amphotericin-b and Eye-Diseases

We report a case of primary cutaneous mucormycosis caused by Mucor irregularis. A 47-year-old farmer was presented to our clinic with the history of progressive red plaque around the inner canthus following dacryocystectomy about a year earlier. Linear, aseptate hyphae were seen by direct KOH examination and in biopsy. Fungal culture revealed light yellow filamentous colonies that were identified as Mucor irregularis by nucleotide sequencing of rRNA gene. Amphotericin B and dexamethasone were used in gradually increasing dosage. The treatment lasted 43 days, and the patient received 760 mg total amphotericin B. The patient was discharged after 2 months of treatment. The plaque became smooth, and fungal culture was negative. There was no recurrence for half a year through telephone follow-ups. A review of published studies revealed 23 cases of Mucor irregularis infection. Most cases resulted following injuries or surgical complications. Farmers and manual laborers were most at risk with males outnumbering females among patients. Amphotericin B and its liposomal preparations remain most effective treatment choices.

Topics: Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Biopsy; Dermatomycoses; Dexamethasone; Eye Diseases; Humans; Male; Microbiological Techniques; Microscopy; Middle Aged; Molecular Sequence Data; Mucor; Mucormycosis; Sequence Analysis, DNA; Treatment Outcome

We present two cases of aspergillus infection confirmed by blood culture and review 30 other cases of genuine aspergillus fungemia and 34 cases of aspergillus pseudofungemia. Multiple different media and blood culture systems were used to isolated Aspergillus. The median time to positive blood culture was 8.5 days (range, 1-27 days) in the genuine cases. Genuine aspergillus fungemia was observed more often after cardiac surgery (n = 11 [34%]) or during neutropenia (n = 9 [28%]) than in other settings. In a recent series of fungemia during neutropenia, 7.6% of all episodes were due to Aspergillus. Other patients at risk for aspergillus fungemia were similar to those at risk for invasive aspergillosis, including patients with AIDS. Seven (44%) of 19 patients who were treated survived. In the group of patients with aspergillus pseudofungemia, there were no deaths, and cultures of additional specimens from the same patient were not positive. Criteria that may be applied to ascertain whether the isolation of Aspergillus from blood cultures is clinically significant are put forward.

Topics: Aged; Amphotericin B; Aspergillosis; Eye Diseases; Eye Infections, Fungal; Female; Fungemia; Humans; Male; Middle Aged

Effective antifungal therapy must be long-term, nondamaging, penetrating to the eye, and highly active against each patient's fungus. Results of antifungal sensitivity testing of 61 collected ocular fungal pathogens and observations in 25 cases treated with one of the nonpolyene antifungal drugs indicated that infection was rapidly controlled and eradicated with restoration of visual acuity, determined by the degree of disorganization present at the time of commencement of rational specific antifungal therapy. Pimaricin has the widest spectrum, a medium level of activity, and rather poor penetration but is recommended as an antifungal prophylactic and as first-line-therapy for ocular fungal disease while awaiting identification and sensitivity testing of the fungus. Flucytosine combined with amphotericin B, or possibly with clotrimazole or miconazole, is recommended for Candida infections. Clotrimazole is the drug of choice for Aspergillus species although miconazole and econazole are more effective with some isolates. Miconazole and econazole are recommended for miscellaneous filamentous fungi although clotrimazole or thiabendazole are superior in some cases. Each of these drugs may be useful in patients infected with Fusarium who do not respond to primaricin. In these cases, drug use should be guided by the results of antifungal sensitivity testing. In addition to medical antifungal therapy some eyes may require excisional keratoplasty with the lens removal and evacuation of the posterior chamber and anterior vitreous cavity.

Topics: Adrenal Cortex Hormones; Adult; Aged; Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus; Blindness; Candida; Candidiasis; Clotrimazole; Cornea; Eye Diseases; Female; Fusarium; Glaucoma; Humans; Imidazoles; Male; Middle Aged; Mycoses; Natamycin; Polyenes

Topics: Adolescent; Adult; Amphotericin B; Animals; Cataract Extraction; Child; Child, Preschool; Electrocoagulation; Eye Diseases; Eye Foreign Bodies; Female; Hemorrhage; Humans; Infant, Newborn; Male; Methicillin; Methods; Middle Aged; Postoperative Complications; Prostheses and Implants; Rabbits; Retina; Retinal Detachment; Retinal Diseases; Urokinase-Type Plasminogen Activator; Uvea; Vitreous Body

Topics: Amphotericin B; Animals; Chorioretinitis; Diagnosis, Differential; Eye Diseases; Fundus Oculi; Histoplasma; Histoplasmosis; Humans; Light Coagulation; Toxoplasmosis, Ocular

Topics: Actinomycosis; Adolescent; Adult; Amphotericin B; Animals; Aspergillosis; Basidiomycota; Blastomycosis; Candidiasis; Cephalosporins; Child; Chromoblastomycosis; Coccidioidomycosis; Conjunctiva; Cryptococcosis; Drug Synergism; Eye Diseases; Female; Fungi; Geotrichosis; Guinea Pigs; Histoplasmosis; Humans; Male; Mucor; Mycetoma; Mycoses; Natamycin; Nystatin; Penicillium; Pityriasis; Rabbits; Rhinosporidiosis; Sporotrichosis; Tinea

Topics: Amphotericin B; Animals; Birds; Chorioretinitis; Europe; Eye Diseases; Haplorhini; Histoplasma; Histoplasmin; Histoplasmosis; History of Medicine; Humans; Rabbits; Rats; United States

