amphotericin-b and Leukemia--Lymphoid

Topics: Acute Disease; Adrenal Cortex Hormones; Amphotericin B; Aspergillosis; Blood Transfusion; Candidiasis; Cryptococcosis; Drug Therapy, Combination; Flucytosine; Hodgkin Disease; Humans; Iron; Leukemia; Leukemia, Lymphoid; Lymphoma; Mucor; Multiple Myeloma; Mycoses; Neutropenia; Rhizopus

Children with hematologic malignancies are at an increased risk of invasive fungal infections and a greater risk has been seen with exposure to building construction. Prophylaxis with high-dose (IV) liposomal amphotericin B (L-AmB) 10 mg/kg once weekly was initiated in our high risk children based on previous pharmacokinetic studies. This treatment regimen was associated with a 26% incidence of adverse infusion reactions.

Topics: Adolescent; Amphotericin B; Antibiotic Prophylaxis; Antifungal Agents; Child; Child, Preschool; Female; Humans; Leukemia, Lymphoid; Male; Mycoses; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma

The prophylactic effect of the oral administration of high-dose amphotericin B syrup for the systemic fungal infection was studied in 36 patients with hematological neoplasms. Twenty nine patients received 2,400 mg/day of Amphotericin B syrup for during the remission induction therapy. One patient received 1,200 mg/day, 3 received 800 mg/day and 3 received 400 mg/day of Amphotericin B syrup. The prophylactic effect was recognized in 24 of 36 patients, 66.7%. As adverse effects gastrointestinal symptoms such as nausea and vomiting, hypochloremia and hypopotassemia associated with hypochloremia was observed in one patient, respectively, however, they were all controllable. The blood levels of Amphotericin B in patients received 2,400 mg/day was 0.092 +/- 0.055 micrograms/ml (n = 40) on 7th day and 0.110 +/- 0.046 micrograms/ml (n = 21) on 28th day, respectively. The administration of high-dose of Amphotericin B syrup is expected not only for the prophylaxis but also for the treatment of the systemic fungal infection.

Topics: Administration, Oral; Adolescent; Adult; Aged; Amphotericin B; Drug Administration Schedule; Female; Humans; Leukemia, Lymphoid; Leukemia, T-Cell; Male; Middle Aged; Multicenter Studies as Topic; Multiple Myeloma; Mycoses

Disseminated fusariosis in children is a rare and serious fungal infection, that occurs especially in neutropenic immunosuppressed patients, treated for malignant hemopathy, or bone marrow transplant recipient. Treatment is difficult and mortality is estimated between 50 and 70% in adult patients. CASE REPORT 1: A ten-year-old boy, treated for an acute lymphoblastic leukemia in second relapse, presented a disseminated fusarium spp infection, that occurred during neutropenia. He died due to fusariosis infection in spite of amphotericin B treatment. CASE REPORT 2: A ten-year-old neutropenic girl, treated for an acute myeloïd leukemia, presented disseminated fusariosis, uncontrolled by amphotericin B. Recovery was observed after voriconazole introduction and resolution of neutropenia. Ten months later, she presented a leukemia's relapse, treated by new intensive chemotherapy with secondary prophylaxis by voriconazole, without fusariosis's recurrence.. Voriconazole, a new triazole agent, seems to be an alternative antifungal agent to amphotericin B for disseminated fusarium infection, either at the acute phase or for secondary prophylaxis.

Topics: Amphotericin B; Antifungal Agents; Child; Drug Combinations; Fatal Outcome; Female; Fusarium; Humans; Immunocompromised Host; Leukemia, Lymphoid; Leukemia, Myeloid; Male; Mycoses; Neutropenia; Pyrimidines; Triazoles; Voriconazole

The synthesis and evaluation of some 2-substituted-1,4-naphthoquinones 2, S-(1,4-naphthoquinon-2-yl)-mercaptoalkanoic acid amides 4, related benzoquinone and naphthoquinone derivatives 6-9 and 2,3-disubstituted 1,4-naphthoquinones 10-11 were carried out. The antifungal, antibacterial, antiviral and anticancer activities were determined by using the standard assay. The results show that compounds 2b and 10a showed in vitro antiviral activity against Influenza-A Virus and Herpes Simplex Virus and possess pronounced antifungal profile whereas 4a showed anticancer activities against Lymphoid Leukaemia P 388.

Topics: Animals; Anti-Infective Agents; Antineoplastic Agents; Cell Line, Tumor; Cell Survival; Influenza A virus; Leukemia, Lymphoid; Mice; Microbial Sensitivity Tests; Naphthoquinones; Simplexvirus; Structure-Activity Relationship

Mucormycosis is an uncommon and frequently fatal fungal infection. It characteristically affects patients with diabetes mellitus or patients with severe immunosuppression. The hallmark of mucormycosis infection is tissue infarction and vascular invasion. We present clinical data and imaging studies of a 16 year-old child with acute lymphoblastic leukemia complicated by disseminated mucormycosis resulting in a pseudoaneurysm of the spleen. This was successfully managed by a combination of systemic antifungal therapy (Amphotericin B) and surgery (splenectomy). This entity has not been described in the literature.

