amphotericin-b and Leukemia--Lymphocytic--Chronic--B-Cell

Histoplasma capsulatum has not typically been associated with sinusitis in either immunocompetent or immunocompromised hosts. We report a case of sinusitis caused by H. capsulatum in a patient with chronic lymphocytic leukemia and discuss the reported cases of this rare clinical manifestation of histoplasmosis in the medical literature.

Topics: Aged; Amphotericin B; Antifungal Agents; Deoxycholic Acid; Drug Combinations; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Sinusitis; Treatment Outcome

A 67-year-old obese man (BMI 38.0) with type 2 diabetes mellitus (DM), chronic atrial fibrillation, and chronic lymphocytic leukemia stage II, stable for 8 years after chemotherapy, and a history of smoking presented to the ED with progressive dyspnea and fever due to SARS-CoV-2 infection. He was admitted to a general ward and treated with dexamethasone (6 mg IV once daily) and oxygen. On day 3 of hospital admission, he became progressively hypoxemic and was admitted to the ICU for invasive mechanical ventilation. Dexamethasone treatment was continued, and a single dose of tocilizumab (800 mg) was administered. On day 9 of ICU admission, voriconazole treatment was initiated after tracheal white plaques at bronchoscopy, suggestive of invasive Aspergillus tracheobronchitis, were noticed. However, his medical situation dramatically deteriorated.

Topics: Acute Kidney Injury; Aged; Amphotericin B; Antibodies, Monoclonal, Humanized; Antifungal Agents; Atrial Fibrillation; Bronchoscopy; COVID-19; Dexamethasone; Diabetes Mellitus, Type 2; Fatal Outcome; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Mucormycosis; Nitriles; Obesity; Oxygen Inhalation Therapy; Pulmonary Aspergillosis; Pyridines; Respiration, Artificial; SARS-CoV-2; Smoking; Tomography, X-Ray Computed; Triazoles; Voriconazole

BACKGROUND Leishmaniasis is a parasitic infection spread by the bite of infected sand flies that are usually present in the Middle East, Africa, and some parts of Asia and Europe. Leishmaniasis manifests in 3 different forms: Visceral (also known as Kala Azar), which is the most serious type; cutaneous, which is the most common type; and mucocutaneous. The symptoms of this infection range from a silent infection to fever, enlargement of the liver and spleen, weight loss, and pancytopenia. CASE REPORT In this case report, we discuss a 73-year-old man known to have chronic lymphocytic leukemia (CLL), presenting with unremitting fever and who to our surprise was found to have Kala Azar. CONCLUSIONS Early diagnosis and treatment are very important in treating visceral leishmaniasis. While the conventional treatment in immunocompromised patients is liposomal amphotericin B, our patient responded to corticosteroids.

Topics: Aged; Amphotericin B; Antiprotozoal Agents; Fever; Glucocorticoids; Humans; Immunocompromised Host; Leishmaniasis, Visceral; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Methylprednisolone Hemisuccinate

Histoplasma microconidia when inhaled are presented in antigenic form to T cells, limiting the extent of infection; however, defects in cellular immunity results in disseminated disease. Chronic lymphocytic leukaemia (CLL) is a lymphoproliferative disorder resulting in functionally impaired lymphocytes, predisposing patients to various opportunistic infections. The author reports a recently treated patient with CLL presenting with constitutional symptoms accompanied by hepatosplenomegaly and diffuse adenopathy. Considering the recent diagnosis and treatment of CLL, initial suspicion was relapsed disease. However, considering the immune deficiency associated with CLL and its treatment, infectious aetiologies were strongly considered. Further investigation revealed a case of disseminated histoplasmosis mimicking CLL in this reported patient. Considering appropriate diagnosis and timely therapy, the reported patient had good prognosis despite being diagnosed with disseminated histoplasmosis. This case highlights consideration of disseminated histoplasmosis in patients presenting with diffuse adenopathy along with hepatomegaly and/or splenomegaly in the right clinical setting.

Topics: Aged; Amphotericin B; Antifungal Agents; Farmers; Fever; Hepatomegaly; Histoplasmosis; Humans; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Opportunistic Infections; Radionuclide Imaging; Splenomegaly; Tomography, X-Ray Computed; Treatment Outcome; Urinalysis; Weight Loss

The small lymphocytic lymphoma is a mature B cell neoplasm with a broad spectrum of clinical presentations. Opportunistic infections that are not related to the treatment, even in advanced stages, have a low incidence rate. There are few case reports in the medical literature of patients who have not received immunosuppressive therapy and present with small lymphocytic lymphoma associated with disseminated histoplasmosis at diagnosis.\ A female 82-year-old patient was admitted due to an intermittent dry cough, asthenia, and adynamia that had persisted for one month. Multiple studies to detect infections and immuno-rheumatic conditions were performed and an extensive cervical, thoracic and peritoneal adenopathic syndrome was diagnosed.\ A flow cytometry and a cervical lymph node biopsy were performed reporting CD19+, CD20dim, CD5+, CD45+, CD23+, CD43neg, and CD10neg phenotypes with restriction in the light kappa chain compatible with a small lymphocytic lymphoma.\ Epithelioid granulomas without necrosis were observed in the lymph node histopathology and special colorations showed no microorganisms. The culture from the lymph node was positive for Histoplasma capsulatum. We initiated treatment with amphotericin B and itraconazole with an adequate response. In the absence of compliance with oncology treatment criteria, the patient was managed on a “watch and wait” basis.\ Opportunistic infections could be the initial clinical manifestation in patients with low-grade lymphoproliferative syndromes. This case report shows that they can develop even in the absence of chemotherapy.