To assess the outcomes of transcutaneous retrobulbar Amphotericin B (TRAMB) for rhino-orbital-cerebral-mucormycosis (ROCM) post-COVID-19, as an adjuvant to standard systemic antifungal therapy.. In this prospective cohort study involving ROCM patients with clinical/radiological orbital involvement, 44 eyes with ROCM stage ≥ 3B received TRAMB for 7 consecutive days with liposomal Amphotericin-B (3.5 mg/ml) with a minimum clinical and radiological follow-up of 3 months. All patients received standard systemic antifungal therapy also as per institutional protocol. Data pertaining to demography, systemic status, clinical involvement, imaging, surgical/medical management were also recorded. Potential eyes for exenteration were excluded. Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 12 Given name: [Mahendra Kumar ] Last name [Garg]. Also, kindly confirm the details in the metadata are correct.All author names are presented accurately. Details in the metadata are correct. Thank you.. Forty-four eyes of 42 patients were included, out of which 30 had diabetes mellitus & 22 had received steroid/oxygen treatment during COVID-19 infection. Forty eyes showed improvement or stable disease on follow-up on radiology. Four eyes which showed progression of the disease in orbit were reaugmented with TRAMB. No patient required exenteration. Subconjunctival haemorrhage occurred in six eyes and temporary blurring of vision in four eyes after TRAMB which resolved spontaneously.. TRAMB, as an adjuvant to standard systemic antifungal therapy, is associated with a significant reduction or stabilisation of orbital involvement. TRAMB should be considered as an adjuvant therapy for ROCM to reduce disease progression as well as to preserve globe or sight. It has a promising role in preventing potential orbital exenterations.

Topics: Amphotericin B; Antifungal Agents; COVID-19; Eye Diseases; Humans; Mucormycosis; Orbital Diseases; Prospective Studies

This study describes the microbiological and histopathological features of patients with COVID-19-associated rhino-orbital mucormycosis (ROM) seen at the L V Prasad Eye Institute between May and August 2021. Diagnosed clinically and radiologically, 24 patients with ROM were included in the study. Deep nasal swabs or endoscopically collected nasal swabs or orbital tissues were submitted for microbiological evaluation and in vitro susceptibility testing by microbroth dilution for natamycin, amphotericin B, caspofungin, posaconazole, ketoconazole, and voriconazole. Cultures were processed by 28S ribosomal DNA polymerase chain reaction and molecular sequencing. A portion of orbital tissues was also sent for histopathological evaluation. The age of the patients ranged from 27 to 75 (mean 48.58 ± 14.09) years and the majority (79%) were male. Nineteen patients were known to be diabetic prior to developing ROM and 18 patients had recovered from active COVID-19 infection. Thirteen patients had a history of hospitalization during COVID-19 infection and eight received steroids. Of the 24 samples, microbiological evaluation identified Rhizopus arrhizus in 12, Rhizopus microsporus in 9, Lichtheimia ramosa in 2, and Rhizopus delemar in 1. Twelve isolates were tested for antifungal susceptibility and all were susceptible to natamycin and amphotericin B. The susceptibility to posaconazole was high, with minimum inhibitory concentration (MIC) < 2 µg/mL for 10/12 (84%) isolates, whereas the MIC of other drugs varied. Histopathological examination of tissues showed acute fulminant disease, granuloma formation, and vascular invasion by the fungal pathogens in these specimens. Rhizopus arrhizus was predominantly associated with ROM and most isolates were susceptible to amphotericin B and posaconazole. Further studies are needed to corroborate the findings and explain possible underlying links.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; COVID-19; Eye Diseases; Female; Humans; India; Male; Middle Aged; Mucormycosis; Natamycin; Rhizopus oryzae

Topics: Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Diseases; Eye Infections, Fungal; Humans; Mucormycosis; Orbital Diseases

To report two cases of COVID-19 under treatment with a corticosteroid; in one case rhino-orbitocerebral mucormycosis and in another one rhino-orbital mucormycosis developed.. A 40-year old woman and a 54-year old man with severe COVID-19 underwent corticosteroid therapy for immune-related lung injuries. The first case presented with a bilateral visual loss and complete ophthalmoplegia of the right eye. The second case presented with vision loss, proptosis, orbital inflammation, and complete ophthalmoplegia on the left side. Histopathologic, nasal endoscopic examinations, and radiologic findings confirmed mucormycosis in both patients. The patients denied orbital exenteration and were managed with systemic amphotericin B and daily endoscopic sinus debridement and irrigation with diluted amphotericin B. Because of the intracranial space involvement, the first case died. The second case was successfully managed surgically and medically.. Rhino-orbital/cerebral mucormycosis may be developed in COVID-19 patients under treatment with corticosteroid, and requires prompt diagnosis and management.

Topics: Adult; Amphotericin B; Antifungal Agents; COVID-19; Eye Diseases; Eye Infections, Fungal; Female; Humans; Male; Middle Aged; Mucormycosis; Ophthalmoplegia; Orbital Diseases; Steroids

Topics: Amphotericin B; Antifungal Agents; Blindness; Brain Diseases; Debridement; Exophthalmos; Eye Diseases; Fatal Outcome; Female; Humans; Magnetic Resonance Imaging; Maxillary Sinusitis; Middle Aged; Mucormycosis; Optic Neuritis

Topics: Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Choroiditis; Cryptococcosis; Cryptococcus gattii; Drug Therapy, Combination; Eye Diseases; Eye Infections, Fungal; Fluconazole; Flucytosine; HIV Infections; Humans; Infusions, Intravenous; Male; Meningitis, Cryptococcal; Retinitis; Tomography, Optical Coherence; Vitreous Body

