amphotericin-b and Hepatitis

Fusariosis, a rare infectious disease of the immunocompromised host, is relatively resistant to amphotericin B (AmB) or other antifungal agents. We describe a 5-year follow-up of a 40 year old woman with T-type acute lymphoblastic leukemia who following chemotherapy developed prolonged high fever, chills, night sweats, and severe weakness. Liver function tests were impaired and abdominal computerized tomography (CT) showed multiple lesions in the liver and abnormal structure of the spleen. A laparotomy revealed multiple granulomas containing Fusarium sp. in the liver, and the spleen was heavily infiltrated by the same fungus. The patient failed to respond to the conventional AmB dosage form (Fungizone) even after a total dose of 3.0 g was given, and developed significant renal impairment. AmB was complexed (in a mole ratio of 1:16) with a mixture of the phospholipids dimyristoyl phosphatidylcholine and dimyristoyl phosphatidylglycerol (mixed in 7:3 mole ratio). The resulting drug complex, AmB-PLC, was then administered (1-4 mg/kg/day, total dose 4.2 g) and subsequently the patient was cured of all symptoms of fusariosis. There were only mild side effects and no nephrotoxicity was evident. On the contrary, marked improvement of the renal function tests occurred during AmB-PLC treatment. Eight months later, she developed a spinal lesion with dense consistency in L5 and S1, and after receiving another course of AmB-PLC (3.1 g) she recovered completely. In a 2 year follow-up period the patient had no further relapse of the fungal disease. Subsequent chemotherapy given for relapse of the leukemia was followed by a new fungal infection, which was treated with AmB-cholesteryl sulfate complex (Amphocil).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Daunorubicin; Dimyristoylphosphatidylcholine; Drug Carriers; Female; Follow-Up Studies; Fusarium; Granuloma; Hepatitis; Humans; Immunocompromised Host; Kidney Diseases; Leukemia-Lymphoma, Adult T-Cell; Mycoses; Neutropenia; Phosphatidylglycerols; Prednisone; Recurrence; Splenic Diseases; Vincristine

The usefulness to diagnose and monitor invasive candidiasis (IC) using beta-glucan (BG) and antibodies against Candida albicans germ tubes (CAGT) was evaluated in a twice-weekly screening of 35 episodes in neutropenic adults at high risk. Three proven IC and three probable IC were assessed. Diagnostic levels of both markers were detected in 100% of proven IC and in 66% of probable IC. Sensitivity, specificity, positive and negative predictive values of BG and anti-CAGT antibodies detection were 83.3%, 89.6%, 62.5% and 96.3%, and 83.3%, 86.2%, 55.5%, 96.1%, respectively. False positive reactions occurred at a rate of 10.3% and 13.8% for the detection of BG and anti-CAGT antibodies, respectively. However, the patients with false positive results were different by each test. Both tests anticipated the clinical and radiological diagnosis, and the initiation of antifungal therapy in most patients. Combination of both tests improved specificity and positive predictive value to 100%.

Topics: Adolescent; Adult; Aged; Amphotericin B; Anemia, Aplastic; Antibodies, Fungal; Antibody Specificity; Antifungal Agents; Antigens, Fungal; beta-Glucans; Candida albicans; Candidiasis; False Positive Reactions; Female; Fluconazole; Fungemia; Hematologic Neoplasms; Hepatitis; Humans; Liposomes; Male; Middle Aged; Neutropenia; Patient Isolation; Predictive Value of Tests; Sensitivity and Specificity

Leishmaniasis is an emerging infectious disease. Due to human migration and tourism, visceral leishmaniasis may become more common in non-endemic areas. In the Mediterranean basin, visceral leishmaniasis typically occurs in rural regions.. We present an unusual urban case of acute liver failure due to visceral leishmaniasis, following a prolonged fever of unknown origin. After obtaining negative results from the bone marrow aspirate, we performed a liver biopsy that elucidated the diagnosis. The liver involvement in visceral leishmaniasis may appear as chronic granulomatous hepatitis. However diffuse hepatitis process, a necro-inflammatory pattern, without forming granulomas were observed in the liver biopsy specimens in this case. Intracytoplasmic Leishmania amastigotes were observed in the liver biopsy specimens and a polymerase chain reaction confirmed the diagnosis. Only five pathological confirmed cases of acute hepatitis due to visceral leishmaniasis have been described so far, just two in adults and both from Barcelona. A revision of the literature is performed.. Acute hepatitis is an uncommon debut of visceral leishmaniasis in immunocompetent patients. Furthermore there are only few cases in the literature that describe the histopathological changes that we found in this patient. In conclusion, in case of acute hepatitis leading to liver failure, leishmaniasis should be considered a differential diagnosis (even in non-endemic countries and without clear epidemiological exposure) and liver biopsy can elucidate the diagnosis.

