amphotericin-b and Encephalitis

Extension of invasive aspergillosis to the central nervous system is associated with high mortality, in part because of poor central nervous system penetration of antifungal drugs. Voriconazole yields fungicidal drug concentrations within the central nervous system, but use of this drug is limited in liver transplant recipients because of hepatotoxicity and drug interactions.. We reviewed medical records and antifungal treatment for all liver transplant recipients from 2007 to 2009 who had cerebral aspergillosis (Proven [2]; Probable [1]; Possible [1]) at week 3, 4, 6, and 12 after transplant.. A 33-year-old white man underwent orthotopic liver transplant for acute liver failure that was caused by acetaminophen overdosage. Risk factors for fungal infection included major blood loss (8 L), prolonged surgery (9 h), and emergency revision transplant that was done because of nonfunctioning of the primary transplant at 48 hours. He developed postoperative aspergillus pneumonia and invasive aspergillosis of the kidneys, brain, and eye. Treatment with voriconazole and amphotericin B was successful, with moderate residual renal impairment.. Voriconazole was effective and safe in the treatment of cerebral aspergillosis in this liver transplant recipient.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Drug Therapy, Combination; Encephalitis; Humans; Liver Transplantation; Male; Pyrimidines; Treatment Outcome; Triazoles; Voriconazole

To evaluate the clinical characteristics of patients affected by hematologic malignancies who developed mucormycosis and to ascertain the factors which influenced the outcome following mycotic infection.. This was a retrospective study conducted over a 15-year period (1987-2001). The study included 59 patients with hematologic malignancies with a proven or probable mucormycosis admitted in 18 Hematology Divisions in tertiary care or university hospitals.. The most frequent sites of infection were lung (64%) and orbito-sinus-facial (24%); cerebral involvement observed in 19% of cases was always associated with other sites of infection. Antifungal treatment was empirically administered in 49 patients (83%); 7 patients underwent radical surgical debridement (12%). Therapy was successful for only 18 patients (37%). Forty-seven patients died within 3 months of the diagnosis of fungal infection: the cause of death was mucormycosis in 41 patients (87%) and progression of hematologic disease in 6 patients (13%). At univariate analysis, the factors that correlated with a positive outcome from infection were the following: male sex, amphotericin B treatment, neutrophil recovery from post-chemotherapy aplasia. At multivariate analysis, the only factor that significantly correlated with recovery from infection was the liposomal amphotericin B treatment.. Mucormycosis is a rare filamentous fungal infection that occurs most frequently in neutropenic patients with acute leukemia. It does not seem to have increased in recent years. Although a reduction of mortality has been observed recently, the mortality rate still remains high. Extensive and aggressive diagnostic and therapeutic procedures are essential in order to improve the prognosis in these patients.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Encephalitis; Female; Fungemia; Hematologic Neoplasms; Humans; Immunocompromised Host; Italy; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Neutropenia; Retrospective Studies; Risk Factors; Sinusitis; Treatment Outcome; Triazoles

Signo del cornete negro en un caso de mucormicosis rinocerebral.

Topics: Aged; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Cavernous Sinus Thrombosis; Combined Modality Therapy; Cranial Nerve Diseases; Dexamethasone; Diagnosis, Differential; Disease Progression; Encephalitis; Ethmoid Sinusitis; Fatal Outcome; Humans; Interferons; Magnetic Resonance Imaging; Male; Maxillary Sinusitis; Melanoma; Mucormycosis; Opportunistic Infections; Rhizopus; Spinal Neoplasms; Tomography, X-Ray Computed; Turbinates

The objective of this investigation was to explore the possibility of treating patients harboring invasive intracranial aspergillosis (InIA) at an early stage. Nineteen patients (age range 18-42 years) from a total of 114 cases of InIA seen from January 1999- December 2009 were included in this investigation. These individuals, all of whom had a past history of treated allergic fungal sinusitis (AFS) were evaluated as to their immune status, clinical presentations, time-intervals and radiological findings. Past records of seven patients indicated skull base erosion and extension of the paranasal (PNS) masses into intracranial cavity, but none had neurological deficits or symptoms suggestive of raised intracranial pressure. All 19 patients had undergone endoscopic clearance of PNS during their first presentations. Both AFS and InIA were found simultaneously in seven patients, while the time-interval between the two forms was as long as 10 years for two patients. Overall mortality was (8/19; 42%) with all deaths attributable to fungal meningo-encephalitis. As InIA carries a high mortality rate, it seems prudent to evaluate and treat these patients early in the course of their illness. The appearance of the invasive form of the disease in patients with a past history of AFS is not uncommon. The allergic form of disease may not be considered as a separate entity from InIA as both the pathologies may exist in same patient.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; Cohort Studies; Encephalitis; Female; Humans; Hypersensitivity; Itraconazole; Male; Meningitis, Fungal; Sinusitis; Skull; Tomography, X-Ray Computed

