amphotericin-b and Myocardial-Infarction

Adverse effects of antileishmanial drugs can affect patients' quality of life and adherence to therapy for visceral leishmaniasis (VL) and post-kala-azar dermal leishmaniasis (PKDL). In Bangladesh, there are 26 treatment centers that manage leishmaniasis cases coming from 100 endemic upazilas (subdistricts) of 26 districts (these include VL, PKDL, treatment failure, and relapse VL and cutaneous leishmaniasis cases). This study aimed to investigate the feasibility of using focused pharmacovigilance for VL (VLPV) in Bangladesh's National Kala-azar Elimination Programme for the early detection and prevention of expected and unexpected adverse drug reactions (ADRs).. This activity has been going on since December 2014. Activity area includes secondary public hospital or Upazila health complex (UHC) in hundred sub districts and Surya Kanta Kala-azar Research Center (SKKRC) in Mymensingh District, a specialized center for management of complicated VL and PKDL cases. Communicable Disease Control (CDC) of the Directorate General of Health Services (DGHS) assigned twenty five of hundred UHCs and SKKRC (total 26) as treatment centers depending on their suitable geographical location. This was implemented for better management of VL cases with Liposomal Amphotericin B (AmBisome®) to ensure patient convenience and proper utilization of this expensive donated drug. A VLPV expert committee and a UHC VLPV team were established, an operational manual and pharmacovigilance report forms were developed, training and refresher training of health personnel took place at UHCs and at the central level, collected information such as patient data including demographics, treatment history and response, adverse events were analyzed. This report includes information for the period from December 2014 to December 2016.. From December 2014 to December 2016, 1327 leishmaniasis patients were treated and 1066 (80%) were available for VLPV. Out of these, 57, 33, 9, and 1% were new VL, PKDL, VL relapse, and other cases, respectively. Liposomal amphotericin B was mostly used (82%) for case management, followed by miltefosine (20%) and paromomycin (3%). Out of the 1066 patients, 26% experienced ADRs. The most frequent ADR was fever (17%, 176/1066), followed by vomiting (5%, 51/1066). Thirteen serious adverse events (SAEs) (eight deaths and five unexpected SAEs) were observed. The expert committee assessed that three of the deaths and all unexpected SAEs were possibly related to treatment. Out of the five unexpected SAEs, four were miltefosine-induced ophthalmic complications and the other was an AmBisome®-induced avascular necrosis of the nasal alae. The Directorate General of the Drug Administration entered the ADRs into the World Health Organization Uppsala Monitoring Centre (WHO-UMC) VigiFlow database.. This study found that VLPV through NKEP is feasible and should be continued as a routine activity into the public health system of Bangladesh to ensure patient safety against anti-leishmanial drugs.

Topics: Acute Kidney Injury; Adolescent; Adult; Aged; Amphotericin B; Antiprotozoal Agents; Bangladesh; Female; Humans; Leishmania donovani; Leishmania tropica; Leishmaniasis, Cutaneous; Leishmaniasis, Visceral; Male; Middle Aged; Myocardial Infarction; Paromomycin; Patient Safety; Pharmacovigilance; Phosphorylcholine; Quality of Life; Recurrence; Survival Analysis

We hereby report a short case of 71-year-old gentleman who developed ST segment elevation myocardial infarction shortly after starting the infusion of liposomal amphotericin B for disseminated histoplasmosis. We also discuss the novel pathogenesis of specific liposomal component of amphotericin B that contributed to the acute cardiopulmonary compromise in our patient leading to subsequent myocardial infarction.

Topics: Aged; Amphotericin B; Antifungal Agents; Histoplasmosis; Humans; Hypotension; Male; Myocardial Infarction

A 38-year-old Japanese man with severe aplastic anemia had invasive pulmonary aspergillosis as a complication. He was treated with amphotericin B for six weeks, but the aspergillosis did not improve. Then he experienced a fatal myocardial infarction. An autopsy revealed disseminated aspergillosis involving pericarditis and Aspergillus embolization to the coronary arteries. This led to the acute myocardial infarction. Cardiac aspergillosis is rare, but should be included within the differential diagnosis when chest pain of unknown origin occurs in an immunosuppressed patient.

Topics: Adult; Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Coronary Disease; Embolism; Humans; Immunocompromised Host; Lung Diseases, Fungal; Male; Myocardial Infarction; Pericarditis

Systemic aspergillosis is encountered with increasing prevalence in immunocompromised patients undergoing chemotherapy. The current communication describes the clinical and postmortem findings in three leukemic patients who developed myocardial infarction secondary to Aspergillus embolization of the coronary arteries. They were all immunosuppressed owing to previous chemotherapy and had been treated for suspected fungal infection with amphotericin B (0.6 mg/kg) for at least 1 week prior to this episode. It is postulated that the infection was spread through the blood since in all three cases the descending branch of the left coronary artery was occluded. Heart involvement resulting from fungal infection should be suspected when chest symptoms of unknown origin occur in this patient population.

Topics: Adult; Amphotericin B; Aspergillosis; Autopsy; Coronary Disease; Female; Humans; Leukemia; Male; Middle Aged; Myocardial Infarction

A case of Torulopsis glabrata endocarditis occurring in a patient 14 months after aortic homograft valve replacement is reported. The infection was not controlled by amphotericin B which led to progressive renal impairment. Re-operation was delayed by the development of multiple infarctions due to coronary emboli. The infection was subsequently eradicated by oral treatment with the newer antifungal agent, 5-fluorocytosine, but death of the patient eventually occurred from an arrhythmia related to the persisting myocardial failure consequent upon episodes of transmural infarction. Current evidence favours the use of early re-operation in all cases of endocarditis in addition to aggressive chemotherapy with a combined regime of amphotericin B and 5-fluorocytosine. Clinical pharmacology of 5-fluorocytosine is briefly discussed.

Topics: Amphotericin B; Aortic Valve; Aortic Valve Stenosis; Autopsy; Candida; Candidiasis; Cytosine; Endocarditis; Flucytosine; Humans; Male; Middle Aged; Myocardial Infarction; Myocardium; Postoperative Complications; Transplantation, Homologous

Topics: Adolescent; Adult; Aged; Amphotericin B; Blastomycosis; Cryptococcosis; Female; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Mycoses; Myocardial Infarction; Radiography