amphotericin-b and Hearing-Loss

Raised intracranial pressure is a hallmark of cryptococcal meningitis and is associated with increased mortality. Continuous drainage of lumbar cerebrospinal fluid is suggested to control intracranial pressure. The complications induced by this treatment have been described. However, nursing care associated with identification and management of complications is less well known. We encountered a patient with human immunodeficiency virus-negative cryptococcal meningitis who developed increasing cerebrospinal fluid pressure, hearing impairment, and limb weakness. The patient's symptoms improved significantly by antifungal therapy and continuous lumbar drainage. Nurses play a vital role in monitoring patients with lumbar drainage for complications and to maintain integrity of the system. The nursing role in this approach is discussed with particular emphasis on recognition of complications and responses toward immediate emergent intervention.

Topics: Amphotericin B; Antifungal Agents; Cerebrospinal Fluid Pressure; Drainage; Female; Flucytosine; Hearing Loss; Humans; Intracranial Pressure; Meningitis, Cryptococcal; Middle Aged; Neuroscience Nursing; Nurse's Role; Spinal Puncture; Treatment Outcome

Cutaneous leishmaniasis typically presents as a painless papule progressing to an ulcer or plaque. In this case study of the ear, the disease manifested as a small painful bump progressing into redness and swelling about the ear with purulent drainage. After multiple oral/intravenous antipseudomonal, antistaphylococcal, and antifungal treatments, there was no improvement. The skin progressed to an erythematous plaque and hemorrhagic ulcer; punch biopsy and speciation revealed Leishmaniasis guyanensis. The patient was switched to a seven-dose course of intravenous L-amphotericin B (visceral leishmaniasis protocol). Within 21 days, pain and edema resolved and the ulcers healed. Three-month follow-up demonstrated no recurrence. Further studies are needed to evaluate the use of L-amphotericin B in Leishmaniasis guyanensis.

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Ear; Guyana; Hearing Loss; Humans; Leishmania guyanensis; Leishmaniasis, Cutaneous; Male; Otitis Externa; Travel

Topics: Adult; Amphotericin B; Antifungal Agents; Calcinosis; Fluconazole; Hearing Loss; Humans; Hydrocephalus; Magnetic Resonance Imaging; Male; Meningitis, Cryptococcal; Pulvinar; Tomography, X-Ray Computed