amphotericin-b and Necrosis

Topics: Amphotericin B; Anti-HIV Agents; Cesarean Section; Debridement; Dermatomycoses; Drug Therapy, Combination; Fungemia; Gestational Age; HIV Infections; Humans; Immunocompromised Host; Infant; Infant, Premature; Infant, Very Low Birth Weight; Infusions, Intravenous; Male; Necrosis; Prognosis; Risk Assessment; Treatment Outcome; Umbilical Veins; Umbilicus

Walled-off necrosis (WON) caused by fungal infection is very rare, and its treatment is more difficult than that of bacterial infection. We present the first case of a patient with refractory fungal-infected WON treated with percutaneous endoscopic necrosectomy and local administration of amphotericin B.A Japanese man in his 30s was hospitalized with severe necrotizing pancreatitis and multiple organ failure. Computed tomography imaging of the abdomen 1 month after the onset of pancreatitis revealed infected WON. Percutaneous drainage revealed purulent necrotic fluid, and culture of the fluid revealed the presence of Candida albicans and C glabrata. WON was treated by percutaneous endoscopic necrosectomy and local administration of amphotericin B. Consequently, the patient's condition improved, and Candida species were not detected in subsequent cultures.The combination of endoscopic necrosectomy with local administration of amphotericin B may be effective in treating refractory fungal-infected WON.

Topics: Adult; Amphotericin B; Candidiasis; Chronic Disease; Endoscopy, Digestive System; Humans; Male; Necrosis; Pancreatitis, Chronic

Mucormycosis is an opportunistic, life-threatening infection in organ transplant recipients. We report a case of surgical wound mucormycosis that extended to a transplanted kidney. The patient was a 59-year-old man who underwent a donation-after-cardiac-death kidney transplant 10 years after receiving a liver transplant. On day 10 after the kidney transplant, he presented with cutaneous and subcutaneous tissues necrotizing at his right lower abdominal surgical wound. The necrotic tissue biopsy and laboratory culture showed different causes, while a polymerase chain reaction quickly identified the causative fungus at the species level. Although the combination therapy consisted of immunosuppressant withdrawal, intravenous Liposome AmB, and aggressive surgical debridement; unfortunately, the cutaneous mucormycosis invaded his transplanted kidney, and the patient was given a graft nephrectomy and subsequent hemodialysis. We review the literature and conclude that mucormycosis in organ transplant recipients is a rare and extremely severe complication. Polymerase chain reaction provides a rapid and accurate diagnostic technique for species identification. Early effective antifungal therapy combined with aggressive surgical intervention and judicious withdrawal of immunosuppressants appears to be indispensable for a favorable outcome.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Debridement; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Mucorales; Mucormycosis; Necrosis; Nephrectomy; Polymerase Chain Reaction; Predictive Value of Tests; Renal Dialysis; Reoperation; Surgical Wound Infection; Treatment Outcome

In this retrospective study, we describe our experience in the diagnosis and management of rhinocerebral mucormycosis (RCM), a rapidly lethal fungal infection.. Between 1997 and 2007, five patients hospitalized for suspicion of RCM. Computed tomography was performed in all cases, and diagnosis was confirmed after anatomopathological or mycological examination. All patients underwent medical and surgical treatment. Follow-up was clinical and radiological with a mean period of 17 months.. All patients were diabetic. Exophthalmia, rhinorrhea, and ophthalmoplegia were the most frequent symptoms observed. One patient had loss of visual acuity and another exhibited peripheral facial palsy. One patient had extensive hemifacial cutaneous necrosis. Nasal endoscopy revealed black necrotic lesions in one case, and another patient had a tumefaction localised in the left middle meatus. Necrotic lesions were most often found in the orbit, the maxillary and the ethmoidal sinuses on computed tomography (four cases for each site). One patient had thrombophlebitis of the cavernous sinus, and another had an intracranial extension. All patients were administered ordinary insulin and intravenous amphotericin B. Surgical debridement of the nasal cavity and the involved sinuses was performed through lateral rhinotomy (four cases) or endoscopy (one case). Unilateral orbital exenteration was associated in two cases. Progression was favourable in four cases; one patient died from sepsis despite aggressive treatment.. Early diagnosis is crucial for the management of RCM. Treatment of underlying disorders, use of intravenous amphotericin B, and aggressive surgical intervention are key in reducing morbidity and mortality rates.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Debridement; Facial Paralysis; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mucormycosis; Nasal Cavity; Necrosis; Nose Diseases; Paranasal Sinus Diseases; Prognosis; Retrospective Studies; Tomography, X-Ray Computed; Visual Acuity; Young Adult

Bronchopulmonary aspergillosis are in the news. Invasive pulmonary aspergillosis raise early diagnostic problems and prevention problems in immunocompromised patients. These infections are no unusual in chronic obstructive pulmonary disease. The diagnosis between aspergilloma and chronic necrotizing pulmonary aspergillosis can be difficult. In allergic bronchopulmonary aspergillosis, epidemiology and therapy are questionable. Real progress has been made due to thoracic computed tomographic scan and mycological methods. Better use of amphotericin B, of amphotericin B lipid formulations and of azole antifungal agents, combined with surgical resection if necessary should improve aspergillosis prognosis.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis, Allergic Bronchopulmonary; Diagnosis, Differential; Humans; Necrosis; Prognosis; Tomography, X-Ray Computed

Mucormycosis is an uncommon infection caused by fungi of the order Mucorales, family Mucoraceae, and almost always occurs in individuals with predisposing factors such as diabetes mellitus, metabolic acidosis, or immunodeficiency states. Although mucormycosis is a rare infection in childhood, sporadic cases of skin infections have been described in young infants and older children; primary skin infection has been associated with multiple nosocomial outbreaks caused by contaminated elastic bandages. In all reported cases involving premature infants, the elimination of the infection involved surgical debridement. We report for the first time successful conservative treatment with intravenous amphotericin B in a premature infant with primary cutaneous infection caused by Rhizopus oryzae.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Dermatomycoses; Dexamethasone; Humans; Infant, Newborn; Infant, Premature, Diseases; Male; Mucormycosis; Necrosis; Respiratory Distress Syndrome, Newborn; Rhizopus

To describe our experience with 6 patients and to review the current literature to update the approach to the diagnosis and treatment of chronic necrotizing pulmonary aspergillosis.. Patient reports and MEDLINE review of English-language literature published after 1980.. Chronic necrotizing pulmonary aspergillosis (CNPA) is a subacute infection most commonly seen in patients with altered local defense from preexisting pulmonary disease or in patients with risk factors that alter systemic immune status. Delays in diagnosis are common. Although initial reports advocated intravenous amphotericin B, itraconazole has emerged as a better initial therapy because of its documented efficacy and minimal toxicity. The dose and duration of therapy should be based on clinical response. In patients who do not respond to medical therapy, pulmonary resection can be considered, but postoperative morbidity is high. Recurrent or relapsing infections occur; chronic maintenance therapy with itraconazole can be considered in patients with residual parenchymal scarring. A wide range of mortality rates has been reported for CNPA. Outcome is most likely influenced by severity of comorbid conditions, extent of underlying pulmonary disease, delays in diagnosis, and initiation of effective therapy.

Topics: Aged; Algorithms; Amphotericin B; Antifungal Agents; Aspergillosis; Chronic Disease; Female; Humans; Itraconazole; Lung Diseases, Fungal; Male; Middle Aged; Necrosis; Pneumonectomy; Prognosis; Risk Factors; Treatment Outcome

The observation of pulmonary mucormycosis occurring in a patient presenting with aplasia induced therapeutically during treatment for acute myeloblastic leukaemia, has led to a review of the characteristics of this rare opportunistic fungal infection: it occurs in a particular condition; the clinical manifestations are characterised by the thrombotic character and the rapidly necrosing nature of the histological lesions; the diagnosis is usually very difficult to make and is linked to the rarity of the pathology and the frequently negative mycological specimens apart from tissue biopsies; the value of a medicosurgical therapeutic strategy on which the prognosis of the infection depends.

