amphotericin-b and Multiple-Organ-Failure

Geotrichum capitatum is a rare fungal pathogen that has infrequently affected immunocompromised patients with onco-hematologic diseases. Geotrichum capitatum invasive infection has been associated with poor prognosis, with a mortality rate ranging from 50% to 90%. Here, we report the first case of Geotrichum capitatum invasive fungal infection in a liver transplant recipient from an unrelated deceased donor, who was effectively treated with amphotericin B and voriconazole. We also reviewed the available literature in the field.

Topics: Amphotericin B; Antifungal Agents; Fatal Outcome; Humans; Immunocompromised Host; Immunosuppressive Agents; Invasive Fungal Infections; Liver Transplantation; Male; Middle Aged; Multiple Organ Failure; Opportunistic Infections; Saccharomycetales; Sepsis; Treatment Outcome; Voriconazole

Blastoschizomyces capitatus infection in a 48-year-old man with acute myelocytic leukaemia is reported. A multiorgan involvement and fulminant course of the fungal infection resulted in the patient's death despite fluconazole prophylaxis, therapy with amphotericin B and administration of granulocyte colony-stimulating factor. Predisposing factors to the infection, clinical relevance of surveillance strains and in vitro antifungal susceptibility testing are discussed.

Topics: Amphotericin B; Antifungal Agents; Fatal Outcome; Fluconazole; Humans; Leukemia, Myeloid, Acute; Male; Microbial Sensitivity Tests; Middle Aged; Mitosporic Fungi; Multiple Organ Failure; Mycoses

Selective decontamination of the digestive tract with topical nonabsorbable antibiotics has been reported to prevent nosocomial infections in patients receiving mechanical ventilation, and the procedure is used widely in Europe. However, it is unclear whether selective decontamination improves survival.. We conducted a randomized, double-blind multicenter study in which 445 patients receiving mechanical ventilation in 15 intensive care units were given either prophylactic nonabsorbable antibiotics (n = 220) or a placebo (n = 225). Topical antibiotics (tobramycin, colistin sulfate, and amphotericin B) or a placebo was administered through a nasogastric tube and applied to the oropharynx throughout the period of ventilation. The main end points were the mortality rate in the intensive care unit and within 60 days of randomization.. A total of 142 patients died in the intensive care unit; 75 (34 percent) in the treatment group and 67 (30 percent) in the placebo group (P = 0.37). Mortality within 60 days of randomization was similar in the two groups (P = 0.40), even after adjustment for factors that were either unbalanced or individually predictive of survival in the two groups (P = 0.70). Pneumonia developed in 59 patients (13 percent) in the intensive care unit within 30 days of enrollment in the study (33 in the placebo group and 26 in the treatment group, P = 0.42). Pneumonia acquired in the intensive care unit and due to gram-negative bacilli was less frequent (P = 0.01) in the treatment group than in the placebo group. The total charges for antibiotics were 2.2 times higher in the treatment group.. Selective decontamination of the digestive tract does not improve survival among patients receiving mechanical ventilation in the intensive care unit, although it substantially increases the cost of their care.

Topics: Administration, Topical; Amphotericin B; Anti-Bacterial Agents; Colistin; Critical Care; Cross Infection; Digestive System; Double-Blind Method; Female; Gram-Negative Bacterial Infections; Humans; Intensive Care Units; Male; Middle Aged; Multiple Organ Failure; Pneumonia; Respiration, Artificial; Survival Rate; Time Factors; Tobramycin

