amphotericin-b and Chest-Pain

We report here the first case of disseminated Emmonsia pasteuriana infection in a patient with AIDS in India. The patient presented with weight loss, dyspnoea, left-sided chest pain and multiple non-tender skin lesions over face and body for 3 months. Disseminated emmonsiosis was diagnosed on microscopic examination and fungal culture of skin biopsy and needle aspirate of lung consolidation. It was confirmed by sequencing internal transcribed spacer region of rDNA, beta tubulin, actin, and intein PRP8. The patient responded to amphotericin B and itraconazole therapy.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Biopsy, Needle; Chest Pain; Chrysosporium; Diagnostic Errors; DNA, Fungal; DNA, Ribosomal; Dyspnea; Female; Humans; India; Itraconazole; Mycoses; Phylogeny; Weight Loss

We evaluated an amphotericin treatment strategy on the basis of duration of candidemia and clinical findings. Patients without neutropenia who had uncomplicated candidemia received 200 mg of amphotericin B over 5-7 days if they had had 1 day of positive cultures (PC group). The clinical cure rate was 93% (95% confidence interval [CI], 77%-99%; n=29 episodes) in the SC group, with no relapses (median follow-up, 272 days). The clinical cure rate was 83% (95% CI, 64%-94%; n=29 episodes) in the PC group, with 1 relapse (4.2%). The results of this pilot study suggest that patients with candidemia may be stratified into risk groups on the basis of the duration of positive blood cultures and other clinical findings. Decisions about the duration of therapy can be made 4-7 days after initiation of treatment. Carefully selected patients with transient uncomplicated candidemia may be safely treated with a short course of amphotericin B. Further prospective validation of this concept should be undertaken particularly to evaluate the impact on low-frequency late complications (e.g., endophthalmitis).

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Chest Pain; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Pilot Projects; Recurrence; Survival Rate; Time Factors; Treatment Outcome

We report a case of pulmonary cryptococcoma, in an adult with recently detected diabetes, mimicking as lung cancer. A 45-year-old gentleman with past history of pulmonary tuberculosis presented with fever, cough with expectoration, pleuritic chest pain and hemoptysis. Chest radiograph and computed tomography revealed right lower lobe mass which significantly enhanced on contrast administration. Ultrasound guided biopsy was done which on histopathological examination showed non-necrotizing granulomas with narrow-based budding yeast cells suggestive of cryptococcosis. Detailed work-up for dissemination of infection was negative. A dramatic response to anti-fungal treatment was observed and the patient is doing fine on follow-up.

Topics: Amphotericin B; Antifungal Agents; Chest Pain; Cough; Cryptococcosis; Cryptococcus neoformans; Fluconazole; Hemoptysis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Tomography, X-Ray Computed; Treatment Outcome

Candida albicans osteomyelitis is a rare disease that occurs in immunocompromised individuals, sometimes with a late diagnosis related to the mismatch between symptoms and candidemia. This case refers to a 36-year-old male patient with a history of oesophageal surgery for achalasia with multiple subsequent surgeries and hospitalisation in the intensive care unit for oesophageal fistula complication. Four months after discharge, the patient was admitted to the infectious diseases department with pain in the 10th-12th left ribs, swelling of the 4th-6th costal cartilage and decreased visual acuity. An MRI study showed thickening and diffuse enhancement, with no defined borders in the cartilage and ribs, compatible with infection. After performing a CT-guided bone biopsy, isolated C. albicans sensitive to antifungal agents was detected. The patient started therapy with liposomal amphotericin B and maintenance fluconazole for 6 months and showed clinical and radiological improvement within this time.

Topics: Adult; Amphotericin B; Antifungal Agents; Blindness; Candida albicans; Candidiasis; Chest Pain; Fluconazole; Humans; Male; Osteomyelitis; Ribs

A young man presented with a history of cough, chest pain and streaky haemoptysis with low-grade fever. Further evaluation revealed a mass in the left hemithorax, which was biopsied to reveal cryptococcoma. The patient was HIV negative. Flow cytometry lymphocyte subset analysis showed reduced CD4+ T lymphocytes. Absolute CD4+ lymphocyte count was only 230 (normal range 530-1300). The patient was started on injectable amphotericin B, which was given for 1 month, and he was discharged on oral fluconazole.

Topics: Adult; Amphotericin B; Antifungal Agents; Chest Pain; Cough; Cryptococcosis; Drug Therapy, Combination; Fluconazole; Hemoptysis; Humans; Lung Diseases, Fungal; Male

Topics: Aged; Amphotericin B; Antifungal Agents; Anxiety Disorders; Arthritis, Infectious; Candida glabrata; Candidiasis; Chest Pain; Diagnosis, Differential; Dyspnea; Female; Humans; Infusions, Intravenous; Knee Prosthesis; Liposomes; Prosthesis-Related Infections; Recurrence; Syndrome

We investigated the clinical characteristics and treatment of patients with a distinctive triad of acute infusion-related reactions (AIRRs) to liposomal amphotericin B (L-AMB) via single-center and multicenter analyses. AIRRs occurred alone or in combination within 1 of 3 symptom complexes: (1) chest pain, dyspnea, and hypoxia; (2) severe abdomen, flank, or leg pain; and (3) flushing and urticaria. The frequency of AIRRs in the single-center analysis increased over time. Most AIRRs (86%) occurred within the first 5 min of infusion. All patients experienced rapid resolution of symptoms after intravenous diphenhydramine was administered. The multicenter analysis demonstrated a mean overall frequency of 20% (range, 0%-100%) of AIRRs among 64 centers. A triad of severe AIRRs to L-AMB may occur in some centers; most of these reactions may be effectively managed by diphenhydramine administration and interruption of L-AMB infusion.

Topics: Abdominal Pain; Adult; Amphotericin B; Antifungal Agents; Chest Pain; Drug Combinations; Dyspnea; Female; Flushing; Humans; Hypoxia; Liposomes; Male; Phosphatidylcholines; Phosphatidylglycerols; Risk Factors