amphotericin-b and Granuloma

Fungal granulomas of the central nervous system are rare and have a high rate of mortality and morbidity, irrespective of treatment. The authors report their experience of managing 66 patients during 15 years and discuss the clinical, radiological, surgical, and pathologic findings. This series is among the largest reported.. A retrospective analysis was performed on patients with intracranial fungal granulomas (ICFGs), treated in the authors' institution, between January 1997 and May 2011. Only mass-forming histopathologically proven ICFGs were included in this study.. The age of the patients ranged from 7 years to 67 years (mean = 32.3 years), and most patients were in the third and fourth decades of life. The study population comprised 47 male and 19 female patients. The most common symptom was headache (41 patients), followed by vomiting (16 patients) and blurring of vision (16 patients). Only 3 patients presented with fever. The duration of symptoms was less than 6 months in all cases and less than 3 months in 39 cases. Anterior cranial fossa and frontal lobe was involved in 35 cases (54.5%), followed by middle cranial fossa in 20 cases (30.3%). Three cases had granulomas in the cerebellopontine angle. Three cases had multicompartmental involvement, and 4 had multilobar involvement. Nine patients had predisposing factors for fungal infection Based on clinical and imaging data, preoperative diagnosis of a possible fungal lesion was made in 44 (some had only computed tomography imaging) patients. All the patients were treated surgically, followed by antifungal treatment with amphotericin-B and/fluconazole/itraconazole for a period of 6 weeks. Eight patients had symptomatic recurrence of lesions 3-12 weeks after treatment and underwent reoperation. Six patients were lost to follow-up. Nine patients died in the postoperative period (within 30 days postoperatively). Fifteen patients died during follow-up because of recurrent lesions, repeat surgery, renal failure, and unrelated causes. Overall mortality was 24 (36.3%). Poor neurologic status before surgery, emergency craniotomy, severe brain edema with mass effect, and opening of ventricles during surgery were associated with poor outcome. Aspergillus species were the causative organism in an overwhelming majority of patients (n = 52) followed by Mucor in 7 cases, Cladosporium in 3 cases, eumycetoma in 2 cases, and maduramycosis and blastomycosis in 1 case each.. ICFGs have high rates of morbidity and mortality. Early diagnosis, radical surgery, and antifungal treatment for 6 weeks may improve outcome. Poor neurologic status of patients at the time of presentation, immunocompromised state, contamination of ventricular cerebrospinal during surgery, and renal failure (attributable to amphotericin-B) are associated with poor outcome.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Brain; Central Nervous System Fungal Infections; Child; Craniotomy; Drug Therapy, Combination; Emergency Treatment; Female; Fluconazole; Granuloma; Humans; Immunocompromised Host; Itraconazole; Male; Middle Aged; Neuroimaging; Recurrence; Renal Insufficiency; Reoperation; Retrospective Studies; Risk Factors; Survival Rate

We report a case of a 27-year-old male who presented with respiratory distress that required mechanical ventilation. Transbronchial biopsy revealed adiaspores of the fungus Emmonsia crescens within granulomata, a condition known as adiaspiromycosis. The patient received amphotericin products and corticosteroids, followed by itraconazole, and made a full recovery. Emmonsia crescens is a saprobe with a wide distribution that is primarily a rodent pathogen. The clinical characteristics of the 20 cases of human pulmonary adiaspiromycosis reported since the last comprehensive case review in 1993 are described here, as well as other infections recently reported for the genus Emmonsia. Pulmonary adiaspiromycosis has been reported primarily in persons without underlying host factors and has a mild to severe course. It remains uncertain if the optimal management of severe pulmonary adiaspiromycosis is supportive or if should consist of antifungal treatment, corticosteroids, or a combination of the latter two. The classification of fungi currently in the genus Emmonsia has undergone considerable revision since their original description, including being grouped with the genus Chrysosporium at one time. Molecular genetics has clearly differentiated the genus Emmonsia from the Chrysosporium species. Nevertheless, there has been a persistent confusion in the literature regarding the clinical presentation of infection with fungi of these two genera; to clarify this matter, the reported cases of invasive Chrysosporium infections were reviewed. Invasive Chrysosporium infections typically occur in impaired hosts and can have a fatal course. Based on limited in vitro susceptibility data for Chrysosporium zonatum, amphotericin B is the most active drug, itraconazole susceptibility is strain-dependent, and fluconazole and 5-fluorocytosine are not active.

Topics: Adult; Amphotericin B; Antifungal Agents; Chrysosporium; Granuloma; Humans; Lung Diseases, Fungal; Male; Radiography; Respiratory Insufficiency

Cryptococcal infection in CNS is frequently seen in HIV patients and those with other immunosuppressed conditions. However, cryptococcal granuloma in CNS in immunocompetent patient is rare. We present one new case of cryptococcoma and review literature to illustrate diagnosis and treatment of these lesions.. We conducted literature search in Pubmed search engine of the National Center for Biotechnology Information.. Seventeen cases of CNS cryptoccoma in immunocompetent patients, including ours, have been reported to date. Of them, two patients had lesions inside spinal cord, and C. neoformans var. gattii was identified in three cases. All patients were symptomatic with normal immunocompetency although two patients had type 2 diabetes mellitus and one had torsades de pointes. Eight patients received surgical treatment and all were given antifungal agents except one suspected of teniasis.. With literature reports and our experiences, we suggest that ring shaped enhancement of mass lesion with or without cystic changes in MR scan may indicate cryptococcoma, but definitive diagnosis relies on pathology study of lesion specimen. Open surgery and anti-fungal therapy should be scheduled, and outcome of cryptococcoma is largely determined by its locations.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Central Nervous System Fungal Infections; Child; Cryptococcosis; Female; Granuloma; Humans; Immunocompetence; Injections, Intravenous; Magnetic Resonance Imaging; Male; Middle Aged; Neurosurgical Procedures; Tomography, X-Ray Computed; Young Adult

The perceptions of coccidioidomycosis as a medical problem has undergone sequential and dramatic metamorphoses since its first description more than a century ago. First thought to be rare and lethal, coccidioidomycosis was subsequently found to be common and often mild. During World War II, its overall impact upon large populations came sharply into focus and the consequences for public health became clearer. Early treatments had significant limitations and toxicities, and therefore treatment of coccidioidomycosis was reserved for only the sickest patients. Since then, safer oral therapies have become commonplace. Despite their availability, there has been no investigation of their use in the less severe and much more common early infections. Even newer drugs such as nikkomycin Z, which might actually cure infections, until very recently have had trouble finding a sponsor to move it through clinical trials. Perceptions once formed by the understanding of coccidioidomycosis as a medical problem now appear to hinder the future study of newer therapeutic opportunities. It is suggested in this review that it is time to revisit and possibly change these perceptions if we are to improve our care of patients.

Topics: Administration, Oral; Aminoglycosides; Amphotericin B; Antifungal Agents; Attitude to Health; Coccidioidomycosis; Granuloma; Humans; Miconazole; Perception; Public Health

Infection of the nervous system by Cryptococcus neoformans most often causes meningitis and meningoencephalitis. While there have been several cases of cerebral cryptoccal granuloma published in the literature, the isolated occurrence of intramedullary cryptococcal granuloma is very rare. We present an immunocompetent patient with such a lesion of the conus medullaris. The patient's clinical symptoms mimicked an intramedullary spinal cord tumor. The diagnosis was made by histopathology, rather than by image or laboratory examinations. The case was successfully managed with surgical removal of the lesion and postoperative anti-fungal treatment.

