amphotericin-b and Kidney-Failure--Chronic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might increase the risk of invasive pulmonary aspergillosis (IPA). Although several case reports and small series have been reported in the general population, scarce information is available regarding coronavirus disease 2019 (COVID-19)-associated IPA in the setting of solid organ transplantation. We describe a case of a kidney transplant recipient with severe COVID-19 that was subsequently diagnosed with probable IPA on the basis of the repeated isolation of Aspergillus fumigatus in sputum cultures, repeatedly increased serum (1 → 3)-β-d-glucan levels, and enlarging cavitary nodules in the CT scan. The evolution was favorable after initiation of isavuconazole and nebulized liposomal amphotericin B combination therapy and the withdrawal of immunosuppression.

Topics: Acute Kidney Injury; Administration, Inhalation; Amphotericin B; Anti-Bacterial Agents; Antibodies, Monoclonal, Humanized; Antifungal Agents; Azithromycin; Ceftriaxone; COVID-19; Deprescriptions; Female; Glucocorticoids; Graft Rejection; Humans; Hydroxychloroquine; Hyperoxaluria, Primary; Immunoglobulins, Intravenous; Immunologic Factors; Immunosuppressive Agents; Invasive Pulmonary Aspergillosis; Kidney Failure, Chronic; Kidney Transplantation; Middle Aged; Mycophenolic Acid; Nitriles; Oxygen Inhalation Therapy; Prednisone; Pyridines; Renal Dialysis; SARS-CoV-2; Sputum; Tacrolimus; Tomography, X-Ray Computed; Triazoles

Fungal peritonitis (FP) is a rare complication of peritoneal dialysis. We herein describe the second case in Asia of Histoplasma capsulatum peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD).. An 85-year-old woman with end-stage renal disease (ESRD) who had been on CAPD for 3 years and who had a history of 3 prior episodes of peritonitis presented with intermittent abdominal pain for 2 weeks and high-grade fever for 3 days. Elevated white blood cell (WBC) count and rare small oval budding yeasts were found in her peritoneal dialysis (PD) fluid. From this fluid, a white mold colony was observed macroscopically after 7 days of incubation, and numerous large, round with rough-walled tuberculate macroconidia along with small smooth-walled microconidia were observed microscopically upon tease slide preparation, which is consistent with H. capsulatum. The peritoneal dialysis (PD) catheter was then removed, and it also grew H. capsulatum after 20 days of incubation. The patient was switched from CAPD to hemodialysis. The patient was successfully treated with intravenous amphotericin B deoxycholate (AmBD) for 2 weeks, followed by oral itraconazole for 6 months with satisfactory result. The patient remains on hemodialysis and continues to be clinically stable.. H. capsulatum peritonitis is an extremely rare condition that is associated with high morbidity and mortality. Demonstration of small yeasts upon staining of PD fluid, and isolation of slow growing mold in the culture of clinical specimen should provide important clues for diagnosis of H. capsulatum peritonitis. Prompt removal of the PD catheter and empirical treatment with amphotericin B or itraconazole is recommended until the culture results are known.

Topics: Administration, Intravenous; Administration, Oral; Aged, 80 and over; Amphotericin B; Antifungal Agents; Asia; Deoxycholic Acid; Drug Combinations; Female; Histoplasma; Histoplasmosis; Humans; Itraconazole; Kidney Failure, Chronic; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Treatment Outcome

Paracoccidioides brasiliensis is the cause of paracoccidioidomycosis, one of the most important systemic mycoses in Latin America. Human disease has been observed in a limited geographic and ecological niche, and it is attributed to exposure to the fungus in soil. Most primary infections are subclinical, as the infection is contained by the host mainly through cell-mediated immune response. However, as the fungus has the ability to survive in a dormant state for long periods, an impairment of the immune response may lead to reactivation and clinical disease. Surprisingly, paracoccidioidomycosis has rarely been reported in transplanted patients. The aim of this communication is to report a case occurring in a kidney recipient in an acute clinical form immediately after transplantation, and to review the available information on previously reported cases.

Topics: Amphotericin B; Antifungal Agents; Bronchoalveolar Lavage; Bronchoalveolar Lavage Fluid; Bronchoscopy; Female; Graft Rejection; Humans; Imipenem; Immunity, Humoral; Immunosuppression Therapy; Immunosuppressive Agents; Itraconazole; Kidney Failure, Chronic; Kidney Transplantation; Latin America; Lung Diseases, Fungal; Methylprednisolone; Middle Aged; Paracoccidioides; Paracoccidioidomycosis; Plasmapheresis; Respiration, Artificial; Tomography, X-Ray Computed; Vancomycin

Topics: Amphotericin B; Antiprotozoal Agents; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Leishmania major; Leishmaniasis, Cutaneous; Male; Middle Aged

A 57-year-old woman with end-stage kidney disease secondary to autosomal dominant polycystic kidney disease developed peritoneal dialysis-related Mucor peritonitis after her pet cockatoo bit through her transfer set. The infection persisted despite more than 8 weeks of treatment with liposomal amphotericin B. On a compassionate basis, she then received oral posaconazole, 800 mg/d, in divided doses for 6 months. She experienced complete remission and has remained disease free since then, for more than 2 years. We review the medical literature about mucormycosis peritonitis which, albeit rare, carries very high mortality. The treatment of choice is liposomal amphotericin B, which failed in our patient. Our case report suggests that posaconazole is an attractive treatment option in patients with peritoneal dialysis-related Mucor peritonitis.

Topics: Amphotericin B; Antifungal Agents; Female; Humans; Kidney Failure, Chronic; Liposomes; Middle Aged; Mucormycosis; Peritoneal Dialysis; Peritonitis; Polycystic Kidney, Autosomal Dominant; Treatment Failure; Treatment Outcome; Triazoles

C albidus and mucormycosis were cultured simultaneously from the pleural space of a patient with end-stage renal disease receiving long-term hemodialysis. There have been only nine previous reports of infection with C albidus, with only one involving the lung. This organism has never before been isolated from the pleural space, and none of the previously reported cases included a coinfection with mucormycosis. We have reviewed and compared all known cases of infection with C albidus.

