amphotericin-b and Esophageal-Diseases

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Clinical Trials as Topic; Cryptococcosis; Drug Resistance, Microbial; Esophageal Diseases; Female; Fluconazole; Fungi; Humans; Ketoconazole; Male; Retrospective Studies

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Candidiasis, Oral; Clinical Trials as Topic; Dermatomycoses; Esophageal Diseases; Humans; Itraconazole; Meningitis, Cryptococcal; Mycoses; Pharyngeal Diseases; Tropical Medicine

Caspofungin is an antifungal agent of the novel echinocandin class. We investigated its efficacy, safety, and tolerability as therapy for oropharyngeal and/or esophageal candidiasis in a phase II dose-ranging study. Patients were randomized in a double-blind manner to receive either caspofungin acetate (35, 50, or 70 mg) or amphotericin B (0.5 mg/kg of body weight) intravenously once daily for 7 to 14 days. A favorable response required both complete resolution of symptoms and quantifiable improvement of mucosal lesions 3 to 4 days after discontinuation of study drug. Efficacy was assessed using a modified intent-to-treat analysis. No hypothesis testing of efficacy was planned or performed. Of 140 enrolled patients, 63% had esophageal involvement and 98% were infected with the human immunodeficiency virus (HIV) (median CD4 count, 30/mm(3)). A modestly higher proportion of patients in each of the caspofungin groups (74 to 91%) achieved favorable responses compared to amphotericin B recipients (63%), but there was considerable overlap in the 95% confidence intervals surrounding these point estimates. Similar trends were found in the subgroups with esophageal involvement, a history of fluconazole failure, and CD4 counts of < or =50/mm(3). A smaller proportion of patients receiving any dose of caspofungin experienced drug-related adverse events compared to patients given standard doses of conventional amphotericin B (P < 0.01). Caspofungin provided a generally well-tolerated parenteral therapeutic option for HIV-infected patients with oropharyngeal and/or esophageal candidiasis in this study.

Topics: Adolescent; Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candidiasis; Caspofungin; Double-Blind Method; Drug Tolerance; Echinocandins; Esophageal Diseases; Female; Humans; Lipopeptides; Male; Middle Aged; Peptides; Peptides, Cyclic; Pharyngeal Diseases; Treatment Outcome

Mucormycosis is an invasive mould that can cause aggressive infection, particularly in immunocompromised patients. Though oesophageal mucormycosis is relatively rare, it remains an elusive and devastating manifestation of this disease. The management is also challenging, due to surgical morbidity and contraindications such as thrombocytopenia in immunocompromised hosts. In this report, we present the case of a 60-year-old Lebanese man with newly diagnosed acute myeloid leukaemia who developed oesophageal mucormycosis after induction chemotherapy with idarubicin/cytarabine (7+3). The diagnosis was made when the patient developed febrile neutropenia and odynophagia. CT scan of the chest revealed a thickened oesophagus. Oesophagogastroduodenoscopy with biopsy, histopathology and PCR were performed, resulting in the diagnosis of

Topics: Amphotericin B; Antifungal Agents; Cytarabine; Esophageal Diseases; Esophagus; Humans; Idarubicin; Immunocompromised Host; Induction Chemotherapy; Leukemia, Myeloid, Acute; Male; Middle Aged; Mucormycosis; Rhizopus; Triazoles

