amphotericin-b and Lung-Diseases

The biological properties of elastase and Aspergillus flavus elastase inhibitor (AFLEI) from A. flavus were examined. Pathogenicity of elastase was investigated in mice immunocompromised with cyclophosphamide, cyclosporine, prednisolone and carrageenan. Compared to cyclophosphamide immunocompromised mice treated with the spores of elastase nonproducing strain, cyclophosphamide immunocompromised mice treated with the spores of elastase producing strain had a significantly shorter survival rate. Molecular mass of AFLEI was determined to be 7525.8 Da. The elastolytic activity of elastases from A. flavus, and human leukocytes were inhibited by AFLEI. The primary structure of AFLEI was determined by the Edman sequencing procedure. The search for amino acid homology with other proteins demonstrated that amino acid residues 1 to 68 of AFLEI are 100% identical to residues 20 to 87 of the hypothetical protein AFUA_3G14940 of A. fumigatus. When immunocompromised mice administered of cyclophosphamide were infected by inhalation of A. flavus then administered amphotericin B (AMPH) alone or in combination with AFLEI, survival rate tended to be higher with combination treatment than with AMPH alone. Moreover, although extensive bleeding was seen in pathology sections taken from rat lung resected 24 h after elastase was administered to the lung via the bronchus, this bleeding was inhibited by AFLEI. The X-ray analysis has revealed that the structure of this inhibitor was wedge shaped and composed of a binding loop and a scaffold protein core. As synthetic-inhibitor strongly inhibited cytotoxicity induced by elastase in human-derived cells, it could prove beneficial for the treatment of pulmonary aspergillosis.

Topics: Amphotericin B; Animals; Aspergillus flavus; Disease Models, Animal; Enzyme Inhibitors; Hemorrhage; Humans; Immunocompromised Host; Lung Diseases; Mice; Pancreatic Elastase; Pulmonary Aspergillosis; Rats

Acute respiratory events occasionally have been observed during the infusion of amphotericin B. Herein we analyze the 21 cases that have been reported, including a fatal reaction observed by us. Some useful guidelines are provided that likely will allow treatment to be continued safely for patients who have experienced such reactions.

Topics: Aged; Amphotericin B; Antifungal Agents; Drug Combinations; Female; Humans; Lung Diseases; Male; Mycoses; Phosphatidylcholines; Phosphatidylglycerols

We report a fatal case of invasive pulmonary aspergillosis in a severely ill neonate and review 43 additional cases of invasive aspergillosis reported from 1955 through 1996 that occurred during the first 3 months of life. Eleven of the 44 patients had primary cutaneous aspergillosis, 10 had invasive pulmonary aspergillosis, and 14 had disseminated disease. Most infections were nosocomial in origin. Prematurity (43%); proven chronic granulomatous disease (14%); and a complex of diarrhea, dehydration, malnutrition, and invasive bacterial infections (23%) accounted for the majority of underlying conditions. At least 41% of the patients had received corticosteroid therapy before diagnosis, but only one patient had been neutropenic. Among patients who received medical and/or surgical treatment, outcome was relatively favorable, with an overall survival rate of 73%. Invasive aspergillosis may occur in neonates and young infants and warrants consideration under certain circumstances. Current therapeutic approaches consist of high-dose amphotericin B and appropriate surgical interventions.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Central Nervous System Diseases; Critical Illness; Cross Infection; Dermatomycoses; Fatal Outcome; Gastrointestinal Diseases; Humans; Infant; Infant, Newborn; Lung Diseases; Male

Topics: Amiodarone; Amphotericin B; Bronchoconstriction; Drug-Related Side Effects and Adverse Reactions; Female; Finland; Humans; Incidence; Lung Diseases; Male; Nitrofurantoin; Penicillamine; Pneumonia; Pulmonary Edema; Risk Assessment; Salicylic Acid

Patients with severe neutropenia are at increased risk for systemic infection with bacteria or fungi. This risk is in proportion to both the degree and duration of the neutropenic process. Although granulocyte transfusion as a means of augmenting host defenses would appear to be a logical therapeutic intervention in clinical contexts involving severe and prolonged neutropenia, several features of granulocyte physiology and collection complicate such considerations. These include the large numbers of granulocytes normally produced by healthy hosts, the short survival of the granulocyte in the circulation after transfusion, the relatively small number of granulocytes which can be collected using currently available pheresis techniques, problems associated with alloimmunization, and the possibility of transferring disease (CMV, toxoplasmosis, hepatitis) by means of these transfusions. In the mid-1970s, well-designed clinical studies strongly suggested that patients with documented Gram-negative sepsis or tissue infection that failed to respond to appropriate antibiotics were significantly benefited by granulocyte transfusions. With recent advances in potent, broad-spectrum antibiotic availability, some have questioned whether these observations remain valid. Several studies regarding the prophylactic use of granulocyte transfusions in patients undergoing allogeneic bone marrow transplantation and/or induction therapy for leukemia have failed to reveal therapeutic benefits and suggested the possibility of significant side effects. These studies are reviewed.

Topics: Agranulocytosis; Amphotericin B; Anti-Bacterial Agents; Blood Transfusion; Bone Marrow Transplantation; Cell Separation; Clinical Trials as Topic; Cytomegalovirus Infections; Granulocytes; Humans; Infant, Newborn; Infant, Newborn, Diseases; Leukapheresis; Lung Diseases; Neutropenia; Sepsis; Transfusion Reaction

Topics: Amphotericin B; Complement Fixation Tests; Diagnosis; Diagnosis, Differential; Epidemiology; Fungi; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Skin Tests; Surgical Procedures, Operative

Optimal clinical care and clinical investigation of patients with mucormycosis are limited by absence of controlled trials, and absence of well-defined predictors of mortality or clinical response. The Deferasirox-AmBisome Therapy for mucormycosis (DEFEAT Mucor) study was the first randomized clinical trial conducted on patients with mucormycosis, and demonstrated that adjunctive deferasirox therapy did not improve outcomes of the disease. The current study describes clinical factors from the 20 patients enrolled to identify those associated with 90-day mortality of the 11 (55%) patients who died by day 90. Age, diabetes mellitus, transplant status, or antifungal therapy were not associated with mortality. However, active malignancy or neutropenia at enrollment were associated with increased mortality. Pulmonary infection was linked with lower Kaplan-Meier survival compared to non-pulmonary infection. Higher baseline serum concentrations of iron and ferritin were also associated with mortality. No patient who progressed clinically during the first 14 days of study therapy survived; however, many patients who clinically improved during that time did not survive to 90 days. In contrast, day 30 clinical response was predictive of 90-day survival. These factors may be useful in defining enrollment randomization stratification critieria for future clinical trials, and in supporting clinical care of patients with mucormycosis.

Topics: Adult; Aged; Amphotericin B; Benzoates; Deferasirox; Double-Blind Method; Ferritins; Humans; Iron; Kaplan-Meier Estimate; Lung Diseases; Middle Aged; Mucor; Mucormycosis; Risk Factors; Time Factors; Treatment Outcome; Triazoles

Aerosolized administrations of amphotericin B deoxycholate (AmBd) and amphotericin B lipid complex (ABLC) in lung transplant recipients were compared for safety and tolerability. The incidence of invasive fungal infections in patients receiving aerosolized amphotericin B formulations as sole prophylaxis was determined.. A prospective, randomized (1:1), double-blinded trial was conducted with 100 subjects. AmBd and ABLC were administered postoperatively by nebulizer at doses of 25 mg and 50 mg, respectively, which were doubled in mechanically ventilated patients. The planned treatment was once every day for 4 days, then once per week for 7 weeks. Treatment-related adverse events and invasive fungal infections were quantitated for 2 months after study drug initiation.. Intent-to-treat analysis revealed study drug was discontinued for intolerance in 6 of 49 (12.2%) and 3 of 51 (5.9%) patients in the AmBd- and ABLC-treated groups, respectively (p=0.313). Subjects receiving AmBd were more likely to have experienced an adverse event (odds ratio 2.16, 95% confidence interval 1.10, 4.24, p=0.02). Primary prophylaxis failure within 2 months of study drug initiation was observed in 7 of 49 (14.3%) AmBd-treated patients and 6 of 51 (11.8%) ABLC-treated patients. No fungal pneumonias were observed. Only two (2%) patients experienced documented primary prophylaxis failure with Aspergillus infections within the follow-up period.. Both aerosol AmBd and ABLC appear to be associated with a low rate of invasive pulmonary fungal infection in the early posttransplant period. Patients receiving ABLC were less likely to experience a treatment-related adverse event.