Topics: Amphotericin B; Antifungal Agents; Bronchoalveolar Lavage Fluid; Bronchoscopy; Hemoptysis; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Necrosis; Opportunistic Infections; Prognosis; Pulmonary Embolism; Tomography, X-Ray Computed

Renal papillary necrosis (RPN) due to Candida is a rare disease with only 19 cases reported over the past 37 years. But the diagnosis in 17 of the 19 cases was not made until a necropsy was carried out. The 2 cases that were diagnosed antemortem had radiographic sonography. A singapore case with candidal RPN was described in detail. Candidal RPN was associated with underlying diseases in all these cases. The disease may be more frequently encountered in the future with the advent of radiographic tools like sonography which was not described prior to 1980. Indeed, patients with underlying diseases who develop persistent candiduria should have radiographic investigation of the urinary tract to detect candidal RPN to that early remedial measures can be carried out.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Diabetes Mellitus, Type 2; Female; Humans; Kidney; Kidney Diseases; Necrosis; Radiography

Pancreatic infection remains a significant clinical problem, with substantial morbidity and mortality. Published case reports of Candida species identified in these infections prompted a review of 17 consecutive patients recently treated for peripancreatic infection by scheduled relaparotomy. Six patients were transferred from other hospitals, all having undergone prior operative intervention (median stay elsewhere: 58 days). The 11 other patients underwent initial operation an average of 14 days after admission. Candida species were identified in the initial operative cultures of 5 patients (29%), three of whom had undergone previous drainage at other hospitals. Two patients (11.7%) had Candida identified at subsequent operation. Six patients were treated with Amphotericin B for a median of 12 days (range 6-32) and a median dosage of 420 mg (range 225-830 mg). All patients were cleared of their Candida infection, but three subsequently died, for an overall mortality of 17.6%. Candida infected patients suffered a 42 per cent mortality. Our series supports the suspicion that Candida is much more frequent (41% of patients) than previously recognized in peripancreatic sepsis, and is commonly acquired after the initial operation. Amphotericin B therapy is effective in clearing Candida infection, but affected patients have a high associated mortality.

Topics: Acute Disease; Adult; Aged; Amphotericin B; Candidiasis; Chronic Disease; Combined Modality Therapy; Drainage; Female; Humans; Incidence; Length of Stay; Male; Middle Aged; Necrosis; Pancreatitis; Reoperation; Severity of Illness Index; Survival Rate; Treatment Outcome

A previously well 59-year-old man developed necrotizing, invasive cellulitis and subsequent osteomyelitis at what was judged to be the site of a bite or sting. The pathogen isolated was Apophysomyces elegans. Eventually, in addition to treatment with intravenous amphotericin B, en bloc resection was required for cure. Only six previous cases of A. elegans infection have been reported in the literature. The lack of underlying disease in six of the total of seven cases contrasts with the usual findings for other zygomycoses. This article describes all seven reported cases as well as the characteristics of this unique fungal pathogen.

Topics: Amphotericin B; Combined Modality Therapy; Debridement; Humans; Immunocompetence; Male; Middle Aged; Mucormycosis; Necrosis; Osteomyelitis; Soil Microbiology; Spider Bites

This case report describes a patient with acute myelocytic leukaemia, who developed a necrotizing bronchial aspergillosis. This is an uncommon, new form of invasive aspergillosis, which is mainly seen in the heart-lung transplantation setting and has only been reported once in another patient with leukaemia. Neither amphotericin B nor liposomal amphotericin (AmBisome) was effective. Only after the immune system had recovered did the infection disappear.

Topics: Amphotericin B; Aspergillosis; Bronchial Diseases; Bronchoscopy; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Necrosis; Radiography

Chronic necrotizing pulmonary aspergillosis is an indolent, locally invasive form of Aspergillus infection. Treatment options are limited and controversial. Resection is often curative if the patient has sufficient ventilatory reserve. Even though intravenous amphotericin B is effective in a few patients, toxicity limits its use. Aerosolized amphotericin B has proven ineffective. Anecdotal reports of intracavitary and endobronchial antifungal therapy show limited success. Our patient had unresectable chronic necrotizing pulmonary aspergillosis treated successfully with intracavitary instillation of amphotericin B, delivered via the flexible fiberoptic bronchoscope.

Topics: Amphotericin B; Aspergillosis; Bronchoscopy; Chronic Disease; Humans; Infusions, Parenteral; Lung Diseases, Fungal; Male; Middle Aged; Necrosis; Radiography

The increase of opportunistic fungal infections raises the need for design and synthesis of new antifungal agents. Taking into account that tetrazole derivatives exhibit antifungal activity, and some of them are in the phase of clinical trials, new tetrazole derivatives bearing pyrrolidine moiety were synthesized in order to present their action mode against C. albicans. The target compounds were obtained by N-alkylation of various 2-arylpyrrolidines with several 1-(3-chloropropyl)-5-aryl-2H-tetrazoles. Regardless of the substituents at tetrazole or pyrrolidine rings reactions took place in 48 h and with satisfactory yields ranging from 53 to 70%. We performed screen of the synthesized compounds to identify these nontoxic inhibiting the C. albicans planktonic and sessile cells, and conducted a series of follow up studies to examine the in vitro and in vivo activity of the most potent antifungals. The leading antifungal inhibitor: 2-{3-[2-(3-Methylphenyl)pyrrolidin-1-yl]propyl}-5-phenyl-2H-tetrazole (3aC) and the randomly selected ones: 5-phenyl-2-[3-(2-phenylpyrrolidin-1-yl)propyl]-2H-tetrazole (3aA), 5-(4-chlorophenyl)-2-{3-[2-(4-fluorophenyl)pyrrolidin-1-yl]propyl}-2H-tetrazole (3cD), and 5-(4-chlorophenyl)-2-{3-[2-(4-chlorophenyl)pyrrolidin-1-yl]propyl}-2H-tetrazole (3cE) showed little to no toxicity against the Vero cell line and Galleria mellonella. 3aC and 3aD, the most active against biofilm in vitro, demonstrated in vivo activity in the invertebrate model of disseminated candidiasis. Flow cytometry analysis showed that necrotic cell death was generated under 3aC due to its interactions with the fungal membrane; this confirmed by the mitochondrial damage (XTT assay) and reduced adhesion to the TR-146 cell line at 46.05 μM. Flow cytometry was used to directly measure the redox state of the treated cells with the fluorescent DCFH probe. Pro-necrotic tetrazole derivatives (3aA, 3aC, 3cD) are unable to induce ROS production in the C. albicans cells. Moreover, CLSM analyses revealed that the tetrazole derivatives (principally 3aC, 3aD, and 3aE) inhibit C. albicans' ability to neutralize macrophages; a more effective phagosomes organisation was observed. 3aC's and 3aD's activity reflected in an attenuation of virulence in disseminated candidiasis in vivo.

Topics: Alkylation; Animals; Antifungal Agents; Biofilms; Candida albicans; Candidiasis; Cell Line; Chlorocebus aethiops; Necrosis; Pyrrolidines; Structure-Activity Relationship; Tetrazoles; Virulence

Invasive fungal infections are a major cause of mortality among solid organ transplant recipients. Scopulariopsis species and their teleomorph Microascus are molds found in soil and decaying organic matter. We report here the case of a woman who underwent bilateral lung transplantation for severe emphysema. On day 25 after transplantation, endobronchial green-black lesions were detected during routine endoscopy. Endobronchial swabs, biopsies, and bronchoalveolar lavage samples were positive for Microascus cirrosus. This fungal infection developed despite voriconazole given for previous persistent invasive aspergillosis. Treatment consisted of a combination of antifungal medication (voriconazole, terbinafine, amphotericin B, and caspofungin) and endoscopic resection of necrosed bronchial mucosa. A favorable clinical outcome was achieved after 7 weeks of treatment. Seven cases of Scopulariopsis/Microascus infection have been previously described in solid organ transplant recipients. Only two survived after treatment with an antifungal combination therapy including echinocandins, posaconazole, and terbinafine. In immunocompromised patients, infection by Microascus species is a rare but life-threatening event because of innate resistance to most common antifungal drugs. Our patient was successfully cured by combined therapy including intravenous voriconazole and caspofungin, oral terbinafine, and inhaled voriconazole and amphotericin B administered for 7 weeks in association with iterative endoscopic debridement to reduce fungal inoculum.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Bronchi; Bronchitis; Endoscopy; Female; Humans; Immunocompromised Host; Lung Transplantation; Middle Aged; Mycoses; Necrosis; Transplant Recipients; Treatment Outcome; Triazoles

Mucormycosis is a rare fungal infection and high mortality that commonly affects patients with the weakened immune system. We present an unusual case of tongue necrosis probably due to the healthcare-associated mucormycosis (HCM) in a diabetic patient. Although cannot be proved with certainty, we surmise that intubation as a risk factor in our case. The diagnosis was confirmed by histopathological examination (HPE) of the necrotic tissue specimen. The patient was responded well to lipid complex amphotericin B (250mg) regime after surgery. Subsequent follow up revealed that no signs of recurrence. Early, recognition, diagnosis, prompt treatment and awareness among clinician are representing the most effective way of managing the disease.

