amphotericin-b and Mouth-Diseases

The worldwide prevalence of leishmaniasis is increasing because of ecologic changes and increased medical profession awareness. Furthermore, solitary cases have been recently reported in Western countries. The authors describe the epidemiology, mode of transmission, and diagnosis of leishmaniasis and present 4 oral cases treated with systemic, localized, or combined therapy. The authors suggest that clinicians should maintain a high index of suspicion for atypical, resistant, oral and perioral lesions in individuals with a history of traveling in certain geographic regions. After diagnosis, treatment should be determined jointly by experts from the fields of oral and maxillofacial surgery, oral medicine, and dermatology based on leishmaniasis species and clinical presentation.

Topics: Adolescent; Adult; Aged; Amphotericin B; Animals; Antimony Sodium Gluconate; Antiprotozoal Agents; Diagnosis, Differential; Endemic Diseases; Female; Humans; Leishmania braziliensis; Leishmania infantum; Leishmania major; Leishmaniasis; Leishmaniasis, Cutaneous; Lip Diseases; Male; Mouth Diseases; Young Adult

Topics: Acyclovir; Aged; Amphotericin B; Antifungal Agents; Antiviral Agents; Aspergillosis; Fatal Outcome; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Mouth Diseases; Paranasal Sinus Diseases; Pyrimidines; Triazoles; Voriconazole

The deep mycoses are uncommon infections, usually acquired from the inhalation or ingestion of fungal spores, sometimes from the soil in areas of endemicity, such as in the Americas and south-east Asia, or from decaying vegetable matter. They are also seen in immunocompromised persons and, increasingly, in HIV-infected persons. Respiratory involvement is frequent, with granuloma formation, and mucocutaneous involvement may be seen. Oral lesions of the deep mycoses are typically chronic but non-specific, though nodular or ulcerative appearances are common. Person-to-person transmission is rare. In HIV disease, the most common orofacial involvement of deep mycoses has been in histoplasmosis, cryptococcosis, aspergillosis and zygomycosis. Diagnosis is usually confirmed by lesional biopsy although culture may also be valuable. Treatment is with amphotericin or an azole.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Aspergillosis; Azoles; Cryptococcosis; Female; Histoplasmosis; HIV Infections; Humans; Lung Diseases, Fungal; Male; Middle Aged; Mouth Diseases; Mucormycosis; Mycoses; Sinusitis

Mucormycosis (phycomycosis, zygomycosis) is an acute opportunistic infection caused by a saprophytic fungus found in soil, bread molds, and decaying fruits and vegetables. Numerous predisposing risk factors are associated with mucormycosis, although most cases have been reported in poorly controlled diabetics or in patients with hematologic malignant conditions. This report presents two cases of oral mucormycosis. One case occurred in the maxilla in a patient with well-controlled diabetes. The other involved the mandible and overlying gingiva in a patient with acute myelogenous leukemia. A review of the literature concerning oral mucormycosis is also presented.

Topics: Adult; Aged; Amphotericin B; Candidiasis, Oral; Diabetes Complications; Gingival Diseases; Humans; Leukemia, Myeloid, Acute; Male; Mandibular Diseases; Maxillary Diseases; Mouth Diseases; Mucormycosis

The deep mycoses are increasing in importance both as opportunistic infections and from exposure in geographically defined areas. Diagnosis may be difficult in both groups. Mucosal involvement may be non-specific (e.g., in disseminated candidiasis) or highly predictive of disseminated disease (e.g., histoplasmosis, blastomycosis and paracoccidioidomycosis). Skin involvement is generally uncommon in disseminated aspergillosis, mucormycosis and cryptococcosis but is more common in candidemia and coccidioidomycosis. Manifestations of mucosal and cutaneous lesions of the deep mycoses are reviewed and the need for an aggressive diagnostic approach stressed. Culture is more specific than histopathologic examination alone but the latter may have to suffice in some cases. Control of underlying disease and administration of amphotericin B remain the mainstays of therapy. Ketoconazole is being evaluated as an alternative in therapy of some deep mycoses.

Topics: Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis; Candidiasis, Cutaneous; Coccidioidomycosis; Cryptococcosis; Dermatomycoses; Flucytosine; Histoplasmosis; Humans; Immunosuppression Therapy; Ketoconazole; Miconazole; Mouth Diseases; Mouth Mucosa; Mucormycosis; Mycoses; Paracoccidioidomycosis; Sporotrichosis; Travel

Topics: Amphotericin B; Antifungal Agents; Asymptomatic Infections; COVID-19; Diabetes Mellitus, Type 2; Female; Humans; Middle Aged; Mouth Diseases; Mucormycosis; Palate, Hard; Rhizopus; SARS-CoV-2