Topics: Adolescent; Adult; Aerosols; Aged; Amphotericin B; Deoxycholic Acid; Double-Blind Method; Drug Combinations; Female; Heart-Lung Transplantation; Humans; Lung Diseases; Lung Transplantation; Male; Middle Aged; Mycoses; Phosphatidylcholines; Phosphatidylglycerols; Postoperative Complications; Racial Groups; Retrospective Studies

Patients with severe neutropenia are at increased risk for systemic infection with bacteria or fungi. This risk is in proportion to both the degree and duration of the neutropenic process. Although granulocyte transfusion as a means of augmenting host defenses would appear to be a logical therapeutic intervention in clinical contexts involving severe and prolonged neutropenia, several features of granulocyte physiology and collection complicate such considerations. These include the large numbers of granulocytes normally produced by healthy hosts, the short survival of the granulocyte in the circulation after transfusion, the relatively small number of granulocytes which can be collected using currently available pheresis techniques, problems associated with alloimmunization, and the possibility of transferring disease (CMV, toxoplasmosis, hepatitis) by means of these transfusions. In the mid-1970s, well-designed clinical studies strongly suggested that patients with documented Gram-negative sepsis or tissue infection that failed to respond to appropriate antibiotics were significantly benefited by granulocyte transfusions. With recent advances in potent, broad-spectrum antibiotic availability, some have questioned whether these observations remain valid. Several studies regarding the prophylactic use of granulocyte transfusions in patients undergoing allogeneic bone marrow transplantation and/or induction therapy for leukemia have failed to reveal therapeutic benefits and suggested the possibility of significant side effects. These studies are reviewed.

Topics: Agranulocytosis; Amphotericin B; Anti-Bacterial Agents; Blood Transfusion; Bone Marrow Transplantation; Cell Separation; Clinical Trials as Topic; Cytomegalovirus Infections; Granulocytes; Humans; Infant, Newborn; Infant, Newborn, Diseases; Leukapheresis; Lung Diseases; Neutropenia; Sepsis; Transfusion Reaction

To evaluate the possibility that in febrile granulocytopenic patients amphotericin B given along with granulocyte transfusions could increase the incidence of pulmonary complications, we studied 43 severely granulocytopenic patients during 46 episodes of fever. Granulocytes were administered as part of the clinical protocol to all 19 patients who had clinically or microbiologically documented infection; the other 24 patients were randomly allocated to treatment with granulocytes (13 patients) or without granulocytes (11 patients). In all, 32 patients received granulocyte transfusions during 35 episodes of fever. Pulmonary complications developed in six patients in each of the two randomized groups. The incidence of pulmonary complications was not influenced by the number of granulocyte transfusions or by the number of granulocytes per transfusion. Pulmonary complications were significantly more likely to occur in patients with fungal infections. Amphotericin B was given according to clinical indications; 21 patients in all received it. Survival was significantly poorer in patients with pulmonary complications, but the administration of amphotericin B was not related either to survival or to the incidence of pulmonary complications. We conclude that pulmonary complications and poor prognosis are related to underlying pulmonary fungal infection and not to any interaction between amphotericin B and granulocyte transfusions.

Topics: Adult; Aged; Amphotericin B; Bacterial Infections; Female; Granulocytes; Humans; Lung Diseases; Male; Middle Aged; Mycoses; Transfusion Reaction

A 51-year-old woman with a medical history of poorly controlled type 1 diabetes mellitus, hyperthyroidism, and tobacco abuse was admitted to the hospital with persistent nausea, vomiting, abdominal discomfort, dry cough, rhinorrhea, and sore throat. She denied fevers, chills, rigors, shortness of breath, hemoptysis, nasal congestion, postnasal drip, and facial pain. She denied any sick contacts, and there was no recent travel outside of Chicago.

Topics: Amphotericin B; Antifungal Agents; Bronchoscopy; Diagnosis, Differential; Female; Humans; Lung; Lung Diseases; Middle Aged; Mucormycosis; Nitriles; Pneumonectomy; Pyridines; Respiration, Artificial; Thoracic Surgery, Video-Assisted; Treatment Outcome; Triazoles

Blastomycosis-associated acute respiratory distress syndrome (ARDS) has a rare incidence. We report the case of a 29-year-old man with blastomycosis-associated ARDS receiving extracorporeal membrane oxygenation and managed with high-dose liposomal amphotericin B. This case illustrates the importance of timely diagnosis of pulmonary blastomycosis and appropriate dosing of antifungal therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Blastomycosis; Extracorporeal Membrane Oxygenation; Humans; Lung Diseases; Male; Respiratory Distress Syndrome

Amphotericin is the preferred treatment for pulmonary histoplasmosis during pregnancy. The long half-life of amphotericin supports less than daily administration.. A 28-year-old pregnant woman diagnosed with recurrent pulmonary histoplasmosis was initiated on liposomal amphotericin 250 mg (4 mg/kg) intravenously daily. After 2 weeks, the patient was discharged and successfully received 250 mg thrice weekly at a hospital-associated outpatient infusion centre. After 6 weeks of outpatient treatment, a chest X-ray demonstrated no remaining disease and therapy was discontinued.. Administration of thrice-weekly liposomal amphotericin in a hospital-associated, outpatient infusion centre may be a promising option for stepdown treatment in patients unable to take itraconazole.

Topics: Adult; Amphotericin B; Antifungal Agents; Female; Histoplasmosis; Humans; Lung Diseases; Outpatients

Topics: Aged; Amphotericin B; Antifungal Agents; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Lung Diseases; Male; Mucormycosis; Nose Diseases; Pancytopenia; Treatment Outcome; Triazoles

Phaeohyphomycosis is an infrequent infection in human beings. However, in recent years, its prevalence has augmented in immunosuppressed patients (mostly in solid organ transplanted patients). Infection can be mucocutaneous or disseminated. In the former, the fungus inoculation occurs mainly through traumatism. Lesions may be polymorphic and asymptomatic, isolated or multiple, and are usually localized in exposed areas of the limbs and head. Treatment is not standardized. When possible, surgical resection of the lesion is combined with systemic antifungals.. We communicate three phaeohyphomycosis cases with cutaneous compromise.. The cases we present show diverse clinical characteristics and varied severity and evolution.. It is important for dermatologists to recognize this cutaneous fungus infection because the diagnosis using microscopic examination and mycological culture depends on the clinical suspicion.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Fasciitis, Necrotizing; Fatal Outcome; Female; Humans; Immunocompromised Host; Itraconazole; Lung Diseases; Male; Middle Aged; Phaeohyphomycosis

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Child; Female; Follow-Up Studies; Humans; Italy; Lung Diseases; Lung Transplantation; Male; Middle Aged; Nebulizers and Vaporizers; Postoperative Complications; Young Adult

Topics: Amphotericin B; Antifungal Agents; Granulomatous Disease, Chronic; Humans; Lung Diseases; Mycoses

Penicillium marneffei may cause life-threatening systemic fungal infection in immune-compromised patients and it is endemic in Southeast Asia. A 39-yr-old HIV-infected male, living in Laos, presented with fever, cough, and facial vesiculopapular lesions, which had been apparent for two weeks. CT scans showed bilateral micronodules on both lungs; Pneumocystis jirovecii was identified by bronchoscopic biopsy. Despite trimethoprim-sulfamethoxazole and anti-tuberculosis medications, the lung lesions progressed and the facial lesions revealed central umbilications. Biopsy of the skin lesions confirmed disseminated penicilliosis, with the culture showing P. marneffei hyphae and spores. The P. marneffei was identified by rRNA PCR. A review of the bronchoscopic biopsy indicated penicilliosis. The patient completely recovered after being prescribed amphotericin-B and receiving antiretroviral therapy. This is the first case of penicilliosis in a Korean HIV-infected patient. It is necessary to consider P. marneffei when immunocompromised patients, with a history of visits to endemic areas, reveal respiratory disease.

