amphotericin-b and Hepatitis-B--Chronic

Disseminated histoplasmosis is an invasive fungal infection documented in patients with impaired cellular immunity coming from endemic areas (America, Asia, Africa). We report two cases of disseminated histoplasmosis in AIDS patients paradigmatic of the multifaceted nature of the disease, which may be an expression either of an advanced state of immunosuppression or the immune reconstitution inflammatory syndrome (IRIS).

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Brazil; Deoxycholic Acid; Diagnosis, Differential; Drug Combinations; Female; Hepatitis B, Chronic; Hepatitis D, Chronic; Histoplasmosis; Homosexuality, Male; Humans; Immunocompromised Host; Invasive Fungal Infections; Italy; Male; Risk Factors; Thailand; Treatment Outcome; Voriconazole

We describe a case of a 62-year-old diabetic woman with hepatocellular carcinoma due to chronic hepatitis B virus infection. Two weeks after orthotopic liver transplantation, endoscopy for massive upper gastrointestinal bleeding revealed a large necrotic area in the gastric fundus. The patient underwent emergency resection. Histopathologically, angioinvasive mold infection compatible with mucormycosis was diagnosed in a large area of necrosis, mimicking an atypically localized gastric ulcer. Foreign bodies originating from transarterial chemoembolization (TACE) performed 7 and 8 months earlier and 40 days before transplantation were identified in the submucosal tissue. The patient was treated with liposomal amphotericin B (LAB) for 5 weeks, followed by 7 weeks of posaconazole. Follow-up biopsies after 1 and 5 months confirmed successful treatment. Review of the radiological images of the TACE procedure showed that some of the TACE material had been diverted to the stomach via an accessory gastric branch originating from the left hepatic artery. TACE agents may be associated with chronic, refractory gastroduodenal ulcers. We hypothesize that the ischemic lesion was first colonized with presumed Mucorales mold and invasive growth was promoted by the posttransplantation immunosuppression. Careful exploration of extrahepatic collaterals during TACE may prevent this complication.

Topics: Amphotericin B; Antifungal Agents; Carcinoma, Hepatocellular; Chemoembolization, Therapeutic; Diabetes Complications; Female; Hepatitis B, Chronic; Histocytochemistry; Humans; Immunocompromised Host; Immunosuppressive Agents; Liver Neoplasms; Liver Transplantation; Microscopy; Middle Aged; Mucorales; Mucormycosis; Stomach Diseases; Triazoles

Topics: Adult; Amphotericin B; Antifungal Agents; Fluconazole; Glucocorticoids; Hepatitis B, Chronic; Humans; Male; Pulmonary Aspergillosis; Tomography, X-Ray Computed

Coexistence of two illnesses in the same patient may result in atypical manifestations of either or both diseases. A case of hepatitis B virus-related cirrhosis in a patient who presented with a pharyngeal mucosal mass lesion as a manifestation of superadded Leishmania infection is presented here. The clue to the diagnosis was the origin of the patient from an area highly endemic for leishmaniasis and the presence of unexplained polyclonal hypergammaglobulinaemia. The patient responded very well to therapy with amphotericin B with complete disappearance of the mucosal lesion.

Topics: Adult; Amphotericin B; Endemic Diseases; Hepatitis B, Chronic; Humans; Hypergammaglobulinemia; Leishmaniasis; Liver Cirrhosis; Male; Mucous Membrane; Pharynx

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Cryptococcosis; Deoxycholic Acid; Drug Combinations; Fungemia; Hepatitis B, Chronic; Hepatomegaly; Herpes Zoster; Histoplasmosis; Humans; Male; Splenomegaly; Toxoplasmosis; Ultrasonography; Uremia

To assess the clinical features of aspergillosis and its diagnosis, prophylaxis and treatment in patients after orthotopic liver transplantation (OLT), and to improve the prognosis of the recipients.. Medical records of consecutive patients who underwent OLT in our liver transplant center from May 2002 to May 2004 were analyzed retrospectively. Those with aspergillus infection complications were studied in detail regarding their infected organs, related factors, treatments and prognoses.. 17 out of 207 recipients of OLT were detected with aspergillosis. The incidence was 8.21 percent. 5 patients infected with superficial aspergillus survived. Of the 12 cases with deep aspergillus infection, 3 with infection limited to the sites of their incisions survived, 2 of the 3 patients with infection in their lungs, and 1 of the 2 patients with it in their livers died, and 4 recipients with multi-organ aspergillus infection died. Among the 7 cases that died, 5 had severe hepatitis, 1 had post-hepatitis liver cirrhosis and 1 had primary liver carcinoma.. Long-term (> or = 3 weeks) broad-spectrum antibiotics and immunosupression were involved in aspergillus infection in our OLT patients. Patients with chronic severe hepatitis had a higher risk of having aspergillus infection. Amphotericin B is still the best choice for treating aspergillosis. Prophylactic administration of anti-fungal medicine, surveillance of fungal infections as a routine, and treatment of the infection in time may help to improve the prognosis of OLT recipients with aspergillosis.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; China; Female; Hepatitis B, Chronic; Humans; Incidence; Liver Cirrhosis; Liver Neoplasms; Liver Transplantation; Male; Middle Aged; Retrospective Studies; Risk Factors