amphotericin-b and Gingival-Diseases

Mucormycosis (phycomycosis, zygomycosis) is an acute opportunistic infection caused by a saprophytic fungus found in soil, bread molds, and decaying fruits and vegetables. Numerous predisposing risk factors are associated with mucormycosis, although most cases have been reported in poorly controlled diabetics or in patients with hematologic malignant conditions. This report presents two cases of oral mucormycosis. One case occurred in the maxilla in a patient with well-controlled diabetes. The other involved the mandible and overlying gingiva in a patient with acute myelogenous leukemia. A review of the literature concerning oral mucormycosis is also presented.

Topics: Adult; Aged; Amphotericin B; Candidiasis, Oral; Diabetes Complications; Gingival Diseases; Humans; Leukemia, Myeloid, Acute; Male; Mandibular Diseases; Maxillary Diseases; Mouth Diseases; Mucormycosis

Due to an increasing number of leukemic patients with invasive gingival aspergillosis during neutropenia (neutrophils <500 cells/microl for >10 days), we evaluated the efficacy of oral itraconazole prophylaxis for preventing this invasive infection at our hospital.. This was a retrospective, non-randomized study to analyze the onset of identified invasive gingival aspergillosis among 536 patients with acute leukemia at risk due to the presence of neutropenia from 1991 to 1998. Patients received itraconazole capsules 100 mg/day prophylactically between April 1994 and December 1996, and 200 mg/day between January 1997 and December 1998. Itraconazole serum levels at day 10 were measured in some patients.. In the 39 months prior to April 1994 without itraconazole prophylaxis, 15 cases of invasive gingival aspergillosis were detected in 192 high risk patients with 469 episodes of neutropenia (7.8% of the high risk patients). Between April 1994 and December 1996, using itraconazole prophylaxis at 100 mg/day, there was a dramatic decrease in the infections resulting in 3 of 198 high risk patients with 511 episodes of neutropenia (1.5% of the high risk patients). Furthermore, between January 1997 and December 1998, using itraconazole prophylaxis at 200 mg/day, no cases of the infection were observed in the 146 high risk patients with 380 episodes of neutropenia. The incidence of invasive gingival aspergillosis was significantly lower among patients administered itraconazole than among those without itraconazole (100 mg/day; P = 0.006 and 200 mg/day; P = 0.001). The mean itraconazole serum level in 20 patients receiving 100 mg/day was 71.78 ng/mL and in 16 patients receiving 200 mg/day was 202.67 ng/ml.. These findings suggest that oral itraconazole could be effective for preventing invasive gingival aspergillosis in neutropenic patients with acute leukemia and warrants further randomized investigation.

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis, Oral; Capsules; Chi-Square Distribution; Chromatography, High Pressure Liquid; Cohort Studies; Fluconazole; Flucytosine; Gingival Diseases; Humans; Immunocompromised Host; Itraconazole; Leukemia, Myeloid, Acute; Leukocyte Count; Neutropenia; Neutrophils; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Risk Factors; Treatment Outcome

Primary invasive aspergillosis of the oral cavity is a rare but serious complication in immunocompromised patients. We report a case of gingival Aspergillus infection in a neutropenic patient with acute myelogenous leukemia, who was successfully treated by an early surgical approach in combination with antifungal medication and granulocyte colon stimulating factors.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Female; Fluconazole; Flucytosine; Gingival Diseases; Granulocyte Colony-Stimulating Factor; Humans; Immunocompromised Host; Itraconazole; Leukemia, Myeloid, Acute; Neutropenia

A 59-year-old Caucasian male patient with AIDS is described who presented with an oral lesion of cryptococcosis. The gingival ulceration was the only detectable lesion of cryptococcosis. Diagnosis was established by histopathologic findings from biopsy and detection of serum cryptococcal antigen. The patient was treated with amphotericin B and flucytosine. After four weeks of therapy cryptococcal antigen turned negative. The oral ulceration diminished in size, but an inflammatory tissue reaction persisted.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Cryptococcosis; Dental Care for Chronically Ill; Drug Therapy, Combination; Fatal Outcome; Flucytosine; Gingival Diseases; Humans; Male; Middle Aged; Mouth Diseases; Ulcer

The fungus Fusarium moniliforme causes fusariosis, which can be invasive and fatal in immunocompromised patients. We report a case of oral Fusarium infection in a granulocytopenic patient with acute myelogenous leukemia who developed necrotic ulceration of the gingiva, extending to the alveolar bone, but was otherwise free of any active systemic lesions. Fusarium moniliforme was identified, by histopathology and culture, to be present in the lesion and was deduced to be the causative organism for this invasive oral infection.

Topics: Acute Kidney Injury; Aged; Agranulocytosis; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Epirubicin; Etoposide; Fatal Outcome; Fusarium; Gingival Diseases; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Maxillary Diseases; Mercaptopurine; Mycoses; Necrosis; Prednisolone; Ulcer; Vindesine

The diagnosis of acute lymphatic non-T-non-B leukaemia of common ALL type was confirmed in a 22-year-old woman. Cytostatic treatment brought full remission for 21/2 years. Renewed cytostatic treatment for recurrence brought about a mucormycosis in the mid-face region during a period of protracted agranulocytosis, despite antibiotic prophylaxis with ketoconazole and cotrimoxazole. The causative mucor organism was demonstrated in smears and biopsy material. The infection was successfully treated with i.v. amphotericin B and débridement of the affected tissue. There remained large tissue defects in the region of gum, nose, upper lip and right oral cavity. Previously the mortality rate of mucormycosis in the course of leukaemia was 100%.

Topics: Adult; Agranulocytosis; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Debridement; Facial Dermatoses; Female; Gingival Diseases; Humans; Leukemia, Lymphoid; Mouth Diseases; Mucormycosis; Nose Diseases; Palate; Paranasal Sinus Diseases

A case of localised histoplasmosis of the gingivae, with no osseous involvement is described in a 50-year-old man. The diagnosis was based on histology, growth on culture and a positive histoplasmin latex test. Therapy was commenced with intravenous amphotericin but was changed to intravenous miconazole because of serious immediate side effects and the development of marked renal impairment and moderate suppression of erythropoiesis. Rebiopsy of the gingival margin showed therapy to be effective. No source of the infection could be traced.

Topics: Amphotericin B; Gingival Diseases; Histoplasmosis; Humans; Imidazoles; Injections, Intravenous; Male; Miconazole; Middle Aged

Topics: Adult; Amphotericin B; Australia; Biopsy; Gingival Diseases; Histoplasma; Histoplasmosis; Humans; Liver; Male; Radiography; Soil Microbiology; Ulcer