amphotericin-b and Cough

Aspergillosis is an infrequent but commonly fatal infection among HIV-infected individuals. We review 342 cases of pulmonary Aspergillus infection that have been reported among HIV-infected patients, with a focus on invasive disease. Invasive pulmonary aspergillosis usually occurs among patients with <50 CD4 cells/mm3. Major predisposing conditions include neutropenia and steroid treatment. Fever, cough, and dyspnea are each present in >60% of the cases. BAL is often suggestive, but biopsy specimens are necessary for definite diagnosis. Amphotericin B is the mainstay of treatment and mortality is > 80%. Avoiding neutropenia and judicious use of steroids may be helpful in prevention. Aggressive diagnostic approach, early initiation of treatment, adequate dosing of antifungals, and close follow-up may improve the currently dismal prognosis.

Topics: Adrenal Cortex Hormones; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspergillosis; Biopsy; Bronchoalveolar Lavage Fluid; CD4 Lymphocyte Count; Cough; Dyspnea; Female; Fever; Follow-Up Studies; Humans; Lung Diseases, Fungal; Male; Neutropenia; Prognosis; Risk Factors; Survival Rate

To compare the acute effects of single nebulized amphotericin B and budesonide in treating cough-related laryngeal sensations in chronic cough patients, a randomized, single-blind, placebo-controlled, parallel-group trial was performed between two groups with positive and negative results of basidiomycetous (BM) fungi in their sputum culture.. Forty patients presenting with chronic cough lasting 8 weeks or longer, whose sputum could be obtained, were recruited for this study. At the first visit, all patients underwent fungal culture sampling of sputum, capsaicin cough inhalation test, pulmonary function tests, and cough-related laryngeal sensation questionnaire (C-LSQ) consisting of 6 items with a severity scale of 0-5 for each item: (1) a sensation of irritation in the throat (SIT); (2) tickle in the throat; (3) throat clearing; (4) urge to cough; (5) a sensation of something stuck in the throat; and (6) a sensation of mucus in the throat (SMIT). The patients were randomly assigned to receive either nebulizer inhalation of 2.5 mg of amphotericin B (Group A) or nebulizer inhalation of 0.5 mg of budesonide (Group B). The efficacies of each therapy were estimated by the change in C-LSQ score.. There were significant differences in the delta score of item 1 (SIT) and item 2 in the BM-negative group and item 6 (SMIT) in the BM-positive group at 60 min after inhalation between Groups A and B (P<0.05).. The results of this study suggested that appropriate use of single inhalation of budesonide or amphotericin B, which would be selected based on the results of sputum culture, may lead to suppression of cough-related laryngeal sensations, such as SIT or SMIT.

Topics: Administration, Inhalation; Adult; Aged; Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Basidiomycota; Budesonide; Case-Control Studies; Chronic Disease; Cough; Female; Humans; Laryngeal Diseases; Lung Diseases, Fungal; Male; Middle Aged; Nebulizers and Vaporizers; Paresthesia; Sensation; Single-Blind Method; Sputum; Surveys and Questionnaires; Treatment Outcome; Young Adult

Drug pharmacokinetics may be significantly altered in patients receiving extracorporeal membrane oxygenation (ECMO). Ensuring the optimized effective dosing of antimicrobials on ECMO remains a challenge. To date, limited data are available regarding the optimal use of amphotericin and triazoles during ECMO. We report a case of altered pharmacokinetics, insufficient liposomal amphotericin B and isavuconazole levels, and the need for escalated doses during ECMO in a patient with severe acute respiratory distress syndrome secondary to pulmonary blastomycosis. A 2-fold increase in the standard total daily dose of both drugs was necessary to overcome low serum concentrations thought to be secondary to drug loss from ECMO circuit sequestration. These findings have important implications for optimizing antimicrobial therapy in patients receiving ECMO to maximize therapeutic efficacy. The use of therapeutic drug monitoring for patients receiving antimicrobial therapy with concurrent ECMO may facilitate appropriate drug dosing to achieve adequate serum concentrations and optimize favorable patient outcomes. Further studies exploring antimicrobial pharmacokinetics during ECMO are needed to inform dosing recommendations in critically ill patients.

