amphotericin-b and Leukemia--Myeloid

Cunninghamella bertholletiae infection occurs most frequently in neutropenic patients affected by haematological malignancies, is associated with an unfavourable outcome. We report a case of rhino-mastoidal fungal infection in a leukaemic patient. Bioptical tissue cultures yield the isolation of a mould with typical properties of Cunninghamella species. Liposomal amphotericin B (L-Amb) therapy combined with surgical intervention brought the lesion to recovery. Nevertheless, the patient died 14 days after bone marrow transplantation (BMT) from bacterial sepsis. Mastoiditis was documented at CT-scan. The conditioning regimen probably caused the reactivation of the Cunninghamella infection that led to the patient's fatal outcome; fungal hyphae were detected after autopsy of brain and lung tissue.

Topics: Amphotericin B; Bone Marrow Transplantation; Cunninghamella; Humans; Immunocompromised Host; Leukemia, Myeloid; Mucormycosis; Opportunistic Infections

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Humans; Leukemia, Myeloid; Rhizopus; Triazoles; Zygomycosis

We describe a case of primary aspergillosis involving the tongue of a patient with acute myeloid leukemia. Intraoral aspergillosis is very rare and we found only 23 cases reported in the English literature. Clinically it was a 2-cm, ulcerated, grayish lesion on the dorsum of the tongue. Microscopically there was invasion of the epithelium, connective tissue and muscle of the tongue by fungal hyphae branching at 45 degrees angle. The large hyphae were easily seen by H & E stain, and were strongly positive for periodic acid-Schiff and Grocott methenamine. The patient was successfully treated with intravenous amphotericin B. Based on clinical, microscopic and culture data, the diagnosis of primary aspergillosis of the tongue was established. Invasive oral aspergillosis is a potentially lethal disease and it should be considered in immunosuppressed patients.

Topics: Acute Disease; Adolescent; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; Humans; Hyphae; Immunocompromised Host; Leukemia, Myeloid; Male; Tongue Diseases

Various adverse effects have been reported with the use of amphotericin B. The respiratory adverse effects include dyspnea, tachypnea, bronchospasm, hemoptysis, and hypoxemia. Stridor has not been previously reported with the use of amphotericin B.. To review the mechanism of action and reports of respiratory adverse effects for amphotericin B, the liposomal preparations of amphotericin B, and the differential diagnosis of stridor.. A MEDLINE search from 1966 to 2002 was performed to review the current literature for possible mechanisms and immunoregulatory effects related to the infusion of amphotericin B.. Amphotericin B has been shown to increase tumor necrosis factor alpha (TNF-alpha) concentrations in macrophages. In addition, it induces prostaglandin E2 synthesis and increases the production of interleukin 1beta (IL-1beta) in mononuclear cells. The immunoregulatory effects of amphotericin B include increases in apoptosis, production of monocyte chemoattractant protein 1, superoxide anion, nitric oxide, and intercellular adhesion molecule 1 expression.. Amphotericin B induces the production of TNF-alpha, interferon-gamma, and IL-1beta, which may potentiate its toxic effects. Some liposomal preparations induced lower levels of TNF-alpha and nitric oxide and may be useful in patients unable to tolerate amphotericin B deoxycholate.

Topics: Acute Disease; Aged; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Drug Compounding; Drug Hypersensitivity; Humans; Leukemia, Myeloid; Male; Respiratory Hypersensitivity; Respiratory Sounds

Invasive fungal infections have increasingly become a matter of concern with regard to patients receiving intensive myelosuppressive therapy for hematologic malignancies. Such infections, especially prolonged neutropenia systemic fungal infections, may contribute substantially to infectious complications and early death. Measures for early detection and effective prophylactic strategies using active and nontoxic antifungal agents are therefore urgently needed.. The current randomized study was initiated to assess the efficacy of oral fluconazole as systemic antifungal prophylaxis for high risk patients with recurrent acute myeloid leukemia undergoing intensive salvage therapy.. Of 68 fully evaluable patients, 36 were randomized to fluconazole in addition to standard prophylaxis with oral co-trimoxazol, colistin sulphate, and amphotericin B suspension, and 32 were randomized to standard prophylaxis only. No major differences between the two groups were observed in the number of episodes of fever of unknown origin (61% vs. 50%) or clinically defined infections (56% vs. 50%). Microbiologically defined infections were more frequent in the fluconazole group (50% vs. 31%), mainly due to a higher incidence of bacteremias (42% vs. 22%). There were two cases of proven invasive fungal infections in each group. Systemic amphotericin B was administered more frequently to patients receiving fluconazole prophylaxis (56% vs. 28%). Fluconazole prophylaxis had no impact on the rate of early death or overall survival.. For patients with high risk recurrent acute myeloid leukemia undergoing intensive salvage therapy, antifungal prophylaxis with fluconazole was not superior to standard prophylaxis only.

Topics: Acute Disease; Administration, Oral; Adolescent; Adult; Aged; Amphotericin B; Antibiotic Prophylaxis; Antifungal Agents; Female; Fluconazole; Humans; Immunocompromised Host; Leukemia, Myeloid; Male; Middle Aged; Mycoses; Prospective Studies; Recurrence; Risk Factors; Salvage Therapy