Topics: Adult; Aged; Amphotericin B; Cryptococcosis; Cryptococcus; Empyema, Pleural; Humans; Kidney Failure, Chronic; Male; Middle Aged; Mucormycosis; Renal Dialysis

During the past decade, attention has focused on the effects of calcium antagonists on renal function. Recent studies using diverse videomicroscopic techniques including the isolated perfused hydronephrotic rat kidney model, which permits direct visualization of afferent and efferent arterioles, have demonstrated that calcium antagonists acutely antagonize preglomerular vasoconstriction. In contrast, most studies suggest that the efferent arteriole appears to be refractory to the vasodilatory effects of these agents. Although the clinical implications of such observations have not been fully delineated, the results of recent studies indicate that calcium antagonists exert salutary effects on renal function in clinical settings characterized by impaired renal hemodynamics, including transplant-associated acute renal insufficiency and, possibly, cyclosporine nephrotoxicity. Evidence has accrued to suggest that calcium antagonists also may be protective against acute radiocontrast-induced nephrotoxicity. Finally, the renal hemodynamic and natriuretic effects of calcium antagonists commend their use as antihypertensive agents in the management of essential hypertension and transplant-associated hypertension.

Topics: Acute Kidney Injury; Amphotericin B; Animals; Calcium Channel Blockers; Contrast Media; Diabetic Angiopathies; Forecasting; Humans; Hypertension; Kidney Failure, Chronic; Kidney Transplantation

This report describes the first successful treatment of an adult on continuous ambulatory peritoneal dialysis with Aspergillus peritonitis. The published literature is also reviewed. Early removal of the peritoneal catheter combined with antifungal chemotherapy appear to be necessary for cure in patients with this disease.

Topics: Aged; Amphotericin B; Aspergillosis; Female; Humans; Kidney Failure, Chronic; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Drug-induced renal disease is a common problem. Drugs cause several renal syndromes, such as prerenal azotemia, fluid and electrolyte abnormalities, acute tubular necrosis, acute interstitial nephritis, and chronic interstitial nephritis. Acute renal failure due to acute tubular necrosis is the most common syndrome and is most frequently caused by aminoglycoside antibiotics, radiographic contrast agents, and amphotericin B. Avoidance of these drugs in volume-depleted or hypotensive patients with preexisting renal disease or in those receiving multiple nephrotoxic drugs is the most effective way to reduce nephrotoxicity. Acute interstitial nephritis is an immune process that is most commonly caused by penicillins, diuretics, allopurinol, nonsteroidal anti-inflammatory drugs, cimetidine, and sulfonamides. Prompt recognition of the disease and cessation of the responsible drug are usually the only necessary therapy. Chronic interstitial nephritis is most often seen after prolonged use of several different types of analgesic agents, including aspirin, acetaminophen, and nonsteroidal anti-inflammatory drugs. These patients develop recurrent papillary necrosis and eventually chronic renal failure. They are also at risk of developing transitional cell carcinomas of the urinary collecting system. Some patients who are receiving cyclosporine also develop chronic renal failure due to interstitial fibrosis.

Topics: Acute Kidney Injury; Amphotericin B; Contrast Media; Humans; Kidney Diseases; Kidney Failure, Chronic; Nephritis, Interstitial

Peritoneal dialysis-associated peritonitis can uncommonly be caused by fungal infections. When they do present, they are associated with significant mortality and morbidity. We describe a case where a sample of peritoneal dialysate fluid grew Rhodotorula muciliginosa, a yeast organism present in the normal environment which has previously been reported as rarely causing peritonitis. We believe this is the first case where the Rhodotorula spp. and its origin has been identified.. A 20 year old male grew Rhodotorula muciliginosa from his peritoneal dialysis fluid on three separate occasions when a fluid sample was sent following a disconnection and subsequent set change. He was not systemically unwell and his peritoneal dialysate was clear. As Rhodotorula spp. is exceedingly difficult to treat our patient had his Tenchkoff catheter removed. Subsequent samples of soil and sand from his bearded dragon and Chilean tarantula cases, kept in his bedroom where dialysis occurred, were tested. The tarantula sand was identified as the source of the Rhodotorula spp. Of note, Candida was isolated from sand from the bearded dragon case. Once his Tenchkoff was removed he was treated with an intravenous course of antifungal therapy. He has since had a new Tenchkoff catheter inserted and recommenced PD following education around pets and hygiene.. In this era where people are keeping increasingly rare and unusual wildlife in their homes, this case highlights the need for clinician and nursing staff awareness of a patient's home environment and hobbies when they are undergoing peritoneal dialysis. Sand from our patient's tarantula case grew the colonising organism but interestingly soil from his bearded dragon case also isolated candida. This can also cause difficult to treat peritonitis.

Topics: Amphotericin B; Animals; Antifungal Agents; Ascitic Fluid; Candida; Humans; Kidney Failure, Chronic; Lizards; Male; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Rhodotorula; Spiders; Young Adult

Mucormycosis is a rare fungal infection often seen in immunocompromised hosts. Isolated renal mucormycosis may however present in immunocompetent children as renal failure and has a uniformly poor prognosis if not detected and treated early into the course of illness. We present a 3-year-old boy with unrelenting pyelonephritis in whom serial urine cultures done were negative. A final diagnosis of isolated renal mucormycosis was made by magnetic resonance imaging and renal biopsy.

Topics: Abdominal Pain; Amphotericin B; Antifungal Agents; Child, Preschool; Dialysis; Fever; Humans; Kidney; Kidney Failure, Chronic; Magnetic Resonance Imaging; Male; Mucorales; Mucormycosis; Pyelonephritis; Treatment Outcome; Triazoles; Urinary Tract Infections; Vomiting

Topics: Adolescent; Amphotericin B; Antigens, Fungal; Antiviral Agents; Biopsy; Bone Marrow; Cytomegalovirus; Cytomegalovirus Infections; Female; Fever of Unknown Origin; Graft Rejection; Histoplasma; Histoplasmosis; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Lymphohistiocytosis, Hemophagocytic; Mycophenolic Acid; Renal Dialysis; Treatment Outcome; Viral Load

