amphotericin-b and Lymphoma--B-Cell

Blastoschizomyces capitatus is a rare fungal pathogen that may lead to severe and fatal systemic infections especially in immunosuppressive individuals. B.capitatus strains have also been reported as the cause of hospital-acquired infections and outbreaks. In this report, three fungemia cases caused by B.capitatus with hematologic malignancies have been presented. The first case was a 20-year-old female with acute lymphoblastic leukemia, the second was a 26-year-old female with B-cell malignant lymphoma and the third was a 7-year-old male with B-cell acute lymphoblastic leukemia. All of the patients have been receiving chemotherapy, and treated with antibacterial and antifungal agents due to neutropenia. The blood cultures obtained from the second and third patients yielded B.capitatus although they were under empirical caspofungin therapy. Those patients have been treated with voriconazole and amphotericin B after the identification of B.capitatus, and clinical improvement were noted during their follow-up. However the first patient who was also under caspofungin therapy had died just before the isolation of B.capitatus from her blood culture. Conventional mycological methods [macroscopic and microscopic morphology, germ tube test, urea hydrolysis, carbohydrate assimilation tests (API 20C AUX; BioMerieux, France), growth temperature, cycloheximide sensitivity] were used for the identification of the isolates. The strains were identified as B.capitatus with the characteristics of annelloconidia formation, urease negativity, carbohydrate utilization, growth at 45°C and resistance to cycloheximide. Antifungal susceptibilities of isolates were determined by using microdilution method (for amphotericin B, fluconazole, itraconazole, voriconazole, ketoconazole) and E-test (for caspofungin). Minimum inhibitory concentration (MIC) values of the three B.capitatus strains were detected as 0.25, 0.125, 0.032 µg/ml for amphotericin B; 2, 2, 16 µg/ml for fluconazole; 0.064, 0.032, 0.032 µg/ml for itraconazole and 0.125, 0.064, 0.064 µg/ml for ketoconazole, respectively, while MIC values of all strains were 0.032 µg/ml for voriconazole and > 32 µg/ml for caspofungin. Since B.capitatus strains were isolated from the cases within about 15 days -sequentially-, the genotypes of the isolates were determined by repetitive sequence-based PCR (DiversiLab System; BioMerieux, France) to investigate the similarity rates. The results of analysis indicated 97% similarity between tw

Topics: Adult; Amphotericin B; Antifungal Agents; Caspofungin; Child; Echinocandins; Female; Fungemia; Humans; Immunocompromised Host; Lipopeptides; Lymphoma, B-Cell; Male; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Pyrimidines; Saccharomycetales; Triazoles; Voriconazole; Young Adult

Primary invasive mold infection of the oral cavity is a rare but serious complication in immunocompromised hosts. We report a case of fatal Trichoderma longibrachiatum stomatitis in a 66-year-old female patient with malignant lymphoma. The infection rapidly disseminated from the oral mucosa to the lungs during neutropenia. Despite intensive antifungal therapy with amphotericin B and itraconazole, there was a fatal progression of the condition. While Trichoderma species have been recognized to be pathogenic in profoundly immunosuppressed hosts, this is the first report of the primary oral focus causing a fatal infection.

Topics: Aged; Amphotericin B; Antifungal Agents; Disease Progression; Fatal Outcome; Female; Gingivitis, Necrotizing Ulcerative; Humans; Immunocompromised Host; Itraconazole; Lung Diseases, Fungal; Lymphoma, B-Cell; Lymphoma, Large B-Cell, Diffuse; Mycoses; Neutropenia; Opportunistic Infections; Stomatitis; Trichoderma

A 35-year-old man with B lymphoblastic lymphoma was treated with bone marrow transplant and aggressive chemotherapy. He developed a Fusarium infection of the great toenail. Septicemic dissemination of a Fusarium sp. occurred 9 months later during a lymphoma relapse. The clinical course of the hyalohyphomycosis was then rapidly fatal despite institution of amphotericin B therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Bone Marrow Transplantation; Fatal Outcome; Foot Dermatoses; Fungemia; Fusarium; Humans; Immunocompromised Host; Lymphoma, B-Cell; Male; Mycoses; Neoplasm Recurrence, Local; Onychomycosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma

A 13-year-old Moroccan boy in The Netherlands developed fever and a lesion resembling ecthyma gangrenosum on the abdomen during cytostatic drug treatment for a lymphoblastic B-cell lymphoma. Scytalidium dimidiatum was cultured from blood and the abdominal skin lesion. The patient was successfully treated with amphotericin B. The fungus Scytalidium dimidiatum is a fairly common plant pathogen in tropical and subtropical countries and is known to cause dermatomycoses in humans in these areas. This case demonstrates that it is necessary to be aware that immigrants from these areas can import their own fungal flora, some members of which may cause life-threatening disease in the case of patients with immune suppression.

Topics: Adolescent; Amikacin; Amphotericin B; Ceftazidime; Drug Therapy, Combination; Humans; Immunocompromised Host; Lymphoma, B-Cell; Male; Mitosporic Fungi; Morocco; Mycoses; Netherlands; Neutropenia; Vancomycin

A case of candida meningitis occurring in a child treated for a lymphoma is reported. Diagnosis was made with Candida albicans culture in the CSF. Blood cultures were negative. Cerebral CT scan was normal. No other localization was found. The child was successfully treated by amphotericin B (initially with 5-fluorocytosin). Fluconazole was continued orally later on. This case is noteworthy by the absence of other localization, the favourable evolution and its occurrence in childhood. The therapeutic attitude and prevention are discussed.

Topics: Abdominal Neoplasms; Adolescent; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Candidiasis; Fluconazole; Follow-Up Studies; Humans; Immunosuppression Therapy; Lymphoma, B-Cell; Male; Meningitis; Neoplasm Recurrence, Local

Mucormycosis is a rare infection that occurs in immunocompromised patients. The rhinocerebral form presents in diabetics as a severe necrotizing sinusitis and is not frequent in patients with haematologic malignancies. Diagnosis requires direct examination and culture of biopsy specimens. Two patients with rhinocerebral mucormycosis and haematologic neoplasms (Non-Hodgkin's lymphoma and acute myeloblastic leukaemia) are described. Both patients had severe drug-induced neutropenia when the infection appeared. One patient died in spite of aggressive treatment with surgery and amphotericin.

Topics: Aged; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Female; Humans; Leukemia, Myeloid, Acute; Lymphoma, B-Cell; Middle Aged; Mucormycosis; Osteitis; Sinusitis; Skull