amphotericin-b and Cellulitis

Ruxolitinib is a novel oral Janus kinase inhibitor that is used for treatment of myeloproliferative diseases. It exhibits potent anti-inflammatory and immunosuppressive effects, and may increase the risk of opportunistic infections. Here, we report a rare case of Cryptococcus neoformans and Mycobacterium haemophilum coinfection in a myelofibrosis patient who was receiving ruxolitinib.. A 70-year-old Thai man who was diagnosed with JAK2V617F-mutation-positive primary myelofibrosis had been treated with ruxolitinib for 4 years. He presented with cellulitis at his left leg for 1 week. Physical examination revealed fever, dyspnea, desaturation, and sign of inflammation on the left leg and ulcers on the right foot. Blood cultures showed positive for C. neoformans. He was prescribed intravenous amphotericin B deoxycholate with a subsequent switch to liposomal amphotericin B due to the development of acute kidney injury. He developed new onset of fever after 1 month of antifungal treatment, and the lesion on his left leg had worsened. Biopsy of that skin lesion was sent for mycobacterial culture, and the result showed M. haemophilum. He was treated with levofloxacin, ethambutol, and rifampicin; however, the patient eventually developed septic shock and expired.. This is the first case of C. neoformans and M. haemophilum coinfection in a patient receiving ruxolitinib treatment. Although uncommon, clinicians should be aware of the potential for multiple opportunistic infections that may be caused by atypical pathogens in patients receiving ruxolitinib.

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Anti-Inflammatory Agents, Non-Steroidal; Antifungal Agents; Cellulitis; Coinfection; Cryptococcosis; Cryptococcus neoformans; Deoxycholic Acid; Drug Combinations; Fungemia; Humans; Male; Mycobacterium haemophilum; Mycobacterium Infections; Nitriles; Opportunistic Infections; Primary Myelofibrosis; Pyrazoles; Pyrimidines

Orbital mucormycosis is a rare but potentially severe and troublesome invasive fungal infection that could be occurred even in healthy individuals. The initial clinical presentation is similar to bacterial pre-septal or septal cellulitis, especially in early stages.. Herein, we describe the successful management of a series of five cases presenting with orbital mucormycosis in previously healthy children.. Orbital mucormycosis is extremely rare in healthy children and maybe life-threatening when diagnosis delayed given a similar clinical presentation with bacterial septal cellulitis. Intravenous antifungal therapy with amphotericin B and timely surgical drainage is live-saving.

Topics: Amphotericin B; Antifungal Agents; Cellulitis; Child, Preschool; Female; Humans; Infant; Male; Mucormycosis; Orbital Diseases; Risk Factors

Topics: Adult; Amphotericin B; Cellulitis; COVID-19; Debridement; Fatal Outcome; Humans; Male; Mediastinitis; Mediastinum; Mucormycosis; Respiratory Insufficiency; SARS-CoV-2; Thoracic Wall; Tomography, X-Ray Computed

Topics: Administration, Intravenous; Administration, Oral; Aged; Amphotericin B; Antifungal Agents; Antigens, Fungal; Cellulitis; Cryptococcosis; Cryptococcus gattii; Debridement; Fluconazole; Humans; Immunocompromised Host; Male; Treatment Outcome

Phaeohyphomycosis is a term used to describe a heterogenous group of cutaneous and systemic mycotic infections caused by melanized fungi. Many fungi have been reported as pathogens of this disease. The disease spectrum ranges from superficial cutaneous infections, deep cutaneous infections, to systemic infections with internal organ involvement. We report two cases of deep cutaneous phaeohyphomycosis on the foot clinically presenting as cellulitis with abscess formation. The pathogens were isolated from the lesion and both were identified as Neoscytalidium dimidiatum by their colony morphology, microscopic features, and sequences of internal transcribed spacers of ribosomal DNA. Both patients did not respond to the therapy with voriconazole and itraconazole, but improved after intravenous amphotericin B.

Topics: Abscess; Aged, 80 and over; Amphotericin B; Antifungal Agents; Ascomycota; Cellulitis; Dermatomycoses; DNA, Fungal; DNA, Ribosomal Spacer; Female; Foot; Humans; Male; Microbiological Techniques; Middle Aged; Molecular Diagnostic Techniques; Phaeohyphomycosis; Sequence Analysis, DNA; Treatment Outcome

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Aspirin; Cellulitis; Dermatomycoses; Drug Combinations; Female; Flucytosine; Gastrostomy; Geotrichosis; Geotrichum; Humans; Magnesium Oxide; Microbial Sensitivity Tests; Surgical Wound Infection

Cryptococcus neoformans is a common fungus found throughout the environment that causes opportunistic disease in immunocompromised individuals. Infection of humans with C neoformans usually manifests as lung disease through inhalation of spores or meningoencephalitis by involvement of the central nervous system. Rarely, dissemination in the form of cutaneous lesions can occur in individuals with long term immunosuppression. We present a patient with C. neoformans manifesting as cellulitis with focal segmental glomerulosclerosis treated with corticosteroids. Because of the mortality associated with disseminated cryptococcosis, early identification, especially of atypical cutaneous presentations is critical from a dermatological perspective.