Topics: Adult; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Bronchoscopy; Dermatomycoses; HIV Infections; Humans; Immunocompromised Host; Laos; Lung Diseases; Male; Penicillium; Pneumocystis carinii; Tomography, X-Ray Computed

We report a case of a life-threatening, recurrent, and azole-resistant pulmonary coccidioidomycosis in a patient receiving long-term fluconazole therapy for a history of coccidioidal meningitis. Since this diagnosis, the patient has received weekly amphotericin B for more than four years and remains in remission with a stable serum Coccidioides complement fixation antibody titer.

Topics: Amphotericin B; Antifungal Agents; Azoles; Coccidioides; Coccidioidomycosis; Drug Resistance, Fungal; Humans; Lung Diseases; Male; Meningitis, Fungal; Middle Aged; Recurrence

Topics: Adolescent; Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Aspergillus; Combined Modality Therapy; Humans; Lung Diseases; Male; Pulmonary Surgical Procedures; Tomography, X-Ray Computed

Coccidioidomycosis, a fungal infection endemic in the southwestern United States, can cause life-threatening infections in immunosuppressed patients. We report the contrasting cases of two adolescents with lupus nephritis, treated with intravenous pulse cyclophosphamide and daily oral corticosteroids, who developed pulmonary coccidioidomycosis. One patient developed a fatal form of fulminant disseminated coccidioidomycosis, while the other patient developed a solitary pulmonary Coccidioides immitis abscess which was responsive to intravenous liposomal amphotericin and fluconazole therapy. Because serologies and initial X-ray studies can be negative, definitive diagnostic studies including bronchoaveolar lavage and needle aspiration should be performed when there is clinical suspicion of coccidioidomycosis in an immunocompromised patient. Immunosuppressed patients with coccidioidomycosis should receive early intravenous amphotericin therapy and may benefit from long-term suppressive antifungal therapy to prevent relapse.

Topics: Abscess; Administration, Oral; Adolescent; Adrenal Cortex Hormones; Amphotericin B; Child; Coccidioidomycosis; Cyclophosphamide; Drug Therapy, Combination; Fatal Outcome; Female; Fluconazole; Humans; Immunosuppressive Agents; Injections, Intravenous; Liposomes; Lung Diseases; Lupus Nephritis; Radiography, Thoracic; Tomography, X-Ray Computed

Fungal infections are frequent following lung transplantation and are associated with high mortality and morbidity. The study aims at 1) reporting our experience with fungal infections after lung transplantation; 2) identifying statistically significant correlations between the occurrence of fungal infections and bacterial infections, cytomegalovirus disease, rejection and steroid therapy; 3) assessing whether the presence of fungal infection has an impact on long-term survival.. 60 lung transplant recipients were studied with respect to incidence, pattern of presentation and median time to presentation of fungal infection after the transplant. Correlation analysis of the variables of interest was undertaken in 30 patients who had a minimum follow-up of 1 year following transplant.. The prevalence of fungal infection was 44%; severe infections occurred in 5 patients (11%). The presence of Candida preoperatively was not associated with an increased risk of fungal infection. In a logistic regression analysis, a significant correlation was found between the occurrence of fungal infection and the following variables: respiratory bacterial infections (p = 0.0003), cytomegalovirus disease (p = 0.00001) and steroid therapy (p = 0.04). No statistically significant difference was found between patients who experienced a fungal infection and those who did not, either in univariate or multivariate survival analysis (p = 0.08).. 1) fungal infections are frequent in lung transplant recipients and may be severe in more than 10% of the cases; 2) the presence of fungi preoperatively is not a contraindication to transplantation: an antifungal prophylaxis is probably indicated in such cases postoperatively; we recommend the use of the less nephrotoxic liposomal Amphotericin B by aerosol route; 3) a statistically significant association exists between fungal infections and both steroid therapy and CMV disease; this suggests that a similar antifungal prophylaxis is indicated in these clinical circumstances; 4) the presence of fungal infection is not an independent prognostic factor of long-term survival.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Bacterial Infections; Cytomegalovirus Infections; Female; Graft Rejection; Humans; Incidence; Lung Diseases; Lung Diseases, Fungal; Lung Transplantation; Male; Middle Aged; Prevalence; Prognosis; Retrospective Studies; Risk Factors; Steroids

Fungal infections remain an important cause of morbidity and mortality in lung transplant recipients. Aerosolized amphotericin B lipid complex (ABLC) may be more efficacious than conventional amphotericin B in the prevention of fungal infections in animal models, but experience with aerosolized ABLC in humans is lacking.. We conducted a prospective, noncomparative study designed to evaluate safety of aerosolized ABLC in lung or heart-lung transplant recipients.. A total of 381 treatments were administered to 51 patients. Complete spirometry records were available for 335 treatments (69 in intubated patients, 266 in extubated patients). ABLC was subjectively well tolerated in 98% of patients. Pulmonary mechanics worsened by 20% or more posttreatment in less than 5% of all treatments. There were no significant adverse events related to study medication in any patient, and 1-year survival for all enrolled patients was 78%.. Administration of nebulized ABLC is safe in the short-term and well-tolerated in lung transplant recipients. Additional prospective, randomized studies are needed to determine the efficacy of aerosolized ABLC alone or in conjunction with systemic therapies in the prevention of fungal infections in lung transplant recipients.

Topics: Adult; Aerosols; Amphotericin B; Antifungal Agents; Candidiasis; Drug Combinations; Heart-Lung Transplantation; Humans; Incidence; Lung Diseases; Lung Transplantation; Middle Aged; Mycoses; Peritonitis; Phosphatidylcholines; Phosphatidylglycerols; Postoperative Period; Prospective Studies; Respiratory Mechanics; Safety; Survival Analysis

We report the first case of hepatitis due to Aspergillus terreus in a 13-year-old boy with common variable immunodeficiency that occurred while the patient was receiving secondary prophylaxis with fluconazole after an episode of pulmonary candidosis. The infection subsided after the addition of itraconazole to the combination of liposomal amphotericin B and granulocyte-macrophage colony-stimulating factor that he was receiving.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Aspergillosis; Candida; Candidiasis; Drug Therapy, Combination; Fluconazole; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Immunocompromised Host; Itraconazole; Liposomes; Liver Abscess; Lung Diseases; Male; Treatment Outcome

Guidelines for the treatment of blastomycosis are presented; these guidelines are the consensus opinion of an expert panel representing the National Institute of Allergy and Infectious Diseases Mycoses Study Group and the Infectious Diseases Society of America. The clinical spectrum of blastomycosis is varied, including asymptomatic infection, acute or chronic pneumonia, and extrapulmonary disease. Most patients with blastomycosis will require therapy. Spontaneous cures may occur in some immunocompetent individuals with acute pulmonary blastomycosis. Thus, in a case of disease limited to the lungs, cure may have occurred before the diagnosis is made and without treatment; such a patient should be followed up closely for evidence of disease progression or dissemination. In contrast, all patients who are immunocompromised, have progressive pulmonary disease, or have extrapulmonary disease must be treated. Treatment options include amphotericin B, ketoconazole, itraconazole, and fluconazole. Amphotericin B is the treatment of choice for patients who are immunocompromised, have life-threatening or central nervous system (CNS) disease, or for whom azole treatment has failed. In addition, amphotericin B is the only drug approved for treating blastomycosis in pregnant women. The azoles are an equally effective and less toxic alternative to amphotericin B for treating immunocompetent patients with mild to moderate pulmonary or extrapulmonary disease, excluding CNS disease. Although there are no comparative trials, itraconazole appears more efficacious than either ketoconazole or fluconazole. Thus, itraconazole is the initial treatment of choice for nonlife-threatening non-CNS blastomycosis.

