amphotericin-b and Infant--Newborn--Diseases

Candida infections are a source of significant mortality and morbidity in the neonatal intensive care unit. Treatment strategies continue to change as additional antifungals become available and studies in neonates are performed. Amphotericin B deoxycholate has been favored for many years, but fluconazole has the most data supporting its use in neonatal Candida infections and is often employed for prophylaxis as well as treatment. Voriconazole and posaconazole have limited utility in the nursery and are rarely used. The echinocandins are increasingly administered for invasive Candida infections, although higher doses are required in neonates than in older children and adults.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Deoxycholic Acid; Dose-Response Relationship, Drug; Drug Combinations; Echinocandins; Fluconazole; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Neonatology; Pyrimidines; Triazoles; Voriconazole

Patients with severe neutropenia are at increased risk for systemic infection with bacteria or fungi. This risk is in proportion to both the degree and duration of the neutropenic process. Although granulocyte transfusion as a means of augmenting host defenses would appear to be a logical therapeutic intervention in clinical contexts involving severe and prolonged neutropenia, several features of granulocyte physiology and collection complicate such considerations. These include the large numbers of granulocytes normally produced by healthy hosts, the short survival of the granulocyte in the circulation after transfusion, the relatively small number of granulocytes which can be collected using currently available pheresis techniques, problems associated with alloimmunization, and the possibility of transferring disease (CMV, toxoplasmosis, hepatitis) by means of these transfusions. In the mid-1970s, well-designed clinical studies strongly suggested that patients with documented Gram-negative sepsis or tissue infection that failed to respond to appropriate antibiotics were significantly benefited by granulocyte transfusions. With recent advances in potent, broad-spectrum antibiotic availability, some have questioned whether these observations remain valid. Several studies regarding the prophylactic use of granulocyte transfusions in patients undergoing allogeneic bone marrow transplantation and/or induction therapy for leukemia have failed to reveal therapeutic benefits and suggested the possibility of significant side effects. These studies are reviewed.

Topics: Agranulocytosis; Amphotericin B; Anti-Bacterial Agents; Blood Transfusion; Bone Marrow Transplantation; Cell Separation; Clinical Trials as Topic; Cytomegalovirus Infections; Granulocytes; Humans; Infant, Newborn; Infant, Newborn, Diseases; Leukapheresis; Lung Diseases; Neutropenia; Sepsis; Transfusion Reaction

Seven patients with Candida meningitis are reported. These 7, plus 21 previously cited cases, were reviewed. This infection arose by two distinct mechanisms: hematogenous dissemination and direct inoculation. Recent antibiotic therapy, corticosteroid administration and severe underlying diseases were important predisposing factors. Fever, meningismus, elevated CSF pressures and localizing neurologic signs were commonly noted. Organisms were seen on gram-stain of CSF in only 43% of cases. Mortality rate in patients receiving inadequate or no antifungal therapy was high (greater than 90%), while those patients given appropriate antifungal drugs, especially intravenous amphotericin B, had a significantly lower mortality rate (38%). Several factors associated with poor prognosis were delineated in this study: diagnostic interval after symptomatic onset longer than two weeks, CSF glucose levels below 35 mg/100 ml and presence of intracranial hypertension and focal neurologic deficits.

Topics: Amphotericin B; Candidiasis; Cerebrospinal Fluid Shunts; Child, Preschool; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Meningitis; Middle Aged; Prognosis

Topics: Amphotericin B; Anti-Bacterial Agents; Bacitracin; Cephalothin; Chloramphenicol; Erythromycin; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infections; Kanamycin; Neomycin; Novobiocin; Penicillin Resistance; Penicillins; Polymyxins; Protein Binding; Staphylococcal Infections; Streptomycin; Sulfonamides; Tetracycline