Topics: Aged; Amphotericin B; Antifungal Agents; Cryptococcus neoformans; Diagnosis, Differential; Fluconazole; Granuloma; Humans; Immunocompetence; Laminectomy; Male; Spinal Cord Diseases; Spinal Cord Neoplasms

Fusariosis, a rare infectious disease of the immunocompromised host, is relatively resistant to amphotericin B (AmB) or other antifungal agents. We describe a 5-year follow-up of a 40 year old woman with T-type acute lymphoblastic leukemia who following chemotherapy developed prolonged high fever, chills, night sweats, and severe weakness. Liver function tests were impaired and abdominal computerized tomography (CT) showed multiple lesions in the liver and abnormal structure of the spleen. A laparotomy revealed multiple granulomas containing Fusarium sp. in the liver, and the spleen was heavily infiltrated by the same fungus. The patient failed to respond to the conventional AmB dosage form (Fungizone) even after a total dose of 3.0 g was given, and developed significant renal impairment. AmB was complexed (in a mole ratio of 1:16) with a mixture of the phospholipids dimyristoyl phosphatidylcholine and dimyristoyl phosphatidylglycerol (mixed in 7:3 mole ratio). The resulting drug complex, AmB-PLC, was then administered (1-4 mg/kg/day, total dose 4.2 g) and subsequently the patient was cured of all symptoms of fusariosis. There were only mild side effects and no nephrotoxicity was evident. On the contrary, marked improvement of the renal function tests occurred during AmB-PLC treatment. Eight months later, she developed a spinal lesion with dense consistency in L5 and S1, and after receiving another course of AmB-PLC (3.1 g) she recovered completely. In a 2 year follow-up period the patient had no further relapse of the fungal disease. Subsequent chemotherapy given for relapse of the leukemia was followed by a new fungal infection, which was treated with AmB-cholesteryl sulfate complex (Amphocil).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Daunorubicin; Dimyristoylphosphatidylcholine; Drug Carriers; Female; Follow-Up Studies; Fusarium; Granuloma; Hepatitis; Humans; Immunocompromised Host; Kidney Diseases; Leukemia-Lymphoma, Adult T-Cell; Mycoses; Neutropenia; Phosphatidylglycerols; Prednisone; Recurrence; Splenic Diseases; Vincristine

The authors report a case of aspergillus granuloma of the brain, in a 28 year old woman, simulating a meningioma. Preoperative diagnosis of aspergilloma is difficult. However, it may be suspected in a patient who has associated pulmonary and paranasal sinus fungal infection. Peroperatively it may be confused with a brain tumour. The lesions usually are in the frontal lobes. Diagnosis can be made only by surgical biopsy with identification of fungal elements. Granuloma induce a good host response, and a high capacity to elaborate antibodies.

Topics: Adult; Aged; Amphotericin B; Aspergillosis; Brain Diseases; Brain Neoplasms; Child; Diagnosis, Differential; Female; Flucytosine; Granuloma; Humans; Male; Meningioma; Middle Aged; Olfaction Disorders; Tomography, X-Ray Computed

Topics: Amphotericin B; Aspergillosis; Candida; Candidiasis; Child; Child, Preschool; Coccidioidomycosis; Coccidiosis; Cryptococcosis; Endocarditis; Granuloma; Histoplasmosis; Humans; Infant; Kidney; Kidney Function Tests; Meningitis; Mycoses; Pneumonia

Topics: Amphotericin B; Animals; Columbidae; Communicable Disease Control; Cryptococcosis; Granuloma; Humans; Meningitis; Refuse Disposal

We report on a 22-years-old Thai male patient with congenital HIV infection. Due to his non-adherence to antiretroviral treatment he developed disseminated

Topics: Amphotericin B; Anterior Chamber; Antifungal Agents; Fungemia; Granuloma; HIV Infections; Humans; Male; Mycoses; Talaromyces; Uveitis, Anterior; Young Adult

Idiopathic CD4 lymphocytopenia (ICL) is a rare disease characterized by marked loss of CD4 T-cells without human immunodeficiency virus infection. CD4 T-cells play an important role in granuloma formation in cryptococcal infection. Thus far, among ICL patients, it has not been concluded definitely whether granuloma is formed or not. We report the case of a 39-year-old woman with ICL and disseminated cryptococcal infection with granuloma formation. She was referred to our department because of a lung mass, osteolytic lesion, and a subcutaneous mass identified on a computed tomography scan, and an elevated C-reactive protein level. Cryptococcus neoformans was isolated from the tissues. She also had marked CD4 lymphocytopenia (33 cells/μL), without human immunodeficiency virus infection. In a biopsy specimen of the lung mass, granulomas containing CD4 T-cells were observed. The cryptococcosis was treated with liposomal amphotericin B followed by fluconazole and she was found to be cured. The CD4 T-cell count was persistently low. This case showed that granulomas containing CD4 T-cells can be formed in ICL patients with cryptococcal infection despite very low CD4 T-cell counts.

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; CD4 Lymphocyte Count; Cryptococcosis; Cryptococcus neoformans; Female; Fluconazole; Granuloma; Humans; Lung; Sjogren's Syndrome; T-Lymphocytopenia, Idiopathic CD4-Positive; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adalimumab; Adult; Amphotericin B; Anti-Inflammatory Agents; Antibodies, Monoclonal; Antiprotozoal Agents; Brazil; Diagnosis, Differential; Granuloma; Humans; Infliximab; Leishmaniasis, Mucocutaneous; Lymphoma, T-Cell; Male; Tumor Necrosis Factor-alpha

Entomophtoramycosis is a type of subcutaneous mycosis which includes both basidiobolomycosis and conidiobolomycosis; the latter is caused by Conidiobolus coronatus, a saprophytic fungus which lives in tropical soils. This mycosis characteristically affects the paranasal sinuses and oropharynx, with the potential to deform the face in patients without apparent immunodeficiency. It has a chronic course of infection with a tendency to form granulomas visible using histology. We present the case of a 28 year-old male agricultural worker, with a clinical profile of 6 months' evolution of rhinofacial tumefaction, nasal obstruction and post-nasal drip who was diagnosed with conidiobolomycosis by means of tissue culture after multiple biopsies of the facial area. The patient received antifungal treatment with amphotericin B and subsequently with itraconazol, resulting in a dramatic improvement without the need for surgical treatment; itraconazol was administered for one year and there was no evidence of relapse at the end of this period. Due to the low frequency of this disease there is no established treatment strategy; however, the use of azoles such as itraconazol with or without adjuvant surgical treatment is increasingly seen in case reports. The present report adds to the clinical experience in Colombia of this rare mycosis and also describes the long-term clinical and therapeutic response.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Conidiobolus; Dermatomycoses; Face; Granuloma; Humans; Itraconazole

Fungi are ubiquitous in nature but have low virulence and cause disease usually when the host defenses are compromised. Fungal infections of the central nervous system are rare and are usually seen in immunocompromised patients. However, in recent years, there has been an increase in the number of central nervous system fungal infections in immunocompetent individuals. Intracranial fungal granulomas are rare space-occupying lesions. Among these, Aspergillus granuloma is the most common. Craniocerebral involvement by aspergillosis usually occurs via the hematogenous route or through contiguous spread from the paranasal sinuses. Predominant symptoms associated with cranial fungal granuloma include headache, vomiting, proptosis, and visual disturbances. Common signs include papilledema, cranial neuropathy, hemiparesis, and meningismus. We present a case of invasive Aspergillus granuloma in an immunocompetent individual, who presented with a palpable mass in the buccal mucosa following removal of an impacted mandibular third molar but with no other characteristic signs and symptoms of invasive fungal granuloma. To our knowledge, there is no documentation of aspergillosis presenting as a swelling in the buccal mucosa. Unexplained swellings in the buccal mucosa should be viewed with a high degree of suspicion and investigated thoroughly at the earliest.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Biopsy; Combined Modality Therapy; Contrast Media; Diagnosis, Differential; Diagnostic Imaging; Female; Granuloma; Humans; Mouth Mucosa; Voriconazole