Topics: Aged, 80 and over; Alzheimer Disease; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 2; Female; Histoplasma; Histoplasmosis; Humans; Hypertension; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Lymph Nodes; Opportunistic Infections; Watchful Waiting

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Diagnosis, Differential; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Mucormycosis; Rhizomucor; Seizures; Stem Cell Transplantation; Temporal Lobe; Tomography, X-Ray Computed

Topics: Aged; Amphotericin B; Antifungal Agents; Bone Marrow; Cell Transformation, Neoplastic; Histoplasmosis; Humans; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Liver; Lymph Nodes; Lymphoma, Large B-Cell, Diffuse; Male; Radionuclide Imaging; Spleen; Treatment Outcome

We undertook the present study to ascertain the contributing risk factors and explore the epidemiological and mycological characteristics of opportunistic candidemia among patients with hematological malignancies.. Observational cross-sectional study in a tertiary care center.. Consecutive patients with hematological malignancies reporting to the collaborating medical and pediatric units with a febrile episode were recruited and screened for candidemia by blood culture. Recovered Candida isolates were speciated and antifungal susceptibility testing was performed as per Clinical and Laboratory Standards Institute guideline (CLSI) guidelines M44-A. Further analysis was done for potential risk factors and compared between culture positive and negative patients.. Of 150 patients recruited, the majority (n=27) were between 51 and 60 years and the male to female ratio was 1.63:1. Fifteen patients (10%) were culture positive. The culture positivity was significantly higher in acute lymphocytic leukemia (ALL) than in non-ALL patients (p=0.03). There was significant association of candidaemia with leucopenia, chemotherapeutic drugs, corticosteroids and presence of indwelling devices. Duration of disease (p=0.032) and duration of hospitalization (p=0.003) were significantly prolonged in culture positive patients. C. tropicalis was the commonest isolate (46.67%), with non- Candida albicans outnumbering C. albicans in all categories of hematological malignancies (2.75:1). All isolates of C. albicans were uniformly sensitive to all the azoles, but only 50% were sensitive to amphotericin B and none to nystatin and flucytosine.. This observational study identifies ALL and chronic lymphocytic leukemia (CLL) as the forms of hematological malignancy predominantly associated with candidemia; specifies risk factors and chemotherapeutic agents predisposing patients towards its occurrence; reports a preponderance of C. tropicalis among the causative agents and finds voriconazole to be the most effective antifungal agent against the recovered isolates. This information could assist in tailoring prophylactic and therapeutic antifungal practices for this infection, according to local epidemiological and mycological characteristics.

Topics: Amphotericin B; Candida albicans; Candida tropicalis; Candidemia; Cross-Sectional Studies; Female; Hematologic Neoplasms; Humans; India; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Nystatin; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prevalence; Risk Factors; Tertiary Care Centers; Voriconazole

Cryptococcus neoformans is a common agent of fungal meningoencephalitis in immunocompromised patients. Cerebral salt-wasting syndrome is one of the rare causes of severe hyponatremia in patients with CNS diseases. The paper describes the first clinical case of a patient, whose onset of chronic lymphocytic leukemia was complicated by cryptococcal meningoencephalitis presenting with mental disorders and severe electrolytic imbalance. Antifungal treatment with amphotericin B and fluconazole could alleviate an infectious process and metabolic disturbances.. Cryptococcus neoformans - частый возбудитель грибкового менингоэнцефалита у пациентов с иммунодефицитом. Церебральный сольтеряющий синдром - одна из редких причин тяжелой гипонатриемии у пациентов с заболеваниями центральной нервной системы. В статье описано первое клиническое наблюдение больного, у которого дебют хронического лимфоцитарного лейкоза осложнился криптококковым менингоэнцефалитом с психическими расстройствами и тяжелыми нарушениями водно-электролитного баланса. Проведение антимикотической терапии амфотерицином В и флуконазолом позволило купировать инфекционный процесс и метаболические нарушения.