We analyzed the 67 of 278 patients with newly-diagnosed AML or 'high-risk' MDS, treated in 1994 and 1995, who developed pneumonia during course 1 of their induction therapy. Pneumonia responded to treatment in 66%, but outcome depended on when pneumonia was diagnosed. Patients with pneumonia diagnosed during week 1 or 2 (group 2 patients) had the lowest response rate (43%). Patients who developed pneumonia in the 3rd week after treatment initiation had the best outcome with all 16 patients recovering. Patients presenting with pneumonia had an intermediate response rate (75%). The different patient groups were comparable with regard to age, underlying disease, prophylactic therapy, and G-CSF application. Although a lower CR rate was not entirely responsible for the lower response rate in group 2, failure to achieve CR predicted unsuccessful treatment of pneumonia in all groups. Fungal pathogens appeared more common in group 2 patients. However, in these patients, administration of amphotericin B was associated with a significantly higher failure rate (15/21 failures vs 2/9 who received no amphotericin B). We conclude that patients who develop pneumonia during week 1 or 2 are a high-risk group, and that use of amphotericin B indicates a particularly poor prognosis, although we present data suggesting that earlier use of amphotericin might be beneficial. Furthermore, since achievement of CR was an important prognostic factor in all groups, WBC transfusions particularly from donors given G-CSF should be considered as a therapeutic option. Finally, since time to failure of induction therapy and time to CR were similar in high-risk patients, new chemotherapy regimens could potentially improve both the CR rate and the outcome of pneumonia.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Anti-Bacterial Agents; Antineoplastic Combined Chemotherapy Protocols; Humans; Leukemia, Myeloid; Middle Aged; Myelodysplastic Syndromes; Pneumonia, Bacterial; Remission Induction; Risk Factors

Systemic fungal infections are recognized at increasing frequency during the course of intensive therapy for acute leukemias and require parenteral antifungal treatment mostly by amphotericin B (ampho B) alone or in combination with 5-Fluorocytosine (5-FC). Because of the potential myelosuppressive side effects of 5-FC it was the aim of the current study to evaluate the recovery of hematopoietic cells after intensive antileukemic therapy in patients receiving ampho B and 5-FC treatment for proven or suspected systemic fungal infections. The study population comprised 87 patients who were treated by standard chemotherapy for acute myeloid leukemia (AML) at first diagnosis or relapse. Twenty-two patients underwent systemic antifungal therapy consisting of ampho B (3 to 10 mg/kg/d) and 5-FC (150 mg/kg/d) for 3 to 33 days (median, 12 days). The remaining 65 patients served as controls to assess the hematologic recovery time (TR) as defined by the interval between the onset of chemotherapy and the post-treatment rise of granulocyte levels to greater than 500 cmm and thrombocyte levels to greater than 20,000 cmm. In patients receiving antifungal therapy, a significant prolongation of TR was observed with a median TR of 29 days compared with a median TR of 24 days (P = 0.0016) for the control group. No correlation was found between TR and the total dose of either ampho B or 5-FC or the type of antileukemic regimen. A possibly direct myelosuppressive effect of a fungal infection was unlikely to explain the findings because the ampho B/5-FC treatment was started in patients with proven or only suspected fungal infections, causing a similar delay of TR in both groups. The present data strongly suggest a myelosuppressive effect of ampho B/5-FC antifungal treatment in patients after intensive chemotherapy for acute leukemias.

Topics: Acute Disease; Adolescent; Adult; Aged; Amphotericin B; Antineoplastic Agents; Candidiasis; Drug Administration Schedule; Drug Therapy, Combination; Flucytosine; Hematopoiesis; Humans; Immune Tolerance; Leukemia, Myeloid; Middle Aged; Random Allocation

Forty-eight neutropenic patients with acute leukaemia were randomly allocated to receive, as antifungal prophylaxis, either ketoconazole, 400 mg once daily (K), or amphotericin B tablets and lozenges (A), or both ketoconazole and amphotericin B together (K + A). Antifungal prophylaxis was considered to have failed if (1) there was evidence of increasing colonization of the oropharynx or faeces with Candida spp. or other yeasts, or (2) if systemic antifungal therapy was begun empirically. Prophylaxis failed in nine of 17 patients given K, in four of 19 given A, and in four of 12 given K + A. The differences between the three regimens were not statistically significant, neither was there any significant difference in the mean duration of neutropenia before prophylaxis failed. The absorption of ketoconazole was impaired when patients were neutropenic. We conclude that ketoconazole was neither more nor less effective than amphotericin B in the prevention of yeast colonization in neutropenic patients.

Topics: Adolescent; Adult; Amphotericin B; Antineoplastic Agents; Candidiasis, Oral; Candidiasis, Vulvovaginal; Drug Therapy, Combination; Female; Humans; Ketoconazole; Leukemia, Myeloid; Male; Middle Aged; Neutropenia; Random Allocation

Continuous administration of amphotericin B deoxycholate over 24 hours (24 h-D-AmB) is better tolerated than rapid infusions. However, toxicity and outcome have not been assessed in a homogenous patient population with acute myeloid leukaemia (AML). We retrospectively analysed renal function and outcome in all adult patients with AML undergoing intensive chemotherapy between 2007 and 2012 at our institution. We compared a patient group with exposure to 24 h-D-AmB to a patient group without exposure to 24 h-D-AmB. One hundred and eighty-one consecutive patients were analysed, 133 (73.5%) received at least 1 dose of 24 h-D-AmB, and 48 (26.5%) did not. Reasons for 24 h-D-AmB initiation were invasive fungal disease (IFD) in 63.5% and empirical treatment for febrile neutropenia in 36.5% of the cases. Most patients with IFD received an oral triazole drug at hospital discharge. Baseline characteristics were well matched. Amphotericin B deoxycholate over 24 hours was given for a median 7 days (interquartile range 3-13). Peak creatinine concentration was higher in the 24 h-D-AmB-group (104.5 vs. 76 μmol/L, P < .001) but normalized within 1 month after therapy (65.5 vs. 65 μmol/L, P = .979). In neither of the 2 groups, end-stage renal disease occurred. There was no difference in 60-day survival (90% vs. 90%) and 2-year survival (58% vs. 58%). Invasive fungal disease partial response or better was observed in 68% of the patients. We conclude that antifungal therapy with continuously infused amphotericin B deoxycholate is safe in patients with AML. An antiinfective strategy based on 24 h-D-AmB in first line followed by an oral triazole compound represents an economically attractive treatment option.

