amphotericin-b and Intestinal-Diseases

We report three cases of zygomycosis (mucormycosis) occurring in three individuals infected with the human immunodeficiency virus (HIV) and review 12 other published cases. We present the only two case reports of disseminated zygomycosis in AIDS patients, and the only AIDS patient with renal zygomycosis to survive without nephrectomy, receiving intravenous (i.v.) amphotericin alone. Coinfection with zygomycosis and HIV is rare, occurs primarily in patients with low CD4+ lymphocyte counts, does not always require the usual predisposing conditions for zygomycosis, and may be the presenting opportunistic infection among HIV-infected persons. Transient episodes of neutropenia occurring within 4 months before presentation may be a risk factor for this disease. Zygomycosis may arise in multiple sites including the basal ganglia, cutaneous tissue, kidney, respiratory tract, and may be disseminated. Occurring more commonly in, but not restricted to, injection drug users, it is significantly associated with sites other than basal ganglia in those patients with advanced HIV disease or AIDS. The presenting symptoms are related to the site of involvement, and the illness may develop insidiously or progress rapidly to a fulminant course. Successful therapy usually consists of surgical debridement and intravenous amphotericin B. Overall mortality in this review is 40%, and is significantly associated with sites of disease inaccessible to surgical debridement.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; CD4 Lymphocyte Count; Female; Fungemia; Humans; Intestinal Diseases; Intestine, Small; Kidney; Kidney Diseases; Male; Middle Aged; Mucorales; Mucormycosis; Neutropenia

Topics: Adult; Amphotericin B; Animals; Anti-Bacterial Agents; Bacitracin; Cats; Cycloserine; Drug Antagonism; Drug Hypersensitivity; Female; Hearing Disorders; Humans; Intestinal Diseases; Kidney Diseases; Liver Diseases; Male; Mental Disorders; Middle Aged; Neomycin; Novobiocin; Polymyxins; Stomach Diseases; Vision Disorders

We conducted a prospective pilot study to evaluate the potential role of combined systemic antifungal and liposomal amphotericin B lock therapy in children with intestinal insufficiency with fungal catheter-related bloodstream infections whose central venous catheters had not been removed. Our results provide supportive evidence for the conduct of larger clinical trials to confirm the efficacy and safety of this approach.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Catheter-Related Infections; Central Venous Catheters; Child; Child, Preschool; Drug Therapy, Combination; Female; Humans; Infant; Intestinal Diseases; Invasive Fungal Infections; Male; Pilot Projects; Prospective Studies

To evaluate the possible related factors to endotoxemia and cytokine activation during the ischemic phase of extracorporeal surgery, and the effect of selective digestive decontamination (SDD) as a preventive measure.. Prospective, open, randomized trial.. Two multidisciplinary ICUs (tertiary care hospitals).. One hundred consecutive patients undergoing cardiopulmonary bypass (CPB), randomly allocated to two groups; gut decontamination (group I = 50 cases) and controls (group II = 50 cases).. Preoperative administration of oral non-absorbable antibiotics (polymyxin E, tobramycin and amphotericin B) versus no administration.. The assessment of decontamination by means of the bacteriologic control of rectal swabs. Determinations of gastric intramucosal pH (gastric pHi) and plasma endotoxin, tumor necrosis factor (TNF) aNd interleukin-6 (IL-6) before surgery and during the ischemic and reperfusion phases of bypass. Rectal aerobic Gram-negative bacilli (AGNB) were significantly reduced in the treated patients and in 56% total eradication was achieved. Endotoxin, TNF and IL-6 plasma levels were significantly lower in this group. By contrast, both endotoxin and TNF/IL-6 levels and gastric pHi correlated with the type of surgical flow (pulsatile versus non-pulsatile).. SDD reduces the gut content of enterobacteria. This may explain the lower endotoxin and cytokine levels detected in decontaminated patients. In addition to SDD, the type of flow employed during bypass seems to influence endotoxemia and cytokine levels.

Topics: Amphotericin B; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cardiopulmonary Bypass; Colistin; Cytokines; Endotoxemia; Enterobacteriaceae; Female; Humans; Intestinal Diseases; Intestines; Ischemia; Male; Middle Aged; Prospective Studies; Surgical Procedures, Operative; Tobramycin

The aim of this study was to determine the efficacy of orally administered amphotericin B (Ampho B) on the elimination and suppression of yeasts in the orointestinal tract and on the clinical success regarding the Ampho B concentrations in faeces and serum. A total of 23 newborns at risk suffering from oral and/or cutaneous candidosis and massive colonization of yeasts in the orointestinal tract received Ampho-Moronal suspension (Squibb-Heyden, München) for 10 days: newborns < 1500 g 4 x 20 mg Ampho B/d and newborns > 1500 g 4 x 40 mg/d. Ampho B was detected in concentrations between 0.6 and 20 micrograms/g in the faeces of all patients 24 hours after beginning and 2-6 days after the end of the application. During this time Ampho B concentrations between 0.06 and 0.58 microgram/ml were also detected in the serum of the newborns. During the administration of Ampho-Moronal suspension for 10 days the initial available yeasts were eliminated in 18 patients (78%) out of the faeces. In 7 out of 17 patients (41%) the oral and cutaneous candidosis was cured. After finishing the administration of Ampho-Moronal Candida albicans was isolated again from the faeces during the following 5 days in half of the newborns who had reached negative mycological findings during the prophylaxis. For that reason Ampho-Moronal should be prophylactically administered for a longer time during the period of increased risk for systemic mycosis.