Patients with severe neutropenia are at increased risk for systemic infection with bacteria or fungi. This risk is in proportion to both the degree and duration of the neutropenic process. Although granulocyte transfusion as a means of augmenting host defenses would appear to be a logical therapeutic intervention in clinical contexts involving severe and prolonged neutropenia, several features of granulocyte physiology and collection complicate such considerations. These include the large numbers of granulocytes normally produced by healthy hosts, the short survival of the granulocyte in the circulation after transfusion, the relatively small number of granulocytes which can be collected using currently available pheresis techniques, problems associated with alloimmunization, and the possibility of transferring disease (CMV, toxoplasmosis, hepatitis) by means of these transfusions. In the mid-1970s, well-designed clinical studies strongly suggested that patients with documented Gram-negative sepsis or tissue infection that failed to respond to appropriate antibiotics were significantly benefited by granulocyte transfusions. With recent advances in potent, broad-spectrum antibiotic availability, some have questioned whether these observations remain valid. Several studies regarding the prophylactic use of granulocyte transfusions in patients undergoing allogeneic bone marrow transplantation and/or induction therapy for leukemia have failed to reveal therapeutic benefits and suggested the possibility of significant side effects. These studies are reviewed.

Topics: Agranulocytosis; Amphotericin B; Anti-Bacterial Agents; Blood Transfusion; Bone Marrow Transplantation; Cell Separation; Clinical Trials as Topic; Cytomegalovirus Infections; Granulocytes; Humans; Infant, Newborn; Infant, Newborn, Diseases; Leukapheresis; Lung Diseases; Neutropenia; Sepsis; Transfusion Reaction

Invasive candidiasis is an important cause of sepsis in extremely low birth weight infants (ELBW, < 1000 g), is often fatal, and frequently results in neurodevelopmental impairment (NDI) among survivors. We sought to assess the antifungal minimum inhibitory concentration (MIC) distribution for Candida in ELBW infants and evaluate the association between antifungal resistance and death or NDI.. This was a secondary analysis of a National Institute of Child Health and Human Development Neonatal Research Network study. MIC values were determined for fluconazole, amphotericin B and micafungin. NDI was assessed at 18-22 months adjusted age using the Bayley Scales of Infant Development. An infant was defined as having a resistant Candida isolate if ≥ 1 positive cultures from normally sterile sites (blood, cerebrospinal fluid, or urine) were resistant to ≥ 1 antifungal agent. In addition to resistance status, we categorized fungal isolates according to MIC values (low and high). The association between death/NDI and MIC level was determined using logistic regression, controlling for gestational age and Bayley Scales of Infant Development (II or III).. Among 137 ELBW infants with IC, MICs were determined for 308 isolates from 110 (80%) infants. Three Candida isolates from 3 infants were resistant to fluconazole. None were resistant to amphotericin B or micafungin. No significant difference in death, NDI, or death/NDI between groups with low and high MICs was observed.. Antifungal resistance was rare among infecting Candida isolates, and MIC level was not associated with increased risk of death or NDI in this cohort of ELBW infants.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis, Invasive; Cohort Studies; Drug Resistance, Fungal; Female; Fluconazole; Gestational Age; Humans; Infant; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Male; Micafungin; Microbial Sensitivity Tests; Neurodevelopmental Disorders; Prospective Studies; Sepsis; Treatment Outcome

Cryptococcal meningitis is uncommon in children, particularly in infants. A 2-day-old boy was admitted with signs suggestive of meningitis. Lumbar puncture confirmed meningitis and cryptococcal infection (cryptococcal antigen and Indian ink stain-positive). His mother was HIV-negative. This is thought to be the youngest case of cryptococcal meningitis to be reported. Cryptococcal infection should be considered in children of all ages with meningitis where there is possible immunodeficiency or failure to respond to initial treatment with antibiotics.

