amphotericin-b and Leukemia--Monocytic--Acute

We present six cases of fusariosis caused by Fusarium solani that were diagnosed over a three-year period in 166 adult patients undergoing chemotherapy for acute leukemia. Necrotic skin lesions were evident in four patients, fungemia in three, and a deep cellulitis around a great toe nail at the time of a febrile illness in two. The mean minimal inhibitory concentration (MIC) of amphotericin B was 3.3 micrograms/mL and of miconazole, 5.3 micrograms/mL; all isolates were resistant to 5-fluorocytosine. All patients received amphotericin B (1.0-1.5 mg/kg per d) plus 5-fluorocytosine. In contrast to results found in the literature, five patients had resolution of their infections, and the one patient who died had necropsy evidence of disseminated fusariosis. Review of our cases and of the literature did not reveal a definitive source for the organism or its portal of entry. Fusarium spp. must be recognized as opportunistic pathogens that cause a potentially fatal infection in compromised patients.

Topics: Adult; Amphotericin B; Female; Flucytosine; Fusarium; Humans; Immune Tolerance; Leukemia; Leukemia, Megakaryoblastic, Acute; Leukemia, Monocytic, Acute; Leukemia, Myeloid, Acute; Leukemia, Prolymphocytic; Male; Middle Aged; Mycoses; Opportunistic Infections

A case of fatal invasion of Scopulariopsis brevicaulis to the bronchus in an acute monocytic leukemia (M(5)) patient is described. This infection leads to mediastinal emphysema, bronchial bleeding, and bronchial obstruction before finally spreading to the entire lung. The patient was initially diagnosed with pulmonary aspergillosis based on clinical signs and morphological examination. However, S. brevicaulis was finally identified by 18S rDNA sequencing. The patient failed lipid amphotericin B therapy and voriconazole plus caspofungin combination therapy. To the best of our knowledge, this is the first report on S. brevicaulis affecting the bronchus and resulting in a fatal prognosis in an M(5) patient.

Topics: Adult; Amphotericin B; Bronchi; Caspofungin; DNA, Fungal; DNA, Ribosomal; Drug Therapy, Combination; Echinocandins; Fatal Outcome; Female; Genes, rRNA; Histocytochemistry; Humans; Leukemia, Monocytic, Acute; Lipopeptides; Lung; Lung Diseases, Fungal; Molecular Sequence Data; Pyrimidines; Radiography, Thoracic; RNA, Fungal; RNA, Ribosomal, 18S; Scopulariopsis; Sequence Analysis, DNA; Tomography, X-Ray Computed; Treatment Failure; Triazoles; Voriconazole

This study, undertaken to compare the susceptibility of THP-1 cells and murine peritoneal macrophages to Leishmania peruviana amastigotes, obtained THP-1 infection with 10 parasites/cell compared to 2 parasites/murine macrophage. The parasite burden was maximal at 72 h post-infection (h.p.i.) for THP-1 cells, while it was still increasing at 120 h.p.i. for murine macrophages. Since in both cases the infection with L. peruviana affected cell viability, we recommend evaluating any leishmanicidal activity at 72 h.p.i. Amphotericin B reduced Leishmania infection by 50% at concentrations of 0.1 microM in THP-1 and murine macrophages at 72 h.p.i. Our results demonstrate that amastigotes of L. peruviana can infect THP-1 cells and murine macrophages and indicate the suitability of this model to screen compounds for leishmanicidal activity.

Topics: Amphotericin B; Animals; Antiprotozoal Agents; Cell Line, Tumor; Cell Survival; Female; Humans; Inhibitory Concentration 50; Leishmania braziliensis; Leukemia, Monocytic, Acute; Macrophages, Peritoneal; Mice; Monocytes

Invasive aspergillosis is an important factor in the morbidity and mortality of patients suffering from hematologic disorders treated with chemotherapy. Treatment with amphotericin B is often limited because of toxicity, particularly nephrotoxicity. We describe a case of invasive pulmonary Aspergillus fumigatus infection in acute myeloid leukemia with renal failure due to amphotericin B therapy, which responded to treatment with a new antifungal agent, micafungin. Micafungin appears to be an effective and safe therapy for Aspergillus infections with renal failure due to amphotericin B.

Topics: Amphotericin B; Aspergillosis; Echinocandins; Humans; Leukemia, Monocytic, Acute; Lipopeptides; Lipoproteins; Lung Diseases, Fungal; Male; Micafungin; Middle Aged; Peptides, Cyclic; Renal Insufficiency; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Humans; Kidney Diseases; Kidney Tubules; Leukemia, Monocytic, Acute; Liposomes; Male; Sodium; Vasopressins

Hepatosplenic candidiasis following granulocytopenic periods is a relatively recently recognised problem in immunocompromised patients, particularly in those with acute leukaemia. We present three patients in whom diagnosis of hepatosplenic candidiasis was suspected on the basis of ultrasonographic (US), computed tomographic (CT) findings and confirmed by laparoscopy and biopsy of liver lesions. All three patients were successfully treated briefly with amphotericin B, followed by a longer period of fluconazole. In one patient laparotomy and surgical evacuation of abscesses was performed. This condition could be more often recognised by careful follow-up of liver function test, C-reactive protein level, ultrasonography, CT and MRI after recovery from chemotherapy-induced neutropenia.

Topics: Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Candidiasis; Female; Fluconazole; Humans; Leukemia-Lymphoma, Adult T-Cell; Leukemia, Monocytic, Acute; Leukemia, Myeloid, Acute; Liver Diseases; Male; Middle Aged; Neutropenia; Opportunistic Infections; Splenic Diseases

We describe an unusual case of a late presentation of a fungal brain abscess in a non-neutropenic child 1 year after completing chemotherapy for M5 acute myeloid leukaemia (AML). Biopsy of the mass identified candidal hyphae and the patient was treated with 5 mg/kg of liposomal amphotericin B for 6 weeks. The lesion resolved completely and the child remains well 2 years later. Invasive fungal infection should be included in the differential diagnosis of unexplained symptoms in patients who have previously received intensive chemotherapy.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Agents; Brain Abscess; Candidiasis; Child, Preschool; Female; Humans; Leukemia, Monocytic, Acute

Fungemia caused by Trichosporon beigelii (cutaneum) has been recently recognized as a fatal infection afflicting immunocompromised patients. The authors report the case of a leukemic patient who developed splenic infection from disseminated T. beigelii. Treatment with amphotericin B, 5-fluorocytosine, and splenectomy proved successful. The etiology of disseminated T. beigelii infection, visceral seeding, and combination antifungal therapy also are discussed.

Topics: Adult; Amphotericin B; Combined Modality Therapy; Flucytosine; Humans; Leukemia, Monocytic, Acute; Male; Mycoses; Opportunistic Infections; Splenectomy; Trichosporon