Topics: Adolescent; Amphotericin B; Aneurysm, False; Antifungal Agents; Female; Humans; Leukemia, Lymphoid; Mucormycosis; Splenectomy; Splenic Diseases

Blastoschizomyces capitatus (Trichosporon capitatum) is an uncommon fungal pathogen. Infections have mostly been seen in immunocompromised patients and use of broad spectrum antibiotics was identified as a risk factor. Treatment has been extremely difficult. A report is presented about a case of fatal B. capitatum infection with clinical septicemia and multiorgan failure during intravenous liposomal amphotericin B therapy.

Topics: Adult; Amphotericin B; Drug Carriers; Fatal Outcome; Humans; Leukemia, Lymphoid; Liposomes; Male; Mycoses; Neutropenia; Treatment Failure; Trichosporon

Topics: Aged; Agranulocytosis; Amphotericin B; Candidiasis; Child; Child, Preschool; Drug Carriers; Fat Emulsions, Intravenous; Female; Fungemia; Humans; Leukemia, Lymphoid; Lymphoma, Non-Hodgkin; Male

A boy with newly diagnosed acute lymphoblastic leukaemia developed mycotic cerebral abscesses despite treatment with amphotericin. He survived this episode on combination antifungal treatment.

Topics: Adolescent; Amphotericin B; Brain Abscess; Candidiasis; Humans; Leukemia, Lymphoid; Male

Topics: Amphotericin B; Female; Humans; Leukemia, Lymphoid; Middle Aged; Pulmonary Edema

Twelve leukemic patients (19%) receiving amphotericin B and aminoglycosides had nephrotoxicity (creatinine value greater than 2.0 mg/dl). Patients with nephrotoxicity tended to be older than patients without nephrotoxicity; gender and total amphotericin B dose were not related to nephrotoxicity. Sodium administration has previously been shown to reverse amphotericin B nephrotoxicity. In this series, among patients receiving ticarcillin at greater than or equal to 18 gm/day (93.6 mEq of sodium per day) the incidence of nephrotoxicity was significantly decreased (1/30, or 3.3%). A multivariate analysis showed that this protective effect of ticarcillin was not dependent on the fact that patients receiving ticarcillin were less likely to receive vancomycin. There were insufficient patients receiving sodium in the absence of ticarcillin to study the effect of sodium alone. However, our observations are consistent with the hypothesis that sodium can prevent renal dysfunction in this clinical situation.

Topics: Adult; Aminoglycosides; Amphotericin B; Anti-Bacterial Agents; Drug Administration Schedule; Female; Humans; Kidney Diseases; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Male; Middle Aged; Sodium; Statistics as Topic; Ticarcillin; Vancomycin

Hepatic candidiasis has been increasingly recognized as a variant of disseminated candidiasis in immunocompromised patients. Five leukemic patients with antemortem diagnosis of hepatic candidiasis are described, and 32 additional cases reported in the literature are reviewed. Cultures of the liver and/or spleen and blood cultures usually give negative results; histopathologic demonstration of Candida organisms in tissue specimens is necessary for a definitive diagnosis. Response to conventional therapy with amphotericin B is poor, and 34.4 percent of the patients died with evidence of active fungal disease. Liposome-encapsulated amphotericin B, which has been successfully used in a limited number of patients with invasive fungal disease, may be an effective and relatively nontoxic drug.

Topics: Adult; Amphotericin B; Biopsy; Candida; Candidiasis; Drug Therapy, Combination; Female; Flucytosine; Humans; Immunologic Deficiency Syndromes; Ketoconazole; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Liver; Liver Diseases; Male

Previous observations suggest that salt loading can help reverse amphotericin-B induced nephrotoxicity. Evidence is presented indicating that sodium supplements provide prophylaxis against the development of amphotericin-B nephrotoxicity. In a retrospective study at Vanderbilt University, 14/21 patients receiving amphotericin B (target dose, 25 mg/day) without salt supplements developed impaired renal function; in 10 instances amphotericin B was temporarily withdrawn. In contrast, only 2/17 patients who received amphotericin B with ticarcillin (with its obligatory sodium supplement) developed nephrotoxicity (P less than 0.01). All four patients, who were receiving the combination of amphotericin B and ticarcillin and who had their ticarcillin therapy stopped, developed nephrotoxicity in the subsequent week. In a prospective observational study at Essen, 20 patients had 24 courses of amphotericin B (target dose, 40 mg/day) with routine supplementation of 1 liter of 0.9% sodium chloride daily. Only two patients showed evidence of nephrotoxicity and no dosage modification of amphotericin B was required in any patient. Four patients with initial evidence of mildly impaired renal function received full supplements without adverse effects or the development of nephrotoxicity. These observations suggest that routine parenteral administration of sodium supplements can help minimize the nephrotoxic potential of amphotericin B.