The treatment of chronic granulomatous fungal sinusitis (CGFS), a rare form of invasive fungal sinusitis, is controversial.. To assess the response to postoperative antifungal therapy in patients with CGFS and suggest an effective treatment protocol.. Clinical records of patients with CGFS who had undergone excisive surgery followed by antifungal therapy were reviewed to assess current disease status.. Fourteen male and 4 female patients were diagnosed with CGFS, based on typical histopathological and fungal smear/ culture results. Aspergillus flavus was isolated from 88.9% cases. Stage 1 patients had resectable sinonasal disease, stage 2 had additional spread to orbit/palate and stage 3 had extensive disease. Follow-up ranged from 6 months to 8 years. Residual disease was seen in all but one patient who received amphotericin B as first line therapy and in none of those who received itraconazole or voriconazole. Even those who received azoles as second line therapy were disease free at last follow-up.. Surgery followed by itraconazole or voriconazole for Stage 1 and 2 disease and voriconazole for stage 3 disease is recommended for a good outcome. Amphotericin B is not recommended as first line therapy for CGFS.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Chronic Disease; Combined Modality Therapy; Female; Granuloma; Humans; Itraconazole; Male; Middle Aged; Mycoses; Sinusitis; Treatment Outcome; Voriconazole

Chronic granulomatous invasive fungal sinusitis (CGIFS) is rare and a consensus on ideal management is lacking. We present an extensive case managed successfully with a conservative approach.. Case report and literature review.. The patient presented with unilateral proptosis, papilledema, and headache. Imaging revealed an infiltrative process with extensive intracranial and intraorbital involvement. Biopsy showed fungal elements and granulomatous reaction consistent with CGIFS. The patient was managed with conservative surgery and long-term oral voriconazole.. This case supports a conservative surgical approach in some patients with extensive CGIFS. Oral voriconazole is effective and has significant advantages over more toxic agents administered intravenously.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Chronic Disease; Granuloma; Humans; Male; Pyrimidines; Sinusitis; Triazoles; Voriconazole

Mucormycosis is a rare opportunistic fungal infection with clinical polymorphism and is rapidly extensive and destructive. It is caused by fungi of the mucorales group in the environment and generally arises in the context of immunosuppression. Often difficult and late, diagnosis is based on mycological and histological examination. We report the case of a 10-year-old patient admitted for a pruritic erythematous scaly eruption located in the right inguinal area associated with satellite lymphadenopathy and lymphedema of the right lower limb. The histological study of the cutaneous biopsy revealed a granulomatous reaction with filaments. The mycological examination of the collection of the cutaneous lesion showed mucorales filaments and a stump of Absidia corymbifera was isolated. Abdomino-pelvic CT showed muscular extension with vascular and ureteral englobement. The diagnosis of cutaneous mucormycosis was made. Immunological investigations were normal. Treatment included itraconazole for 3months followed by IV amphotericin B for 1month, with favorable clinical and radiological progression. Mucormycosis is an uncommon fungal infection whose cutaneous localization is rare. It occurs exceptionally in immunocompetent patients and is clinically manifested by a vesicular and pustular rash progressing to ulceration. The diagnosis is confirmed by mycological and histological studies. Treatment consists of antifungal therapy associated with surgical excision of necrotic and infected tissue.

Topics: Amphotericin B; Antifungal Agents; Child; Dermatomycoses; Erythema; Granuloma; Groin; Humans; Immunocompetence; Itraconazole; Lymphedema; Male; Mucormycosis; Pruritus

Nasal masses in the koala (Phascolarctos cinereus) are not uncommon and can be challenging to diagnose and treat. Differential diagnoses for nasal masses in the koala are cryptococcal granulomas, nasal polyps, nasal adenocarcinoma, and osteochondromatosis. This report describes successful surgical approaches for two adult koalas with nasal masses and includes photodocumentation and description of the anatomy of the koala nasal passages from the postmortem transverse sectioning of a normal koala head. Surgical removal of the nasal masses in these koalas resulted in a rapid resolution of clinical signs.

Topics: Amphotericin B; Animals; Anti-Bacterial Agents; Antifungal Agents; Cryptococcosis; Cryptococcus; Female; Granuloma; Itraconazole; Male; Nose Neoplasms; Phascolarctidae; Skull

A 3-yr-old female koala (Phascolarctos cinereus) was diagnosed with a nasal sinus granuloma caused by Cryptococcus gattii after a pre-shipment examination revealed a latex cryptococcal agglutination titer of 1:512. Successful medical and surgical treatment of the granuloma was monitored using serial latex cryptococcal agglutination titers, serum levels of antifungal drugs, and advanced imaging.

Topics: Amphotericin B; Animals; Antifungal Agents; Cryptococcosis; Cryptococcus gattii; Female; Fluconazole; Granuloma; Itraconazole; Phascolarctidae; Sinusitis

A 39-year-old man from Argentina, who had come to Japan 13 years previously, had been suffering from oral pain for several months. He was biopsied twice and treated with oral predonisolone without improvement. A number of white granular lesions with erosions were observed on the hard palate and buccal mucosa. Histopathological examination revealed a well-demarcated abscess with an accumulation of neutrophils, surrounded by epithelioid cell granulomas. Round eosinophilic bodies, considered to be fungal elements, positive for PAS and Grocott staining, were observed. Chest CT revealed cavities in the lung. A white yeast-like colony was cultured from bronchial lavage fluid and Paracoccidioides brasiliensis was identified. The patient was treated with liposomal amphotericin B followed by oral itraconazole 400 mg/day, with a favorable clinical course. Paracoccidioidomycosis, an imported mycosis, is rare in Japan and sometimes causes difficulty in diagnosis, resulting in inappropriate treatment.

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; Granuloma; Humans; Itraconazole; Japan; Lung; Male; Paracoccidioides; Paracoccidioidomycosis; Treatment Outcome

We observed morphological manifestation of encephalitis 3, 7, 10 and 28 days after intravenous infection of adult male CBA mice with Candida albicans. Compounds were administered intraperitoneally every other day starting from the next day postinfection. Untreated animals (100%) died over the period between days 18 and 20 postinfection; 60% animals receiving oxidized dextran alone survived by day 28 of observation. All animals treated with amphotericin B and composition of amphotericin B and oxidized dextran survived. On day 3 postinfection, the count of macrophage infiltrates and granulomas in the cerebral interstitium of mice treated with amphotericin B was equal to that in untreated mice, but was sufficiently lower in animals treated with the composition or oxidized dextran alone. On day 10, this index was similar in all groups and was approximately 5 times lower than in untreated animals on day 3. On day 28, macrophage infiltrates and granulomas were absent in the brain of all treated mice. These data suggest that oxidized dextran produced a therapeutic effect, which manifested earlier than the effect of amphotericin B and potentiated its effect, probably due to its competition with Candida albicans for mannose receptors on the brain-blood barrier endothelium.