Topics: Adolescent; Amphotericin B; Antifungal Agents; Cellulitis; Cranial Nerve Diseases; Delayed Diagnosis; Diabetes Complications; Disease Progression; Disease Susceptibility; Encephalitis; Fatal Outcome; Female; Fungemia; Humans; Male; Middle Aged; Mucormycosis; Multiple Organ Failure; Opportunistic Infections; Sinusitis; Vision Disorders

Mucormycosis is an invasive fungal infection usually observed in immunocompromised patients. Mucormycosis is rapidly fatal without an early diagnosis and treatment. We report five patients of rhino-orbital-cerebral mucormycosis and a literature review.. The medical records of five patients presenting with rhino-orbital-cerebral mucormycosis, admitted between January 1995 and December 2007, were analyzed. All patients underwent tissue biopsy. The histologic sections revealed the presence of non-septate hyphae of the order Mucorales.. The five patients, three men and two women, between 27 and 61 years of age, were all diabetic. The main symptoms were exophthalmia (five patients), facial swelling (four patients), periorbital cellulitis (four patients), and cranial nerve palsy (four patients). Anterior rhinoscopy revealed palatine or nasal necrotic lesions in four patients. All presented with diabetic ketoacidosis and CT scan revealed rhino-orbital-cerebral involvement in every patient. All patients were given intravenous amphotericin B. Four patients underwent surgical debridement of necrotic tissue. Two patients survived.. Mucormycosis is usually a fatal infection in diabetic patients. Early diagnosis should be based on imaging data and histology. Amphotericin B must be rapidly initiated and associated with aggressive surgical debridement to reduce mortality.

Topics: Acute Kidney Injury; Adult; Aged; Amphotericin B; Antifungal Agents; Biopsy; Cavernous Sinus Thrombosis; Combined Modality Therapy; Cranial Nerve Diseases; Debridement; Diabetes Complications; Diabetic Ketoacidosis; Disease Susceptibility; Drug Substitution; Encephalitis; Exophthalmos; Female; Humans; Ketoconazole; Male; Middle Aged; Mucorales; Mucormycosis; Orbital Cellulitis; Retrospective Studies; Rhinitis; Sinusitis; Tomography, X-Ray Computed

We observed morphological manifestation of encephalitis 3, 7, 10 and 28 days after intravenous infection of adult male CBA mice with Candida albicans. Compounds were administered intraperitoneally every other day starting from the next day postinfection. Untreated animals (100%) died over the period between days 18 and 20 postinfection; 60% animals receiving oxidized dextran alone survived by day 28 of observation. All animals treated with amphotericin B and composition of amphotericin B and oxidized dextran survived. On day 3 postinfection, the count of macrophage infiltrates and granulomas in the cerebral interstitium of mice treated with amphotericin B was equal to that in untreated mice, but was sufficiently lower in animals treated with the composition or oxidized dextran alone. On day 10, this index was similar in all groups and was approximately 5 times lower than in untreated animals on day 3. On day 28, macrophage infiltrates and granulomas were absent in the brain of all treated mice. These data suggest that oxidized dextran produced a therapeutic effect, which manifested earlier than the effect of amphotericin B and potentiated its effect, probably due to its competition with Candida albicans for mannose receptors on the brain-blood barrier endothelium.

Topics: Amphotericin B; Animals; Antifungal Agents; Brain; Candida albicans; Candidiasis; Cell Movement; Dextrans; Drug Synergism; Encephalitis; Granuloma; Macrophages; Male; Mice; Mice, Inbred CBA; Oxidation-Reduction; Survival Rate

We report two patients with cryptococcal meningitis and combined immunodeficiency with unusual magnetic resonance imaging findings of gadolinium-enhancing white matter lesions, quite different from cryptococcomas and seen prior to anti-fungal treatment. The lesions resembled demyelinating plaques and resolved. In one patient, biopsy of the lesion revealed cryptococci, non-specific inflammatory changes and occasional small perivascular lymphocyte collections, but not demyelination. Leukoencephalopathy, previously rarely observed in Cryptococcal meningitis, was thought to be the sequelae of amphotericin toxicity. Our cases demonstrate cryptococcal meningitis may present with leukoencephalopathy, possibly as an immune response to the organism.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Brain; Dementia, Vascular; Encephalitis; Glucocorticoids; Humans; Immunocompromised Host; Macrophages; Male; Meningitis, Cryptococcal; Middle Aged; Nerve Fibers, Myelinated