Topics: Adult; Amphotericin B; Antifungal Agents; Debridement; Drug Substitution; Humans; Male; Mouth Diseases; Mucormycosis; Nose Diseases; Orbital Diseases; Palate; Pancytopenia; Triazoles

Midline destructive lesions have multiple possible etiologies, which can be grouped into neoplastic, infectious, or vasculitis-associated. The purpose of these case reports and literature review was to highlight the need to include mucocutaneous leishmaniasis in the diagnosis of midfacial lesions in any patient who has lived in Leishmania-endemic areas because this entity meets all of the clinical criteria to be considered a form of midline destructive lesion. We present two cases of mucocutaneous leishmaniasis that occurred in a Bolivian male immigrant and a European male traveler to Panama, in whom lesions were misdiagnosed as different midline destructive lesions with different causes (Wegener, vasculitis, and natural killer or T-cell lymphoma [NKTL]). The conclusion of our work is that all patients with midline destructive lesions should undergo histologic and molecular studies to be evaluated for mucosal leishmaniasis, particularly patients whose clinical history suggests this possibility. In cases of uvular involvement, biopsy of this region might be a possible alternative to nasal biopsy.

Topics: Adult; Aged; Amphotericin B; Antiprotozoal Agents; Combined Modality Therapy; Diagnosis, Differential; Humans; Leishmaniasis, Mucocutaneous; Male; Meglumine; Meglumine Antimoniate; Mouth Diseases; Nose Diseases; Organometallic Compounds

Primary mucosal leishmaniasis is a rare infectious disease, particularly in immunocompetent patients. We present a 50-year-old patient with a 6-week history of a painful lesion of the left buccal mucosa that mimicked cancer. The exophytic lesion looked invasive, and we took an incisional biopsy specimen to exclude cancer. The diagnosis of leishmaniasis was unexpected, and the patient was successfully treated with amphotericin B for five weeks. After five months the patient had a visceral recurrence. Chronic exophytic and ulcerated mucosal lesions that do not heal within 3-4 weeks should be regarded as the first signs of oral cancer, but primary oral leishmaniasis can easily mimic it.

Topics: Amphotericin B; Antiprotozoal Agents; Diagnosis, Differential; Follow-Up Studies; Humans; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Mouth Diseases; Mouth Mucosa; Mouth Neoplasms; Recurrence

During a research project on fungal Candida species in patients wearing obturator treated with radiotherapy for their recurrent nasopharyngeal carcinoma, we serendipitously observed the presence of black fungus in two consecutive samples from a patient.. The samples were collected from a 57 year-old Hong Kong gentleman who diagnosed to have undifferentiated type of nasopharyngeal carcinoma. He was treated with definitive concurrent chemoradiotherapy followed by adjuvant chemotherapy and then received a second-course radiotherapy with IMRT. 18S rDNA sequencing revealed that the isolates belong to Exophiala dermatitidis which was susceptible to fluconazole, itraconazole, ketoconazole and voriconazole. Interestingly, E. dermatitidis isolates were resistant to caspofungin and one isolate was resistant to amphotericin B. Both isolates formed biofilms comparable to that of Candida albicans. Single isolate of E. dermatitidis showed hemolysin and proteinase ability comparable to C. albicans whilst the other isolate was not.. We, for the first time, reported the discovery of a black fungus-E. dermatitidis isolates derived from a patient with nasopharyngeal carcinoma treated with radiotherapy. These isolates were shown to be resistant to caspofungin, a major antifungal agent for systemic candidiasis. As little is known about the black fungus in the clinical setting, it is important that clinicians must keep abreast of the new discovery in this field.

Topics: Amphotericin B; Antifungal Agents; Biofilms; Carcinoma; Caspofungin; Chemoradiotherapy; Chemotherapy, Adjuvant; Drug Resistance, Fungal; Echinocandins; Exophiala; Fluconazole; Humans; Immunocompromised Host; Itraconazole; Ketoconazole; Lipopeptides; Male; Middle Aged; Mouth Diseases; Nasopharyngeal Neoplasms; Neoplasm Recurrence, Local; Opportunistic Infections; Phaeohyphomycosis; Radiotherapy, Intensity-Modulated; Voriconazole

In comparison to the range of antibiotics used in medicine, the spectrum of antifungal and antiviral drugs used in primary dental care is relatively limited. In practical terms, there are only three antifungal agents and two antiviral agents that have a role. This paper will describe the clinical presentation of orofacial candidal and viral infections and the use of antimicrobial drugs in their management.