Aspergillosis is one of the most common invasive fungal infections in immunocompromised patients. Sinonasal region and upper respiratory tract are commonly involved regions whereas oesophagus is seldom involved. We present an 18-year-old male with acute lymphoblastic leukaemia with aspergillosis of oesophagus which is a rare region of involvement. The diagnosis was confirmed by the examination of the cultures of endoscopic biopsy material. The patient was already receiving empirical liposomal amphotericin B, due to severe hepatotoxicity the therapy was switched to another antifungal (caspofungin). Here we report a case of successful treatment of invasive oesophageal aspergillosis by caspofungin.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Aspergillosis; Caspofungin; Echinocandins; Esophageal Diseases; Humans; Lipopeptides; Liver; Liver Function Tests; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Oropharyngeal candidiasis (OPC) and esophageal candidiasis (EPC) are frequent complications in AIDS patients. The use of Fluconazole, an effective and a low toxicity drug, has been associated to the emergency of secondary resistant strains. For this reason, in vitro antifungal susceptibility tests are necessary to predict a therapeutic failure. Etest is an easy to perform alternative test, that has showed a good agreement with the broth microdilution reference method (NCCLS, document M27-A).. To measure the susceptibility of C. albicans isolates from AIDS patients complicated with OPC and EPC to Amphotericin B (AmB) and Fluconazole (Flu) using Etest.. Twenty strains from 20 AIDS patients were studied. AmB was tested in RPMI 1640 agar and Flu in Casitone agar.. All studied strains showed minimal inhibitory concentrations (MICs) < 1 mg/mL for AmB. A highly resistant strain to Flu (> 256 mg/mL) was isolated from a patient previously treated with Flu.. In AIDS patients with OPC and EPC, the susceptibility to Flu of the isolates should be screened, to detect resistant strains. Etest is a reliable alternative in these cases, for laboratories that cannot use the reference method.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Candidiasis, Oral; CD4 Lymphocyte Count; Drug Resistance, Fungal; Esophageal Diseases; Female; Fluconazole; Humans; Male; Microbial Sensitivity Tests; Pharyngeal Diseases

V-echinocandin (VER-002; LY303366) is a semisynthetic derivative of echinocandin B and a potent inhibitor of fungal (1, 3)-beta-D-glucan synthase. We studied the antifungal efficacy, the concentrations in saliva and tissue, and the safety of VER-002 at escalating dosages against experimental oropharyngeal and esophageal candidiasis caused by fluconazole-resistant Candida albicans in immunocompromised rabbits. Study groups consisted of untreated controls, animals treated with VER-002 at 1, 2.5, and 5 mg/kg of body weight/day intravenously (i.v.), animals treated with fluconazole at 2 mg/kg/day i.v., or animals treated with amphotericin B at 0.3 mg/kg/day. VER-002-treated animals showed a significant dosage-dependent clearance of C. albicans from the tongue, oropharynx, esophagus, stomach, and duodenum in comparison to that for untreated controls. VER-002 also was superior to amphotericin B and fluconazole in clearing the organism from all sites studied. These in vivo findings are consistent with the results of in vitro time-kill assays, which demonstrated that VER-002 has concentration-dependent fungicidal activity. Esophageal tissue VER-002 concentrations were dosage proportional and exceeded the MIC at all dosages. Echinocandin concentrations in saliva were greater than or equal to the MICs at all dosages. There was no elevation of serum hepatic transaminase, alkaline phosphatase, bilirubin, potassium, or creatinine levels in VER-002-treated rabbits. In summary, the echinocandin VER-002 was well tolerated, penetrated the esophagus and salivary glands, and demonstrated dosage-dependent antifungal activity against fluconazole-resistant esophageal candidiasis in immunocompromised rabbits.

Topics: Amphotericin B; Anidulafungin; Animals; Antifungal Agents; Candidiasis; Candidiasis, Oral; Drug Resistance, Microbial; Echinocandins; Esophageal Diseases; Esophagus; Female; Fluconazole; Immunosuppression Therapy; Peptides, Cyclic; Pharyngeal Diseases; Rabbits; Saliva

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candidiasis; Esophageal Diseases; HIV Seropositivity; HIV-1; Humans; Male; Pancreatitis; Substance Abuse, Intravenous

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candidiasis; Chemical and Drug Induced Liver Injury; Esophageal Diseases; HIV-1; Humans; Male

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Candidiasis; Candidiasis, Oral; Child, Preschool; Drug Resistance, Microbial; Esophageal Diseases; Female; Humans; Male; Middle Aged; Triazoles

Topics: Adult; Amphotericin B; Anaphylaxis; Candidiasis; Drug Hypersensitivity; Esophageal Diseases; Female; Humans; Liposomes; Male; Meningitis, Fungal

We describe a patient with the acquired immunodeficiency syndrome who had persistent oral esophageal pseudomembranous candidiasis clinically refractory to nystatin, clotrimazole, and ketoconazole. In vitro resistance to clotrimazole was demonstrated as well. The patient received temporary relief with intravenous amphotericin B therapy, but this was associated with serious adverse effects, including transfusion-requiring anemia, azotemia, and severe thrombophlebitis. Despite two courses of intravenous amphotericin B therapy, the patient's highly symptomatic, recurrent oral and esophageal candidiasis continued. The patient was then treated with fluconazole and obtained immediate relief without associated adverse effects.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Candida albicans; Candidiasis, Oral; Clotrimazole; Deglutition Disorders; Drug Resistance, Microbial; Esophageal Diseases; Fluconazole; Humans; Ketoconazole; Male

