represent an effective component of a multidrug therapeutic regimen for the treatment of this amoebic infection.

Topics: Acanthamoeba; Amebiasis; Amebicides; Amphotericin B; Anti-Bacterial Agents; Antilymphocyte Serum; Biopsy; Cardiomyopathies; Drugs, Investigational; Endoscopy; Female; Fluconazole; Flucytosine; Heart Transplantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Magnetic Resonance Imaging; Metacarpal Bones; Metronidazole; Middle Aged; Phosphorylcholine; Polymerase Chain Reaction; Radiography; Sinusitis; Skin

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Cardiomyopathies; Electrocardiography; Heart Block; Humans; Male; Middle Aged; Opportunistic Infections; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Triazoles

Topics: Amphotericin B; Antifungal Agents; Blood Pressure; Cardiomyopathies; Cryptococcosis; Drug Carriers; Electrocardiography; Female; Flucytosine; Heart; Heart Function Tests; Heart Rate; Humans; Liposomes; Middle Aged; Radionuclide Imaging

The exposure to Aspergillus organisms/spores is likely common, but disease caused by tissue invasion with these fungi is uncommon and occurs primarily in the setting of immunosuppression. We report a case of rapidly advancing invasive endomyocardial aspergillosis secondary to prolonged usage of multiple broad-spectrum antibiotics in a nonimmunocompromised host. A 36-year-old cotton textile worker presented to our institution with a 3-month history of weight loss and fatigue. He reported receiving prolonged use of multiple broad-spectrum antibiotic treatment. The echocardiogram demonstrated multiple endomyocardial vegetations and a mass in the left atrium. Myocardial biopsy specimen revealed an invasive endomyocardial aspergillosis. The patient was investigated for immune deficiency including HIV, and this workup was negative. Treatment was started with amphotericin B and heparin for presumed left atrial thrombus. The patient died because of a rupture of mycotic aneurysm that resulted in cerebral hemorrhage. This case illustrates the risk of an invasive fungal infection in a nonimmunocompromised host who is a prolonged user of antibiotics in the setting of environmental exposure of opportunistic invasive fungal infections.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Cardiomyopathies; Cerebral Hemorrhage; Fatal Outcome; Humans; Intracranial Aneurysm; Male; Opportunistic Infections; Rupture; Ultrasonography; Urinary Tract Infections

We report two patients, who developed dilated cardiomyopathy and subsequent congestive heart failure after treatment with amphotericin B (AmB). The echocardiographic findings and the symptoms of heart failure resolved after the discontinuation of the drug. The clinical data from our cases and two similar cases reported in the literature suggest that the presence of other factors predisposing to cardiac dysfunction may facilitate the occurrence of this rare side effect.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Cardiomyopathies; Female; Female Urogenital Diseases; Fever; Humans; Injections, Intravenous; Male; Male Urogenital Diseases; Middle Aged; Withholding Treatment

Intracardiac fungal masses can develop following episodes of candidemia in premature infants with indwelling right atrial lines. We report the first premortem diagnosis and successful surgical removal of Candida-containing intracardiac masses in three premature infants. All had central venous lines and had been on systemic antibiotics prior to the development of candidemia. By echocardiography, two were pedunculated, solitary masses within the right atrium. Amphotericin B and 5-flucytosine for 21 to 42 days controlled the Candida sepsis, but the masses became increasingly mobile and did not decrease in size. In the third infant, large, irregular masses extended from the right atrium to the main pulmonary artery, and surgical removal was recommended 4 days after the start of antifungal therapy. In all three patients, the masses were nearly the size of the main pulmonary artery and presumably contained viable organisms. Removal was accomplished with the aid of cardiopulmonary bypass for two and inflow stasis for one infant weighing only 1,300 gm. The masses were filled with viable Candida organisms. All patients tolerated the operation well and have been followed up for 1 to 3.6 years without evidence of recurrent Candida infection. The case of a fourth infant, weighing 1,320 gm, is also reported. This infant had a bacteria-containing intra-atrial mass, which was removed successfully with the aid of inflow occlusion. This report documents the following points: (1) Echocardiography provides a noninvasive method of diagnosing the development of intracardiac masses and should be performed in infants who have had candidemia and a central venous line. (2) Prolonged systemic antifungal therapy does not appear to either sterilize or promote regression of the masses. (3) The masses can be safely removed, even in the premature infant, with either inflow stasis or cardiopulmonary bypass. (4) Surgical removal is an effective component of the treatment of infection in these infants.

Topics: Amphotericin B; Candidiasis; Cardiomyopathies; Female; Flucytosine; Humans; Infant, Newborn; Infant, Premature; Male

Topics: Adolescent; Adult; Aged; Amphotericin B; Aspergillus; Candida albicans; Cardiomyopathies; Child; Child, Preschool; Cryptococcus; Endocarditis; Endocardium; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Mycoses; Myocarditis; Myocardium; Pericardium