amphotericin-b and Fetal-Death

Pregnant women with respiratory symptoms of pleuritic pain and productive cough should undergo evaluation for coccidioidomycosis. This should include a history of travel or residency in endemic areas and careful assessment for toxic erythema, erythema nodosum, or erythema multiforme. To confirm a diagnosis of this disease, a sputum culture, wet mount, and serological tests should be performed. The risk of dissemination, which is highest in the second and third trimesters, can be estimated by a complement-fixation titer. In disseminated cases aggressive treatment with amphotericin B has improved the previously reported high maternal and neonatal mortality rate. Fortunately, case reports do not indicate that transplacental spread occurs. Reactivation or exacerbation of a chronic low-grade infection during pregnancy may occur in patients treated for prior disseminated disease (32, 34). Interestingly, both of the reported cases of reactivation or exacerbation occurred in insulin-dependent diabetics.

Topics: Adult; Amphotericin B; Coccidioidomycosis; Diabetes Mellitus, Type 1; Erythema Multiforme; Erythema Nodosum; Female; Fetal Death; Humans; Insulin Infusion Systems; Opportunistic Infections; Pregnancy; Pregnancy Complications, Infectious; Pregnancy in Diabetics; Pregnancy Trimester, Second

We report one case of severe Candida glabrata chorioamnionitis and septicemy occurring in a twin pregnancies achieved by in vitro fertilization techniques which resulted in pregnancy loss after preterm rupture of the membrane at 22 weeks of gestation despite a treatment with amphotericin B.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Candida glabrata; Candidiasis; Chorioamnionitis; Female; Fertilization in Vitro; Fetal Death; Fetal Membranes, Premature Rupture; Humans; Pregnancy; Pregnancy, Multiple; Sepsis; Twins

The embryotoxic action of amphotericin B and its methyl derivative was compared in rats after their intravenous and intraamniotic administration. The concentrations of amphotericin B and its methyl derivative in the amniotic cavity on days 13, 14 and 15 of pregnancy were 1.5 and 36 micrograms/ml, respectively. When administered intravenously during the preimplantation period the antibiotics had no embryotoxic action. Intravenous administration of amphotericin B in a dose of 500 micrograms/kg and its derivative in a dose of 2000 micrograms/kg during organ genesis induced a decrease in the craniocaudal size. In a dose of 3000 micrograms/kg administered intravenously the methyl derivative of amphotericin B induced an increase in postimplantation death rates. Administration of amphotericin B to the amniotic cavity had no damaging action. Administration of the methyl derivative on day 15 of pregnancy led to anomalous development of the lower extremities and slower ossification. The threshold doses by the embryotoxic action for intravenous administration are 500 micrograms/kg for amphotericin B and 2000 micrograms/kg for the methyl derivative. Administration of the antibiotics to the amniotic cavity revealed potential teratogenic properties of the amphotericin B methyl derivative.

Topics: Abnormalities, Drug-Induced; Amnion; Amphotericin B; Animals; Disease Models, Animal; Dose-Response Relationship, Drug; Female; Fetal Death; Fetal Growth Retardation; Hindlimb; Injections; Injections, Intravenous; Pregnancy; Rats; Teratogens