Topics: Amphotericin B; Antifungal Agents; Azoles; Blastomyces; Blastomycosis; Cost-Benefit Analysis; Female; Humans; Immunocompromised Host; Lung Diseases; Opportunistic Infections; Outcome Assessment, Health Care; Pregnancy; Pregnancy Complications, Infectious

In previous work acute toxic effects of amphotericin B (AB) were reduced in both in vitro and in vivo tests when AB was associated with a triglyceride-rich emulsion (AB-emulsion). The present paper compares the severity of the histopathological alterations as determined by morphometry produced in the target tissues (kidneys, liver, and lungs) by AB-emulsion with those produced by the conventional formulation AB-deoxycholate (DOC) following subacute AB treatment. No morphological alterations were seen in the spleen and heart following both AB-DOC and AB-emulsion treatment. Although the alterations in the liver, kidneys and lungs are basically the same for both formulations, the intensity of the changes varies considerably. AB-emulsion always caused statistically decreased severity of morphologic alterations, compared to AB-DOC by stereological measurements, for the three treatment regimes of AB-administration. These three treatment regimens consisted of 1 mg AB/kg of body weight every 48 hours for 20 days, 2 mg AB/kg of body weight every 48 hours for 12 days, and 2 mg AB/kg of body weight for 4 consecutive days. Thus, these regimens consisted of total doses varying from 8-12 mg/kg of body weight. Specifically, these morphological changes included proximal and distal tubular edema, inflammation and tubular cell degeneration in the kidney and a moderate inflammation of the portal region in the liver. Vacuolization of hepatocytes only occurred for AB-DOC treatment. In addition, acute interstitial inflammation was observed in the lungs prior to interstitial and alveolar edema. The intensity of the histopathological damage increase with the dose and with the reduction in the time interval between AB administrations. Abnormal serum biochemical parameters were observed for serum urea which was higher for both treated AB-groups, as compared to control, and for iron which was lower for the AB-DOC group. In conclusion, the decreased severity of the morphological alterations in the kidneys, liver, and lungs following subacute treatment with AB-emulsion, as compared to AB-DOC formulation, confirms our previous results consisting of acute toxic effects induced by in vitro and in vivo tests with AB-emulsion treatment.

Topics: Amphotericin B; Animals; Antifungal Agents; Chemical and Drug Induced Liver Injury; Deoxycholic Acid; Fat Emulsions, Intravenous; Kidney; Kidney Diseases; Liver; Liver Diseases; Lung; Lung Diseases; Male; Myocardium; Rats; Rats, Wistar; Triglycerides

In vitro and in vivo anti-Candida albicans and anti-Aspergillus fumigatus activities of NND-502, a new imidazole-antimycotic, were compared with those of fluconazole (FCZ), itraconazole (ITZ) and/or amphotericin B (AmB). NND-502 exhibited strong in vitro antifungal activity against both fungal species; its MIC against C. albicans was 1-4 times lower than that of FCZ, and its MIC against A. fumigatus was at least 60-2000 times lower than that of ITZ and AmB. In vivo antifungal treatments with each drug were initiated 1 h after inoculation in the experimental models, so that antifungal potential reflected prophylactic activity rather than therapeutic activity. The oral regimen of NND-502 in a murine model of systemic C. albicans infection was much less effective than that of FCZ. In vivo anti-A. fumigatus activity of oral NND-502 in a murine model of systemic infection was apparently superior to that of FCZ and ITZ in terms of prolonging survival. In addition to the murine model of systemic aspergillosis, intravenous NND-502 was shown to be highly effective in a rat model of pulmonary aspergillosis compared with intravenous AmB; 90% of animals survived at a dose of 2.5 mg/kg per day of NND-502 while only 30% of animals escaped death when 5 mg/kg per day of AmB was used. This potent efficacy of NND-502 was also confirmed in a sublethal challenge study in which the administration of the agent at a dose as low as 1.25 mg/kg per day resulted in the significant reduction of organisms in the lung; no comparable effect of AmB was found.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Candida albicans; Candidiasis; Imidazoles; Lung Diseases; Male; Microbial Sensitivity Tests; Rats; Rats, Sprague-Dawley

Topics: Adult; Amphotericin B; Antifungal Agents; Bone Marrow; Female; Histoplasmosis; Humans; Lung Diseases

A 58-year-old woman with acute myelogenous leukemia in complete remission underwent successful pulmonary resection for massive hemoptysis occurring after resolution of pulmonary aspergillosis. Despite the fact that the role of surgery in the treatment of pulmonary mycosis in immunocompromised hosts is still to be clearly defined, emergency lung resections can be successfully performed in this group of patients with almost immediate recovery of stable clinical parameters. Brisk recovery can reduce overall morbidity and mortality and allow for early resumption of any necessary treatment for underlying disease.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Fatal Outcome; Female; Hemoptysis; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Lung; Lung Diseases; Middle Aged; Radiography, Thoracic; Salvage Therapy

The microbiology, epidemiology, clinical features, and treatment of aspergillosis are discussed. Aspergillosis is a fungal infection that is increasingly found in patients with advanced HIV disease. The lung is involved in almost 75 percent of aspergillus infections. The central nervous system is the second most commonly infected site, occurring in about 10 to 15 percent of reported cases. Sinus involvement is recognized as a feature of aspergillosis, accounting for about 75 percent of all cases of fungal sinusitis seen in AIDS patients. While these infections are more than likely localized, dissemination to many organs can occur. The prognosis of patients with aspergillosis is poor, and its treatment is difficult. Treatment with amphotericin B is considered the gold standard, but responses are limited, with only 20 to 30 percent of patients responding in most cases. Itraconzole is approved as a second-line therapy. Surgery may also be appropriate for some cases of aspergillosis.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Central Nervous System Diseases; HIV Infections; Humans; Itraconazole; Lung Diseases; Sinusitis

Topics: Amphotericin B; Carbidopa; Cytarabine; Dose-Response Relationship, Drug; Female; Humans; Leukemia, Myelomonocytic, Acute; Levodopa; Lung Diseases; Middle Aged; Parkinson Disease, Secondary

Encephalopathy, leukoencephalopathy, and secondary parkinsonism occurred in 3 children with refractory leukemia undergoing allogenic bone marrow transplantation (BMT) who were treated with high-dose amphotericin B for pulmonary aspergillosis or sinus aspergillosis that did not involve the nervous system. Treatment included high-dose cytosine arabinoside, cyclophosphamide, and total body irradiation prior to the BMT. The children developed a progressively worsening encephalopathy and parkinsonian features, characterized by resting tremor, cogwheel rigidity, and masklike facies. Neuroimaging studies showed cerebellar, cerebral, and basal ganglia atrophy, as well as frontal and temporal lobe white matter involvement. Two of the 3 patients recovered, although 1 has residual intellectual impairment. The third succumbed to non-central nervous system Epstein-Barr virus-lymphoproliferative disease and had autopsy-confirmed leukoenephalopathy.

Topics: Adolescent; Amphotericin B; Antineoplastic Agents; Aspergillosis; Bone Marrow Transplantation; Brain Diseases; Child; Cyclophosphamide; Cytarabine; Humans; Leukemia, Myeloid, Acute; Lung Diseases; Male; Methotrexate; Parkinson Disease; Radiation Injuries

A model of primary pulmonary aspergillosis in rabbits was developed to reproduce the persistent levels of profound granulocytopenia and the histopathologic features of bronchopneumonia, vascular invasion, and hemorrhagic infarction encountered in humans. D-mannitol was detectable in bronchoalveolar lavage fluid by gas-liquid chromatography/mass spectroscopy, and galactomannan was measurable in serum by latex agglutination immunoassay. A pharmacokinetically distinctive unilamellar vesicle formulation of liposomal amphotericin B, 5 mg/kg/day intravenously, compared with high-dose conventional desoxycholate amphotericin B, 1 mg/kg/day intravenously, was more effective in preventing nephrotoxicity, increasing survival, reducing the number of viable organisms, and decreasing tissue injury due to Aspergillus organisms. Thus, D-mannitol in lavage fluid and galactomannan in serum may be useful markers of pulmonary aspergillosis, and liposomal amphotericin B was significantly more effective and safer than desoxycholate amphotericin B for treatment of pulmonary aspergillosis in profoundly granulocytopenic rabbits.