Topics: Amphotericin B; Animals; Antifungal Agents; Brain; Candida albicans; Candidiasis; Cell Movement; Dextrans; Drug Synergism; Encephalitis; Granuloma; Macrophages; Male; Mice; Mice, Inbred CBA; Oxidation-Reduction; Survival Rate

Topics: Amphotericin B; Antifungal Agents; Central Nervous System Fungal Infections; Diagnostic Errors; Epiglottis; Female; Granuloma; Histoplasmosis; Humans; Middle Aged; Recurrence; Spinal Cord; Tuberculosis, Meningeal

Paracoccidioidomycosis is a systemic mycosis with a geographic distribution that is limited to Central and South America; Brazil has the highest number of cases. Severe disseminated disease caused by paracoccidioidomycosis was observed in acquired immunodeficiency syndrome patients who live or have resided in endemic paracoccidioidomycosis areas. Here we describe a male patient admitted to a large public hospital with diffuse nodular infiltrates observed in chest radiographs and with erosion at the second rib near the sternum. Blood tests showed anti-human immunodeficiency virus antibodies, a human immunodeficiency virus viral load of 59,700 (4.8 log), and CD4 144/mm(3), with negative serology result for fungal infections. Aspirate of the rib lesion showed cells with a typical morphology of Paracoccidioides brasiliensis, aside from benign inflammatory cells. The histology of the rib biopsy showed typical granulomas and immunostained fungal cells. Although there was no growth in the Sabouraud cultures, Paracoccidioides brasiliensis gp43 and rDNA genes were detected in the aspirate by polymerase chain reaction. Therapy with amphotericin resulted in complete recovery. This type of bone lesion is rare and has been described primarily in the juvenile form of paracoccidioidomycosis; it must be included in the differential diagnosis of bone lesions in adult acquired immunodeficiency syndrome patients of endemic areas.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Bacterial Agents; Bone Diseases, Infectious; CD4-Positive T-Lymphocytes; DNA, Bacterial; DNA, Ribosomal; Drug Therapy, Combination; Granuloma; Humans; Itraconazole; Male; Middle Aged; Paracoccidioides; Paracoccidioidomycosis; Ribs; Sulfadiazine; Treatment Outcome; Viral Load

Histoplasmosis is endemic to the midwestern and east central states in the United States near the Mississippi and the Ohio River valleys. Ninety-nine percent of patients exposed to histoplasmosis develop only subclinical infection. Liver involvement as a part of disseminated histoplasmosis is well known; however, isolated hepatic histoplasmosis without any other stigmata of dissemination is extremely rare and the literature is limited to only two case reports. We present a rare case of isolated granulomatous hepatitis due to histoplasmosis in a 35-year-old female with dermatomyositis receiving low-dose prednisone and methotrexate. There was no evidence of fungal dissemination elsewhere. High clinical suspicion is critical for early diagnosis and treatment.

Topics: Adult; Amphotericin B; Antifungal Agents; Female; Granuloma; Hepatitis; Histoplasmosis; Humans; Liver

In CBA mice infected with C. albicans, phasic pattern of granulomatosis development was observed. In all groups, the number of granulomas in the liver was minimum on day 56 after infection. Treatment with free amphotericin B and its composition with dialdehyde dextran (CA) reduced the number of infiltrations and granulomas in the liver, the changes were more pronounced in animals receiving CA. A different pattern of cyclic fluctuations of cortisol content in the blood and adrenal glands and progesterone content in the adrenal gland was observed. By the end of observation (day 84), cortisol content in the blood and adrenals of mice treated with CA was considerably lower than in untreated mice and animals receiving amphotericin B.

Topics: Adrenal Cortex Hormones; Adrenal Glands; Amphotericin B; Animals; Anticoagulants; Antifungal Agents; Candidiasis; Dextrans; Drug Therapy, Combination; Granuloma; Hydrocortisone; Liver; Male; Mice; Mice, Inbred CBA; Progesterone

A composition of amphotericin B and dialdehyde dextran was used for the therapy of male C57Bl/6 mice with systemic candidiasis. The composition was more effective than free amphotericin B. A decrease in the number and size of candidal granulomas in the lungs was more significant after therapy with the study composition (compared to free amphotericin B).

Topics: Amphotericin B; Animals; Antifungal Agents; Candidiasis; Dextrans; Granuloma; Inflammation; Lung Diseases, Fungal; Male; Mice; Mice, Inbred C57BL

A 57-year-old Japanese man complained of pain on micturition. The prostate was of normal size but hard. Transrectal needle biopsy demonstrated granulomatous prostatitis with small focal abscesses. Staining with periodic acid-Schiff, Grocott's methenamine silver and Fontana-Masson revealed yeast-form fungus in the granulomas. The mucoid capsule of the fungus stained with mucicarmine. PCR specific for cryptococcal 18S rDNA using DNA extracted from the pathological specimen was positive, and the sequence was homologous to Cryptococcus neoformans. A diagnosis of cryptococcal granulomatous prostatitis was made. The patient was then found to suffer from meningitis and lung abscess, and was treated with amphotericin B and flucytosine. Careful histological and molecular studies are beneficial to reach the correct diagnosis and to prevent an unfavorable outcome of disseminated cryptococcosis.

Topics: Abscess; Amphotericin B; Antifungal Agents; Carmine; Coloring Agents; Cryptococcosis; Cryptococcus neoformans; DNA, Fungal; DNA, Ribosomal; Drug Therapy, Combination; Flucytosine; Granuloma; Humans; Lung Diseases, Fungal; Male; Meningitis, Cryptococcal; Methenamine; Middle Aged; Periodic Acid-Schiff Reaction; Prostatitis; Ribotyping; RNA, Fungal; RNA, Ribosomal, 18S; Silver Nitrate; Staining and Labeling

Visceral leishmaniasis (VL) or Kala-azar is a common parasitic infection among children in Iran. The records of 249 children with VL were evaluated retrospectively. The clinical, hematologic, and bone marrow biopsy findings were studied. In particular, we assessed whether there was an association between bone marrow biopsy findings and prognosis. Five major groups were identified: (1) hypercellular marrow with many Leishman Donovan (LD) bodies, (2) multiple noncaseating granulomas with a few LD bodies, (3) diffuse fibrosis with rare LD bodies, (4) benign lymphoid nodules with many LD bodies, and (5) marrow necrosis with many LD bodies. The patients with hypercellular marrow and benign lymphoid nodules were alive and responded well to glucantime therapy. The patients with marrow fibrosis and marrow necrosis died and were resistant to any type of therapy. Patients with granulomas did not respond to glucantime therapy but responded to amphotericin B. However, less than half of the patients died owing to malnutrition and misdiagnosis. We correlated the bone marrow biopsy findings with the treatment outcomes and prognosis. The outcome was excellent in cases of hypercellular marrow, very poor in cases of fibrosis and necrosis, and intermediate in cases of granulomas. As a result, we believe that bone marrow biopsy findings can be helpful for assessing the prognosis of VL patients.

Topics: Amphotericin B; Antiprotozoal Agents; Biopsy; Bone Marrow; Bone Marrow Examination; Child; Child, Preschool; Female; Fibrosis; Granuloma; Humans; Leishmaniasis, Visceral; Male; Meglumine; Meglumine Antimoniate; Necrosis; Organometallic Compounds; Prognosis; Retrospective Studies

We compared the efficacy of treatments in a rabbit model of coccidioidal meningitis (CM).. Rabbits were infected intracisternally with Coccidioides immitis and treated with intravenous amphotericin B lipid complex (ABLC), deoxycholate amphotericin B (dAMB), oral fluconazole or diluent [sterile 5% dextrose in water (D5W)]. Survival and cfu in brain, spinal cord and CSF were determined and histology studied. Amphotericin B (AMB) concentrations in serum, CSF and tissue were determined by bioassay.. Fluconazole-treated rabbits and controls lost weight and had decreased mobility. All treatments prolonged survival (P = 0.005) and reduced cfu in brain and spinal cord (P

Topics: Administration, Oral; Amphotericin B; Animals; Antifungal Agents; Arteritis; Body Temperature; Brain; Cisterna Magna; Coccidioides; Drug Combinations; Fluconazole; Granuloma; Injections, Intravenous; Male; Meningitis, Fungal; Phosphatidylcholines; Phosphatidylglycerols; Rabbits; Spinal Cord; Survival Analysis

Lysosomotropic composition of dialdehyde dextran and amphotericin B had a greater therapeutic effect in mice with systemic candidiasis compared to free amphotericin B. This composition normalized glucocorticoid function of the adrenal glands and decreased the severity of liver destruction at late terms of granulomatous inflammation.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis; Dextrans; Disease Models, Animal; Drug Therapy, Combination; Granuloma; Liver Diseases; Male; Mice; Mice, Inbred C57BL

Cryptococcal spinal arachnoiditis occurs in patients with meningitis and usually when they are immunocompromised. Spinal symptoms in cryptococcosis are rare and a very exceptional entity in the immunocompetent population. We present a young immunocompetent male who developed progressively increasing paraparesis due to primary cryptococcal arachnoiditis, who showed significant improvement after antifungal therapy. Although extremely rare, spinal arachnoiditis in an immunocompetent individual can be caused due to cryptococcus, as in our case. This case illustrates and emphasizes the necessity for an exhaustive and complete investigation, with a high index of suspicion for fungal etiology in patients presenting with spinal arachnoiditis or other disabling, progressive spinal cord syndromes of unknown etiology. Awareness of this presentation is necessary to avoid delay in diagnosis and management of this potentially curable condition.

