amphotericin-b and Empyema

Current management of infections in thoracic surgery is reviewed. The selection of patients for the use of antibiotics prophylactically, the diagnosis and treatment of pulmonary infection in immunosuppressed patients, indications for operation in patients with fungal infections, bronchiectasis, lung abscess, and empyema, and the management of mediastinitis after sternotomy and of postpneumonectomy space infections is described.

Topics: Amphotericin B; Anti-Bacterial Agents; Antitubercular Agents; Bronchiectasis; Empyema; Humans; Infection Control; Lung Abscess; Lung Diseases, Fungal; Pneumonectomy; Pneumonia; Postoperative Complications; Sternum; Surgical Wound Infection; Thoracic Surgery; Tuberculosis, Pulmonary

Topics: Administration, Inhalation; Amphotericin B; Antifungal Agents; Aspergillus fumigatus; Bronchial Fistula; Empyema; Humans; Male; Middle Aged; Pleural Diseases; Pulmonary Aspergillosis

A 72-year-old man was admitted to our hospital because of a low grade fever and malaise. He had received a middle to lower esophagectomy and proximal gastrectomy with reconstruction of a gastric conduit for esophageal cancer 12 years previously. Chest X-ray and CT scan revealed massive pleural effusion and consolidations on the right side. Candida glabrata was isolated 4 times from pleural fluid specimens. Candida antigen was negative in both serum and pleural effusion. However, while serum beta-D-glucan was negative, the level of beta-D-glucan in pleural effusion was extremely elevated. Thus, the patient was diagnosed as having C. glabrata empyema. He was treated with insertion of a thoracostomy tube followed by intrapleural instillation of amphotericin B and intravenous administration of micafungin. Pleural effusion was reduced and the repeated culture of the pleural effusion became negative after 27 days of treatment. Empyema with C. glabrata is rare and the present case is the second report of the disease in the Japanese literature.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Echinocandins; Empyema; Humans; Lipopeptides; Male; Micafungin; Thoracostomy

Candida parapsilosis is an extremely rare cause of meningitis. We report the case of a neonate born at 26+4 weeks of gestation who was admitted to the neonatal intensive care unit at our institution due to respiratory immaturity. During the course of a 3-month hospitalization, the neonate developed fever and lethargy. A lumbar puncture revealed milky-white, turbid cerebrospinal fluid which contained many nucleated cells, mostly neutrophils. Microscopic examination of the cerebrospinal fluid revealed marked acute inflammation and fungal yeast forms, and cultures of the cerebrospinal fluid and peripheral blood yielded C. parapsilosis. Imaging studies subsequently revealed a subdural empyema related to epidural migration of a central venous catheter (CVL). The neonate received extended therapy with amphotericin B and fluconazole. He responded favorably to therapy and was discharged 3 months after birth. This case underscores the clinical importance of the recognition and treatment of a potentially lethal fungal pathogen of the central nervous system and the need for awareness of complications resulting from CVL malposition.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Catheterization, Central Venous; Empyema; Epidural Space; Fluconazole; Foreign-Body Migration; Humans; Infant, Newborn; Male; Meningitis, Fungal; Radiography

We report two cases of empyema as a complication of the percutaneous instillation of antifungal drugs for pulmonary and pleural aspergillosis. Case 1 underwent percutaneous administration of amphotericin B and fluconazole for 2 months. Six months later, the patient was found to have an Aspergillus empyema with a bronchopleural fistula. Case 2 with pulmonary and pleural aspergillosis underwent percutaneous administration of amphotericin B for one month. Four months later, the patient underwent pleural drainage due to empyema. Pleural biopsy revealed pleural aspergillosis. In both cases, it was suggested that the preceding Aspergillus infection and percutaneous instillation of antifungals resulted in the development of empyema.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Empyema; Fluconazole; Humans; Injections; Lung Diseases, Fungal; Male; Middle Aged; Pleural Diseases

Topics: Aged; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Diagnosis, Differential; Empyema; Empyema, Tuberculous; Female; Humans; Lung Diseases, Fungal; Postoperative Complications; Recurrence; Thoracoplasty; Time Factors; Tuberculosis, Pulmonary

Topics: Amphotericin B; Antitubercular Agents; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Bronchial Fistula; Empyema; Empyema, Tuberculous; Fistula; Humans; Male; Middle Aged; Pleural Diseases; Radionuclide Imaging; Xenon Radioisotopes

Topics: Adult; Amphotericin B; Aspergillosis; Bronchial Fistula; Empyema; Humans; Lung Diseases, Fungal; Male; Precipitin Tests; Prednisone; Radioimmunoassay; Skin Tests

Topics: Adult; Amphotericin B; Candidiasis; Empyema; Humans; Male; Tonsillectomy

Topics: Amphotericin B; Candidiasis; Empyema; Humans; Lung Diseases, Fungal; Male; Mycoses; Radiography, Thoracic

Topics: Amphotericin B; Anti-Bacterial Agents; Candidiasis; Child, Preschool; Chylothorax; Empyema; Humans; Male; Nystatin; Pleural Effusion; Postoperative Complications; Pulmonary Artery; Radiography, Thoracic; Subclavian Artery; Surgical Wound Infection; Tetralogy of Fallot

Topics: Abscess; Amphotericin B; Brain Abscess; Candidiasis; Carrier State; Child; Chloramphenicol; Colistin; Deoxyribonucleases; DNA; Empyema; Enteritis; Humans; Kanamycin; Meningitis; Methicillin; Penicillins; Peritonitis; Phlebitis; Pneumonia; Pneumothorax; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Sulfadiazine; Troleandomycin

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

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Empyema