Topics: Amphotericin B; Blood Urea Nitrogen; Creatinine; Drug Therapy, Combination; Humans; Infusions, Intravenous; Kidney Diseases; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Middle Aged; Mycoses; Penicillins; Risk; Sodium; Ticarcillin

Topics: Agranulocytosis; Amphotericin B; Female; Humans; Ketoconazole; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Male; Middle Aged; Mycoses; Neutropenia

A twelve year old boy with acute lymphoblastic leukemia was treated with combination chemotherapy. Two weeks later a cellulitis of the left upper and lower eyelid appeared, followed by a rapidly increasing, deep necrotic inflammation of the periorbital area leading to proptosis. Mucormycosis was identified by histology and microbiology. The spreading inflammatory process was arrested by amphotericin B in a total dose of 1.2 g combined with a drainage of the necrotic tissue of the paranasal sinus, left orbit and bifrontal cerebral abscess. The patient is still in complete continuous remission four years later but a large defect of the nasal, maxillary and orbital area remains. This case demonstrates that the usual fatal outcome of mucormycosis in leukemia is curable with amphotericin B and aggressive surgery.

Topics: Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Child; Combined Modality Therapy; Eyelid Diseases; Humans; Leukemia, Lymphoid; Male; Meningoencephalitis; Mucormycosis; Nose Diseases; Orbital Diseases

The diagnosis of acute lymphatic non-T-non-B leukaemia of common ALL type was confirmed in a 22-year-old woman. Cytostatic treatment brought full remission for 21/2 years. Renewed cytostatic treatment for recurrence brought about a mucormycosis in the mid-face region during a period of protracted agranulocytosis, despite antibiotic prophylaxis with ketoconazole and cotrimoxazole. The causative mucor organism was demonstrated in smears and biopsy material. The infection was successfully treated with i.v. amphotericin B and débridement of the affected tissue. There remained large tissue defects in the region of gum, nose, upper lip and right oral cavity. Previously the mortality rate of mucormycosis in the course of leukaemia was 100%.

Topics: Adult; Agranulocytosis; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Debridement; Facial Dermatoses; Female; Gingival Diseases; Humans; Leukemia, Lymphoid; Mouth Diseases; Mucormycosis; Nose Diseases; Palate; Paranasal Sinus Diseases

We report a cluster of primary cutaneous aspergillosis in six children with hematologic malignancy. When first seen, they had hemorrhagic bullae caused by Aspergillus flavus, Aspergillus fumigatus, and Aspergillus niger at the sites of insertion of intravenous cannulas or where arm boards had been taped to the extremities. Rapid diagnosis of cutaneous aspergillosis was made by direct examination of the blister roof with potassium hydroxide before it progressed to a necrotic ulcer. Intravenous amphotericin was instituted promptly in five of six patients, and none died of disseminated aspergillosis. Epidemiologic investigation tracked the source of aspergillus to a storeroom with a false ceiling that had recently been repaired for a water leak.

Topics: Amphotericin B; Aspergillosis; Aspergillus; Child; Child, Preschool; Cross Infection; Dermatomycoses; Equipment Contamination; Female; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Male; Materials Management, Hospital

A 54-year-old woman entered the hospital for induction chemotherapy for acute lymphocytic leukemia. On hospital day 23, while the patient was neutropenic, an erosive lesion appeared on the left side of the tongue. During the next several days the lesion extended over the dorsum of the tongue and was golden orange. Surface scrapings were obtained; the involved site underwent a biopsy and was cultured. Branching septate mycelia of varying diameters were seen on microscopic examination of direct mounts and a biopsy specimen of the tongue. Eight to ten colonies of a fungus grew out in culture. The fungus was golden orange on Sabouraud's glucose agar and brown-gray on corn-meal agar, and was identified as Ramichloridium schulzeri. The lesion regressed during the next two weeks while the patient received amphotericin B therapy and showed an increased granulocyte count. This case seems to be the first authenticated infection caused by this uncommonly encountered soil saprophyte.

Topics: Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Female; Humans; Leukemia, Lymphoid; Middle Aged; Mitosporic Fungi; Mycoses; Syndrome; Tongue Diseases

Topics: Amphotericin B; Cryptococcosis; Female; Flucytosine; Humans; Leukemia, Lymphoid; Middle Aged

Topics: Amphotericin B; Candidiasis, Cutaneous; Candidiasis, Oral; Child; Esophagitis; Female; Humans; Ketoconazole; Leukemia, Lymphoid; Male; Nystatin; Thrombocytopenia