Topics: Acyclovir; Amphotericin B; Antifungal Agents; Antiviral Agents; Candidiasis, Oral; Cheilitis; Dental Care; Fluconazole; Glossitis; Guanine; Herpes Zoster; Humans; Miconazole; Mouth Diseases; Nystatin; Primary Health Care; Stomatitis, Herpetic

Rhinocerebral mucormycosis (RCM) is a rare, fulminating opportunistic fungal infection caused by a fungus of order Mucorales. These fungi are ubiquitus, subsisting on decaying vegetation and diverse organic material. Although fungi and spores of Mucorales show minimal intrinsic pathogenicity towards normal person, they can initiate aggressive and fulminating infection in immunocompromised host. Since RCM occurs infrequently, it may pose a diagnostic and therapeutic dilemma for those who are not familiar with its clinical presentation.. We present a patient with classical presentation of RCM involving paranasal sinuses, orbit, and cranial base who was treated by combination of aggressive surgical and medical therapy.. The purpose of this paper is to draw attention to the clinical presentation and pathogenesis of RCM and to emphasize need for high index of suspicion in diagnosis and treatment.

Topics: Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Diabetic Ketoacidosis; Fatal Outcome; Female; Humans; Infusions, Intravenous; Lip Diseases; Maxilla; Middle Aged; Mouth Diseases; Mucormycosis; Nose; Nose Diseases; Opportunistic Infections; Orbital Diseases; Paranasal Sinus Diseases; Tomography, X-Ray Computed

The term leishmaniasis comprises a group of diseases caused by different protozoan species of the genus Leishmania. There are three main clinical forms of leishmaniasis: visceral, cutaneous and mucocutaneous. Exclusive involvement of the mucosa is very rare.. To present a case of mucocutaneous leishmaniasis in an elderly patient, discuss the clinical presentation, diagnostic process and treatment emphasizing the distinctions from other granulomatous lesions.. A 71-year-old male presenting with a symptomatic lesion on the hard and soft palate, which had developed over a period of 6 months was evaluated. The oral exam revealed a lesion with multiple ulcerated nodules on the hard and soft palate extending to the oropharynx. The diagnostic hypothesis was chronic infectious disease (paracoccidioidomycose, tuberculosis and leishmaniasis) or squamous cell carcinoma. Histopathological, histochemical and immunohistochemical analysis were performed. A chest x-ray revealed a normal pulmonary pattern. The Montenegro skin test was positive. The definitive diagnosis was leishmaniasis with exclusive oral manifestation and the patient was treated with liposomal amphotericin.. Localized oral mucosa leishmaniasis is an uncommon event in an immunocompetent patient. Dentists play an important role in the diagnosis of oral leishmaniasis, which has systemic repercussions.

Topics: Aged; Amphotericin B; Antiprotozoal Agents; Carcinoma, Squamous Cell; Diagnosis, Differential; Follow-Up Studies; Humans; Immunohistochemistry; Leishmaniasis; Male; Mouth Diseases; Mouth Neoplasms; Oral Ulcer; Palate, Hard; Palate, Soft; Paracoccidioidomycosis; Tuberculosis, Oral

Mucosal leishmaniasis (ML) is an oral disease caused by the parasite Leishmania donovani. The disease has been proven to be pandemic in many areas of the world. It affects young men living in leishmaniasis-endemic areas. ML might be accompanied or proceeded by visceral leishmaniasis (VL), although in most of the cases seen in Sudan, ML occurs as a primary lesion. ML can mimic oral cancer or fungal infections, with ulceration as the most common finding in ML lesions. In this report, the patient came from an area known to be endemic for VL. Although the lesions were not ulcerative, the patient history was indicative for ML. Early detection and proper diagnosis were of great help in the cure and prognosis of the disease.

Topics: Amphotericin B; Antiprotozoal Agents; Chlorhexidine; Humans; Leishmaniasis; Male; Middle Aged; Mouth Diseases; Mouthwashes; Sudan

To present a clinical report of palatal zygomycosis, its epidemiological, mycological features, and our treatment experience.. Retrospective report.. This is a 25-year long retrospective trial of clinically and mycologically proven cases of zygomycosis. Some patients underwent a biopsy of the palatal lesion and autopsy. This study reports the treatment experience with amphotericin B alone and in combination with itraconazole and fluconazole.. Twenty-one cases (18.75%) of zygomycosis with palatal involvement were included in the study, from a total of 112 cases screened. Mean age was 36.5 years, with 18 adults and three children. The associated pre-disposing factors were: ketoacidotic diabetes (five type-1 and 15 type-2), and acute leukaemia in one patient. The clinical varieties were as follows: 19 cases of rhinocerebral (RC) involvement and two disseminated cases. Palatal ulcers occurred in 3/21 early cases (14.3%) and in 16/21 cases after the nasal involvement. All patients received amphotericin B; in four patients, it was combined with itraconazole and four with fluconazole. Clinical and mycological cure was achieved in 4/21 patients (19.04%).. Zygomycosis with palatal involvement occurs in around 18% of cases, usually associated with RC modalities; it has an acute and generally lethal course.