Topics: Acute Disease; Adult; Aged; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Deoxycholic Acid; Drug Combinations; Female; Humans; Infusion Pumps; Leukemia, Myeloid; Male; Middle Aged; Mycoses; Neutropenia; Retrospective Studies; Survival Analysis; Treatment Outcome

Gap junctional intercellular communication (GJIC) is typically decreased in malignant tumors. Gap junction is not presented between hematopoietic cells but occurred in bone marrow stromal cells (BMSCs). Connexin 43 (Cx43) is the major gap junction (GJ) protein; our previous study revealed that Cx43 expression and GJIC were decreased in acute leukemic BMSCs. All-trans retinoic acid (ATRA) increases GJIC in a variety of cancer cells and has been used to treat acute promyelocytic leukemia, but the effects of ATRA on leukemic BMSCs is unknown. In this study, we evaluated the potential effects of ATRA on cell cycle, proliferation, and apoptosis of leukemic BMSCs. Effects of ATRA on Cx43 expression and GJIC were also examined.. Human BMSCs obtained from 25 patients with primary acute leukemia, and 10 normal healthy donors were cultured. Effects of ATRA on cell cycle, cell proliferation, and apoptosis were examined with or without co-treatment with amphotericin-B. Cx43 expression was examined at both the mRNA and protein expression levels. GJIC was examined by using a dye transfer assay and measuring the rate of fluorescence recovery after photobleaching (FRAP).. ATRA arrested the cell cycle progression, inhibited cell growth, and increased apoptosis in leukemic BMSCs. Both Cx43 expression and GJIC function were increased by ATRA treatment. Most of the observed effects mediated by ATRA were abolished by amphotericin-B pretreatment.. ATRA arrests cell cycle progression in leukemic BMSCs, likely due to upregulating Cx43 expression and enhancing GJIC function.

Topics: Acute Disease; Adult; Amphotericin B; Antineoplastic Agents; Apoptosis; Blotting, Western; Cell Communication; Cell Cycle Checkpoints; Cell Proliferation; Cells, Cultured; Connexin 43; Female; Fluorescence Recovery After Photobleaching; Gap Junctions; Gene Expression; Humans; Leukemia, Myeloid; Male; Mesenchymal Stem Cells; Microscopy, Confocal; Reverse Transcriptase Polymerase Chain Reaction; Tretinoin

Topics: Amphotericin B; Biopsy, Needle; Follow-Up Studies; Foot Dermatoses; Fungemia; Fusarium; Humans; Immunocompromised Host; Immunohistochemistry; Leukemia, Myeloid; Magnetic Resonance Imaging; Male; Middle Aged; Muscular Diseases; Mycoses; Opportunistic Infections; Risk Assessment; Severity of Illness Index; Toes; Treatment Outcome

Meningitis is a common evolution in progressive disseminated histoplasmosis in children, and is asymptomatic in many cases. In leukemia, the impaired of the T cells function can predispose to the disseminated form. The attributed mortality rate in this case is 20%-40% and the relapse rate is as high as 50%; therefore, prolonged treatment may be emphasized. We have described a child with acute myeloid leukemia (AML), that developed skin lesions and asymptomatic chronic meningitis, with a good evolution after prolonged treatment with amphotericin B deoxycholate followed by fluconazole.

Topics: Acute Disease; Adolescent; Amphotericin B; Antifungal Agents; Chronic Disease; Deoxycholic Acid; Drug Combinations; Drug Therapy, Combination; Fluconazole; Histoplasmosis; Humans; Immunocompromised Host; Leukemia, Myeloid; Male; Meningitis, Fungal; Treatment Outcome

We describe 2 patients with hematologic malignancy who developed endophthalmitis due to Trichosporon beigelii during the course of treatment with multiagent chemotherapy. Blood cultures revealed T beigelii for both patients. Although one of the patients was treated with fluconazole (FLCZ) and 5-fluorocytosine, the trichosporonous endophthalmitis was resistant to both drugs. This patient subsequently received amphotericin B (AMPH-B) therapy, and the eyes were treated with vitrectomy. The second patient also received AMPH-B for FLCZ-resistant trichosporonous chorioretinitis. In both patients, systemic treatment with AMPH-B successfully resolved the trichosporonous endophthalmitis that was resistant to multiple antifungal drugs. Endophthalmitis due to trichosporonosis is difficult to treat. The administration of AMPH-B is likely to be more effective in treating endophthalmitis due to trichosporonosis when the disease is at an early stage.

Topics: Acute Disease; Adult; Amphotericin B; Antifungal Agents; Drug Resistance, Fungal; Endophthalmitis; Female; Fluconazole; Flucytosine; Humans; Leukemia, Myeloid; Male; Middle Aged; Mycoses; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Trichosporon

Invasive fungal rhinosinusitis (IFR) is a life-threatening infection. Its onset is subtle and a late diagnosis leads to severe complications. Death may occur within a few weeks notwithstanding treatment. We describe a comprehensive pre- and post-operative approach to care for haematological patients with IFR. Five haematological patients with IFR were treated with systemic antifungal therapy and endoscopic surgical debridement of infected tissues, followed by amphotericin-B directly instilled in the sinuses by a new type of ethmoidal drainage. The IFR remitted in all cases; after 32 months of follow-up, three patients are still alive, and two have died of other causes. Two of the patients who experienced IFR progression to the brain at the IFR onset are still alive. The pharmacological and surgical approach with the post-operative local therapy by a new ethmoidal drainage system could support radical antifungal sinus treatment, thus improving the overall survival.