Topics: Amphotericin B; Antifungal Agents; Cellulitis; Cryptococcosis; Cryptococcus neoformans; Cyclosporine; Fluconazole; Flucytosine; Fungemia; Glomerulosclerosis, Focal Segmental; Humans; Immunocompromised Host; Immunosuppressive Agents; Leg Dermatoses; Male; Middle Aged; Prednisone; Skin

Topics: Amphotericin B; Cellulitis; Humans; Infant, Extremely Low Birth Weight; Infant, Extremely Premature; Infant, Newborn; Itraconazole; Mycoses; Neosartorya

Topics: Amphotericin B; Antifungal Agents; Cellulitis; Diabetes Mellitus, Type 2; Female; Hand Dermatoses; Histoplasma; Histoplasmosis; Humans; Hypothyroidism; Immunocompromised Host; Immunosuppressive Agents; Itraconazole; Middle Aged; Panniculitis; Pemphigus

Topics: Amphotericin B; Antifungal Agents; Blepharoptosis; Cellulitis; Diabetes Complications; Diagnosis, Differential; Enterobacter aerogenes; Enterobacteriaceae Infections; Humans; Male; Middle Aged; Mucormycosis; Necrosis; Ophthalmoplegia; Orbit; Orbital Diseases; Rhizopus; Sinusitis; Vision Disorders; Visual Acuity; Zygomycosis

Cellulitis is an unusual presentation of cryptococcal infection in renal allograft recipients. In such patients, disseminated cryptococcal infection can result in significant morbidity and mortality. Patients are often treated with antibiotics before a definitive diagnosis is made, delaying appropriate therapy. We describe the case of a 43-year-old post renal transplant recipient presenting with fever and swelling in the right thigh. On physical examination, the patient was found to have features suggestive of cellulitis with minimal slurring of speech. Material obtained from incision and drainage of the wound showed yeast cells resembling Cryptococcus spp. Blood culture and cerebrospinal fluid culture were also found to have growth of Cryptococcus neoformans. He received treatment with amphotericin B 6 mg/kg daily intravenously for two weeks, then continued with fluconazole 400 mg daily for three months. The patient showed a remarkable improvement. There was no recurrence of cryptococcosis after four months of follow-up. The diagnosis of disseminated cryptococcosis should be considered in differential diagnosis of cellulitis among non HIV immunocompromised hosts. A high clinical suspicion and early initiation of therapy is needed to recognize and treat patients effectively.

Topics: Adult; Amphotericin B; Antifungal Agents; Cellulitis; Cryptococcosis; Cryptococcus; Cryptococcus neoformans; Diagnosis, Differential; Fluconazole; Humans; Immunocompromised Host; Kidney Transplantation; Male; Treatment Outcome

Topics: Adolescent; Amphotericin B; Antifungal Agents; Cellulitis; Cranial Nerve Diseases; Delayed Diagnosis; Diabetes Complications; Disease Progression; Disease Susceptibility; Encephalitis; Fatal Outcome; Female; Fungemia; Humans; Male; Middle Aged; Mucormycosis; Multiple Organ Failure; Opportunistic Infections; Sinusitis; Vision Disorders

Topics: Aged; Amphotericin B; Anticoagulants; Antifungal Agents; Cellulitis; Cryptococcosis; Dermatomycoses; Fatal Outcome; Female; Fungemia; Heparin, Low-Molecular-Weight; Hepatitis, Autoimmune; Humans; Immunocompromised Host; Immunosuppressive Agents; Liver Cirrhosis; Lung Diseases, Fungal; Necrosis; Prednisone; Radiography; Thrombophilia

Topics: Amphotericin B; Antibodies, Fungal; Antifungal Agents; Cellulitis; Cryptococcosis; Cryptococcus neoformans; Female; Fluconazole; Hepatitis C; Humans; Liver Cirrhosis; Middle Aged; Perineum; Pneumonia; Radiography; Suppuration; Vulva

Fusariosis is one of the emerging invasive fungal infections over the last decade. However, its recent rise has been in its ability to produce disseminated infection in severely immunosuppressed patients with neutropenia. In solid organ transplantation, fusariosis remains an uncommon picture mainly with nodules, subcutaneous abscesses, ulcers, or necrotic skin lesions resembling erthyma gangrenosum. Herein, we have reported a case of cellulitis, subcutaneous nodules, and abscesses due to Fusarium spp in a liver transplantation patient who was successfully treated with polyenes and surgical resection.

