amphotericin-b and Heroin-Dependence

Topics: Adult; Amphotericin B; Antifungal Agents; Buprenorphine; Candidiasis; Endocarditis; Endophthalmitis; Eye Infections, Fungal; Fatal Outcome; Flucytosine; Hepatitis C, Chronic; Heroin Dependence; Humans; Male; Mycoses; Pneumonia, Staphylococcal; Recurrence; Shock, Cardiogenic; Substance Abuse, Intravenous; Tricuspid Valve; Ultrasonography

The management of Candida albicans endophthalmitis in intravenous drug abusers (IVDAs) has yet to be established. Early vitrectomy was previously reported as a promising treatment for C. albicans endophthalmitis. In our series, C. albicans endophthalmitis was diagnosed for 15 IVDAs. Funduscopic examinations confirmed severe vitritis in 12 patients and chorioretinitis in three. Blood and vitreal cultures were positive for C. albicans for seven and eight patients, respectively. Patients with vitritis received antifungal therapy before and after vitrectomy. Amphotericin B or fluconazole therapy was given according to the physician's preference. Vitrectomy was defined as early if it was performed within 1 week after the diagnosis of vitritis. All seven patients who underwent early vitrectomy had a favorable response without complications. Two of three patients who underwent late vitrectomy developed blindness or scotoma. Blindness was also described in two patients with vitritis who did not undergo vitrectomy. Early vitrectomy preceded and followed by antifungal therapy seems to be appropriate management of vitritis in IVDAs.

Topics: Adult; Amphotericin B; Antifungal Agents; Blindness; Candidiasis; Combined Modality Therapy; Endophthalmitis; Eye Infections, Fungal; Female; Fluconazole; Heroin Dependence; Humans; Injections, Intravenous; Male; Visual Acuity; Vitrectomy

We report a case of Penicillium marneffei infection, acquired in Thailand, in a Swedish HIV-infected immunodeficient heroin addict. This is the first case of penicilliosis marneffei diagnosed in Sweden. The patient had fever without focal symptoms. Cultures from bronchoalveolar lavage fluid and a mediastinal lymph node yielded the dimorphic fungus Penicillium marneffei. Treatment with amphotericin B followed by itraconazole was successful. Penicillium marneffei infection should be considered in HIV patients with fever who have visited Southeast Asia, especially northern Thailand and southern China.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Heroin Dependence; Humans; Itraconazole; Male; Mycoses; Penicillium; Sweden; Thailand

The case of a white-heroin addict who developed disseminated candidiasis following coinfection by Candida glabrata and Candida albicans is reported. Genomic random amplified polymorphic DNA typing suggested that the Candida glabrata blood isolates originated in the oral cavity of the patient. This case strengthens the evidence that Candida species other than Candida albicans can be involved in the pathogenesis of disseminated candidiasis in heroin addicts.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; DNA, Fungal; Fungemia; Heroin Dependence; HIV Seropositivity; Humans; Injections, Intravenous; Male; Mouth; Skin; Species Specificity

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus; Aspergillus fumigatus; Heroin Dependence; Humans; Lumbar Vertebrae; Lymphocytes; Male; Neutrophils; Osteomyelitis; Phagocytosis; Spinal Diseases; Thoracic Vertebrae

Nine heroin addicts with presumed candidal endophthalmitis were seen in Glasgow between November 1982 and April 1984. Six patients during a two month period in 1983. The physical symptoms and signs observed, results of laboratory investigations and responses to anti-fungal chemotherapy are reported. Epidemiological factors relating to possible sources of infection are explored.

Topics: Adolescent; Adult; Amphotericin B; Candidiasis; Disease Outbreaks; Endophthalmitis; Female; Fundus Oculi; Heroin Dependence; Humans; Ketoconazole; Male; Scotland

Of 38 heroin addicts treated for systemic candidal infections, 36 had metastatic cutaneous lesions (deep-seated scalp nodules and pustulosis in hairy zones), 15 had ocular localizations (mainly chorioretinitis), and 10 had osteoarticular involvement (vertebrae, costal cartilage, knees, and sacroiliac). Such cutaneous lesions have not previously been described in classical systemic candidiasis; we also observed hair invasion by candidal hyphae. Candida albicans was the exclusive species isolated, in contrast to other visceral candidiases in heroin addicts. All isolates were sensitive to amphotericin B, flucytosine, and ketoconazole. Thirty-one visceral localizations were treated only with ketoconazole. Results were favorable in 15 of 18 cutaneous, 6 of 6 ocular, and 4 of 7 osteoarticular cases of involvement. This outbreak coincided with introduction of a new heroin on the drug market in the Paris area. C. albicans was not isolated from the drug. Pathogenesis of this syndrome is unclear.

Topics: Adult; Aged; Amphotericin B; Bone Diseases; Candida albicans; Candidiasis; Candidiasis, Cutaneous; Eye Diseases; Female; Flucytosine; France; Heroin Dependence; Humans; Joint Diseases; Ketoconazole; Male; Middle Aged; Osteoarthritis; Scalp; Syndrome

Over a two-year period 8 patients were hospitalized with a presumptive diagnosis of Candida endophthalmitis. 6 patients were heroin addicts, while in the 2 other patients no risk factor could be identified. The presumptive diagnosis was based on the typical findings of retinohyalitic exudate and exclusion of other factors causing endophthalmitis. Intravenous therapy with amphotericin-B and flucytosin resulted in definitive scar healing. In 1 patient vitrectomy was necessitated by recurrence of endophthalmitis resistant to antifungal therapy.