Topics: Agranulocytosis; Amphotericin B; Animals; Antigens, Fungal; Aspergillosis; Aspergillus fumigatus; Biomarkers; Bronchoalveolar Lavage Fluid; Ergosterol; Galactose; Kidney Diseases; Life Tables; Liposomes; Lung Diseases; Mannans; Mannitol; Opportunistic Infections; Rabbits; Survival Analysis

Patients with previous invasive fungal infections (IFI) are at high risk of reactivation of the infection during BMT, even after an apparently curative antifungal treatment. We report four patients who suffered an IFI after intensive chemotherapy for acute leukemia and were later submitted for BMT. One patient had developed a chronic systemic candidiasis during consolidation chemotherapy and received prophylactic oral or iv fluconazole (200 mg daily) throughout BMT. Two patients developed an invasive pulmonary aspergillosis after intensive chemotherapy, one of them after salvage therapy for post-allogeneic BMT relapse and the other after consolidation therapy. The former patient underwent partial lobectomy after treatment with amphotericin B before a second allogeneic BMT was performed. Both patients received prophylactic itraconazole (400 mg daily by mouth) throughout the BMT procedure. The fourth patient had pneumonia caused by Scedosporium apiospermum (the anamorph form of the fungus Pseudallescheria boydii) during consolidation chemotherapy which was successfully treated with itraconazole. During BMT he also received oral itraconazole (400 mg daily) as prophylaxis against reactivation of the infection. All four patients had successful BMT and none had clinical, radiological or microbiological evidence of reactivation of IFI during BMT.

Topics: Administration, Oral; Adolescent; Adult; Amphotericin B; Aspergillosis; Aspergillus; Bone Marrow Transplantation; Candida; Candidiasis; Female; Fluconazole; Humans; Incidence; Itraconazole; Leukemia, Myeloid, Acute; Leukemia, Promyelocytic, Acute; Lung Diseases; Male; Mycetoma; Mycoses; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pseudallescheria; Recurrence; Risk Factors

Mucormycosis is known to cause rhinocerebral and pulmonary disease in patients with diabetes, leukemia, and lymphoma. However, the characteristics and outcome of these infections have not been well described in the BMT population. In a 17-year consecutive series of BMT patients, 13 of 1500 patients (0.9%) developed mucormycosis. Ten of the transplants were allogeneic and three autologous. Six infections occurred within 90 days of transplant, and six occurred at or within several days of autopsy. Seven patients were neutropenic and another patient had just engrafted at diagnosis of infection. Sites of infection were lung-brain (n = 4), sinonasal region (n = 3), lung (n = 2), disseminated (n = 2), lung-kidney (n = 1), and bone-muscle (n = 1). All patients were treated with prolonged amphotericin B therapy. Surgical debridement was employed in the three sinonasal infections. Death from mucormycosis occurred in ten of 13 (77%) patients. Two patients are alive, including one who had resolution of sinonasal infection. Mucormycosis may occur in both neutropenic and non-neutropenic patients, and may occur long after hospital discharge for BMT. These infections are often fatal, although patients with limited sinonasal disease may have a better prognosis, especially with early diagnosis and aggressive antifungal therapy.

Topics: Adolescent; Adult; Amphotericin B; Bone Marrow Transplantation; Brain Diseases; Child; Child, Preschool; Female; Humans; Immunocompromised Host; Leukemia; Lung Diseases; Male; Mucormycosis; Paranasal Sinuses; Prospective Studies; Treatment Outcome

Cryptococcus infections of the lung and central nervous system have become major problems in immuno-compromised patients, leading to the need for additional treatment protocols. We have utilized a Cryptococcus-mouse model that mimics human cryptococcal disease to evaluate the efficacy of amphotericin B-liposomes (AmpB-Lip) when delivered by small-particle aerosol (SPA). In the model, initial intranasal inoculation leads to a pulmonary infection that spreads after 2 to 3 weeks to distant organs, including the brain. Aerosols of AmpB-Lip that were generated by a Collison nebulizer had mass median aerodynamic diameters of 1.8 microns and contained 10.3 micrograms of AmpB per liter. When AmpB-Lip SPA was begun at 24 h postinoculation, a single 2-h treatment (0.3 mg of AmpB per kg of body weight) was effective in reducing pulmonary Cryptococcus infection. This regimen was more effective than intravenous administration of AmpB-Lip given for 3 continuous days. This single 2-h exposure to AmpB-Lip also was effective in reducing pulmonary Cryptococcus infection when treatment was delayed for 7 or 14 days. At day 21, when organisms had spread to the brain in all animals, the single 2-h aerosol treatment reduced the number of cryptococci in the brain as well as in the lungs. AmpB-Lip SPA administered once for 2 h on days 7, 14, and 21 also was effective in increasing the duration of survival of infected animals. These results demonstrate that aerosolized AmpB-Lip can be effective in treating both local, pulmonary Cryptococcus disease and systemic disease.

Topics: Aerosols; Amphotericin B; Animals; Cryptococcosis; Cryptococcus neoformans; Drug Carriers; Liposomes; Lung Diseases; Mice

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Aspergillosis; Dermatomycoses; Graft Rejection; Humans; Immunosuppressive Agents; Liver Cirrhosis, Alcoholic; Liver Transplantation; Lung Diseases; Male; Middle Aged

Topics: Adult; Amphotericin B; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Carriers; Female; Hemodynamics; Humans; Infusions, Intravenous; Liposomes; Lung; Lung Diseases; Pulmonary Gas Exchange

We reviewed the clinical course in 43 patients from eight medical centers who were given the diagnosis of chronic mucocutaneous candidiasis, a rare disorder of unknown cause that may occur in childhood. Recurrent or severe infections with organisms other than Candida were seen in 80% of the patients. There were nine cases of septicemia. Seven patients have died; six of these deaths were directly related to non-Candida infectious complications. Endocrine dysfunction, including Addison disease (11 patients) and hypothyroidism (9 patients), was seen in 19 of 43 patients. Immunologic studies failed to reveal a consistent abnormality, although two of five patients with reversed T4/T8 ratios are among those who have died. Ketoconazole was effective in controlling symptoms of candidiasis in most patients. The findings from this study indicate that non-Candida infections cause serious morbidity and may result in death in patients with chronic mucocutaneous candidiasis.

Topics: Adolescent; Amphotericin B; Autoimmune Diseases; Candidiasis; Candidiasis, Chronic Mucocutaneous; Child; Child, Preschool; Endocrine System Diseases; Family; Female; Flucytosine; Humans; Immunoglobulin A; Immunoglobulin G; Incidence; Infant; Infections; Ketoconazole; Lung Diseases; Male; Survival Rate

Topics: Amphotericin B; Cytomegalovirus Infections; Graft vs Host Disease; Granulocytes; Humans; Lung Diseases; Transfusion Reaction

Topics: Amphotericin B; Cryptococcosis; Cryptococcus neoformans; Dose-Response Relationship, Drug; Humans; Lung Diseases

One hundred twenty-five granulocyte transfusions were given concurrently with amphotericin B to 31 granulocytopenic patients with acute leukemia during a four year period. Twenty-six patients had culture-documented, and 5 had presumed fungal infections; pulmonary infiltrates were present in 26 patient courses. Eight patients developed pulmonary deterioration temporally related to therapy with amphotericin, granulocyte transfusions, or both. One event occurred following amphotericin alone. Three additional reactions occurred in alloimmunized patients with antibodies to human leukocyte antigens (HLA) who received random donor granulocytes, which may indicate a potential mechanism for the pulmonary reactions. Two reactions potentially represent an adverse interaction between amphotericin and granulocytes, but these were reversible and were not unlike reactions expected with each modality alone. Our data fail to document a specific detrimental interaction between granulocyte transfusions and amphotericin beyond the reactions associated with each modality, and the data suggest that other clinical factors, particularly infection and alloimmunization, also contribute to pulmonary decompensation. We nevertheless recommend great care and attention be given to administering these modalities in the setting of severely ill patients.