Topics: Amphotericin B; Biopsy; Cellulitis; Fusarium; Graft Rejection; Hepatitis C; Humans; Liver Cirrhosis; Liver Transplantation; Male; Middle Aged; Mycoses; Pyrimidines; Skin; Treatment Outcome; Triazoles; Voriconazole

Mucormycosis is a fatal infection of the immunocompromised individual. It is unusual to affect healthy individuals. We report eight such cases of infection caused by this emerging fungal pathogen in healthy patients. Of the eight cases, three were infected with Apophysomyces elegans, again an unusual pathogen causing mucormycosis.. Retrospective case review conducted at a tertiary referral center.. From 1999 to 2003, eight cases of mucormycosis were managed in otherwise healthy patients. Seven of them were treated with surgery. Clinical presentation, imaging studies, mycologic findings, operative findings at surgery, and postoperative results were evaluated. A review of the literature pertaining to mucormycosis infecting otherwise healthy patients and A. elegans infecting otherwise healthy patients in the nose and paranasal sinuses also was done.. Of the eight cases, three were infected with A. elegans, with no history of trauma or any invasive procedure. Seven patients underwent surgical treatment. Histopathologic examination showed broad, sparsely aseptate, thin-walled hyphae and angioinvasion with thrombosis.. Mucormycosis must be considered in the differential diagnosis of any severe acute headache, sinusitis, or orbital cellulites, not only in immunocompromised patients but also in the absence of any underlying disease. Successful treatment requires tissue débridement and injection of amphotericin B.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Cellulitis; Debridement; Diagnosis, Differential; Female; Headache; Humans; Immunocompetence; Injections; Male; Middle Aged; Mucorales; Mucormycosis; Orbital Diseases; Retrospective Studies; Sinusitis; Treatment Outcome

With the advent of potent immunosuppressive therapies used in solid organ transplantation, patients are more susceptible to a variety of infectious organisms. Infections may result from atypical pathogens and present in an unusual manner. We describe a case of progressive disseminated histoplasmosis presenting as cellulitis in a renal transplant recipient and review this disease.

Topics: Adult; Amphotericin B; Cellulitis; Disease Progression; Female; Graft Rejection; Histoplasma; Histoplasmosis; Humans; Kidney Transplantation; Living Donors; Postoperative Complications; Treatment Outcome

Facial cellulitis caused by odontogenic bacterial infection is frequently encountered; however, facial cellulitis caused by Candida albicans infection is rarely found. A patient with oral submucous fibrosis (OSF) and unknown diabetes mellitus (DM) was treated in our out-patient dental clinic by biweekly submucosal injection of 40 mg triamcinolone acetonide into bilateral buccal mucosae plus forced mouth opening performed by the two hands of the clinician. The interincisal distance of the patient improved from 28 to 48 mm after four times of steroid injection. The symptoms and signs of OSF also improved markedly. Unfortunately, facial candidal cellulitis occurred 2 months after the last time of steroid injection treatment. The infection was cured by incision and drainage, intravenous administration of amphotericin B (100 mg once a day for a week), and an appropriate medical control of DM. No recurrence of facial cellulitis was found during the follow-up period of 18 months. To prevent the occurrence of facial cellulitis after a high-dose steroid therapy, some prophylactic procedures should be taken before the initiation of the steroid treatment.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Cellulitis; Diabetes Complications; Drainage; Face; Follow-Up Studies; Glucocorticoids; Humans; Male; Middle Aged; Oral Submucous Fibrosis; Triamcinolone Acetonide

Children with acute lymphoblastic leukemia (ALL) are at risk for serious electrolyte abnormalities. The authors report their experience in managing a child with ALL who developed severe hyperphosphatemia as a consequence of a large exogenous load of phosphorus from high-dose liposomal amphotericin B. Health care providers need to recognize this potentially life-threatening complication of liposomal amphotericin B, since early detection and intervention can prevent significant morbidity.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Calcium Carbonate; Candidiasis; Cellulitis; Child; Drug Carriers; Female; Headache; Humans; Hyperparathyroidism, Secondary; Immunocompromised Host; Itraconazole; Liposomes; Mucormycosis; Orbital Diseases; Parathyroid Hormone; Phosphates; Phosphatidylcholines; Phosphatidylglycerols; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Seizures; Sinusitis; Vitamin D

Cryptococcus neoformans, an opportunistic fungus, may cause cutaneous disease by dissemination from primary lung infection or, more rarely, by direct cutaneous inoculation. Cellulitis in an immunocompromised host who does not respond to conventional antibacterial therapy should alert the physician to consider other diagnoses, including cryptococcal skin infection.

