amphotericin-b and Nervous-System-Diseases

To investigate diagnostic aspects of invasive aspergillosis (IA) in allogeneic BMT recipients, the charts of 22 consecutive patients with IA transplanted in 1989-1995 were reviewed. IA was diagnosed 69-466 days (median 131 days) post BMT. In 16 patients (73%), a definite or probable diagnosis of IA was made during life. Respiratory symptoms were the presenting feature in half of the patients followed by neurological symptoms (27%). Chest X-ray revealed single or multiple nodular lesions in 10 patients; cavitation was observed in five patients. Tissue biopsy was the most common method of diagnosis (nine patients: lungs 6, liver 1, subcutaneous tissue 1, brain 1). Five IA cases were detected by nine guided fine needle lung biopsies in eight patients and without complications. Bronchoalveolar lavage was performed in 14 patients with findings suggestive of invasive pulmonary aspergillosis in eight cases. Lungs were the most common organ affected (90%) followed by central nervous system (41%). The diagnosis of IA is still difficult, and a large number of patients have advanced infection at diagnosis. Methods for early diagnosis are needed. Patients with a clinical suspicion of IA should be treated vigorously with antifungal agents during the diagnostic work-up.

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Aspergillus niger; Autopsy; Biopsy, Needle; Bone Marrow Transplantation; Bronchoalveolar Lavage Fluid; C-Reactive Protein; Cohort Studies; Female; Fever; Graft Survival; Graft vs Host Disease; Hematologic Neoplasms; Hemoptysis; Humans; Lung; Male; Middle Aged; Nervous System Diseases; Neutropenia; Radiography, Thoracic; Respiratory Tract Diseases; Tomography, X-Ray Computed; Transplantation, Homologous

The clinical course and response to therapy of seven patients with cryptococcosis and AIDS were reviewed. One patient was still in the primary stage of cryptococcosis in AIDS, i.e. the stage that is characterized by the sole cultural detection of Cryptococcus neoformans in the respiratory tract. The other six patients were in the secondary stage, where C. neoformans can be detected from the cerebrospinal fluid (CSF), blood, urine, faeces and other body sites. The main presenting features (headache, fever, nausea) were due to central nervous system involvement, although meningism and mental changes were rarely present, and CSF changes were very subtle. Treatment with amphotericin B and flucytosine was very effective, there being no more growth of fungi in cultures in most cases. Adverse reactions to the drugs used occurred frequently and consisted mainly of anaemia, hepatosis and fever. Diagnosis in the primary stage of cryptococcosis may improve the prognosis.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Cryptococcosis; Flucytosine; Humans; Male; Nervous System Diseases; Opportunistic Infections

Topics: Amphotericin B; Animals; Brain Diseases; Coccidioidomycosis; Dogs; Humans; Macaca mulatta; Mycoses; Nervous System Diseases

Topics: Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Humans; Lung Diseases; Lung Diseases, Fungal; Nervous System Diseases; Neurologic Manifestations; Peripheral Nervous System Diseases; Poisoning; Toxicology