Allogeneic bone marrow transplantations were carried out between March 1983 and July 1985 in 31 patients aged 7 to 45 years (median 18 years). Acute lymphoblastic leukaemia in 1st to 5th remission was present in 8 patients, acute myeloblastic leukaemia in 1st and 2nd remission in 4 patients, chronic myeloid leukaemia, with various remission status, in 6 patients, 3 patients had severe aplastic anaemia and there were single cases of myelodysplasia and immature cell megakaryocytic myelosis. Transplantation was carried out during relapse in 8 patients with either acute myeloid or lymphoblastic leukaemia. Phenotypic HLA-identical mothers (n = 2) as well as genotypic HLA-identical siblings (n = 27), and in two cases HLA-non-identical mothers, served as bone marrow donors. In leukaemia patients the conditioning treatment consisted of fractionated total body irradiation and high dose cyclophosphamide or etoposide. Patients with severe aplastic anaemia received cyclophosphamide (4 X 50 mg/kg) and fractionated total nodal irradiation (total dose 8 Gy). 19 patients (61%) survived 14 to 605 days after bone marrow transplantation. 15 patients (48%) continue to remain in complete remission with Karnofsky indices of greater than or equal to 90%. Causes for death were infection (n = 3), interstitial pneumonia (n = 3), relapse (n = 3) as well as single cases involving acute graft-versus-host-disease, non-engraftment of donor marrow and veno-occlusive disease of the liver.

Topics: Acyclovir; Adolescent; Adult; Amphotericin B; Anemia, Aplastic; Bone Marrow Transplantation; Child; Cyclophosphamide; Etoposide; Female; Graft Survival; Graft vs Host Disease; Herpes Genitalis; HLA Antigens; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Male; Methotrexate; Middle Aged; Nystatin; Prednisolone; Tissue Donors; Whole-Body Irradiation

We describe a perplexing asthmatic patient who had chronic lymphatic leukemia that developed recurrent severe and prolonged attacks of asthma which required almost continuous hospitalization. Clinical findings of fever, leukocytosis, right lower lobe infiltrate and mouth candidiasis were suggestive of bronchopulmonary candidiasis. No further diagnostic tests were done and the patient responded favorably to amphotericin B therapy. A review of bronchopulmonary candidiasis in adults is discussed briefly. Lung biopsy should be reserved only for the most obscure and problematic cases.

Topics: Amphotericin B; Asthma; Candidiasis; Female; Humans; Leukemia, Lymphoid; Lung Diseases, Fungal; Middle Aged

We report a case of rhinocerebral mucormycosis in a patient with acute lymphoblastic leukaemia undergoing remission induction therapy. The diagnosis was suspected on the characteristic clinical features and confirmed by histology and culture of infected tissue obtained by biopsy. Treatment was successful because of early institution of antifungal therapy, repeated surgical debridement and established of remission in the underlying disease.

Topics: Adult; Amphotericin B; Debridement; Diagnosis, Differential; Female; Humans; Leukemia, Lymphoid; Mucormycosis; Paranasal Sinus Diseases

Coccidioidomycosis tenosynovitis is an unusual rheumatological manifestation of Coccidioides immitis infection. We report a case in a 46-year-old man with leukemia. The literature is reviewed and the treatment discussed.

Topics: Amphotericin B; Coccidioidomycosis; Humans; Leukemia, Lymphoid; Male; Middle Aged; Tenosynovitis

The authors described a 6 years old boy suffering from acute lymphoblastic leukemia and treated by the B.F.M. protocol who presented during intensive chemotherapy period a aspergillus renal abscess apparently unique. During the postoperative period the evolution was progressively favorable under prolonged anti-fungal treatment. The different clinical features, the non facilities of diagnosis and the mean possibility of treatment in aspergillus infection in immunodeficient patients are reviewed.

Topics: Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Child; Humans; Kidney; Kidney Diseases; Leukemia, Lymphoid; Male; Neutropenia

Topics: Adult; Amphotericin B; Combined Modality Therapy; Humans; Leukemia, Lymphoid; Male; Mucormycosis; Pneumonectomy; Pneumonia

Progressive disseminated histoplasmosis (PDH) is a rare consequence of infection with Histoplasmia capsulatum. Usually fatal if untreated, PDH generally is cured by appropriate amphotericin B treatment. Of 31 persons with uncomplicated PDH treated with amphotericin B, we found that relapse occurred in five (16%) after an interval of up to nine years after initial therapy. Review of these five cases and 31 additional relapsing cases from the literature indicates that fungal endocarditis or endarteritis without surgical treatment, underlying lymphoreticular neoplasm, and amphotericin B dosage of less than 2 g appear to be associated with relapse of PDH.

Topics: Aged; Amphotericin B; Antifungal Agents; Endocarditis; Histoplasmosis; Humans; Imidazoles; Ketoconazole; Leukemia, Lymphoid; Lymphoma, Non-Hodgkin; Male; Middle Aged; Piperazines; Recurrence; Retrospective Studies; Time Factors

A favourable outcome was observed in a 12 year-old boy who developed invasive pulmonary and cerebral aspergillosis during antineoplastic treatment for central nervous system relapse of acute lymphoblastic leukemia. Combination therapy with amphotericin B and 5-Fluorocytosine led to complete regression of pulmonary infiltrates. Despite enlargement of the cerebral lesion monitored by computerized tomography, no viable fungi were found in the completely resected abscess after a 4 weeks' course of antifungal treatment preceding neurosurgery. Histological examination confirmed the diagnosis of an aspergillotic abscess. The initially severe neurological symptoms disappeared after successful surgery. Aspergillus fumigatus was detected in the soil of a potted ornamental plant in the mother's living room, suggesting that this might have been the source of the infectious agent.

