amphotericin-b and Hydronephrosis

Obstructive uropathy caused by upper urinary tract fungal ball formation is an uncommon but well recognized clinical entity. The clinical course and management of an infant with unilateral fungal ball obstruction is described. Ultrasound and Tc-diaminotetraethylpentacetic acid (DTPA) renal scan contributed significantly to the diagnosis and management of this patient. Complete resolution of the obstruction was achieved by treatment with intravenous amphotericin B and oral 5-fluorocytosine. The clinical course and management of 35 patients described in the literature indicate that prematurity, use of broad spectrum antibiotics, prolonged hospital stay and the use of intravascular catheters are predisposing factors. The mortality rate is 34%. Young age, small size, the presence of candidaemia and withholding antifungal therapy are poor prognostic factors. A rational plan of treatment, extrapolated from the literature, is presented which may help to reduce the mortality rate in this condition.

Topics: Amphotericin B; Candidiasis; Drug Therapy, Combination; Flucytosine; Humans; Hydronephrosis; Infant; Infant, Newborn; Kidney Diseases; Kidney Pelvis; Male; Ureteral Obstruction

Very low birth weight infants often have multiple predisposing conditions for the development of invasive candidiasis. In patients with systemic candidiasis, the kidney is vulnerable to the formation of cortical abscesses or obstructive intrarenal masses ("fungus balls"), usually at the ureteropelvic junction. Ureteropelvic junction obstructive fungal uropathy necessitates invasive debridement to restore renal function. A very low birth weight infant, infected with Candida, was first seen with hypertension, renal insufficiency, and urine cultures positive for fungus; obstructive bladder fungus ball was diagnosed by ultrasonography. Mechanical disruption with amphotericin B bladder irrigation was accomplished via ultrasonographic guidance, relieving renal obstruction and insufficiency. Systemic antifungal therapy was completed with amphotericin B and flucytosine. The first reported case of bladder obstructive fungal uropathy in a neonate is added to a review of 16 cases of neonatal renal obstructive uropathy.

Topics: Administration, Intravesical; Amphotericin B; Candidiasis; Humans; Hydronephrosis; Hypertension, Renal; Infant, Newborn; Infant, Premature, Diseases; Male; Ultrasonography; Urinary Bladder Diseases

Symptomatic involvement of the genitourinary tract as a manifestation of disseminated Coccidioides immitis infection is uncommon. We report a case of a colovesical fistula secondary to Coccidioides immitis infection and review the pertinent medical literature.

Topics: Adult; Amphotericin B; Coccidioidomycosis; Genital Diseases, Male; Humans; Hydronephrosis; Intestinal Fistula; Ketoconazole; Male; Prostatic Diseases; Sigmoid Diseases; Urinary Bladder Diseases; Urinary Bladder Fistula

A 7-year-old boy presented with a chronic, indurated, tender left thigh swelling in association with a hypertensive emergency. He had a bilateral moderate degree of hydronephrosis and a left perinephric abscess, and MRI features of posterior reversible encephalopathy syndrome. Histopathological examination of the biopsy specimen demonstrated eosinophilic fasciitis with filamentous fungi. Basidiobolus ranarum was isolated from the culture. The fungus was also isolated from a perinephric fluid aspirate. Computerised tomography of the abdomen demonstrated features consistent with fungal invasion of the pelvic floor muscles and urinary bladder, leading to bilateral hydronephrosis. He required multiple antihypertensive drug therapy and was treated with intravenous amphotericin B, oral itraconazole and potassium iodide. Antihypertensive agents were discontinued after 2 weeks of antifungal therapy. At 6-months follow-up, the hydronephrosis had resolved completely. Perinephric abscess associated with basidiobolomycosis has not been reported previously.

Topics: Abscess; Amphotericin B; Antifungal Agents; Antihypertensive Agents; Biopsy; Child; Entomophthorales; Histocytochemistry; Humans; Hydronephrosis; Hypertension; Itraconazole; Magnetic Resonance Imaging; Male; Microscopy; Perinephritis; Potassium Iodide; Radiography, Abdominal; Tomography, X-Ray Computed; Treatment Outcome; Zygomycosis

Phaeohyphomycosis is a heterogeneous group of opportunistic infections caused by dematiaceous molds, which are distributed worldwide as plant pathogens but rarely cause human diseases. However, due to the growing populations of immunocompromised patients, these fungi are frequently recognized as important human pathogens. We are reporting this very rare, unique case for the first time from Islamabad, Pakistan, describing the association of visceral Phaeohyphomycosis caused by the opportunistic fungus Alternaria alternata, affecting the left kidney, with the immunocompromised state in a young incidentally detected patient with insulin-dependent type I diabetes. The case was diagnosed on the basis of a high index of clinical suspicion, microbial cultures, microscopy, imaging studies and endourological procedures. The patient did not respond well to the highly sensitive Amphotericin B, resulting in loss of the kidney. Therefore, we suggest that clinicians involved in treating immunocompromised patients should have a high degree of clinical suspicion for such opportunistic pathogens to allow timely initiation of the correct diagnostic and therapeutic work-up.