Investigations of both virulence factors and antifungal susceptibility profiles are crucial for understanding the pathogenesis and prognosis of ophthalmic mycoses. In this study, we investigated the in vitro antifungal susceptibility of amphotericin B (AMB), voriconazole (VRC), and natamycin (NAT) against a set of 50 fungal isolates obtained from patients with ocular mycoses using the Clinical and Laboratory Standards Institute broth microdilution method. In addition, putative virulence factor, such as secretory phospholipases and proteinases, and biofilm formation activity were analyzed. The geometric means (GMs) of the minimum inhibitory concentrations (MICs) of the antifungals across all isolates were the following (in increasing order): VRC (0.70 μg/mL), AMB (0.81 μg/mL), and NAT (1.05 μg/mL). The highest activity against 14 Aspergillus strains was exhibited by VRC (GM MIC: 0.10 μg/mL), followed by AMB and NAT (GM MICs: 0.21 and 0.27 μg/mL), respectively. However, for 12 Fusarium spp., the GM MIC of VRC (2.66) was higher than those of NAT and AMB (GM MICs 1.3 and 0.8 μg/mL, respectively). Proteinase and phospholipase activity were observed in 30 % and 42 % of the isolates, respectively, whereas only 8 % of the isolates were able to produce biofilms. Phospholipase activity was observed in all Fusarium isolates, but not in any of the Aspergillus isolates. In contrast, biofilm-forming capability was detected in 25 % of the Fusarium isolates, but none of the Aspergillus isolates. The differences in the MICs of AMB, VRC, and NAT, biofilm-forming ability and proteinase and phospholipase activities among the isolates were not significant (p > 0.05). Overall, our study suggests no significant correlation between the antifungal susceptibility profiles and virulence attributes of ocular fungal isolates.

Topics: Amphotericin B; Antifungal Agents; Biofilms; Drug Resistance, Fungal; Eye Diseases; Fungi; Humans; Microbial Sensitivity Tests; Mycoses; Natamycin; Opportunistic Infections; Peptide Hydrolases; Phospholipases; Virulence; Virulence Factors; Voriconazole

Topics: Amphotericin B; Antifungal Agents; Biopsy; Brain Diseases; Deoxycholic Acid; Diabetes Mellitus, Type 2; Drug Combinations; Eye; Eye Diseases; Fatal Outcome; Female; Humans; Kidney Failure, Chronic; Magnetic Resonance Imaging; Middle Aged; Mucormycosis; Multiple Organ Failure; Paranasal Sinuses; Temporal Lobe

The goal of this study was to compare in vitro and in vivo efficacy of moxifloxacin and liposomal amphotericin B (Amp-B) monotherapies and combination treatment against Candida albicans in an exogenous endophthalmitis model in rabbit eyes. Microplate dilution tests and checkerboard analysis were performed to detect in vitro efficacies. Endophthalmitis was induced by intravitreal injection of C. albicans in 40 rabbit eyes with simultaneous intravitreal drug injection according to prophylactic treatment groups. Group 1 (control group) received 0.1 mL of balanced salt solution, group 2 (moxi group) 100 microg moxifloxacin/0.1 mL, group 3 (Amp-B group) 10 microg liposomal Amp-B/0.1 mL, and group 4 (combi group) both 100 microg moxifloxacin/0.1 mL [DOSAGE ERROR CORRECTED] and 10 microg liposomal Amp-B/0.05 mL intravitreally. Clinical examination, quantitative analysis of microorganisms, and histopathologic examination were performed as in vivo studies. The minimum inhibitory concentration of liposomal Amp-B against C. albicans was found to be 1 microg/mL. Moxifloxacin showed no inhibition of in vitro C. albicans growth. The minimum inhibitory concentration values of liposomal Amp-B for C. albicans were reduced two- to eightfold with increasing concentrations of moxifloxacin in vitro. In vivo, there was no C. albicans growth in the combi group (zero of eight eyes), whereas three eyes (37.5%) showed growth in the Amp-B group. Vitreous inflammation, retinal detachment, focal retinal necrosis, and outer nuclear layer loss were found to be lower in the moxi group compared with the control group. Ganglion cell and inner nuclear layer loss was observed in all eyes (100%) in both the moxi and combi groups, whereas only in 25% (two of eight eyes) in the Amp-B group. Moxifloxacin strongly augments the efficacy of liposomal Amp-B against C. albicans in vitro, although it has no in vitro antifungal activity when used alone. It is interesting that we found a synergistic effect for in vitro tests but failed to demonstrate it in vivo. When 100 microg moxifloxacin/0.1 mL is given intravitreally, it has some toxic effects that are limited to the inner retinal layers.

Topics: Amphotericin B; Animals; Antifungal Agents; Aza Compounds; Candida albicans; Candidiasis; Colony Count, Microbial; Disease Models, Animal; Drug Resistance, Fungal; Drug Therapy, Combination; Endophthalmitis; Eye Diseases; Eye Infections, Bacterial; Eye Infections, Fungal; Fluoroquinolones; Microbial Sensitivity Tests; Moxifloxacin; Quinolines; Rabbits; Vitreous Body

Candida glabrata endophthalmitis following keratoplasty is rare and almost always associated with positive donor rim culture.. A 63-year-old patient, diagnosed Fuch's endothelial dystrophy in both eyes underwent a penetrating keratoplasty in his right eye. He had multiple underlying medical problems, which included diabetes mellitus, hypertension, hypoadrenalism on oral dexamethasone and fatty liver secondary to hypertrigliseridemia. He developed multiple suture abscesses, corneal haziness, retrocorneal white plaques and a level of hypopyon two weeks after an uneventful penetrating keratoplasty in his right eye. Cultures of the donor button and the transport media culture were negative. Candida glabrata was isolated successfully from the aqueous and vitreous taps. He was treated with a combination of topical, intracameral, intravitreal and intravenous Amphotericin B. His final visual acuity remained poor due to the haziness of the corneal button.. Candida glabrata endophthalmitis following penetrating keratoplasty can occur in negative donor rim and transport media cultures. The growth of the organism is facilitated by the patient's immunocompromised status. Awareness by the ophthalmologists and appropriate choice of antibiotics are mandatory in this challenging condition.

