amphotericin-b and Lung-Diseases--Obstructive

We report on a case of subcutaneous infection of the arm caused by the coelomycetous fungus Nattrassia mangiferae (formerly Hendersonula toruloidea) in a steroid-dependent diabetic man with chronic obstructive lung disease. The man was a resident of Arizona, where the fungus is known to be endemic on Eucalyptus camaldulensis and on citrus trees. Diagnosis of fungal infection was made by observation of narrow hyphal filaments by histopathology of biopsy specimens and isolation of a fast-growing black mold which demonstrated hyphae and arthroconidia of varying widths typical of the Scytalidium synanamorph (S. dimidiatum). The formation of pycnidia, which at maturity expressed conidia with a central median dark band, allowed for the confirmation of the isolate as N. mangiferae. Remission of the lesions occurred following intravenous therapy with amphotericin B, followed by topical clotrimazole treatment. We use this patient's case report as an opportunity to review the literature on cases of deep infection caused by Scytalidium species, to evaluate the antifungal susceptibilities of a spectrum of Scytalidium isolates, and to review the taxonomy of Scytalidium species isolated from human infections.

Topics: Aged; Amphotericin B; Antifungal Agents; Arm; Dermatomycoses; Diabetes Mellitus, Type 1; Humans; Lung Diseases, Obstructive; Male; Microbial Sensitivity Tests; Mitosporic Fungi; Skin

Three cases of chronic pulmonary histoplasmosis affecting aged patients with chronic obstructive pulmonary disease are reported. They had a history of recurrent episodes of respiratory infection and presented radiological lung lesions inducing a misdiagnosis of chronic pulmonary tuberculosis of the adults. The diagnosis of histoplasmosis, suggested by the immunodiffusion test and the detection of yeastlike cells in smeared and stained sputum, was confirmed by the isolation and identification of Histoplasma capsulatum var. capsulatum in selective media. The treatment was carried out with amphothericin B and ketoconazole or itraconazole. Clinical, radiologic, mycologic and serologic improvement was obtained in all the patients. However, relapses occurred within a period of 1 to 18 months after the interruption of the treatment. Mycological diagnosis and the difficulties observed in the treatment were discussed. In addition data on the epidemiology of histoplasmosis in the state of Rio de Janeiro, Brazil, were presented.

Topics: Aged; Amphotericin B; Antifungal Agents; Brazil; Fatal Outcome; Female; Histoplasma; Histoplasmosis; Humans; Immunodiffusion; Itraconazole; Ketoconazole; Lung Diseases, Fungal; Lung Diseases, Obstructive; Male; Middle Aged; Radiography, Thoracic; Recurrence; Sputum

This study evaluated the clinical features and treatment outcomes in patients with endogenous Aspergillus endophthalmitis.. The study design was a multicenter retrospective chart review.. Ten patients (12 eyes) with culture-proven endogenous Aspergillus endophthalmitis treated by 1 of the authors were studied.. Intravitreous amphotericin B injection, pars plana vitrectomy, systemic amphotericin B therapy, and oral anti-fungal therapy were performed.. Elimination of endogenous Aspergillus endophthalmitis and Snellen visual acuity, best corrected, were measured.. All patients had a 1- to 3-day history of pain and marked loss of visual acuity in the involved eyes. Varying degrees of vitritis was present in all 12 eyes. In 8 of 12 eyes, a central macular chorioretinal inflammatory lesion was present. Four patients (six eyes) had associated pulmonary diseases and were receiving concurrent steroid therapy. One of these patients with chronic asthma also was abusing intravenous drugs. Overall, six patients (six eyes) had a history of intravenous drug abuse, whereas a seventh patient (one eye) was suspected of abusing intravenous drugs. Blood cultures and echocardiograms were negative for systemic aspergillosis. Management consisted of a pars plana vitrectomy in 10 of 12 eyes. Intravitreous amphotericin B was administered in 11 of 12 eyes. Systemic amphotericin B therapy was used in eight patients. One patient was treated with oral antifungal agents. In three eyes without central macular involvement, final visual acuities were 20/25 to 20/200. In eight eyes with initial central macular involvement, final visual acuities were 20/400 in three eyes and 5/200 or less in four eyes. Two painful eyes with marked inflammation, hypotony, and retinal detachment were enucleated.. Endogenous Aspergillus endophthalmitis usually has an acute onset of intraocular inflammation and often has a characteristic chorioretinal lesion located in the macula. Although treatment with pars plana vitrectomy and intravitreous amphotericin B is capable of eliminating the ocular infection, the visual outcome generally is poor, especially when there is direct macular involvement.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Asthma; Endophthalmitis; Eye Infections, Fungal; Female; Fundus Oculi; Humans; Injections; Lung Diseases, Obstructive; Male; Middle Aged; Retrospective Studies; Substance Abuse, Intravenous; Treatment Outcome; Visual Acuity; Vitrectomy; Vitreous Body

The case of a 77-year-old man in whom a large digital ulcer with undermined edges was due to cutaneous infection by Cryptococcus neoformans variety neoformans serotype D, probably following direct inoculation, is reported. Long-term steroid treatment for chronic obstructive pulmonary disease may have been a risk factor. A 12-day course of intravenous amphotericin B at a cumulative dose of 750 mg, followed by oral fluconazole at a daily dose of 600 mg for six weeks, resulted in healing of the skin lesion. Manifestations of primary cutaneous cryptococcosis in immunocompetent or immunocompromised patients are reviewed.

Topics: Administration, Oral; Aged; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Fingers; Fluconazole; Humans; Immunocompromised Host; Lung Diseases, Obstructive; Male; Steroids

We report the case of a 43 year old male patient, with normal immune function, who presented with right middle and lower lobe collapse. At bronchoscopy, a white lobulated lesion was seen, completely obstructing the origin of bronchus intermedius. Bronchial washings and biopsy of the lesion demonstrated cryptococcal organisms. The patient responded clinically and radiologically to amphotericin B and flucytosine; however, repeat bronchoscopy revealed only partial resolution of the endobronchial lesion.

Topics: Adult; Amphotericin B; Antifungal Agents; Bronchial Diseases; Bronchoscopy; Cryptococcosis; Flucytosine; Humans; Lung Diseases, Obstructive; Male; Radiography