Topics: Adult; Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Cough; Dyspnea; Extracorporeal Membrane Oxygenation; Fever; Humans; Male

In contrast to adults, coccidioidomycosis is a rare disease in infants and the mechanisms of disease acquisition are not well described in infants. The purpose of this study was to describe the clinical presentation, treatment, and outcome of pulmonary coccidioidomycosis in infants in an endemic area.. We performed a retrospective observational study of all patients less than 12 months of age admitted to a tertiary free standing children's hospital from 2003-2012 diagnosed with coccidioidomycosis.. Thirteen infants were hospitalized during the study period. The majority of the patients presented with upper and/or lower respiratory tract infection. The most common presenting symptoms included fever (77%), cough (61%), and respiratory distress (38%). Disseminated disease, included pericardial effusion, neck abscess, and lesions in the cerebellum, basal ganglia and left temporoparietal skull. Fluconazole was the initial, antifungal agent used. Amphotericin B was reserved for significant lung disease and disseminated cases. Failed response to fluconazole and amphotericin B were treated with a combination of voriconazole and caspofungin. Average length of treatment was 4 years. All patients survived to hospital discharge. The majority of the patients had resolution of chest radiograph and coccidiodal complement fixing antibody titers.. Infant coccidioidomycosis has a non-specific presentation and can mimic common infant respiratory illnesses. In endemic areas, coccidioidomycosis should be considered in the differential diagnosis of infants with pulmonary symptoms unresponsive to conventional treatment. Pediatr Pulmonol. 2016;51:858-862. © 2016 Wiley Periodicals, Inc.

Topics: Amphotericin B; Antifungal Agents; Caspofungin; Coccidioidomycosis; Cough; Diagnosis, Differential; Echinocandins; Endemic Diseases; Female; Fever; Fluconazole; Humans; Infant; Lipopeptides; Lung Diseases, Fungal; Male; Retrospective Studies; Treatment Outcome; Voriconazole

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

To compare clinical features, diagnosis and therapeutic effect between pulmonary histoplasmosis and progressive disseminated histoplasmosis.
 Methods: A retrospective analysis for 12 cases of hospitalized patients with histoplasmosis, who was admitted in Xiangya Hospital, Central South University during the time from February 2009 to October 2015, was carried out. Four cases of pulmonary histoplasmosis and 8 cases of progressive disseminated histoplasmosis were included. The differences of clinical features, imaging tests, means for diagnosis and prognosis were analyzed between the two types of histoplasmosis.
 Results: The clinical manifestations of pulmonary histoplasmosis were mild, such as dry cough. However, the main clinical symptoms of progressive disseminated histoplasmosis were severe, including recurrence of high fever, superficial lymph node enlargement over the whole body, hepatosplenomegaly, accompanied by cough, abdominal pain, joint pain, skin changes, etc.Laboratory examination showed pancytopenia, abnormal liver function and abnormal coagulation function. One pulmonary case received the operation of left lower lung lobectomy, 3 cases of pulmonary histoplasmosis and 6 cases of progressive disseminated histoplasmosis patients were given deoxycholate amphotericin B, itraconazole, voriconazole or fluconazole for antifungal therapy. One disseminated case discharged from the hospital without treatment after diagnosis of histoplasmosis, and 1 disseminated case combined with severe pneumonia and active tuberculosis died ultimately.
 Conclusion: As a rare fungal infection, histoplasmosis is easily to be misdiagnosed. The diagnostic criteria depends on etiology through bone marrow smear and tissues biopsy. Liposomeal amphotericin B, deoxycholate amphotericin B and itraconazole are recommended to treat infection for histoplasma capsulatum.. 目的：比较肺型与进展播散型组织胞浆菌病的临床特点、诊断及预后差异。 方法：回顾性分析中南大学湘雅医院2009年2月至2015年10月期间收治的组织胞浆菌病住院患者12例，其中肺型4例，进展播散型8例。从临床表现、影像学、确诊途径及预后等方面分析两者之间的差异性。 结果：肺型组织胞浆菌病临床表现轻微，干咳多见。进展播散型患者全身症状明显，极易出现反复高热、全身浅表淋巴结肿大、肝脾肿大，可合并咳嗽、腹痛、关节痛、皮肤改变等。实验室检查示全血细胞减少、肝功能异常、凝血功能异常等。1例肺型患者给予了左下肺切除术，其余3例肺型及6例进展播散型患者分别给予两性霉素B脱氧胆酸盐、伊曲康唑、伏立康唑或氟康唑抗真菌感染治疗，好转出院，1例播散型确诊后暂未治疗即出院，1例播散型因合并重症肺炎及活动性肺结核治疗无效死亡。结论：组织胞浆菌病临床少见，极易漏诊或误诊，依靠骨髓涂片、病理组织切片特殊染色明确病原学是目前确诊的主要依据，推荐两性霉素B脂质体、两性霉素B脱氧胆酸盐及伊曲康唑抗感染治疗。.