Topics: Absidia; Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Child; Diabetic Ketoacidosis; Drug Combinations; Female; Fluconazole; Humans; Itraconazole; Male; Mouth Diseases; Mucormycosis; Nose Diseases; Opportunistic Infections; Oral Ulcer; Palate; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Rhizopus; Treatment Outcome; Zygomycosis

A 58 year old male, chronic smoker, with diabetes mellitus (Type II), residing in Madhya Pradesh presented with dysphagia, hoarseness, odynophagia and significant weight loss. Microlaryngoscopy showed reddish ulcerated area involving valleculae, and pharyngo-epiglottic fold. Histopathological examination showed foamy macrophages containing Histoplasma capsulatum. Patient initially responded to Azoles, relapsed three months after stopping the treatment and presented with oral lesions. Biopsy showed H. capsulatum, histologically as well as on culture. The mycelial phase converted to yeast phase on B.H.I.A. at 37 degrees C confirming the isolate as H. capsulatum. The patient responded well to amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Disease Progression; Histoplasma; Histoplasmosis; Humans; Laryngeal Diseases; Laryngoscopy; Larynx; Male; Middle Aged; Mouth Diseases; Recurrence

Topics: Adolescent; Adult; Alternaria; Amphotericin B; Antifungal Agents; Chronic Disease; Deoxycholic Acid; Drug Combinations; Female; Humans; Mouth Diseases; Mycoses; Treatment Outcome; Triazoles

A case of mucormycosis causing palatal necrosis and orbital apex syndrome is reported successfully treated with systemic antifungal therapy, surgical debridement and control of underlying disease process. After one year of follow-up patient is blind with anatomically preserved right eye and ptosis as well as having palatal obturator. Mucormycosis should be considered in differential diagnosis of palatal necrosis and orbital apex syndrome.

Topics: Adult; Amphotericin B; Combined Modality Therapy; Debridement; Follow-Up Studies; Humans; Infusions, Intravenous; Male; Mouth Diseases; Mucormycosis; Necrosis; Orbital Diseases; Palate; Risk Assessment; Severity of Illness Index; Syndrome; Treatment Outcome

The in vitro susceptibility of 618 Candida isolates to fluconazole, itraconazole, voriconazole, ketoconazole, miconazole, amphotericin B, and nystatin was determined. The isolates were obtained from 559 patients who had attended the UK dental hospital departments in Cardiff, Belfast, Glasgow or London. Antifungal susceptibility was assessed using a broth microdilution method following the National Committee for Clinical Laboratory Standards (NCCLS) M27-A guidelines. The majority of the test strains were C. albicans (n = 521) with few of these being resistant to fluconazole (0.3%). A low incidence of fluconazole resistance (0-6.8%) was similarly evident with all non albicans species (Candida glabrata, 5 of 59 resistant; Candida krusei, 0 of 7 resistant; Candida tropicalis, 0 of 13 resistant; Candida parapsilosis, 0 of 12 resistant; other Candida species, 0 of 6 resistant). Voriconazole, ketoconazole, and miconazole also revealed high activity against both C. albicans and non albicans isolates, and 23.7% of C. glabrata isolates were found to be resistant to itraconazole. There was little difference in the antifungal susceptibilities of Candida isolated from patients who had a history of previous antifungal therapy compared with those who had not received antifungal treatment. In summary, this surveillance study of antifungal susceptibility of oral candidal isolates in the UK, through the collaboration of four dental hospitals, demonstrates that oral Candida species have a high level of susceptibilities to a range of antifungal agents.

Topics: Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida glabrata; Candida tropicalis; Candidiasis, Oral; Drug Resistance, Fungal; Fluconazole; Humans; Itraconazole; Ketoconazole; Miconazole; Mouth Diseases; Nystatin; Pyrimidines; Triazoles; Voriconazole

We report 10 cases of histoplasmosis with oral manifestations seen in a teaching hospital in Brazil.. This is a retrospective study of the sociodemographic, clinicopathologic, and treatment data of these cases.. Overall, 8 of 10 cases were seropositive for human immunodeficiency virus (HIV), whereas 2 were negative. The predominant oral manifestations found in HIV-seropositive patients were ulcers, oral pain, and odynophagia; both of the HIV-seronegative patients were symptom-free. HIV infection was suspected in 7 cases because of the presence of oral lesions of histoplasmosis. Asthenia, fever, weight loss, lymphadenopathy, and hepatosplenomegaly were found only in HIV-seropositive patients. Radiographs in 3 out of 10 patients suggested pulmonary involvement. Amphotericin B was the antifungal therapy chosen, and clinical remission of oral lesions occurred in an average of 30 days (accumulated doses: 500-1500 mg). Itraconazole was very effective as a follow-up treatment in terms of prevention of recurrence.. Histoplasmosis only rarely affects HIV-seronegative patients; however, the possibility of hidden immunodepression should be considered when oral manifestations of histoplasmosis are present.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Brazil; Female; Histoplasmosis; HIV Seropositivity; Humans; Itraconazole; Male; Middle Aged; Mouth Diseases; Retrospective Studies

