amphotericin-b and Liver-Cirrhosis

Triazole antifungal drugs may rarely cause serious allergic reactions including angioedema. No standardized tests are available to predict cross-reactivity within the azole class and little guiding information exists on whether to change therapy within the class or to another class after a serious allergic reaction. Herein we report the first successful use, to our knowledge, of graded isavuconazole introduction for treatment of aspergillosis in a liver transplant recipient with severe voriconazole allergy.

Topics: Amphotericin B; Angioedema; Antifungal Agents; Aspergillus; Desensitization, Immunologic; Drug Administration Schedule; Drug Hypersensitivity; Female; Humans; Liver Cirrhosis; Liver Transplantation; Lung; Middle Aged; Nitriles; Pulmonary Aspergillosis; Pyridines; Tomography, X-Ray Computed; Treatment Outcome; Triazoles; Voriconazole

Candida species, including Candida dubliniensis, are a rare cause of meningitis. Herein, we report the second case of C. dubliniensis meningitis in a 49-year-old man with a history of hepatitis C virus-related cirrhosis, substance use disorder, and recent exposure to intravenous antibiotic therapy, presenting with confusion, abnormal gait, and urinary incontinence. Magnetic resonance imaging (MRI) of the brain showed marked hydrocephalus and leptomeningeal enhancement. Initial cerebrospinal fluid (CSF) studies were concerning for bacterial meningitis, although cultures were negative. Despite empiric treatment with broad-spectrum antibiotics, the patient's mental status declined. The diagnosis of C. dubliniensis meningitis was not made until the third lumbar puncture. The patient was treated with liposomal amphotericin B and flucytosine. Despite improvement of hydrocephalus on MRI of the brain and sterilization of CSF, the patient's mental status declined and he expired. This case highlights the difficulty in the diagnosis of C. dubliniensis meningitis as multiple lumbar punctures may be necessary. C. dubliniensis meningitis should be considered in the differential diagnosis for a patient with risk factors such as end-stage liver disease, human immunodeficiency virus infection, recent chemotherapy, substance use disorders, and recent broad-spectrum antibiotic use. A high index of suspicion is necessary as delay in initiation of therapy is associated with high mortality. The optimal treatment strategy has not been determined.

Topics: Amphotericin B; Antifungal Agents; Brain; Candida; Candidiasis; Cerebrospinal Fluid; Fatal Outcome; Flucytosine; Hepatitis C, Chronic; Humans; Liver Cirrhosis; Magnetic Resonance Imaging; Male; Meningitis; Middle Aged; Substance-Related Disorders

Only few cases of rhino-orbital mucormycosis in patients with liver cirrhosis are described in the literature and most of these patients showed an associated diabetes mellitus. We describe a case of rhino-orbital mucormycosis in a patient with liver cirrhosis without other risk factors.

Topics: Amphotericin B; Antifungal Agents; Eye Infections, Fungal; Female; Humans; Immunocompetence; Liver Cirrhosis; Middle Aged; Mucormycosis; Orbit Evisceration; Orbital Diseases; Paranasal Sinus Diseases; Tomography, X-Ray Computed

Invasive cerebral aspergillosis always developed in immunocompromised host. Early diagnosis may save life in this critical condition; however, it is difficult to reach. Herein, we presented an unusual case of invasive cerebral aspergillosis in a cirrhotic patient. A 47-year-old man presented with progressive deterioration of consciousness for three days. The patient had a history of alcoholic liver cirrhosis, Child-Pugh class C. Magnetic resonance imaging (MRI) of brain showed multi-focal parenchymal lesions, which was consistent with multiple brain abscesses. The diagnosis of invasive cerebral aspergillosis was made by molecular based laboratory methods including Aspergillus galactomannan antigen assay and oligonucleotide array. Despite treatment with the antifungal agent, Amphotericin B, the patient died at the ninth day of hospitalization. Our findings suggest that liver cirrhosis can be one of risk factors of invasive cerebral aspergillosis, and support the diagnosing usefulness of MRI, Aspergillus galactomannan antigen assay, and oligonucleotide array.

