amphotericin-b and Empyema--Pleural

We report a case of

Topics: Adenine; Aged; Amphotericin B; Antibodies, Monoclonal, Murine-Derived; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Cryptococcosis; Cryptococcus neoformans; Cyclophosphamide; Doxorubicin; Empyema, Pleural; Fluconazole; Humans; Lymphoma, Large B-Cell, Diffuse; Male; Piperidines; Prednisone; Pyrazoles; Pyrimidines; Rituximab; Vincristine

C albidus and mucormycosis were cultured simultaneously from the pleural space of a patient with end-stage renal disease receiving long-term hemodialysis. There have been only nine previous reports of infection with C albidus, with only one involving the lung. This organism has never before been isolated from the pleural space, and none of the previously reported cases included a coinfection with mucormycosis. We have reviewed and compared all known cases of infection with C albidus.

Topics: Adult; Aged; Amphotericin B; Cryptococcosis; Cryptococcus; Empyema, Pleural; Humans; Kidney Failure, Chronic; Male; Middle Aged; Mucormycosis; Renal Dialysis

A 57-yr-old man with a chronic lung cavity presumed to be related to ankylosing spondylitis and/or old cavitary tuberculosis presented with hemoptysis and rapidly developed lower extremity paresis and hypoesthesia. On chest radiograph he had a left upper lobe lesion suggestive of aspergilloma combined with a large left empyema with bronchopleural fistula. Serologic analysis demonstrated precipitins and very high titer IgG antibodies to Aspergillus fumigatus antigens. Decompressive laminectomy from T1 to T5 was performed, with drainage of A. fumigatus culture-positive material from an epidural abscess compressing the spinal cord. Chest drainage was required for control of the empyema. With a total course of 3 g of intravenously administered amphotericin B, rehabilitative therapy, and chronic empyema drainage, he is now at home and ambulatory with assistance. He is also being followed by regular serum assays of IgG antibodies to Aspergillus proteins. We report the case of an apparent long-term survivor of a formerly lethal and/or nonreversible paraplegic condition. The critical factors compared with previous cases with a poor outcome would appear to be prompt neurosurgical intervention, restoration of a normal number of T-cells, effective long-term chest drainage, and high dose amphotericin treatment.

Topics: Abscess; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Empyema, Pleural; Epidural Space; Humans; Lung Diseases, Fungal; Male; Middle Aged; Spinal Cord Compression

Cases of empyema associated with

Topics: Amphotericin B; Empyema, Pleural; Female; Histoplasma; Histoplasmosis; Humans; Injections, Intravenous; Middle Aged; Pleural Effusion; Therapeutic Irrigation; Thoracoscopy

Chest fungal infection is a rarely seen lethal disease with rapid progression. Sufficient residence time of antifungal agent with therapeutic concentration in the chest is an essential point during anti-infection therapy, which is hard to achieve via conventional systemic drug delivery. We here by describe a case of successful treatment of fungal Chest infection via local pleural lavage. A 59 years old male was hospitalized due to chest pain. X-ray of chest and bacterial culture of thoracic drainage fluid and blood indicated severe chest infection of Candida albicans. The patient was initially administered intravenously with amphotericin B (25mg/day). However, the symptoms were not significantly improved after 5 days of treatment. Then one-hour pleural lavage of 5mg amphotericin B in volume of 50ml 5% glucose solution was added once daily. On day 12, bacterial cultures showed negative, and chest X-ray exhibited apparent decrease of shadow area, also other examinations such as body temperature and white blood cell count suggested significant improvement of infection. The therapeutic strategy of amphotericin B was maintained until two consecutive bacterial cultures were negative, then was switched back to intravenous drip alone for another one month found. No significant adverse effects were observed during the treatment. In conclusion, this case demonstrates a new local pleural lavage method of amphotericin B for chest fungal infection, which may provide a reference for the treatment of such cases.

Topics: Amphotericin B; Antifungal Agents; Bronchoalveolar Lavage; Candida albicans; Candidiasis; Empyema, Pleural; Humans; Male; Middle Aged

We report the penetration of liposomal amphotericin B into the pleural fluid of a patient with pulmonary zygomycosis and empyema. The ratio of area under the concentration-versus-time curve in pleural fluid (AUC(pleural fluid)) to that in serum (AUC(serum)) for liposomal amphotericin B over 24 h was 9.4%, with pleural fluid concentrations of 2.12 to 4.91 microg/ml. Given the relatively low level of intrapleural penetration of liposomal amphotericin B, chest tube drainage may be warranted for successful treatment of zygomycotic empyema.

Topics: Amphotericin B; Antifungal Agents; Empyema, Pleural; Female; Humans; Liposomes; Lung Diseases, Fungal; Middle Aged; Mucormycosis; Pleural Effusion

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Drainage; Empyema, Pleural; Humans; Male; Middle Aged; Tomography, X-Ray Computed

A 12-year-old immunocompromised boy was hospitalized because of invasive aspergillosis with lung and central nervous system involvement. He was treated with surgery and liposomal amphotericin B, but he developed a pulmonary empyema and a bronchopleural-cutaneous fistula. A catheter was placed through the fistula, and amphotericin B (up to 50 mg in 10 ml of 5% dextrose) was instilled daily into the pleural cavity for 45 days. Treatment was well-tolerated, and the empyema resolved completely, with no evidence of recurrence after 2 years of follow-up.

Topics: Amphotericin B; Aspergillosis; Child; Empyema, Pleural; Follow-Up Studies; Fungemia; Humans; Immunocompromised Host; Infusions, Intravenous; Injections, Intralesional; Magnetic Resonance Imaging; Male; Risk Assessment; Tomography, X-Ray Computed; Treatment Outcome

A 28 year old man with asthma, bronchopulmonary aspergillosis, pulmonary thromboembolic disease, and pulmonary hypertension developed Aspergillus fumigatus empyema complicating a pneumothorax. His condition progressively deteriorated despite treatment with intravenous and intrapleural amphotericin B, but improved promptly after substituting nebulised liposomal amphotericin B and oral itraconazole. This experience suggests that nebulised liposomal amphotericin B is well tolerated and merits further assessment in the treatment of pulmonary fungal disease.

Topics: Administration, Inhalation; Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Asthma; Drug Carriers; Drug Therapy, Combination; Empyema, Pleural; Humans; Hypertension, Pulmonary; Itraconazole; Liposomes; Male; Nebulizers and Vaporizers; Pulmonary Embolism

We describe here a case of cryptococcal empyema thoracis and periauricular pyogenic abscess in a child with Bruton's agammaglobulinaemia. The cryptococcal empyema thoracis was treated with intravenous amphotericin B and intravenous fluconazole for six weeks followed by oral fluconazole. The pyogenic periauricular abscess was surgically drained and treated with intravenous ceftazidime and cloxacillin for two weeks. He also received monthly intravenous immunoglobulin.

Topics: Abscess; Agammaglobulinemia; Amphotericin B; Ceftazidime; Child, Preschool; Cloxacillin; Combined Modality Therapy; Cryptococcosis; Empyema, Pleural; Fluconazole; Humans; Immunization, Passive; Male; Opportunistic Infections; Otitis Externa

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Empyema; Empyema, Pleural; Fungicides, Industrial; Humans; Injections; Pleura