amphotericin-b and Dyspnea

Blastoschizomyces capitatus infection is a rare fungal infection; mainly occurring in immunodeficient patients, which can cause multiple organ involvement. At present, there is no clear designated treatment regimen. This case was a rare example of Blastoschizomyces capitatus lung infection in patient with normal immune function, which was effectively controlled by combined antifungal therapy.. We report a 67-year-old male smoker, who, after cleaning a small bungalow for a long period, without any protective measures, developed cough with expectoration, fever and dyspnea. Pre-admission anti-infective medication (amoxicillin and roxithromycin) had little effect, and the patient's condition worsened. He had a past history of pulmonary tuberculosis with pleurisy 6 years before. Chest computed tomography (CT) showed evidence of old tuberculosis in the right upper lobe and inflammation in both lower lobes. White blood cell count was 14.51×109/L, neutrophils was 13.39×109/L and C-reactive protein (CRP) was 170 mg/L. Broad-spectrum antibiotics piperacillin sodium 4.0 g and tazobactam sodium 0.5 g q8h were administered empirically for 5 days. Blastoschizomyces capitatus infection was confirmed by next generation of macro genome sequencing (NGS) of bronchoalveolar lavage fluid and mass spectrum analysis of sputum. He was then switched to voriconazole antifungal therapy combined with aerosol inhalation of amphotericin B. His temperature normalized, expectoration and dyspnea were relieved. Total white cell count fell to 8.10×109/L, neutrophils to 5.81×109/L, and CRP to 76.8 mg/L.. This case demonstrates that Blastoschizomyces capitatus infection can occur in patients with normal immune function. Mass spectrometry and metagenomic NGS methods may have an advantage over traditional methods in identifying this fungal infection. In addition, the combination of voriconazole and nebulized amphotericin B can be employed as a novel regimen for treating Blastoschizomyces capitatus infection. For pulmonary infection with a history of environmental exposure, early pathogen identification and culture, and appropriate antibiotic treatment are key to optimizing outcome.

Topics: Aged; Amphotericin B; Antifungal Agents; Dyspnea; Humans; Lung; Male; Mycoses; Pneumonia; Voriconazole

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

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

A 41-year-old man infected with HIV-1 developed fever up to 39.8 degrees C together with nonproductive cough and dyspnoea. Lactate dehydrogenase concentration rose from a level of 998 U/l to 6307 U/l. As pneumocystis carinii pneumonia was at first suspected he was treated with co-trimoxazole (1600 mg sulfamethoxazole and 320 mg trimethoprim, four times daily). But the symptoms did not abate. Bone-marrow puncture revealed numerous macrophages containing ovoid inclusions typical of Histoplasma capsulatum varietas capsulatum. The diagnosis of disseminated histoplasmosis was confirmed by culture and serologically by an increase in Histoplasma polysaccharide antigen. On treatment with amphotericin B (at first 10 mg, then 50 mg daily for 4 weeks) the symptoms regressed within a few days. After the concentrations of lactate dehydrogenase and Histoplasma antigen had become normal again, maintenance treatment was changed to itraconazole (200 mg twice daily), after a total amphotericin B dose of 1150 mg. The patient has remained free of recurrence.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antigens, Fungal; Diagnosis, Differential; Drug Therapy, Combination; Dyspnea; Histoplasma; Histoplasmosis; HIV-1; Humans; Itraconazole; Male

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

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

Mucormycosis is a rare opportunistic infection usually associated with immunosuppression, diabetes mellitus or haematological malignancy. Herein, we report an unusual case of mucormycosis in a 46-yr-old male patient with diabetes presenting with an endotracheal mass obstructing the trachea and cartilage damage. Histological examination of the bronchoscopy biopsy specimens revealed invasive mucormycosis. The patient was treated with intravenous amphotericin B followed by removal of the lesion via bronchoscopy.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Bronchoscopy; Cartilage; Dyspnea; Humans; Male; Middle Aged; Mucormycosis; Necrosis; Radiography; Trachea; Tracheal Diseases

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

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

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Chemistry, Pharmaceutical; Dyspnea; Fungemia; Humans; Male; Middle Aged

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

Pulmonary toxicity with acute dyspnea occurred during infusion of a liposomal amphotericin B preparation (AmBisome) in two adult leukemic patients. The preparation was administered as a one hour infusion at a dose of 3 mg/kg body weight. Within 15 min after starting the infusion, both patients experienced sudden onset of dyspnea and chest tightness. Physical examination showed the patients to be anxious and restless with tachycardia and orthopnea but without other cardiopulmonary findings. No elevation of body temperature, rigors or chills were recorded. Symptoms disappeared within minutes after discontinuing the infusion. At present, the pathophysiologic mechanisms underlying these side effects are unknown.