Topics: Amphotericin B; Antifungal Agents; Antigens, Fungal; Aspergillus fumigatus; Brain Abscess; Fatal Outcome; Humans; Liver Cirrhosis; Magnetic Resonance Imaging; Male; Middle Aged; Oligonucleotide Array Sequence Analysis

Trichosporon species are ubiquitously spread and known to be part of the normal human flora of the skin and gastrointestinal tract. Trichosporon spp. normally cause superficial infections. However, in the past decade Trichosporon spp. are emerging as opportunistic agents of invasive fungal infections, particularly in severely immunocompromised patients. Clinical isolates are usually sensitive to triazoles, but strains resistant to multiple triazoles have been reported.. We report a high-level pan-azole resistant Trichosporon dermatis isolate causing an invasive cholangitis in a patient after liver re-transplantation. This infection occurred despite of fluconazole and low dose amphotericin B prophylaxis, and treatment with combined liposomal amphotericin B and voriconazole failed.. This case and recent reports in literature show that not only bacteria are evolving towards pan-resistance, but also pathogenic yeasts. Prudent use of antifungals is important to withstand emerging antifungal resistance.

Topics: Amphotericin B; Antifungal Agents; Cholangitis; Drug Resistance, Fungal; Hepatic Encephalopathy; Humans; Liver Cirrhosis; Liver Transplantation; Male; Microbial Sensitivity Tests; Middle Aged; Peritonitis; Phylogeny; Trichosporon; Trichosporonosis; Voriconazole

The clinical characteristics and outcomes in cryptococcal meningitis (CM) have been shown to vary depending on the underlying condition. The purpose of this study was to investigate these differences in patients with and without hepatitis B virus (HBV) infection.. We performed a retrospective study at the Third Affiliated Hospital of Sun Yat-Sen University from January 2006 to June 2012. Thirty-two HBV-positive patients and 58 HBV-negative patients were included.. Among the 90 patients with CM, 32 (35.6%) were HBV-infected. CM occurred in a younger population in the HBV-positive group, with a higher Charlson comorbidity score than the HBV-negative group. The HBV-positive group presented with lower initial complaints of visual symptoms, lower cerebrospinal fluid (CSF) white blood cell counts, lower percentages of the total protein in the CSF exceeding 0.45 g/l, higher glucose levels in the CSF, a higher percentage of positive results for Cryptococcus culture in the CSF, more extraneural involvement sites, and a higher proportion of normal brain images than the HBV-negative group. Factors for a poor prognosis in the HBV-positive group included liver cirrhosis and HBV DNA >10³ copies/ml. In the HBV-uninfected group, lower glucose in the CSF and hydrocephalus were the indicators of an unsatisfactory outcome.. Certain clinical features of CM were found to be significantly different between HBV-infected and HBV-uninfected patients, including age and initial laboratory findings, as well as the indicators of an unsatisfactory outcome. Host defense defects in the HBV-infected group may lead to a lower intensity of inflammation in the pathogenesis of CM compared with the HBV-uninfected patients and may account for these divergences between the two groups.

Topics: Adolescent; Adult; Aged; Amphotericin B; Anti-Infective Agents; Child; Cryptococcus; Female; Fluconazole; Flucytosine; Hepatitis B; Hepatitis B virus; Humans; Liver Cirrhosis; Meningitis, Cryptococcal; Middle Aged; Multivariate Analysis; Retrospective Studies; Treatment Outcome; Young Adult

Topics: Aged; Amphotericin B; Anticoagulants; Antifungal Agents; Cellulitis; Cryptococcosis; Dermatomycoses; Fatal Outcome; Female; Fungemia; Heparin, Low-Molecular-Weight; Hepatitis, Autoimmune; Humans; Immunocompromised Host; Immunosuppressive Agents; Liver Cirrhosis; Lung Diseases, Fungal; Necrosis; Prednisone; Radiography; Thrombophilia

Topics: Amphotericin B; Antibodies, Fungal; Antifungal Agents; Cellulitis; Cryptococcosis; Cryptococcus neoformans; Female; Fluconazole; Hepatitis C; Humans; Liver Cirrhosis; Middle Aged; Perineum; Pneumonia; Radiography; Suppuration; Vulva

Fusariosis is one of the emerging invasive fungal infections over the last decade. However, its recent rise has been in its ability to produce disseminated infection in severely immunosuppressed patients with neutropenia. In solid organ transplantation, fusariosis remains an uncommon picture mainly with nodules, subcutaneous abscesses, ulcers, or necrotic skin lesions resembling erthyma gangrenosum. Herein, we have reported a case of cellulitis, subcutaneous nodules, and abscesses due to Fusarium spp in a liver transplantation patient who was successfully treated with polyenes and surgical resection.