To determine Candida colonisation/infection in renal transplant patients and to determine the resistance pattern against antifungal drugs.. This prospective, observational study was conducted at Al-Sayyed Hospital, Rawalpindi, Pakistan, from January to October 2014, in collaboration with the Microbiology and Public Health Laboratory's, Islamabad campus..The clinical specimens investigated included respiratory tract secretions, blood, urine, high vaginal swab, skin scrapings, and plastic devices samples.. Of the 7,850 samples, 164(2.08%) were positive for Candida. Candida albicans were most prevalent as they were found in 114(69%) samples. Besides, 56(34%) of the positive samples were resistant to one or more antifungal agents. Highest resistance was obtained against fluconazole. We found only 5(3.04%) positive samples of Candida glabrata; of them, 3(60%)were resistant. In case of Candida spp, 27(48%) resistance was observed. In Candida albicans, 23(41%) of the samples were found to be resistant. Most of the Candida isolates was recovered from bronchial alveolar lavage.. Although Candida albicans remained the main responsible species for Candida infections, but non-albican Candida species are also emerging.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candida glabrata; Candidiasis; Cross-Sectional Studies; Drug Resistance, Fungal; Fluconazole; Humans; Ketoconazole; Kidney Failure, Chronic; Kidney Transplantation; Microbial Sensitivity Tests; Pakistan; Prevalence; Prospective Studies; Tertiary Care Centers; Voriconazole

Fungal peritonitis is an uncommon complication in peritoneal dialysis patients. We report a case of blastomyces dermatitis peritonitis in a nonimmunocompromised peritoneal dialysis patient, who initially presented with symptoms of lower extremity weakness and altered mental status. Peritoneal blastomycosis is rare condition and not previously reported in end stage renal disease patients on peritoneal dialysis. Fungal peritonitis can present with subtle clinical findings so a high index of suspicion is needed as early detection and treatment may decrease mortality and morbidity.

Topics: Amphotericin B; Blastomyces; Blastomycosis; Female; Humans; Kidney Failure, Chronic; Middle Aged; Peritoneal Dialysis; Peritonitis

Timely diagnosis of invasive fungal infections (IFI) in renal transplant (RT) patients on immunosuppression is often difficult, jeopardizing their life and graft. We reported IFI and their causative fungal agents in post-RT patients.. This was a retrospective 6-year clinical study carried out from 2010 to 2015 on 1900 RT patients. Clinical data included patient-donor demographics, time to onset of infection, risk factors and graft function in terms of serum creatinine (SCr). To identify IFI, we examined bronchoalveolar lavage (BAL), blood, tissue, and wound swab samples by conventional mycological methods.. IFI were diagnosed in 30 (1.56%) patients on triple immunosuppression, mainly males (n = 25) with mean age of 36.57 ± 11.9 years at 13.12 ± 18.35 months post-RT. Aspergillus species was identified in 11 BAL, one tissue, and one wound specimen each, 30.76% of these were fatal and 15.38% caused graft loss; Candida albicans was in nine BAL, four blood, two wound swab, and one tissue specimens, 25% of these were fatal and 25% had graft loss and one mucor in BAL which was fatal. Seven patients were diabetic, 10 had superadded cytomegalovirus infection, and 15 were anti-rejected.. IFI are associated with increased morbidity and mortality in RT patients. Triple immunosuppression, broad spectrum antibiotics for ≥ two weeks, diabetes and superadded infection are added risks for these patients. Prevention, early diagnosis, and appropriate management are necessary to improve their prognosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillus; Candida albicans; Female; Graft Survival; Humans; Immunosuppression Therapy; India; Invasive Fungal Infections; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Outcome Assessment, Health Care; Postoperative Complications; Retrospective Studies; Transplants

A case of disseminated infection caused by Penicillium chrysogenum in a 10-year-old boy with a history of Henoch-Schönlein purpura and proliferative glomerulonephritis, treated with immunosuppressors, is reported herein. The patient had a clinical picture of 2 weeks of fever that did not respond to treatment with broad-spectrum antibiotics and amphotericin B. Computed tomography imaging showed diffuse cotton-like infiltrates in the lungs, hepatomegaly, mesenteric lymphadenopathy, and multiple well-defined round hypodense lesions in the spleen. His treatment was changed to caspofungin, followed by voriconazole. One month later, a splenic biopsy revealed hyaline septate hyphae of >1μm in diameter. Fungal growth was negative. However, molecular analysis showed 99% identity with P. chrysogenum. A therapeutic splenectomy was performed, and treatment was changed to amphotericin B lipid complex and caspofungin. The patient completed 2 months of treatment with resolution of the infection. P. chrysogenum is a rare causative agent of invasive fungal infections in immunocompromised patients, and its diagnosis is necessary to initiate the appropriate antifungal treatment.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Caspofungin; Child; Echinocandins; Fever; Glomerulonephritis; Humans; Hyalohyphomycosis; IgA Vasculitis; Immunocompromised Host; Kidney Failure, Chronic; Lipopeptides; Male; Penicillium chrysogenum; Spleen; Splenectomy; Tomography, X-Ray Computed; Treatment Outcome; Voriconazole

Topics: Amphotericin B; Antifungal Agents; Biopsy; Brain Diseases; Deoxycholic Acid; Diabetes Mellitus, Type 2; Drug Combinations; Eye; Eye Diseases; Fatal Outcome; Female; Humans; Kidney Failure, Chronic; Magnetic Resonance Imaging; Middle Aged; Mucormycosis; Multiple Organ Failure; Paranasal Sinuses; Temporal Lobe

To determine the frequency of yeast in the oral cavity of patients with chronic renal failure, undergoing hemodialysis (PCRFH); identification and antifungal susceptibility profile of yeast and demographic profile of patients.. We performed mouthwash in 146 PCRFH; the rinse fluid was collected and cultured, yeasts grown were identified by phenotypic and molecular methods. The antifungal susceptibility profile was determined against nystatin, amphotericin B, fluconazole, voriconazole, and caspofungin based in Clinical and Laboratory Standards Institute (document M27-A3).. Positive culture was observed in 39% of patients, of whom 53% were women; the median of dialysis time was 2.9 years. The age of the colonized patients varied between 26 and 84 years, with a median of 52.5 years. PCRFH over 45 years were significantly more colonized (P = 0.0108) as well as denture wearers (84.0%). We isolated 81 yeasts, predominantly Candida albicans (63%) followed by Candida glabrata. In general, yeasts were sensitive to the evaluated antifungal agents, but there was significant variation in the minimum inhibitory concentration, especially among non-C. albicans Candida (NCAC) compared to fluconazole, caspofungin, and amphotericin B. NCAC required significantly higher concentrations of fluconazole (P < 0.01).. The rate of colonization by yeasts in PCRFH was high, and there was variability in species distribution and antifungal susceptibility profile. These results are little known in this group of patients and are important for controlling the risk of developing invasive fungal infections.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida glabrata; Candida tropicalis; Caspofungin; Colony Count, Microbial; Dentures; Diabetes Complications; Echinocandins; Female; Fluconazole; Humans; Hypertension; Kidney Failure, Chronic; Lipopeptides; Male; Microbial Sensitivity Tests; Middle Aged; Mouth; Mycology; Nystatin; Phenotype; Pyrimidines; Renal Dialysis; Time Factors; Triazoles; Voriconazole

This is the first case reported of central venous catheter-related fungemia due to C. neoformans. A patient with chronic renal failure developed a fungemia during the treatment of a dialysis-associated bacteremia. Cryptococcus neoformans grew in the catheter tip and blood culture. We addressed questions about this catheter-related fungemia.