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Brain Abscess; Child; Flucytosine; Humans; Immunosuppression Therapy; Leukemia, Lymphoid; Lung Diseases, Fungal; Male; Meningeal Neoplasms

A retrospective evaluation was made on the value of amphotericin B lozenges in the selective elimination of yeasts from the oropharynx. Four different groups of severely granulocytopenic patients were studied. All 77 patients received amphotericin B orally as a suspension or as tablets. Four amphotericin B lozenges were also administered daily for topical antimycotic decontamination of the oropharynx. This was done in the presence of colonization-resistance decreasing factors such as a nasogastric tube (Group I, 19 patients) or mucosal damage (Group III, 25 patients) and in patients with four or more consecutive throat swab cultures with yeasts (Group IV, 11 patients). The 22 patients in Group II did not receive lozenges. The addition of lozenges resulted in a decrease in the mean "growth density" of Candida cells in the oropharynx. This reduction was significant in Group III (p less than 0.01) and Group IV (p less than 0.02) and became evident during the first week of treatment. In patients with a nasogastric tube, however, 51.8% of the throat swab cultures revealed yeasts. Increasing the dose of the lozenges might improve the results in these patients. Topical treatment of the oropharynx with amphotericin B lozenges is advocated for patients who are susceptible to Candida infections.

Topics: Amphotericin B; Candida; Candidiasis, Oral; Dosage Forms; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Neutropenia; Oropharynx; Retrospective Studies

Two patients with acute leukemia were found to have candidal splenic abscesses. Both patients were in remission and had normal granulocyte counts at the time the abscesses became evident. Both patients were treated with splenectomy and antifungal therapy with a definite response. The incidence and treatment of fungal splenic abscesses in leukemia patients is discussed with emphasis on the role of splenectomy.

Topics: Abscess; Acute Disease; Amphotericin B; Candidiasis; Humans; Infant; Leukemia; Leukemia, Lymphoid; Male; Splenectomy; Splenic Diseases

Topics: Adult; Amphotericin B; Candidiasis; Female; Fever; Humans; Leukemia, Lymphoid; Muscular Diseases; Prognosis; Skin Diseases

Candidal pericarditis is extremely rare. Its clinical diagnosis and successful treatment has not been reported earlier. A case reported of a 30-year-old male with acute lymphoblastic leukaemia complicated with exudative pleuropericarditis, probably initially of leukaemic origin. Following persisting fever cultures of blood and pericardial fluid yielded massive growth of candida albicans. After 3 weeks treatment with intravenous amphotericin B, flucytosine and miconazole, the blood and pericardial fluid was sterilized. A sufficient amphotericin B concentration in the pericardial fluid was obtained without local instillation.

Topics: Adult; Amphotericin B; Candidiasis; Humans; Leukemia, Lymphoid; Male; Pericarditis

An immunosuppressed patient had zygomycosis and was successfully treated with amphotericin B. Infection was rapidly diagnosed by demonstration of hyphae in impression smears of lung tissue and was confirmed by subsequent culture. Rapid diagnosis and prompt therapy are believed to have contributed to the successful outcome.

Topics: Amphotericin B; Fungi; Humans; Leukemia, Lymphoid; Lung Diseases, Fungal; Male; Middle Aged

Two additional cases of systemic mycosis due to Trichosporon cutaneum are reported and are compared with the previously published case of Rivera and Cangir. Both patients (a four-year-old male and a 57-year-old female) had acute leukemia for which they were receiving chemotherapy, and both presented with fever that was unresponsive to conventional antibiotics. Both had positive blood cultures for Trichosporon cutaneum. The disease was further documented in the four-year-old male by renal biopsy and by bone marrow culture; he was treated with apparent success with amphotericin B. However, the 57-year-old female died shortly after the begining of similar treatment, and autopsy demonstrated involvement of the left kidney, spleen, bone marrow, and liver. The organism in both these cases, as well as the case of Rivera and Cangir, exhibited both hyphal and yeastlike forms in tissue sections. We believe that the therapeutic success in the case of the four-year-old male was primarily related to his remission from leukemia.

Topics: Amphotericin B; Child, Preschool; Female; Humans; Kidney; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Male; Middle Aged; Mycoses; Yeasts

Three children with the rare occurrence of zygomycosis are descibed: two had involvement of a solitary lesion of gangrenous cellulitis on the buttocks, and th third was a neonate with gastric performation and a gangrenous appendicitis. All three patients were compromised hosts (two with leukemia and one a premature infant with respiratory distress syndrome). All three patients appeared to have acquired the same organism. Rhizopus oryzae, from the same fomites, elastic bondages (Elastoplast). The Center for Disease Control has received several other reports of zygomycosis traceable to the same material. Alll three of our patients were cured of their infections. Early diagnosis and a combined surgical and chemotherapeutic approach appear to prevent death from zygomycosis.