Topics: Amphotericin B; Antifungal Agents; Debridement; Diabetes Complications; Diabetic Ketoacidosis; Female; Humans; Immunocompromised Host; Intubation; Malaysia; Middle Aged; Mucormycosis; Necrosis; Risk Factors; Tongue; Treatment Outcome

Mucormycosis is one of the rapidly progressing and lethal form of fungal infection which involves the nose and paranasal sinuses of the head and the neck regions. Mucormycosis also remains a threat to patients with uncontrolled diabetes or other predisposing systemic conditions. It manifests as rhinocerebral, pulmonary, gastrointestinal, cutaneous or disseminated form. The underlying conditions can influence clinical presentation and often delay diagnosis, with resultant poor outcomes.. We report a case of rhinocerebral mucormycosis in a 75 year-old diabetic patient with emphasise on diagnosis, treatment and survival options of patient from this potentially fatal fungal infection. Extra oral examination revealed mild non-tender swelling on the face, unable to see from left eye, impaired sense of smell, difficulty in speech and nasal stuffiness. Intra-oral examination showed necrosis of mucosa and underlying bone in relation to canine to the tuberosity area of the left vestibular region of the maxilla.. Timely diagnosis is critical to survival and minimization of morbidity. Institution of surgical and medical therapy is critical in maximizing the likelihood of good outcome.

Topics: Aged; Amphotericin B; Antifungal Agents; Humans; Male; Mucormycosis; Necrosis; Paranasal Sinuses; Tomography, X-Ray Computed; Triazoles

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcus neoformans; Diagnosis, Differential; Fluconazole; Flucytosine; Humans; Male; Meningitis, Cryptococcal; Necrosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Skin Ulcer; Thigh

Mucormycosis are rare fungal infections occurring chiefly in the lung or the rhinocerebral compartment, particularly in patients with immunodeficiency or mellitus diabetes. We report the case of an elderly patient with cutaneous mucormycosis caused by Rhizopus microsporus.. An 89-year-old man presented a skin lesion of the forearm rapidly becoming inflammatory and necrotic. The patient had been treated for 2months with oral corticosteroids for idiopathic thrombocytopenia. Histological and mycological examination of the skin biopsy revealed the presence of a filamentous fungus, R. microsporus. The outcome was unfavorable, despite prescription of high-dose liposomal amphotericin B.. Mucormycosis are infrequent opportunistic infections caused by angio-invasive fungi belonging to the Mucorales order. Cutaneous presentations are rare, and in rare cases the species R. microsporus is isolated in clinical samples. Diagnosis is based on histological examination highlighting the characteristic mycelium within infected tissue, together with ex vivo mycological identification using morphological and molecular methods. Treatment consists of liposomal amphotericin B combined with debridement surgery.. R. microsporus is a marginal fungal species rarely isolated in clinical practice, and even less in dermatology departments. This clinical case report highlights the severity of infection with this fungus, particularly in the absence of early surgery.

Topics: Adrenal Cortex Hormones; Aged, 80 and over; Amphotericin B; Biopsy; Dermatomycoses; Dose-Response Relationship, Drug; Humans; Male; Mucormycosis; Necrosis; Opportunistic Infections; Palliative Care; Rhizopus; Skin; Thrombocytopenia

Mucormycosis is a life threatening condition caused by invasion of fungi of the order Mucorales. Gastrointestinal invasion is very rare and often lethal, particularly in disseminated mucormycosis. We present the case of a 26-year-old woman from North Africa with type 2 diabetes who, after a cholecystectomy, developed unexplained septic shock and haematemesis due to gastric necrosis. Computed tomography (CT) revealed a disseminated fungal invasion of the lungs, kidney and paranasal sinuses. A gastrectomy and subsequent amphotericin B treatment resolved her condition. The number of patients with mucormycosis is increasing. Early diagnosis of high risk patients with CT and biopsies from which fungi are directly isolated must be followed by surgery and systemic amphotericin B infusion.

Topics: Adult; Amphotericin B; Antifungal Agents; Female; Gastrectomy; Hematemesis; Humans; Kidney Diseases; Lung Diseases, Fungal; Mucormycosis; Necrosis; Paranasal Sinus Diseases; Shock, Septic; Stomach; Stomach Diseases; Tomography, X-Ray Computed

Mucormycosis is a rare but aggressive fungal infection that predominantly affects immunocompromised patients. We report a case that highlights the importance of knowledge to enable prompt diagnosis and management of an otherwise fatal phenomenon.

Topics: Aged, 80 and over; Amphotericin B; Anemia, Aplastic; Antifungal Agents; Escherichia coli Infections; Fatal Outcome; Female; Humans; Immunocompromised Host; Mucormycosis; Necrosis; Rhizopus; Tongue; Triazoles

Topics: Amphotericin B; Antifungal Agents; Blepharoptosis; Cellulitis; Diabetes Complications; Diagnosis, Differential; Enterobacter aerogenes; Enterobacteriaceae Infections; Humans; Male; Middle Aged; Mucormycosis; Necrosis; Ophthalmoplegia; Orbit; Orbital Diseases; Rhizopus; Sinusitis; Vision Disorders; Visual Acuity; Zygomycosis

Mucormycosis is a rapidly progressive fungal infection that usually occurs in patients with diabetes mellitus or in immunocompromised patients. Sinus involvement is the most common clinical presentation and the rates of mortality increase with the orbital extension. The treatment of mucormycosis includes aggressive surgical debridement and systemic antifungal therapy. Early diagnosis and prompt initiation of effective antifungal drugs are essential for successful outcome. However, the role of orbital exenteration for the case of orbital involvement remains controversial, and the drugs effective against mucormycosis are limited. We present a successfully treated case with rhino-orbital mucormycosis caused by Rhizopus oryzae in a diabetic and dialysis patient. The early diagnosis, surgical debridement and a new combination therapy with liposomal amphotericin B and micafungin were effective. This new combination antifungal therapy will be useful for the treatment of mucormycosis.

Topics: Aged; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Drug Therapy, Combination; Echinocandins; Endoscopy; Humans; Lipopeptides; Magnetic Resonance Imaging; Male; Maxillary Sinus; Maxillary Sinusitis; Micafungin; Necrosis; Opportunistic Infections; Orbital Diseases; Rhinitis; Rhizopus; Tomography, X-Ray Computed; Turbinates

Topics: Accidents, Traffic; Amphotericin B; Biopsy; Debridement; Face; Fatal Outcome; Female; Humans; Mucormycosis; Multiple Trauma; Necrosis; Sepsis; Young Adult

Topics: Aged; Amphotericin B; Anticoagulants; Antifungal Agents; Cellulitis; Cryptococcosis; Dermatomycoses; Fatal Outcome; Female; Fungemia; Heparin, Low-Molecular-Weight; Hepatitis, Autoimmune; Humans; Immunocompromised Host; Immunosuppressive Agents; Liver Cirrhosis; Lung Diseases, Fungal; Necrosis; Prednisone; Radiography; Thrombophilia

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Diagnosis, Differential; Female; Humans; Hyphae; Maxilla; Maxillary Diseases; Maxillary Sinus; Middle Aged; Mucositis; Necrosis; Palatal Obturators; Paranasal Sinus Diseases; Stomatitis; Tooth Extraction

