amphotericin-b and Heart-Diseases

A 38-year-old woman was diagnosed with systemic lupus erythematosus and received immunosuppressive therapy. After 6 months of treatment, workup for low-grade fever yielded elevated enzyme-linked immunosorbent assay titers for Aspergillus antigen in serum and ascites, leading to the diagnosis of disseminated aspergillosis. Transthoracic echocardiography revealed a claviform vegetation attached to the left ventricular anterior septum. Two days after the start of antifungal Amphotericin-B therapy, the patient suffered from several neurologic disorders. A second transthoracic echocardiography revealed that the vegetation decreased in size. Two weeks later, the vegetation increased again. Combination therapy of Amphotericin-B and Voriconazole was initiated, and the vegetation eventually disappeared completely. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:231-232, 2018.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Echocardiography; Female; Heart Diseases; Heart Ventricles; Humans; Lupus Erythematosus, Systemic; Voriconazole

Invasive aspergillosis(IA) is a potentially lethal complication of Aspergillus infection affecting mainly immunocompromised hosts; however, during the last two decades its incidence was increasingly observed in critically ill immunocompetent patients. The objective of this study is to describe the clinical characteristics of histologically proven endomyocardial and pericardial invasion, in the context of IA, in critically ill patients. Eight critically ill patients with histopathological confirmation of endomyocardial/pericardial aspergillosis were evaluated. Risk factors, clinical and laboratory characteristics, treatment, histopathological characteristics and mortality were recorded. Signs and symptoms of cardiac dysfunction were not observed in any of the patients. Therapy was administered to six of them shortly after the first positive culture. The observed histopathological lesions included haemorrhagic lesions, small vessels with central thrombosis and surrounding consolidated tissue with necrosis. Voriconazole, caspofungin, lipid amphotericin B and itraconazole were the used antifungals. The mortality rate was high (87.5%). Endomyocardial and pericardial aspergillosis are devastating complications of invasive aspergillosis. Clinical suspicion is low making the diagnosis difficult, therefore histopathological examination of tissues are required. The mortality is high.

Topics: Amphotericin B; Antifungal Agents; Caspofungin; Critical Illness; Echinocandins; Female; Heart Diseases; Humans; Immunocompetence; Immunocompromised Host; Incidence; Invasive Fungal Infections; Lipopeptides; Male; Middle Aged; Myocardium; Pericardium; Risk Factors; Voriconazole

To characterize the clinical and epidemiological profiles of patients with visceral leishmaniasis (VL) treated with liposomal amphotericin B (LAmB) and to identify prognostic factors for death from VL in 2008-2012 in the state of Minas Gerais, Brazil.. A historical cohort study was conducted using data obtained from treatment requests forms, Brazilian Notifiable Disease Information System and the Mortality Information System. Case-fatality rates of patients with VL treated with LAmB were compared with patients treated with other therapies. Logistic regression analysis was used to identify prognostic factors for death.. The overall case-fatality rate of the 577 patients treated with LAmB was 19.4%. Prognostic factors for death from VL were age between 35 and 49 years (OR 2.7; 95% CI 1.3-5.4) and above 50 years (OR 2.6; 95% CI 1.3-4.9), jaundice (OR 2.2; 95% CI 1.2-3.7), kidney disease (OR 2.8; 95% CI 1.6-4.9), presence of other infections (OR 2.4; 95% CI 1.5-4.1), edema (OR 2.0; 95% CI 1.1-3.4), platelet count below 50.000/mm3 (OR 3.6; 95% CI 2.1-6.0), AST higher than 100 U/L (OR 2.2; 95% CI 1.3-3.8), and assistance in non-specialized institutions (OR 1.9; 95% CI 1.0-3.5).. Case-fatality rates were higher than that observed among patients with VL treated with other therapies. Identification of prognostic factors of death from VL may allow early diagnosis of patients prone to such outcome and prompt an expeditious and appropriate management of VL to reduce fatality rates.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antiprotozoal Agents; Brazil; Child; Child, Preschool; Cohort Studies; Comorbidity; Edema; Female; Heart Diseases; HIV Infections; Humans; Infant; Jaundice; Leishmaniasis, Visceral; Liver Failure; Male; Middle Aged; Prognosis; Renal Insufficiency; Risk Factors; Young Adult

We report the case of a renal transplant recipient with pulmonary and splenic mucormycosis whose demise was accelerated by a myocardial abscess. Once pulmonary and splenic mucormycosis was diagnosed, liposomal amphotericin B was started and immunosuppressant treatments were discontinued. The pulmonary cavities regressed during treatment, but new myocardial and peri-allograft abscesses developed. The myocardial abscess diffusely infiltrated the left ventricular wall and was associated with akinesia, which led to sudden cardiac arrest. This case demonstrates a rare manifestation of mucormycosis and highlights the fatality and invasiveness of this infection.