A wide spectrum of oral lesions has been associated with human immunodeficiency viral infection (HIV), or AIDS. This report describes the case of an HIV-infected patient who developed a case of disseminated sporotrichosis whose first clinical sign was the presence of orofacial lesions. A histopathological study of this patient's biopsy specimens taken from the oropharyngeal lesions revealed a number of rounded and/or oval free-spore forms of Sporothrix schenkii, the identification of which was corroborated by culturing skin lesion exudate on Sabouraud's glucose agar. To the best of our knowledge to date, this is the first time a case of the oral manifestation of sporotrichosis in association with HIV infection has been described in the dental literature.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Biopsy; Facial Dermatoses; Gingival Hyperplasia; HIV Infections; Humans; Male; Mouth Diseases; Oropharynx; Periodontal Diseases; Pharyngeal Diseases; Sporothrix; Sporotrichosis

The aim of this study was to evaluate the relevance of in vitro antifungal susceptibility to clinical response in neutropenic patients with invasive oral aspergillosis.. Nine isolates of Aspergillus species were obtained from invasive oral infections in 9 patients with hematologic malignancies and tested for their in vitro susceptibility to amphotericin B, fluconazole, miconazole, 5-fluorocytosine, and itraconazole. Minimal inhibitory concentration values of the 5 drugs were obtained for each fungus through use of a microdilution broth method. The patients were treated with intravenous amphotericin B (30-50 mg/day) in combination with oral 5-fluorocytosine (3000-6000 mg/day) and/or oral itraconazole (200 mg/day).. Amphotericin B and itraconazole were found to be very active, with minimal inhibitory concentration values of 0.861 and 0.194 microg/mL, respectively. Miconazole and 5-fluorocytosine showed minimal inhibitory concentration values of 1.72 and 3.56 microg/mL, respectively. On the other hand, fluconazole FCZ showed low activity, with a minimal inhibitory concentration value in excess of 64.0 microg/mL. During neutropenia, combined antifungal chemotherapy stabilized oral aspergillosis and prevented the spread of oral lesions in 8 patients in whom neutrophil counts eventually recovered.. The results imply that in vitro susceptibility testing may serve as an informative parameter with respect to the efficacy of these antifungals in the treatment of invasive oral aspergillosis, inducing fungal stasis until the neutrophils recover.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Aspergillosis; Aspergillus; Drug Combinations; Drug Evaluation; Female; Fluconazole; Flucytosine; Humans; Immunocompromised Host; Itraconazole; Leukemia; Lymphoma; Male; Miconazole; Microbial Sensitivity Tests; Middle Aged; Mouth Diseases; Neutropenia

Topics: Adult; Amphotericin B; Dermatomycoses; Diabetes Complications; Facial Dermatoses; Female; Humans; Mouth Diseases; Mucormycosis; Nose Diseases; Orbital Diseases; Oroantral Fistula; Osteonecrosis; Paranasal Sinus Diseases

A 12-year-old girl had been presenting a woody infiltration and erythema in the frontal region and on the entire left half of the face, leading to deformity of the nose and buccal fissure, and adenomegaly in a posterior cervical chain, for the last 18 months. Sinusitis was diagnosed and treated with antibiotics, and submitted to ethmoid sinusotomy, with no improvement. Several laboratory tests were made to find the correct diagnosis. An intradermal test for delayed hypersensitivity showed a positive reaction (5 mm) with necrosis for metabolic antigens for Conidiobolus. An oral mucosa biopsy showed a dense lymphohistiocytic infiltrate and focal points of necrosis. Gomori staining for fungi revealed countless wide, nonseptate hyphae. Amphotericin B was prescribed during 35 days, with no improvement. Terbinafine given orally was started in association with amphotericin B. Reduction of the lesions was observed 2 months later. No side effects were seen during 4 months of treatment.

Topics: Amphotericin B; Antifungal Agents; Antigens, Fungal; Child; Dermatomycoses; Drug Combinations; Entomophthora; Erythema; Ethmoid Sinusitis; Facial Dermatoses; Female; Humans; Lymphatic Diseases; Mouth Diseases; Naphthalenes; Nose Diseases; Terbinafine

A 59-year-old Caucasian male patient with AIDS is described who presented with an oral lesion of cryptococcosis. The gingival ulceration was the only detectable lesion of cryptococcosis. Diagnosis was established by histopathologic findings from biopsy and detection of serum cryptococcal antigen. The patient was treated with amphotericin B and flucytosine. After four weeks of therapy cryptococcal antigen turned negative. The oral ulceration diminished in size, but an inflammatory tissue reaction persisted.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Cryptococcosis; Dental Care for Chronically Ill; Drug Therapy, Combination; Fatal Outcome; Flucytosine; Gingival Diseases; Humans; Male; Middle Aged; Mouth Diseases; Ulcer