Topics: Abdominal Pain; Amphotericin B; Antifungal Agents; Biopsy; Cough; Death; Deoxycholic Acid; Diagnostic Errors; Drug Combinations; Fever; Hepatomegaly; Histoplasma; Histoplasmosis; Humans; Invasive Fungal Infections; Itraconazole; Lung; Lung Diseases, Fungal; Pneumonia; Recurrence; Retrospective Studies; Splenomegaly; Treatment Outcome; Tuberculosis

Topics: Amphotericin B; Antifungal Agents; Biomarkers; Child; Cough; Cryptococcosis; Fever; Fluconazole; Humans; Lung; Lung Diseases, Fungal; Male; Radiography, Thoracic; Tomography, X-Ray Computed

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

Mycetoma is defined as a fungus ball that fills a preexisting lung cavity, most frequently being of tuberculous or sarcoid etiology. The most frequently isolated fungus is the species of Aspergillus, but other fungi such as Fusarium or Zygomycetes can also be present. Most patients lack symptoms. However, presentation may also be with hemoptysis, which can be massive and life-threatening. We describe the case of a 50-year-old man with a history of prior pulmonary tuberculosis, with recurrent episodes of cough and hemoptysis. He was diagnosed to have mycetoma in the left upper lobe cavity. The mycetoma was extracted through bronchoscopy under general anesthesia using a cryoprobe. Treatment was completed with amphotericin B instilled in the cavity and the patient was placed on oral itraconazole. This is the first case report to date in which cryotherapy was used to remove a mycetoma.

Topics: Amphotericin B; Antifungal Agents; Bronchoscopy; Cough; Cryotherapy; Fusariosis; Hemoptysis; Humans; Instillation, Drug; Lung Diseases, Fungal; Male; Middle Aged; Mycetoma; Radiography; Recurrence; Tuberculosis, Pulmonary

A 43 year-old diabetic woman, who suffered chronic cough and brown expectoration, is presented in this clinical problem. X-ray exam and CT thorax scan showed a cavitary lung lesion, located at the upper field of the left lung. This lesion had 5 cm in diameter, with a thick wall and a spherical shadow inside. The diagnosis of chronic cavitary pulmonary coccidioidomycosis was based on the isolation of Coccidioides sp. from cultures of expectoration and bronchoalveolar lavage, and the detection of specific antibodies in immunodiffusion test and counterimmunoelectrophoresis with coccidiodin. Her diabetes was not well controlled. She was treated with intravenous amphotericin B and oral itraconazole, with good clinical response; after four months of treatment the patient abandoned clinical controls. We suppose that the patient presented a coccidioidal fungus ball, inside a chronic cavitary lesion due to pulmonary coccidiodomycosis. She came from an endemic zone of coccidioidomycosis in the Northwest of the Argentine Republic (Catamarca Province).

Topics: Adult; Amphotericin B; Antifungal Agents; Argentina; Bronchoalveolar Lavage Fluid; Coccidioides; Coccidioidin; Coccidioidomycosis; Cough; Diabetes Mellitus, Type 2; Drug Therapy, Combination; Dyspnea; Endemic Diseases; Female; Humans; Itraconazole; Lung Diseases, Fungal; Sputum; Tomography, X-Ray Computed

Coccidioidomycosis is a fungal infection endemic to south-west USA, north Mexico and parts of Central and South America. We report here a case of primary pulmonary coccidioidomycosis in a previously healthy 14-year-old boy in China, which is considered a non-endemic country. The patient had non-specific symptoms of pulmonary infection, including fever, non-productive cough and night sweats. Both spherules and endospores of Coccidioides immitis were seen histologically following transbronchial biopsy of a cavitary lesion. The patient was treated with amphotericin B and fluconazole. Follow up 6 months post discharge found that the patient made a good recovery.