Topics: Amphotericin B; Antifungal Agents; Catheter-Related Infections; Catheterization, Central Venous; Cryptococcosis; Cryptococcus neoformans; Fatal Outcome; Female; Fungemia; Humans; Kidney Failure, Chronic; Middle Aged; Renal Dialysis

Visceral leishmaniasis (VL) is a well recognized opportunistic infection in immunosuppressed patients, which may cause febrile illness. We describe 4 renal transplant patients with VL in an endemic area in Brazil and their response to therapy. In 3 cases the diagnosis was confirmed by bone marrow aspirate that revealed the presence of Leishmania. In 1 case the bone marrow aspirate was inconclusive and the diagnosis was made through spleen biopsy that showed the presence of the parasite. VL needs to be considered as a cause of febrile illness in transplanted patients living in endemic areas.

Topics: Adult; Amphotericin B; Animals; Antiprotozoal Agents; Biopsy, Needle; Bone Marrow; Brazil; Diagnosis, Differential; Female; Humans; Kidney Failure, Chronic; Kidney Transplantation; Leishmaniasis, Visceral; Male; Middle Aged; Spleen; Transplantation Conditioning

Long-term dialysis in children with multiple handicaps has become easier with the advent of continuous ambulatory peritoneal dialysis (PD). Due to the widespread use of PD and the long survival of patients with spina bifida, an increasing number of patients with spina bifida are on PD. The viability and safety of PD in spina bifida patients with a ventriculoperitoneal shunt (VPS) have been a matter of concern. Some authors consider the presence of a VPS a relative contraindication for PD, but more recent reports suggest that PD under close monitoring is not contraindicated. We report a 17-year-old girl born with meningomyelocele, hydrocephalus and neurogenic bladder who was maintained on VPS. She reached end-stage renal failure 17 years later and was put on PD based on family and patient preference. She had an uneventful course in the initial 9 months, but later developed fungal peritonitis which was successfully managed with catheter withdrawal and an intravenous antifungal agent (amphotercin 0.75 mg/kg). Simultaneous ventricle-aspirated cerebrospinal fluid was sterile. To our knowledge, this is the first report of fungal infection in such a patient. Although we share the view that PD is not an absolute contraindication in patients with a functioning VPS, its likely complications, especially infectious complications in developing countries, should be kept in mind before initiating PD in such patients.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Female; Growth Disorders; Humans; Hydrocephalus; Kidney Failure, Chronic; Meningomyelocele; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Recurrence; Spina Bifida Cystica; Urinary Bladder, Neurogenic; Urinary Catheterization; Urinary Tract Infections; Ventriculoperitoneal Shunt

Rhinocerebral mucormycosis is a rapidly progressive and often fatal infection frequently seen in patients with uncontrolled diabetes mellitus and hematologic malignancies. The disease is difficult to diagnose because it often masquerades as bacterial sinusitis. The current report describes a 69-year-old white woman with diabetes mellitus who was prescribed high-dose prednisone therapy for chronic obstructive pulmonary disease. Two weeks after treatment initiation, she presented to the hospital with facial edema on the right side, mouth pain, and general weakness. No black eschars on the nasal mucosae or palates were present on admission. Although bacterial etiology was initially suspected, surgery and tissue samples revealed the presence of rhinocerebral mucormycosis. The patient died at 6 days postadmission despite aggressive medical and surgical intervention. The current report discusses the risk factors associated with rhinocerebral mucormycosis as well as the necessity of early diagnosis and treatment to improve patient outcomes.

Topics: Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Comorbidity; Diabetes Mellitus; Disease Progression; Edema; Fatal Outcome; Female; Glucocorticoids; Humans; Immunocompromised Host; Kidney Failure, Chronic; Mucormycosis; Prednisone; Pulmonary Disease, Chronic Obstructive; Risk Factors; Sinusitis

A woman on continuous ambulatory peritoneal dialysis (CAPD) due to renal failure in systemic lupus erythematosus (SLE) developed fungal peritonitis and survived following treatment with amphotericin B and removal of the dialysis catheter. The causative organism, Aspergillus fumigatus is very rare in fungal peritonitis and may be related in this case to the combination of SLE, end-stage renal disease (ESRD) and their treatment.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Drug Therapy, Combination; Female; Humans; Kidney Failure, Chronic; Lupus Erythematosus, Systemic; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Aged; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Caspofungin; Drug Therapy, Combination; Echinocandins; Follow-Up Studies; Humans; Kidney Failure, Chronic; Lipopeptides; Male; Peptides, Cyclic; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Risk Assessment; Severity of Illness Index; Treatment Outcome

Topics: Abscess; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Biopsy, Fine-Needle; Caspofungin; Contraindications; Cyclosporine; Delayed Graft Function; Drug Interactions; Echinocandins; Fever of Unknown Origin; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Lipopeptides; Male; Middle Aged; Mycophenolic Acid; Peptides, Cyclic; Postoperative Complications; Prednisone; Pyrimidines; Radionuclide Imaging; Stenotrophomonas maltophilia; Surgical Wound Infection; Thyroiditis; Triazoles; Ultrasonography; Voriconazole