Topics: Acute Disease; Adult; Aged; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Chronic Disease; Female; Humans; Immunocompromised Host; Leukemia, Myeloid; Male; Middle Aged; Myeloproliferative Disorders; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sinusitis; Stem Cell Transplantation

Invasive pulmonary aspergillosis is a serious infectious complication in immunocompromised especially neutropenic patients. Despite improvements in early diagnosis and effective treatment, invasive pulmonary aspergillosis is still a devastating opportunistic infection. These infections also interfere with the anticancer treatment. We report our experience in the diagnosis and therapeutic management of sinopulmonary aspergillosis in 4 children with hematologic malignancy. All patients except the first were neutropenic when sinopulmonary aspergillosis was diagnosed. Clinical signs included fever, cough, respiratory distress, swallowing difficulty, headache, facial pain-edema and hard palate necrosis. Radiodiagnostic methods showed bilateral multiple nodular infiltrations, soft tissue densities filling all the paranasal sinuses, and bronchiectasis. Diagnosis of aspergillosis was established by bronchoalveolar lavage in one case, tissue biopsy, positive sputum and positive cytology, respectively, in the other 3 cases. One patient was treated with liposomal amphotericin B and other 3 cases were treated with liposomal amphotericin B + itraconozole. Outcome was favorable in all cases except the one who died due to respiratory failure. Early diagnosis, appropriate treatment and primary disease status are important factors on prognosis of Aspergillus infections in children with hematological malignancy.

Topics: Acute Disease; Adolescent; Amphotericin B; Antifungal Agents; Aspergillosis; Burkitt Lymphoma; Child; Drug Therapy, Combination; Female; Humans; Immunocompromised Host; Itraconazole; Leukemia, Myeloid; Lung Diseases, Fungal; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prognosis; Radiography, Thoracic; Time Factors; Tomography, X-Ray Computed

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Bacterial Infections; Humans; Leukemia, Myeloid; Mycoses; Neutropenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma

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

Topics: Acute Disease; Aged; Amphotericin B; Female; Humans; Leukemia, Myeloid; Recurrence; Sweet Syndrome; Treatment Outcome

Topics: Amphotericin B; Antifungal Agents; Arthritis, Infectious; Aspergillosis; Aspergillus fumigatus; Debridement; Diagnosis, Differential; Elbow; Humans; Leukemia, Myeloid; Male; Middle Aged; Radiography

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Caspofungin; Drug Therapy, Combination; Echinocandins; Fatal Outcome; Fever; Humans; Immunocompromised Host; Leukemia, Myeloid; Lipopeptides; Liposomes; Male; Middle Aged; Mycoses; Neutropenia; Peptides; Peptides, Cyclic; Trichosporon

Topics: Amphotericin B; Animals; Antifungal Agents; Candida glabrata; Candidiasis; Catheters, Indwelling; Colony Count, Microbial; Diagnostic Errors; Humans; Leukemia, Myeloid; Platelet Count; Thrombocytopenia

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Aspergillosis; Bone Marrow Transplantation; Bronchoalveolar Lavage Fluid; Child; Enzyme-Linked Immunosorbent Assay; Fatal Outcome; Galactose; Humans; Leukemia, Myeloid; Lung Diseases, Fungal; Male; Mannans; Postoperative Complications

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Cytarabine; Frozen Sections; Humans; Idarubicin; Immunosuppressive Agents; Leukemia, Myeloid; Male; Middle Aged; Mucormycosis; Thoracic Wall

Invasive rhinocerebral mucormycosis is a rare and often fatal opportunistic fungal infection. It is encountered in immunocompromised hosts exemplified by those with diabetes, human immunodeficiency viruses and particularly haematologic malignancies typically after high-dose chemotherapy and stem cell transplantation. In contrast to the more usual outcome with rapid progression and death. We now describe a successful eradication attributable to the use of a newly available antifungal agent.. Haematology department and bone marrow transplantation unit.. Two patients are contrasted. The first with acute leukaemia developed rapidly progressive facial swelling with mucormycosis proven on biopsy. Treatment over 2 months with maximally tolerated doses of amphotericin failed to halt intracranial extension and death resulted. The second, presented with acute lymphoblastic leukaemia in August 1997, underwent successful autologous bone marrow transplantation in February 1998. Relapse followed in March 1999 and after reinduction and consolidation receive a matched unrelated volunteer allograft in September 1999. A second recurrence was documented in April 2000 and in spite of achieving remission he developed a fever that was managed empirically with intravenous amphotericin and, on discharge, oral itraconazole. Left-sided facial swelling expanded rapidly and biopsy showed extensive invasion of the maxillary sinus with mucormycosis. FK463 was added on 5 June 2000 with gradual reduction in facial pain and within 1 month all clinical signs and resolved. Serial biopsies that included histopathologic investigation and microbiologic cultures confirmed eradication of the invasive mucor. In view of the potential danger of recrudescence this treatment regimen was continued through further chemotherapy and, once again disease-free, a second matched unrelated volunteer allograft took place in August 2000. Full reassessment at the time failed to demonstration any residual fungus. Engraftment was confirmed but neutropenic sepsis resulted in severe inflammatory response syndrome with progression to multiple organ dysfunction to which he succumbed without any evidence of leukaemic or systemic mycosis.. Echinocandin FK463 is of documented value in managing invasive candidiasis and aspergillosis. This is believed to be the first case of successful outcome with one of the angiotrophic zygomycetes.