Topics: Amphotericin B; Cryptococcus neoformans; HIV Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Meningitis, Cryptococcal

To study the clinical characteristics, antibiotics sensitivity, outcome and risk factors of neonatal septicemia caused by Candida haemulonii.. A retrospective analysis was performed on clinical characteristics and antibiotics sensitivity after 8 cases of neonatal septicemia caused by Candida haemulonii were identified; each of these patients had at least one positive result of bacterial culture for Candida haemulonii.. The 8 cases born at gestational age of 178-260 d, weighing 835-2 055 g, developed the infection from May to July at 10-34 d after hospitalization. Among the 8 patients, 7 were cured, 1 died during hospitalization after the treatments were given up because of serious complications. The 8 patients with septicemia caused by Candida haemulonii had similar clinical chariacteristics to those of other neonatal candidemia, such as apnea, fever, abdominal distension, jaundice etc. They had abnormal auxiliary examination with increased C-reactive protein (CRP), declined platelet (PLT) count to different degrees. All of the 8 patients had peripherally inserted central catheter (PICC) and broad-spectrum antibiotics were applied. C. haemulonii as an emergent fungal pathogen had varying degrees of resistance to fluconazole, amphotericin B, itraconazole, or ketone, but was susceptible to voriconazole.. The characteristics of neonatal septicemia caused by Candida haemulonii were similar to those caused by other candida, and the main risk factors are the low birth weight, PICC, and usage of broad-spectrum antibiotics. It mainly occurred in May to July which is hot and humid season.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; C-Reactive Protein; Candida; Candidiasis; Fluconazole; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Microbial Sensitivity Tests; Retrospective Studies; Sepsis

Colonisation may be the first step for the development of Candida infection. The source of neonatal colonisation is thought to be the hospital environment or the maternal vaginal tract. This study investigated to what extend Candida isolates in neonates are similar to isolates from their mother's vaginal tract. Vaginal samples were collected from 347 pregnant women within 48 h before delivery. Samples from oral and rectal mucosa of their neonates were collected within 24-72 h after delivery, were cultured and yeast species were identified. Antifungal susceptibility tests against six antifungal agents were performed. All paired isolates from mother and infant were genotyped by pulse field gel electrophoresis. A total of 82 mothers and of 16 infants were found colonised by Candida spp. C. albicans was the most common species in pregnant women (n = 68) followed by C. glabrata (n = 11). Only C. albicans was isolated from infants, mainly (14/16) from rectal site. All colonised neonates were born to mothers colonised by C. albicans. Candida genotyping revealed identical strains in all investigated neonate-mother pairs. All isolates were susceptible to amphotericin B. Our findings strongly suggest that vertical transmission has the principal role in the neonatal colonisation by C. albicans in the very first days of life.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Female; Genotype; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Male; Pregnancy; Pregnancy Complications, Infectious; Vagina; Young Adult

A 5-week-old infant presented with a fever, and was diagnosed with congenital human immunodeficiency virus and histoplasmosis. Both infections were likely transmitted vertically. The child was effectively treated with antifungal medications and highly active antiretroviral therapy. This represents the first case of delayed presentation of vertically transmitted histoplasmosis, and the first case in a nonendemic area.

Topics: Amphotericin B; Antifungal Agents; Female; Guatemala; Histoplasma; Histoplasmosis; HIV Infections; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infectious Disease Transmission, Vertical; Itraconazole; Mothers

Randomized controlled trials suggest that prophylactic administration of antifungal agents reduce the rate of colonization and invasive Candida infection in a subgroup of high-risk very low birth weight (VLBW) neonates. The extent of antifungal prophylaxis use in the United Kingdom and Ireland is unknown.. A postal questionnaire was administered to neonatologists practicing in the United Kingdom and Ireland caring for VLBW infants. Information was requested on the prophylactic agents used, dosing schedules and duration of therapy. The rationale for reported practices was also ascertained.. The response rate was 55% (125/228). Antifungal prophylaxis use was reported by 66 (53%) respondents. First-line agents utilized included oral nystatin (53%) and intravenous fluconazole (41%). The most frequent indications for antifungal prophylaxis included antibiotic administration in 45 (68%) and decreased birth weight in 33 (50%) respondents. The majority of respondents who did not use antifungal prophylaxis felt that the perceived rate of invasive fungal disease within their unit was not high enough to justify its use.. A small majority of clinicians caring for VLBW neonates routinely use antifungal prophylaxis. This reflects the wide variation in the incidence of invasive disease, lack of guidelines supporting a role for prophylaxis and concerns related to emergence of resistant strains.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Fluconazole; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Very Low Birth Weight; Nystatin; Practice Patterns, Physicians'