Topics: Abscess; Administration, Topical; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Drug Administration Schedule; Endophthalmitis; Eye Diseases; Fuchs' Endothelial Dystrophy; Humans; Injections, Intraocular; Injections, Intravenous; Keratoplasty, Penetrating; Male; Middle Aged; Sutures; Transplants; Ultrasonography; Vitreous Body

Topics: Aged; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Drug Therapy, Combination; Eye Diseases; Eye Infections, Fungal; Fluconazole; Flucytosine; Humans; Male; Middle Aged; Ultrasonography; Vitrectomy; Vitreous Body

To standardize in-vitro antifungal susceptibility testing by agar dilution method to find out the minimum inhibitory concentration (MIC) of amphotericin B, fluconazole and ketoconazole on ocular fungal isolates.. A total of 180 ocular fungal isolates (130 filamentous fungi and 50 yeasts) were included. The antifungal drugs such as amphotericin B (0.0625-8 microg/mL), fluconazole (0.2-819.6 microg/mL) and ketoconazole (0.025-6.4 microg/mL) were incorporated in doubling dilutions in the yeast nitrogen base medium. The MIC was determined as the lowest concentration of the antifungal drug preventing growth of macroscopically visible colonies on drug containing plates when there was visible growth on the drug-free control plates.. All 50 ocular isolates of yeast were susceptible to amphotericin B, while two (4%) and five (10%) strains were resistant to fluconazole and ketoconazole respectively. Of the 130 filamentous fungi tested, six (4.6%) were resistant to amphotericin B, 49 (37.7%) and 10 (7.6%) were resistant to fluconazole and ketoconazole respectively. Percentile 50 (MIC 50) and Percentile 90 (MIC 90) for all the three antifungal agents were calculated. Aspergillus niger, Aspergillus terreus and Candida krusei were found to be resistant to fluconazole and ketoconazole.. This technique was found to be reliable, cost effective and easy to perform with consistent results.

Topics: Amphotericin B; Antifungal Agents; Aspergillus; Candida; Drug Resistance, Fungal; Eye Diseases; Fluconazole; Keratitis; Ketoconazole; Microbial Sensitivity Tests; Mitosporic Fungi; Mycoses

To determine the toxicity of various doses of intravitreal amphotericin B deoxycholate, amphotericin B lipid complex (ABLC), and liposomal amphotericin B (L-AmB).. Fifty-two rabbits were divided into two treatment groups (groups A and B). Thirteen treatments were administered intravitreally to the 104 rabbit eyes. Treatments included a control plus 10, 20, 30, and 50 micro g amphotericin B deoxycholate, ABLC, and L-AmB. Eye examinations were performed before injection and on day 11 for group A and on day 18 for group B. At death, on days 13 and 21 in groups A and B, respectively, vitreous humor was aspirated and concentrations of amphotericin B were determined by high performance liquid chromatography (HPLC), followed by enucleation for histologic studies.. Significantly more eyes treated with ABLC showed development of vitreal opacities than developed in eyes treated with amphotericin B deoxycholate or L-AmB (P < 0.05). Vitreal band formation was significantly higher in ABLC-treated eyes than in those treated with L-AmB, (P = 0.039). Vitreal inflammation was greater in eyes treated with L-AmB (75%), amphotericin B deoxycholate (78%), and ABLC (91%) than with the control (50%; P = 0.08). Retinal ganglion cell loss was greater in eyes treated with amphotericin B deoxycholate (81%), L-AmB (91%), and ABLC (97%) than with the control (38%; P = 0.003). Amphotericin B concentrations were measurable for all doses of the three formulations.. Based on histologic data, increasing doses of all three agents appear to be associated with increasing toxicity, however based on ophthalmologic data, L-AmB appears to be less toxic than either amphotericin B deoxycholate or ABLC.

Topics: Amphotericin B; Animals; Antifungal Agents; Chromatography, High Pressure Liquid; Deoxycholic Acid; Drug Combinations; Eye Diseases; Phosphatidylcholines; Phosphatidylglycerols; Rabbits; Retinal Diseases; Retinal Ganglion Cells; Vitreous Body

To describe an unusual case of disseminated sporotrichosis with intraocular involvement.. Interventional case report.. An 18-year-old man presented with disseminated ulcerated skin lesions. Fundus examination showed fluffy opacities in the vitreous and a retinal granuloma in the left eye. Biopsy of the skin lesion and lymph node showed the presence of numerous fungus cells. Culture was positive for the diagnosis of disseminated sporotrichosis.. Although intraocular infection due to Sporothrix schenckii is uncommon, it can occur in case of disseminated sporotrichosis. Systemic therapy is a successful means to control skin and ocular sporotrichosis.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Biopsy; Eye Diseases; Eye Infections, Fungal; Granuloma; Humans; Male; Retinal Diseases; Skin; Sporothrix; Sporotrichosis; Vitreous Body