Mucormycosis is an aggressive fungal infection which may still cause fatal complications. However, the rarity of this disease has made optimal treatment a controversial issue. This study aimed to evaluate the use of topical amphotericin B in endoscopic management of rhinocerebral mucormycosis.. Thirty patients with infection limited to the nose and sinuses were selected. Patients underwent endoscopic debridement of all necrotic tissue; cottonoid pledgets soaked in amphotericin B solution were then placed in the nasal cavity. Subsequently, long-term antifungal therapy was administered.. The overall survival rate was 60 per cent (18 cases); survival rates in the diabetic and malignancy groups were 70.58 and 40 per cent, respectively. Apart from predisposing factors, orbital and maxillary sinus involvement also had a significant correlation with patient outcome.. Topical use of amphotericin B combined with endoscopic surgical debridement, followed by intravenous amphotericin B treatment, may constitute acceptable management for selected patients, with less morbidity than conventional treatments.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Debridement; Diabetes Complications; Disease Susceptibility; Drug Delivery Systems; Endoscopy; Female; Humans; Injections, Intravenous; Male; Middle Aged; Mucormycosis; Necrosis; Nose Diseases; Orbital Diseases; Paranasal Sinus Diseases; Survival Rate; Treatment Outcome; Young Adult

Topics: Amphotericin B; Antifungal Agents; Biopsy; Debridement; Fatal Outcome; Female; Hemochromatosis; Hepatic Encephalopathy; Humans; Intubation, Gastrointestinal; Liver; Liver Failure, Acute; Middle Aged; Mucormycosis; Necrosis; Nose; Nose Diseases; Opportunistic Infections; Triazoles

A rare case of oromandibular Rhizopus oryzae infection is described in a 55-year-old woman with acute myeloid leukaemia and decompensated diabetes mellitus. The infection developed during induction chemotherapy when the patient was neutropenic. She was treated with a combination of amphotericin B lipid formulation and caspofungin plus surgery. Debridement surgery included excision of the lower lip, chin, floor of the mouth, a portion of the tongue, as well as mandibular resection at the level of the horizontal branches. Eight weeks of combined antifungal therapy were followed by secondary prophylaxis with amphotericin B lipid formulation during consolidation chemotherapy after achieving complete response of both leukaemia and mucormycosis. Reconstructive surgery was carried out including insertion of a new biomaterial porous mandibular prosthesis, which showed excellent functionality after long-term follow-up, followed by several plastic surgery procedures once good tolerability and no adverse effects of the prosthesis were observed. This case shows that a well-coordinated multidisciplinary approach is critical to increase the chances of clinical success in this life-threatening infection.

Topics: Amphotericin B; Antifungal Agents; Caspofungin; Chin; Drug Therapy, Combination; Echinocandins; Female; Humans; Leukemia, Myeloid, Acute; Lipopeptides; Mandible; Middle Aged; Mouth; Mucormycosis; Necrosis; Plastic Surgery Procedures

The patient was a 61-year-old man. From the end of May 2007 he suffered from pain in the left anterior chest, had fever and consulted our hospital on May 27. On admission chest CT revealed consolidation in the left lung. In venous blood and sputum culture Streptococcus pneumoniae was identified as the causative organism, but despite improvement as a result of treatment, the upper lobe of the left lung showed cavity formation. Inside the cavity, fluid level formation was observed and percutaneous cavernous drainage was performed. Pus culture revealed infection with Aspergillus fumigatus, and we diagnosed chronic necrotizing pulmonary aspergillosis (CNPA). In addition to intravenous antifungal drug administration, 20 mg of amphotericin B (AMPH-B) was administered intracavitary. As symptoms and laboratory findings improved, the patient was discharged on October 12. We reported this case because pneumococcal pneumonia complicated by lung abscess formation is relatively rare, and topical treatment was effective against CNPA.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Chronic Disease; Humans; Injections, Intralesional; Lung; Lung Abscess; Lung Diseases, Fungal; Male; Middle Aged; Necrosis; Pneumococcal Infections; Pneumonia, Pneumococcal; Treatment Outcome

Mucormycosis is a rare opportunistic infection usually associated with immunosuppression, diabetes mellitus or haematological malignancy. Herein, we report an unusual case of mucormycosis in a 46-yr-old male patient with diabetes presenting with an endotracheal mass obstructing the trachea and cartilage damage. Histological examination of the bronchoscopy biopsy specimens revealed invasive mucormycosis. The patient was treated with intravenous amphotericin B followed by removal of the lesion via bronchoscopy.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Bronchoscopy; Cartilage; Dyspnea; Humans; Male; Middle Aged; Mucormycosis; Necrosis; Radiography; Trachea; Tracheal Diseases

Fungal necrotizing otitis externa is rare, although its frequency has increased over the last few years. We report four cases, which to our knowledge make up the largest series published and discuss the main diagnostic problems and the management of this infection.. Our study investigated two men and two women, all diabetics, aged between 69 and 74 years. All four patients were first treated for bacterial necrotizing otitis externa. Diagnosis was reviewed after a lack of response to antibiotic therapy. Aspergillus flavus and Candida parapsilosis were the fungal agents isolated in each of the two patients. Diagnosis was established based on the pathological specimen for one patient. The last patient was treated without identifying the causal fungus. Two patients developed facial paralysis during disease progression. Treatment was based on intravenous amphotericin B and oral itraconazole. Three patients are now free of disease after a three- to six-month course of antifungal therapy; one patient was not followed up.. Fungal necrotizing otitis externa should be suspected in cases where there is no response to antipseudomonal antibiotic therapy. Deep biopsies from the external auditory canal or the mastoid are usually needed to confirm the diagnosis.

Topics: Aged; Amphotericin B; Antifungal Agents; Candidiasis; Female; Fluconazole; Humans; Male; Necrosis; Otitis Externa; Tomography, X-Ray Computed

Visceral leishmaniasis (VL) or Kala-azar is a common parasitic infection among children in Iran. The records of 249 children with VL were evaluated retrospectively. The clinical, hematologic, and bone marrow biopsy findings were studied. In particular, we assessed whether there was an association between bone marrow biopsy findings and prognosis. Five major groups were identified: (1) hypercellular marrow with many Leishman Donovan (LD) bodies, (2) multiple noncaseating granulomas with a few LD bodies, (3) diffuse fibrosis with rare LD bodies, (4) benign lymphoid nodules with many LD bodies, and (5) marrow necrosis with many LD bodies. The patients with hypercellular marrow and benign lymphoid nodules were alive and responded well to glucantime therapy. The patients with marrow fibrosis and marrow necrosis died and were resistant to any type of therapy. Patients with granulomas did not respond to glucantime therapy but responded to amphotericin B. However, less than half of the patients died owing to malnutrition and misdiagnosis. We correlated the bone marrow biopsy findings with the treatment outcomes and prognosis. The outcome was excellent in cases of hypercellular marrow, very poor in cases of fibrosis and necrosis, and intermediate in cases of granulomas. As a result, we believe that bone marrow biopsy findings can be helpful for assessing the prognosis of VL patients.

Topics: Amphotericin B; Antiprotozoal Agents; Biopsy; Bone Marrow; Bone Marrow Examination; Child; Child, Preschool; Female; Fibrosis; Granuloma; Humans; Leishmaniasis, Visceral; Male; Meglumine; Meglumine Antimoniate; Necrosis; Organometallic Compounds; Prognosis; Retrospective Studies

Infectious mononucleosis (IM) is a rare cause of aplastic anemia in adults. We report of a patient in whom aplastic anemia, mucormycosis and aspergillosis complicated during the course of IM and successfully treated with liposomal amphotericin B. According to our searches in literature, we could not find a similar patient complicated and successfully treated like ours.

