amphotericin-b and Hemorrhage

The biological properties of elastase and Aspergillus flavus elastase inhibitor (AFLEI) from A. flavus were examined. Pathogenicity of elastase was investigated in mice immunocompromised with cyclophosphamide, cyclosporine, prednisolone and carrageenan. Compared to cyclophosphamide immunocompromised mice treated with the spores of elastase nonproducing strain, cyclophosphamide immunocompromised mice treated with the spores of elastase producing strain had a significantly shorter survival rate. Molecular mass of AFLEI was determined to be 7525.8 Da. The elastolytic activity of elastases from A. flavus, and human leukocytes were inhibited by AFLEI. The primary structure of AFLEI was determined by the Edman sequencing procedure. The search for amino acid homology with other proteins demonstrated that amino acid residues 1 to 68 of AFLEI are 100% identical to residues 20 to 87 of the hypothetical protein AFUA_3G14940 of A. fumigatus. When immunocompromised mice administered of cyclophosphamide were infected by inhalation of A. flavus then administered amphotericin B (AMPH) alone or in combination with AFLEI, survival rate tended to be higher with combination treatment than with AMPH alone. Moreover, although extensive bleeding was seen in pathology sections taken from rat lung resected 24 h after elastase was administered to the lung via the bronchus, this bleeding was inhibited by AFLEI. The X-ray analysis has revealed that the structure of this inhibitor was wedge shaped and composed of a binding loop and a scaffold protein core. As synthetic-inhibitor strongly inhibited cytotoxicity induced by elastase in human-derived cells, it could prove beneficial for the treatment of pulmonary aspergillosis.

Topics: Amphotericin B; Animals; Aspergillus flavus; Disease Models, Animal; Enzyme Inhibitors; Hemorrhage; Humans; Immunocompromised Host; Lung Diseases; Mice; Pancreatic Elastase; Pulmonary Aspergillosis; Rats

Topics: Amphotericin B; Antifungal Agents; Blood Donors; Blood Transfusion; Granulocytes; Hemorrhage; Infection Control; Leukemia; Platelet Transfusion; Transfusion Reaction; Vancomycin

Topics: Adolescent; Adult; Amphotericin B; Animals; Cataract Extraction; Child; Child, Preschool; Electrocoagulation; Eye Diseases; Eye Foreign Bodies; Female; Hemorrhage; Humans; Infant, Newborn; Male; Methicillin; Methods; Middle Aged; Postoperative Complications; Prostheses and Implants; Rabbits; Retina; Retinal Detachment; Retinal Diseases; Urokinase-Type Plasminogen Activator; Uvea; Vitreous Body

The morbidity and death rate of visceral leishmaniasis (VL) is important. The aim of our study is to find prognosis factors of VL. Two hundred and thirty two children with VL were retrospectively studied. These children were followed in Rabta and Kairouan hospitals between 1985 and 1998. We identify 7 prognosis factors, at the hospital admission, visit delayed more than 56 days, fever during more than 21 days, normal or low temperature, haemorrhagic syndrome hemoglobin rate < 5.5 g/dl, sedimentation rate < 25 mm and hypoalbuminaemia < 30 g/l. The presence of one prognosis factors or more appears to consider amphotericin B as a first-line treatment.

Topics: Amphotericin B; Antiprotozoal Agents; Blood Sedimentation; Child; Child, Preschool; Female; Fever; Hemorrhage; Humans; Hypoalbuminemia; Infant; Leishmaniasis, Visceral; Male; Prognosis; Retrospective Studies; Risk Factors; Time Factors

Gastrointestinal mucormycosis is a rare, often fatal, systemic infection found predominantly in immunocompromised patients. We report a case of gastrointestinal mucormycosis in a 53-year-old female with non-Hodgkin's lymphoma. Following her first course of chemotherapy, bowel obstruction developed as a result of mucormycosis. Despite treatment with antifungal therapy, she required a laparotomy owing to severe haemorrhage caused by mucormycosal invasion of her iliac artery. With continued antifungal treatment and further chemotherapy, she ultimately underwent reversal of her Hartmann's procedure and remains disease-free.

Topics: Amphotericin B; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Cyclophosphamide; Disease-Free Survival; Doxorubicin; Female; Gastrointestinal Diseases; Granulocyte-Macrophage Colony-Stimulating Factor; Hemorrhage; Humans; Iliac Artery; Immunocompromised Host; Intestinal Fistula; Lymphoma, Non-Hodgkin; Middle Aged; Mucormycosis; Prednisolone; Vascular Fistula; Vincristine

Ulcerative tracheobronchial aspergillosis after lung transplantation (ltx) may lead to bronchial-pulmonary artery fistula that results in fatal bleeding. We report our early experience with combined systemic, aerolized and topical application of amphotericin B in 3 cases of bronchial aspergillosis after ltx. Two patients are still alive, but 1 died of bleeding from a fistula between the left upper lobe bronchus and the pulmonary artery. Aspergillosis in the second patient resolved with minimal stenosis of the left main and the left upper lobe bronchus, and the third patient developed an anastomotic stenosis that was successfully dilated.

