amphotericin-b and Deglutition-Disorders

Dysphagia following cardiac surgery is a frequently encountered problem, being most commonly due to the sternotomy incision and/or prolonged intubation. Oesophageal candidiasis is an increasing problem that is usually associated with immunosuppression or immunodeficiency. We report a 59 years age, immunocompetent lady whom had developed dysphagia and odynophagia following open cardiac surgery and long term course of antibiotics. Diagnosis of Candida oesophagitis was established after radiological, endoscopic and microbiological evidence, and successful treatment with combined topical and systemic antifungal therapy was achieved. Possibility of immunodeficiency was excluded. We believe that this lady developed oesophageal candidiasis due to a long-term course of broad spectrum antibiotics. We discuss the various diagnostic modalities and treatment options.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candidiasis, Oral; Deglutition Disorders; Dilatation; Drug Therapy, Combination; Esophagitis; Female; Humans; Immunocompetence; Middle Aged; Nystatin; Thoracic Surgery; Treatment Outcome

Histoplasmosis is an endemic and systemic mycosis, caused by the dimorphic fungus Histoplasma capsulatum var capsulatum. Disseminated disease in immunocompromised patients generally results from the reactivation of latent foci after a prolonged period of asymptomatic infection. We report a case of laryngeal histoplasmosis as the unique clinical manifestation of a progressive form of the disease in a patient with advanced HIV/AIDS disease. Histopathological analysis of laryngeal biopsy smears revealed granulomas containing Histoplasma-like organisms. Treatment with amphotericin B followed by itraconazole resulted in complete remission of laryngeal lesions. To our knowledge, this is the third case report of laryngeal histoplasmosis in a patient with AIDS.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Antiretroviral Therapy, Highly Active; Deglutition Disorders; Histoplasmosis; Humans; Itraconazole; Laryngitis; Male; Middle Aged; Treatment Refusal

Laryngeal leishmaniasis is an unusual form of the disease. We report the case of a patient who consulted for dysphonia and dysphagia in a context of asthenia and weight loss. The patient had lesions that were suggestive of laryngeal cancer but were revealed to be leishmaniasis by histopathology examination and polymerase chain reaction. Treatment with amphotericin B and miltefosine permitted complete resolution of the lesions and no recurrence during the 18-month follow-up period.

Topics: Aged; Amphotericin B; Antiprotozoal Agents; Deglutition Disorders; Diagnosis, Differential; Dysphonia; Humans; Laryngeal Neoplasms; Larynx; Leishmaniasis; Male; Phosphorylcholine

Topics: Amoxicillin; Amphotericin B; Antifungal Agents; Biopsy; Candidiasis; Deglutition Disorders; Esophagitis; Esophagoscopy; Humans; Male; Middle Aged; Penicillins; Predictive Value of Tests; Radiography

A 40-year-old man with aortic stenosis and disseminated histoplasmosis did not respond to treatment with itraconazole. Though there was no haemodynamic deterioration, valvar regurgitation, or embolic phenomena a presumptive diagnosis of infective endocarditis was made. This was confirmed at aortic valve replacement. Antifungal treatment was continued for 18 months after valve replacement and serological tests for Histoplasma became progressively more negative during a three year follow up.

Topics: Adult; Amphotericin B; Aortic Valve; Aortic Valve Stenosis; Combined Modality Therapy; Deglutition Disorders; Endocarditis; Follow-Up Studies; Heart Valve Prosthesis; Histoplasmosis; Humans; Itraconazole; Male; Weight Loss

We describe a patient with the acquired immunodeficiency syndrome who had persistent oral esophageal pseudomembranous candidiasis clinically refractory to nystatin, clotrimazole, and ketoconazole. In vitro resistance to clotrimazole was demonstrated as well. The patient received temporary relief with intravenous amphotericin B therapy, but this was associated with serious adverse effects, including transfusion-requiring anemia, azotemia, and severe thrombophlebitis. Despite two courses of intravenous amphotericin B therapy, the patient's highly symptomatic, recurrent oral and esophageal candidiasis continued. The patient was then treated with fluconazole and obtained immediate relief without associated adverse effects.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Candida albicans; Candidiasis, Oral; Clotrimazole; Deglutition Disorders; Drug Resistance, Microbial; Esophageal Diseases; Fluconazole; Humans; Ketoconazole; Male

Topics: Amphotericin B; Candidiasis; Deglutition Disorders; Esophageal Diseases; Esophagoscopy; Humans; Mycoses; Radiography

Topics: Amphotericin B; Candida; Candidiasis; Deglutition Disorders; Diagnosis, Differential; Esophageal Diseases; Female; Humans; Infusions, Parenteral; Middle Aged; Nystatin; Radiography