Topics: Adolescent; Adult; Agranulocytosis; Amphotericin B; Female; Granulocytes; Humans; Infections; Leukemia; Lung; Lung Diseases; Male; Middle Aged; Radiography, Thoracic; Transfusion Reaction

We reviewed 60 consecutive flexible bronchoscopies done during a 36-month period in 48 pediatric cancer patients with undiagnosed pulmonary infiltrates. Diagnostic procedures during bronchoscopy included 40 brushings, 50 bronchoalveolar lavages, and 6 transbronchial and mucosal biopsies. A total of 16 specific diagnoses were made by bronchoscopy (27% diagnostic yield), including infection (12), pulmonary leukemia (3), and lymphoma (1). The largest proportion of specific diagnoses came from lavage (14/50) and the smallest from brushings (1/40). Biopsies were also useful for selected patients. The low overall yield for bronchoscopy was probably due to the routine use of empiric broad-spectrum antibiotics and antifungal therapy, as well as trimethoprim-sulfamethoxazole prophylaxis for Pneumocystis carinii pneumonitis. Subsequent specific diagnoses were obtained by other procedures (open biopsy, needle aspiration, or autopsy) for 10 patients with negative bronchoscopy results and 3 patients with diagnostic bronchoscopies. These additional diagnoses included 7 infections (Pneumocystis carinii (1), Candida tropicalis (1), cytomegalovirus (1), and Aspergillus (4), and 6 other diagnoses with nonspecific histologic findings. A positive bronchoscopy result may be useful, but negative bronchoscopy findings do not justify delaying other diagnostic procedures or discontinuing antibiotic and antifungal therapy in children with cancer and pulmonary infiltrates.

Topics: Adolescent; Adult; Amphotericin B; Anti-Bacterial Agents; Biopsy; Bronchoscopy; Child; Child, Preschool; Humans; Lung Diseases; Neoplasms; Pneumonia, Pneumocystis; Therapeutic Irrigation

Topics: Amphotericin B; Flucytosine; Humans; Imidazoles; Lung Diseases; Mycoses; Triazoles

Topics: Aged; Amphotericin B; Blood Transfusion; Cough; Female; Fever; Humans; Lung Diseases; Mucormycosis; Thrombocytopenia

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

The use of granulocyte transfusions in profoundly neutropenic patients has increased markedly in recent years. Whenever a pulmonary infiltrate develops during the course of these transfusions, the question arises as to what role the transfusions are playing and whether the transfusions should be discontinued to prevent pulmonary deterioration. We have analyzed our recent experience of 593 granulocyte transfusions in 93 patients. 18 patients (19%) developed respiratory compromise or pulmonary infiltrates at some time during the course of granulocyte transfusion. 6 of the 18 cases were reactions to the granulocytes while the remainder were due to fluid overload or other causes. The risk of pulmonary complications did not correlate with the development of cytotoxic leukocyte antibodies, length of transfusion, or concomitant use of Amphotericin. They appeared to be more common in patients with active sepsis. Acute life-threatening pulmonary reactions were rare. Patients receiving granulocyte transfusions should be monitored carefully for pulmonary infiltrates, but other cases should be sought before the transfusions are discontinued.

Topics: Acute Disease; Agglutination; Amphotericin B; Bacterial Infections; Bronchopulmonary Sequestration; Child; Child, Preschool; Granulocytes; Humans; Infant; Lung Diseases; Respiratory Distress Syndrome; Transfusion Reaction

Amphotericin B is used increasingly in high-risk patients with profound neutropenia and suspected sepsis. We have observed serious pulmonary reactions characterized by acute dyspnea, hypoxemia, and interstitial infiltrates on chest films in patients receiving amphotericin B and leukocyte transfusions. We reviewed 6 1/2 years of experience at the National Institutes of Health to determine whether this combination was associated with pulmonary toxicity not characteristic of either therapy alone. Amphotericin was used during 22 of 57 leukocyte-transfusion courses. Acute respiratory deterioration occurred during 14 (64 per cent) of these courses but in only two (6 per cent) of 35 courses without amphotericin (P less than 0.01). In seven cases, respiratory deterioration began during or immediately after amphotericin infusion, and it contributed to death in five patients. Diffuse intraalveolar hemorrhage was found when lung biopsy or autopsy was performed. Acute respiratory deterioration was not observed in comparably neutropenic patients given amphotericin but not leukocyte transfusions during the same period. It was mot common when amphotericin was begun with or after institution of daily leukocyte transfusions. Leukocyte transfusions may cause changes in the lungs that amplify the acute toxicity of amphotericin, thereby permitting severe pulmonary reactions.

Topics: Adolescent; Adult; Amphotericin B; Child; Dyspnea; Female; Humans; Hypoxia; Leukocyte Transfusion; Lung Diseases; Male; Middle Aged; Neutropenia; Sepsis; Transfusion Reaction

Topics: Amphotericin B; Humans; Leukemia; Leukocyte Transfusion; Lung Diseases; Sepsis; Transfusion Reaction

Topics: Amphotericin B; Cryptococcosis; Granuloma; Humans; Lung Diseases; Male; Middle Aged; Radiography

Reports in the literature of patients surviving mucormycosis involving the craniofacial structures are exceedingly rare. The necessity for early diagnosis by recognition of any of the six key signs and symptoms is emphasized. The futility of standard diagnostic tools, other than biopsy, is noted. An underlying debilitating condition such as diabetic ketoacidosis can predispose the patient to an acute infection by this usually nonpathogenic organism. The requirement for prompt treatment of the debilitating condition together with treatment to eradicate the fungus is stressed.

Topics: Abscess; Adult; Amphotericin B; Cavernous Sinus; Cranial Nerves; Dental Caries; Diabetes Complications; Diabetic Coma; Diabetic Neuropathies; Diagnosis, Differential; Face; Humans; Insulin; Lung Diseases; Male; Mucormycosis; Ophthalmoplegia; Pneumonia; Sinus Thrombosis, Intracranial; Skull; Tooth Diseases; Urinary Tract Infections

Toxicity and failure of treatment with amphotericin B are stimuli for researchers to evaluate alternative antifungal antimicrobics. Also, data from susceptibility tests of Coccidioides immitis are sparse. With use of a defined, synthetic culture medium, C. immitis (25 strains). Candida albicans (21 strains), and Cryptococcus neoformans (21 strains) were tested against flucytosine, clotrimazole, and amphotericin B. Molecule for molecule, the sequency of activity was: clotrimazole greater than amphotericin B greater than flucytosine (totally inactive) C. immitis; and clotrimazole greater than amphotericin B greater than flucytosine with C. albicans and C. neoformans. With four strains of C. immitis, the minimal inhibitory concentration (of amphotericin B) was the same when inocula of arthrospores were tested as when corresponding spherules/endospores were tested simultaneously and identically. The clinical outcome of coccidioidomycosis in 17 patients treated with amphotericin B correlated best with minimal inhibitory concentration after incubation of cultures for 48 hr; a favorable response was associated with minimal inhibitory concentrations of less than or equal 1.0 mug/ml. Because clinical isolates of fungi appear to vary in susceptibility, in vitro tests may have clinical utility.