Trichosporon asahii causes white piedra, an infection of hair shafts and onychomycosis in immunocompetent patients, as well as various localized or disseminated invasive infections in immunodeficient hosts. We describe a 26-week gestation 890-g vaginally delivered female neonate who had severe respiratory distress syndrome and on the sixth day of life developed Klebsiella pneumoniae sepsis. At the same time two blood cultures were positive for T. asahii. The neonate was also colonized with T. asahii in the pharynx and perineum. The infant was successfully treated with conventional amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Klebsiella Infections; Klebsiella pneumoniae; Mycoses; Respiratory Distress Syndrome, Newborn; Sepsis; Trichosporon

We report a case of maternal brain death at 25 weeks gestation in which aggressive maternal hemodynamic, respiratory, and metabolic support and tocolytic drug therapy resulted in prolongation of pregnancy for 25 days. The indication for delivery was torulopsis giabrata amnionitis, which may have occurred due to transmembrane or transplacental route. The baby was treated for fungal sepsis, and did well. Premature labor may occur spontaneously after maternal brain death, and may be precipitated by infection or by maternal drug therapy. The myriad of hemodynamic and endocrine issues associated with maternal brain death complicate the choice of tocolytic drugs, but this case illustrates that uterine activity can be successfully blocked, potentially diminishing risks to the newborn, following the tragedy of maternal brain death during pregnancy.

Topics: Adult; Amphotericin B; Brain Death; Candidiasis; Cerebral Hemorrhage; Disease-Free Survival; Fatal Outcome; Female; Fungemia; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Obstetric Labor, Premature; Pneumonia; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Pregnancy Trimester, Second; Tocolysis

Liposomal amphotericin B L-Amp B, a novel formulation of Amp B, is effective for the treatment of invasive fungal infections in children and adults and is associated with less toxicity than the conventional preparation. Data on the use of L-Amp B in neonates is scarce. We describe the clinical course of two premature infants who were treated with L-Amp B (one infant had candidemia, and the other had candidemia and meningitis), and provide a summary of previously published experience on this topic. L-Amp B may be an option for therapy of invasive candidiasis in neonates who are at high risk of nephrotoxicity and other amphotericin-related reactions, but clinical trials are necessary to document its safety and efficacy in this age group.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Drug Carriers; Fatal Outcome; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Liposomes; Male

A compassionate use protocol for AmBisome (liposomal amphotericin B) was announced by NeXstar Pharmaceuticals. Eligible patients include those immunosuppressed from bone marrow transplantation, active chemotherapy for cancer, or the administration of other immunosuppressive agents; AIDS patients; premature and newborn infants; or patients otherwise compromised.

Topics: Acquired Immunodeficiency Syndrome; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Bone Marrow Transplantation; Clinical Protocols; Drug Carriers; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Liposomes; Mycoses

Topics: Amphotericin B; Candidiasis; Drug Therapy, Combination; Flucytosine; Humans; Infant, Newborn; Infant, Newborn, Diseases

Topics: Amphotericin B; Arthritis, Infectious; Bone Development; Candidiasis; Femur; Flucytosine; Follow-Up Studies; Humans; Humerus; Infant, Newborn; Infant, Newborn, Diseases; Knee Joint; Male; Osteomyelitis; Radiography; Shoulder Joint

The incidence of Candida meningitis in the neonatal period is increasing, and 63% of reported patients have either died or are mentally retarded. We report a newborn with Candida meningitis and arthritis who did well after treatment with intravenous and intrathecal amphotericin B, along with oral flucytosine.