Mucormycosis is a rare opportunistic infection but a fulminant disease. We report the 4 first cases of rhinocerebral mucormycosis diagnosed in Sfax region (Tunisia). They occurred in insulin dependent diabetes and developed varying clinical manifestations from facial cellulites to ocular and cerebral extension. The diagnosis of mucormycosis was not initially evoked, but confirmed tardively by anatomopathologic and mycologic examinations. The evolution was favourable in 2 cases by administration of amphotericine B associated with extensive surgical debridement and correction of the diabetes. Two patients had a fatal outcome. This infection has a severe prognosis and necessitates early diagnosis.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Diabetes Mellitus, Type 1; Eye Diseases; Fatal Outcome; Female; Humans; Male; Middle Aged; Mucormycosis; Nose Diseases; Prognosis; Tunisia

Topics: Aged; Amphotericin B; Brain Diseases; Eye Diseases; Fatal Outcome; Female; Humans; Mucormycosis; Nose Diseases

The incidence of systemic mycotic infections, though formerly rare, has increased dramatically over the past two decades. Candida albicans has been recognized as the most common pathogen in endogenous fungal endophthalmitis. Accurate antemortem diagnosis of disseminated candidiasis is made, however, only in a few cases. Ocular findings may often provide the first definitive clue to an underlying mycotic infection. We present four cases of candidal endophthalmitis; in each the ophthalmologist played a major role in the early diagnosis of the underlying systemic infection, allowing specific therapeutic measures to be taken. We also discuss the common predisposing factors, ocular symptoms and findings, clinical course, and response to antifungal therapy.

Topics: Aged; Amphotericin B; Candidiasis; Endophthalmitis; Eye Diseases; Female; Flucytosine; Fluorescein Angiography; Fundus Oculi; Humans; Male; Middle Aged; Retinal Diseases; Uveitis; Visual Acuity; Vitreous Body

Topics: Adult; Amphotericin B; Candidiasis; Eye Diseases; Humans; Kidney Transplantation; Male; Postoperative Complications; Ureteral Obstruction

Topics: Amphotericin B; Eye Diseases; Humans; Mycoses

Of 38 heroin addicts treated for systemic candidal infections, 36 had metastatic cutaneous lesions (deep-seated scalp nodules and pustulosis in hairy zones), 15 had ocular localizations (mainly chorioretinitis), and 10 had osteoarticular involvement (vertebrae, costal cartilage, knees, and sacroiliac). Such cutaneous lesions have not previously been described in classical systemic candidiasis; we also observed hair invasion by candidal hyphae. Candida albicans was the exclusive species isolated, in contrast to other visceral candidiases in heroin addicts. All isolates were sensitive to amphotericin B, flucytosine, and ketoconazole. Thirty-one visceral localizations were treated only with ketoconazole. Results were favorable in 15 of 18 cutaneous, 6 of 6 ocular, and 4 of 7 osteoarticular cases of involvement. This outbreak coincided with introduction of a new heroin on the drug market in the Paris area. C. albicans was not isolated from the drug. Pathogenesis of this syndrome is unclear.

Topics: Adult; Aged; Amphotericin B; Bone Diseases; Candida albicans; Candidiasis; Candidiasis, Cutaneous; Eye Diseases; Female; Flucytosine; France; Heroin Dependence; Humans; Joint Diseases; Ketoconazole; Male; Middle Aged; Osteoarthritis; Scalp; Syndrome

Topics: Amphotericin B; Antifungal Agents; Aspergillus flavus; Aspergillus fumigatus; Aspergillus oryzae; Coccidioides; Eye Diseases; Humans; Metronidazole; Mycoses; Orbital Diseases

Systemic protothecosis was diagnosed in a 7-year-old dog that had only ocular manifestations. During the 3-month course of disease, a variety of drugs was administered, including amphotericin B, gentamicin, and ketoconazole. The ocular signs initially abated, but subsequently worsened during this period. The dog was found dead 3 months after initial examination, and systemic protothecosis was confirmed at necropsy.

Topics: Amphotericin B; Animals; Chloramphenicol; Dog Diseases; Dogs; Eye Diseases; Gentamicins; Infections; Ketoconazole; Prototheca

Experimental designs in ophthalmologic research frequently treat both eyes of a subject in the same fashion: e.g., therapy with a specific drug or control. In these two-eye designs, observations from the same subject are often positively correlated. Failure to account for this correlation is a serious error which overstates the precision of studies, resulting in falsely significant results. This paper reviews the statistical methods appropriate for studies where endpoints are quantitative. We present: (1) the use of analysis of variance (t-test when there are 2 treatment conditions) to estimate differences between all experimental treatments, (2) the use of contrasts to estimate differences between specific treatments, and (3) methods for analysis of data from multiple experiments. Because of the ubiquity of incorrect analysis of data from two-eye designs in the ophthalmologic research literature and the serious consequences of this error, we propose a limited statistical review of manuscripts to ascertain if the statistical analysis matched the experimental design.

Topics: Amphotericin B; Analysis of Variance; Animals; Candidiasis; Eye Diseases; In Vitro Techniques; Keratitis; Ketoconazole; Ophthalmology; Rabbits; Statistics as Topic

Fifteen cases of postoperative Candida parapsilosis endophthalmitis occurring secondary to a contaminated lot of an irrigating solution were studied. All patients underwent a vitreous tap or diagnostic and therapeutic vitrectomy. Eleven of the 15 specimens were positive for the organism. Fourteen patients were treated with pars plana vitrectomy surgery. All patients were treated with intravitreal amphotericin B and systemic amphotericin B and 5-fluorocytosine. Two clinical recurrences were successfully treated with intravitreal amphotericin B, removal of the pseudophakos, and oral ketoconazole. The intraocular lens was retained in 11 of the 14 pseudophakic patients. Final visual acuities ranged from 20/25 to no light perception with eight of 15 patients having 20/60 or better visual acuities. Measurable levels of intraocular amphotericin B were found after systemic amphotericin B administration. Two patients with totals of 20 and 30 micrograms of intravitreal amphotericin B over 48 and 96 hours, respectively, had near normal ERGs one year later. Posterior capsulotomy and vitrectomy appear to decrease amphotericin B toxicity and allow sequential intraocular injection of this drug within a short time period.