Topics: Amphotericin B; Antiprotozoal Agents; Biopsy; Diagnosis, Differential; Fever; Hepatitis; Humans; Leishmaniasis, Visceral; Liver Failure, Acute; Male; Middle Aged; Polymerase Chain Reaction

Topics: Acute Disease; Amphotericin B; Animals; Antiprotozoal Agents; Biopsy; Dogs; Hepatitis; Humans; Leishmania infantum; Leishmaniasis, Visceral; Liver; Male; Middle Aged; Severity of Illness Index; Treatment Outcome; Zoonoses

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Candidiasis, Invasive; Chemotherapy-Induced Febrile Neutropenia; Cytarabine; Daunorubicin; Fluorine Radioisotopes; Fluorodeoxyglucose F18; Hepatitis; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Middle Aged; Multimodal Imaging; Positron-Emission Tomography; Radiopharmaceuticals; Splenic Diseases; Tomography, X-Ray Computed

Topics: Abdominal Wall; Acute Kidney Injury; Adult; Amphotericin B; Anti-Infective Agents; Antibiotic Prophylaxis; Antifungal Agents; Clostridium Infections; Cytomegalovirus Infections; Debridement; Dermatomycoses; Hepatitis; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Mucormycosis; Opportunistic Infections; Postoperative Complications; Primary Graft Dysfunction; Reoperation; Triazoles

Histoplasmosis is endemic to the midwestern and east central states in the United States near the Mississippi and the Ohio River valleys. Ninety-nine percent of patients exposed to histoplasmosis develop only subclinical infection. Liver involvement as a part of disseminated histoplasmosis is well known; however, isolated hepatic histoplasmosis without any other stigmata of dissemination is extremely rare and the literature is limited to only two case reports. We present a rare case of isolated granulomatous hepatitis due to histoplasmosis in a 35-year-old female with dermatomyositis receiving low-dose prednisone and methotrexate. There was no evidence of fungal dissemination elsewhere. High clinical suspicion is critical for early diagnosis and treatment.

Topics: Adult; Amphotericin B; Antifungal Agents; Female; Granuloma; Hepatitis; Histoplasmosis; Humans; Liver

Topics: Acute Disease; Amphotericin B; Antiprotozoal Agents; Drug Therapy, Combination; Hepatitis; Humans; Leishmaniasis, Visceral; Lupus Erythematosus, Systemic; Male; Middle Aged; Treatment Outcome

The emergence of new antifungal compounds with alternative mechanisms of action and improved tolerability has opened up new therapeutic possibilities for the use of combined antifungal treatment in life-threatening systemic fungal infections. A case report of an 8-year-old allogeneic stem cell transplant recipient who developed a central venous catheter tunnel infection caused by Aspergillus flavus is presented here. In spite of conventional and subsequent liposomal amphotericin B therapy the infection progressed rapidly and the necrosis extended further to the thoracic wall, pleura and the right lung. Combined treatment consisting of liposomal amphotericin B and caspofungin was instituted. After 30 days of dual therapy the deep fungal infection resolved and the extensive soft tissue defect showed scarring. One year post-transplant, the patient is well, with normal bone marrow function and full donor chimerism. Although there is limited clinical data on the effectiveness of echinocandins in pediatric patients with documented invasive fungal infections, this case report shows that combining liposomal amphotericin B with caspofungin could be advantageous.

Topics: Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Aspergillus flavus; Bone Marrow Transplantation; Caspofungin; Catheterization, Central Venous; Child; Cicatrix; Disease Progression; Drug Synergism; Drug Therapy, Combination; Echinocandins; Equipment Contamination; Female; Hepatitis; Humans; Immunocompromised Host; Leukocyte Transfusion; Lipopeptides; Liposomes; Necrosis; Peptides, Cyclic; Pneumothorax; Postoperative Complications; Remission Induction; Salvage Therapy; Torque teno virus; Transplantation, Homologous

Invasive fungal infection continues to pose a significant threat to immunocompromised patients. The authors describe a pediatric patient receiving chemotherapy for acute undifferentiated leukemia who developed presumptive Aspergillus species infection disseminated to lung, liver, spleen, and bone. The authors report the successful treatment of this infection with the addition of voriconazole, a triazole antimycotic, to treatment with amphotericin and surgical debridement, in the setting of ongoing intensive chemotherapy.