Histoplasmosis is a fungal infection caused by the organism Histoplasma capsulatum. Disseminated disease usually occurs in immunosuppressed patients or in patients with chronic illnesses. Although relatively uncommon, histoplasmosis has been reported in patients with AIDS, and oral lesions have been noted on multiple sites and in various clinical presentations. We present two HIV-positive cases with oral lesions as the initial signs of histoplasmosis. Both patients responded well to IV amphotericin B but later suffered recurrences despite being maintained on systemic antifungal therapy.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Histoplasmosis; HIV Infections; Humans; Ketoconazole; Male; Mouth Diseases

Topics: Aged; Amphotericin B; Chronic Disease; Diagnosis, Differential; Female; Histoplasmosis; Humans; Ketoconazole; Maxillary Diseases; Mouth Diseases; Mouth Neoplasms; Ulcer

Topics: Amphotericin B; Ethmoid Bone; Ethmoid Sinus; Female; Humans; Middle Aged; Mouth Diseases; Mucormycosis; Necrosis; Nose Diseases; Palate; Paranasal Sinus Diseases; Turbinates; Ulcer

The clinicopathologic characteristics of invasive oral aspergillosis in 16 immunocompromised patients who developed this infection during antileukemic chemotherapy are described. The primary site of the infection was the marginal gingiva, there was severe spontaneous pain, and the patients developed spiking fever and granulocytopenia. Necrotic ulceration of the gingiva rapidly extended to the contiguous mucosa, muscle, and bone. Microscopically, the necrotic tissue contained thrombotic vascular infarcts and there were hyphae that showed frequent transverse septa and dichotomous branching. The invasive organisms were not responsive to amphotericin B in the absence of remission of the leukemia and restoration of the depressed host defenses. In 15 patients who showed improvement of hematologic status, oral aspergillosis was controlled by the combination of antifungal chemotherapy and debridement of necrotic tissues.

Topics: Adult; Aged; Agranulocytosis; Amphotericin B; Aspergillosis; Female; Humans; Immunocompromised Host; Leukemia; Male; Middle Aged; Mouth Diseases; Necrosis; Nystatin

Fungal surveillance cultures have been studied as potential predictors of invasive or disseminated mycoses. Several studies have demonstrated that the presence of Candida tropicalis in mucosal surveillance cultures has a high predictive value for invasive fungal infection due to this pathogen in granulocytopenic patients. By comparison, surveillance cultures for Candida albicans have a poor positive predictive value for invasive fungal infection. The value of routine surveillance cultures of the nares for Aspergillus spp. has not been consistently confirmed. The use of surveillance cultures for less common fungal pathogens, such as Trichosporon beigelii, also remains unclear. Fungal surveillance cultures of the inanimate hospital environment have proven useful in identifying the source of conidia in well-defined clusters or outbreaks of nosocomial aspergillosis and other mycoses. As investigational tools, fungal surveillance cultures also may be useful for studying the effects of new antifungal agents on mucosal flora. Fungal surveillance cultures, especially for C. tropicalis and possibly Aspergillus spp. in high-risk populations, may be useful when a pathogen-directed approach to antifungal therapy is used. However, the time required, diagnostic limitations, and expense of routine mucosal fungal surveillance cultures must be balanced against the effect of this information on therapeutic decisions. Empirical antifungal therapy and early diagnostic approaches for high-risk patients may obviate the need for routine fungal surveillance cultures while decreasing the frequency of invasive mycoses.

Topics: Amphotericin B; Bacteria; Fungi; Humans; Mouth Diseases; Mycoses; Neoplasms

Topics: Acyclovir; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Herpes Labialis; Humans; Mouth Diseases; Mycoses; Neoplasms

Aspergillus infection can be a major cause of morbidity in immunocompromised patients, especially when there is pulmonary involvement. Diagnosis of aspergillosis is often complicated by the varied clinical presentation and compromised medical status of such patients. Four cases of head and neck Aspergillus infections in bone marrow transplant patients are presented. Involvement predominantly was limited to the oral cavity and/or sinuses, and in one case, the ear. Two cases were successfully managed with a combined antibiotic and surgical approach, and one case with antibiotics only. The fourth case was managed with antibiotics and surgery, but fatal hemorrhage secondary to sinus involvement developed.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Aspergillus fumigatus; Bone Marrow Transplantation; Child; Female; Humans; Male; Maxillary Sinus; Middle Aged; Mouth Diseases; Otitis; Sinusitis

The diagnosis of acute lymphatic non-T-non-B leukaemia of common ALL type was confirmed in a 22-year-old woman. Cytostatic treatment brought full remission for 21/2 years. Renewed cytostatic treatment for recurrence brought about a mucormycosis in the mid-face region during a period of protracted agranulocytosis, despite antibiotic prophylaxis with ketoconazole and cotrimoxazole. The causative mucor organism was demonstrated in smears and biopsy material. The infection was successfully treated with i.v. amphotericin B and débridement of the affected tissue. There remained large tissue defects in the region of gum, nose, upper lip and right oral cavity. Previously the mortality rate of mucormycosis in the course of leukaemia was 100%.

