amphotericin-b and Heart-Failure

We evaluated an amphotericin treatment strategy on the basis of duration of candidemia and clinical findings. Patients without neutropenia who had uncomplicated candidemia received 200 mg of amphotericin B over 5-7 days if they had had 1 day of positive cultures (PC group). The clinical cure rate was 93% (95% confidence interval [CI], 77%-99%; n=29 episodes) in the SC group, with no relapses (median follow-up, 272 days). The clinical cure rate was 83% (95% CI, 64%-94%; n=29 episodes) in the PC group, with 1 relapse (4.2%). The results of this pilot study suggest that patients with candidemia may be stratified into risk groups on the basis of the duration of positive blood cultures and other clinical findings. Decisions about the duration of therapy can be made 4-7 days after initiation of treatment. Carefully selected patients with transient uncomplicated candidemia may be safely treated with a short course of amphotericin B. Further prospective validation of this concept should be undertaken particularly to evaluate the impact on low-frequency late complications (e.g., endophthalmitis).

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Chest Pain; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Pilot Projects; Recurrence; Survival Rate; Time Factors; Treatment Outcome

Histoplasmosis is an endemic mycosis with global distribution, primarily reported in immunocompromised individuals. A 29-year old immunocompetent male presented with fever, hepatosplenomegaly and pancytopenia. His peripheral blood showed features suggestive of intravascular hemolysis and echocardiography showed features suggestive of pulmonary arterial hypertension. Bone marrow showed yeast with morphology suggestive of

Topics: Adult; Amphotericin B; Antifungal Agents; Fever; Heart Failure; Hemolysis; Hepatomegaly; Histoplasmosis; Humans; Immunocompetence; Itraconazole; Lymphohistiocytosis, Hemophagocytic; Male; Pancytopenia; Splenomegaly

To compare the clinical and epidemiological features, treatments, and outcomes of patients with isolated right-sided and left-sided fungal endocarditis and to determine the risk factors for in-hospital mortality in patients with Candida sp endocarditis.. A retrospective review of all consecutive cases of fungal endocarditis from five hospitals was performed. Clinical features were compared between patients with isolated right-sided and left-sided endocarditis. In the subgroup of fungal endocarditis due to Candida species, binary logistic regression analysis was performed to determine variables related to in-hospital mortality.. Seventy-eight patients with fungal endocarditis were studied. Their median age was 50 years; 55% were male and 19 patients (24%) had isolated right-sided endocarditis. Overall, cardiac surgery was performed in 46 patients (59%), and in-hospital mortality was 54%. Compared to patients with left-side fungal endocarditis, patients with isolated right-sided endocarditis had lower mortality (32% vs. 61%; p=0.025) and were less often submitted to cardiac surgery (37% vs. 66%; p=0.024). The most frequent etiology was Candida spp (85%). In this subgroup, acute heart failure (odds ratio 5.0; p=0.027) and exclusive medical treatment (odds ratio 11.1; p=0.004) were independent predictors of in-hospital death, whereas isolated right-sided endocarditis was related to a lower risk of mortality (odds ratio 0.13; p=0.023).. Patients with isolated right-sided fungal endocarditis have particular clinical and epidemiological features. They were submitted to cardiac surgery less often and had better survival than patients with left-sided fungal endocarditis. Isolated right-sided endocarditis was also a marker of a less harmful illness in the subgroup of Candida sp endocarditis.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida; Echinocandins; Endocarditis; Female; Fluconazole; Follow-Up Studies; Heart Failure; Hospital Mortality; Humans; Male; Middle Aged; Mycoses; Retrospective Studies; Risk Factors; Treatment Outcome

Ventricular arrhythmias are a common cause of death in patients with heart failure (HF). Structural and electrical abnormalities in the heart provide a substrate for such arrhythmias. Canine tachypacing-induced HF models of 4-6 weeks duration are often used to study pathophysiology and therapies for HF. We hypothesized that a chronic canine model of HF would result in greater electrical and structural remodeling than a short term model, leading to a more arrhythmogenic substrate.. HF was induced by ventricular tachypacing for one (short-term) or four (chronic) months to study remodeling.. Left ventricular contractility was progressively reduced, while ventricular hypertrophy and interstitial fibrosis were evident at 4 month but not 1 month of HF. Left ventricular myocyte action potentials were prolonged after 4 (p<0.05) but not 1 month of HF. Repolarization instability and early afterdepolarizations were evident only after 4 months of HF (p<0.05), coinciding with a prolonged QTc interval (p<0.05). The transient outward potassium current was reduced in both HF groups (p<0.05). The outward component of the inward rectifier potassium current was reduced only in the 4 month HF group (p<0.05). The delayed rectifier potassium currents were reduced in 4 (p<0.05) but not 1 month of HF. Reactive oxygen species were increased at both 1 and 4 months of HF (p<0.05).. Reduced Ito, outward IK1, IKs, and IKr in HF contribute to EAD formation. Chronic, but not short term canine HF, results in the altered electrophysiology and repolarization instability characteristic of end-stage human HF.