Aspergillus peritonitis is a rare disease in continuous peritoneal dialysis. It is a severe form of peritonitis, which is frequently lethal. We report a case of Aspergillus fumigatus peritonitis in a female patient on automated peritoneal dialysis (APD), who was successfully treated with intravenous amphotericin B and the removal of the peritoneal catheter. As delayed treatment has an increased mortality rate, it is mandatory to remove the catheter and to start intravenous treatment with amphotericin B empirically.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Drug Therapy, Combination; Female; Humans; Itraconazole; Kidney Failure, Chronic; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Amphotericin B is used commonly to treat fungal infections. Unfortunately, little information exists regarding the use of intravenous amphotericin B in patients with end-stage renal disease (ESRD).. We retrospectively reviewed the clinical course of patients receiving amphotericin B during hemodialysis (HD). Twenty-five episodes of systemic fungal infection occurring in 24 patients with ESRD treated with parenteral amphotericin B administered during HD were noted. Patients received a maintenance dose of 0.5 to 1.0 mg/kg amphotericin B intravenously thrice weekly during HD sessions. Twenty-three patients received either 500 or 1000 mg of amphotericin B, whereas 1 patient with AIDS received a total of 6,500 mg.. Intradialytic hypotension developed in 27.7% of HD sessions during treatment with amphotericin B compared with 28.8% of 20 HD sessions evaluated before initiation of amphotericin B therapy. Four patients exhibited a temperature rise greater than 38.8 degrees C during drug infusion (1 episode per patient). Increases in heart rate and ventricular ectopy were rare. Serum potassium concentrations as well as Kt/V and urea reduction ratio did not change significantly. All patients (except the patient with AIDS) resolved their respective fungal infections.. Intradialytic administration of amphotericin B was generally well tolerated. Our observations suggest that amphotericin B is effective and safe for outpatient intradialytic therapy when administered according to protocol.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Hemodialysis Solutions; Humans; Kidney Failure, Chronic; Middle Aged; Mycoses; Renal Dialysis; Retrospective Studies; Treatment Outcome

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus niger; Cadaver; Creatinine; Diuresis; Humans; Kidney; Kidney Failure, Chronic; Kidney Transplantation; Liver Transplantation; Male; Middle Aged; Tissue Donors; Treatment Outcome; Ultrasonography

Pentavalent antimonial drugs are habitually the first choice for treating leishmaniasis, although they possess well-known toxicity and may present some therapeutic failure. Lipid formulations of amphotericin B (LFAB) have been increasingly used for treating several types of leishmaniasis. However, the administration of such lipid formulations specifically to patients with cutaneous leishmaniasis (CL) is still rare, including immunocompromised patients to whom standard treatments are more frequently contraindicated. We describe here two cases of immunocompromised patients with CL, one of them with AIDS, representing the first case of AIDS and CL co-infection treated with LFAB described in the literature. The patient achieved therapeutic success with a total 1.500 mg dose of amphotericin B colloidal dispersion. The other had diabetes mellitus as well as kidney failure and was under dialysis, having obtained the healing of lesion with a total dose of 600 mg of liposomal amphotericin B. Thus, the authors suggest that LFAB can represent a safe, efficient and less toxic therapeutic alternative to pentavalent antimonials, as well as to the so-called second line drugs, pentamidine and amphotericin B deoxycholate.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Antiprotozoal Agents; Drug Combinations; Humans; Immunocompromised Host; Kidney Failure, Chronic; Leishmaniasis, Cutaneous; Liposomes; Male; Middle Aged; Phosphatidylcholines; Phosphatidylglycerols

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Humans; Kidney Failure, Chronic; Kidney Transplantation; Liposomes; Lung Diseases, Fungal; Male

Phenotypic identification of fungi in clinical microbiology laboratories is often difficult and late, especially for slow growing and rarely encountered fungi. We describe the application of 18S ribosomal RNA (rRNA) gene sequencing in the early diagnosis of a case of Exophiala peritonitis. A yeast-like fungus was isolated from the dialysate fluid of a 66-year-old man undergoing continuous ambulatory peritoneal dialysis. It grew slowly after 12 days of incubation to yield mature cultures to permit recognition of microscopic features resembling those of Exophiala, a dematiacerous mold. 18S rRNA gene sequencing provided results 12 days earlier than phenotypic identification and revealed 15 base difference (0.9%) between the isolate and Exophiala sp. strain GHP 1205 (GenBank Accession no. AJ232954), indicating that the isolate most closely resembles a strain of Exophiala species. The patient responded to 4 weeks of intravenous amphotericin B therapy. Early identification of the fungus was important for the choice of anti-fungal regimen. As opportunistic fungal infections in immunocompromised patients are globally emerging problems, the development of molecular techniques for fungal identification is crucial for early diagnosis and appropriate treatment.

Topics: Aged; Amphotericin B; Base Sequence; Dialysis Solutions; Exophiala; Genes, rRNA; Humans; Kidney Failure, Chronic; Male; Molecular Sequence Data; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Polymerase Chain Reaction; Risk Assessment; RNA, Ribosomal, 18S; Sensitivity and Specificity; Treatment Outcome

Administration and clearance of amphotericin B infused during high-efficiency or high-efficiency/high-flux dialysis were studied in two end-stage renal disease patients requiring systemic antimycotic treatment for fungal peritonitis. Amphotericin B concentrations were measured in the arterial and venous dialysis ports as well as in the ultrafiltrate. Amphotericin B is poorly dialyzable while administered during hemodialysis sessions with high-efficiency (CA 210) or high-efficiency/high-flux (CT 190 G) membranes. Amphotericin B infusion during hemodialysis was well tolerated and can be administered conveniently in an outpatient dialysis setting, avoiding prolonged hospitalization for parenteral antifungal therapy.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Humans; Kidney Failure, Chronic; Male; Peritonitis; Renal Dialysis

Infected graft transplantation is an unwelcome complication that may lead to serious consequences in the immunosuppressed host. It can be caused by infection of the donor or by contamination of the organ during harvest, preservation and handling, or at transplantation. With current donor evaluation protocols, the risk of transmitting infections by exogenous contaminated grafts seems to be more frequent than true donor-transmitted infections. Nevertheless, although rare and usually free of clinically significant sequelae, if contamination is by some virulent organisms such as Staphylococcus aureus, gram-negative bacilli, or fungi, severe complications may occur. We report the clinical outcome of liver, heart, and kidney recipients from a single donor. Both renal allografts had to be removed because of renal artery rupture secondary to Candida albicans infection. Careful donor evaluation before transplantation, unusually early presentation of mycosis leading to anastomotic renal artery disruption, the histopathologic findings of the grafts, and the absence of Candida infection in the liver and heart recipients make us believe that exogenous contamination of the grafts occurred during donor procedure, kidney processing, or at transplantation. In summary, because infected grafts can lead to serious complications, besides careful donor screening, it is important to achieve early recognition of contaminated organs by culturing the perfusate to start specific antibiotic or antifungal therapy after transplantation if necessary and avoid the rare but, in this case, fatal consequences of these infections.

