amphotericin-b and Intestinal-Perforation

Topics: Amphotericin B; Bacterial Infections; Digestive System; Humans; Intestinal Perforation; Male; Tobramycin

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Arthritis, Rheumatoid; Colitis, Ulcerative; Combined Modality Therapy; Drainage; Fatal Outcome; Gastrointestinal Diseases; Humans; Ileal Diseases; Intestinal Perforation; Intraoperative Complications; Jejunal Diseases; Liposomes; Male; Mucormycosis; Peritonitis; Postoperative Complications; Shock, Septic; Triazoles

The following case illustrates an ileal perforation and reactive hemophagocytic syndrome (RHS) resulting from disseminated histoplasmosis in a patient with Human Immunodeficiency Virus (HIV) from Puerto Rico. Although the diagnosis was established by histopathologic findings and a positive bone marrow culture, Histoplasma capsulatum-specific real-time Polymerase Chain Reaction (PCR) allowed to confirm the diagnosis from formalin-fixed, paraffin-embedded tissue. Interestingly, the Histoplasma antigens in both serum and urine samples were falsely negative. Amphotericin B lipid complex (Abelcet), followed by oral itraconazole, led to a successful response and resolution of symptoms. A short review of the clinical signs and symptoms, diagnostic tests, and therapeutic options for disseminated histoplasmosis is done, with emphasis on the role of Histoplasma-specific real-time PCR as a molecular diagnostic tool and the efficacy of treatment with one of the lipid formulations of amphotericin B.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Drug Combinations; Histoplasma; Histoplasmosis; HIV Infections; HIV-1; Humans; Ileum; Intestinal Perforation; Lymphohistiocytosis, Hemophagocytic; Male; Phosphatidylcholines; Phosphatidylglycerols; Puerto Rico; Treatment Outcome

Mucormycosis is an uncommon opportunistic fungal infection that may develop in immunocompromised patients with conditions such as diabetes mellitus, leukemia, lymphoma, or human immunodeficiency virus (HIV), or after transplantation with immunosupperessive therapy. We report a case of gastric perforation caused by a mucormycosis infection in a patient with acute myelogenous leukemia (AML). The patient was treated successfully with gastrectomy and the aggressive use of intravenous amphotericin B. He is still alive 1 year after his operation.

Topics: Amphotericin B; Antifungal Agents; Gastrectomy; Humans; Immunocompromised Host; Intestinal Perforation; Leukemia, Myeloid, Acute; Male; Middle Aged; Mucormycosis; Stomach; Treatment Outcome

Two consensus conferences taking place in the United States and Spain were organized to optimize diagnosis and treatment of Candida spp. infections. Among other results, clinical scenarios in which early prescription of antifungal agents is indicated were identified.. To determine the criteria followed by physicians for prescribing antifungal agents in critically ill patients in our country and to investigate adherence to the guidelines proposed by the consensus conferences.. A questionnaire was designed and directed to 4th- and 5th-year residents in intensive care medicine and to specialists in intensive care with training in infectious diseases or other medical areas. Four case reports for which expert consensus indicates early antifungal treatment were included in the questionnaire; 1) recurrent peritonitis secondary to perforation of the digestive tract, with mixed flora including fungi; 2) persistent febrile syndrome in a patient with multiple mucosal fungal colonizations treated with broad-spectrum antibiotics; 3) candiduria and pyuria in a febrile patient; and 4) candidemia.. A total of 135 questionnaires from 45 different ICUs were returned (60% response rate). In the candidemia and fungal peritonitis examples, early treatment with antifungal agents was indicated in 100% and 85.9% of responses, respectively, whereas for sepsis with multifocal candidiasis and candiduria associated with pyuria and fever, early treatment was prescribed in only 41.5% and 55.6% of responses, respectively. There were no significant differences in response with regard to degree of training of the physicians surveyed. Fluconazole prescription predominated, mainly at doses of 400 mg/day, in mixed peritonitis, disseminated candidiasis and candiduria, whereas amphotericin B lipid formulations were preferentially indicated in cases of candidemia. Antifungal treatment (early or late) was prescribed in all responses for candidemia, in 95.5% for mixed peritonitis (fungi and bacteria), in 79.5% for multifocal candidiasis in patients with persistent sepsis, and in 77.9% for candiduria with fever and pyuria.. Adherence to recommendations from the consensus conferences was high among intensive medicine specialists, with no differences according to level of training in infectious diseases.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Case Management; Consensus Development Conferences as Topic; Critical Care; Data Collection; Drug Utilization; Fever; Fluconazole; Fungemia; Guideline Adherence; Humans; Internship and Residency; Intestinal Perforation; Mycoses; Peritonitis; Practice Guidelines as Topic; Practice Patterns, Physicians'; Spain; Surveys and Questionnaires; Urinary Tract Infections