Topics: Amphotericin B; Appendicitis; Bandages; Cellulitis; Child; Female; Humans; Infant, Newborn; Leukemia, Lymphoid; Male; Mucormycosis; Peptic Ulcer Perforation; Respiratory Distress Syndrome, Newborn; Rhizopus; Stomach Ulcer

Allescheria boydii (Petriellidium boydii) has previously been described as a cause of Madura foot and pulmonary and other visceral infections. This report describes infection of the maxillary sinus and facial soft tissue with A. boydii in a compromised host. The infection did not respond to antibiotics, including amphotericin B and 5-fluorocytosine. Miconazole was not used in our patient, although in vitro data obtained after death indicated sensitivity of the fungus to miconazole.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Face; Flucytosine; Humans; Leukemia, Lymphoid; Male; Maxillary Sinus; Mycoses; Paranasal Sinus Diseases; Pseudallescheria

A 3-year-old boy with acute lymphoblastic leukemia developed a right frontal lobe abscess from which Allescheria (Petriellidium) boydii was cultured. The mycotic infection complicating his underlying disease appeared to be confined to the brain. Surgical drainage and therapy with amphotericin B were followed by eventual recovery with no neurologic deficits.

Topics: Amphotericin B; Ascomycota; Brain Abscess; Child, Preschool; Drainage; Humans; Leukemia, Lymphoid; Male; Mycoses

Infection with Histoplasma capsulatum in 58 patients whose immune responses were suppressed (Immunosuppressed patients) (16 from the present series and 42 described previously) was analyzed. The most common underlying diseases were Hodgkin's disease (29 per cent), chronic lymphocytic leukemia (19 per cent) and acute lymphocytic leukemia (17 per cent). Sixty-three per cent of the patients had received cytotoxic drugs, and 57 per cent had taken corticosteroids. Widely disseminated infection occurred in 88 per cent of the patients, with predominant involvement of lungs and organs of the reticuloendothelial system. Localized pulmonary infection was present in the remaining patients. The most useful diagnostic method was bone marrow biopsy with microscopic examination for the intracellular yeast form of H. capsulatum. Biopsy of oral lesions, lung, liver and lymph node also proved diagnostically helpful. Growth of H. capsulatum in culture was frequently too slow to be beneficial in diagnosing histoplasmosis in ill patients. Serologic methods were of little diagnostic help in this population of immunosuppressed patients. The response to amphotericin B therapy was excellent (6.7 per cent mortality rate) in those patients in whom the diagnosis was established early and in whom a full course of antifungal therapy could be given. In contrast, the mortality rate in patients who received no antifungal therapy or less than 1 g of amphotericin B was 100 per cent.

Topics: Adult; Aged; Amphotericin B; Diagnosis, Differential; Female; Histoplasmosis; Hodgkin Disease; Humans; Immunosuppression Therapy; Kidney Transplantation; Leukemia, Lymphoid; Lupus Erythematosus, Systemic; Male; Middle Aged; Pneumonia; Sarcoidosis; Transplantation, Homologous

The clinical and pathological findings in 46 patients with cryptococcosis at Memorial Sloan-Kettering Cancer Center from 1956 to 1972 are reported. The striking predilection for cryptococcal infection in patients with leukemias and lymphomas is again confirmed. Of 41 patients with neoplastic disease, those with chronic lymphatic leukemia (CLL), Hodgkin's Disease, chronic myelogenous leukemia (CML), myeloma and lymphosarcoma had the highest incidence of cryptococcosis. In all cases, neoplastic disease was widespread when infection occurred. All of these patients had leukopenia and absolute lymphopenia at the time of infection. Thirty-nine were on steroids. Thirty-one patients with neoplastic disease had disseminated infection. Review of pathology revealed a spectrum of inflammatory lesions. Histiocytic-lymphocytic infiltrates occurred in the central nervous system in 10 patients. In six cases, reaction was granulomatous. There were single instances of suppurative and fibrotic reactions. Mortality from infection was high in patients with neoplastic disease. Twenty-four of 28 deaths occurred within 60 days as a result of infection. Within one year, 10 more patients died, nine of cryptococcosis. Only three survived more than one year, and all patients died within 600 days. Twenty-nine patients with neoplastic disease received amphotericin B. Only nine survived more than 60 days.