Topics: Action Potentials; Amphotericin B; Analysis of Variance; Animals; Arrhythmias, Cardiac; Delayed Rectifier Potassium Channels; DNA Primers; Dogs; Electrocardiography; Electron Spin Resonance Spectroscopy; Heart Failure; Immunoblotting; Myocardial Contraction; Patch-Clamp Techniques; Potassium Channels, Inwardly Rectifying; Reactive Oxygen Species; Real-Time Polymerase Chain Reaction; Time Factors; Ventricular Remodeling

To investigate spontaneous reporting relationships between representative antifungal agents and congestive heart failure (CHF)-related adverse events (AE) we performed multiple disproportionality analyses of the US FDA AERS database. Specifically we performed analysis of drug-AE associations (2D) plus drug-drug-AE and drug-AE-AE-associations (3D), the latter two to explore the potential contribution of reported pharmacodynamic interactions, overexposure from pharmacokinetic interactions, and drug overdose. Itraconazole displayed a pattern of statistical reporting dependencies across multiple analyses (2D and 3D). Amphotericin B was the only other antifungal that demonstrated a 2D SDR with CHF-related events. Itraconazole demonstrated multiple SDRs with calcium channel blockers in suspect drug-only 3D analysis. There was one other SDR with fluconazole and propanolol and three SDRs involving valproate and fluconazole that may have been do at least in part to duplicate reporting. Less specific 3D analysis including both suspect plus concomitant medications showed a greater number and variety of SDRs with multiple antifungals. Statistical reporting dependencies with CHF-related events did not appear to be a consistent pharmacological (e.g., azole/triazole)/therapeutic (i.e., antifungal) class effect. Itraconzole was unique in the pattern of statistical reporting dependencies with CHF-related events which is consistent with findings from independent data sets.

Topics: Adverse Drug Reaction Reporting Systems; Amphotericin B; Antifungal Agents; Databases, Factual; Drug Interactions; Drug Overdose; Fluconazole; Heart Failure; Humans; Itraconazole; Propranolol

Zygomycosis can manifest as severe infections, particularly in immunocompromised patients, which can be nosocomial in nature resulting from complications of invasive procedures. We report the case of a 65-year-old woman with a medical history of unclassified inflammatory rheumatism who underwent arteriovenous extracorporeal membrane oxygenation because of a myocardial failure following the drainage of a tuberculous tamponade. This procedure was complicated by a superinfection of the scarpa which revealed a disseminated zygomycosis with renal involvement. A favorable outcome was achieved after 15 months of antifungal therapy involving the use of liposomal amphotericin B followed with posaconazole which involved the close monitoring of the concentrations of this antifungal. Extracorporeal membrane oxygenation is a frequent procedure which could be complicated with severe fungal nosocomial infections such as zygomycosis. The outcome of such complication can be favorable with the utilization of new antifungal therapies.

Topics: Acute Kidney Injury; Aged; Amphotericin B; Antifungal Agents; Cross Infection; Extracorporeal Membrane Oxygenation; Female; France; Heart Failure; Humans; Immunocompromised Host; Kidney; Mucormycosis; Rheumatic Fever; Rhizopus; Treatment Outcome; Triazoles; Tuberculosis, Pulmonary

For the first time in the literature to date, we report 2 cases of transplantation of yeast-infected cardiac allografts. In both cases, endocardial vegetations were observed before graft implantation. Microbiologic samples grew yeasts: Rhodotorula glutinis was found close to the left atrial appendage in the first case and Candida parapsilosis was identified in a vegetation located at the base of the tricuspid valve in the second case. We discuss the possible routes of donor organ infection and management of these 2 unusual cases.

Topics: Adult; Amphotericin B; Candida albicans; Candidiasis; Fluconazole; Follow-Up Studies; Graft Survival; Heart Failure; Heart Transplantation; Humans; Male; Middle Aged; Mycoses; Risk Assessment; Severity of Illness Index; Tissue Donors; Transplantation, Homologous; Transplants; Treatment Outcome; Yeasts

A 72-year-old man was treated for fungal tricuspid valve endocarditis (TVE) with significant tricuspid valvular regurgitation and severe congestive heart failure caused by Candida parapsilosis. The patient had received hyperalimentation and antibiotic therapy for three months through a central venous catheter after the surgical treatment of ileus. The patient was treated medically with amphotericin B and fluconazole because of high surgical risk due to severe pulmonary emphysema, and he responded well. Although TVE caused by C. parapsilosis is rare, we should consider this possibility in patients receiving long-term hyperalimentation and antibiotic therapy using a central venous catheter.