Topics: Amphotericin B; Arachnoiditis; Biopsy; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus neoformans; Diagnosis, Differential; Granuloma; Humans; Infusions, Intravenous; Low Back Pain; Magnetic Resonance Imaging; Male; Sacrum; Spinal Diseases; Tuberculosis, Spinal

Topics: Adult; Amphotericin B; Animal Husbandry; Animals; Animals, Wild; Antifungal Agents; Argentina; Chrysosporium; Coccidioidomycosis; Diagnosis, Differential; Granuloma; Humans; Lung Diseases, Fungal; Male; Radiography; Respiratory Distress Syndrome; Rodent Diseases

Involvement of the brain by neurotropic, dematiaceous fungi namely Cladosporium bantianum is extremely rare. The disease is very resistant to treatment and prone for frequent relapses despite treatment with amphotericin B and flucytosine, the drugs of choice for the infection. Surgery is often required for resection of the fungal granuloma. Isolation of the fungus from the tissue specimens and its culture, showing dark colored fungal colonies clinches the diagnosis. Animal inoculation studies can provide insights to the portal of entry of the organism. We hereby report a case of fungal granuloma of the brain due to C. bantianum, which responded favorably to intensive antifungal treatment alone, with relevant review of literature.

Topics: Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Cladosporium; Fluconazole; Granuloma; Headache; Humans; Magnetic Resonance Imaging; Male; Review Literature as Topic; Staining and Labeling

We report two cases of cutaneous cryptococcosis in male patients without underlying disease. Case 1 had a granulomatous mass on his right neck, gradually enlarging for 3 months. After the mass was debrided surgically in a hospital, the incision wound gradually developed into a severe ulceration. Mycological examination revealed Cryptococcus neoformans infection. It was significant that histopathology of both pre-surgery granuloma and post-surgery ulceration revealed thick-walled spores with thick capsule. Chest X-ray revealed a shadow in the left lower lung. After treatment with amphotec for 21 days, the lesion healed. Case 2 had an approximately 2 x 2 cm solitary dull nodule on his right thigh, which had been present for 8 months. Mycological examination confirmed that the lesion was caused by C. neoformans. The patient's ratio of peripheral blood CD4(+) cell was slightly reduced. After 14 days of treatment with oral fluconazole, followed by oral itraconazole for 2 months, mycological and clinical cure were achieved. The two isolates were identified as C. neoformans var. gattii serotype C and C. neoformans var. grubii serotype A.

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Fluconazole; Granuloma; Humans; Itraconazole; Male; Neck; Spores, Fungal; Thigh

We report the first case of Phialemonium obovatum fungemia with subsequent caseating granulomatas in the lung and Crohn disease-like involvement of the gastrointestinal tract in a bone marrow transplant recipient. This phaeoid fungus has been rarely described as an opportunistic infection in immunosuppressed patients. The patient was diagnosed with chronic myelogenous leukemia and underwent subsequent peripheral bone marrow transplant. After 6 months, he developed graft-versus-host disease of the skin and liver with fever and severe diarrhea. Fecal bacterial cultures and cytomegalovirus serologies were negative. Computed tomographic scan showed a peripheral pulmonary mass. A lung wedge biopsy of the lesion showed septate branching hyphae (4-5 microm in diameter) with terminal globular structures (10 microm in diameter). The hyphae were similar in width to that of an Aspergillus species but had a more moniliform appearance. Blood cultures grew a pure culture of P. obovatum. He was treated with amphotericin B and itraconazole for 6 months without remission of the diarrhea. Biopsies of the stomach, colon, and rectum showed granulomatous inflammation with marked crypt distortion simulating Crohn disease. In retrospect, the fungus was found to be resistant to both of the aforementioned drugs and susceptible to voriconazole and posaconazole. The gastrointestinal findings raise the possibility of further dissemination of a partially treated Phialemonium infection.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Bone Marrow Transplantation; Drug Resistance, Fungal; Fungemia; Gastrointestinal Diseases; Graft vs Host Disease; Granuloma; Humans; Immunocompromised Host; Itraconazole; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Lung Diseases, Fungal; Male; Middle Aged; Opportunistic Infections; Pyrimidines; Triazoles; Voriconazole

Cryptococcosis is the third most common invasive fungal infection in organ transplant recipients after candidiasis and aspergillosis. It occurs almost exclusively in the late posttransplantation period (>6 months after the initiation of immunosuppression). Subclinical onset of meningitis is the usual clinical presentation. Despite initiation of therapy, the mortality rate associated with this infection in this patient population remains high. To the best of our knowledge, this report describes one of the first cases of a rare entity: a primary cutaneous cryptococcosis in a renal transplant recipient disclosed by skull osteomyelitis and pseudotumoral intracranial extension. Surgical debridement and azole antifungal therapy were performed. Ten months after the onset of treatment, the patient feels good, clinical examination findings are normal, and no sign of evolutive cryptococcosis is noted.

Topics: Abscess; Amphotericin B; Animals; Antifungal Agents; Combined Modality Therapy; Cryptococcosis; Debridement; Diagnosis, Differential; Ducks; Environmental Exposure; Facial Injuries; Fluconazole; Graft Rejection; Granuloma; Granulomatosis with Polyangiitis; Humans; Immunocompromised Host; Immunosuppression Therapy; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Opportunistic Infections; Osteitis; Osteolysis; Parietal Bone; Postoperative Complications; Remission Induction; Seminoma; Skull Neoplasms; Subcutaneous Tissue; Testicular Neoplasms

In an experiment conducted using male CBA mice, cellular events during granulomatous Candida-induced inflammation were studied both in untreated animals and in animals treated with a new lysosomotropic composition, consisting of amphotericin B in intracellularly prolonged dextran immunomodulating matrix. To induce systemic Candida granulomatous inflammation, mice were given a single 0.2 ml intraperitoneal injection of Candida albicans culture (2.5 x 10(9) microbial bodies) dissolved in 0.9% isotonic saline. The findings obtained indicate greater therapeutic effect of amphotericin B and dextran dialdehyde composition as compared with a free (unconjugated) form of amphotericin B, that was manifested by the disappearance of granulomas and the capacity to prevent the development of spontaneous destructive processes in granulomas. Independent antimycotic effect of dextran dialdehyde was also demonstrated.

