amphotericin-b and Encephalomyelitis

Combined, simultaneous or sequential antifungal therapy has often been considered an appropriate option to improve the results obtained with monotherapy. Anidulafungin belongs to the echinocandin family, which has a different mechanism of action from the remaining antifungal agents, a characteristic that heralds a good chance of synergy with other groups. However, most of the data available on the efficacy of different combinations comes from animal models of infection, "in vitro" data and case reports, while data from controlled clinical trials are scarce. The available data are insufficient to allow us to conclude that the efficacy of combined therapy is significantly superior to that of monotherapy. However, the efficacy of combined therapy may be adequate for the treatment of severe invasive mycoses associated with high mortality rates, such as forms of aspergillosis that provoke central nervous system involvement, extensive pulmonary involvement, cavitated areas, or respiratory failure and infections caused by multiresistant fungi.

Topics: Amphotericin B; Anidulafungin; Animals; Antifungal Agents; Azoles; Clinical Trials as Topic; Drug Evaluation, Preclinical; Drug Synergism; Drug Therapy, Combination; Echinocandins; Encephalomyelitis; Fungemia; Guinea Pigs; Humans; Lung Diseases, Fungal; Mice; Mycoses

A 25-year-old immunocompetent male heroin addict was admitted for acute confusion associated with gait disorders of three month duration. The diagnosis was meningoencephalomyeloradiculitis secondary to Candida albicans infection. Outcome was good after a 6-month regimen with antifungal drugs. Neurological complications of Candida albicans infection are rare and prognosis is generally poor. This case report illustrates diagnostic and therapeutic difficulties encountered.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Cauda Equina; Encephalomyelitis; Humans; Magnetic Resonance Imaging; Male; Meningoencephalitis; Movement Disorders; Radiculopathy

A case of primary amebic meningoencephalomyelitis due to Naegleria sp observed in a 14 years old boy is reported. Symptoms due to myelitis at the dorsal level assumed ascending character during the first days of disease. Manifestations due to encephalic involvemente were discrete. Cerebrospinal fluid changes were marked by pleocytosis, and the eosinophil cells participation in the cytomorphological profile was persitently high. Amphotericin-B was used intravenously (25 mgm/day) until 1,500 mgm of total dosis. Remission of encephalitis manifestations was prompt, as well as of meningeal signs. Cerebrospinal fluid changes disappeared progressively. Sensitive-motor changes due to spinal cord involvement persisted as permanent sequelae. Naegleria sp., was isolated from the cerebrospinal fluid in the acute stage of the disease, as well as, from the water of a lagoon where the patient used to swim.

Topics: Adolescent; Amebiasis; Amphotericin B; Encephalomyelitis; Humans; Male; Meningoencephalitis