Topics: Acute Disease; Adolescent; Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Combined Modality Therapy; Drug Evaluation; Echinocandins; Fatal Outcome; Female; Humans; Immunocompromised Host; Itraconazole; Leukemia, Myeloid; Lipopeptides; Lipoproteins; Male; Micafungin; Mucormycosis; Multiple Organ Failure; Peptides, Cyclic; Periodontal Abscess; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sinusitis; Splenectomy; Systemic Inflammatory Response Syndrome; Transplantation, Homologous

A case report of acute invasive fungal rhinosinusitis in 28 year old woman with acute myeloid leukemia is described in this paper. The diagnosis of the fungal disease was based on clinical presentation, endoscopic evaluation of nasal cavity, computed tomography and magnetic resonance imaging of the paranasal sinuses and histopathological findings. An aggressive treatment including antifungal therapy (amphotericin B), antibiotics and the surgery of paranasal sinuses was implemented. Unfortunately the underlying disease and the fungal invasion progressed rapidly and the patient died on the forth week post-op due to cardiorespiratory failure.

Topics: Adult; Amphotericin B; Antifungal Agents; Fatal Outcome; Female; Humans; Leukemia, Myeloid; Mycoses; Rhinitis; Sinusitis

A 14-year-old girl with leukemia had Doppler ultrasound evidence of hepatic necrosis, thought to be caused by a lipid formulation of amphotericin B, which has not been previously reported. It seems prudent to exert caution when retreating patients with previous hepatocellular damage with lipid formulations of amphotericin B.

Topics: Adolescent; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Chemical and Drug Induced Liver Injury; Cytarabine; Etoposide; Female; Humans; Idarubicin; Leukemia, Myeloid; Liposomes; Liver; Liver Diseases

Leukaemic patients with advanced disease and severe fungal infections as well as older patients with substantial co-morbidity are usually excluded from conventional allotransplantation because of increased morbidity and mortality. We approached allogeneic transplantation in four patients with a median age of 62 years (one chronic myeloid leukaemia in blast crisis, one high-risk acute myeloid leukaemia (AML) in first complete remission (CR1), one AML in 2nd relapse, one AML in CR2 with pre-existing fungal lung infections (two aspergillus, two mucor) and additional co-morbidity (diabetes n = 2, aortic aneurysm n = 1, arterial sclerosis n = 2) by combining non-myeloablative conditioning with an intensified supportive care regimen, including amphotericin B and 4-12 (median 9) prophylactic granulocyte transfusions from granulocyte colony-stimulating factor (G-CSF)-stimulated volunteer donors. G-CSF was also given to patients until neutrophil recovery. All four patients recovered to a neutrophil count of 0.5 x 109/l after a median of 11.5 d (range 11-13 d). Prophylactic granulocyte transfusions also reduced the need for platelet transfusions and minimized mucositis. All patients were discharged at a median of 25 d (range 18-59 d) and are alive and well after a median follow-up of > 390 d (range 336-417 d) without evidence of leukaemia. Regression of the fungal lesions was documented in three patients, with a slight progression detected by computerized tomography scan of the chest in one patient. We conclude that pulmonary fungal infections are not a contraindication for allogeneic stem cell transplantation, if non-myeloablative conditioning regimens are used in combination with granulocyte transfusions, intravenous amphotericin B and G-CSF.

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Aortic Aneurysm; Arteriosclerosis; Aspergillosis, Allergic Bronchopulmonary; Bone Marrow Transplantation; Cell Count; Diabetes Complications; Diabetes Mellitus; Granulocyte Colony-Stimulating Factor; Humans; Leukemia; Leukemia, Myeloid; Leukemia, Myeloid, Chronic-Phase; Lung Diseases, Fungal; Male; Middle Aged; Neutrophils; Platelet Count; Recurrence; Remission Induction; Tomography, X-Ray Computed; Transplantation, Homologous; Treatment Outcome

The incidence of disseminated infection with Scedosporium species is increasing in patients with haematological malignancy. Two fatal cases are reported of patients with acute myeloid leukaemia and neutropenia who presented with Scedosporium endophthalmitis. Diagnosis of fungal infection was delayed as blood and vitreous cultures were positive only after 3 days in patient 1 and blood culture was positive at 7 days in patient 2. Despite antifungal therapy with amphotericin B and additional fluconazole in patient 2, both patients died of overwhelming fungal septicaemia. Post-mortem examination of the right globe in patient 1 showed haemorrhagic necrotizing chorioretinitis with numerous fungal hyphae in choroidal vessels, choroid, retina and vitreous. Scedosporium species are often resistant to conventional antifungal therapy including amphotericin B. Diagnosis is difficult and mortality in disseminated infection is high.

Topics: Acute Disease; Adult; Amphotericin B; Antifungal Agents; Endophthalmitis; Eye Infections, Fungal; Fatal Outcome; Female; Fluconazole; Fungemia; Humans; Leukemia, Myeloid; Male; Middle Aged; Mycetoma; Neutropenia; Scedosporium

Invasive fungal infections are a major cause of mortality in neutropenic cancer patients. To determine whether a polymerase chain reaction (PCR)-based assay enabled the identification of patients at risk for invasive fungal infections, a prospective monitoring once per week was performed during 92 neutropenic episodes in patients receiving chemotherapy for acute leukaemia or high-dose therapy followed by allogeneic or autologous stem cell transplantation, with the investigators blinded to clinical and microbiological data. PCR positivity was documented in 34 out of 92 risk episodes. All patients developing proven invasive fungal infection were found PCR positive, and PCR was found to be the earliest indicator of invasive fungal infection preceding clinical evidence by a mean of 5.75 d (range 0-14 d). In febrile neutropenic patients without a prior history of invasive fungal infection, a sensitivity of 100% and a specificity of 73% of the PCR assay for the development of proven or probable invasive fungal infection was documented. In conclusion, panfungal PCR performed prospectively once a week enabled the identification of patients at high risk for invasive fungal infections.