Topics: Amphotericin B; Anemia, Aplastic; Aspergillosis; Female; Humans; Infectious Mononucleosis; Middle Aged; Mucormycosis; Necrosis; Paranasal Sinuses; Tomography, X-Ray Computed; Treatment Outcome

Keloids are a hyperproliferative response of connective tissue in response to trauma. The mechanism by which this occurs is poorly understood and currently no successful treatment exists.. Senescent fibroblasts form during wound repair, as the result of oxidative stress. They have a major role in the control of fibroblast proliferation and extracellular matrix synthesis, acting as inhibitors. The defective induction of stress-induced senescent phenotype (SIPS) creates an insufficient number of senescent cells, diminishing the inhibitor effect, causing the uncontrolled hyperproliferation and keloid formation. In the proposed mechanism of keloid formation, fibroblasts have a major role, but it is also possible that other cells are involved, like keratinocytes and melanocytes. Accepting the hypothesis to be correct, a therapy that induces senescence can be used to prevent the keloid formation. Current therapies are only partially effective because they either induce senescence in too few cells or in enough number of cells, but at the same time inducing death (apoptosis and necrosis) of other cells. Dead cells are probably the source of a new repair cycle (proliferation), therefore the process of keloid formation is only postponed but not blocked. A more efficient prevention of keloid formation could be achieved using specific drugs or physical methods that induce senescence and not cell death. Therapies based on photodynamic and PUVA therapy, capable to induce predominantly cell senescence, can be possibly effective. The magnitude of oxidative stress, created during photodynamic therapy, can be reduced and used to produce sublethal doses, to cause senescence instead of cell death. Except standard photosensitizers, other drugs could be used, that are not so powerful in inducing oxidative stress, i.e. amphotericin B in combination with UV light.

Topics: Amphotericin B; Apoptosis; Cell Proliferation; Cellular Senescence; Extracellular Matrix; Fibroblasts; Humans; Keloid; Keratinocytes; Melanocytes; Necrosis; Photochemotherapy; Photosensitizing Agents; Ultraviolet Rays; Wound Healing

Topics: Amphotericin B; Antifungal Agents; Chin; Diabetes Complications; Ecthyma; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Middle Aged; Necrosis; Neutropenia; Zygomycosis

Topics: Adult; Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Foot Ulcer; Humans; Itraconazole; Male; Necrosis; Osteomyelitis; Pain; Wound Healing

Topics: Amphotericin B; Antifungal Agents; Catheterization; Dermatomycoses; Equipment Contamination; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Necrosis; Zygomycosis

Extrapulmonary manifestations of tuberculosis involving the central nervous system (CNS) due to haematogenous spread are not a rare entity. It presents as meningitis or tuberculoma. Tuberculoma is a granulomatous inflammatory process mimicking a neoplasm radiologically, so usually a biopsy is performed.. Our study consisted of 23 pathologically proven cases of tuberculomas between 1988 and 2003. Patients were discussed clinically, radiologically and histologically. Headache, fever, weight loss and weakness are the most common clinical manifestations. Our patient's ages vary from 3 to 67 years with a mean of 31.8 years. Ninety-five percent of patients had bad social, economic and nutritional conditions. None of them were infected by human immunodeficiency virus (HIV). All patients had similar contrast-enhancing lesions radiologically. The majority of tuberculomas were located supratentorially. Only one patient presented two foci of (cerebral and cerebellar) tuberculomas. Nineteen tuberculomas were intracerebral; two were located in the cerebellum and one was intramedullary. Among those lesions, one cavernous sinus tuberculoma and one sellar tuberculoma were identified. Only two patients underwent stereotactic biopsy and 21 patients underwent surgical excision. Histopathologic examination revealed granulomatous inflammation with central caseous necrosis in all patients.. Diagnosis of tuberculoma can be difficult, and in most of our cases, the clinical diagnosis was 'neoplasm'. For this reason, clinicians must always be aware of it and consider it in the differential diagnosis of central nervous system mass lesions.

Topics: Adolescent; Adult; Aged; Amphotericin B; Anti-Infective Agents; Brain Diseases; Child; Child, Preschool; Diagnosis, Differential; Female; Fever; Headache; Humans; Magnetic Resonance Imaging; Male; Meningitis; Middle Aged; Necrosis; Retrospective Studies; Socioeconomic Factors; Tuberculoma, Intracranial

The patient was a 42-year-old man who visited a physician with fever, and was diagnosed with pulmonary abscess. Antibiotic therapy was ineffective, and he was referred to our hospital. Chest CT scanning revealed a lesion with cavity formation with an infiltrative shadow in the right upper lobe, and another infiltrative shadow in the left upper lobe. Chronic necrotizing pulmonary aspergillosis (CNPA) was diagnosed on the basis of positive culture of bronchial lavage specimens and positive serological test results for Aspergillus, in addition to the clinical and radiographic features. Intravenous administration of micafungin (MCFG) was initiated with combination therapy of percutaneous cavity drainage, inhaled amphotericin B and oral itraconazole. Clinical symptoms and findings gradually improved, and he was discharged after 40 days of MCFG therapy. MCFG was safe and effective therapy in this case, and may be considered a new therapeutic option for CNPA.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Chronic Disease; Drug Therapy, Combination; Echinocandins; Humans; Itraconazole; Lipopeptides; Lipoproteins; Lung Diseases, Fungal; Male; Micafungin; Necrosis; Peptides, Cyclic

The emergence of new antifungal compounds with alternative mechanisms of action and improved tolerability has opened up new therapeutic possibilities for the use of combined antifungal treatment in life-threatening systemic fungal infections. A case report of an 8-year-old allogeneic stem cell transplant recipient who developed a central venous catheter tunnel infection caused by Aspergillus flavus is presented here. In spite of conventional and subsequent liposomal amphotericin B therapy the infection progressed rapidly and the necrosis extended further to the thoracic wall, pleura and the right lung. Combined treatment consisting of liposomal amphotericin B and caspofungin was instituted. After 30 days of dual therapy the deep fungal infection resolved and the extensive soft tissue defect showed scarring. One year post-transplant, the patient is well, with normal bone marrow function and full donor chimerism. Although there is limited clinical data on the effectiveness of echinocandins in pediatric patients with documented invasive fungal infections, this case report shows that combining liposomal amphotericin B with caspofungin could be advantageous.

Topics: Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Aspergillus flavus; Bone Marrow Transplantation; Caspofungin; Catheterization, Central Venous; Child; Cicatrix; Disease Progression; Drug Synergism; Drug Therapy, Combination; Echinocandins; Equipment Contamination; Female; Hepatitis; Humans; Immunocompromised Host; Leukocyte Transfusion; Lipopeptides; Liposomes; Necrosis; Peptides, Cyclic; Pneumothorax; Postoperative Complications; Remission Induction; Salvage Therapy; Torque teno virus; Transplantation, Homologous

Topics: Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Blood Vessels; Diabetes Complications; Fatal Outcome; Gangrene; Hand; Humans; Injections, Intravenous; Itraconazole; Male; Microscopy; Middle Aged; Necrosis; Soft Tissue Infections; Thorax; Thrombosis; Zygomycosis

Topics: Abdominal Pain; Adrenal Cortex Hormones; Adult; Amphotericin B; Antibodies, Monoclonal; Antifungal Agents; Biopsy; Colon; Colonoscopy; Crohn Disease; Diagnosis, Differential; Diagnostic Errors; Diarrhea; Hematologic Tests; Histoplasma; Histoplasmosis; Humans; Infliximab; Male; Necrosis

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

A case and the treatment of a 42-year-old male patient with orbito-facial mucormycosis are presented by the authors. The most important steps in the treatment of this opportunistic infection--with a lethality rate of 30-50 %--are as follows: immediate diagnosis, specific antimycotic therapy (Amphotericin-B treatment), a series of extensive surgical interventions and adequate control of patient's diabetes mellitus.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Cheek; Diagnosis, Differential; Drug Administration Schedule; Humans; Male; Mucormycosis; Necrosis; Orbital Diseases; Treatment Outcome

Caspofungin (CAS) has recently been approved for treatment of invasive aspergillosis. In clinical trials, CAS-induced nephrotoxicity was markedly less pronounced compared to amphotericin B (AmB). Nevertheless, in a recent trial, nephrotoxicity in CAS-treated patients was considerably more pronounced than in preceding studies. Therefore, the aim of this study was to assess toxic effects of CAS on human renal proximal and distal tubular epithelial cells (PTC and DTC) in vitro, and to compare them to those of AmB.. Cells were isolated from human kidney tissue, and exposed to clinically relevant concentrations of CAS and AmB for 24 h. Total DNA content and cell viability were determined by DAPI staining and a modified MTT assay. For testing of cytotoxicity, LDH activity was measured in cell culture supernatants. To assess apoptotic effects, AnnexinV-binding assay and DAPI staining for detection of fragmented DNA were performed.. DTC were more vulnerable towards the antifungal agents than PTC. In contrast to AmB, cell-damaging effects of CAS were less severe. DAPI staining revealed slight and dose-dependent antiproliferative effects of CAS at concentrations reflecting relevant plasma levels. At these concentrations, cell viability, determined by MTT assay, was not decreased in PTC and DTC. LDH release was marginally increased in a dose-dependent manner; apoptosis was not detected. Nevertheless, at CAS concentrations reflecting potential tissue concentrations, cell damaging effects were considerably more pronounced.. Our results suggest that CAS is less nephrotoxic than AmB in vitro. The antiproliferative and cytotoxic effects of CAS predominantly affect DTC, which seem to be more susceptible to CAS-induced damage.