Topics: Aged; Amphotericin B; Candidiasis; Cataract Extraction; Eye Diseases; Female; Flucytosine; Humans; Ketoconazole; Male; Middle Aged; Ophthalmic Solutions; Therapeutic Irrigation

Seven young men developed disseminated candidiasis within 10 days of a single episode of intravenous heroin abuse. Sequential development of eye and skin lesions was noted in all cases. The bone or costal cartilage was involved in five. Ocular manifestations of candidiasis included episcleritis, chorioretinitis, and endophthalmitis. A presumptive diagnosis of candida chorioretinitis was established rapidly by culture of Candida albicans from involved skin and costal cartilage. Systemic therapy with amphotericin B plus 5-fluorocytosine resulted in cure of the episcleritis, chorioretinitis, osteomyelitis, costochondritis, and skin infection. Pars plana vitrectomy with local instillation of amphotericin B was required to cure chorioretinitis associated with vitreal extension of infection.

Topics: Adult; Amphotericin B; Candidiasis; Eye Diseases; Flucytosine; Heroin; Humans; Male; Substance-Related Disorders

A case of bilateral necrotizing scleritis due to Aspergillus oryzae is reported. The patient was a former addict of intravenous narcotics treated five years previously for meningitis due to the same organism. A seeding focus in the thoracic spine was eventually found. The patient responded well to combined local and systemic therapy with amphotericin B, flucytosine, and natamycin. This represents, to the best of our knowledge, both the first reported case of ocular disease due to this species of Aspergillus and of isolated scleral, nonintraocular involvement in endogenous oculomycosis.

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Aspergillus oryzae; Child; Cocaine; Eye Diseases; Female; Flucytosine; Heroin; Humans; Inflammation; Injections, Intravenous; Meningitis; Natamycin; Sclera; Substance-Related Disorders

A 49-year-old outdoor laborer had an endophthalmitis in one eye and small posterior segment lesions in the other, as well as raised lesions on his skin. The diagnosis of disseminated North American blastomycosis was established by the performance of a biopsy on one of the skin lesions. The ocular inflammation slowly improved with intravenous amphotericin B therapy, and the ocular lesions, presumably caused by Blastomyces dermatitidis, were followed clinically for six months. The patient died of a hospital-acquired pneumonia caused by Staphylococcus aureus.

Topics: Amphotericin B; Blastomycosis; Dermatomycoses; Endophthalmitis; Eye Diseases; Humans; Male; Middle Aged

Topics: Amphotericin B; Child; Cladosporium; Eye Diseases; Humans; Male; Mycoses; Retinal Detachment; Vitreous Body

We have described a case of Cryptococcus neoformans endophthalmitis, especially rare in the absence of simultaneous CNS involvement. The key to management appears to lie in early diagnosis, which is difficult because there are multiple causes of uveitis; clinical examination will not establish the specific cause. If clinical improvement is not apparent after several days of nonspecific therapy and other studies have failed to yield a diagnosis, appropriate stains and cultures of vitreal aspirate should be done for fungi and other organisms. Amphotericin B plus 5-fluorocytosine is the treatment of choice, possibly with intravitreal instillation of amphotericin B and vitrectomy.

Topics: Amphotericin B; Cryptococcosis; Eye Diseases; Female; Flucytosine; Humans; Middle Aged

A patient with unexplained lung abscess six years previously, developed chronic meningitis, and later, bilateral chorioretinitis. The organism found was Cryptococcus neoformans. The patient was successfully treated with amphotericin B and 5-fluorocytosine.

Topics: Adult; Amphotericin B; Cryptococcosis; Eye Diseases; Female; Flucytosine; Humans; Lung Abscess

In studying the dose-related ocular toxicity of amphotericin B in vitrectomized eyes, up to 5 micrograms/0.1 ml concentration of amphotericin C was nontoxic to the ocular structure when injected in the anterior part of the vitreous cavity. Intravitreal injection of 2.5 micrograms of amphotericin B halted fungal endophthalmitis, which was experimentally induced in rabbit eyes, even after 16 days of infection. Combined treatment of vitrectomy and intravitreal injection of amphotericin B not only cured the fungal endophthalmitis but it also cleared the ocular media from opacities.

Topics: Amphotericin B; Animals; Candidiasis; Dose-Response Relationship, Drug; Evaluation Studies as Topic; Eye Diseases; Rabbits; Vitreous Body

Topics: Aged; Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Cataract Extraction; Eye Diseases; Female; Flucytosine; Humans; Methods; Miconazole; Mycoses; Natamycin; Postoperative Complications; Rabbits

A survey is given of the clinical picture of an infection with Cryptococcus neoformans. The symptoms and therapy are reviewed and the case history of a 13 year old boy suffering from this fungus infection is discussed.