Topics: Adult; Agranulocytosis; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Debridement; Facial Dermatoses; Female; Gingival Diseases; Humans; Leukemia, Lymphoid; Mouth Diseases; Mucormycosis; Nose Diseases; Palate; Paranasal Sinus Diseases

The presence of yeasts in oral lichen planus (OLP) lesions was studied in cultivations from 41 OLP patients and by histological examination in 39 of these cases. The histological features of OLP were also recorded. The cultivation results were compared with those of a randomly selected, age- and sex-matched control group without mucosal changes. The extent of growth was recorded as "sparse" (1-10 colonies), "model-rate" (11-40 colonies), or "heavy" (greater than 40 colonies). Yeasts were found to be present on cultures or histologic sections from a total of 19 OLP patients (46%). "Moderate-heavy" growth was obtained in 29% of the OLP cases but in only 7% of the control group. Candida albicans accounted for over 80% of the yeasts. The histological examination revealed only 3 cases of invasive fungal growth. Regarding the criteria of OLP, hyperortho- or hyperparakeratosis and a band-shaped subepithelial infiltration of lymphocytes were present in all specimens, basilar liquefaction degeneration in 87% and an eosinophilic zone in 77%. Local treatment with amphotericin B (Fungizone) in 18 OLP patients with positive findings resulted in subjective relief of symptoms in 89% of the patients. Clinical improvement was seen in 94%. The presence of Candida was significantly correlated to low secretion rate in unstimulated saliva.

Topics: Adult; Aged; Amphotericin B; Candida; Candidiasis, Oral; Female; Humans; Lichen Planus; Male; Middle Aged; Mouth Diseases; Saliva; Secretory Rate; Yeasts

The authors present 10 cases of histoplasmosis, 3 due to H. capsulatum, and 7 to H. duboisii. The presenting signs were stomatological or laryngeal with H. capsulatum, and ganglionic, cutaneous, or skeletal with H. duboisii. Diagnosis was confirmed by the discovery of histoplasms in the lesions: 7 times the examination of a needle biopsy sample was positive; in 8 cases out of 10, culture on Sabouraud's medium was positive; in 3 cases out of 4 the inoculated hamster showed the presence of a histoplasmosis. Histological examination of lesions biopsies demonstrated histoplasms in the 9 cases studied. The intradermal reaction to histogical examination of lesion biopsies demonstrated histoplasms in the 9 cases studied. The intradermal reaction to histoplasmin, positive in only 1 out of 7 cases, and serological tests which showed precipitating antibodies in only 4 cases out of 10, are of very little diagnostic value. All patients were treated with amphotericin B, sometimes associated with clotrimazole (3 cases), miconazole (1 case), and rifampicin (2 cases). Two relapses occurred, one, after too soon an interruption of treatment relapsed two months later, and the other followed 18 months after a total dose of 4,200 mg of amphotericin. Surgical treatment of active subcutaneous ganglionic and bony foci may be necessary, and was employed in three cases, with a favourable result in a case of severe disseminated histoplasmosis.

Topics: Adolescent; Adult; Africa; Aged; Amphotericin B; Child; Child, Preschool; Clotrimazole; Female; Histoplasmosis; Humans; Infant; Lymph Node Excision; Male; Miconazole; Middle Aged; Mouth Diseases; Rifampin

A patient who has had three distinct recurrences of disseminated histoplasmosis over 22 years is presented. Measurements of cellular and humoral immune response to histoplasmin antigens were compared with previously reported data. Although initially sulfisoxazole therapy led to regression of disease, over the past 13 years she has required three courses of amphotericin B, each time with resolution of signs and symptoms. Despite minimal evidence of a cellular or humoral immune response to this organism, the patient has done well. Although disseminated histoplasmosis is often a fatal disease, this woman has tolerated the infection well.

Topics: Adult; Amphotericin B; Antibody Formation; Female; Histoplasmosis; Humans; Immunity, Cellular; Mouth Diseases; Pharyngeal Diseases; Recurrence; Skin Manifestations; Sulfisoxazole

Rhinocerebral mucormycosis is a fungal diseases that has a 50% mortality. Its occurrence has increased, possibly because of greater use of chemotherapeutic agents that mya compromise the immunologic defenses of the host or alter the normal flora. The earliest signs, ulceration and pain, may appear in the mouth. In the patient described in this report, the autopsy showed that mucormycosis had entered the brain cells.