Mucormycosis is rare, life-threatening fungal infection. Frequently observed in those patients having underlying immunosuppression such as, diabetes, organ transplantation, Human immunodeficiency virus (HIV) infection, and elevated serum iron. However, invasive intestinal mucormycosis occurring in immunocompetent individuals without the traditional risk factors is extremely rare clinical phenomenon.. We report a 40-year-old male patient who presented with 1 week history of diffuse abdominal pain and high grade fever, associated with vomiting and frequent loose stools. Has history of chronic alcohol ingestion. Otherwise, no past history of chronic medical illness, nor he had contact with individuals with similar illness. He was in a septic shock with multiple organ failure up on presentation to emergency room. Physical examination revealed icterus sclera with abdominal tenderness. He was immediately resuscitated using crystalloids, supported with inotrope, and antibiotics. Histopathological examination of tissue sample from colonic ulcer biopsy revealed invasive intestinal mucormycosis. Patient showed full clinical and histopathological resolution after course of parenteral Liposomal Amphotercin B.. This case highlights the fact that, despite its life-threatening nature, it's possible to treat patients with invasive intestinal mucormycosis with aggressive antifungal and supportive care without surgical intervention, provided that all the necessary supportive care were initiated early and the disease was diagnosed early and appropriate medical management was initiated timely. In addition, it's important to consider intestinal mucormycosis even in patients who are immunocompetent without traditional risk factors.

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; Colitis; Disease Susceptibility; Early Diagnosis; Emergency Service, Hospital; Humans; Male; Mucormycosis; Multiple Organ Failure; Risk Factors; Shock, Septic; Time-to-Treatment

Mucormycosis is an aggressive invasive fungal infection that occurs rarely in immunocompetent but frequently in immunocompromised patients. We present a case of a 68-year-old patient with cutaneous mucormycosis due to Rhizopus pusillus. He was initially hospitalized for invasive pulmonary aspergillosis and diabetes mellitus secondary to acute graft-versus-host treatment with glucocorticoids after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. Treatment with liposomal amphotericin B and posaconazole was initiated but the patient developed septic shock with multiple organ failure and died 5 days later. The risk factors, clinical presentation, treatment, and prognosis of cutaneous mucormycosis in hematopoietic stem cell and solid organ transplant patients are discussed.

Topics: Aged; Amphotericin B; Antifungal Agents; Fatal Outcome; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Invasive Fungal Infections; Male; Mucormycosis; Multiple Organ Failure; Rhizopus; Shock, Septic; Skin; Triazoles

To assess compliance with international guidelines for costly antifungal prescriptions and to compare these results with a first study performed in 2007.. Retrospective study including all costly antifungal prescriptions made in surgical and medical intensive care units and in a hepatobiliary, pancreatic, and digestive surgery unit. Prescriptions were assessed in terms of indication, dosage, and antifungal de-escalation.. Seventy-four treatments were analyzed. Treatments were prescribed for prophylactic (1%), empirical (22%), pre-emptive (16%), or targeted therapy (61%). Caspofungin accounted for 68% of prescriptions, followed by voriconazole (20%) and liposomal amphotericin B (12%). Indication was appropriate in 91%, debatable in 1%, and inappropriate in 8%. Dosage was appropriate in 69%, debatable in 8%, and inappropriate in 23%. Prescriptions were inappropriate for the following reasons: lack of dosage adjustment in light of the hepatic function (10 cases), underdosage or excessive dosage by>25% of the recommended dose in seven cases. De-escalation to fluconazole was implemented in 40% of patients presenting with a fluconazole-susceptible candidiasis.. The overall incidence of appropriate use was higher in 2012 compared with 2007 (62% and 37% respectively, P=0.004). Nevertheless, costly antifungal prescriptions need to be optimized in particular for empirical therapy, dosage adjustment, and potential de-escalation to fluconazole.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Caspofungin; Echinocandins; Female; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Lipopeptides; Male; Middle Aged; Multiple Organ Failure; Mycoses; Organ Transplantation; Retrospective Studies; Survival Rate; Treatment Outcome; Voriconazole; Young Adult

Topics: Amphotericin B; Aortic Aneurysm, Abdominal; Aortic Dissection; Disease Progression; Fatal Outcome; Female; Humans; Marfan Syndrome; Mesenteric Ischemia; Middle Aged; Mucormycosis; Multiple Organ Failure; Polymethyl Methacrylate; Postoperative Complications; Risk Assessment; Soft Tissue Infections

Topics: Administration, Intravesical; Aged; Amphotericin B; Antifungal Agents; Candidiasis; Device Removal; Female; Humans; Intraabdominal Infections; Intrauterine Devices; Multiple Organ Failure; Postoperative Care; Shock, Septic; Uterine Diseases