Topics: Administration, Oral; Amphotericin B; Arthritis, Infectious; Candidiasis; Cytosine; Drug Therapy, Combination; Flucytosine; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Injections, Spinal; Male; Meningitis

Meningitis due to Candida albicans was successfully treated in a 1.1 kg premature infant using combined antifungal therapy of amphotericin B for three weeks and 5-fluorocytosine for four months. Hydrocephalus and profound psychomotor retardation were present one year later. Psychomotor retardation, aqueductal stenosis and hydrocephalus were found to be common in a review of 16 previously reported cases of central nervous system (CNS) candidiasis in newborn infants. The diagnosis and institution of therapy were frequently delayed, and the mortality rate was 29% in the 17 patients reviewed here. The subacute course, lack of clinical findings, variable cerebrospinal fluid (CSF) findings, negative CSF cultures due to low concentrations of organisms, slow in vitro growth of C. albicans and misinterpretation of positive cultures as contaminants are factors frequently leading to delayed diagnoses. Using combination therapy, it should be possible to use lower doses and shorter courses of amphotericin B therapy for C. albicans meningitis in the newborn infant.

Topics: Adolescent; Amphotericin B; Candidiasis; Cytosine; Drug Therapy, Combination; Female; Flucytosine; Follow-Up Studies; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Male; Meningitis; Pregnancy; Psychomotor Disorders

Topics: Administration, Oral; Amphotericin B; Candidiasis; Flucytosine; Humans; Imidazoles; Infant; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Miconazole

Topics: Amphotericin B; Candidiasis; Female; Fetofetal Transfusion; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Meningitis; Pregnancy; Twins

Topics: Amphotericin B; Anti-Bacterial Agents; Candidiasis; Humans; Immunity; Infant; Infant, Newborn; Infant, Newborn, Diseases; Meningitis

Topics: Amphotericin B; Arizona; Coccidioides; Coccidioidomycosis; Humans; Indians, North American; Infant, Newborn; Infant, Newborn, Diseases; Male; Prognosis; Sputum

Topics: Amphotericin B; Candidiasis, Cutaneous; Candidiasis, Oral; Candidiasis, Vulvovaginal; Contraceptive Agents; Female; Granuloma; Humans; Infant, Newborn; Infant, Newborn, Diseases; Natamycin; Nystatin; Pregnancy

Topics: Amphotericin B; Arthritis; Candida albicans; Candidiasis; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Joint Diseases; Meconium; Meningitis; Periostitis; Radiography

Topics: Amphotericin B; Birth Weight; Blood Glucose; Blood Urea Nitrogen; Calcium, Dietary; Candidiasis; Dietary Carbohydrates; Dietary Proteins; Humans; Hydrogen-Ion Concentration; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Newborn, Diseases; Monosaccharides; Parenteral Nutrition; Potassium; Protein Hydrolysates; Respiratory Insufficiency; Sodium

Topics: Amphotericin B; Arthritis, Infectious; Candidiasis; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Injections, Intra-Articular; Injections, Intravenous; Injections, Spinal; Meningitis; Pregnancy

Topics: Acremonium; Adult; Amphotericin B; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Meningitis; Mycoses

Topics: Amphotericin B; Bronchopneumonia; Candidiasis; Child; Colistin; Female; Humans; Iatrogenic Disease; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Male; Meningitis; Sepsis; Sterilization; Vaccination

Topics: Acute Kidney Injury; Amphotericin B; Bronchopneumonia; Burns; Candida; Candidiasis; Child; Drug Therapy; Erythroblastosis, Fetal; Female; Geriatrics; Heart Failure; Humans; Hyperbilirubinemia; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Postgastrectomy Syndromes; Renal Insufficiency; Sepsis; Toxicology; Uterine Cervical Neoplasms; Wounds, Gunshot

Topics: Amphotericin B; Candida albicans; Candidiasis; Chloramphenicol; Communicable Diseases; Female; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Nystatin; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Tetracycline