Topics: Acute Disease; Adolescent; Amphotericin B; Antifungal Agents; Aspergillosis; Combined Modality Therapy; Debridement; Drug Therapy, Combination; Female; Hepatitis; Humans; Leukemia; Lung Diseases, Fungal; Opportunistic Infections; Osteomyelitis; Pyrimidines; Remission Induction; Sacroiliac Joint; Splenic Diseases; Triazoles; Voriconazole

A 7-year-old child had unusual manifestation of cryptococcosis; liver and lymph node involvement predominated. There was evidence of cryptococcal hepatitis, extrahepatic biliary obstruction, and subsequent cirrhosis of the liver. Despite widespread dissemination, underlying immune disturbance was not evident. The patient was treated with two courses of amphotericin and 5-flucytosine.

Topics: Amphotericin B; Child; Cholestasis, Extrahepatic; Cryptococcosis; Flucytosine; Hepatitis; Humans; Liver; Liver Cirrhosis; Lymphatic Diseases; Male

Topics: Amphotericin B; Antineoplastic Agents; Candidiasis; Disease Susceptibility; Hepatitis; Humans; Neoplasms; Splenic Diseases

A 33-yr-old Puerto Rican women was hospitalized for chemotherapy and multiple antibiotic treatment for relapse of acute myelomonocytic leukemia. While she was already receiving amphotericin for suspected Aspergillus infection, she developed hepatomegaly and abnormal liver enzymes with high serum bilirubin. The blood cultures were negative. Percutaneous liver biopsy revealed granulomatous fungal hepatitis identified by cultures as Trichosporon cutaneum. In spite of the continued administration of amphotericin, with the addition of 5-fluorocytosine, Trichosporon was later cultured from her blood, and she succumbed to fungemia and polymicrobial sepsis.

Topics: Adult; Amphotericin B; Aspergillosis; Biopsy; Female; Flucytosine; Hepatitis; Humans; Leukemia, Myeloid; Liver; Mitosporic Fungi; Mycoses; Pregnancy; Pregnancy Complications

Transfer factor is a dialyzable extract of sensitized leukocytes, which transfers reactivity from skin test-positive donors to skin test-negative recipients. Transfer factor supplied by our laboratory has been used therapeutically to induce cellular immunity in 78 patients around the world. Many patients received multiple doses of transfer factor ranging from 1 unit given every 6 months for 3 years to 1 unit every week for 6 months to as much as 8 units per week for a brief period. A total of 299 units of transfer factor have been given. Diseases in which transfer factor appeared to cause improvement include the Wiskott-Aldrich syndrome, severe combined immunodeficiency disease, mucocutaneous candidiasis, chronic active hepatitis, coccidioidmycosis, dysgammaglobulinemia, Behcet disease, aphthous stomatitis, linear morphea, familial keratoacanthoma and malignancy.

Topics: Amphotericin B; Behcet Syndrome; Binding Sites, Antibody; Candidiasis, Cutaneous; Coccidioidomycosis; Dysgammaglobulinemia; Hepatitis; Humans; Immunity, Cellular; Immunologic Deficiency Syndromes; Immunotherapy; Keratoacanthoma; Macrophage Migration-Inhibitory Factors; Monocytes; Neoplasms; Scleroderma, Localized; Stomatitis, Aphthous; Transfer Factor; Wiskott-Aldrich Syndrome

Topics: Adult; Amphotericin B; Cell Migration Inhibition; Chlorella; Complement System Proteins; Fluorescent Antibody Technique; Hepatitis; Humans; Immunity, Maternally-Acquired; Immunodiffusion; Immunoglobulins; Immunotherapy; Infections; Injections, Intravenous; Lymphocyte Activation; Male; Skin Manifestations

Topics: Adolescent; Adult; Amoeba; Amphotericin B; Brain; Bronchopneumonia; Child; Chloroquine; Electrocardiography; Emetine; Eosinophils; Exudates and Transudates; Female; Hepatitis; Humans; Male; Meningoencephalitis; Metronidazole; Myocarditis; Myocardium; Penicillins; Pulmonary Edema; Sulfadiazine; Sulfisoxazole

Topics: Adult; Amphotericin B; Biopsy; Cholangitis; Cryptococcosis; Diagnostic Errors; Flucytosine; Granuloma; Hepatitis; Humans; Liver; Male; Meningitis; Neurologic Manifestations