amphotericin-b and Klebsiella-Infections

Primary cutaneous mucormycosis is an unusual mycotic infection associated to immunosupression. We present a 34 year-old woman with HIV infection with a necrotic primary mucormycosis of the skin associated to a venous catheter. She was treated with amphotericin B and surgical debridement.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Catheterization; Combined Modality Therapy; Debridement; Drug Therapy, Combination; Fasciitis, Necrotizing; Female; Forearm; Humans; Klebsiella Infections; Mucormycosis; Occlusive Dressings; Pneumonia, Pneumocystis; Skin Ulcer

This study aimed to highlight the association of stellate neuroretinitis occurring secondary to endogenous candidemia.. We report an unusual presentation of endogenous Candida endophthalmitis as a stellate neuroretinitis in the setting of Cornelia de Lange syndrome.. A 34-month-old girl with severe Cornelia de Lange syndrome and a history of parenteral nutrition dependence requiring a chronic central venous catheter presented with bilateral endophthalmitis secondary to candidemia. In one eye, the endophthalmitis had the atypical presentation as a stellate neuroretinitis.. This case represents a unique association of stellate neuroretinitis secondary to Candida infection in a patient with Cornelia de Lange syndrome.

Topics: Administration, Ophthalmic; Amphotericin B; Antifungal Agents; Bacteremia; Candida albicans; Candidemia; Candidiasis; Child, Preschool; De Lange Syndrome; Endophthalmitis; Eye Infections, Fungal; Female; Humans; Intravitreal Injections; Klebsiella; Klebsiella Infections; Retinitis; Voriconazole

We present the case of a 74-y-old HIV-negative female who suffered simultaneously from multiple opportunistic infections and a Klebsiella pneumoniae sepsis during high-dose steroids for giant cell arteritis. The patient was treated with a purine analog due to hairy cell leukaemia 10 y previously. Purine analog therapy can lead to long lasting defects in cell-mediated immunity. In these patients, treatment with steroids should be closely monitored with CD4 counts.

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Anti-Inflammatory Agents; Antifungal Agents; Antineoplastic Agents; Aspergillosis; Cladribine; Cytomegalovirus; Dexamethasone; Esophagitis; Female; Giant Cell Arteritis; Herpes Simplex; Humans; Klebsiella Infections; Klebsiella pneumoniae; Leukemia, Hairy Cell; Methylprednisolone; Opportunistic Infections; Pneumocystis carinii; Trimethoprim, Sulfamethoxazole Drug Combination

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

Systemic mycosis is among the most feared opportunistic infections in the immunocompromised host. Difficulty and delay in diagnosis and treatment often result in poor outcomes. In this communication a metastatically spreading form of subcutaneous aspergillosis developed in a patient with a history of allogeneic stem cell transplantation for relapsed Hodgkin's lymphoma. Strikingly, necrotizing cutaneous papules or ulcerating lesions were absent. Diagnosis was accomplished after excision of a clinically non-suggestive subcutaneous nodule. Despite prompt initiation of antimycotic therapy the outcome was fatal; dosage of conventional and liposomal amphotericin B was limited due to treatment-related toxicities. This case report describes a novel form of aspergillosis and underlines the need for an aggressive diagnostic approach in severely immunocompromised patients.

Topics: Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Bleomycin; Carmustine; Combined Modality Therapy; Cyclophosphamide; Cytarabine; Dacarbazine; Deoxycytidine; Dexamethasone; Doxorubicin; Etoposide; Fatal Outcome; Gemcitabine; Hematopoietic Stem Cell Transplantation; Hodgkin Disease; Humans; Immunocompromised Host; Klebsiella Infections; Klebsiella pneumoniae; Lung Diseases, Fungal; Male; Melphalan; Neoplasm Recurrence, Local; Opportunistic Infections; Pneumonia, Bacterial; Pneumonia, Pneumocystis; Prednisone; Procarbazine; Salvage Therapy; Skin; Transplantation, Homologous; Vinblastine; Vincristine

Topics: Accidents, Traffic; Amphotericin B; Blood Transfusion; Candida albicans; Candidiasis; Child, Preschool; Drug Resistance, Microbial; Drug Therapy, Combination; Fluconazole; Humans; Klebsiella Infections; Male; Microbial Sensitivity Tests; Mycoses; Pichia; Pseudomonas Infections; Wounds and Injuries

Topics: Acetylmuramyl-Alanyl-Isoglutamine; Adjuvants, Immunologic; Amphotericin B; Animals; Aspergillosis; Aspergillus fumigatus; Cefmenoxime; Disease Models, Animal; Immunocompromised Host; Klebsiella Infections; Klebsiella pneumoniae; Lung Diseases, Fungal; Male; Mice; Pneumonia; Rats

An outbreak caused by a Klebsiella aerogenes resistant to ceftazidime, cefuroxime, cefotaxime, ampicillin and piperacillin and sensitive to aminoglycosides, imipenem and temocillin occurred in a teaching hospital's busy multi-disciplinary Intensive Care Unit over a 3-month period. Four patients had bacteraemia and a further four were colonized. Traditional infection control measures failed to eradicate the outbreak. The introduction of a selective gastrointestinal decontamination regimen consisting of tobramycin, amphotericin and colistin as a gel to the oropharynx, nose and rectum and a suspension via a nasogastric tube resulted in rapid disappearance of the outbreak strain with no new isolates being detected clinically or in surveillance specimens over an 8-week period.

Topics: Amphotericin B; Colistin; Cross Infection; Disease Outbreaks; Gastrointestinal Diseases; Hospitals, Teaching; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Tobramycin

The recovery of an adequate granulocyte count after chemotherapy is the most important prognostic factor in neutropenic patients. In granulocytopenic patients, the risk of infection is very high and its course usually severe. Empiric antibiotic treatment must be started as soon as fever rises and blood cultures have been taken. The combination of an anti-pseudomonas penicillin with an aminoglycoside is presently the standard empiric therapy for febrile granulocytopenic patients. If the clinical response is inadequate, antimicrobial therapy should be adjusted to a bactericidal activity of greater than 1:16 in the serum. If antibiotic therapy fails, a fungal infection should be considered and amphotericin B added empirically. Patients must be closely supervised for superinfections. Therapeutic transfusions of granulocytes have proven useful in severe granulocytopenia and when antibiotic therapy has failed.

Topics: Amphotericin B; Anti-Bacterial Agents; Drug Antagonism; Drug Therapy, Combination; Humans; Klebsiella Infections; Leukemia; Leukocyte Count; Leukopenia; Mycoses; Pseudomonas Infections

A premature neonate developed advanced bilateral endophthalmitis before the significance of underlying Candida sepsis was appreciated. Severe endophthalmitis resulted in corneal thinning, descemetocele formation, and perforation. The infection occurred in the clinical setting of broad-spectrum antibiotic therapy and indwelling intravenous catheters. Cultures of blood and catheter tips had been positive for Candida but were not considered significant until advanced ocular infection was noted. The septic process resulted in the infant's death after systemic amphotericin B therapy was discontinued because of renal toxicity.

Topics: Amphotericin B; Candidiasis; Corneal Diseases; Endophthalmitis; Eye; Humans; Infant, Newborn; Infant, Premature, Diseases; Klebsiella Infections; Male; Nystatin