Topics: Adolescent; Amphotericin B; Cryptococcosis; Eye Diseases; Flucytosine; Humans; Male

Topics: Adult; Aged; Amphotericin B; Candida albicans; Candidiasis; Cytosine; Drug Therapy, Combination; Eye Diseases; Female; Flucytosine; Humans; Male; Middle Aged; Mycoses

A 79-year-old female patient suffered from iridocyclitis of both eyes. In the fundus of the left eye equatorially a preretinal questionable granuloma (size 1/2 d.d.) was found; the first hint of a mycotic involvement. In the enucleated right bulbus, an abscess-like granulomatous focus with a diameter of 10 mm was found. Several round encapsulated cells having a diameter of 7 to 20 mu and looking like with Cryptococcus neoformans were microscopically demonstrable in the pus obtained from this abscess. Since the fungus could not be cultured, it may be assumed that a spontaneous healing occurred. The only known basic disease was a temporary uremia (330 mg0/0 urea and 7.0 mg0/0 creatinin). The role of amphotericin B therapy in this patient is discussed.

Topics: Aged; Amphotericin B; Cryptococcosis; Cryptococcus; Eye Diseases; Female; Humans

A 29 year old male, admitted with diabetic keto-acidosis, was found to have rhinocerebral phycomycosis (mucormycosis) involving the left eye and the left hard palate with perforation into the maxillary antrum. Despite late diagnosis, full recovery was obtained following intravenous Amphotericin B (total dose : 3.015 gm in 4 months) and extensive surgery (debridement and unilateral eye enucleation). The circumstances of onset of the disease and its clinical characteristics are discussed; the main features of its management are analyzed.

Topics: Adult; Amphotericin B; Diabetic Ketoacidosis; Eye Diseases; Humans; Male; Maxillary Sinus; Mucormycosis; Palate; Paranasal Sinus Diseases

Rhinocerebral mucormycosis (phycomycetes), a human fungal disease with oral and perioral findings, has an extremely high morbidity and mortality. The disease is most frequently seen in patients with poorly controlled diabetes. The symptoms, findings, and treatment of rhinocerebral mucormycosis are discussed, and two case histories are presented.

Topics: Adult; Amphotericin B; Blepharoptosis; Cellulitis; Diagnosis, Differential; Eye Diseases; Female; Humans; Male; Maxillary Sinus; Middle Aged; Mucormycosis; Nose Diseases; Ophthalmoplegia; Orbit; Palatal Neoplasms; Palate; Paranasal Sinus Neoplasms; Paresthesia; Radiography; Sinus Thrombosis, Intracranial; Ulcer; Vision Disorders

Topics: Adolescent; Amphotericin B; Biopsy; Candida albicans; Candidiasis; Cataract; Diagnostic Errors; Eye Diseases; Flucytosine; Heroin Dependence; Humans; Male; Visual Acuity; Vitreous Body

Topics: Abscess; Administration, Topical; Adult; Amphotericin B; Anti-Bacterial Agents; Anti-Inflammatory Agents; Atropine; Cornea; Ethylmercury Compounds; Eye Diseases; Eye Injuries; Glucocorticoids; Humans; Male; Mitosporic Fungi; Mycoses; Ointments; Ophthalmic Solutions; Phenylephrine

Topics: Aged; Amphotericin B; Blindness; Eye Diseases; Female; Humans; Inflammation; Intraocular Pressure; Male; Mycoses; Peptic Ulcer; Postoperative Complications; Sudan; Visual Acuity

Topics: Adult; Amphotericin B; Candida albicans; Candidiasis; Eye Diseases; Female; Fundus Oculi; Humans; Infusions, Parenteral; Ophthalmoscopy

Topics: Adult; Amphotericin B; Candida albicans; Candidiasis; Eye Diseases; Humans; Male; Sepsis

Topics: Abscess; Amphotericin B; Black or African American; Blastomyces; Blastomycosis; Drainage; Exophthalmos; Eye Diseases; Humans; Louisiana; Lung Diseases, Fungal; Male; Middle Aged; North America; Orbit

Topics: Amphotericin B; Candida albicans; Candidiasis; Child; Electroencephalography; Eye Diseases; Fever; Fundus Oculi; Humans; Inflammation; Injections, Intravenous; Male; Meningitis; Parenteral Nutrition; Visual Acuity

Topics: Amphotericin B; Anterior Chamber; Antifungal Agents; Candida; Candidiasis; Cataract Extraction; Diabetes Complications; Drainage; Eye Diseases; Female; Humans; Middle Aged; Neomycin; Nystatin; Polymyxins; Punctures; Sulfates; Time Factors; Visual Acuity

Topics: Amphotericin B; Animals; Aspergillosis; Candidiasis; Eye Diseases; Humans; Keratitis; Mycoses; Natamycin; Nystatin; Rabbits

Topics: Abscess; Amphotericin B; Animals; Candida albicans; Candidiasis; Disease Models, Animal; Eye Diseases; Injections; Rabbits; Time Factors; Vitreous Body

Topics: Amphotericin B; Antifungal Agents; Cornea; Corneal Transplantation; Curettage; Eye Diseases; Fungi; Humans; Methods; Mycoses; Natamycin; Nystatin

Topics: Amphotericin B; Antifungal Agents; Evaluation Studies as Topic; Eye Diseases; Flucytosine; Humans; Imidazoles; Keratitis

Topics: Adult; Amphotericin B; Biopsy; Diabetic Ketoacidosis; Eye Diseases; Humans; Male; Mucormycosis; Nose Diseases; Orbit; Skin

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Cornea; Corneal Ulcer; Eye Diseases; Humans; Male; Mitosporic Fungi; Mycoses

Topics: Amphotericin B; Antifungal Agents; Eye Diseases; Griseofulvin; Humans; Nystatin; Optic Neuritis; Papilledema; Vision Disorders