Topics: Acute Disease; Amphotericin B; Drug Carriers; Dyspnea; Humans; Infusions, Intravenous; Leukemia, Myeloid, Acute; Liposomes; Male; Middle Aged; Respiratory System

Topics: Adult; Amphotericin B; Aspergillosis, Allergic Bronchopulmonary; Dyspnea; Female; Humans; Respiratory Therapy

One hundred and ninety-five series of granulocyte transfusions in 144 patients were evaluated with respect to possible severe pulmonary toxicity from concomitant administration of granulocytes and amphotericin B. Dyspnea as a side effect of granulocyte transfusion was equally common among patients receiving amphotericin B and those in a matched control group not receiving amphotericin B. Granulocyte transfusions and amphotericin B were given simultaneously in 35 transfusion series, involving 32 patients. Respiratory deterioration, defined as the appearance of new pulmonary infiltrates on chest x-ray, occurred in 11 of these 35 episodes. Patients developing respiratory deterioration were similar to those not developing respiratory deterioration in age, diagnosis, disease status, duration of concomitant therapy, and outcome, but more often had positive fungal cultures as an indication for treatment (91% versus 58%; p = 0.1). In 8 patients, the episodes of respiratory deterioration were readily explained by congestive heart failure, by simultaneous bacteremia or fungemia, or by fungal pneumonia discovered at autopsy. One patient had a leukoagglutinin reaction (responsive to steroids) and the other 2 had unexplained, but reversible respiratory deterioration. We concluded that concomitant administration of granulocyte transfusions and amphotericin B is not associated with unexpected or rapidly fatal pulmonary toxicity and when appropriate, can be safely accomplished.

Topics: Adolescent; Adult; Aged; Agranulocytosis; Amphotericin B; Candidiasis; Child; Child, Preschool; Dyspnea; Escherichia coli Infections; Granulocytes; Humans; Lung; Middle Aged; Neutropenia; Pseudomonas Infections; Time Factors

Amphotericin B is used increasingly in high-risk patients with profound neutropenia and suspected sepsis. We have observed serious pulmonary reactions characterized by acute dyspnea, hypoxemia, and interstitial infiltrates on chest films in patients receiving amphotericin B and leukocyte transfusions. We reviewed 6 1/2 years of experience at the National Institutes of Health to determine whether this combination was associated with pulmonary toxicity not characteristic of either therapy alone. Amphotericin was used during 22 of 57 leukocyte-transfusion courses. Acute respiratory deterioration occurred during 14 (64 per cent) of these courses but in only two (6 per cent) of 35 courses without amphotericin (P less than 0.01). In seven cases, respiratory deterioration began during or immediately after amphotericin infusion, and it contributed to death in five patients. Diffuse intraalveolar hemorrhage was found when lung biopsy or autopsy was performed. Acute respiratory deterioration was not observed in comparably neutropenic patients given amphotericin but not leukocyte transfusions during the same period. It was mot common when amphotericin was begun with or after institution of daily leukocyte transfusions. Leukocyte transfusions may cause changes in the lungs that amplify the acute toxicity of amphotericin, thereby permitting severe pulmonary reactions.

Topics: Adolescent; Adult; Amphotericin B; Child; Dyspnea; Female; Humans; Hypoxia; Leukocyte Transfusion; Lung Diseases; Male; Middle Aged; Neutropenia; Sepsis; Transfusion Reaction

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Chlorambucil; Dyspnea; Female; Hemoptysis; Humans; Lung Diseases, Fungal; Male; Nystatin; Prednisone; Radiography; Respiratory Hypersensitivity

Topics: Adolescent; Adult; Aged; Amphotericin B; Anemia; Animals; Cote d'Ivoire; Cricetinae; Dyspnea; Electrocardiography; Female; Hepatomegaly; Histoplasma; Histoplasmosis; Humans; Male; Splenomegaly; Tachycardia; Time Factors