Topics: Adolescent; Amphotericin B; Asian People; Coccidioides; Coccidioidomycosis; Cough; Fluconazole; Humans; Lung Diseases, Fungal; Male; Treatment Outcome

A 71-year-old woman had suffered for 6 weeks from fatigue, dry cough and fever. Five years previously breast cancer had been diagnosed and had been successfully treated with subtotal mastectomy and postoperative radiotherapy, as well as aromatase inhibitor until shortly before the present admission. There was no history of travel to tropical countries, but during the last summer she had spent two weeks in Northern Italy. [corrected]. On admission the body temperature was 38,5 C with a mild tachycardia (108/min). Laboratory findings revealed a pancytopenia and slightly elevated liver enzymes. The ultrasound showed a hepatosplenomegaly. The investigation of the bone marrow showed a great amount of parasitic forms due to visceral leishmaniasis [corrected] TREATMENT, COURSE AND DIAGNOSIS: Treatment with liposomal amphotericin B brought about rapid improvement, the dry cough subsided and the laboratory results became normal.. Pancytopenia, fever, dry cough and hepatosplenomegaly after travelling to Mediterranean countries should raise suspicion of visceral leishmaniasis. This diagnosis is confirmed by direct detection of the parasite in the bone marrow. Administration of liposomal amphotericin B is efficacious and safe, bringing about full recovery in up to 90% of cases.

Topics: Aged; Amphotericin B; Antiprotozoal Agents; Aromatase Inhibitors; Breast Neoplasms; Chemotherapy, Adjuvant; Cough; Diagnosis, Differential; Fatigue; Female; Fever; Hepatomegaly; Humans; Italy; Leishmaniasis, Visceral; Liposomes; Mastectomy, Segmental; Pancytopenia; Prognosis; Radiotherapy, Adjuvant; Splenomegaly; Tachycardia; Travel

Cases of visceral leishmaniasis (VL) in the course of human immunodeficiency virus (HIV) infection have regularly been recorded, mainly in southern Europe. HIV infection can increase the risk of VL development by 10-100 times in endemic areas. We describe the occurrence of this co-infection in 15 patients from Brazil. The mean age of the patients was 38 +/- 8.8 yr, with 86.6% males. The mean time between HIV diagnosis and the onset of visceral leishmaniasis was 44 +/- 39 mo. The main signs and symptoms presented at admission were splenomegaly (73%), weight loss (73%), cough (67%), fever (67%), asthenia (60%), and diarrhea (60%). The mean T CD4+ lymphocyte count was 173.7 +/- 225.6 cells/mm3, and viral load was 51,030 +/- 133,737/mm3. Treatment consisted of pentavalent antimonials (67% of cases). Most (87%) patients recovered from VL infection; death occurred in 1 patient due to septic shock. VL is an important opportunistic infection in HIV patients, which is potentially fatal, even when correct treatment is completed. Treatment should be done with pentavalent antimonials or amphotericin B in the case of relapse. Although there is no consensus, secondary prophylaxis should be considered in severe cases.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antiprotozoal Agents; Antiretroviral Therapy, Highly Active; Asthenia; Bone Marrow; Brazil; CD4 Lymphocyte Count; Cough; Diarrhea; Female; Fever; HIV Infections; Humans; Leishmaniasis, Visceral; Male; Meglumine; Meglumine Antimoniate; Middle Aged; Organometallic Compounds; Pancytopenia; Retrospective Studies; Splenomegaly; Time Factors; Weight Loss

Recently, we have reported a new clinical disease concept called fungus-associated chronic cough (FACC), which entailed the following manifestations: (1) chronic cough; (2) the presence of environmental fungi, particularly basidiomycetous (BM) fungi, in the sputum; and (3) good clinical response to antifungal drugs. To clarify the relationship between the exposure to environmental fungi and the development of cough attacks, we reviewed the clinical records of patients with FACC and performed a molecular biological analysis of the BM fungi.. We successfully selected 8 patients with chronic cough, wherein a sputum culture yielded B. adusta beforehand; moreover, we conducted allergological tests such as the immediate-type skin test, a serological test, bronchoprovocation test, and lymphocyte stimulation test (LST), using the antigenic solution of B. adusta. The efficacy of individualized therapy and the clinical manifestations in the eight patients were examined.. All the eight patients were diagnosed with FACC. Although three patients who did not show a positive reaction to the bronchoprovocation test or LST showed excellent clinical response to anti-fungal drugs; other 5 patients who showed a positive reaction to the bronchoprovocation test and/or LST seemed to be more intractable because of taking a longer time for complete remission and more frequent recurrence of cough.. It was suggested that so-called allergic fungal cough (AFC), which is characterized by sensitization to B. adusta, may be included in a part of chronic intractable cough.