Topics: Amphotericin B; Annexin A5; Antifungal Agents; Apoptosis; Caspofungin; Cell Proliferation; Cell Survival; Cells, Cultured; DNA Fragmentation; Echinocandins; Fluorescent Dyes; Humans; In Vitro Techniques; Indoles; Kidney; Kidney Tubules, Distal; Kidney Tubules, Proximal; L-Lactate Dehydrogenase; Lipopeptides; Necrosis; Peptides, Cyclic

Renal involvement is an unusual complication of human visceral leishmaniasis (VL). The kidney lesions are characterized more by interstitial damage than glomerular or vascular damage. This case represents a 20 years-old man admitted with pancytopenia, purpura, acute renal failure, and nephrotic syndrome associated with heavy proteinuria. The diagnosis of VL was made on bone marrow smear cytology where Leishmania amastigotes were found. The renal biopsy revealed a segmental necrotising glomerulonephritis with 70% crescents. Treatment with liposomal amphotericine B alone has been ineffective on the course of renal failure, however, partial recovery was obtained after the administration of high dose corticosteroids. We present the various clinical, biological, and histological aspects of this case, from the south of France. It gave us the opportunity to discuss these unusual manifestations of immunomediated necrotising skin and renal lesions.

Topics: Acute Kidney Injury; Adult; Amphotericin B; Antiprotozoal Agents; Glomerulonephritis; Glucocorticoids; Humans; Leishmaniasis, Visceral; Male; Methylprednisolone; Necrosis

Topics: Abdominal Wall; Amphotericin B; Antifungal Agents; Biopsy; Debridement; Enterobacteriaceae Infections; Fatal Outcome; Heart Transplantation; Humans; Male; Middle Aged; Mucormycosis; Necrosis; Peritonitis; Postoperative Complications; Radiography, Abdominal; Rare Diseases; Superinfection; Tomography, X-Ray Computed

A 65-year-old man with pneumoconiosis visited our hospital for dyspnea on effort. Chest radiography and computed tomography on admission showed cavities with an air-fluid level, consolidation in the right lower lung, and right pleural effusion. The thoracic cavity and an infected cyst were drained, and antibiotics were administered. On detection of molds like Aspergillus species and of aspergillus antigen from the sputum, aspergillosis was suspected and amphotericin B was administered intravenously. Renal dysfunction caused by amphotericin B led to its withdrawal. Abnormal shadows in the chest radiographs and computed tomograms did not improve. To aid in diagnosis, percutaneous intracavitary endoscopy was performed. Yellow-white mural nodules resembling cauliflower were found on endoscopic examination, and a biopsy specimen of the nodules showed hyphae of Aspergillus. Aspergillus fumigatus was cultured from the intracavity fluid. Pulmonary aspergillosis was diagnosed and amphotericin B was administered via the drainage catheter in order to protect renal function. The abnormal shadows then disappeared and the subsequent clinical course was good. In this case, percutaneous intracavitary endoscopy was useful in diagnosing pulmonary aspergillosis.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Chronic Disease; Endoscopy; Humans; Lung Diseases, Fungal; Male; Necrosis

Rhinocerebral mucormycosis is an invasive fungal infection initiated in the paranasal sinuses that frequently progresses to orbital and brain involvement. If recognized early, involvement is limited to the nasal cavity and paranasal sinuses. Diabetics in poor control are at greatest risk, however, any immunocompromised individual may be infected. The mainstays of therapy are reversal of immunosuppression, systemic amphortericin B, and surgical débridement. Survival has improved dramatically, yet deaths still occur if the infection is not recognized and not treated early in its course or if the source of immunocompromise is not reversible. Several case examples illustrate the clinical course of this unusual, but potentially fatal, fungal infection. Taxonomy, clinical presentation, diagnosis, and management of mucormycosis of the paranasal sinuses are reviewed in detail.

Topics: Aged; Amphotericin B; Antifungal Agents; Biopsy; Female; Humans; Male; Middle Aged; Mucormycosis; Necrosis; Nose Diseases; Paranasal Sinus Diseases; Rhizopus; Tomography, X-Ray Computed; Turbinates

Fusarium is a newly emerging fungal pathogen associated with significant morbidity and mortality in the immunocompromised host. We have reviewed our hospital's experience with Fusarium between 1985 and 1995. Fusarium species were isolated from 22 specimens, representing 11 patients. Cases were not clustered by time period. The median age of the patients was 36.5 years (range 17-69 years). The sources of the organism were 12 skin lesions from eight patients, seven blood cultures from two patients and one specimen each from a Hickman catheter tip, nail clippings and a bronchoalveolar lavage. Seven of the patients had chemotherapy-induced neutropenia when the Fusarium was isolated. Five of them developed invasive fusarosis during acute leukaemia induction treatment. They remained neutropenic, and none survived. The other two patients recovered from neutropenia and were treated successfully for this infection. The remaining four patients were not neutropenic or immunocompromised. Three grew Fusarium from skin or nail clippings and one from bronchial alveolar lavage (BAL). There was no evidence of invasive disease in any of the four. None of them received antifungal therapy, and they were all alive at last follow-up. We conclude that Fusarium is a newly emerging infection in neutropenic patients. A high index of suspicion, especially for skin lesions, will help in early diagnosis before systemic and visceral dissemination. Excision of the initial focus of infection and antifungal therapy, aided by speedy neutrophil recovery, are likely to protect patients threatened with these fatal infections. Fusarium isolated from non-neutropenic, non-immunosuppressed patients is not significant and does not merit systemic antifungal treatment.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Dermatomycoses; Female; Foot Dermatoses; Fusarium; Humans; Immunocompromised Host; Leukemia; Male; Middle Aged; Necrosis; Neutropenia; Retrospective Studies; Skin

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

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Drug Therapy, Combination; Humans; Immunocompromised Host; Joint Diseases; Male; Miconazole; Necrosis

A 64-year-old woman with a history of old tuberculosis, had a fungus ball shadow with meniscus sign in the upper right lung field on a chest X-ray film in 1991. Based on the chest X-ray findings, pulmonary aspergilloma was suspected. Because the size of the intracavitary fungus ball increased, the patient was treated with itraconazole over one year in 1995, but there was no improvement. One month later, she was admitted because of fever, hemoptysis and productive cough, and chest X-ray showed an enlargement of intracavitary mass and infiltrative shadow in the right lung. Chronic necrotizing aspergillosis was diagnosed on the basis of her clinical and radiographic features, and positive serological test. Although itraconazol and amphotericin B were given, cavity and intracavitary fungus ball shadow kept growing. Combination therapy of antifungal drugs and ulinastatin markedly improved symptoms and resulted in complete disappearance of the fungus ball on chest CT scan.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Chronic Disease; Drug Therapy, Combination; Female; Glycoproteins; Humans; Lung Diseases, Fungal; Middle Aged; Necrosis; Trypsin Inhibitors

Multiple necrotizing skin lesions due to Fusarium solani in an elderly man with acute myelogenous leukemia is described.

Topics: Amphotericin B; Antifungal Agents; Dermatomycoses; Female; Fluconazole; Fusarium; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Necrosis; Skin

Necrotizing myofascial fungal infections of the upper extremity is a rare event even in immunocompromised hosts. We report the course of a renal transplant patient who developed extensive necrotizing myofascial infection of an upper extremity secondary to Histoplasma capsulatum. Initial, functional, upper limb salvage was achieved after aggressive surgical debridement and high doses of amphotericin B. The patient ultimately succumbed to systemic fungal sepsis. The etiology and treatment of these infections are discussed.