Topics: Alternaria; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Humans; Hydronephrosis; Hypoglycemic Agents; Immunocompromised Host; Insulin; Male; Nephrectomy; Opportunistic Infections; Phaeohyphomycosis; Predictive Value of Tests; Risk Factors; Treatment Outcome; Urinary Tract Infections; Young Adult

Topics: Amphotericin B; Antifungal Agents; Child; Contracture; Humans; Hydronephrosis; Male; Tinea; Trichophyton

Fungal urinary tract infections are commonly encountered in the hospitalized neonate. Although these infections most commonly take the form of cystitis, the infection may be complicated by the formation of fungal bezoars, with subsequent urinary tract obstruction. In certain cases, endosurgical debulking or extraction of the fungal bezoar may be necessary. This is particularly challenging in neonates due to their often-compromised physiologic state and small size. We report a case of a premature infant with bilateral obstructing renal fungal bezoars in whom a percutaneous catheter-based thrombectomy system was used successfully to debulk the fungal burden.

Topics: Amphotericin B; Antifungal Agents; Bezoars; Candida albicans; Candidiasis; Catheterization; Humans; Hydronephrosis; Infant, Newborn; Infant, Premature; Kidney; Nephrostomy, Percutaneous; Thrombectomy; Ultrasonography; Urinary Tract Infections

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Epididymitis; Humans; Hydronephrosis; Infant; Kidney; Kidney Diseases; Male; Risk Factors; Treatment Outcome; Ultrasonography

The authors report a case of acute renal failure caused by fungal bezoar in the renal pelvis. The patient was successfully treated with bilateral percutaneous nephrostomy drainage. He had been admitted because of necrotizing enterocolitis, at the age of 26 days. Eventually, his bowel was reduced to 40 cm of small intestine, including 5 cm of terminal ileum. Candida sepsis developed during central total parenteral nutrition, at the age of 76 days. Five weeks after the diagnosis of systemic candidiasis, sudden anuria developed, and ultrasonography showed echogenic material in both renal pelvises. Bilateral percutaneous nephrostomy catheters were placed in the renal pelvises, and local irrigation with amphotericin B was performed for 3 weeks. The renal function of the baby was completely recovered, without systemic antifungal treatment.

Topics: Acute Kidney Injury; Amphotericin B; Antifungal Agents; Bezoars; Candidiasis; Catheterization, Central Venous; Fungemia; Humans; Hydronephrosis; Infant, Newborn; Kidney Pelvis; Male; Parenteral Nutrition, Total; Ultrasonography

Unilateral renal obstruction secondary to fungus balls is described in a premature infant. Noninvasive medical management, which included amphotericin B and 5-flucytosine therapy and forced diuresis, resulted in disappearance of fungus balls and resolution of the obstruction.

Topics: Amphotericin B; Candidiasis; Diuresis; Flucytosine; Humans; Hydronephrosis; Infant, Newborn; Infant, Premature, Diseases; Kidney; Male; Ultrasonography; Ureteral Obstruction

Primary renal candidiasis and hydronephrosis were diagnosed in two premature neonates in whom systemic hypertension developed. The clinical course in these patients and in 16 patients with renal candidiasis described in the literature indicated that prematurity, use of broad-spectrum antibiotics, and use of intravenous (IV) catheters are predisposing factors. Anuria and flank mass were the initial manifestations in the reviewed cases. Only four of the 16 patients survived following either antifungal therapy or nephrectomy. Both of our patients survived after antifungal therapy with amphotericin B and flucytosine for systemic effect as well as topical instillation of amphotericin B solution via a nephrostomy. We believe that a high index of suspicion in infants at risk and early institution of antifungal therapy for systemic as well as topical effect can improve the outcome in infants with renal candidiasis.

Topics: Amphotericin B; Candidiasis; Drug Therapy, Combination; Female; Flucytosine; Humans; Hydronephrosis; Hypertension; Infant; Infant, Newborn; Infant, Premature, Diseases; Kidney Diseases; Kidney Pelvis; Male

Topics: Adult; Amphotericin B; Candidiasis; Humans; Hydronephrosis; Male; Urinary Catheterization