amphotericin-b and Hypotension

Colonic cryptococcal infection is unusual in people living with HIV (PLWH) and even more so without concomitant neurological compromise. Published case reports describe diarrhea and other intestinal manifestations that are often confused with systemic tuberculosis infection. We describe an Peruvian woman living with HIV on antiretroviral therapy who presented hypotensive with a 6-month history of fever and epigastric pain, in addition to episodes of sporadic diarrhea. Due to the suspicion of systemic tuberculosis, antituberculosis treatment was started. Days later, without clinical improvement, colonoscopy revealed ulcers in the transverse colon. Histopathological examination of biopsied tissue was compatible with

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Female; Fluconazole; HIV Infections; Humans; Hypotension; Immunosuppression Therapy; Pain; Treatment Outcome

This pilot study compared the toxicity of a one hour with a four hour amphotericin B infusion in children. There were more severe chills in the former group on the first day of infusion, and more hypotension in the latter group over the study duration.

Topics: Adolescent; Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Child; Child, Preschool; Double-Blind Method; Drug Administration Schedule; Female; Humans; Hypotension; Infant; Infusions, Intravenous; Male; Pilot Projects; Shivering

Complement (C) activation can underlie the infusion reactions to liposomes and other nanoparticle-based medicines, a hypersensitivity syndrome that can be partially reproduced in animal models. However, the sensitivities and manifestations substantially differ in different species, and C activation may not be the only cause of pathophysiological changes. In order to map the species variation of C-dependent and -independent pseudoallergy (CARPA/CIPA), here we used known C activators and C activator liposomes to compare their acute hemodynamic, hematological, and biochemical effects in rats. These C activators were cobra venom factor (CVF), zymosan, AmBisome (at 2 doses), its amphotericin B-free vehicle (AmBisombo), and a PEGylated cholesterol-containing liposome (PEG-2000-chol), all having different powers to activate C in rat blood. The pathophysiological endpoints measured were blood pressure, leukocyte and platelet counts, and plasma thromboxane B2, while C activation was assessed by C3 consumption using the Pan-Specific C3 assay. The results showed strong linear correlation between C activation and systemic hypotension, pointing to a causal role of C activation in the hemodynamic changes. The observed thrombocytopenia and leukopenia followed by leukocytosis also correlated with C3 conversion in case of C activators, but not necessarily with C activation by liposomes. These findings are consistent with the double hit hypothesis of hypersensitivity reactions (HSRs), inasmuch as strong C activation can fully account for all symptoms of HSRs, but in case of no-, or weak C activators, the pathophysiological response, if any, is likely to involve other activation pathways.

Topics: Amphotericin B; Animals; Cholesterol; Complement Activation; Complement C3-C5 Convertases; Complement System Proteins; Drug Hypersensitivity Syndrome; Elapid Venoms; Humans; Hypotension; Leukocytosis; Leukopenia; Liposomes; Nanoparticles; Polyethylene Glycols; Rats; Thrombocytopenia; Zymosan

We hereby report a short case of 71-year-old gentleman who developed ST segment elevation myocardial infarction shortly after starting the infusion of liposomal amphotericin B for disseminated histoplasmosis. We also discuss the novel pathogenesis of specific liposomal component of amphotericin B that contributed to the acute cardiopulmonary compromise in our patient leading to subsequent myocardial infarction.

Topics: Aged; Amphotericin B; Antifungal Agents; Histoplasmosis; Humans; Hypotension; Male; Myocardial Infarction

To study the prevalence of risk factors and outcome of fungal infections in patients with severe acute pancreatitis.. Fifty consecutive patients with severe acute pancreatitis were investigated for evidence of fungal infection by weekly culture of body fluids and aspirate from pancreatic/peripancreatic tissue and samples collected at necrosectomy. All patients were managed as per a standard protocol. Patients with documented fungal infection were treated with intravenous amphotericin or fluconazole. Data were analyzed using SPSS software (version 13), and risk factors for fungal infection and mortality were determined.. Fungal infection was documented in 18 (36%) of 50 patients with Candida albicans (the commonest species). The incidence of fungal infection steadily increased with increasing duration of hospital stay. Those with fungal infection more often had evidence of respiratory failure (P = 0.031) and hypotension (P = 0.031) at admission, prolonged hospital stay > 4 weeks (P = 0.034), longer duration of antibiotics (P = 0.003), received total parenteral nutrition (P = 0.005), and required mechanical ventilation (P = 0.001) in contrast to those without fungal infection. The logistic regression analysis found the independent risk factors for fungal infection to be antibiotic therapy for > 4 weeks and hypotension at hospitalization. Of the 18 patients with fungal infection, 13 were administered intravenous antifungals; eight of these patients survived, while the five who did not receive antifungals died.. Fungal infection was detected in 36% of our patients. The independent risk factors associated with it were hypotension at hospitalization and prolonged antibiotic therapy. Antifungal therapy improved their chances of survival.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Female; Fluconazole; Humans; Hypotension; Length of Stay; Logistic Models; Male; Middle Aged; Mycoses; Odds Ratio; Pancreatectomy; Pancreatitis, Acute Necrotizing; Parenteral Nutrition, Total; Prevalence; Prospective Studies; Respiration, Artificial; Respiratory Insufficiency; Risk Assessment; Risk Factors; Severity of Illness Index; Time Factors; Treatment Outcome