Among 3,501 individuals receiving endoscopic examination for the upper digestive tract, 41 were found to have esophageal candidiasis including 17 malignancies, 14 immunological disorders, 4 diabetes mellitus, 7 other underlying diseases and 7 apparently healthy subjects. The diagnosis was made either by brushing of the esophagus or by histological examination of the biopsied specimen. Systemic invasion of fungi was observed mainly in patients with malignancy involving the hematopoietic system, and most of them had been treated by corticosteroids, antibiotics or anticancer agents. Although complications associated with esophageal candidiasis are rare, it is emphasized that those patients with malignancy as well as impared immunity should be carefully examined for esophageal candidiasis, in order to prevent the fungi from developing invasive candidiasis. It should be noted that a few cases of gastric ulcer treated by H2 blocker revealed esophageal candidiasis, suggesting that decrease of gastric acidity might be one of the factors involved in this pathological condition.

Topics: Amphotericin B; Autoimmune Diseases; Candidiasis; Esophageal Diseases; Esophagoscopy; Female; Humans; Immune Tolerance; Ketoconazole; Male; Middle Aged; Neoplasms; Prospective Studies

Patients with the hyperimmunoglobulin E-recurrent infection (Job's) syndrome, which is characterized by an elevated immunoglobulin E level, recurrent staphylococcal infections, and an abnormality of neutrophil chemotaxis, have been reported to have visceral Candida infections in addition to their more frequent pyogenic infections. We report a patient with Job's syndrome who presented with massive hematemesis secondary to esophageal cryptococcosis. A thorough evaluation for an occult neoplasm or extraesophageal cryptococcosis was negative. The patient received a 6-wk course of amphotericin B (970 mg) and 5-fluorocytosine with complete radiographic and endoscopic resolution of the lesion. He is doing well 18 mo after therapy. The patient was not anergic, and his response to T-cell mitogens, helper-to-suppressor T-cell ratio, total number of T cells, and immunoglobulin-producing capability were all normal. This case is unusual in that it is the first documentation of a cryptococcoma of the esophagus and underscores the importance of culturing abnormal specimens for unsuspected pathogens in unusual clinical circumstances.

Topics: Adult; Amphotericin B; Cryptococcosis; Cryptococcus neoformans; Endoscopy; Esophageal Diseases; Flucytosine; Humans; Job Syndrome; Male; Phagocyte Bactericidal Dysfunction

Topics: Adrenal Cortex Hormones; Adult; Aged; Amphotericin B; Antineoplastic Agents; Candidiasis; Esophageal Diseases; Gastrointestinal Diseases; Humans; Middle Aged

A patient had clinical, endoscopic, and roentgenographic signs of esophageal carcinoma, but biopsies and brushings were negative. At operation he was found to have blastomycosis localized to the esophagogastric region and adjacent lymph nodes. There was no evidence of pulmonary disease. He was treated successfully by partial esophagectomy and amphotericin. The literature on esophageal blastomycosis is reviewed.

Topics: Adult; Amphotericin B; Blastomycosis; Diagnosis, Differential; Esophageal Diseases; Esophageal Neoplasms; Esophagogastric Junction; Granuloma; Humans; Male

Topics: Amphotericin B; Candidiasis; Deglutition Disorders; Esophageal Diseases; Esophagoscopy; Humans; Mycoses; Radiography

Topics: Airway Obstruction; Amphotericin B; Child, Preschool; Esophageal Diseases; Fungi; Humans; Laryngeal Diseases; Male; Mycoses; Orbit; Respiratory Insufficiency; Tracheal Diseases; Zygoma

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Oral; Esophageal Diseases; Fluoroscopy; Humans; Leukemia; Leukemia, Myeloid; Male; Middle Aged; Nystatin

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Esophageal Diseases; Esophagus; Humans; Nystatin; Radiography

Topics: Amphotericin B; Candida; Candidiasis; Deglutition Disorders; Diagnosis, Differential; Esophageal Diseases; Female; Humans; Infusions, Parenteral; Middle Aged; Nystatin; Radiography

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Disease; Esophageal Diseases; Esophagus; Humans