Topics: Adult; Aged; Amphotericin B; Candida albicans; Child; Child, Preschool; Clotrimazole; Coccidioides; Coccidioidomycosis; Cryptococcus; Cryptococcus neoformans; Cytosine; Drug Resistance, Microbial; Female; Flucytosine; Humans; Imidazoles; Lung Diseases; Male; Microbial Sensitivity Tests; Middle Aged; Pregnancy; Pregnancy Complications, Infectious; Spores, Fungal

Topics: Agranulocytosis; Amphotericin B; Anemia, Aplastic; Anemia, Hemolytic; Anti-Bacterial Agents; Ataxia; Bacitracin; Cardiovascular Diseases; Chemical and Drug Induced Liver Injury; Chloramphenicol; Deafness; Gastrointestinal Diseases; Gentamicins; Humans; Kanamycin; Kidney Diseases; Leukopenia; Lung Diseases; Neomycin; Neuromuscular Diseases; Nitrofurantoin; Optic Neuritis; Peripheral Nervous System Diseases; Skin Diseases; Streptomycin; Sulfonamides; Tetracycline; Thrombocytopenia; Vertigo

Topics: Amphotericin B; Antibodies; Complement System Proteins; Cryptococcosis; Flucytosine; Humans; Immunity, Cellular; Immunoelectrophoresis; Lung Diseases; Male; Middle Aged

Topics: Amphotericin B; Antibodies, Fungal; Antigens, Fungal; Arthrodermataceae; Candida; Coccidioides; Coccidioidomycosis; Complement Fixation Tests; Female; Humans; Hypersensitivity, Delayed; Immunity, Maternally-Acquired; Immunization, Passive; Immunotherapy; Leukocytes; Lung Diseases; Lymphocyte Activation; Lymphocytes; Middle Aged; Precipitin Tests; Skin Tests; Streptodornase and Streptokinase; Tissue Extracts

Topics: Adult; Amphotericin B; Brain Diseases; Cryptococcosis; Humans; Injections, Intravenous; Injections, Spinal; Lung; Lung Diseases; Male; Pneumonectomy

Topics: Adolescent; Adult; Amphotericin B; Animals; Asian People; Cerebrospinal Fluid Proteins; Child; Columbidae; Cryptococcosis; Cryptococcus neoformans; Cytosine; Evaluation Studies as Topic; Female; Glucose; Humans; Hypertension; Lung Diseases; Male; Meningitis; Middle Aged; Myasthenia Gravis; Peptic Ulcer; Prognosis; Schizophrenia; Singapore; Tuberculosis, Meningeal

Topics: Amphotericin B; Cryptococcosis; Diagnosis, Differential; Follow-Up Studies; Humans; Lung; Lung Diseases; Lung Diseases, Fungal; Postoperative Care; Radiography

Topics: Amphotericin B; Aspergillosis; Biopsy; Drainage; Heart Transplantation; Humans; Lung Diseases; Male; Methods; Middle Aged

Topics: Adult; Amphotericin B; Bacteriological Techniques; Biopsy; Brain Abscess; Cerebrospinal Fluid Proteins; Hemiplegia; Humans; Isoniazid; Joint Diseases; Lung Diseases; Male; Meningitis; Nocardia Infections; Polymyxins; Prednisone; Pseudomonas Infections; Sarcoidosis; Skin Diseases; Sporotrichosis; Tetracycline

Topics: Adolescent; Adult; Aged; Agriculture; Amphotericin B; Bacteriological Techniques; Biopsy; Black People; Blastomycosis; Child; Child, Preschool; Climate; Complement Fixation Tests; Desensitization, Immunologic; Environmental Exposure; Female; Geological Phenomena; Geology; Histological Techniques; Humans; Infant; Lung Diseases; Male; Middle Aged; Mining; North Carolina; Occupational Diseases; Potassium Iodide; Skin Diseases; Skin Tests; Soil Microbiology; Stilbamidines; White People

Topics: Adolescent; Adult; Aged; Amphotericin B; Female; Humans; Lung Diseases; Male; Middle Aged; Tetracycline

Topics: Amphotericin B; Diagnosis, Differential; Female; Humans; Lung Diseases; Lung Diseases, Fungal; Middle Aged; Occupational Diseases; Sarcoidosis; Sporotrichosis; Tuberculosis, Pulmonary

Topics: Aminosalicylic Acids; Amphotericin B; Drug Resistance, Microbial; Histoplasmosis; Humans; Isoniazid; Lung Diseases; Male; Middle Aged; Mycobacterium; Mycobacterium Infections; Radiography, Thoracic; Sputum; Streptomycin

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus; Bronchial Diseases; Humans; Iodine; Lung Diseases; Lung Diseases, Fungal; Male; Precipitin Tests; Prednisone; Respiratory Hypersensitivity; Skin Tests; Sodium; United States

Topics: Aerosols; Amphotericin B; Asthma; Bronchial Diseases; Bronchodilator Agents; Cystic Fibrosis; Eosinophilia; Isotonic Solutions; Lung Diseases; Mucus; Polymyxins; Radiography; Sodium Chloride; Spirometry; Sputum; Ultrasonics; Ventilators, Mechanical

Topics: Adult; Amphotericin B; Blastomyces; Blastomycosis; Bone Diseases; Bronchial Diseases; Fluorescent Antibody Technique; France; Humans; Immunodiffusion; Kidney Diseases; Lung Diseases; Male; Tunisia

Topics: Adolescent; Amphotericin B; Candidiasis, Cutaneous; Candidiasis, Oral; Drug Resistance, Microbial; Female; Humans; Lung Diseases; Middle Aged; Nystatin; Oral Manifestations; Sarcoidosis

Topics: Amphotericin B; Ampicillin; Anti-Bacterial Agents; Bronchial Diseases; Humans; Influenza, Human; Kanamycin; Lung Diseases; Methicillin; Novobiocin; Oleandomycin; Tetracycline

Topics: Adult; Aged; Amphotericin B; Bronchi; Cryptococcosis; Cryptococcus; Female; Follow-Up Studies; Humans; Lung Diseases; Lung Diseases, Fungal; Male; Middle Aged; Pleural Effusion; Radiography; Sputum

Topics: Adult; Aged; Amphotericin B; Biopsy; Bronchi; Cryptococcosis; Cryptococcus; Female; Humans; Lung; Lung Diseases; Lung Diseases, Fungal; Lymphadenitis; Male; Middle Aged; Sputum

Topics: Abscess; Adolescent; Amphotericin B; Blastomyces; Blastomycosis; Bone Diseases; Foot Diseases; Humans; Leprosy; Lung Diseases; Male; Mozambique; Prostatic Diseases; Skin Diseases; Sputum

Topics: Adult; Amphotericin B; Aspergillosis; Female; Humans; Lung Diseases; Radiography

Topics: Amphotericin B; Complement Fixation Tests; Histoplasmosis; Humans; Lung Diseases; Male; Middle Aged; Oral Manifestations; Tongue Diseases

Topics: Amphotericin B; Blastomycosis; Female; Humans; Lung Diseases; Lung Diseases, Fungal; Male; North Carolina; Stilbamidines

Topics: Adult; Amphotericin B; Blastomycosis; Geography; Humans; Lung Diseases; Male

Topics: Amphotericin B; Diagnosis; Drug Therapy; Fungi; Histoplasmosis; Lung Diseases; Lung Diseases, Fungal; Pathology; Radiography, Thoracic; Surgical Procedures, Operative

Topics: Adolescent; Amphotericin B; Child; Complement Fixation Tests; Drug Therapy; Histoplasmosis; Humans; Infant; Lung Diseases; Lung Diseases, Fungal; Mediastinum; Pericarditis; Prednisone; Radiography, Thoracic; Skin Tests; Tracheal Stenosis

Topics: Amphotericin B; Aspergillosis; Drug Therapy; Geriatrics; Humans; Lung Diseases; Tomography; Tomography, X-Ray Computed

Topics: Amphotericin B; Biopsy; Cryptococcosis; Diagnosis, Differential; Drug Therapy; Humans; Lung Diseases; Lymph Nodes; Pathology; Prednisone; Sarcoidosis