Topics: Adult; Amphotericin B; Antifungal Agents; Fatal Outcome; Female; Heart Diseases; Humans; Immunocompromised Host; Kidney Transplantation; Mucormycosis; Myocardium

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Female; Heart Atria; Heart Diseases; Humans; Infant, Newborn; Infant, Premature, Diseases; Uveitis

The use of indwelling central catheters for long-term administration of hyperalimentation, chemotherapy or other intravenous therapies is increasing. This unusual presentation of a catheter-induced right atrial thrombus was complicated by fungal infection. We present a case of a paediatric sickle-cell patient who underwent surgical removal of a right atrial thrombus secondary to fungal (Candida tropicalis) endocarditis from an indwelling catheter. Successful thrombus removal utilizing cardiopulmonary bypass and subsequent discharge underscores the importance of surgical therapy in treating this important complication.

Topics: Amphotericin B; Anemia, Sickle Cell; Antifungal Agents; Blood Transfusion; Candidiasis; Cardiopulmonary Bypass; Catheterization, Central Venous; Child, Preschool; Combined Modality Therapy; Embolism; Endocarditis; Heart Atria; Heart Diseases; Humans; Intraoperative Complications; Male; Postoperative Complications; Respiratory Tract Infections; Thrombosis

Topics: Adult; Amphotericin B; Cytarabine; Female; Heart Atria; Heart Diseases; Humans; Superior Vena Cava Syndrome; Thrombosis

Candida has become the most prevalent cerebral mycosis at autopsy, indicating a significant incidence coupled with inadequate eradication. Of 29 patients with systemic candidiasis, 48 percent (14 of 29) also had central nervous system involvement. Of these patients, however, only 21 percent (three of 14) had antemortem diagnosis, and only one of these three patients remains alive; the two patients with antemortem diagnosis who died had a meningeal form that, although easier to document on the basis of cerebrospinal fluid examination, is now distinctly rarer than other forms of the disease in adults. The lone surviving patient was treated with amphotericin B for endocarditis and mycotic aneurysms of the cerebral vessels. One clue to central nervous system candidal infection was the striking correlation between cardiac and cerebral involvement; 80 percent of patients with myocardial or valve infection also had central nervous system candidiasis. Most forms of immunosuppression represent a risk factor for both the systemic and cerebral mycoses. Neuropathologically, there is a spectrum of disease entities associated with Candida, including two previously unrecognized lesions reported herein: fungus balls of both white and gray matter and mycotic aneurysms secondary to Candida parapsilosis. Other parenchymal presentations include thrombosis, vasculitis, abscess, hemorrhage, and demyelination. For drug therapy such as amphotericin B to be more effective, earlier diagnosis of these parenchymal infections must be sought.

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Candidiasis; Central Nervous System Diseases; Female; Heart Diseases; Heart Valve Diseases; Humans; Male; Middle Aged

Topics: Amphotericin B; Candidiasis; Catheterization; Child; Cytosine; Heart Atria; Heart Diseases; Humans; Infant, Newborn; Male; Parenteral Nutrition; Thrombosis; Umbilical Veins

Topics: Aged; Amphotericin B; Blood Urea Nitrogen; Coccidioidomycosis; Complement Fixation Tests; Epididymitis; Heart Diseases; Humans; Hypocalcemia; Immunity; Kidney; Male; Potassium; Potassium Chloride; Skin Diseases

Topics: Adult; Amphotericin B; Brain; Cryptococcosis; Diagnosis, Differential; Heart Diseases; Humans; Lung; Male; Meningitis; Nephrocalcinosis; Prednisolone; Sarcoidosis; Sepsis

Topics: Administration, Intravenous; Amphotericin B; Animals; Dog Diseases; Dogs; Dosage Forms; Heart Diseases; Injections; Injections, Intravenous; Kidney Diseases; Mycoses; Pharmacology; Toxicology