amphotericin-b and Gastrointestinal-Hemorrhage

To determine the incidence of hematogenous candida endophthalmitis in seriously ill patients given parenteral hyperalimentation fluids, 131 hyperalimented postoperative patients were prospectively evaluated. All patients were screened weekly for the development of chorioretinal lesions, blood cultures positive for Candida albicans, and signs and symptoms of candida infection. Thirteen (9.9%) of 131 patients developed chorioretinal lesions compatible with hematogenous candida endophthalmitis. Seven of the 13 patients with eye lesions had blood cultures positive for yeast, whereas only two of 118 without eye lesions had blood cultures positive for yeast (P less than 0.0005). Thus, the occurrence of eye lesions consistent with hematogenous candida endophthalmitis correlated with positive blood cultures for yeast and strongly suggested invasive candidiasis.

Topics: Amphotericin B; Candidiasis; Candidiasis, Oral; Chorioretinitis; Culture Media; Endophthalmitis; Gastrointestinal Hemorrhage; Humans; Intertrigo; Parenteral Nutrition; Parenteral Nutrition, Total; Urinary Tract Infections; Wound Infection

Histoplasmosis is an invasive mycosis caused by inhalation of the spores of dimorphic fungi Histoplasma capsulatum. The disease manifests in the lung as acute or chronic pulmonary histoplasmosis and in severe cases gets disseminated in multiple organs like skin, adrenal gland, central nervous system, lymph node, liver, spleen, bone marrow, and gastrointestinal tract. It occurs most commonly in immunodeficient patients like HIV-positive patients and transplant recipients, while immunocompetent hosts are affected rarely. In cases of gastrointestinal histoplasmosis, the samples are collected for culture and biopsy should be sent for histopathological examination for definitive diagnosis. We conducted a retrospective study of colonic biopsies performed in the department of gastroenterology in a tertiary care hospital of north India from January 2014 to December 2015. Five cases of colonic histoplasmosis were diagnosed on histopathology out of which 4 patients were from north India while 1 patient was from Myanmar. The patients presented with various complaints, including loose stools, diarrhea, altered bowel habits, and gastrointestinal bleeding. The prognosis is very good after early and aggressive treatment while the disease is fatal if it remains untreated. In our study, 2 patients died within few days of diagnosis due to delay in the diagnosis, dissemination, and associated complications. Other patients were started on amphotericin B deoxycholate and are under follow-up. An early diagnosis of gastrointestinal histoplasmosis is important as appropriate treatment leads to long-term survival while untreated cases are almost fatal.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Biopsy; Colon; Colonoscopy; Deoxycholic Acid; Diarrhea; Drug Combinations; Female; Follow-Up Studies; Gastrointestinal Hemorrhage; Histoplasma; Histoplasmosis; Humans; India; Male; Middle Aged; Prognosis; Retrospective Studies; Time Factors

Two hemophiliacs infected with human immunodeficiency virus (HIV) presented with hematochezia secondary to gastrointestinal involvement with Histoplasmosis capsulatum. In one patient who was already receiving fluconazole, the diagnosis was obscured. Both patients responded to amphotericin B followed by intraconazole, with no recurrence of bleeding.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Diagnosis, Differential; Fluconazole; Gastrointestinal Diseases; Gastrointestinal Hemorrhage; Hemophilia A; Histoplasmosis; Humans; Male; Middle Aged

A young woman with acute myelocytic leukemia developed acute lower gastrointestinal bleeding immediately after a first remission induction of her leukemia. After the site of bleeding was located in the descending colon, a necrotic bleeding ulcer was resected. Histologic examination of the ulcer established the diagnosis of gastrointestinal mucormycosis. Treatment with amphotericin B was administered because of the high risk of dissemination. The patient has been followed for 9 months with no evidence of relapse of infection. Survival after gastrointestinal mucormycosis in acute leukemia has not previously been reported in the English language literature. Success in managing mucormycosis depends on the adherence to the recommended principles of early aggressive diagnostic measures, excisional surgery, amphotericin B therapy, and control of the underlying predisposing condition.

Topics: Adult; Amphotericin B; Female; Gastrointestinal Hemorrhage; Humans; Leukemia, Myeloid, Acute; Mucormycosis

Two cases of candidiasis occured in the stomach. The first is a case of disseminated candidiasis with stomach wall involvement. The patient had Hodgkin's disease and responded to chemotherapy and amphotericin B. The second is a case of superficial invasion of Candida in a stitch ulcer. Systemic and local factors influence growth of Candida in the stomach.

Topics: Aged; Amphotericin B; Candida; Candidiasis; Female; Gastritis; Gastrointestinal Hemorrhage; Hodgkin Disease; Humans; Male; Middle Aged; Stomach Ulcer; Sutures