amphotericin-b and Mediastinitis

Infection with Histoplasma capsulatum occurs commonly in areas in the Midwestern United States and Central America, but symptomatic disease requiring medical care is manifest in very few patients. The extent of disease depends on the number of conidia inhaled and the function of the host's cellular immune system. Pulmonary infection is the primary manifestation of histoplasmosis, varying from mild pneumonitis to severe acute respiratory distress syndrome. In those with emphysema, a chronic progressive form of histoplasmosis can ensue. Dissemination of H. capsulatum within macrophages is common and becomes symptomatic primarily in patients with defects in cellular immunity. The spectrum of disseminated infection includes acute, severe, life-threatening sepsis and chronic, slowly progressive infection. Diagnostic accuracy has improved greatly with the use of an assay for Histoplasma antigen in the urine; serology remains useful for certain forms of histoplasmosis, and culture is the ultimate confirming diagnostic test. Classically, histoplasmosis has been treated with long courses of amphotericin B. Today, amphotericin B is rarely used except for severe infection and then only for a few weeks, followed by azole therapy. Itraconazole is the azole of choice following initial amphotericin B treatment and for primary treatment of mild to moderate histoplasmosis.

Topics: Amphotericin B; Antifungal Agents; Central Nervous System Diseases; Endocarditis; Histoplasmosis; Humans; Lung Diseases, Fungal; Mediastinitis

Reported here is a case of mediastinitis caused by Aspergillus fumigatus and Staphylococcus epidermidis following a heart transplantation that was successfully treated with amphotericin B in combination with new antifungal drugs (caspofungin and voriconazole), antibiotics and superficial wound drainage. A review of the literature revealed that Aspergillus as a cause of mediastinitis has been rarely described. In the few existing reports, evolution was generally fatal, especially in immunocompromised patients, despite treatment with antifungal drugs and surgery.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Caspofungin; Echinocandins; Female; Heart Transplantation; Humans; Lipopeptides; Mediastinitis; Middle Aged; Peptides, Cyclic; Pyrimidines; Surgical Wound Infection; Triazoles; Voriconazole

Fenestrated Fontan operation was performed in a 19-year-old male with a diagnosis of right isomerism syndrome. Postoperatively, fungal endocarditis due to Candida Albicans and mediastinitis by Methicilin resistant Staphylococcus Aureus (MRSA) occurred. For Candida endocarditis, combined surgery and medical treatment with amphotericin B was effective. MRSA mediastinitis was successfully treated by continuous closed irrigation with 0.5% povidone-iodine solution. This is the 17th reported case of fungal endocarditis after open heart surgery in Japanese literature.

Topics: Adult; Amphotericin B; Candidiasis; Cardiac Surgical Procedures; Endocarditis; Heart Atria; Humans; Male; Mediastinitis; Methicillin Resistance; Postoperative Complications; Pulmonary Artery; Staphylococcal Infections; Staphylococcus aureus

Topics: Adult; Amphotericin B; Cellulitis; COVID-19; Debridement; Fatal Outcome; Humans; Male; Mediastinitis; Mediastinum; Mucormycosis; Respiratory Insufficiency; SARS-CoV-2; Thoracic Wall; Tomography, X-Ray Computed

Mediastinitis is a serious complication after cardiac surgery. While bacteria are the more common pathogens, fungal infections are rare. In particular, several cases of postoperative Aspergillus mediastinitis have been reported, the majority of which had an extremely poor outcome.. A case of mediastinitis in a 42-year-old patient due to Aspergillus fumigatus after cardiac surgery is described. Two main risk factors were found: cardiogenic shock requiring veno-arterial extracorporeal life support and failure of primary closure of the sternum. A full recovery was attained after surgical drainage and antifungal therapy with liposomal amphotericin B, followed by a combination of voriconazole and caspofungin. The patient was followed for 18 months without relapse.. This is an extremely rare case of postoperative Aspergillus mediastinitis exhibiting a favourable outcome. Based on a systematic review of the literature, previous cases were examined with a focus on risk factors, antifungal therapies, and outcomes.. The clinical features of postoperative Aspergillus mediastinitis may be paucisymptomatic, emphasizing the need for a low index of suspicion in cases of culture-negative mediastinitis or in indolent wound infections. In addition to surgical debridement, the central component of antifungal therapy should include amphotericin B or voriconazole.