Topics: Adult; Agricultural Workers' Diseases; Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Brain; Cognition Disorders; Contrast Media; Deoxycholic Acid; Disasters; Drug Combinations; Encephalitis; Facial Dermatoses; Gadolinium; Humans; Itraconazole; Louisiana; Lung Diseases, Fungal; Magnetic Resonance Imaging; Male; Phosphatidylcholines; Phosphatidylglycerols; Skin Ulcer

Topics: Adult; Amphotericin B; Antifungal Agents; Basal Ganglia; Encephalitis; Female; Heroin; Humans; Mucormycosis; Substance Abuse, Intravenous

Cryptococcal meningo-encephalitis is a rare disease occurring more frequently in immunocompromised hosts.. We report the case of an apparently immunocompetent patient who developed a recurrent neurological deficit with lymphocytic meningitis. The time from the first symptoms to diagnosis was 8 months. We noted mild CD4+ lymphocytopenia (500 cells/mm3) without HIV infection. CD4+ lymphocytes were not reactive for a panel of antigens.. This case illustrates the usefulness of cerebrospinal fluid Cryptococcus Neoformans antigen test in patients with an unexplained neurological syndrome with a lymphocytic meningitis together with quantification of circulating lymphocytes clusters and analyse of their function in opportunistic infections.

Topics: Amphotericin B; Antifungal Agents; Antigens, Fungal; Brain; CD4 Lymphocyte Count; Cerebrospinal Fluid; Cryptococcus neoformans; Drug Therapy, Combination; Encephalitis; Flucytosine; Humans; Immunocompetence; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal; Middle Aged; Treatment Outcome

Infections due to non-neoformans cryptococci are rare. We report the first case of a human infection caused by Cryptococcus uniguttulatus. Ventriculitis caused by this organism developed in a 65-year-old woman who had had repair of an internal carotid aneurysm. In vitro sensitivity testing showed the Cryptococcus species sensitive to amphotericin B and itraconazole. Treatment with amphotericin led to resolution of the infection.

Topics: Aged; Amphotericin B; Antifungal Agents; Carotid Artery, Internal, Dissection; Cerebral Ventricles; Craniotomy; Cross Infection; Cryptococcus; Drainage; Encephalitis; Fatal Outcome; Female; Humans; Meningitis, Cryptococcal; Microbial Sensitivity Tests; Recurrence; Serotyping; Subarachnoid Hemorrhage; Ventriculostomy

Central nervous system (CNS) aspergillosis carries a uniformly poor prognosis in bone marrow transplant recipients. Amphotericin B can be bound to lipid carriers leading to improvement of its therapeutic index. We describe the successful medical management of CNS aspergillosis in an allogeneic bone marrow transplant patient with administration of Amphotericin B Lipid Complex.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Aspergillosis; Bone Marrow Transplantation; Drug Combinations; Encephalitis; Female; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Phosphatidylcholines; Phosphatidylglycerols; Prognosis

Case report on a lethal meningo-encephalitis due to Cryptococcus neoformans in a 14-year-old girl without serious immunodeficiency inclusive HIV-infection. The detection of high quantities of cells of Cryptococcus neoformans (about 10,000/ml) and high levels of Cryptococcus antigen (up to 1:2048) in the cerebrospinal fluid are remarkable. The patient was treated with a triple combination of amphotericin B, flucytosine and fluconazole. After 18 days the cerebrospinal fluid was sterile. Nevertheless considerable lesions of the brain arised. The patient died from the Cryptococcus infection on day 74 of the antimycotic therapy. Cryptococcosis should be included into the differential diagnosis of the chronic lymphocytic pleocytosis of the cerebrospinal fluid connected with symptoms of intracranial pressure and ocular symptoms.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Antigens, Fungal; Cryptococcosis; Cryptococcus neoformans; Diagnosis, Differential; Drug Therapy, Combination; Encephalitis; Fatal Outcome; Female; Fluconazole; Flucytosine; HIV Seronegativity; Humans; Immunologic Deficiency Syndromes

A 30-year-old male and a 40-year-old female presented with Aspergillus fungal granuloma in the cerebral locations involving the gasserian-ganglion and its divisions in one case and was densely adherent to the lateral dural wall of the cavernous sinus in the other. Both patients were otherwise healthy with no evidence of immuno-suppression. The lesions resembled benign tumor on preoperative imaging and intraoperative consistency and vascularity. The lesions were successfully and completely resected. Both patients developed major cerebral arterial territory infarcts in the postoperative phase, remote from the site of operation, leading to crippling neurological deficits in one patient and death in the other. The unusual location and the unusual and similar clinical course suggests that awareness of the possibility of ischemic complications after surgical resection of intracranial aspergillomas is necessary.