Topics: Acute Disease; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Candidiasis; Female; Fever of Unknown Origin; Genes, Fungal; Hematopoietic Stem Cell Transplantation; Humans; In Situ Hybridization; Leukemia, Myeloid; Liver Diseases; Lung Diseases, Fungal; Male; Middle Aged; Monitoring, Physiologic; Neutropenia; Polymerase Chain Reaction; Sensitivity and Specificity

Candida kruzei-related systemic infections are increasing in frequency, particularly in patients receiving prophylaxis with antifungal triazoles. A Caucasian male with newly diagnosed acute myeloid leukaemia (AML M1) developed severe and persistent fever associated with a micropustular eruption scattered over the trunk and limbs during induction chemotherapy. Blood cultures grew Candida kruzei, and biopsies of the skin lesions revealed a candida vasculitis. He responded to high doses of liposomal amphotericin B and was discharged well from hospital.

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Candidiasis; Drug Carriers; Humans; Leukemia, Myeloid; Liposomes; Male; Middle Aged; Triazoles; Vasculitis

Topics: Acute Disease; Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Dermatomycoses; Fusarium; Humans; Leukemia, Myeloid; Male; Ulcer

A retrospective study of 23 patients with acute leukaemia and hepatosplenic candidiasis (HSC) was conducted to evaluate clinical treatment characteristics in terms of amount and duration of antifungal agents and to assess treatment outcome. Patients were admitted to two major tertiary care centres between 1990 and 1998. The diagnosis of HSC was based on clinical, blood cultures, histologic and imaging studies. Patients were treated with amphotericin B without interruption of the planned chemotherapy regimens. Serial magnetic resonance imaging (MRI) studies were the main tool for following patients' response and activity of the fungal lesions in conjunction with clinical and laboratory parameters. Treatment with amphotericin B was continued until resolution of all clinical symptoms and signs attributable to HSC, obtaining negative blood cultures and the appearance of at least healed lesions on MRI. Amphotericin B was discontinued in four patients because of severe nephrotoxicity (two patients), or continuous fever and persistent fungal lesions on MRI (two patients). Amphotericin B lipid complex (ABELCET) was successfully used as salvage therapy for these refractory patients. Four patients died with evidence of HSC despite treatment and supportive measures. The response rate for treatment of HSC was 82%. The mean total dose of amphotericin B including empirical treatment was 4 g and the median duration of treatment for responding patients was 112 d. The median number of days of anti- fungal treatment before the disappearance of fever was 19 d. Our results confirmed the need for protracted courses of antifungal agents for the successful eradication of HSC. Chemotherapy for the underlying disorder should not be interrupted or delayed in order to treat HSC.

Topics: Acute Disease; Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Candidiasis; Female; Fever; Humans; Leukemia, Myeloid; Liver Diseases; Male; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Splenic Diseases

Hepatosplenic candidiasis (HSC) is an emerging complication of the treatment of patients with acute leukemia. Treatment of this infection can be very difficult and data on the duration of antifungal therapy are not available. We evaluated the efficacy of amphotericin B lipid complex (ABLC) for the treatment of five patients with acute leukemia and HSC. The dose of the administered ABLC ranged between 5 and 11 mg/kg per day and the median duration of therapy was 4.3 months. Four patients had complete response to the above treatment with resolution of fever and improvement in the radiologic findings. One patient refused to continue treatment and subsequently died with relapsed leukemia and disseminated Candida infection. Preliminary data suggest that ABLC is a well-tolerated and effective treatment for HSC and should be considered for phase II trials as front line treatment for this type of deep seated fungal infections.

Topics: Acute Disease; Adult; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Candidiasis; Chemical and Drug Induced Liver Injury; Drug Combinations; Female; Humans; Leukemia, Myeloid; Liver Diseases; Male; Middle Aged; Phosphatidylcholines; Phosphatidylglycerols; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Splenic Diseases

Compared to non-invasive aspergillosis, invasive aspergillosis in the region of the mouth, jaw and face has rarely been reported. It occurs particularly often in the presence of haematological oncological illness. The case of a patient suffering from acute myeloid leukemia is described; he contracted invasive aspergillosis of the lungs and the alveolar processes in the course of chemotherapeutic treatment. All the alveolar processes in the region of the premolars and molars were demarcated and had to be removed by sequestrectomy. The therapy of invasive aspergillosis should be carried out within the framework of intensive interdisciplinary treatment. In addition to systemic and local antimycotic therapy, the debridement of necrotic hard and soft tissue was necessary.

Topics: Acute Disease; Adult; Alveolar Process; Alveolectomy; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Aspergillosis; Humans; Jaw Diseases; Leukemia, Myeloid; Lung Diseases, Fungal; Male; Osteonecrosis

Despite its common adverse effects intravenous (i.v.) amphotericin B is an indispensable antifungal drug in childhood oncology. We report here on three cases of painful cyanotic Raynaud's phenomenon after i.v. administration or inhalation of amphotericin B. A liposomal i.v. preparation of amphotericin B was well tolerated by the infants. Spasms of peripheral vessels mediated by thromboxane A2 could be responsible for the Raynaud's phenomenon. Hence, inhibitors of prostaglandin synthesis are suggested for therapy.

