amphotericin-b and Diplopia

Topics: Amphotericin B; Anti-Infective Agents; Biopsy; Brain Neoplasms; Central Nervous System Infections; Diagnosis, Differential; Diplopia; Face; Female; Gait Disorders, Neurologic; Glioma; Humans; Immunocompetence; Infections; Magnetic Resonance Imaging; Middle Aged; Neurosurgical Procedures; Paresthesia; Prototheca; Taste Disorders; Tetracycline

Cryptococcal meningitis is an opportunistic infection predominantly affecting immunocompromised patients but rarely can affect the immunocompetent. We describe a 53-year-old Caucasian man who presented complaining of a 2-week history of severe bilateral eye pain and diplopia. His only known risk factor was that he lived in a horse farm and recently shot bats and pigeons in his barn. He visited an outside hospital during this time without a diagnosis established. After further deliberation, we obtained a lumbar puncture (LP) which revealed an opening pressure (OP) of 27 cm H

Topics: Agricultural Workers' Diseases; Amphotericin B; Antifungal Agents; Cryptococcus neoformans; Diplopia; Drug Therapy, Combination; Eye Pain; Fluconazole; Humans; Immunocompetence; Male; Meningitis, Cryptococcal; Meningoencephalitis; Middle Aged; Opportunistic Infections; Rare Diseases

Fungal rhinosinusitis is being recognized and reported with increasing frequency over the last two decades worldwide. Intracranial extension is the most dreaded complication of fungal sinusitis with high mortality rates. We report a case of chronic rhinosinusitis in a 55-year-old diabetic male, caused by Fusarium species. The patient was diagnosed as a case of chronic left maxillary sinusitis with cavernous sinus thrombosis. The sinus lavage showed fungal elements on direct microscopic examination and culture revealed growth of Fusarium species within 4 days of incubation. Conservative therapy with IV amphotericin B resulted in favorable outcome of the patient. This is an extremely rare case where cavernous sinus thrombosis occurred as a complication secondary to Fusarium species rhinosinusitis.

Topics: Amphotericin B; Cavernous Sinus Thrombosis; Cefotaxime; Chronic Disease; Diabetes Mellitus, Type 2; Diplopia; Disease Susceptibility; Fusariosis; Fusarium; Headache; Humans; Insulin; Magnetic Resonance Imaging; Male; Maxillary Sinusitis; Middle Aged; Photophobia; Rhinitis; Vomiting

Invasive fungal sinusitis of the paranasal sinuses in a healthy immunocompetent person is uncommon. Isolated involvement of any paranasal sinus, particularly sphenoid sinus is rare. In this study, five immunocompetent patients who had no nasal complaints but obscure symptoms of headache and orbital symptoms such as diplopia, retro-orbital pain and loss of vision were diagnosed to be having fulminant fungal sinusitis of the sphenoid sinus. Three patients had aspergillosis and two patients had mucormycosis. These patients initially presented to neurologists and ophthalmologists because they had no ENT complaints. The diagnosis was made on endoscopy, radiology and histopathology. They were treated aggressively according to the standard protocols. The purpose of this paper is to bring to light the changing clinical spectrum of invasive fungal sinusitis. It can occur in immunocompetent patients and in the form of isolated sphenoid sinus involvement.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Diplopia; Endoscopy; Fatal Outcome; Female; Headache; Humans; Immunocompetence; Magnetic Resonance Imaging; Male; Mucormycosis; Sinusitis; Sphenoid Sinus; Tomography, X-Ray Computed; Vision Disorders

Genera of the order Mucorales (Rhizopus, Mucor, Rhizomucor, Absidia, Apophysomyces, Cunninghamella, and Saksenaea) cause an angioinvasive infection called zygomycosis. Mortality rates can approach 100% depending on the patient's underlying disease and form of zygomycosis. We report here on the unusual case of a patient with acute myelogenous leukemia and zygomycosis unresponsive to monotherapy with liposomal amphotericin B, who responded favorably following the addition of the echinocandin caspofungin acetate.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Caspofungin; Combined Modality Therapy; Cytarabine; Debridement; Diplopia; Drug Therapy, Combination; Echinocandins; Humans; Idarubicin; Immunocompromised Host; Leukemia, Myeloid, Acute; Lipopeptides; Male; Middle Aged; Mitoxantrone; Opportunistic Infections; Orbital Diseases; Peptides, Cyclic; Sinusitis; Zygomycosis

We report three cases of deep-seated and systemic Candida albicans infection in which inadequate dosages of fluconazole were used, leading to breakthrough fungaemia, candidal osteomyelitis and endocarditis. The need to modify fluconazole dosage in patients receiving continuous venovenous haemofiltration is discussed.

Topics: Adult; Aged; Amphotericin B; Amputation, Surgical; Antifungal Agents; Arthrodesis; Candidiasis; Diplopia; Fatal Outcome; Female; Fluconazole; Flucytosine; Hemofiltration; Hernia, Inguinal; Humans; Male; Meningococcal Infections; Osteomyelitis; Pulmonary Ventilation; Vitrectomy

Aspergillosis of the paranasal sinuses is a well-established clinical entity which has recently been classified into non-invasive and invasive forms with distinct sub-divisions of both types. Two cases are described, both highlighting potential serious complications of the disease as well as the importance of adequate medical and surgical treatment in effecting a favourable outcome. The disease is reviewed and the question as to whether cases necessarily fall into previously-defined clinical and pathological categories is also discussed.

Topics: Adult; Amphotericin B; Aspergillosis; Diagnosis, Differential; Diplopia; Ethmoid Sinusitis; Female; Humans; Male; Paranasal Sinus Diseases; Prednisolone; Sphenoid Sinusitis; Tomography, X-Ray Computed