Topics: Aged; Amphotericin B; Antifungal Agents; Candidiasis; Catheterization, Central Venous; Echocardiography; Endocarditis; Fluconazole; Heart Failure; Humans; Male; Time Factors; Tricuspid Valve; Tricuspid Valve Insufficiency

To describe the incidence of acute renal insufficiency and identify potential risk factors associated with this adverse medical event.. A cohort analytic study of patients with documented or suspected bacterial pneumonia.. Nationwide survey of 74 acute care hospitals across the US.. A total of 1822 adult patients with documented or suspected bacterial pneumonia who were receiving a cephalosporin, penicillin, or an aminoglycoside were enrolled. Patients were excluded if the duration of antimicrobial therapy was < 3 days or if the pneumonia was judged to be nonbacterial.. Clinical pharmacists completed standardized data collection forms on all patients enrolled in the study. Information regarding patient demographics, concurrent illnesses and medications, antibiotic administration, representative laboratory data, and the occurrence of any adverse clinical event was specifically captured. Information regarding the development of acute renal insufficiency was targeted as an event to be captured.. Univariate and multivariate analyses were performed to identify significant risk factors for acute renal insufficiency. A subset analysis was similarly performed to identify risk factors associated with aminoglycoside-related acute renal insufficiency.. Of the patients enrolled in this study, 8.2 percent developed acute renal insufficiency. Risk factors for acute renal insufficiency included renal disease, aminoglycoside therapy, nosocomial pneumonia, elevated estimated creatinine clearance prior to study entry, cardiac arrest/shock, congestive heart failure, total duration of antibiotics > 7 days, clindamycin therapy, liver disease, and first-generation cephalosporin usage. Risk factors for aminoglycoside-related acute renal insufficiency identified via multiple logistic regression included amphotericin B, congestive heart failure, aminoglycoside trough concentration > 1.5 mg/L, and clindamycin therapy.. The risk factors identified for acute renal insufficiency suggest that severity of illness strongly influences the development of renal insufficiency. Theoretically, the results of this study could serve as a framework for developing risk prevention programs within individual hospitals. Specific risk factors could be identified for a patient population and risk factors that could be modified could then be targeted for intervention. This type of information can also assist clinicians in predicting the probability of the adverse event for a particular patient and subsequently minimizing this risk by initiating intense monitoring or modifying the drug regimen.

Topics: Acute Kidney Injury; Aged; Aged, 80 and over; Aminoglycosides; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Cohort Studies; Female; Heart Failure; Humans; Incidence; Male; Middle Aged; Pneumonia; Population Surveillance; Risk Factors; United States

A patient is reported who had Histoplasma capsulatum endocarditis, a rare form of disseminated histoplasmosis. He also had disseminated intravascular coagulopathy and defects in cell-mediated immune responses to Histoplasma antigens. Prompt etiologic diagnosis was made by stain of tissue from a mouth ulcer and confirmed by culture of the organism from blood. An echocardiogram compared to a previous normal echocardiogram indicated changes consistent with a vegetation. Histologic examination of the resected valve demonstrated organisms. Amphotericin B administration (3.4 g) plus an aortic valve replacement resulted in cure.

Topics: Adult; Amphotericin B; Disseminated Intravascular Coagulation; Endocarditis; Female; Heart Failure; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged

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

Topics: Amphotericin B; Blastomycosis; Cardiomegaly; Heart Failure; Histoplasmosis; Humans; Hydrocortisone; Hypokalemia; Lung Diseases, Fungal; Male; Middle Aged; Potassium; Sodium; Water-Electrolyte Balance

Topics: Amphotericin B; Anaphylaxis; Anemia; Anuria; Blushing; Feeding and Eating Disorders; Fever; Headache; Heart Failure; Humans; Hypokalemia; Kidney Diseases; Liver Diseases; Meningitis; Nausea; Pain; Paralysis; Paresthesia; Phlebitis; Seizures; Thrombocytopenia; Toxicology; Ventricular Fibrillation; Vertigo; Vomiting

Topics: Acute Kidney Injury; Amphotericin B; Bronchopneumonia; Burns; Candida; Candidiasis; Child; Drug Therapy; Erythroblastosis, Fetal; Female; Geriatrics; Heart Failure; Humans; Hyperbilirubinemia; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Postgastrectomy Syndromes; Renal Insufficiency; Sepsis; Toxicology; Uterine Cervical Neoplasms; Wounds, Gunshot