Topics: Administration, Inhalation; Administration, Topical; Adult; Aerosols; Amphotericin B; Anastomosis, Surgical; Antifungal Agents; Aspergillosis; Bronchi; Bronchial Diseases; Bronchial Fistula; Constriction, Pathologic; Fatal Outcome; Female; Hemorrhage; Humans; Lung Diseases, Fungal; Lung Transplantation; Male; Middle Aged; Pulmonary Artery; Vascular Fistula

Phialophora is a dematiaceous fungus isolated from soil and wood. Human infections including chromoblastomycosis, mycotic keratitis, cutaneous infections, and prosthetic valve endocarditis have been reported. We report a case of fatal hemorrhage due to Phialophora verrucosa in a patient with prolonged neutropenia undergoing autologous bone marrow transplant (BMT) for acute myelogenous leukemia (AML). Bacterial infections complicated induction and consolidation chemotherapies. Liposomal amphotericin B (LAMB) was given from day +33 to day +72 for febrile neutropenia. Death occurred on day +74 due to tracheal hemorrhage. Autopsy revealed granulation tissue on the posterior wall of the trachea with fungal hyphae on histopathology; the tissue grew Phialophora verrucosa. In vitro susceptibility studies revealed a minimum inhibitory concentration to AmB of 0.1 microg/ml. This represents the first reported case of invasive P. verrucosa in a BMT patient leading to fatal hemorrhage, despite large cumulative doses of LAMB to which the organism remained susceptible.

Topics: Adult; Amphotericin B; Antifungal Agents; Antiprotozoal Agents; Bone Marrow Transplantation; Female; Hemorrhage; Humans; Leukemia, Myeloid, Acute; Liposomes; Mycoses; Neutropenia; Phialophora; Trachea

We investigated the safety and efficacy of amphotericin B colloidal dispersion (ABCD) for the treatment of invasive pulmonary aspergillosis in persistently granulocytopenic rabbits. Treatment groups included ABCD in dosages of 1, 5, and 10 mg/kg/day intravenously or conventional desoxycholate amphotericin B (DAmB) at 1 mg/kg/day intravenously. Antifungal activity was directly related to increasing dosage of ABCD as determined by the concentration of Aspergillus fumigatus organisms in lungs and the frequency of hemorrhagic pulmonary lesions. At 5 and 10 mg/kg/day, there was a significant reduction in the tissue burden of A. fumigatus as measured by percent culture-positive lobes and CFU per gram of tissue (P < or = 0.001), whereas at 1 mg/kg/day measured by percent culture-positive lobes and CFU per gram of tissue (P < or = 0.001), whereas at 1 mg/kg/day the tissue burden of A. fumigatus was not significantly different from that in untreated controls. Microbiological clearance was significantly greater at 1 mg of DAmB per kg per day than at 1 mg of ABCD per kg per day (P < or = 0.001). There was no difference in microbiological clearance of bronchoalveolar lavage fluid among the treatment groups as measured by CFU per milliliter. As determined by survival, ABCD at 5.0 mg/kg/day was more effective than DAmB at 1.0 mg/kg/day and ABCD at 10 mg/kg/day. ABCD at 10 mg/kg/day was more nephrotoxic than the lower dosages of ABCD and resulted in higher mortality. Impairment of glomerular filtration developed as a direct function increasing the ABCD dosage (r = 0.77; P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Agranulocytosis; Amphotericin B; Animals; Aspergillosis; Bronchoalveolar Lavage Fluid; Colloids; Creatinine; Dose-Response Relationship, Drug; Female; Heart; Hemorrhage; Immunosuppression Therapy; Kidney Diseases; Kidney Function Tests; Lung; Lung Diseases, Fungal; Rabbits

Topics: Adult; Amphotericin B; Australia; Chorioretinitis; Eye Diseases; Eye Manifestations; Hemorrhage; Histoplasmosis; Humans; Male; Prednisone; Retinal Vessels; Visual Acuity

Topics: Amphotericin B; Ampicillin; Colon; Colostomy; Complement Fixation Tests; Hemorrhage; Histoplasmosis; Humans; Hydrocortisone; Laparotomy; Male; Middle Aged

Topics: Adenoidectomy; Amphotericin B; Anemia; Anti-Bacterial Agents; Ear, Inner; Hemorrhage; Hydrocarbons; Meningitis; Mycoses; Nystatin; Otitis Media; Otolaryngology; Pediatrics; Pharynx; Streptomycin; Tonsillectomy; Toxicology; Vitamins