Topics: Amphotericin B; Antigens, Bacterial; Central Nervous System; Cryptococcosis; Cryptococcus neoformans; Female; Hodgkin Disease; Humans; Leukemia, Lymphoid; Leukemia, Myeloid; Lung; Lymphoma, Large B-Cell, Diffuse; Male; Multiple Myeloma; Neoplasms

A number of different amphotericin B (AmB)-1,3-bis(2 chloroethyl)-1-nitrosourea (BCNU) treatment regimens were evaluated with our model of transplantable AKR leukemia. We found that dose levels and treatment schedules were critical in determining the number of survivors. A 4-day treatment regimen of 0.5 mg AmB/mouse on days 1, 2, 3, and 4 and 0.2 mg BCNU/mouse on day 4 was found to be the most effective and has been chosen as our standard regimen. The efficacy of the treatment regimen depended on the presence of a large tumor burden, and the response was abolished when the mice were preirradiated or treated with the immunosuppressive agent, cyclophosphamide. These results, as well as others which we discuss, supported our notion that AmB affected host immune response to the tumor.

Topics: Amphotericin B; Animals; Carmustine; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Synergism; Drug Therapy, Combination; Female; Immunity; Immunosuppression Therapy; Leukemia, Experimental; Leukemia, Lymphoid; Lymphocytes; Mice; Mice, Inbred AKR

Pulmonary mucormycosis in an ill patient with poorly controlled chronic lymphocytic leukemia was diagnosed with open lung biopsy without excision. He improved on medical management and became ambulatory. At autopsy one year later, no residual mucormycosis was present. Better control of leukemia and more specific antimicrobial therapy are discussed as potentially important factors in patient management.

Topics: Aged; Amphotericin B; Biopsy; Child; Diabetes Complications; Humans; Leukemia, Lymphoid; Lung; Lung Diseases, Fungal; Male; Mucormycosis

Four nonabsorbable antibiotics (streptomycin, neomycin, bacitracin, and amphotericin B) and a germicidal dip solution (Zephiran chloride/water) were used to eliminate all the detectable bacteria from conventional AKR mice. Control mice were not decontaminated and were used as such. When antibiotic-decontaminated and control mice developed clinical manifestations of spontaneous lymphatic leukemia, each was treated for the disease with an antitumor drug (cyclophosphamide [CP]) at weekly intervals. With the decontamination procedure, mice of each of the two groups became bacteria-free after 16 weeks of continuous oral administration of the antibiotics and two separate germicidal dippings. All decontaminated mice remained free of bacteria throughout the experiment. The bacterial flora of the control mice remained unaltered. With CP therapy, the mean survival time of the female decontaminated mice was 65 days, whereas that of male mice was 218 days. The average survival time of the CP-treated control leukemic mice was 51 days. Untreated decontaminated or control mice usually died of leukemia within 7 days after the onset of symptoms of leukemia. Although CP therapy was not curative, it did prolong the life expectancy of the decontaminated mice significantly.

Topics: Amphotericin B; Animals; Bacitracin; Benzalkonium Compounds; Cyclophosphamide; Decontamination; Female; Germ-Free Life; Leukemia, Lymphoid; Male; Mice; Mice, Inbred AKR; Neomycin; Streptomycin; Time Factors

A patient with chronic lymphocytic leukemia developed extensive pneumonia due to Cryptococcus neoformans. A presumptive diagnosis based on results of a Wright's stain of the sputum was made and appropriate antifungal therapy was started. C neoformans was cultured in COUNTS AS HIGH AS 8 X 10(5)/ml of sputum and was present morphologically for three weeks after sputum cultures had become negative. During the patient's first week of hospitalization, C neoformans was cultured from sputum and on cough plates but from no other source in his room. This suggests the possibility of transmitting the fungus to susceptible persons by droplets from patients having extensive pulmonary cryptococcosis.

Topics: Amphotericin B; Cryptococcosis; Humans; Leukemia, Lymphoid; Lung Diseases, Fungal; Male; Middle Aged; Sputum

Trichosporon cutaneum is a fungus known to cause superficial nodules over the distal third of hair shafts, mainly scalp hair, and to produce a clinical entity known as piedra. This superficial mycosis occurs mostly in temperate and tropical regions and is rarely seen in North America. Trichosporon cutaneum spesis is described here in a 12-year-old boy with acute lymphocytic leukemia in relapse. To our knowledge this is the first case reported in the literature. Emphasis is made of the increasing rate of fungal diseases as well as of "opportunistic" infections in this type of immunosuppressed patient.

Topics: Amphotericin B; Anti-Bacterial Agents; Bleomycin; Child; Cytarabine; Enterobacteriaceae Infections; Flucytosine; Humans; Leukemia, Lymphoid; Male; Mycoses; Sepsis; Vincristine; Yeasts

This report describes a patient with acute lymphoblastic leukemia who developed arthritis of the knee caused by Candida tropicalis. Systemic therapy with amphotericin B apparently suppressed but did not eliminate the infection. Resolution of the arthritis occurred only after three intra-articular injections of amphotericin B. Intra-articular administration of amphotericin B may be a useful adjunct to systemic antifungal therapy in the treatment of these infections.