Topics: Administration, Inhalation; Adolescent; Amphotericin B; Antifungal Agents; Child; Cyanosis; Female; Humans; Injections, Intravenous; Leukemia, Myeloid; Leukemia, Myelomonocytic, Chronic; Liposomes; Lymphoma, Large-Cell, Anaplastic; Male; Raynaud Disease

We report on seven adult leukemic patients who were autografted in spite of a prior history of invasive pulmonary aspergillosis (IPA). Their median age was 41 years (range: 19-61); six patients were male and one female. All seven had acute myeloblastic leukemia (AML) and underwent an autologous marrow transplantation (ABMT) with a marrow purged in vitro by mafosfamide. IPA was suspected prior to ABMT on clinical and radiological features. CT scan confirmed nodular infiltrates and cavitations in six cases. Microbiological documentation consisted of: identification of the fungus from bronchoalveolar lavage: one case, positive antigenemia: one case, positive antibodies: two cases. Prior ABMT patients received amphotericin B for a median total dose of 1915 mg (range: 970-3300). No patient underwent surgery. The median time from diagnosis of IPA to ABMT was 7.3 months (range: 3-10). During ABMT all patients received prophylactic amphotericin B and itraconazole. No patient died from toxicity and no IPA reactivation was observed in any patients. Post-graft, itraconazole was kept on for a median of 3 months (range: 3-5). This study demonstrates that IPA occurring during the management of AML patients is not necessarily a contraindication to subsequent ABMT.

Topics: Acute Disease; Adolescent; Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Bone Marrow Purging; Bone Marrow Transplantation; Bronchoalveolar Lavage Fluid; Cause of Death; Combined Modality Therapy; Cyclophosphamide; Feasibility Studies; Female; Humans; Itraconazole; Leukemia, Myeloid; Lung Diseases, Fungal; Male; Middle Aged; Premedication; Tomography, X-Ray Computed; Transplantation Conditioning; Transplantation, Autologous

We undertook a retrospective review of all patients with hematologic malignancies in whom candidemia developed during chemotherapy-induced neutropenia in 1989 and 1990. Candidemia developed in 11 patients; five were receiving therapeutic doses of amphotericin B at the time of infection. Disseminated infection occurred in 2 of 5 patients with breakthrough infection and 3 of 6 patients with candidemia before receipt of amphotericin B. Among patients with breakthrough candidemia there was a trend toward more-prolonged neutropenia prior to infection (P = .069), but otherwise they were indistinguishable from other candidemic patients with regard to risk factors for candidemia. Amphotericin B-susceptible Candida albicans was isolated from two patients and Candida krusei from three patients with breakthrough infection. All patients were treated with amphotericin B; all breakthrough infections responded to treatment. Neutropenic patients with breakthrough candidemia were clinically similar to those whose candidemia preceded amphotericin B therapy, and there was no increase in morbidity and mortality among individuals with breakthrough infection.

Topics: Acute Disease; Adult; Aged; Amphotericin B; Candida; Candida albicans; Candidiasis; Fatal Outcome; Female; Humans; Leukemia, Myeloid; Male; Middle Aged; Neutropenia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Treatment Failure

A 52-year-old male diagnosed with acute myeloid leukemia (AML) developed an invasive middle-ear mucormycosis during the neutropenic period after consolidation chemotherapy which resolved successfully with surgery and antifungal therapy. The patient underwent autologous peripheral blood stem cell transplantation (APBSCT) in first complete remission with antifungal prophylaxis with liposomal amphotericin B (AmB). There was no clinical, radiological or microbiological data of mycotic reactivation. This is the first reported stem cell transplantation (SCT) in a patient with prior invasive mucormycosis.

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cytarabine; Facial Paralysis; Hematopoietic Stem Cell Transplantation; Humans; Idarubicin; Leukemia, Myeloid; Male; Mastoid; Middle Aged; Mitoxantrone; Mucormycosis; Myringoplasty; Neutropenia; Otitis Media, Suppurative; Remission Induction; Transplantation Conditioning; Transplantation, Autologous

Invasive Trichosporon capitatum infections are seldom reported. We present here five cases of septicemia. All patients had an acute myeloblastic leukemia and were severely neutropenic. They have also been treated before the onset of the fungal infection with broad-spectrum antibiotherapy and also with an oral azole antifungal agent. The role of this antifungal therapy in the development of T. capitatum infection is discussed. The prognosis of T. capitatum infections is severe. Eight of the 10 published cases had a fatal outcome and one of our patients died of the fungal infection in spite of the treatment.

Topics: Adult; Amphotericin B; Bone Marrow Transplantation; Female; Graft vs Host Disease; Humans; Immunocompromised Host; Leukemia, Myeloid; Male; Middle Aged; Mycoses; Neutropenia; Prognosis; Sepsis; Trichosporon

A 21-year-old man with acute myeloid leukaemia developed cavitating pneumonia while neutropenic and on broad spectrum antibiotics following induction chemotherapy. Trichosporon beigelii was isolated from several samples of sputum. He was successfully treated with amphotericin B. Previous reports of lung infection with this organism are reviewed.

Topics: Adult; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Humans; Leukemia, Myeloid; Lung Diseases, Fungal; Male; Mitosporic Fungi; Neutropenia; Pneumonia; Sputum; Trichosporon

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

Two cases of disseminated fungal infection due to Fusarium species, that occurred during a 4-month period, are reported. Both patients had a myeloproliferative disorder for which they had received intensive cytotoxic and immunosuppressive therapy, and both died despite treatment with amphotericin B. This report and review of the recent literature suggest that Fusarium is emerging as a newly recognized fungal pathogen in immunosuppressed patients.

Topics: Adult; Amphotericin B; Fusarium; Humans; Immunosuppressive Agents; Leukemia, Myeloid; Male; Middle Aged; Multiple Myeloma; Mycoses

Topics: Amphotericin B; Blood Transfusion; Candidiasis, Oral; Female; Humans; Leukemia, Myeloid; Lung Diseases; Middle Aged

Candida rugosa was isolated from two patients. One patient had acute leukemia and developed invasive disease due to this yeast on two occasions while granulocytopenic. Her infection was eventually cured after treatment with amphotericin B. In another immunocompromised patient, the yeast was isolated from the sputum in the presence of a pulmonary infiltrate, but there was no other evidence for a pathogenic role. Antifungal susceptibility testing of the first patient's isolate and three environmental isolates showed all four to be susceptible to amphotericin B, miconazole, and flucytosine, and only the patient isolate was resistant to ketoconazole. These results suggest possibilities for therapy in future encounters. It appears that C. rugosa, a common pathogen in cattle, can be pathogenic in humans under the appropriate circumstances.