Topics: Adult; Aged; Allergens; Amphotericin B; Antifungal Agents; Bronchial Provocation Tests; Coriolaceae; Cough; DNA, Fungal; Environmental Exposure; Female; Humans; Itraconazole; Male; Middle Aged; Polymerase Chain Reaction; Skin Tests; Sputum; Young Adult

A 20-year-old Welsh Mountain Pony (212 kg) mare was initially presented for a chronic cough, fever, weight loss and low grade abdominal pain. She later developed dyspnoea, tachypnoea and exercise intolerance. The presence of multiple masses (up to 17 cm diameter) in the pulmonary parenchyma was established using lateral thoracic radiography and transthoracic ultrasonography. Encapsulated, budding yeasts were observed in smears made from transtracheal washings and needle aspirates of the pulmonary lesions. Cryptococcus gattii (synonym: Cryptococcus neoformans variety gattii; Cryptococcus bacillisporus) was cultured from the transtracheal washings and aspirates of the lung masses. The pony was successfully treated using daily intravenous infusions of amphotericin B (typically 0.5 mg/kg in 1 L 5% dextrose in water over 1 h, following premedication with 50 mg flunixin intravenously) over a 1 month period, until a cumulative dose of 3 g had been administered. Treatment was considered to be successful on the basis of progressive improvement in clinical signs, reduction in the size of pulmonary cryptococcomas, 48 kg weight gain and a reduction in the cryptococcal antigen titre from 4096 to 256, 1 year after cessation of treatment.

Topics: Amphotericin B; Animals; Antifungal Agents; Cough; Cryptococcosis; Diagnosis, Differential; Female; Horse Diseases; Horses; Infusions, Intravenous; Pneumonia; Radiography; Ultrasonography

A 43-year-old man with no past history presented with symptoms of fever, cough and dyspnoea arising from invasive pulmonary aspergillosis and was found to have myelodysplastic syndrome with monosomy 7. Before initiation of chemotherapy, he deteriorated rapidly, developing multi-organ failure requiring mechanical ventilation, and he eventually succumbed despite amphotericin B treatment. The importance of monosomy 7 in determining immune function in patients with myelodysplastic syndrome is emphasised.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Bone Marrow Examination; Chromosomes, Human, Pair 7; Cough; Cytogenetics; Dyspnea; Fatal Outcome; Fever; Humans; Immunocompromised Host; Lung Diseases, Fungal; Male; Monosomy; Multiple Organ Failure; Myelodysplastic Syndromes; Tomography, X-Ray Computed

Our institution used an experimental protocol for the use of inhaled amphotericin B as a prophylactic measure to prevent fungal disease in severely immunocompromised patients. We did a prospective study of the physiologic effects of amphotericin B administration. We looked specifically at oxygen saturation levels, peak flow values, and symptoms of patients given amphotericin B. We collected data on a series of 18 patients and of 132 amphotericin B administrations. Four (22%) of the patients stopped treatments because of nausea and vomiting which were believed to be due to the inhaled amphotericin B. For the remaining patients, no treatment was stopped because of symptoms or physiologic changes caused by amphotericin B, although there were 9 instances of clinically significant bronchospasm as defined by a drop in peak flow of 20% or more, 9 clinically relevant increases in cough, and 3 clinically relevant increases in dyspnea. Forty-eight percent of the clinically relevant changes occurred in patient 8. Another 16% occurred in asthmatic subjects who were significantly more likely (p = 0.03) to experience a 20% or more drop in peak flow than were patients without asthma. The physiologic profile of the response to inhaled amphotericin B is acceptable.

Topics: Administration, Inhalation; Adult; Aerosols; Agranulocytosis; Amphotericin B; Asthma; Bone Marrow Transplantation; Cough; Dyspnea; Humans; Immunocompromised Host; Leukemia; Lung Diseases, Fungal; Nausea; Nebulizers and Vaporizers; Oxygen; Prospective Studies; Pulmonary Ventilation; Vomiting

Topics: Aged; Amphotericin B; Blood Transfusion; Cough; Female; Fever; Humans; Lung Diseases; Mucormycosis; Thrombocytopenia