Topics: Adult; Amphotericin B; Aspergillosis; Cavernous Sinus; Cerebral Infarction; Combined Modality Therapy; Craniotomy; Encephalitis; Fatal Outcome; Female; Hemiplegia; Humans; Male; Seizures

We describe a case of post-operative ventriculitis in an immunocompetent patient caused by an unusual organism, namely Rhodotorula rubra. The patient was treated successfully with antifungal agents.

Topics: Adult; Amphotericin B; Cerebral Ventricles; Encephalitis; Female; Flucytosine; Humans; Immune Tolerance; Meningeal Neoplasms; Meningioma; Mycoses; Postoperative Complications; Rhodotorula

We describe a case of granulomatous encephalitis caused by Bipolaris (Drechslera) hawaiiensis in an immunocompetent patient. An 18-year-old man with a seven-month history of seizures and right leg weakness was found by computed tomographic scan to have a left frontoparietal enhancing lesion. Biopsy of the lesion revealed granulomatous inflammation and numerous septate hyphae. Culture of the biopsy specimen yielded a pure culture of B hawaiiensis in four days. Susceptibility studies revealed the organism to be sensitive to amphotericin B (minimal inhibitory concentration [MIC] equals 0.25 mg/L) and miconazole lactate (MIC equals 0.064 mg/L), but resistant to flucytosine (MIC greater than 100 mg/L). No synergy was demonstrated with amphotericin B and flucytosine in vitro. The patient was successfully treated with surgery and systemic and intrathecal amphotericin B therapy, and a negative culture was obtained from a repeated brain biopsy six weeks later.

Topics: Adolescent; Amphotericin B; Combined Modality Therapy; Encephalitis; Granuloma; Hemiplegia; Humans; Male; Miconazole; Mycoses; Seizures; Tomography, X-Ray Computed

The clinical course and response to therapy of 27 patients with cryptococcosis and the acquired immunodeficiency syndrome were reviewed. Cryptococcosis was the initial manifestation of the syndrome in 7 patients, and the initial opportunistic infection in an additional 7. Meningitis was the commonest clinical feature (18 patients). Blood cultures and serum cryptococcal antigen were frequently positive. In patients with meningitis, leukocyte count, protein level, and glucose level in cerebrospinal fluid were frequently normal; cerebrospinal fluid India ink test (82%), culture (100%), and cryptococcal antigen (100%) were usually positive. Only 10 of 24 patients had no evidence of clinical activity of cryptococcal infection after completion of therapy; 6 of these 10 had relapses shown by clinical findings or at autopsy. Standard courses of amphotericin B alone or combined with flucytosine were ineffective. Cryptococcosis in patients with the syndrome is a debilitating disease that does not respond to conventional therapy; earlier diagnosis or long-term suppressive therapy may improve the prognosis.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Antibodies, Fungal; Antigens, Fungal; Cryptococcosis; Cryptococcus neoformans; Drug Therapy, Combination; Encephalitis; Flucytosine; Humans; Meningitis; Retrospective Studies; Serologic Tests

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Amphotericin B; Child; Communicable Diseases; Encephalitis; Female; Humans; Immunoglobulins; Injections, Spinal; Male; Prognosis

Topics: Adult; Amphotericin B; Cryptococcosis; Cytosine; Drug Evaluation; Drug Therapy, Combination; Encephalitis; Flucytosine; Humans; Injections, Intravenous; Injections, Spinal; Male

Topics: Amphotericin B; Candidiasis; Child, Preschool; Encephalitis; Humans; Hypersensitivity, Delayed; Immunity, Maternally-Acquired; Immunotherapy; Infant; Meningitis

Topics: Amebiasis; Amebicides; Amoeba; Amphotericin B; Brain; Brain Stem; Central Nervous System Diseases; Cerebrospinal Fluid Proteins; Encephalitis; Humans; Leukocyte Count; Lymphocytosis; Male; Middle Aged; Necrosis; Temporal Lobe; Water Pollution

Topics: Amphotericin B; Cryptococcosis; Encephalitis; Humans; Male; Middle Aged

A case of cryptococcal meningo-encephalitis is described. Treatment with the fungicidal agent amphotericin B resulted in temporary improvement, but the patient relapsed and died 17 months after diagnosis. The pathology and treatment of the disease are discussed.

Topics: Amphotericin B; Cerebrospinal Fluid; Cryptococcosis; Drug Therapy; Encephalitis; Humans; Meningoencephalitis; Pathology

Topics: Amphotericin B; Cryptococcosis; Encephalitis; Humans; Isoniazid; Meningoencephalitis; Streptomycin; Tetracycline; Tuberculosis; Tuberculosis, Pulmonary

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Encephalitis; Humans; Meningoencephalitis

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus; Encephalitis; Humans; Meningoencephalitis