Topics: Aged; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Candida; Candidiasis; Female; Humans; Immune Tolerance; Leukemia, Hairy Cell; Leukemia, Myeloid; Male; Microbial Sensitivity Tests; Middle Aged; Recurrence; Sputum

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Endocarditis; Flucytosine; Humans; Intracranial Embolism and Thrombosis; Leukemia, Myeloid; Lung Diseases, Fungal; Male; Middle Aged

Although infections due to Candida have become increasingly recognized in recent years, laryngeal candidiasis remains a poorly described and infrequently diagnosed manifestation of mucous membrane candidal infection. Seven cases of isolated laryngeal candidiasis (ILC) have been identified at our institution during the past eight years (one before and six after death). Clinical, laboratory, and histopathologic findings from those seven cases, as well as from 12 additional cases reported in the literature, are reviewed. When hoarseness and dysphagia occur in patients with significant underlying disease who are receiving broad-spectrum antimicrobic therapy, a diagnosis of ILC should be considered. The diagnostic procedure of choice is indirect laryngoscopy with specimens submitted for culture and histopathologic study. On confirmation of the diagnosis, amphotericin B is the recommended therapy. Early treatment may limit morbidity and prevent systemic candidal dissemination.

Topics: Adult; Aged; Amphotericin B; Candida albicans; Candidiasis; Child; Female; Humans; Laryngeal Diseases; Laryngeal Mucosa; Leukemia, Myeloid; Male; Middle Aged

Topics: Aged; Amphotericin B; Cryptococcosis; Humans; Leukemia, Myeloid; Lung Diseases, Fungal; Male; Obesity

Topics: Amphotericin B; Aspergillosis, Allergic Bronchopulmonary; Humans; Leukemia, Myeloid; Male; Middle Aged; Rifampin

A 33-yr-old Puerto Rican women was hospitalized for chemotherapy and multiple antibiotic treatment for relapse of acute myelomonocytic leukemia. While she was already receiving amphotericin for suspected Aspergillus infection, she developed hepatomegaly and abnormal liver enzymes with high serum bilirubin. The blood cultures were negative. Percutaneous liver biopsy revealed granulomatous fungal hepatitis identified by cultures as Trichosporon cutaneum. In spite of the continued administration of amphotericin, with the addition of 5-fluorocytosine, Trichosporon was later cultured from her blood, and she succumbed to fungemia and polymicrobial sepsis.

Topics: Adult; Amphotericin B; Aspergillosis; Biopsy; Female; Flucytosine; Hepatitis; Humans; Leukemia, Myeloid; Liver; Mitosporic Fungi; Mycoses; Pregnancy; Pregnancy Complications

Of 78 patients with blastomycosis, 3 patients had received glucocorticoid therapy prior to diagnosis and 3 others had an underlying hematologic malignancy (chronic lymphocytic leukemia, chronic myelogenous leukemia, multiple myeloma). The clinical picture in these 6 patients was similar to blastomycosis in nonimmunosuppressed patients (in contrast to histoplasmosis or coccidioidomycosis in immunosuppressed patients in whom a distinct clinical syndrome is often seen). The patients presented with chronic pulmonary infiltrates or with isolated skin ulcers. The response to therapy was good if the diagnosis was made early. Blastomycosis can occur in immunosuppressed patients. However, the spectrum of underlying illness is not that seen in opportunistic histoplasmosis or coccidioidomycosis, where patients with T-cell defects predominate. Possible explanations for the rarity of blastomycosis in more classically T-cell-immunosuppressed patients are discussed.

Topics: Adult; Aged; Amphotericin B; Blastomycosis; Female; Humans; Immunosuppression Therapy; Leukemia; Leukemia, Myeloid; Male; Middle Aged; Multiple Myeloma; Prednisone

A 6-year-old boy with acute monocytic leukemia and therapy-induced leukopenia developed multiple necrotizing skin lesions where an intravenous administration unit had been secured to his arm and hand. Biopsy and cultures demonstrated Aspergillus flavus as the etiologic agent without evidence of systemic dissemination. Resolution of the infection occurred following systemic amphotericin B therapy and a granulocyte transfusion.

Topics: Amphotericin B; Aspergillosis; Aspergillus flavus; Blood Transfusion; Child; Dermatomycoses; Granulocytes; Humans; Leukemia, Myeloid; Leukopenia; Male

We have reported the successful treatment of a patient with acute leukemia complicated by pulmonary aspergillosis, a commonly fatal situation. Specific diagnosis was obtained easily by transbronchial lung biopsy. Our therapeutic approach included aggressive treatment of both the underlying malignant process and the aspergillosis with a combination of amphotericin B and rifampin.

Topics: Amphotericin B; Aspergillosis; Drug Therapy, Combination; Humans; Leukemia, Myeloid; Lung Diseases, Fungal; Male; Middle Aged; Rifampin

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

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: Adult; Amphotericin B; Candidiasis; Candidiasis, Oral; Esophageal Diseases; Fluoroscopy; Humans; Leukemia; Leukemia, Myeloid; Male; Middle Aged; Nystatin

Topics: Adult; Amphotericin B; Aspergillosis; Cytarabine; Female; Humans; Leukemia, Myeloid; Lung Diseases, Fungal; Nystatin; Pulmonary Embolism; Remission, Spontaneous

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