Topics: Amphotericin B; Animals; Candida albicans; Candidiasis; Dextrans; Granuloma; Lymph Nodes; Lymphatic Diseases; Male; Mice; Mice, Inbred CBA

Topics: Adolescent; Amphotericin B; Antifungal Agents; Child; Cryptococcosis; Cryptococcus neoformans; Granuloma; Humans; Immunocompetence; Lymph Nodes; Lymphadenitis; Male; Staining and Labeling; Treatment Outcome

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

Of the 21 patients with aspergillosis of central nervous system seen during the years 1990-1997, 16 (76%) had aspergillosis of sino-cranial origin. The occupation in patients with sino-cranial aspergillosis was either agricultural or manual work and predisposing risk factors were present in only two (12.5%) patients. Skull-base syndromes were the presenting features in 13 patients and three patients presented with features of intracranial space-occupying lesion. Paranasal sinus mass lesions were seen in all the 16 patients. Computerized tomography showed intracranial extradural-enhancing mass lesions in the anterior, middle or posterior cranial fossa in nine (68%) patients, intracranial and orbital lesions in four and orbital lesions in three. Well-formed granuloma with dense fibrosis was the histological feature. Survival rates were not good even after surgical and antifungal chemotherapy. Surgical treatment was subradical in our series. The majority of cases of sinocranial aspergillosis are reported from countries with temperate climates and the high incidence in these regions is probably related to constant exposure to the high spore content of pathogenic Aspergillus species in the 'mouldy' work environment.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Biopsy; Brain Diseases; Central Nervous System Fungal Infections; Climate; Female; Flucytosine; Granuloma; Humans; India; Male; Middle Aged; Occupational Diseases; Orbital Diseases; Risk Factors; Sinusitis; Tomography, X-Ray Computed

Fluconazole was reported to be an effective alternative to Amphotericin B for candidal endophthalmitis. However, the dose for systemic use had not been determined and few pathological reports on its use have been published. An epiretinal membrane harvested from a regressed candidal endophthalmitis in a patient treated with fluconazole (200 mg/day) was sent for pathologic study. On the inner side of the retina, a granuloma was found. Fungal debris was found within the center of the granuloma, but an intact fungus was seen next to the granuloma. Pathologic study showed incomplete treatment in this case, although systemic status had improved. The use of systemic fluconazole should be maintained for a longer period of time to treat candidal endophthalmitis.

Topics: Amphotericin B; Candidiasis; Endophthalmitis; Female; Fluconazole; Granuloma; Humans; Middle Aged

We report the occurrence of invasive Candida albicans infection with disseminated cutaneous Candida granulomas in a patient with aplastic anaemia after viral hepatitis. Fungal elements in a skin biopsy specimen were detected by PAS stain and identified as Candida sp. by immunohistochemistry directed against the C. albicans mannan surface antigen. Based on rapid diagnosis of Candida granuloma and by Candida-positive cultures of blood and swabs, systemic treatment with liposomal amphotericin B led to survival of the patient.

Topics: Adult; Amphotericin B; Anemia, Aplastic; Antibodies, Fungal; Antibodies, Monoclonal; Antifungal Agents; Antigens, Fungal; Antigens, Surface; Candida albicans; Candidiasis; Dermatomycoses; Granuloma; Hepatitis, Viral, Human; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immunocompromised Host; Immunohistochemistry; Male; Mannans; Polysaccharides, Bacterial; Sepsis

A case of extra-axial fungal (Blastomyces dermatitidis) granuloma in the region of the lower clivus is presented. The lesion simulated a meningioma both on radiological examination and on the macroscopic appearance at operation.

Topics: Adult; Amphotericin B; Antifungal Agents; Blastomyces; Brain Stem; Female; Granuloma; Humans; Magnetic Resonance Imaging

Nasopharyngeal conidiobolomycosis caused by Conidiobolus coronatus was diagnosed in a horse after endoscopic and histopathologic examinations of a biopsy specimen. The fungal lesions in the nasopharynx were substantially reduced in size after intralesional injection of amphotericin B through the biopsy channel of a videoendoscope in combination with i.v. administration of sodium iodide and oral administration of potassium iodide during a 2-month period. Endoscopy performed 15 months after initial examination revealed regression of the granulomatous masses in the nasopharynx and complete disappearance of the nasal masses. Two months later, clinical signs recurred, and the owner elected euthanasia without evaluation and treatment. Nasopharyngeal conidiobolomycosis may be treated successfully with intralesional injection of amphotericin B in combination with administration of sodium iodide and potassium iodide, but there is a possibility of recrudescence of infection.

Topics: Administration, Oral; Amphotericin B; Animals; Antifungal Agents; Endoscopy; Entomophthora; Female; Granuloma; Horse Diseases; Horses; Injections, Intralesional; Injections, Intravenous; Mycoses; Nasopharyngeal Diseases; Potassium Iodide; Recurrence; Sodium Iodide

To describe the MR appearance of necrotizing fungal granulomas occurring in the liver of leukemic patients with hepatosplenic fungal disease and transfusional hemosiderosis on antifungal antibiotics.. Four patients with acute myelogenous leukemia (n = 2) or acute lymphocytic leukemia (n = 2) who developed hepatosplenic fungal disease, and were treated with antifungal medication, underwent MRI examination on a 1.5 T MR imager. MR images were prospectively evaluated and correlated with liver biopsy (three patients), and clinical picture (one patient).. Multiple liver lesions measuring approximately 1 cm in diameter were identified in all patients. Lesions possessed a distinctive MR appearance: central mild hyperintensity with a peripheral ring of very low signal intensity on precontrast T1- and T2-weighted images. The central region of the lesions enhanced following gadolinium administration with the peripheral ring remaining low in signal intensity.. Necrotizing fungal granulomas in the liver of patients with transfusional hemosiderosis on treatment with antifungal antibiotics have a distinctive appearance of moderate high signal intensity center on T1- and T2-weighted and postgadolinium MR images with a peripheral rim of low signal intensity. This appearance reflects the presence of iron-laden macrophages in the periphery of granulomas and may be expected in processes that initiate an immune response involving aggregation of macrophages in the liver of patients with transfusional iron overload.

Topics: Acute Disease; Adolescent; Adult; Amphotericin B; Antifungal Agents; Candidiasis; Child; Female; Granuloma; Hemosiderosis; Humans; Itraconazole; Leukemia; Liver; Magnetic Resonance Imaging; Male; Middle Aged; Necrosis; Opportunistic Infections; Transfusion Reaction

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Biopsy; Cholestasis; Diagnosis, Differential; Fatal Outcome; Granuloma; Histoplasmosis; Humans; Liver; Liver Diseases; Male

We describe a patient with chronic granulomatous disease who presented with erythematous papular skin lesions on the chest, back, and arm. Examination of biopsy specimens from the lesions on the arm and back showed suppurative granulomata in association with acute and chronic inflammation. Histopathologic examination of a specimen from the lesion on the arm revealed fungal elements, and cultures yielded Microascus cinereus. The patient was treated with 2.5 g of intravenous amphotericin B, and the lesions resolved. We report what is, to our knowledge, the first case of invasive disease due solely to M. cinereus.

Topics: Amphotericin B; Ascomycota; Child; Dermatomycoses; Female; Granuloma; Granulomatous Disease, Chronic; Humans; Opportunistic Infections

This is the second case report of a temporal bone osteomyelitis caused by Blastomyces dermatitidis, which presented as a chronic serous otitis media. The presenting serous otitis media was refractory to conventional medical and surgical management and progressed to a temporal bone osteomyelitis prior to diagnosis. B. dermatitidis is a rare fungal pathogen that causes a systemic pyogranulomatous disease that primarily manifests itself in the skin, bones, pulmonary, and genitourinary systems. If left untreated it is associated with a high rate of mortality. The otologic presentation of this rare disease is emphasized, while the clinical and therapeutic features are reviewed.