Topics: Adolescent; Adult; Amphotericin B; Anastomosis, Surgical; Aneurysm, Ruptured; Antifungal Agents; Candidiasis; Carcinoma, Hepatocellular; Female; Heart Transplantation; Humans; Kidney Failure, Chronic; Kidney Transplantation; Liver Neoplasms; Liver Transplantation; Male; Middle Aged; Renal Artery; Reoperation; Tissue Donors; Ultrasonography

A 19-year-old female on chronic peritoneal dialysis developed acute peritonitis; multiple peritoneal fluid and catheter tip cultures yielded Penicillium species. She promptly responded to catheter removal and intravenous amphotericin B, followed by oral fluconazole, without further recurrences 1 year later. This is the first reported case of Penicillium peritonitis in the pediatric population. We review the microbiology and clinical spectrum of this disease, as well as the few previous reported cases in adults.

Topics: Adult; Amphotericin B; Antifungal Agents; Female; Fluconazole; Humans; Kidney Failure, Chronic; Penicillium; Peritoneal Dialysis; Peritonitis

We report two cases of invasive pulmonary aspergillosis due to Aspergillus flavus in one patient who with chronic nephritis and to A. fumigatus in another with malignant lymphoma. After receiving intravenous liposomal amphotericin B therapy for 31 and 35 days, respectively, the patients were cured and did not experience any severe adverse effects.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Drug Carriers; Humans; Infusions, Intravenous; Kidney Failure, Chronic; Liposomes; Lung Diseases, Fungal; Lymphoma; Male; Middle Aged; Radiography

Fungal infections in renal transplant recipients are less common than bacterial infections; however, the morbidity from fungal infections is high. There is limited information in the literature concerning post-transplantation cryptococcal infection due to environmental exposure of patients living in high-risk areas. We report three patients who were diagnosed with cryptococcal meningitis after kidney transplantation. Cryptococcal titers prior to transplant surgery were negative in all three patients. These patients all lived in rural areas and demonstrated evidence of environmental exposure leading to subsequent cryptococcal meningitis. All patients had exposure to pigeon and chicken excreta and, after treatment, two patients are alive and well with excellent allograft function. The third patient has marginal renal function but is currently not on dialysis. Early diagnosis is essential for salvage from these potentially lethal infections. Intense headache was a prominent feature in the clinical presentation of our patients, and should signal the need for early sampling and culture of spinal fluid. Meningismus was not present in any of our patients, even when other systemic symptoms were identified. We recommend a high index of suspicion post-transplantation for all patients who may have environmental or occupational exposure to cryptococcus. If infection is detected quickly and treatment instituted promptly, patient recovery and allograft survival are possible. Long-term therapy with fluconazole, a non-nephrotoxic agent, should permit eradication of the infection with preservation of kidney function.

Topics: Amphotericin B; Antifungal Agents; Fluconazole; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Meningitis, Cryptococcal; Middle Aged; Ohio; Postoperative Complications; Rural Population

A 52-year-old woman with a seven-year history of rheumatoid arthritis (RA) was transferred to our department with chronic renal failure to undergo hemodialysis. She had been treated with prednisolone for a long time, and had renal amyloidosis secondary to RA. During her hospitalization, a left pleural effusion developed. Pleural fluid cultured positive for Cryptococcus neoformans (CN), and the CN antigen was detected in both pleural fluid and serum. Chest computerized tomography revealed an infiltrate shadow in the left lower lung field suggestive of CN infection. This was successfully treated with anti-fungal agents. Pleural effusion is an unusual manifestation of pulmonary cryptococcosis. We should consider a diagnosis of CN infection when pleural effusion is observed in compromised patients such as those receiving a long-term corticosteroid treatment.

Topics: Amphotericin B; Amyloidosis; Anti-Inflammatory Agents; Antifungal Agents; Arthritis, Rheumatoid; Cryptococcosis; Cryptococcus neoformans; Female; Humans; Kidney Failure, Chronic; Lung Diseases, Fungal; Middle Aged; Pleural Effusion; Prednisolone

A renal transplant recipient with isolated cerebral aspergilloma 4 months after allograft transplantation is reported. On admission cerebral computed tomography showed a ring-enhancing mass in the left frontal hemisphere and aspirated purulent material revealed A. fumigatus hyphae. He was cured by short-term antifungal therapy and neurosurgical removal of the well demarcated lesion. He is still alive more than two years later and the renal transplant is well functioning. This is the first report of a renal transplant recipient with isolated cerebral aspergillosis without any relapse and only the third patient who has survived longer than 3 months. Early diagnostic procedures with rapid confirmation of aspergillus infection are pivotal for a benign clinical course.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Brain Diseases; Combined Modality Therapy; Craniotomy; Drainage; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged

Continuous spinal anesthesia technique with portex sets was used for treatment of neuroinfection. The patients was 43 years old woman with meningitis caused by Cryptococcus sp. suffered from chronic kidney failure, after transplantation and graft removal because of it's rejection. Effectiveness of therapy confirmed high value of CSA not only for pain treatment, but for central nervous system diseases as well.

Topics: Adult; Amphotericin B; Anesthesia, Spinal; Anti-Bacterial Agents; Cryptococcosis; Female; Graft Rejection; Humans; Injections, Spinal; Kidney Failure, Chronic; Kidney Transplantation; Meningitis; Pain