Topics: Amphotericin B; Biopsy; Cellulitis; Fusarium; Graft Rejection; Hepatitis C; Humans; Liver Cirrhosis; Liver Transplantation; Male; Middle Aged; Mycoses; Pyrimidines; Skin; Treatment Outcome; Triazoles; Voriconazole

Coexistence of two illnesses in the same patient may result in atypical manifestations of either or both diseases. A case of hepatitis B virus-related cirrhosis in a patient who presented with a pharyngeal mucosal mass lesion as a manifestation of superadded Leishmania infection is presented here. The clue to the diagnosis was the origin of the patient from an area highly endemic for leishmaniasis and the presence of unexplained polyclonal hypergammaglobulinaemia. The patient responded very well to therapy with amphotericin B with complete disappearance of the mucosal lesion.

Topics: Adult; Amphotericin B; Endemic Diseases; Hepatitis B, Chronic; Humans; Hypergammaglobulinemia; Leishmaniasis; Liver Cirrhosis; Male; Mucous Membrane; Pharynx

Topics: Adult; Amphotericin B; Humans; Leishmaniasis, Visceral; Liver Cirrhosis; Liver Transplantation; Male; Treatment Outcome

Invasive aspergillosis (IA) is a severe complication of liver transplantation. Risk factors for IA after deceased donor liver transplantation (DDLT) have been presented in several reports, but are not well established for living donor liver transplant recipients. Here, a retrospective case-control study was performed. Five cases with IA were investigated after living donor liver transplantation (LDLT) between January 1999 and December 2002 at Kyoto University Hospital. For comparison, living donor liver transplant recipients without IA were taken as controls. These patients had undergone LDLT 1 month before or after each IA case and had the same survival times as the latter. We evaluated the clinical and laboratory findings for both groups up until their demise. Patients with IA after LDLT had a very poor prognosis. By univariate analysis, risk factors for IA were preoperative intensive care unit stay (P = 0.02) and preoperative steroid administration (P = 0.02). Preoperative steroid administration for fulminant hepatitis possibly predisposed to the development of IA after LDLT.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Bacterial Infections; Cephalosporins; Female; Humans; Immunosuppression Therapy; Liver Cirrhosis; Liver Transplantation; Living Donors; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors

Topics: Adolescent; Amphotericin B; Antifungal Agents; Candidiasis; Caspofungin; Drug Resistance, Fungal; Echinocandins; Female; Humans; Lipopeptides; Liver Cirrhosis; Liver Transplantation; Male; Middle Aged; Peptides, Cyclic; Postoperative Complications; Recurrence; Reoperation

To assess the clinical features of aspergillosis and its diagnosis, prophylaxis and treatment in patients after orthotopic liver transplantation (OLT), and to improve the prognosis of the recipients.. Medical records of consecutive patients who underwent OLT in our liver transplant center from May 2002 to May 2004 were analyzed retrospectively. Those with aspergillus infection complications were studied in detail regarding their infected organs, related factors, treatments and prognoses.. 17 out of 207 recipients of OLT were detected with aspergillosis. The incidence was 8.21 percent. 5 patients infected with superficial aspergillus survived. Of the 12 cases with deep aspergillus infection, 3 with infection limited to the sites of their incisions survived, 2 of the 3 patients with infection in their lungs, and 1 of the 2 patients with it in their livers died, and 4 recipients with multi-organ aspergillus infection died. Among the 7 cases that died, 5 had severe hepatitis, 1 had post-hepatitis liver cirrhosis and 1 had primary liver carcinoma.. Long-term (> or = 3 weeks) broad-spectrum antibiotics and immunosupression were involved in aspergillus infection in our OLT patients. Patients with chronic severe hepatitis had a higher risk of having aspergillus infection. Amphotericin B is still the best choice for treating aspergillosis. Prophylactic administration of anti-fungal medicine, surveillance of fungal infections as a routine, and treatment of the infection in time may help to improve the prognosis of OLT recipients with aspergillosis.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; China; Female; Hepatitis B, Chronic; Humans; Incidence; Liver Cirrhosis; Liver Neoplasms; Liver Transplantation; Male; Middle Aged; Retrospective Studies; Risk Factors

Paecilomyces lilacinus was the causal agent of a case of subcutaneous infection in a patient with liver cirrhosis. Surgical treatment in combination with systemic amphotericin B therapy led to complete recovery. Retrospectively performed microdilution testing revealed dose dependent in vitro susceptibility of the isolate to voriconazole (MIC = 2 g/ml) and terbinafine (MIC = 1 microg/ml).