Topics: Amphotericin B; Antifungal Agents; Biopsy; Brain Diseases; Deoxycholic Acid; Diabetes Mellitus, Type 2; Drug Combinations; Eye; Eye Diseases; Fatal Outcome; Female; Humans; Kidney Failure, Chronic; Magnetic Resonance Imaging; Middle Aged; Mucormycosis; Multiple Organ Failure; Paranasal Sinuses; Temporal Lobe

Scedosporium prolificans (S. prolificans) is a type of mold, which rarely affects immunocompromised people. We treated a 71-year-old woman with acute myeloid leukemia (AML-M5a) with low-dose cytarabine, acralubicin, and filgrastim as the induction therapy. On day 7 after the initiation of chemotherapy, she became febrile and agranulocytic, and developed anal pain ; therefore, we discontinued the chemotherapy on day 8. Broad-spectrum antibiotics, micafungin, and then liposomal amphotericin B were ineffective. The serum concentration of β-D-glucan was 525 pg/mL. She died of multiple organ failure on day 17. S. prolificans was detected from the blood culture on day 13. Physicians should consider Scedosporium spp. infection when principal antifungal agents are ineffective and fungal infection is strongly suspected.

Topics: Aged; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; beta-Glucans; Biomarkers; Echinocandins; Fatal Outcome; Female; Fungemia; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Lipopeptides; Micafungin; Multiple Organ Failure; Scedosporium; Treatment Failure

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Fatal Outcome; Fever; Flucytosine; HIV Infections; Humans; Male; Multiple Organ Failure; Respiratory Distress Syndrome

Topics: Adolescent; Amphotericin B; Antifungal Agents; Cellulitis; Cranial Nerve Diseases; Delayed Diagnosis; Diabetes Complications; Disease Progression; Disease Susceptibility; Encephalitis; Fatal Outcome; Female; Fungemia; Humans; Male; Middle Aged; Mucormycosis; Multiple Organ Failure; Opportunistic Infections; Sinusitis; Vision Disorders

Mucormycosis of the gastrointestinal tract is a rare infection that usually occurs in patients who are immunocompromised and carries a high mortality. We report four cases of gastrointestinal mucormycosis seen over a one year period with different presentations, risk factors and different anatomical sites of involvement. A preoperative diagnosis was made only in one patient. All underwent surgery, three survived and one died postoperatively from multiorgan failure.

Topics: Adult; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Fatal Outcome; Gastrointestinal Diseases; Humans; Infant; Male; Mucormycosis; Multiple Organ Failure; Opportunistic Infections; Risk Factors; Tomography, X-Ray Computed; Young Adult

Matched sibling donor hematopoietic stem cell transplantation is the standard of care for severe aplastic anemia, with an overall survival of 80% to 90%. Only 60% to 70% of patients respond to treatment with immunosuppressive therapy. The main life threatening complications are infections, graft failure, and graft versus host disease. A 10-year-old patient with severe aplastic anemia underwent matched sibling donor hematopoietic stem cell transplantation, but developed sudden onset of fatal multiorgan failure on day +12. The cause of death was found only after autopsy.

Topics: Amphotericin B; Anemia, Aplastic; Child; Female; Hematopoietic Stem Cell Transplantation; Humans; Mucormycosis; Multiple Organ Failure; Pyrimidines; Rhizomucor; Triazoles; Voriconazole

Topics: Amphotericin B; Biopsy, Needle; Blastomycosis; Bronchoalveolar Lavage Fluid; Bronchoscopy; Diagnosis, Differential; Fatal Outcome; Fever; Humans; Lung Diseases, Fungal; Male; Middle Aged; Multiple Organ Failure; Respiratory Distress Syndrome; Tomography, X-Ray Computed