Topics: Administration, Oral; Amphotericin B; Candidiasis; Feces; Humans; Infant, Newborn; Intestinal Diseases; Mycoses; Risk Factors

A double blind, placebo-controlled trial was performed to test the efficacy of prevention of nosocomial infections by selective digestive decontamination. Placebo or tobramycin (80 mg) and colistin (100 mg) was given four times daily via the gastric tube. Amphotericin B (500 mg/6 h) was administered to all patients. As our ICU is divided into two separate subunits, intestinal decontamination or placebo was administered alternatively to patients of the two subunits during two 3-month periods, separated by a 2-month period without prevention. The decontamination (n = 97) and placebo groups (n = 84) were similar with respect to age, sex, severity score and diagnostic categories on admission. Intestinal decontamination alone failed to significantly reduce the number of infected patients (26% vs 34.5%, p = 0.20), but was effective on ICU-acquired infections (0.33 vs 0.60, p = 0.02) especially gram-negative infection rates (0.17 vs 0.43, p = 0.01). The onset of the first ICU-acquired infection was delayed (9 vs 13 days, p less than 0.001) and incidence of pneumonia (2 vs 13 cases, p less than 0.01) including bacterial pneumonia (0 vs 8 cases, p less than 0.01) was significantly decreased. However, mean ICU stay and mortality were not significantly modified by intestinal decontamination.

Topics: Amphotericin B; Clinical Protocols; Colistin; Cross Infection; Double-Blind Method; Female; Humans; Intensive Care Units; Intestinal Diseases; Length of Stay; Male; Middle Aged; Pneumonia; Prospective Studies; Tobramycin

A 53-year-old woman was hospitalized due to septic shock after developing pneumococcal pneumonia after undergoing esophageal cancer surgery. Her transverse colon became perforated after receiving antimicrobial chemotherapy; therefore, emergency subtotal colectomy was performed. Fungi detected in both her colon tissue and a drainage sample indicated intestinal mucormycosis. Early intensive treatment with high-dose liposomal amphotericin B was successful, and she was subsequently discharged from the hospital. The fungal isolates were identified to be Lichtheimia ramosa and Aspergillus calidoustus via gene sequencing using panfungal primers as well as species-specific primers against elongation factor 1 and beta-tubulin for detecting Lichtheimia and Aspergillus, respectively.

Topics: Amphotericin B; Antifungal Agents; Aspergillus; Female; Humans; Intestinal Diseases; Middle Aged; Mucormycosis; Treatment Outcome

Topics: Amphotericin B; Humans; Intestinal Diseases; Liver Transplantation; Male; Middle Aged; Mucormycosis; Rhizopus

Penicillium sp., other than P. marneffei, is an unusual cause of invasive disease. These organisms are often identified in immunosuppressed patients, either due to human immunodeficiency virus or from immunosuppressant medications post-transplantation. They are a rarely identified cause of infection in immunocompetent hosts.. A 51 year old African-American female presented with an acute abdomen and underwent an exploratory laparotomy which revealed an incarcerated peristomal hernia. Her postoperative course was complicated by severe sepsis syndrome with respiratory failure, hypotension, leukocytosis, and DIC. On postoperative day 9 she was found to have an anastamotic breakdown. Pathology from the second surgery showed transmural ischemic necrosis with angioinvasion of a fungal organism. Fungal blood cultures were positive for Penicillium chrysogenum and the patient completed a 6 week course of amphotericin B lipid complex, followed by an extended course oral intraconazole. She was discharged to a nursing home without evidence of recurrent infection.. Penicillium chrysogenum is a rare cause of infection in immunocompetent patients. Diagnosis can be difficult, but Penicillium sp. grows rapidly on routine fungal cultures. Prognosis remains very poor, but aggressive treatment is essential, including surgical debridement and the removal of foci of infection along with the use of amphotericin B. The clinical utility of newer antifungal agents remains to be determined.

Topics: Abdomen, Acute; Amphotericin B; Antifungal Agents; Female; Humans; Intestinal Diseases; Intestines; Middle Aged; Mycoses; Penicillium chrysogenum; Treatment Outcome

We report a case of persistent annular erythema of infancy in a 4-month-old boy. Physical and laboratory parameters showed no sign of internal disease or specific infection except a massive Candida albicans colonization (> 103 organisms/mm3) of the lower gastrointestinal tract. Oral treatment with amphotericin B for 2 weeks resulted in a complete remission of the skin lesions indicating Candida colonization as a trigger.