Topics: Amphotericin B; Combined Modality Therapy; Debridement; Fasciitis; Fatal Outcome; Forearm; Histoplasmosis; Humans; Kidney Transplantation; Male; Middle Aged; Myositis; Necrosis; Opportunistic Infections; Postoperative Complications

Seventy-two cases of Aspergillus sinusitis were analyzed during a period of 14 years from January 1980 through October 1993. There were 60 cases of primary type and 12 cases of secondary type. The maxillary and ethmoid sinuses were most commonly affected in both primary and secondary types. The sphenoid sinus was commonly involved in secondary type. Fourteen (23%) cases of primary type and 4 (33%) cases of secondary type demonstrated sinus wall destruction on computed tomography or magnetic resonance images. Seventy percent of primary type and all cases of secondary type showed focal or diffuse areas of increased attenuation in the soft tissue mass on computed tomography scans. Sixteen cases assessed by magnetic resonance imaging showed decreased signal intensities on T1-weighted images and markedly reduced signal intensities on T2-weighted images. Fifty-nine (98%) of 60 cases of primary type were noninvasive, and 1 was invasive. In secondary type, 10 (83%) of 12 patients had noninvasive disease. The most common coexisting disease in secondary aspergillosis was diabetes mellitus. Thickened mucosa with necrotic brownish green material, which was the most common finding in both types, was found in 33 patients with primary type and in 5 with secondary type. Surgery was performed in most cases, among which 4 patients received chemotherapy after surgery with amphotericin B with or without flucytosine. All patients were cured without recurrence during a mean follow-up period of 13 months.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Child; Diabetes Complications; Ethmoid Sinusitis; Female; Flucytosine; Humans; Magnetic Resonance Imaging; Male; Maxillary Sinusitis; Middle Aged; Necrosis; Sinusitis; Sphenoid Sinusitis; Tomography, X-Ray Computed; Treatment Outcome

To describe the MR appearance of necrotizing fungal granulomas occurring in the liver of leukemic patients with hepatosplenic fungal disease and transfusional hemosiderosis on antifungal antibiotics.. Four patients with acute myelogenous leukemia (n = 2) or acute lymphocytic leukemia (n = 2) who developed hepatosplenic fungal disease, and were treated with antifungal medication, underwent MRI examination on a 1.5 T MR imager. MR images were prospectively evaluated and correlated with liver biopsy (three patients), and clinical picture (one patient).. Multiple liver lesions measuring approximately 1 cm in diameter were identified in all patients. Lesions possessed a distinctive MR appearance: central mild hyperintensity with a peripheral ring of very low signal intensity on precontrast T1- and T2-weighted images. The central region of the lesions enhanced following gadolinium administration with the peripheral ring remaining low in signal intensity.. Necrotizing fungal granulomas in the liver of patients with transfusional hemosiderosis on treatment with antifungal antibiotics have a distinctive appearance of moderate high signal intensity center on T1- and T2-weighted and postgadolinium MR images with a peripheral rim of low signal intensity. This appearance reflects the presence of iron-laden macrophages in the periphery of granulomas and may be expected in processes that initiate an immune response involving aggregation of macrophages in the liver of patients with transfusional iron overload.

Topics: Acute Disease; Adolescent; Adult; Amphotericin B; Antifungal Agents; Candidiasis; Child; Female; Granuloma; Hemosiderosis; Humans; Itraconazole; Leukemia; Liver; Magnetic Resonance Imaging; Male; Middle Aged; Necrosis; Opportunistic Infections; Transfusion Reaction

The authors describe a rare case of rhinocerebral mucormycosis. This is an acute, suppurative mycosis with poor prognosis. It has a particular affinity for rhinocerebral tissue and less frequently affects pulmonary tissue. Mucormycosis affects immunosuppressed patients and more than 75% of the cases involve patients suffering from acidosis, especially diabetic ketoacidosis. One characteristic feature is that the blood vessels are flooded causing thromboses, infarction and emboli. The disease is spread through the blood vessels or by expansion. The first clinical symptoms can be confused with an early stage of acute sinusitis with mucosanguineous rhinorrhea, facial tumescence and pain. In 50% of the cases there is rhinocerebral and orbital involvement. If the disease remains untreated it can prove fatal in 10 to 14 days. Effective treatment relies on an early diagnosis and prompt administration of intravenous amphotericin B as well as avulsion of the necrotic areas. To date only 200 cases of this severe pathology have been described. The present work is an attempt to throw further light on this disorder.

Topics: Adult; Amphotericin B; Diabetes Mellitus; Female; Humans; Mucormycosis; Necrosis; Nose

Topics: Abdominal Muscles; Amphotericin B; Cellulitis; Combined Modality Therapy; Debridement; Female; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Mucormycosis; Necrosis; Rhizopus

The fungus Fusarium moniliforme causes fusariosis, which can be invasive and fatal in immunocompromised patients. We report a case of oral Fusarium infection in a granulocytopenic patient with acute myelogenous leukemia who developed necrotic ulceration of the gingiva, extending to the alveolar bone, but was otherwise free of any active systemic lesions. Fusarium moniliforme was identified, by histopathology and culture, to be present in the lesion and was deduced to be the causative organism for this invasive oral infection.

Topics: Acute Kidney Injury; Aged; Agranulocytosis; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Cytarabine; Epirubicin; Etoposide; Fatal Outcome; Fusarium; Gingival Diseases; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Male; Maxillary Diseases; Mercaptopurine; Mycoses; Necrosis; Prednisolone; Ulcer; Vindesine

The authors test antibiotic strategies aimed at either mitigating bacterial translocation from the gut or delivering antibiotics specifically concentrated by the pancreas for prevention of early secondary infection after acute necrotizing pancreatitis.. Infection currently is the principal cause of death after severe pancreatitis. The authors have shown that the risk of bacterial infection correlates directly with the degree of tissue injury in a rodent model of pancreatitis. Bacteria most likely arrive by translocation from the colon.. Severe acute necrotizing pancreatitis was induced in rats by a combination of low-dose controlled intraductal infusion of glycodeoxycholic acid superimposed on intravenous cerulein hyperstimulation. At 6 hours, animals were randomly allocated to five treatment groups: controls, selective gut decontamination (oral antibiotics and cefotaxime), oral antibiotics alone, cefotaxime alone, or imipenem. At 96 hours, surviving animals were killed for quantitative bacterial study of the cecum, pancreas, and kidney.. The 96-hour mortality (35%) was unaffected by any treatment regimen. Cecal gram-negative bacteria were significantly reduced only by the oral antibiotics. Pancreatic infection was significantly reduced by full-gut decontamination and by imipenem, but not by oral antibiotics or by cefotaxime alone. Renal infection was reduced by both intravenous antibiotics.. Early pancreatic infection after acute necrotizing pancreatitis can be reduced with a full-gut decontamination regimen or with an antibiotic concentrated by the pancreas (imipenem) but not by unconcentrated antibiotics of similar spectrum (cefotaxime) or by oral antibiotics alone. These findings suggest that 1) both direct bacterial translocation from the gut and hematogenous seeding interplay in pancreatic infection while hematogenous seeding is dominant at extrapancreatic sites and 2) imipenem may be useful in clinical pancreatitis.

Topics: Acute Disease; Administration, Oral; Amphotericin B; Animals; Bacteria; Bacterial Infections; Bacterial Physiological Phenomena; Cecal Diseases; Cefotaxime; Colistin; Disease Models, Animal; Drug Therapy, Combination; Imipenem; Injections, Intravenous; Kidney Diseases; Male; Necrosis; Pancreas; Pancreatic Diseases; Pancreatitis; Rats; Rats, Sprague-Dawley; Survival Rate; Tobramycin

A 49-year-old man with a history of left upper lung lobectomy for pulmonary asperigilloma developed a productive cough in the middle of April 1992, and his chest X-ray film showed infiltration of the left S6. Treatment with several different antibiotics was tried, but the shadow expanded and developed a cavity over the following 8 months. A clinical diagnosis of chronic necrotizing pulmonary aspergillosis was made, based on repeated detection of Aspergillus fumigatus in the patient's sputum and in specimens obtained by fiberoptic branchoscopy and percuraneous needle biopsy. Prior lobectomy and a marked idiopathic decrease in ventilation and perfusion in the affected lung are risk factors for this disease. Slow intravenous infusion of amphotericin B eradicated the fungus without any side effects. Measurement of drug concentrations during treatment revealed that the concentration in the sputum was far higher than that in the serum, and was also far higher than the minimum inhibitory concentration for the fungus.