Topics: Adult; Amphotericin B; Blastomyces; Blastomycosis; Central Nervous System; Ear, Middle; Female; Granuloma; Hearing Loss, Conductive; Humans; Ketoconazole; Magnetic Resonance Imaging; Osteomyelitis; Otitis Media; Temporal Bone; X-Rays

We report a rare case of germinoma with granulomatous reaction arising from the corona radiata. This 20-year-old man was admitted to our hospital complaining of progressive motor weakness on the right side. CT demonstrated a poorly demarcated high density area in the left corona radiata, which was heterogeneously enhanced after administration of contrast medium. Moreover, the continuity of the mass to the ventricular wall was confirmed on MRI. At the first operation, subtotal removal of the tumor was performed through a fronto-parietal craniotomy. The diagnosis for the specific neoplasm was not established histologically, but granuloma caused by fungal infection was the most likely cause of the lesion. We tried amphotericin B (AmB), and remission of the tumor was obtained. However, during the following 3 months, the size of the tumor gradually enlarged again. AmB was repeatedly administered, but this time the treatment was ineffective. Six months later, on May 21, 1990, the second operation was performed and histological examination revealed typical germinoma consisting of two-cell pattern. Subsequently, the patient underwent focal irradiation of 33 Gy to the tumor site, and the tumor completely disappeared. As intracranial germinomas are observed to be successfully cured by radiotherapy and/or chemotherapy, choice of the therapeutic management must be carefully determined according to the histological diagnosis, especially in young people. A variety of locations of germinomas and the accompanying granulomatous reactions could create some diagnostic confusion, so great care must be taken in the treatment of much intracranial germinomas.

Topics: Adult; Amphotericin B; Brain Neoplasms; Cerebral Cortex; Combined Modality Therapy; Diagnosis, Differential; Dysgerminoma; Granuloma; Humans; Magnetic Resonance Imaging; Male

We previously described an in vitro assay showing that neutrophils (PMNs) from patients with paracoccidioidomycosis (PARA) have a specific digestive deficiency against suspensions of live Paracoccidioides brasiliensis. We now report that this defect is equally detectable against autoclaved, but not Amphotericin B-killed P. brasiliensis. The use of autoclaved suspensions facilitates the use of our in vitro assay. It might allow the development of an in vitro intradermal test for digestion of fungi. Differential digestive ability of phagocytes against live (or autoclaved) and Amphotericin-B killed fungi is of conceptual interest. It may be relevant in understanding therapeutic effect of Amphotericin B.

Topics: Amphotericin B; Granuloma; Hot Temperature; Humans; Microscopy, Electron; Mitosporic Fungi; Neutrophils; Paracoccidioides; Paracoccidioidomycosis; Phagocytosis; Sonication

We describe a case of granulomatous encephalitis caused by Bipolaris (Drechslera) hawaiiensis in an immunocompetent patient. An 18-year-old man with a seven-month history of seizures and right leg weakness was found by computed tomographic scan to have a left frontoparietal enhancing lesion. Biopsy of the lesion revealed granulomatous inflammation and numerous septate hyphae. Culture of the biopsy specimen yielded a pure culture of B hawaiiensis in four days. Susceptibility studies revealed the organism to be sensitive to amphotericin B (minimal inhibitory concentration [MIC] equals 0.25 mg/L) and miconazole lactate (MIC equals 0.064 mg/L), but resistant to flucytosine (MIC greater than 100 mg/L). No synergy was demonstrated with amphotericin B and flucytosine in vitro. The patient was successfully treated with surgery and systemic and intrathecal amphotericin B therapy, and a negative culture was obtained from a repeated brain biopsy six weeks later.

Topics: Adolescent; Amphotericin B; Combined Modality Therapy; Encephalitis; Granuloma; Hemiplegia; Humans; Male; Miconazole; Mycoses; Seizures; Tomography, X-Ray Computed

Topics: Amphotericin B; Arthritis, Infectious; Diagnosis, Differential; Granuloma; Humans; Knee Joint; Male; Middle Aged; Myositis; Sporotrichosis

A patient with South American blastomycosis (paracoccidioidomycosis) was studied using computed tomography (CT), which showed six granulomas in the brain. The patient was treated with amphotericin B and observed by repeated CT scans. Two of the lesions disappeared completely after the first cycle of treatment, and residual images, probably representing granulomas in the cicatricial stage, remained after completion of the treatment.

Topics: Amphotericin B; Brain Diseases; Granuloma; Humans; Male; Middle Aged; Paracoccidioidomycosis; Tomography, X-Ray Computed

Topics: Amphotericin B; Child; Child, Preschool; Coccidioidomycosis; Granuloma; Humans; Male; Miconazole; Radiography; Tracheal Diseases; Tracheal Stenosis

A 48 year-old-female with a choroidal granuloma presented a systemic picture of paracoccidioidomycosis proven by rhinopharyngeal biopsy. The clinical picture, the differential diagnosis and the therapeutic test are discussed. This is the first time that the fluorescein angiography is described in such cases.

Topics: Amphotericin B; Choroid; Female; Granuloma; Humans; Hydrocortisone; Middle Aged; Paracoccidioidomycosis; Uveal Diseases

The CT features of a young female patient suffering from systemic candidiasis with intracerebral manifestation are reported. The definite diagnosis was made by spinal fluid cultures. The diffuse granulomatous lesions as well as an abscess formation remitted after specific therapy with 5-fluorocytosine and amphotericin B for now more than 1 year. In contrast to reports of other cases with mycosis of the central nervous system this case of candidiasis shows lesions of primarily increased attenuation coefficients.

Topics: Adult; Amphotericin B; Brain Abscess; Candidiasis; Female; Flucytosine; Granuloma; Humans; Tomography, X-Ray Computed

A case of an intrathecal cryptococcal granuloma in the cauda equina is reported. Successful and minimally toxic therapy with intrathecal amphotericin B and oral 5-fluorocytosine, preceded by surgery, is described.

Topics: Adolescent; Amphotericin B; Cauda Equina; Cryptococcosis; Flucytosine; Granuloma; Humans; Injections, Spinal; Male; Spinal Cord Diseases

Topics: Amphotericin B; Cryptococcosis; Granuloma; Humans; Lung Diseases; Male; Middle Aged; Radiography

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

We present a patient with a recurrent intracerebral blastomycotic granuloma. The computerized tomographic scan appearance of this lesion is illustrated. Of the 81 reported cases of intracranial blastomycosis, only 35 have represented solid intracerebral lesions; the other patients have had spinal lesions or meningitis. This patient represents the first reported recurrence of an intracerebral blastomycotic granuloma. The treatment utilized, surgical resection combined with intravenous and intraventricular amphotericin B, represents a unique approach to this problem. The diagnosis and currently advocated treatment of intracranial blastomycosis is reviewed, particularly in regard to the potential for recurrence of blastomycosis.

Topics: Adult; Amphotericin B; Blastomycosis; Brain Diseases; Granuloma; Humans; Injections, Intravenous; Male; Recurrence

A patient with oesophageal stenosis caused by Histoplasma granulomas is reported. He was treated with an initial combined course of intravenous amphotericin B and oral rifampicin. Complications included adrenal insufficiency, operative perforation of the oesophagus, amphotericin nephrotoxicity and tuberculosis. The histoplasmosis has not recurred for over 3 years.

Topics: Aged; Amphotericin B; Drug Therapy, Combination; Esophageal Stenosis; Granuloma; Histoplasmosis; Humans; Male; Rifampin

An adult renal transplant recipient was complicated with cryptococcal lung granuloma and meningitis. Treatment with the antifungal agents, 5-fluorocytocin and clotrimazole had to be discontinued due to side effects. Whereas, the intrathecal administration of amphotericin B proved effective for meningitis but intravenously it induced acute tubular necrosis to the transplanted kidney. In order to cure the persistant fungal lung granulomas in renal transplant patients early surgical excision seems to be essential.