Tissue concentrations of amphotericin B were determined in autopsy material of patients who had been treated with liposomal amphotericin B or amphotericin B colloidal dispersion (colloidal amphotericin B) for suspected or proven invasive fungal infection.. Amphotericin B tissue levels were measured in liver, spleen, lung, kidney, and myocardial and brain tissue of 20 patients who had been treated with lipid-formulated amphotericin B, before they died from multi-organ failure. Seven patients had been treated with liposomal amphotericin B (AmBisome) and thirteen with colloidal amphotericin B (Amphocil). Tissue samples were obtained during routine autopsy, homogenized and extracted with methanol. Amphotericin B concentrations were measured using HPLC after purification by solid phase extraction.. The highest amphotericin B levels were found in liver and spleen, followed by kidney, lung, myocardium and brain. In the lung higher amphotericin B concentrations were found after treatment with amphotericin B colloidal dispersion than after therapy with liposomal amphotericin B.. The choice of lipid formulation may influence amphotericin B penetration into the lung.

Topics: Adult; Aged; Amphotericin B; Autopsy; Brain Chemistry; Chromatography, High Pressure Liquid; Female; Humans; Kidney; Liver; Lung; Male; Middle Aged; Multiple Organ Failure; Mycoses; Myocardium; Spleen; Tissue Distribution; Tissue Extracts

Topics: Accidents, Occupational; Aged; Agriculture; Amphotericin B; Antifungal Agents; Caspofungin; Drug Therapy, Combination; Echinocandins; Fatal Outcome; Humans; Lipopeptides; Male; Multiple Organ Failure; Mycoses; Peptides, Cyclic; Sepsis; Species Specificity; Trichosporon

Invasive rhinocerebral mucormycosis is a rare and often fatal opportunistic fungal infection. It is encountered in immunocompromised hosts exemplified by those with diabetes, human immunodeficiency viruses and particularly haematologic malignancies typically after high-dose chemotherapy and stem cell transplantation. In contrast to the more usual outcome with rapid progression and death. We now describe a successful eradication attributable to the use of a newly available antifungal agent.. Haematology department and bone marrow transplantation unit.. Two patients are contrasted. The first with acute leukaemia developed rapidly progressive facial swelling with mucormycosis proven on biopsy. Treatment over 2 months with maximally tolerated doses of amphotericin failed to halt intracranial extension and death resulted. The second, presented with acute lymphoblastic leukaemia in August 1997, underwent successful autologous bone marrow transplantation in February 1998. Relapse followed in March 1999 and after reinduction and consolidation receive a matched unrelated volunteer allograft in September 1999. A second recurrence was documented in April 2000 and in spite of achieving remission he developed a fever that was managed empirically with intravenous amphotericin and, on discharge, oral itraconazole. Left-sided facial swelling expanded rapidly and biopsy showed extensive invasion of the maxillary sinus with mucormycosis. FK463 was added on 5 June 2000 with gradual reduction in facial pain and within 1 month all clinical signs and resolved. Serial biopsies that included histopathologic investigation and microbiologic cultures confirmed eradication of the invasive mucor. In view of the potential danger of recrudescence this treatment regimen was continued through further chemotherapy and, once again disease-free, a second matched unrelated volunteer allograft took place in August 2000. Full reassessment at the time failed to demonstration any residual fungus. Engraftment was confirmed but neutropenic sepsis resulted in severe inflammatory response syndrome with progression to multiple organ dysfunction to which he succumbed without any evidence of leukaemic or systemic mycosis.. Echinocandin FK463 is of documented value in managing invasive candidiasis and aspergillosis. This is believed to be the first case of successful outcome with one of the angiotrophic zygomycetes.

Topics: Acute Disease; Adolescent; Adult; Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Combined Modality Therapy; Drug Evaluation; Echinocandins; Fatal Outcome; Female; Humans; Immunocompromised Host; Itraconazole; Leukemia, Myeloid; Lipopeptides; Lipoproteins; Male; Micafungin; Mucormycosis; Multiple Organ Failure; Peptides, Cyclic; Periodontal Abscess; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Sinusitis; Splenectomy; Systemic Inflammatory Response Syndrome; Transplantation, Homologous

Topics: Adult; Amphotericin B; Antifungal Agents; Female; Histoplasmosis; Humans; Multiple Organ Failure; Shock, Septic; Switzerland

Saccharomyces cerevisiae is an unusual cause of clinical infection. We describe three bone marrow transplant patients on a haematology unit who developed possible invasive disease with the organism. Two patients died and both these patients appeared to have a related strain of S. cerevisiae. Screening for S. cerevisiae from throat and stool samples revealed four further patients who were carriers. Genotyping of the invasive and carriage strains demonstrated an indistinguishable strain from patients who had been on the unit at the same time, suggesting cross-infection.