Fungal peritonitis (FP) is a rare but serious complication of chronic peritoneal dialysis (CPD) therapy and is associated with high morbidity and CPD drop-out. Risk factors and management of FP remain controversial. We reviewed our experience with FP in an attempt to identify risk factors and to examine outcome in relation to treatment strategies. Between March 1984 and August 1994, 704 patients were maintained on CPD therapy in our unit. A total of 1,712 episodes of peritonitis were identified among these patients. Fungal peritonitis accounted for 55 (3.2%) of these episodes. The patients on CPD therapy who developed FP were similar to those who did not develop FP with regard to age, gender, underlying etiology for end-stage renal disease, and comorbid disease. Prior antibiotic use was noted in 87.3% of episodes of FP. The peritonitis rate in the patients who developed FP was one episode every 5.1 months compared with one episode every 9.9 patient-months in the CPD patients who did not develop this infection. Candida sp caused 74.5% of the episodes of FP. All patients were treated with antifungal drugs. In 85.5% of infections the Tenckhoff catheter was removed within 1 week of the diagnosis of FP; 31.9% of the patients who had the Tenckhoff catheter removed did not have the catheter replaced because of death or transfer to hemodialysis. In the patients who developed FP, 68.1% had the Tenckhoff catheter replaced; of these patients, 90.6% and 59.4% were on CPD therapy 1 and 6 months after catheter replacement, respectively. We conclude that risk factors identified in our population include peritonitis rate and prior antibiotic use. Fungal peritonitis is rare in our CPD population, and although it leads to significant CPD drop-out, it can be managed in many patients with antifungal therapy, early catheter removal, and temporary hemodialysis. Of the catheters replaced between 2 and 8 weeks after the diagnosis of FP, 91% functioned successfully, allowing continuation of CPD.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Case-Control Studies; Catheters, Indwelling; Female; Fluconazole; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis; Peritonitis; Risk Factors; Treatment Outcome

Fungi have become an increasingly important cause of peritonitis in patients undergoing continuous ambulatory peritoneal dialysis. The most common cause of fungal peritonitis is Candida. However, in recent years unusual and "nonpathogenic" fungi have been reported as etiologic agents of CAPD-associated peritonitis. We are reporting the first case of CAPD-associated peritonitis caused by Monilia sitophila. This organism had previously been considered to be non-pathogenic, and a troublesome laboratory contaminant. Our patient was successfully managed with intravenous and intraperitoneal amphotericin B, followed by oral itraconazole, without removal of her Tenckhoff catheter.

Topics: Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Cross Infection; Drug Therapy, Combination; Female; Humans; Injections, Intraperitoneal; Injections, Intravenous; Itraconazole; Kidney Failure, Chronic; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Adolescent; Amphotericin B; Female; Graft Rejection; Humans; Immunosuppressive Agents; Kidney; Kidney Failure, Chronic; Kidney Transplantation; Mucormycosis; Opportunistic Infections; Postoperative Period

Topics: Amphotericin B; Humans; Kidney Failure, Chronic; Male; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Soil Microbiology

Topics: Aged; Amphotericin B; Candidiasis; Humans; Kidney Failure, Chronic; Male; Peritoneal Dialysis; Peritonitis; Remission, Spontaneous

Topics: Adult; Amphotericin B; Female; Humans; Kidney Failure, Chronic; Leishmaniasis, Visceral; Renal Dialysis

Rhinocerebral mucormycosis (RCM) is a rare, fulminant fungal infection that usually occurs in diabetic or immunocompromised patients. The mortality rate has been reduced recently with the advent of amphotericin B combined with aggressive surgery. Eleven RCM patients have been treated over the past five years at Srinagarind Hospital. Eight had underlying diabetes, five had renal failure and three of them had both. In eight patients, the diagnosis was established by KOH preparation before histological confirmation. Only two cases revealed positive cultures for Rhizopus spp and Cunninghamella spp. All patients underwent surgical treatments (extensive debridement, 8 cases; sphenoidectomy, 7 cases; ethmoidectomy 8 cases; maxillectomy 5 cases and orbital exenteration, 6 cases). Amphotericin B was administered to all patients as soon as the diagnosis of RCM was made. Only three patients survived. Early diagnosis and cooperation among ophthalmologist, otolaryngologist and physician are the most important factors for the survival of patients with mucormycosis.

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Diabetes Complications; Female; Humans; Kidney Failure, Chronic; Male; Middle Aged; Mucorales; Mucormycosis; Paranasal Sinus Diseases; Patient Care Team; Rhizopus

Fungal infection has become increasingly more important in patients undergoing continuous ambulatory peritoneal dialysis. We report here a case of Histoplasma capsulatum infection in such a Hong Kong Chinese patient who presented with fever and peritonitis. Histoplasma capsulatum was isolated from the dialysis fluid and histoplasma antibody was detected in the serum. The patient responded to the combined treatment of fluconazole, 5-flurocytosine and amphotericin B. This is the first reported case of histoplasmosis in Hong Kong.

Topics: Amphotericin B; Fluconazole; Flucytosine; Histoplasma; Histoplasmosis; Humans; Kidney Failure, Chronic; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory

We report a case of Candida norvegensis invasive disease in an immunosuppressed renal transplant patient on continuous ambulatory peritoneal dialysis. Multiple cultures of peritoneal fluid, blood, and tracheal suction done over a 2-week period were positive for this unusual isolate. Despite treatment with amphotericin B and flucytosine the patient died. This is the first report of C. norvegensis fungemia documented by culture.

Topics: Adult; Amphotericin B; Blood; Candida; Candidiasis; Drug Therapy, Combination; Flucytosine; Humans; Immunosuppressive Agents; Kidney Failure, Chronic; Male; Microbial Sensitivity Tests; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis

Topics: Adolescent; Amphotericin B; Catheters, Indwelling; Cryptococcosis; Female; Humans; Kidney Failure, Chronic; Peritoneal Dialysis; Peritonitis

Topics: Amphotericin B; Cryptococcosis; Female; Humans; Kidney Failure, Chronic; Leukemia, Lymphocytic, Chronic, B-Cell; Meningitis; Middle Aged; Recurrence; Time Factors

Fungal infection is an uncommon cause of peritonitis in patients on continuous ambulatory peritoneal dialysis (CAPD). This report describes the clinical and microbiological features of 10 cases of fungal peritonitis. Although all patients survived, morbidity was high. Abscess and adhesion formation were particular problems. Only two patients were able to return to CAPD after microbiological cure. Currently available treatment strategies for fungal peritonitis are reviewed.

Topics: Adult; Aged; Amphotericin B; Catheters, Indwelling; Female; Flucytosine; Humans; Kidney Failure, Chronic; Male; Middle Aged; Mycoses; Peritoneal Dialysis, Continuous Ambulatory; Peritoneal Lavage; Peritonitis

Cyclosporin-A (CsA) was given to 22 patients who received allogeneic bone marrow transplants as therapy for aplastic anemia and hematologic malignancies. The drug was given daily for 180 days starting with the day of marrow infusion. Engraftment was not impaired and myelotoxicity was not observed. Cutaneous graft-versus-host disease (GVHD) developed in five patients and all either spontaneously resolved or promptly responded to therapy with steroids. Five patients developed systemic GVHD and all responded to therapy with steroids, but only two survived. Interstitial pneumonia was seen in six patients and was fatal in all of them. Liver function abnormalities were seen in 14 patients but could not positively be correlated with CsA administration. Renal function abnormalities were seen in 17 patients. Amphotericin-B therapy contributed significantly to the renal failure. Serum levels of CsA, measured by radioimmunoassay, could not be correlated with the presence of liver or renal function abnormalities. Overall survival so far has been 50.0%. Second malignancies were not observed, but one patient relapsed with leukemia at 343 days.