Topics: Amphotericin B; Aspergillosis; Chronic Disease; Humans; Infusions, Intravenous; Lung Diseases, Fungal; Male; Middle Aged; Necrosis

We present an unusual case of 30-year-old man who was admitted to our hospital with dysesthesia of the limbs and skin eruptions. Polyarteritis nodosa was diagnosed based on the histopathological examination of sural nerve and renal biopsies. A month after initiation of corticosteroid therapy, a small infiltrative shadow was detected in the right mid-lung field by chest X-ray. Aspergillus infection was suspected based on a culture of bronchial lavage fluid. Despite intravenous administration of the antifungal agents, miconazole and fluconazole, a thin-walled cavity with a fungus ball gradually formed in the infiltrative lesion. The patient's clinicopathological findings were consistent with a diagnosis of chronic necrotizing pulmonary aspergillosis, a rare aspergillus infection in the lung. Treatment with intracavitary instillation of amphotericin B proved effective.

Topics: Adult; Amphotericin B; Aspergillosis; Chronic Disease; Humans; Immunocompromised Host; Instillation, Drug; Lung; Lung Diseases, Fungal; Male; Necrosis; Polyarteritis Nodosa; Prednisolone

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

A 52-year-old man with chronic necrotizing pulmonary aspergillosis complicated by a residual tuberculous cavity was admitted to the hospital because of fever and a new infiltration shadow in the right lower lobe. Aspergillus was isolated repeatedly from his sputum, though he had been treated with itraconazol for 9 months. Combination therapy with itraconazol (200 mg) and inhaled amphotericin B (AMPC, 10 mg, 4 times a day) was begun. The infiltration shadow gradually resolved. The concentration of AMPC in serum was measured by high-performance liquid chromatography, and was found to be 0.09 micrograms/ml, which is equal to the AMPC concentration obtained with daily oral administration of 2400 mg. This case shows that, contrary to previous opinion, AMPC can be effectively administered by inhalation. We know of no previous reports of similar cases. In addition, itraconazol and inhaled AMPC may have had a synergistic effect in this case.

Topics: Administration, Inhalation; Administration, Oral; Amphotericin B; Antifungal Agents; Aspergillosis; Chronic Disease; Drug Therapy, Combination; Humans; Itraconazole; Lung Diseases, Fungal; Male; Middle Aged; Necrosis; Tuberculosis, Pulmonary

Rhinocerebral mucormycosis is a fulminating, devastating fungal disease, usually associated with debilitating diseases such as diabetes mellitus, leukaemia and immunosuppressive conditions. Ten patients with this rare disease have been treated over the past 14 years at the Beilinson Medical Centre. Nine patients had an underlying debilitating disease and one patient had latent diabetes mellitus which was diagnosed only after presentation of mucormycosis. Only two of the 10 patients survived. Early aggressive surgical debridement, together with amphotericin B and correction of underlying metabolic acidosis were found to be important factors associated with survival.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Diabetes Complications; Diabetes Mellitus; Female; Humans; Injections, Intravenous; Male; Middle Aged; Mucormycosis; Nasal Septum; Necrosis; Photomicrography; Tomography, X-Ray Computed; Turbinates

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

A 40-year-old man with renal failure due to membranous glomerulonephritis received a cadaveric renal transplant and immunosuppressive therapy with cyclosporine, azathioprine and steroids. Initially the transplantation was successful. 12 days after the transplantation, however, serous secretion appeared in the wound. Later, black necrosis was seen. Fungal culture showed growth of a zygomycete species. Rhizopus rhizopodiformis, with high in-vitro resistance to amphotericin B, flucytosine, fluconazole, ketoconazole and itraconazole. The MIC value for the allylamine derivative SF86-327 (Exoderil) was 1.6 micrograms/ml. Microscopic examination of sections from a surgical revision showed necrosis of the fat tissue and massive hyphal invasion of the perirenal fat, which contained semi-crystalline material anisotropic as seen in polarized light and characteristically staining with rubeanic acid. These histological data indicate a lipase-induced in-vivo splitting of lipids into fatty acids. In-vitro R. rhizopodiformis showed very high extracellular lipase production. 11 days after initiation of amphotericin B therapy cultures and sections remained positive for rhizopus. Amphotericin B was therefore supplemented with Exoderil orally, cyclosporine and steroids were maintained, and azathioprine was discontinued. The wound granulated, shrank, and healed completely in 10 weeks.

Topics: Adult; Amphotericin B; Antifungal Agents; Humans; Kidney Transplantation; Lipase; Male; Microbial Sensitivity Tests; Mucormycosis; Necrosis; Rhizopus; Surgical Wound Infection

We have described a patient with cavitary pulmonary fungal infection, probably blastomycosis, with necrotizing arteritis of the skin. The pulmonary and skin lesions resolved with amphotericin B therapy.

Topics: Adult; Amphotericin B; Arteritis; Blastomycosis; Dermatomycoses; Diagnosis, Differential; Female; Granulomatosis with Polyangiitis; Humans; Lung Diseases, Fungal; Necrosis

The retinal toxicity of intravitreally administered amphotericin B was compared in non-vitrectomised versus vitrectomised rabbit eyes. Doses of 5 and 10 micrograms in both groups resulted in transient vitritis but had no effect on electroretinograms. Histopathological examination four weeks after injection showed vitreous cells and minimal areas of retinal necrosis in both groups at 5 or 10 micrograms doses. At these doses vitrectomy did not modify the retinotoxic effects of intravitreally administered amphotericin B. At higher doses marked toxicity was found in both vitrectomised and non-vitrectomised groups.

Topics: Amphotericin B; Animals; Dose-Response Relationship, Drug; Electroretinography; Necrosis; Rabbits; Retina; Retinal Detachment; Retinal Diseases; Vitrectomy; Vitreous Body

Topics: Amphotericin B; Aspergillosis; Aspergillus niger; Calcium Oxalate; Humans; Lung; Lung Diseases, Fungal; Male; Middle Aged; Necrosis; Sputum

Topics: Amphotericin B; Animals; Injections, Intramuscular; Muscles; Necrosis; Rats; Solubility; Time Factors

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

Topics: Adult; Amphotericin B; Diabetes Complications; Humans; Male; Mucorales; Mucormycosis; Necrosis; Ophthalmologic Surgical Procedures; Palate

Topics: Amphotericin B; Animals; Cataract; Dose-Response Relationship, Drug; Female; Inflammation; Injections; Male; Necrosis; Rabbits; Retina; Retinal Detachment; Retinal Diseases; Retinal Hemorrhage; Time Factors; Vitreous Body

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Blood Vessels; Brain Diseases; Fungi; Heroin Dependence; Humans; Kidney Diseases; Male; Mucormycosis; Necrosis; Urography

Topics: Amebiasis; Amebicides; Amoeba; Amphotericin B; Brain; Brain Stem; Central Nervous System Diseases; Cerebrospinal Fluid Proteins; Encephalitis; Humans; Leukocyte Count; Lymphocytosis; Male; Middle Aged; Necrosis; Temporal Lobe; Water Pollution

Topics: Amphotericin B; Animals; Deoxycholic Acid; Electroretinography; Fundus Oculi; Injections; Necrosis; Rabbits; Retina; Retinal Detachment; Sodium; Vitreous Body

Topics: Adult; Amphotericin B; Conjunctiva; Cryptococcosis; Cryptococcus; Eye Diseases; Fundus Oculi; Humans; Lupus Erythematosus, Systemic; Male; Meningitis; Necrosis; Optic Nerve; Papilledema; Prednisone; Pupil; Retina; Retinitis

Topics: Amphotericin B; Animals; Ciliary Body; Eye Diseases; Histoplasmosis; Hyperemia; In Vitro Techniques; Iritis; Necrosis; Rabbits