Topics: Adult; Amphotericin B; Antifungal Agents; Bone Marrow Transplantation; Carrier State; Cross Infection; DNA, Fungal; Drug Therapy, Combination; Fatal Outcome; Feces; Female; Flucytosine; Genotype; Humans; Immunocompromised Host; Infection Control; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Mass Screening; Multiple Organ Failure; Mycoses; Pharynx; Saccharomyces cerevisiae

We present a case of systemic fungal infection caused by Apophysomyces elegans in a 50-year-old patient who developed a progressive skin lesion after a motor vehicle crash. Histopathological and mycological examination of the surgical sample showed non-septated hyphae characteristic of mucoraceous fungi. Despite extensive surgical debridement, and parenteral administration of amphotericin B, the patient died of multi-organ failure. Autopsy findings suggested systemic involvement. The fungi recovered from culture had non-apophyseal and globose sporangi, and branched sporaniophores and was identified as Apophysomyces elegans.

Topics: Amphotericin B; Antifungal Agents; Fatal Outcome; Humans; Male; Middle Aged; Mucorales; Mucormycosis; Multiple Organ Failure; Wound Infection; Wounds and Injuries

Topics: Amphotericin B; Antifungal Agents; Aorta, Abdominal; Aspergillosis; Aspergillus flavus; Blood Vessel Prosthesis; Diagnosis, Differential; Fatal Outcome; Humans; Male; Middle Aged; Multiple Organ Failure; Prosthesis-Related Infections; Reoperation; Shock, Septic; Time Factors

Topics: Amphotericin B; Antifungal Agents; Fatal Outcome; Female; Humans; Liver Abscess; Middle Aged; Multiple Organ Failure; Mycoses; Saccharomyces cerevisiae

A 43-year-old man with no past history presented with symptoms of fever, cough and dyspnoea arising from invasive pulmonary aspergillosis and was found to have myelodysplastic syndrome with monosomy 7. Before initiation of chemotherapy, he deteriorated rapidly, developing multi-organ failure requiring mechanical ventilation, and he eventually succumbed despite amphotericin B treatment. The importance of monosomy 7 in determining immune function in patients with myelodysplastic syndrome is emphasised.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Bone Marrow Examination; Chromosomes, Human, Pair 7; Cough; Cytogenetics; Dyspnea; Fatal Outcome; Fever; Humans; Immunocompromised Host; Lung Diseases, Fungal; Male; Monosomy; Multiple Organ Failure; Myelodysplastic Syndromes; Tomography, X-Ray Computed

Opportunistic fungal infection is a rare but severe complication in allogeneic bone marrow transplant (BMT) recipients. We report a 49-year-old patient who developed pneumonitis after BMT, due to a Mucorales fungus (class Zygomycetes), Absidia corymbifera. Infections due to mucormycosis are likely to become increasingly recognized even though the occurrence after BMT has only been described sporadically. We postulate that the patient was contaminated before BMT despite no intensive drug treatment or other iatrogenic features, related to his poor living conditions and developed the infection during aplasia. He immediately received i.v. liposomal amphotericin B (AmBisome) and GM-CSF. Because there was no response, the infected area and necrotic tissue were resected. Despite initial clinical and biological improvement and the absence of Mucor on mycological examination post-surgery, the patient died 3 weeks later from bilateral pulmonary infection and multiorgan failure.

Topics: Absidia; Amphotericin B; Antifungal Agents; Bone Marrow Transplantation; Fatal Outcome; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Multiple Organ Failure; Necrosis; Opportunistic Infections; Postoperative Complications; Transplantation, Homologous