Topics: Adolescent; Adult; Amphotericin B; Candidiasis; Drug Therapy, Combination; Female; Flucytosine; Heroin Dependence; Humans; Male; Panophthalmitis

Wangiella dermatitidis is an infrequently encountered dematiacious fungus that usually causes localized infections of the skin and subcutaneous tissues. This report presents the first well-documented case of natural valve infection caused by this organism as it occurred in intravenous drug abuser. His course has been complicated by relapsing infection of two aortic prostheses and dissemination to the vertebral spine. Treatment with a combination of amphotericin B, rifampin, and ketoconazole has arrested the progression of his infection. The microbiologic features and existing clinical information regarding this fungus are reviewed and in vitro susceptibility data for the present isolate are presented.

Topics: Adult; Amphotericin B; Aortic Valve; Drug Therapy, Combination; Endocarditis; Heart Valve Diseases; Heroin Dependence; Humans; Ketoconazole; Male; Mitosporic Fungi; Mycoses; Recurrence; Reoperation; Rifampin

Topics: Adult; Amphotericin B; Candidiasis; Diagnosis, Differential; Endophthalmitis; Female; Heroin; Heroin Dependence; Humans; Injections, Intravenous; Male; Toxoplasmosis, Ocular

Topics: Adolescent; Adult; Amphotericin B; Candidiasis; Endophthalmitis; Fundus Oculi; Heroin Dependence; Humans; Male

Topics: Adult; Amphotericin B; Female; Heroin Dependence; Humans; Male; Mycoses; Uveitis

Patients with endogenous Candida endophthalmitis associated with intravenous (IV) drug abuse may manifest ocular and systemic signs different from those seen in other forms of endogenous Candida endophthalmitis. There may be a sparcity of evidence of systemic candidiasis, including negative serology and normal physical examination results. Anterior uveitis and extensive vitreous involvement are common and do not necessarily have associated typical retinal lesions, which are more commonly seen in the compromised host. This may occur either because of the more transitory nature of choroidal or retinal lesions or because these patients often seek treatment at later stages. Even with a typical clinical picture, it is difficult to get culture confirmation of the diagnosis. Material obtained by vitrectomy must be concentrated before inoculation of media because of the known difficulty of culturing Candida from the vitreous cavity.

Topics: Adult; Amphotericin B; Candidiasis; Endophthalmitis; Fundus Oculi; Heroin Dependence; Humans; Male; Middle Aged

Successful treatment of fungal endocarditis is being described with increasing frequency. Two patients, previously reported as free of disease by two different groups of investigators, subsequently died in our institutions with evidence of continued disease. Both patients had been receiving antifungal chemotherapy at the time their case histories were reported. The lack of clinical signs and symptoms in fungal endocarditis, the suppression of manifestations of infection by chemotherapy, and the uncertain reliability of laboratory aids led us to suggest guidelines in reporting results of therapuetic regimens. These include avoidance of terms implying cure in patients who are concurrently maintained on chemotherapy, indication of attempts to evaluate fungemia, and minimum follow-up of 1-2 years' duration. The potential utility of serologic studies is illustrated by the course of one of these patients.

Topics: Adult; Amphotericin B; Aortic Valve Stenosis; Candidiasis; Cytosine; Endocarditis; Flucytosine; Heart Valves; Heroin Dependence; Humans; Male; Miconazole; Middle Aged; Prostheses and Implants; Recurrence; Surgical Wound Infection

Topics: Adult; Amphotericin B; Candidiasis; Endophthalmitis; Flucytosine; Heroin Dependence; Humans; Male

Topics: Adolescent; Amphotericin B; Biopsy; Candida albicans; Candidiasis; Cataract; Diagnostic Errors; Eye Diseases; Flucytosine; Heroin Dependence; Humans; Male; Visual Acuity; Vitreous Body

Fungal endocarditis occurs in heroin addicts, patients who have undergone cardiovascular surgery, and patients who are treated for prolonged periods with intravenous fluids and broad spectrum antibiotics. The organisms associated with endocardial infection differ in each of these groups. Candida parapsilosis is the fungal species most commonly isolated from narcotics addicts, Aspergillus species are most frequently found in patients after cardiovascular surgery, and Candida albicans occurs most frequently in patients who have received prolonged courses of intravenous fluids and antibiotics. Despite the availability of antifungal antibiotics and surgery, over 80% of patients with documented fungal endocarditis die of this infection. Thus, early diagnosis of fungal invasion and prevention of established endocardial infection are essential. Antifungal therapy and/or careful followup should be considered in patients in whom "transient fungemia" is documented by blood culture and serological and untrasonic techniques should be further evaluated as a means of early diagnosis.

Topics: Adolescent; Adult; Aged; Amphotericin B; Aspergillosis; Candida; Candidiasis; Cardiac Surgical Procedures; Endocarditis; Female; Fever; Flucytosine; Heart Valve Prosthesis; Heroin Dependence; Humans; Male; Middle Aged; Mycoses; Postoperative Complications

Topics: Adult; Amphotericin B; Aortic Valve; Blood; Candida; Candidiasis; Culture Media; Endocarditis; Heart Valve Prosthesis; Heroin Dependence; Humans; Male; Time Factors

Topics: Adult; Amphotericin B; Candida albicans; Candidiasis; Endophthalmitis; Eye; Heroin Dependence; Humans; Inhalation; Male; Pupil; Vitreous Body

Topics: Adult; Aminohydrolases; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Cell-Free System; Cytosine; Drug Resistance, Microbial; Endocarditis; Female; Flucytosine; Heroin Dependence; Humans; Imidazoles; Recurrence; Trityl Compounds

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Blood Vessels; Brain Diseases; Fungi; Heroin Dependence; Humans; Kidney Diseases; Male; Mucormycosis; Necrosis; Urography