Topics: Amphotericin B; Anti-Bacterial Agents; Candidiasis; Erythema; Facial Dermatoses; Humans; Infant; Intestinal Diseases; Intestine, Large; Male; Treatment Outcome

A 21-month-old male child presented with malnutrition and painless abdominal masses. The masses were provisionally diagnosed as being abdominal lymphoma. Pre-operative investigations did not establish any other cause. The diagnosis of primary gastrointestinal aspergilloma was obtained only post-operatively by histopathology and tissue culture. Following surgery, the tumour grew rapidly and massively despite intravenous amphotericin-B, in the recommended doses. The tumour caused recurrent intestinal obstruction which necessitated multiple extensive surgical excisions. The patient finally died due to sepsis and gastrointestinal bleeding. We believe this to be the first description of a primary gastrointestinal aspergilloma with aggressive local infiltration in a non-neutropenic child.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Diagnosis, Differential; Fatal Outcome; Humans; Infant; Intestinal Diseases; Intestinal Obstruction; Male; Recurrence

Topics: Adult; Amphotericin B; Biopsy; Candidiasis, Chronic Mucocutaneous; Humans; Interferon-gamma; Intestinal Diseases; Itraconazole; Male; Prototheca; Treatment Outcome

This study aimed at making a comparative assessment of the growth of pure cultures of Human Intestinal Spirochaetes (HIS) in a control medium without antibiotics and in media including antibiotics (spectinomycin, rifampin, colistin, polymyxin B, amphotericin B, vancomycin, spiramycin) whose use had been indicated in the literature in connection with the isolation of HIS or animal intestinal spirochaetes. All the strains of HIS tested grew in media to which appropriate concentrations of those drugs had been added giving a final number of CFU/ml +/- 10 times the number of CFU/ml observed in the control medium. These results indicate that a selective medium to be used for the isolation of HIS may include appropriate concentrations of one or more of the following antibiotics: spectinomycin (100-1,000 micrograms/ml), rifampin (10-30 micrograms/ml), vancomycin (6.25 micrograms/ml), colistin (6.25 micrograms/ml), polymyxin B (5 micrograms/ml), spiramycin (1-10 micrograms/ml) and amphotericin B (0.05-35 micrograms/ml).

Topics: Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Antibiotics, Antitubercular; Antifungal Agents; Bacteriological Techniques; Child, Preschool; Colistin; Culture Media; Female; Humans; Intestinal Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Polymyxin B; Rifampin; Spectinomycin; Spiramycin; Spirochaetales; Vancomycin

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Erythema; Female; Humans; Intestinal Diseases; Male; Middle Aged; Nystatin

UK-49,858 (fluconazole), a new, orally absorbed bis-triazole derivative, has been evaluated against systemic infections with Candida albicans in normal and immunosuppressed mice and against an intestinal infection with C. albicans in immunosuppressed mice. Orally administered ketoconazole was used as a comparison agent throughout, and orally administered amphotericin B was included for comparative in the experimental intestinal infection. In a 10-day dosage regimen, UK-49,858 was far more active than ketoconazole against systemic infections with C. albicans in normal and immunosuppressed mice. In normal mice, extension of UK-49,858 dosing to 30 days resulted in prolongation of survival to over 90 days, and up to 60% of treated animals had no detectable C. albicans in their kidneys. In addition, over 90% of mice with intestinal candidiasis had culture-negative feces after a 3-day treatment with UK-49,858, but only 62 and 23% of mice gave this response after amphotericin B and ketoconazole therapy, respectively. These data suggest that UK-49,858 may be of value in the treatment of systemic and gastrointestinal infections due to C. albicans in humans.

Topics: Amphotericin B; Animals; Antifungal Agents; Candidiasis; Female; Fluconazole; Immune Tolerance; Intestinal Diseases; Ketoconazole; Kinetics; Mice; Triazoles

Topics: Adult; Aged; Amphotericin B; Candidiasis; Drug Resistance, Microbial; Female; Glucosamine; Humans; Intestinal Diseases; Male; Middle Aged

Topics: Adolescent; Adult; Aged; Amphotericin B; Candida albicans; Candidiasis; Female; Humans; Intestinal Diseases; Male; Middle Aged

Topics: Amphotericin B; Biopsy; Colitis; Diarrhea; Histoplasma; Histoplasmosis; Humans; Intestinal Diseases; Male; Microscopy, Electron; Middle Aged; Mucous Membrane; Rectum

Topics: Amphotericin B; Drug Therapy; Histoplasma; Histoplasmosis; Humans; Intestinal Diseases; Intraabdominal Infections; Pathology

Topics: Agammaglobulinemia; Amphotericin B; Biopsy; Blood Protein Electrophoresis; Drug Therapy; Histoplasmosis; Humans; Intestinal Diseases; Intestinal Mucosa; Intestine, Small; Pathology; Protein-Losing Enteropathies; Radiography; Serum Albumin; Serum Albumin, Radio-Iodinated; Serum Globulins; South Africa