Topics: Amphotericin B; Brain Diseases; Female; Humans; Middle Aged; Mouth Diseases; Mucormycosis; Necrosis; Nose Diseases; Prognosis; Ulcer

Three cases of mucormycosis are presented; two with unusual aspects: one with previously unreported involvement of the mandible, and one presenting as a cavernous sinus thrombosis. Review of the literature reveals a limited number of survivors. Survival in two of the cases presented here suggests that early diagnosis, aggressive therapy with surgery, and amphotericin B should improve the prognosis.

Topics: Aged; Amphotericin B; Cavernous Sinus; Female; Humans; Mouth Diseases; Mucormycosis; Sinus Thrombosis, Intracranial

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Candidiasis, Oral; Diaper Rash; Drug Resistance, Microbial; Female; Griseofulvin; Humans; Male; Mouth Diseases; Nystatin; Ointments; Paronychia; Pruritus Ani; Skin Diseases; Tinea; Tinea Pedis; Tinea Versicolor

Topics: Adult; Amphotericin B; Blastomycosis; Brazil; Humans; Lung Diseases, Fungal; Lymph Nodes; Lymphatic Diseases; Male; Mouth Diseases; Respiration; Respiratory Function Tests; South America

Topics: Adult; Aged; Amphotericin B; Blastomycosis; Diagnosis, Differential; Histoplasmosis; Humans; Laryngeal Diseases; Laryngeal Neoplasms; Lip Diseases; Male; Middle Aged; Mouth Diseases; Mouth Neoplasms; Mycoses

Topics: Amphotericin B; Basidiomycota; Biopsy; Female; Humans; Infant; Mouth Diseases; Mouth Mucosa; Mycoses; Palate; Spores, Fungal; Ulcer

Topics: Adult; Amphotericin B; Basidiomycota; Fungi; Humans; Male; Mouth Diseases; Mycoses; Nose Diseases; Potassium Iodide; Surgery, Plastic

Topics: Amphotericin B; Anesthetics, Local; Anti-Bacterial Agents; Anti-Infective Agents, Local; Humans; Hydrocortisone; Methylcellulose; Mouth Diseases; Mouthwashes; Pharyngeal Diseases; Tablets

Topics: Amphotericin B; Histamine H1 Antagonists; Histoplasmosis; Humans; Male; Middle Aged; Mouth Diseases

Topics: Adult; Africa, Western; Amphotericin B; Bacteriological Techniques; Diagnosis, Differential; Female; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Mouth Diseases; Skin Diseases

Topics: Adult; Amphotericin B; Aspergillosis; Blood Urea Nitrogen; Cheek; Environmental Exposure; Female; Humans; Mouth Diseases; Tooth Extraction

Topics: Amphotericin B; Diabetes Complications; Female; Humans; Injections, Intravenous; Male; Mouth Diseases; Mucormycosis; Oral Manifestations; Tooth Extraction

Topics: Adult; Aged; Amphotericin B; Biopsy; Carcinoma, Bronchogenic; Coronary Disease; Diagnosis, Differential; Female; Glottis; Histoplasmosis; Humans; Laryngeal Diseases; Laryngoscopy; Lung Neoplasms; Male; Middle Aged; Mouth Diseases; Oral Manifestations; Palate; Tongue Diseases

Topics: Amphotericin B; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Mouth Diseases; Pharyngeal Diseases; Time Factors

Topics: Aged; Amphotericin B; Histoplasmosis; Humans; Male; Mouth Diseases; Oral Manifestations; Ulcer

Topics: Addison Disease; Adrenal Gland Diseases; Adult; Aged; Amphotericin B; Chronic Disease; Diagnosis, Differential; Female; Histoplasma; Histoplasmosis; Humans; Laryngeal Diseases; Male; Mechlorethamine; Middle Aged; Mouth Diseases; Oral Manifestations; Tongue Diseases

Topics: Amphotericin B; Blastomycosis; Child; Humans; Male; Mandible; Mouth Diseases; Staining and Labeling

Topics: Amphotericin B; Candidiasis; Denmark; Diagnosis; Drug Therapy; Humans; Mouth Diseases; Mycoses; Nystatin; Oral Manifestations; Organic Chemicals

Topics: Acremonium; Amphotericin B; Anti-Bacterial Agents; Antigen-Antibody Reactions; Asthma; Bone Diseases; Candidiasis; Diet; Diet Therapy; Drug Therapy; Food Hypersensitivity; Granuloma; Humans; Immunotherapy, Active; Jaw; Mouth Diseases; Palate; Paranasal Sinuses; Pathology; Sinusitis; Skin Tests; Spores; Spores, Fungal