Topics: Aged; Amphotericin B; Antifungal Agents; Comorbidity; Fluconazole; Humans; Hyponatremia; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Meningitis, Cryptococcal; Syndrome

Invasive fungal infections are a major cause of morbidity and mortality in allogeneic stem cell transplant recipients. They can occasionally involve the tracheobronchial tree with serious clinical consequences. Tracheobronchial involvement is often an unexpected finding during diagnostic bronchoscopy. Herein, we report a case of pseudomembranous tracheobronchitis caused by Rhizopus sp. in an allogeneic stem cell transplant recipient.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Bronchitis; Bronchoscopy; Fatal Outcome; Graft vs Host Disease; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Mucormycosis; Nausea; Respiratory Insufficiency; Rhizopus; Stem Cell Transplantation; Tracheitis; Transplantation, Homologous

Topics: Absidia; Aged, 80 and over; Amphotericin B; Anemia, Hemolytic, Autoimmune; Antibodies, Monoclonal, Murine-Derived; Antifungal Agents; Combined Modality Therapy; Cryoglobulinemia; Cyclophosphamide; Debridement; Dexamethasone; Fatal Outcome; Female; Humans; Immunocompromised Host; Immunosuppressive Agents; Leukemia, Lymphocytic, Chronic, B-Cell; Liposomes; Mucormycosis; Purpura, Thrombocytopenic, Idiopathic; Rituximab

Topics: Aged; Amphotericin B; Antibodies, Monoclonal, Murine-Derived; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Cryptococcus neoformans; Cyclophosphamide; Drug Therapy, Combination; Fatal Outcome; Flucytosine; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Meningitis, Cryptococcal; Rituximab; Time Factors; Vidarabine

Topics: Alemtuzumab; Amphotericin B; Antibodies, Monoclonal, Humanized; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Antiprotozoal Agents; Humans; Immunocompromised Host; Leishmaniasis, Visceral; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Opportunistic Infections; Treatment Outcome

Cryptococcosis is a disseminated fungal disease typically associated with immunosuppression and characterized by high mortality rates. Cryptococcus neoformans has been reported to be isolated from blood cultures in around 20% of patients with cryptococcosis, and cryptococcemia has been correlated with poor prognosis. We report a case of fatal C. neoformans fungemia in a neutropenic patient with a history of chronic lymphocytic leukemia treated with alemtuzumab. The patient presented with loss of consciousness and died after 5 days of antifungal therapy with liposomal amphotericin B. The international literature regarding opportunistic infections after immunosuppressive therapy with alemtuzumab with particular attention on fungal infections has also been reviewed.

Topics: Aged; Alemtuzumab; Amphotericin B; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antibodies, Neoplasm; Antifungal Agents; Antineoplastic Agents; Cryptococcosis; Cryptococcus neoformans; Fatal Outcome; Fungemia; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Neutropenia; Opportunistic Infections

Topics: Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Cyclophosphamide; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Meningitis, Cryptococcal; Meningoencephalitis; Myeloablative Agonists

Topics: Administration, Inhalation; Amphotericin B; Antifungal Agents; Caspofungin; Echinocandins; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Lipopeptides; Male; Middle Aged; Peptides, Cyclic; Zygomycosis

We report two cases of cryptococcosis in patients with Waldenstrom's macroglobulinaemia and chronic lymphocytic leukaemia that responded to prolonged therapy with systemic amphotericin and flucytosine. Cryptococcosis, although more common in those with impaired cell mediated immunity, should also be considered as a complication in patients with impaired antibody responses.

Topics: Aged; Amphotericin B; Antifungal Agents; Cryptococcosis; Drug Therapy, Combination; Female; Flucytosine; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Opportunistic Infections; Waldenstrom Macroglobulinemia

Invasive aspergillosis is a severe complication in the immunocompromised patient. Despite antifungal treatment the mortality rate is higher than 90% if the immunity deficiency is not corrected. The use and dosage of conventional amphotericin B (deoxycholate-suspended formulation) is limited by its toxicity, especially nephrotoxicity. To reduce these untoward effects, amphotericin B has been formulated in liposomes. Better tolerance and lower nephrotoxicity in the liposomal formulations allow higher doses to be given safely, even in the presence of renal failure. Liposomal encapsulated amphotericin B (LAmB) is a safe and effective alternative to conventional formulations for antifungal therapy. We present a case of a 60-year-old man affected by chronic lymphocytic leukaemia. In the course of his disease and after chemotherapy treatment, he presented an invasive aspergillosis of the lung and paransal sinuses. The rhino-sinusal lesion had progressed despite surgical debridement and treatment with amphotericin B in a dosage of 50 mg per day. Moreover, renal impairment caused by conventional amphotericin was detected. Then, LAmB was started at a dose of 150 mg per day. Treatment with LAmB has resulted in clinical recovery and radiologic ressolution.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillosis, Allergic Bronchopulmonary; Deoxycholic Acid; Drug Carriers; Drug Combinations; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Liposomes; Male; Middle Aged; Remission Induction; Sinusitis; Treatment Failure

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Female; Humans; Immune Tolerance; Leukemia, Lymphocytic, Chronic, B-Cell; Lung Diseases, Fungal; Middle Aged; Opportunistic Infections

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