Topics: Adult; Amphotericin B; Antifungal Agents; Cellulitis; Cryptococcosis; Cryptococcus neoformans; Diagnosis, Differential; Female; Flucytosine; Humans; Renal Dialysis

Topics: Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Birefringence; Cellulitis; Cryptococcosis; Cryptococcus; Fluconazole; Humans; Male; Middle Aged; Pemphigus; Prednisone; Skin

A previously healthy, 18-month-old girl developed edema and erythema around her left eye 1 week after getting sand in that eye. The patient did not respond to oral or intravenous antibiotics. A mass developed around the eye, and biopsy revealed Conidiobolus incongruus. The patient failed to respond to amphotericin B 1 mg/kg, and susceptibility tests indicated multiantifungal resistance. A combination of antifungal therapy, hyperbaric oxygen, and surgery was required for successful treatment. Three months after treatment the child was disease free. There is no definitive therapy for Conidiobolus incongruus infections, although various drugs have been administered with some success. When susceptibility tests determine multidrug resistance, radical resection with antifungal chemotherapy and hyperbaric oxygen may be necessary as well as lifesaving.

Topics: Amphotericin B; Antifungal Agents; Cellulitis; Conidiobolus; Female; Humans; Infant; Itraconazole; Mycoses; Orbit

The first case of a cutaneous cryptococcosis associated with systemic erythematous lupus (SLE) diagnosed in our Mycology Reference Centre is presented: a 24-year-old female patient diagnosed with SLE, nephrotic syndrome, arterial hypertension, renal insufficiency due to glomerulonephritis type IV and cellulitis in the right thigh and gluteus. Cryptococcus neoformans was isolated by cutaneous biopsy and haemoculture. Cryptococcal antigen was detected in serum by the latex agglutination test. As the patient did not respond to fluconazol intravenous treatment, amphotericin B administration was performed. She died of acute renal insufficiency.

Topics: Adult; Agglutination Tests; Amphotericin B; Antifungal Agents; Antigens, Fungal; Cellulitis; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Fatal Outcome; Female; Fluconazole; Fungemia; Humans; Injections, Intravenous; Lupus Erythematosus, Systemic; Renal Insufficiency

Topics: Aged; Amphotericin B; Cellulitis; Diabetes Mellitus, Type 2; Gangrene; Humans; Male; Mucormycosis

Topics: Aged; Amphotericin B; Antifungal Agents; Cellulitis; Cryptococcosis; Dermatomycoses; Female; Fluconazole; Flucytosine; Humans; Immunocompetence; Itraconazole; Leg Dermatoses

Topics: Abdominal Muscles; Amphotericin B; Cellulitis; Combined Modality Therapy; Debridement; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Mucormycosis; Necrosis; Rhizopus

A case of zygomycosis due to Rhizopus microsporus variety microsporus in a patient who was receiving haemodialysis is described. This infection resulted in amputation of the right hand. Criteria to identify the fungus are presented. The pathogenesis and treatment of zygomycosis are discussed.

Topics: Amphotericin B; Amputation, Surgical; Cellulitis; Female; Hand; Humans; Middle Aged; Mucormycosis; Renal Dialysis; Rhizopus

Candida albicans rarely infects the lacrimal drainage system. This paper describes a case of bilateral C. albicans dacryocystitis following midfacial trauma. The patient presented with recurrent facial cellulitis and a fistula opening onto the cheek. The condition was controlled only after bilateral dacryocystorhinostomy along with amphotericin B therapy. This appears to be the first reported case in which the lacrimal sacs acted as a reservoir for microorganisms causing recurrent facial cellulitis.

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Candidiasis; Cellulitis; Dacryocystitis; Female; Humans; Maxillary Fractures; Zygomatic Fractures

Three children with the rare occurrence of zygomycosis are descibed: two had involvement of a solitary lesion of gangrenous cellulitis on the buttocks, and th third was a neonate with gastric performation and a gangrenous appendicitis. All three patients were compromised hosts (two with leukemia and one a premature infant with respiratory distress syndrome). All three patients appeared to have acquired the same organism. Rhizopus oryzae, from the same fomites, elastic bondages (Elastoplast). The Center for Disease Control has received several other reports of zygomycosis traceable to the same material. Alll three of our patients were cured of their infections. Early diagnosis and a combined surgical and chemotherapeutic approach appear to prevent death from zygomycosis.