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Cardiac Surgical Procedures; Caspofungin; Echinocandins; Female; Humans; Lipopeptides; Mediastinitis; Voriconazole

A 55-year-old woman was admitted for orthotopic heart transplantation. Her medical history was notable for multiple cardiovascular problems, including ischemic cardiomyopathy that necessitated circulatory support with a left ventricular assist device. Five weeks after undergoing orthotopic heart transplantation, she developed Aspergillus calidoustus mediastinitis, for which she underwent a prolonged course of antifungal treatment that comprised (in sequence) posaconazole for 11 days, voriconazole for 10 days, and amphotericin B for 42 days. During this period, she also underwent repeated mediastinal drainage and sternal débridement, followed by sternal wiring and coverage with bilateral pectoralis advancement flaps. Four months postoperatively, she was discharged from the hospital with a successfully controlled infection and a healed sternum. To our knowledge, only 3 previous cases of Aspergillus mediastinitis after orthotopic heart transplantation have been reported in the literature, none of which was Aspergillus calidoustus.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Combined Modality Therapy; Debridement; Drainage; Drug Administration Schedule; Drug Therapy, Combination; Female; Heart Transplantation; Humans; Mediastinitis; Middle Aged; Reoperation; Surgical Flaps; Surgical Wound Infection; Time Factors; Treatment Outcome; Triazoles; Voriconazole

Trichoderma longibrachiatum is an emerging pathogen in immunocompromised patients. We report a case of Trichoderma post-operative mediastinitis and peritonitis in a child with complex congenital cardiac disease and functional asplenia. The patient was treated unsuccessfully, initially with caspofungin alone followed by a combination of voriconazole (systemic and topical), caspofungin and intraperitoneal amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Caspofungin; Child, Preschool; Echinocandins; Fatal Outcome; Female; Heart Defects, Congenital; Humans; Immunocompromised Host; Lipopeptides; Mediastinitis; Mycoses; Peritoneal Dialysis; Peritonitis; Postoperative Complications; Pyrimidines; Spleen; Triazoles; Trichoderma; Voriconazole

Post-sternotomy infectious complications, including superficial and deep wound infections, sternal osteomyelitis and mediastinitis, are rarely caused by fungi. Trichosporon asahii is the main Trichosporon species that causes systemic infection in humans. Most cases involved neutropenic patients with hematologic malignancies. We report a unique case of a non-cancer, non-neutropenic but severely ill patient who developed an ultimately lethal T. asahii infection after sternotomy. We speculate that our patient had been colonized with the fungus and his surgical site infection may have been related to his emergency revascularization surgery. Therapy with liposomal amphotericin failed to sterilize the bloodstream despite in vitro susceptibility results. The addition of voriconazole helped sterilizing the bloodstream without changing the outcome. Physicians must be aware of the continuously expanding spectrum of infections with this emerging difficult-to-treat fungal pathogen.

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Fatal Outcome; Humans; Male; Mediastinitis; Mycoses; Osteomyelitis; Sepsis; Sternotomy; Surgical Wound Infection; Trichosporon

Descending mediastinitis occurs as a complication of oropharyngeal or cervical infections and its delayed diagnosis and treatment are associated with high mortality. A rare case of an odontogenic infection in a diabetic patient, complicated by Candida parapsilosis and Candida krusei parapharyngeal space infection, descending mediastinitis and aspiration pneumonia is described. Isolate identification was based on colonial and microscopic morphological characteristics and carbohydrate assimilation test results. The patient was successfully treated with surgical drainage and debridement, broad spectrum antibacterials and liposomal amphotericin B followed by prolonged oral voriconazole therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis, Oral; Diabetes Mellitus, Type 2; Female; Humans; Mediastinitis; Opportunistic Infections; Pyrimidines; Triazoles; Voriconazole

Topics: Administration, Oral; Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Diagnosis, Differential; Fibrosis; Follow-Up Studies; Glucocorticoids; Humans; Itraconazole; Male; Mediastinal Diseases; Mediastinitis; Mediastinum; Radiography, Thoracic; Time Factors; Tomography, X-Ray Computed; Treatment Outcome

We report the case of a 22-month-old immunocompetent male child with fibrosing mediastinitis secondary to zygomycosis, an unusual presentation of a rare fungal infection. This patient was successfully treated with amphotericin B and itraconazole for 20 weeks. Stenting of the superior vena cava was helpful in relieving the patient's superior vena cava syndrome.

Topics: Amphotericin B; Antifungal Agents; Fibrosis; Humans; Infant; Itraconazole; Male; Mediastinitis; Stents; Superior Vena Cava Syndrome; Treatment Outcome; Zygomycosis

Topics: Amphotericin B; Fungi; Histocytochemistry; Humans; Infant; Male; Mediastinitis; Mucormycosis; Mycoses