amphotericin-b and Cholangitis

Trichosporon species are ubiquitously spread and known to be part of the normal human flora of the skin and gastrointestinal tract. Trichosporon spp. normally cause superficial infections. However, in the past decade Trichosporon spp. are emerging as opportunistic agents of invasive fungal infections, particularly in severely immunocompromised patients. Clinical isolates are usually sensitive to triazoles, but strains resistant to multiple triazoles have been reported.. We report a high-level pan-azole resistant Trichosporon dermatis isolate causing an invasive cholangitis in a patient after liver re-transplantation. This infection occurred despite of fluconazole and low dose amphotericin B prophylaxis, and treatment with combined liposomal amphotericin B and voriconazole failed.. This case and recent reports in literature show that not only bacteria are evolving towards pan-resistance, but also pathogenic yeasts. Prudent use of antifungals is important to withstand emerging antifungal resistance.

Topics: Amphotericin B; Antifungal Agents; Cholangitis; Drug Resistance, Fungal; Hepatic Encephalopathy; Humans; Liver Cirrhosis; Liver Transplantation; Male; Microbial Sensitivity Tests; Middle Aged; Peritonitis; Phylogeny; Trichosporon; Trichosporonosis; Voriconazole

Topics: Acute Disease; Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Cholangitis; Female; Humans; Leukemia

A case of biliary atresia treated by Kasai portoenterostomy was re-explored a year later for refractory cholangitis, which failed to respond to antibiotic treatment. Unexpectedly, the granulation tissue obstructing the porta hepatis contained pseudohyphae of Candida albicans. After curettage and Amphotericin B local irrigation, the patient became afebrile and anicteric.

Topics: Amphotericin B; Bile Ducts; Candidiasis; Cholangitis; Female; Humans; Infant; Postoperative Complications; Reoperation

Topics: Amphotericin B; Anti-Bacterial Agents; Candidiasis; Cholangitis; Female; Humans; Middle Aged

Topics: Adult; Amphotericin B; Biopsy; Cholangitis; Cryptococcosis; Diagnostic Errors; Flucytosine; Granuloma; Hepatitis; Humans; Liver; Male; Meningitis; Neurologic Manifestations