Three premature infants (<800 g) showed invasive Candida at the site of their intestinal perforations. This entity is distinct from Candida peritonitis complicating necrotizing enterocolitis and was uniformly fatal. Recognition and aggressive antifungal therapy may improve outcomes.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Enteritis; Fatal Outcome; Female; Humans; Infant, Newborn; Infant, Premature; Intestinal Perforation; Male

A renal transplant patient presented with ileal perforation due to histoplasmosis 3 years after transplantation. Mesenteric lymph nodes and lungs were also affected by the disease. She was successfully treated with amphotericin B followed by ketoconazole.

Topics: Adult; Amphotericin B; Diagnosis, Differential; Female; Histoplasmosis; Humans; Ileal Diseases; Intestinal Perforation; Ketoconazole; Kidney Transplantation

Topics: Adult; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Appendicitis; Appendix; Aspergillosis; Combined Modality Therapy; Cytarabine; Daunorubicin; Humans; Ileal Diseases; Iliac Vein; Intestinal Perforation; Ischemia; Leukemia, Myeloid, Acute; Male; Mitoxantrone; Neutropenia; Thrombosis

Over a 2-year period, all surgical patients from whom Candida was isolated from intra-abdominal specimens were evaluated. All but 1 of the 49 evaluable patients had either a spontaneous perforation (57%) or a surgical opening of the gastrointestinal tract (41%). Candida caused infection in 19 patients (39%), of whom 7 had an intra-abdominal abscess and 12 peritonitis. In the other 30 patients (61%), there were no signs of infection and specific surgical or medical treatment was not required. Candida was more likely to cause infection when isolated in patients having surgery for acute pancreatitis than in those with either gastrointestinal perforations or other surgical conditions. The development of a clinical infection was significantly associated with a high initial or increasing amount of Candida in the semiquantitative culture. Surgery alone failed in 16 of 19 patients (84%), of whom 7 died and 9 recovered after combined antifungal and surgical treatment. The overall mortality and the mortality related to infections were significantly higher in the patients with intraabdominal candidal infections than in those without such infections.

Topics: Abscess; Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Candida; Candidiasis; Child; Child, Preschool; Combined Modality Therapy; Drainage; Female; Humans; Infant; Intestinal Perforation; Male; Middle Aged; Pancreatitis; Peritoneum; Peritonitis; Postoperative Complications; Prospective Studies; Retrospective Studies; Time Factors

Topics: Administration, Oral; Amphotericin B; Arrhythmias, Cardiac; Brain Diseases; Cytosine; Flucytosine; Gastrointestinal Diseases; Humans; Hypokalemia; Injections, Intravenous; Injections, Spinal; Intestinal Perforation; Kidney Diseases; Meningitis; Mycoses; Paralysis; Radiculopathy; Vision Disorders

Topics: Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Candida albicans; Candidiasis; Child, Preschool; Female; Humans; Intestinal Perforation; Male; Middle Aged; Peritonitis; Quadriplegia; Stomach Ulcer