Topics: Adolescent; Adult; Amphotericin B; Bone Marrow Transplantation; Chemical and Drug Induced Liver Injury; Child; Cyclophosphamide; Cyclosporins; Female; Graft Survival; Graft vs Host Reaction; Humans; Kidney; Kidney Failure, Chronic; Liver; Male; Pulmonary Fibrosis

An immunocompromised patient with severe hypoxemia was found by transbronchial lung biopsy to have Torulopsis glabrata as the sole pathogen in lung. An antibody response to this organism was demonstrated, confirming its role as a pathogen and indicating a role for serodiagnosis of T glabrata infection.

Topics: Adult; Amphotericin B; Candida; Drug Therapy, Combination; Histoplasmosis; Humans; Immunosuppression Therapy; Kidney Failure, Chronic; Lung Diseases, Fungal; Male; Pneumonia; Rifampin

Thirty patients were treated with continuous ambulatory peritoneal dialysis during 313 patients months. 26 episodes of peritonitis defined by a cloudy dialysate with more than 100 cells/mm1 and more than 50 p. cent of polynuclear were observed. The organisms initially responsible were Gram-positive in 11 cases (6 Staphylococcus aureus, 1 Staphylococcus albus, 4 Streptococcus viridans), a gram negative in 3 cases (1 Klebsiella, 1 serratio, one unidentified), a Candida in 2 cases. In 10 cases, the culture was negative, Initial treatment was peritoneal lavage (40 l/day) with in situ antibiotics: in the absence of Candida, the association sulfamethoxazole (SMZ) (80 mg/l) and trimethoprim (TMP) (16 mg/l) was used; when Candida was present amphotericin B (5 mg/l) was used. The association SMZ + TMP led to cure of PT in 17 cases, in 7 +/- 4 days. In 5 cases, this initial treatment was changed at the 48th hour because of initial resistance in one case or secondary resistance of Candida surinfection (2 cases). Candida surinfection occurred later in 2 other cases. For these 6 primary or secondary Candida peritonitis, the catheter was changed within 48 hours. Nevertheless, death occurred in 3 cases and cure was obtained after 51 +/- 11 days in the 3 other cases.. 1) The initial treatment by SMZ + TMP appears quite effective in most cases (73%). 2) The severity and the high incidence of Candida surinfection suggest that its systematic prophylaxis may be appropriate.

Topics: Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Candidiasis; Drug Combinations; Humans; Kidney Failure, Chronic; Middle Aged; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Peritonitis; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination

Five cases of disseminated histoplasmosis complicating renal transplantation are reported. Nine previously reported cases from the literature are reviewed. In this setting disseminated histoplasmosis usually presents as a nonspecific systemic febrile illness that may be fulminant or more subacute. Five of 14 patients presented with skin lesions; only one patient presented with primary pulmonary symptoms of cough and dyspnea. Three of our patients and three others previously reported on survived the infection and maintained good function in the transplanted kidney despite prolonged therapy with amphotericin B. Immunosuppression was the only predisposing factor that could be identified with certainty in the five patients reported on herein. However, in two of the five patients the onset of disseminated histoplasmosis coincided with a well documented cytomegalovirus infection; the viral infection may have been a factor predisposing to infection in these two cases.

Topics: Adult; Amphotericin B; Female; Glomerulonephritis; Histoplasmosis; Humans; Kidney Failure, Chronic; Kidney Transplantation; Male; Middle Aged; Polycystic Kidney Diseases; Transplantation, Homologous

Topics: Amphotericin B; Ascitic Fluid; Cryptococcus; Cytosine; Flucytosine; Humans; Kidney Failure, Chronic; Male; Middle Aged; Mycoses; Peritoneal Dialysis; Peritonitis

Two patients undergoing peritoneal dialysis with permanent indwelling peritoneal catheters who developed Candida albicans peritonitis are presented. Both patients were successfully treated with low dose intravenous amphotericin B. Sequential candida precipitin assays were performed and the diagnostic application is discussed.

Topics: Acute Kidney Injury; Adult; Aged; Amphotericin B; Antibodies, Fungal; Candidiasis; Catheters, Indwelling; Dose-Response Relationship, Drug; Drug Resistance, Microbial; Humans; Kidney Failure, Chronic; Male; Peritoneal Dialysis; Peritonitis; Surgical Wound Infection

Topics: Adult; Amphotericin B; Antifungal Agents; Blood Proteins; Cholesterol; Creatinine; Cytosine; Flucytosine; Humans; In Vitro Techniques; Kidney Failure, Chronic; Kidneys, Artificial; Molecular Weight; Mycoses; Protein Binding; Renal Dialysis; Triglycerides

Serum levels of amphotericin B were serially determined during and after a course of therapy in an anephric patient who developed systemic candidiasis after an unsuccessful renal transplantation. There was no progressive accumulation of drug in serum, and the pattern of disappearance of drug from serum was similar to that published for patients with normal renal function. The dialyzability of amphotericin B was studied in vivo during a 6-h period of hemodialysis, by an in vitro dialysis of amphotericin B in water by using similar equipment, and a Pellicon membrane filter which retains molecular species of 100,000 molecular weight and higher. These studies revealed that the drug is not dialyzable with conventional hemodialysis membranes, regardless of protein binding in plasma, and is excluded from passing through the Pellicon membrane filter.

Topics: Adult; Amphotericin B; Candidiasis; Filtration; Humans; Kidney Failure, Chronic; Kidney Function Tests; Kidney Transplantation; Kinetics; Male; Membranes, Artificial; Molecular Weight; Protein Binding; Renal Dialysis

Topics: Adult; Aged; Amphotericin B; Brain; Brain Diseases; Cerebral Angiography; Cerebral Arteries; Cerebrovascular Disorders; Diabetes Complications; Diabetic Ketoacidosis; Female; Fungi; Humans; Intracranial Aneurysm; Kidney Failure, Chronic; Male; Middle Aged; Mycoses