amphotericin-b and Cerebellar-Diseases

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

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

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

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

BACKGROUND Cryptococcal meningitis in patients who are seronegative for the human immunodeficiency virus (HIV) and in patients who are splenectomized is rare. This report is an unusual case of meningeal and cerebellar infection due to the encapsulated yeast, Cryptococcus neoformans, which has not previously been associated with asplenia. CASE REPORT A 65-year-old HIV-negative patient with a previous splenectomy, presented with a three-day history of fever, vomiting, and headache. His symptoms progressed to generalized body aches, persistent fever, and neck stiffness. A lumbar puncture was performed, and cerebrospinal fluid (CSF) culture grew Cryptococcus neoformans. Treatment commenced with intravenous amphotericin B and flucytosine. The patient required serial lumbar punctures due to persistent raised intracranial pressure (ICP). Magnetic resonance imaging (MRI) of the brain showed acute meningitis and cerebellitis. Antimicrobial therapy and CSF drainage resulted in clinical improvement.  CONCLUSIONS The occurrence of meningeal and cerebellar cryptococcosis in an asplenic patient is rare, and few cases have been previously reported. This case report highlights the possibility of invasive cryptococcal infection, or cryptococcosis, in asplenic individuals in the absence of HIV infection.

Topics: Aged; Amphotericin B; Antifungal Agents; Cerebellar Diseases; Cryptococcus neoformans; Diagnosis, Differential; Drug Therapy, Combination; Fluconazole; Flucytosine; Follow-Up Studies; HIV Seronegativity; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal; Rare Diseases; Risk Assessment; Severity of Illness Index; Splenectomy; Treatment Outcome

Cryptococcosis is an opportunistic fungal infection whose etiology is. Male patient with 65 old years, from an area of subtropical climate with chronic exposure to poultry, without pathological antecedents, who presented clinical picture consistent with headache, fever, seizures and altered mental status.. Initially without menigeal signs or intracranial hypertension and normal neurological examination. Later, the patient developed ataxia, dysdiadochokinesia and limb loss. By lumbar punction and image of nuclear magnetic resonance (NMR) cerebellitis cryptococcal was diagnosticated.. Antifungal therapy with amphotericin B and fluconazole was performed, however the patient died.. The cryptococcosis has different presentations, it´s a disease whose incidence has been increasing since the advent of the HIV / AIDS pandemy, however the commitment of the encephalic parenchyma and in particular the cerebellum is considered rare. In this way we are facing the first case of cryptococcal cerebellitis in our midst.. La Criptococosis es una infección micótica oportunista cuya etiología es el complejo. Paciente masculino de 65 años, procedente de un área rural con exposición crónica a aves de corral, sin antecedentes patológicos, con cuadro clínico inicial consistente en cefalea crónica, fiebre, convulsiones y alteración del estado mental.. Al principio sin signos de hipertensión intracraneana ni meníngeos y examen neurológico normal, con posterior desarrollo de ataxia, disdiadococinesia y dismetría. Se diagnosticó Cerebelitis Criptocococica con ayuda de repetidos estudios de LCR y resonancia magnética nuclear.. Se inició terapia antifúngica con Anfotericina B y Fluconazol, con respuesta tórpida y el paciente fallece.. La Cerebelitis Criptocococica es una presentación clínica infrecuente que requiere sospecha clínica y recursos diagnósticos para definir el tratamiento de forma temprana. La inmunosupresión no es requisito para padecer esta infección.

Topics: Aged; Amphotericin B; Antifungal Agents; Cerebellar Diseases; Cryptococcosis; Fatal Outcome; Fluconazole; Humans; Magnetic Resonance Spectroscopy; Male

Mucormycosis is a deadly invasive fungal infection whose characteristics are only partially understood.. Data on mucormycosis obtained in France between 2005 and 2007 from 2 notification systems were merged. The 2008 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definition criteria were applied and risk factors for death were analyzed by hazard ratios (HRs) calculated from the Cox proportional hazards regression model.. A total of 101 cases (60 proven, 41 probable), mostly in men (58%) >50 years (mean age, 50.7 ± 19.9) were recorded. Hematological malignancies represented 50% (median time for occurrence, 8.8 months after disease onset), diabetes 23%, and trauma 18% of cases. Sites of infection were lungs (28%; 79% in hematology patients), rhinocerebral (25%; 64% in diabetic patients), skin (20%), and disseminated (18%). Median time between first symptoms and diagnosis was 2 weeks. The main fungal species were Rhizopus oryzae (32%) and Lichtheimia species (29%). In cases where the causative species was identified, R. oryzae was present in 85% of rhinocerebral forms compared with only 17% of nonrhinocerebral forms (P < .001). Treatment consisted of surgery in 59% and antifungals in 87% of cases (liposomal amphotericin B in 61%). Ninety-day survival was 56%; it was reduced in cases of dissemination compared with rhinocerebral (HR, 5.38 [2.0-14.1]; P < .001), pulmonary (HR, 2.2 [1.0-4.7]; P = .04), or skin localization (HR, 5.73 [1.9-17.5]; P = .002); survival was reduced in cases of hematological malignancies compared with diabetes mellitus (HR, 2.3 [1.0-5.2]; P < .05) or trauma (HR, 6.9 [1.6-28.6], P = .008) and if ≥2 underlying conditions (HR, 5.9 [1.8-19.0]; P = .004). Mucormycosis localization remained the only independent factor associated with survival.. This 3-year study performed in one country shows the diverse clinical presentation of mucormycosis with a high prevalence of primary skin infection following trauma and a prognosis significantly influenced by localization.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Cerebellar Diseases; Child; Data Collection; Dermatomycoses; Diabetes Mellitus; Female; France; Hematologic Neoplasms; Humans; Lung; Male; Middle Aged; Mucormycosis; Prognosis; Proportional Hazards Models; Retrospective Studies; Rhizopus; Risk Factors; Survival Analysis; Treatment Outcome; Wounds and Injuries; Young Adult