Topics: Aged; Amphotericin B; Cataract Extraction; Eye Diseases; Female; Humans; Male; Middle Aged; Mycoses; Postoperative Complications; Prednisone; Visual Acuity

Topics: Acremonium; Adult; Amphotericin B; Aspergillosis; Candidiasis; Conjunctiva; Cornea; Corneal Transplantation; Corneal Ulcer; Curettage; Eye Diseases; Eye Injuries; Female; Fusarium; Humans; Male; Mycoses; Nystatin; Potassium Iodide

Topics: Abscess; Adrenal Cortex Hormones; Adult; Amphotericin B; Aspergillosis; Aspergillus; Chloramphenicol; Cornea; Corneal Transplantation; Dexamethasone; Eye Diseases; Eye Injuries; Humans; Male; Natamycin; Nystatin; Ophthalmic Solutions; Oxacillin; Sulfacetamide; Transplantation, Homologous

Topics: Adult; Amphotericin B; Australia; Chorioretinitis; Eye Diseases; Eye Manifestations; Hemorrhage; Histoplasmosis; Humans; Male; Prednisone; Retinal Vessels; Visual Acuity

Topics: Aged; Amphotericin B; Candidiasis; Eye Diseases; Humans; Male; Mycoses; Postoperative Complications

Topics: Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Candida; Candidiasis; Child; Eye Diseases; Female; Humans; Infant; Male; Middle Aged; Nystatin; Steroids

Topics: Adult; Aged; Amphotericin B; Biopsy; Diabetes Complications; Diabetic Ketoacidosis; Ethmoid Bone; Eye Diseases; Female; Fungi; Humans; Infant; Male; Maxillary Sinus; Middle Aged; Mycoses; Nystatin; Orbit; Sphenoid Bone

Topics: Amphotericin B; Anti-Bacterial Agents; Candida; Candidiasis; Cornea; Cortisone; Culture Media; Eye Diseases; Germany, West; Griseofulvin; Humans; Male; Mycoses; Nystatin

Topics: Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Candida; Child; Cornea; Cortisone; Eye Diseases; Female; Griseofulvin; Humans; Keratitis; Male; Middle Aged; Mycoses; Nystatin

Topics: Actinomycosis; Amphotericin B; Animals; Antifungal Agents; Atropine; Chorioretinitis; Conjunctivitis; Eye Diseases; Hot Temperature; Humans; Laser Therapy; Light Coagulation; Mycoses; Natamycin; Nocardia Infections; Nystatin; Penicillins; Rabbits; Sporotrichosis; Streptomycin; Sulfacetamide; Sulfadiazine; Vitreous Body

Topics: Adrenal Cortex Hormones; Amphotericin B; Biopsy; Blepharoptosis; Blindness; Brain Diseases; Child; Child, Preschool; Conjunctiva; Edema; Exophthalmos; Eye Diseases; Humans; Inflammation; Male; Mucormycosis; Paranasal Sinuses; Penicillins; Sinusitis

Topics: Adult; Amphotericin B; Conjunctiva; Cryptococcosis; Cryptococcus; Eye Diseases; Fundus Oculi; Humans; Lupus Erythematosus, Systemic; Male; Meningitis; Necrosis; Optic Nerve; Papilledema; Prednisone; Pupil; Retina; Retinitis

Topics: Amphotericin B; Child; Dacryocystitis; Eye Diseases; Female; Histoplasmosis; Humans; Lacrimal Apparatus; Orbit; Radiography; Skull; Tibia

Topics: Adult; Amphotericin B; Blepharoptosis; Blindness; Contact Lenses; Diabetes Complications; Eye Diseases; Female; Humans; Middle Aged; Mucormycosis

Topics: Aged; Amphotericin B; Animals; Electroretinography; Eye Diseases; Female; Humans; In Vitro Techniques; Male; Methods; Mycoses; Rabbits

Topics: Acrocephalosyndactylia; Amphotericin B; Corneal Ulcer; Eye Diseases; Female; Humans; Middle Aged; Radiography; Strabismus; Sulfacetamide

Topics: Adult; Amphotericin B; Biopsy; Coccidioidomycosis; Eye Diseases; Female; Humans; Liver; Liver Diseases; Radiography, Thoracic

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Eye Diseases; Female; Glaucoma; Humans; Male; Middle Aged; Mycoses; Uveitis

Topics: Amphotericin B; Animals; Ciliary Body; Eye Diseases; Histoplasmosis; Hyperemia; In Vitro Techniques; Iritis; Necrosis; Rabbits

Topics: Acremonium; Amphotericin B; Aqueous Humor; Blood; Cataract Extraction; Drug Therapy; Endophthalmitis; Eye Diseases; Geriatrics; Humans; Injections, Intravenous; Keratitis; Mycoses; Pharmacology; Postoperative Complications; Uveitis

Topics: Amphotericin B; Blindness; Cataract Extraction; Eye Diseases; Humans; Mycoses; Postoperative Complications

Topics: Amphotericin B; Candidiasis; Child; Craniocerebral Trauma; Eye Diseases; Humans

Topics: Acremonium; Amphotericin B; Ascomycota; Candidiasis; Cataract; Cataract Extraction; Drug Therapy; Eye Diseases; gamma-Globulins; Griseofulvin; Humans; Mycoses; Nystatin; Postoperative Complications; Steroids; Toxicology

Topics: Amphotericin B; Chorioretinitis; Diagnosis; Drug Therapy; Eye Diseases; Histoplasmosis; Humans

Topics: Amphotericin B; Animals; Antifungal Agents; Conjunctiva; Eye Diseases; Fungicides, Industrial; Humans; Male; Mycoses; Rabbits