Topics: Amphotericin B; Arthritis, Infectious; Candidiasis; Child; Female; Humans; Injections, Intra-Articular; Injections, Intravenous; Knee Joint; Leukemia, Lymphoid

Treatment of a transplantable leukemia in AKR mice with both amphotericin B and 1,3-Bis(2-chloroethyl)-1-nitrosourea cured a significant percentage of animals with advanced disease. Some long-term survivors developed paralysis, and they invariably demonstrated central nervous system (CNS) leukemia. Some of these animals had a systemic relapse of their leukemia, and the CNS appeared to act as a focus for systemic dissemination. The occurrence patterns and histopathologic features of the CNS leukemia in the long-term survivors were strikingly similar to those observed in humans with acute lymphoblastic leukemia.

Topics: Amphotericin B; Animals; Brain; Carmustine; Central Nervous System Diseases; Disease Models, Animal; Female; Leukemia, Experimental; Leukemia, Lymphoid; Meninges; Mice; Mice, Inbred AKR; Neoplasm Metastasis; Neoplasm Recurrence, Local; Paralysis; Spinal Cord

Topics: Adolescent; Age Factors; Agranulocytosis; Amphotericin B; Bone Marrow; Child; Child, Preschool; Female; Hepatomegaly; Histoplasmosis; Humans; Leukemia, Lymphoid; Leukopenia; Male; Radiography; Remission, Spontaneous; Splenomegaly

Topics: Amphotericin B; Child, Preschool; Histoplasmosis; Humans; Leukemia, Lymphoid; Male

Topics: Amphotericin B; Asparaginase; Candidiasis; Child, Preschool; Daunorubicin; Fusarium; Humans; Leukemia, Lymphoid; Male; Prednisone; Skin; Vincristine

Topics: Acute Disease; Adolescent; Adult; Aged; Amphotericin B; Aspergillosis; Autopsy; Biopsy; Candidiasis; Candidiasis, Oral; Child, Preschool; Female; Fever of Unknown Origin; Humans; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Middle Aged; Mucor; Mycoses; Retrospective Studies

Topics: Adolescent; Adult; Agammaglobulinemia; Amphotericin B; Anuria; Azathioprine; Biopsy; Bis-Trimethylammonium Compounds; Busulfan; Child; Child, Preschool; Chlorambucil; Cyclophosphamide; Female; Graft Rejection; Humans; Immunosuppressive Agents; Kidney Transplantation; Leukemia, Lymphoid; Lymphoma, Non-Hodgkin; Male; Methotrexate; Middle Aged; Mycosis Fungoides; Pneumonia, Pneumocystis; Prednisone; Transplantation, Homologous; Vincristine

Topics: Adult; Agglutination Tests; Amphotericin B; Anti-Bacterial Agents; Candida; Candidiasis; Child; Cyclophosphamide; Cytarabine; Evaluation Studies as Topic; False Negative Reactions; Female; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Male; Mercaptopurine; Methotrexate; Middle Aged; Nitrosourea Compounds; Precipitin Tests; Prednisone; Serologic Tests; Vinblastine; Vincristine

Topics: Amphotericin B; Child; Cryptococcosis; Female; Humans; Leukemia, Lymphoid; Leukocyte Count; Meningitis

Topics: Adult; Aged; Amphotericin B; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus; Diabetes Complications; Female; Follow-Up Studies; Hodgkin Disease; Humans; Leukemia, Lymphoid; Lupus Erythematosus, Systemic; Male; Meningitis; Middle Aged; Sarcoidosis; Silicosis

Topics: Adrenal Cortex Hormones; Adult; Aged; Agranulocytosis; Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Candidiasis; Child; Child, Preschool; Female; Histoplasmosis; Humans; Leukemia, Lymphoid; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Middle Aged

Topics: Aged; Amphotericin B; Cryptococcosis; Humans; Leukemia, Lymphoid

Topics: Amphotericin B; Anti-Bacterial Agents; Antineoplastic Agents; Candidiasis; Drug Therapy; Esophagoscopy; Esophagus; Hodgkin Disease; Humans; Leukemia; Leukemia, Lymphoid; Leukemia, Myeloid; Lymphoma, Large B-Cell, Diffuse; Lymphoma, Non-Hodgkin; Multiple Myeloma; Neoplasms; Sarcoma

Topics: Amphotericin B; Arizona; Coccidioidomycosis; Humans; Leukemia; Leukemia, Lymphoid; Lung Diseases; Lung Diseases, Fungal; Prednisone; Sarcoidosis; Toxicology

Topics: Amphotericin B; Child; Clinical Laboratory Techniques; Cryptococcosis; Cryptococcus; Diagnosis, Differential; Drug Therapy; Fever; Humans; Leukemia; Leukemia, Lymphoid; Lung Diseases; Lung Diseases, Fungal; Lymphadenitis; Meningitis; Radiography; Sulfadiazine

Topics: Amphotericin B; Brain Diseases; Cryptococcosis; Hodgkin Disease; Humans; Leukemia; Leukemia, Lymphoid; Lymphocytes; Meningitis

Topics: Amphotericin B; Brain Diseases; Cryptococcosis; Hematologic Diseases; Hodgkin Disease; Humans; Leukemia; Leukemia, Lymphoid; Meningitis