Structure-activity relationship studies were carried out by chemical modification of manzamine A (1), 8-hydroxymanzamine A (2), manzamine F (14), and ircinal isolated from the sponge Acanthostrongylophora. The derived analogues were evaluated for antimalarial, antimicrobial, and antineuroinflammatory activities. Several modified products exhibited potent and improved in vitro antineuroinflammatory, antimicrobial, and antimalarial activity. 1 showed improved activity against malaria compared to chloroquine in both multi- and single-dose in vivo experiments. The significant antimalarial potential was revealed by a 100% cure rate of malaria in mice with one administration of 100 mg/kg of 1. The potent antineuroinflammatory activity of the manzamines will provide great benefit for the prevention and treatment of cerebral infections (e.g., Cryptococcus and Plasmodium). In addition, 1 was shown to permeate across the blood-brain barrier (BBB) in an in vitro model using a MDR-MDCK monolayer. Docking studies support that 2 binds to the ATP-noncompetitive pocket of glycogen synthesis kinase-3beta (GSK-3beta), which is a putative target of manzamines. On the basis of the results presented here, it will be possible to initiate rational drug design efforts around this natural product scaffold for the treatment of several different diseases.

Topics: Animals; Anti-Infective Agents; Carbazoles; Cerebellar Diseases; Indole Alkaloids; Mice; Microbial Sensitivity Tests; Molecular Structure; Neurogenic Inflammation; Porifera; Stereoisomerism; Structure-Activity Relationship

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Cerebellar Diseases; Combined Modality Therapy; Feasibility Studies; Female; Follow-Up Studies; Humans; Injections, Intralesional; Middle Aged; Treatment Outcome

Cryptococcal infection of the brain is commonly seen in immunocompromised patients but rarely considered as the differential diagnosis in immunocompetent patients. We present two cases of cryptococcosis involving the brain in immunocompetent patients, which strongly mimicked tuberculous infection in both conventional as well as advanced magnetic resonance (MR) imaging, and the disease was only confirmed after histopathological/cerebrospinal fluid serological study. One patient was a 52-year-old woman, and the second patient was a 23-year-old man. These two cases highlight the need for workup of fungal infections in immunocompetent patients from the tuberculous endemic regions, even when the imaging is highly suspicious of tuberculous lesions. The imaging findings in advanced MR imaging techniques such as diffusion, perfusion, susceptibility-weighted imaging and MR spectroscopy are discussed.

Topics: Amphotericin B; Antifungal Agents; Cerebellar Diseases; Cryptococcus neoformans; Diagnosis, Differential; Diffusion Magnetic Resonance Imaging; Female; Flucytosine; Humans; Immunocompetence; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Meninges; Meningitis, Cryptococcal; Middle Aged; Tomography, X-Ray Computed; Tuberculosis, Meningeal; Young Adult

Eumycetoma in the cerebellopontine angle region is extremely uncommon with no case being reported as per an extensive review of the literature by the authors. The authors report a case of cerebellopontine angle eumycetoma in a young female managed by subtotal decompression and antifungal treatment. The pre-operative diagnosis of eumycetoma in this location is extremely difficult and the role of histopathology is very important to characterize this uncommon lesion. The prognosis of this bizarre pathology is dismal despite all treatment modalities as compared to the usual tumors of the cerebellopontine angle that generally have a favorable outcome.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Edema; Brain Stem; Cerebellar Diseases; Cerebellopontine Angle; Decompression, Surgical; Drug Therapy, Combination; Female; Humans; Hydrocephalus; Ketoconazole; Magnetic Resonance Imaging; Mycetoma; Otitis Media with Effusion; Scedosporium; Tomography, X-Ray Computed; Ventriculoperitoneal Shunt

Intracranial aspergillosis is occasionally seen among immunocompromised patients, the incidence increasing in consequence to large-scale use of chemotherapy against malignancies and immunosuppression after organ transplantation. Immunocompetent patients harboring invasive intracranial fungal infections still remain an elusive diagnosis.. A 7-month-old immunocompetent infant who developed and harbored cerebellar aspergillosis until 3 years of age is reported.. Radical surgical resection of posterior fossa mass (aspergilloma) and parenteral administration of Amphotericin B led to a successful outcome.. The differential diagnosis at both stages of presentation and the possible mode of infection are discussed according to the radiological images. Preoperative diagnosis on the basis of imaging is difficult. The pathogenesis of such an infection remains uncertain. Parenteral Amphotericin B, followed by prolonged itraconazole therapy, remains the "gold standard" modality for central nervous system fungal infections in adjunct to aggressive surgical debridement.

Topics: Amphotericin B; Cerebellar Diseases; Humans; Infant; Itraconazole; Male; Neuroaspergillosis

This is the first reported case of cerebral blastomycosis successfully treated with amphotericin B lipid complex.

Topics: Adult; Amphotericin B; Antifungal Agents; Blastomycosis; Central Nervous System Fungal Infections; Cerebellar Diseases; Drug Combinations; Female; Humans; Itraconazole; Phosphatidylcholines; Phosphatidylglycerols; Recurrence

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

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

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

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

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

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

Topics: Amphotericin B; Animals; Atrophy; Canada; Cerebellar Diseases; Cerebellum; Sheep; Sheep, Domestic; United Kingdom