Topics: Amphotericin B; Aspergillosis; Drug Therapy; Geriatrics; Lung Diseases; Lung Diseases, Fungal; Pulmonary Aspergillosis; Radiography, Thoracic

Topics: Amphotericin B; Aspergillosis; Dermatomyositis; Drug Therapy; Humans; Lung Diseases; Lung Diseases, Fungal; Prednisolone; Pulmonary Aspergillosis; Radiography, Thoracic; Toxicology

Topics: Aged; Amphotericin B; Cryptococcosis; Drug Therapy; Fungi; Geriatrics; Humans; Lung Diseases; Lung Diseases, Fungal; Postoperative Care; Radiography, Thoracic; Surgical Procedures, Operative

Topics: Amphotericin B; Animals; Anti-Bacterial Agents; Antibiotics, Antitubercular; Antifungal Agents; Brain Diseases; Candida; Candidiasis; Kidney Diseases; Lung Diseases; Lung Diseases, Fungal; Mice; Nystatin; Pharmacology; Research; Spleen; Virulence

Topics: Adrenal Gland Diseases; Amphotericin B; Brain Diseases; Cerebrospinal Fluid; Cryptococcosis; Dermatomycoses; Diagnosis; Gastroenterology; Geriatrics; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Meningitis; Pathology

Topics: Amphotericin B; Black People; Complement Fixation Tests; Diagnosis, Differential; Histoplasmosis; Humans; Infant; Lung Diseases; Lung Diseases, Fungal; Pathology; Radiography, Thoracic; Rest; Surgical Procedures, Operative; Tennessee; Tuberculosis; Tuberculosis, Pulmonary

Topics: Amphotericin B; Blastomycosis; Diagnosis, Differential; Fungi; Geriatrics; Hoarseness; Humans; Laryngitis; Laryngoscopy; Larynx; Larynx, Artificial; Lung Diseases; Lung Diseases, Fungal; Pathology; Radiography, Thoracic

Topics: Amphotericin B; Child; Diagnosis, Differential; Exudates and Transudates; Histoplasmosis; Humans; Lung Diseases; Pleural Effusion

Topics: Amphotericin B; Biopsy; Fungi; Histoplasmosis; Humans; Injections, Intravenous; Lung Diseases; Lung Diseases, Fungal; Pathology; Pharynx; Toxicology

Topics: Amphotericin B; Blastomycosis; Blood Cell Count; Blood Chemical Analysis; Dermatomycoses; Dosage Forms; Humans; Lung Diseases; Lung Diseases, Fungal; North America; Nose; Toxicology

Topics: Amphotericin B; Brain Diseases; Cryptococcosis; Cryptococcus; Diagnosis; Diagnosis, Differential; Humans; Lung Diseases; Lung Diseases, Fungal; Meninges; Pathology; Physiology; Sepsis

Topics: Amphotericin B; Drug Therapy; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Mexico; Prognosis; Toxicology

Topics: Actinomycosis; Adrenal Cortex Hormones; Amphotericin B; Anti-Bacterial Agents; Antineoplastic Agents; Cardiac Surgical Procedures; Cats; Classification; Dogs; Epidemiology; Hematology; Hospitals; Hospitals, General; Infarction; Lung Diseases; Lymphatic System; Metabolic Diseases; Mycoses; Nocardia Infections; Pathology; Periodontal Diseases; Rodentia; Skin Ulcer; Thoracic Surgery; Toxicology; United Kingdom

Topics: Amphotericin B; Antigen-Antibody Reactions; Child; Complement Fixation Tests; Drug Therapy; Fungi; Histoplasmosis; Humans; Infant; Lung Diseases; Lung Diseases, Fungal; Pathology; Radiography, Thoracic; Skin Tests; Sulfanilamide; Sulfanilamides; Sulfonamides

Topics: Amphotericin B; Child; Drug Therapy; Histoplasmosis; Humans; Infant; Lung Diseases; Lung Diseases, Fungal; Radiography, Thoracic; Sulfonamides; Tuberculosis; Tuberculosis, Pulmonary

Topics: Amphotericin B; Complement Fixation Tests; Diagnosis, Differential; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Pathology; Radiography, Thoracic; Skin Tests; Toxicology

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

Topics: Amphotericin B; Coccidioidomycosis; Diagnosis, Differential; Drug Therapy; Humans; Infant; Lung Diseases; Lung Diseases, Fungal; Pathology; Prognosis; Radiography, Thoracic; Serologic Tests; Skin Tests; Toxicology; Tuberculosis; Tuberculosis, Miliary

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; Aspergillosis; Bronchi; Bronchography; Catheterization; Drug Therapy; Drug Tolerance; Geriatrics; Humans; Iodides; Lung Diseases; Lung Diseases, Fungal; Microbiology; Sputum

Topics: Amphotericin B; Aspergillosis; Bronchoscopy; Chloramphenicol; Datura stramonium; Iodides; Isoniazid; Lung Diseases; Nystatin; Penicillin G; Penicillin G Procaine; Pneumonectomy; Potassium Iodide; Procaine; Pulmonary Aspergillosis; Radiography, Thoracic; Stilbamidines; Streptomycin; Thoracoplasty; Toxicology

Topics: Amphotericin B; Cryptococcosis; Humans; Lung Diseases; Lung Diseases, Fungal; Pneumonectomy

Topics: Amphotericin B; Cryptococcosis; Humans; Injections, Intraventricular; Lung Diseases; Lung Diseases, Fungal; Meningitis; Pathology; Radiography, Thoracic

Topics: Amphotericin B; Biopsy; Candidiasis; Chlorambucil; Diagnosis, Differential; Hodgkin Disease; Humans; Lung Diseases; Lung Diseases, Fungal; Pneumonia; Pneumonia, Pneumococcal; Prednisone; Radiography, Thoracic; Vancomycin

Topics: Agglutination; Amphotericin B; Animals; Antigens; Antigens, Fungal; Blood; Body Fluids; Central Nervous System Diseases; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus; Cryptococcus neoformans; Fluorescent Antibody Technique; Hodgkin Disease; Latex Fixation Tests; Lung Diseases; Microspheres; Rabbits; Research; Rubber

Topics: Amphotericin B; Aspergillosis; Diagnosis, Differential; Humans; Lung Diseases; Lung Diseases, Fungal; Microbiology; Nystatin; Radiography, Thoracic; Tuberculosis; Tuberculosis, Pulmonary

Topics: Amphotericin B; Bronchoscopy; Complement Fixation Tests; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Pneumonectomy; Postoperative Complications; Skin Tests; Sputum

Topics: Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Humans; Lung Diseases; Lung Diseases, Fungal; Nervous System Diseases; Neurologic Manifestations; Peripheral Nervous System Diseases; Poisoning; Toxicology

Topics: Actinomycosis; Amphotericin B; Anti-Bacterial Agents; Blastomycosis; Coccidioidomycosis; Cryptococcosis; Fungi; Histoplasmosis; Humans; Lung Diseases; Lung Diseases, Fungal; Nocardia Infections; Penicillins; Radiography, Thoracic; Sulfadiazine; Thoracic Diseases

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Echinococcosis; Fungicides, Industrial; Lung Diseases; Medical Records

Topics: Amphotericin B; Antifungal Agents; Drug-Related Side Effects and Adverse Reactions; Fungicides, Industrial; Lung Diseases; Mycoses

Topics: Amphotericin B; Antifungal Agents; Fungicides, Industrial; Histoplasmosis; Lung Diseases

Topics: Amphotericin B; Antifungal Agents; Coccidioidomycosis; Fungicides, Industrial; Lung Diseases

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Fungicides, Industrial; Humans; Lung Diseases

Topics: Amphotericin B; Antifungal Agents; Follow-Up Studies; Histoplasmosis; Humans; Lung Diseases

Topics: Amphotericin B; Antifungal Agents; Disease; Histoplasmosis; Humans; Lung Diseases; Medical Records; Mononuclear Phagocyte System

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Lung Diseases; Pneumonia