Topics: Abscess; Adult; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Dermatomycoses; Germany; Humans; Liver Cirrhosis; Male; Microbial Sensitivity Tests; Paecilomyces

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Fatal Outcome; Humans; Liver Cirrhosis; Male; Meningitis, Cryptococcal; Middle Aged; Opportunistic Infections; Subdural Effusion; Tomography, X-Ray Computed

A 7-year-old child had unusual manifestation of cryptococcosis; liver and lymph node involvement predominated. There was evidence of cryptococcal hepatitis, extrahepatic biliary obstruction, and subsequent cirrhosis of the liver. Despite widespread dissemination, underlying immune disturbance was not evident. The patient was treated with two courses of amphotericin and 5-flucytosine.

Topics: Amphotericin B; Child; Cholestasis, Extrahepatic; Cryptococcosis; Flucytosine; Hepatitis; Humans; Liver; Liver Cirrhosis; Lymphatic Diseases; Male

A 44-year-old man was admitted with symptoms compatible with Addison crisis. Abdominal computer tomography revealed extensive bilateral adrenal abscesses. Histoplasma capsulatum was cultured from a needle aspirate. The patient was HIV-seronegative and had no underlying malignancy. He may have acquired the infection during several stays in endemic areas in the United States, South America and Asia. The case was also remarkable for moderate brain atrophy, thrombosis of the portal and splenic veins and liver cirrhosis caused by alpha-1-antitrypsin deficiency (phenotype MZ). The patient recovered fully under substitution of adrenal hormones and antifungal treatment. He received intravenous amphotericin B (75 mg q24h) for 10 days, followed subsequently by oral treatment with itraconazole (400 mg q24h) over several months. Radiologic follow-up 9 and 18 months later showed a pronounced decrease of the inflammatory adrenal lesions.

Topics: Abscess; Acute Disease; Addison Disease; Adrenal Gland Diseases; Adult; alpha 1-Antitrypsin Deficiency; Amphotericin B; Histoplasmosis; Humans; Itraconazole; Liver Cirrhosis; Male; Tomography, X-Ray Computed

Topics: Amphotericin B; Diabetes Mellitus, Type 1; Drug Carriers; Humans; Liposomes; Liver Cirrhosis; Male; Meningitis, Cryptococcal; Middle Aged

A case of portal vein thrombosis due to Candida albicans in a patient with alcoholic hepatic cirrhosis in the absence of hepatocarcinoma is described. Infection is a known cause of portal vein thrombosis but thrombosis by Candida albicans has not to our knowledge been previously reported.

Topics: Amphotericin B; Candidiasis; Humans; Liver Cirrhosis; Male; Middle Aged; Portal Vein; Thrombosis

Topics: Adrenal Glands; Agammaglobulinemia; Amphotericin B; Brain; Carcinoma; Carcinoma, Hepatocellular; Cryptococcosis; Cryptococcus; Diabetes Complications; Granuloma; Humans; Immunologic Deficiency Syndromes; Kidney Neoplasms; Liver Cirrhosis; Liver Neoplasms; Male; Middle Aged

Topics: Adult; Amphotericin B; Ascites; Candida; Candidiasis; Diagnosis, Differential; Diagnostic Errors; Humans; Liver Cirrhosis; Male; Peptic Ulcer Perforation; Peritonitis; Radiography; Stomach Ulcer

Topics: Adult; Amphotericin B; Aneurysm, Infected; Aorta; Aortic Diseases; Aortic Valve; Aspergillosis; Embolism; Endocarditis; Endocardium; Heart Aneurysm; Humans; Liver; Liver Cirrhosis; Male; Tricuspid Valve

Topics: Adult; Amphotericin B; Brain Diseases; Cerebral Ventriculography; Electroencephalography; Histoplasmosis; Humans; Liver Cirrhosis; Male