Topics: Acute Kidney Injury; Adult; Amphotericin B; Cryptococcosis; Granuloma; Humans; Immunosuppressive Agents; Kidney Transplantation; Kidney Tubular Necrosis, Acute; Lung Diseases, Fungal; Male; Meningitis; Postoperative Complications; Transplantation, Homologous

Topics: Adolescent; Amphotericin B; Brain Diseases; Cryptococcosis; Female; Granuloma; Humans; Male

Topics: Adolescent; Adult; Amphotericin B; Candidiasis; Child, Preschool; Esophageal Stenosis; Esophagitis; Granuloma; Humans; Infant; Male

Topics: Adult; Amphotericin B; Biopsy; Cholangitis; Cryptococcosis; Diagnostic Errors; Flucytosine; Granuloma; Hepatitis; Humans; Liver; Male; Meningitis; Neurologic Manifestations

Topics: Adult; Amphotericin B; Brain Diseases; Central Nervous System Diseases; Cryptococcosis; Cytosine; Fluorine; Granuloma; Humans; Male; Meningitis; Microscopy, Phase-Contrast; Middle Aged; Spinal Cord Diseases; Temporal Lobe

Topics: Adult; Amphotericin B; Biopsy; Cheek; Coccidioidomycosis; Dermatomycoses; Facial Dermatoses; Female; Granuloma; Humans; Nose Diseases; Pregnancy; Pregnancy Complications, Infectious

Topics: Adult; Amphotericin B; Brain Diseases; Cerebral Angiography; Cryptococcosis; Follow-Up Studies; Granuloma; Humans; Injections, Intravenous; Injections, Spinal; Male; Motor Cortex; Recurrence

Topics: Amphotericin B; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Contraceptive Agents; Female; Granuloma; Humans; Infant, Newborn; Infant, Newborn, Diseases; Natamycin; Nystatin; Pregnancy

Topics: Aged; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Candidiasis, Oral; Carcinoma; Diagnosis, Differential; Female; Granuloma; Humans; Lip Diseases; Pityriasis; Skin Neoplasms

Topics: Amphotericin B; Fungi; Granuloma; Heart Failure; Humans; Infant; Male; Mediastinal Diseases; Mycoses; United States

Topics: Amphotericin B; Child; Complement Fixation Tests; Granuloma; Histoplasma; Humans; Hydrocortisone; Lung; Male; Mediastinal Diseases; Radiography; Serologic Tests; Tracheal Stenosis

Topics: Adult; Amphotericin B; Candidiasis, Oral; Female; Germany, East; Granuloma; Humans

Topics: Amphotericin B; Candidiasis, Cutaneous; Female; Granuloma; Humans; Immunologic Deficiency Syndromes; Infant, Newborn

Topics: Adrenal Glands; Agammaglobulinemia; Amphotericin B; Brain; Carcinoma; Carcinoma, Hepatocellular; Cryptococcosis; Cryptococcus; Diabetes Complications; Granuloma; Humans; Immunologic Deficiency Syndromes; Kidney Neoplasms; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged

Topics: Amphotericin B; Amyloidosis; Antifungal Agents; Candidiasis, Cutaneous; Granuloma; Humans; Leg; Lichen Planus; Natamycin

Topics: Adult; Agricultural Workers' Diseases; Amphotericin B; Antifungal Agents; Candida; Cheek; Chromoblastomycosis; Cytosine; Fluorine; Granuloma; Humans; Laryngeal Diseases; Male

Topics: Adult; Aged; Amphotericin B; Blastomyces; Blastomycosis; Bone and Bones; Bone Diseases; Breast; Breast Diseases; Female; Granuloma; Histoplasmosis; Humans; Lung; Lung Diseases, Fungal; Lymph Nodes; Male; Middle Aged; Pneumonia; Skin; Skin Diseases; Smoking; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Fungi; Granuloma; Humans; Male; Mouth; Mycoses; Nose; Nose Diseases; Salicylamides

Topics: Adolescent; Adult; Amphotericin B; Candida; Child; Female; Granuloma; Humans; Male; Serum Globulins; Skin Tests

Topics: Adult; Amphotericin B; Coccidioides; Coccidioidomycosis; Complement Fixation Tests; Granuloma; Humans; Injections, Intra-Articular; Knee Joint; Male; Synovitis

Topics: Amphotericin B; Anti-Bacterial Agents; Candidiasis; Child; Child, Preschool; Granuloma; Humans; Male; Mouth Mucosa; Nails; Nose; Scalp; Staphylococcal Infections

Topics: Amphotericin B; Cryptococcosis; Granuloma; Humans; Male; Middle Aged; Skull Neoplasms

Topics: Adult; Amphotericin B; Coccidioides; Coccidioidomycosis; Female; Granuloma; Humans; Knee; Male; Middle Aged; Radiography; Synovial Membrane; Synovitis

Topics: Alanine Transaminase; Amphotericin B; Aspartate Aminotransferases; Candidiasis; Child; Darkness; Granuloma; Humans; Infusions, Parenteral; Male; Skin

Topics: Amphotericin B; Candidiasis; Child, Preschool; Female; Fungal Vaccines; Granuloma; Humans; Paronychia; Phagocytosis; Scalp Dermatoses

Topics: Aged; Amphotericin B; Candidiasis, Cutaneous; Granuloma; Humans; Male

Topics: Adult; Amphotericin B; Aspergillosis; Eyelids; Granuloma; Humans; Male

Topics: Acremonium; Amphotericin B; Anti-Bacterial Agents; Antigen-Antibody Reactions; Asthma; Bone Diseases; Candidiasis; Diet; Diet Therapy; Drug Therapy; Food Hypersensitivity; Granuloma; Humans; Immunotherapy, Active; Jaw; Mouth Diseases; Palate; Paranasal Sinuses; Pathology; Sinusitis; Skin Tests; Spores; Spores, Fungal

Topics: Addison Disease; Adrenal Gland Diseases; Adrenal Glands; Adrenal Insufficiency; Amphotericin B; Blastomycosis; Digoxin; Drug Therapy; Granuloma; Humans; Hydrocortisone; Hypoadrenocorticism, Familial; Norepinephrine; Pathology; Prednisone

Topics: Administration, Cutaneous; Amphotericin B; Candidiasis, Cutaneous; Child; Drug Therapy; Granuloma; Toxicology

Topics: Administration, Cutaneous; Amphotericin B; Arm; Candidiasis, Cutaneous; Drug Therapy; Granuloma; Humans

Topics: Administration, Cutaneous; Amphotericin B; Candidiasis, Chronic Mucocutaneous; Candidiasis, Cutaneous; Granuloma; Humans

Topics: Amphotericin B; Candidiasis; Candidiasis, Chronic Mucocutaneous; Granuloma; Humans

Topics: Achondroplasia; Amphotericin B; Bronchiectasis; Candidiasis, Chronic Mucocutaneous; Candidiasis, Cutaneous; Child; Granuloma; Humans; Injections, Intravenous; Nystatin; Organic Chemicals; Pathology

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Dermabrasion; gamma-Globulins; Granuloma; Skin Diseases

Topics: Agammaglobulinemia; Amphotericin B; Antifungal Agents; Candidiasis; Dermabrasion; Granuloma; Humans; Hypergammaglobulinemia; Plastics; Surgery, Plastic

Topics: Amphotericin B; Candidiasis; Candidiasis, Chronic Mucocutaneous; Granuloma; Humans; Skin Diseases

Topics: Amphotericin B; Antifungal Agents; Coccidioidomycosis; Dermatomycoses; Granuloma; Humans; Sepsis

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Candidiasis, Chronic Mucocutaneous; Granuloma; Hypothyroidism; Medical Records