Topics: Amphotericin B; Appendicitis; Bandages; Cellulitis; Child; Female; Humans; Infant, Newborn; Leukemia, Lymphoid; Male; Mucormycosis; Peptic Ulcer Perforation; Respiratory Distress Syndrome, Newborn; Rhizopus; Stomach Ulcer

Cutaneous mucormycosis in a renal transplant recipient resulted in gangrenous cellulitis of the neck at an internal jugular cannula site. This nosocomial process was due to a histologically confirmed infection, and cultures revealed Mucor sp. The patient died despite surgical debridement and amphotericin B therapy. Cutaneous mucormycosis is a relatively rare entity with only 12 cases previously reported. In renal transplant patients only nine cases of renal transplant patients only nine cases of mucormycosis have been reported and only one was cutaneous. Also, this case reported is the second originating at an intravenous cannula site; the first recorded patient was diabetic.

Topics: Amphotericin B; Cellulitis; Debridement; Dermatomycoses; Gangrene; Humans; Kidney Transplantation; Male; Middle Aged; Mucormycosis; Neck; Postoperative Complications; Transplantation, Homologous

Progressive gangrenous cellulitis due to Rhizopus arrhizus following colostomy destroyed the entire abdominal wall of a young woman and caused her death. A similar infection in an 11-year-old kidney transplant recipient was diagnosed more promptly and treated successfully with extensive debridement and amphotericin B. Nine similar cases found in the literature were reviewed. All 11 patients appeared to have had prior tissue injury at the original site of infection, and seven had diabetes mellitus. The disease was initially misdiagnosed in most of the patients, progressed rapidly in eight, and was fatal in four. Phycomycotic gangrenous cellulitis should be included in the differential diagnosis of progressive necrotizing lesions of the skin, especially in diabetic patients, but it can be identified promptly only by histologic examination of the infected tissue. Urgent radical excision and amphotericin therapy are recommended.

Topics: Abdominal Muscles; Adult; Amphotericin B; Biopsy; Cellulitis; Child; Colostomy; Diagnosis, Differential; Female; Gangrene; Humans; Immunosuppressive Agents; Kidney Transplantation; Postoperative Complications; Rhizopus; Transplantation, Homologous

Rhinocerebral mucormycosis (phycomycetes), a human fungal disease with oral and perioral findings, has an extremely high morbidity and mortality. The disease is most frequently seen in patients with poorly controlled diabetes. The symptoms, findings, and treatment of rhinocerebral mucormycosis are discussed, and two case histories are presented.

Topics: Adult; Amphotericin B; Blepharoptosis; Cellulitis; Diagnosis, Differential; Eye Diseases; Female; Humans; Male; Maxillary Sinus; Middle Aged; Mucormycosis; Nose Diseases; Ophthalmoplegia; Orbit; Palatal Neoplasms; Palate; Paranasal Sinus Neoplasms; Paresthesia; Radiography; Sinus Thrombosis, Intracranial; Ulcer; Vision Disorders

Cellulitis of the scrotum and penis is caused, in the majority of instances, by a beta hemolytic streptococci without a discernible portal of entry. Clostridium, occasionally, will result in this disease as a manifestation of a perirectal abscess. In either instance, fluid accumulates rapidly in the closed space between Colles' and Buck's fascia, producing intense swelling of the scrotum. If this compartment is not immediately decompressed by linear incisions, devascularization of the scrotal and penile skin will often occur, resulting in gangrene. Immediate treatment of the bacterial infection with penicillin also is essential. If gangrene does develop, radical debridement of the necrotic tissue as well as a wide margin of adjacent inflamed skin must be undertaken. Continual monitoring of the microflora of the debrided would is essential for the selection of the appropriate antibiotic against any secondary intruders. Coverage of the granulating would is accomplished when the would bacterial count is below 10-5 per gram of tissue.

Topics: Amphotericin B; Anti-Bacterial Agents; Antistreptolysin; Candida albicans; Candidiasis; Cellulitis; Debridement; Gangrene; Genital Diseases, Male; Humans; Immunity; Male; Middle Aged; Penile Diseases; Scrotum; Skin Diseases; Skin Transplantation; Streptococcal Infections; Transplantation, Autologous