amphotericin-b and Pancreatitis

We present a case of bilateral polymicrobial osteomyelitis with Candida tropicalis and Candida krusei, and review the literature on Candida osteomyelitis.. PubMed was searched for cases of Candida osteomyelitis published in the English-language literature between 1970 and 2010.. A 60-year-old previously healthy man was hospitalized with gallstone pancreatitis. Between 3 weeks and 6 months after hospitalization, he developed bilateral osteomyelitis of the feet with C. tropicalis and C. krusei. The patient was treated with surgery, fluconazole, and a liposomal formulation of amphotericin B. The left lower limb was amputated, and at a 2-year follow-up, the patient had almost no pain in his right foot.. We identified 40 new cases in the literature since the latest review in 2004. Most cases of Candida osteomyelitis are caused by Candida albicans, but an increasing number are caused by non-albicans species. The prognosis is favorable, with full recovery in the majority of cases.. Candida osteomyelitis should be considered when a patient presents with risk factors and pain without previous trauma, because Candida, despite being part of the normal flora, is the fourth leading cause of hematogenous nosocomial infections. The recommended treatment is surgery and fluconazole as monotherapy or initially combined with a fungicidal agent, either a different amphotericin B formulation or an echinocandin.

Topics: Amphotericin B; Antifungal Agents; Candida; Candida tropicalis; Cross Infection; Drug Combinations; Echinocandins; Fluconazole; Follow-Up Studies; Gallstones; Hospitalization; Humans; Male; Middle Aged; Osteomyelitis; Pancreatitis; Treatment Outcome

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

To investigate the prevention and therapy of fungal infection in patients with severe acute pancreatitis (SAP).. Seventy patients with SAP admitted from Jan. 1998 to Dec. 2002 were randomly divided into garlicin prevention group, fluconazole (low dosage) prevention group and control group. The incidence of fungal infection, the fungal clearance and mortality after treatment were compared.. The incidence of fungal infection in garlicin group and fluconazole group was lower than that in control group (16% vs 30%, P<0.05 and 9% vs 30%, P<0.01, respectively). Amphotericin B or therapy-dose fluconazole had effects on patients with fungal infection in garlicin group and control group, but had no effects on patients with fungal infection in fluconzole group.. Prophylactic dosage of antifungal agents (garlicin or low dosage fluconazole) can reduce the incidence of fungal infection in patients with SAP. But once fungal infection occurs, amphotericin B should be used as early as possible if fluconazole is not effective.

Topics: Acute Disease; Adult; Aged; Allyl Compounds; Amphotericin B; Antifungal Agents; Disulfides; Female; Fluconazole; Humans; Incidence; Male; Middle Aged; Mycoses; Pancreatitis; Prospective Studies; Treatment Outcome

Candida lusitaniae is an uncommon pathogen that accounts for approximately 1% of patients with candidiasis. In this report, we present the case of a 24-year-old woman with severe pancreatitis who was emergently admitted to Northern Yokohama Hospital. We started treating the pancreatitis and infections according to her culture results. However, her symptoms, accompanied by a necrotic pancreas, did not improve. Finally, C. lusitaniae was detected in the blood and catheter samples. We started antifungal treatment according to the culture results, but the patient died. Generally, the mortality rate for acute pancreatitis ranges from 3% for patients with interstitial edematous pancreatitis to 17% for those who develop pancreatic necrosis. Although we chose appropriate antibiotics and antifungal agents based on the culture results, the treatments failed. Early detection, sufficient doses of antimicrobials and frequent monitoring using sample culture are crucial because infection control may be inadequate, especially in tissues with low blood flow, such as necrotic tissues.

Topics: Acute Disease; Adult; Antifungal Agents; Candida; Candidiasis; Female; Humans; Pancreatitis; Young Adult

Topics: Aged, 80 and over; Amphotericin B; Cryptococcus neoformans; Cysts; Humans; Male; Meningitis, Cryptococcal; Pancreatitis; Ventriculoperitoneal Shunt

Topics: Acute Disease; Adolescent; Amphotericin B; Anesthetics, Intravenous; Anti-Bacterial Agents; Humans; Liposomes; Male; Pancreatitis; Propofol

Though liposomal amphotericin B has been available in Germany since 1992, efficacy and safety of this formulation of amphotericin B are still not well-documented in children. As far as gastrointestinal side-effects are concerned, an elevated alkaline phosphatase and elevated transaminases have been reported. In our department, liposomal amphotericin B had been used since 1994 to treat patients with proven or suspected fungal infections in a daily dose of 1-3 mg kg-1. Additionally, patients with high-dose chemotherapy and autologous stem cell support received liposomal amphotericin B prophylactically in a dose of 1 mg kg(-1) three times per week. We performed a retrospective analysis of all 31 patients who had received liposomal amphotericin B by 1999. In five patients, an isolated transient elevation of the serum lipase level during, or shortly after, the therapy with liposomal amphotericin B was detected. Three of these patients showed clinical signs of pancreatitis, with one patient displaying slightly elevated transaminases. So far, elevated levels of serum lipase have not been described as a possible side-effect of a liposomal amphotericin B therapy. The pathogenesis of this elevation is unclear. As possible reasons, an enzyme induction due to fat overload or a toxic damage of the pancreatic tissue by the liposomes or amphotericin B itself are discussed.

Topics: Adolescent; Amphotericin B; Child; Child, Preschool; Female; Humans; Infant; Lipase; Liposomes; Male; Mycoses; Neoplasms; Neutropenia; Pancreatitis; Pancrelipase; Retrospective Studies

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antimony; Antiprotozoal Agents; Humans; Leishmaniasis, Visceral; Male; Meglumine; Meglumine Antimoniate; Nephrotic Syndrome; Organometallic Compounds; Pancreatitis

Topics: Acute Disease; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Candidiasis; Esophageal Diseases; HIV Seropositivity; HIV-1; Humans; Male; Pancreatitis; Substance Abuse, Intravenous

Pancreatic infection by Candida is an infrequent entity. We report two cases and review literature. A 67 year-old woman who was admitted for severe acute pancreatitis of biliary origin developed high fever during fourth week of stay; it was secondary to a pancreatic abscess due to Candida. On the other hand, a 67 year-old man with severe acute biliary pancreatitis and renal insufficiency showed an abscess of similar characteristics that was identified during fourth week of evolution. Both of them recovered completely after surgical drainage and antifungical parenteral treatment. The use of broad spectrum antibiotics recently recommended for prophylaxis of pancreatic infection in patients with necrotizing acute pancreatitis, can favour opportunistic infection by several agents. Pancreatic abscesses by Candida often occurs in patients receiving broad spectrum antibiotics, although it isn't an essential condition. The fact that Candida could be only a contaminant may delay diagnosis and early treatment, and then it can determine a poor outcome. Adequate treatment is urgent surgical drainage associated with antifungical parenteral therapy. Usefulness of antifungic drugs in patients undergoing long term antibiotic prophylaxis for secondary infection must be evaluated.

Topics: Abscess; Acute Disease; Aged; Amphotericin B; Antifungal Agents; Candidiasis; Drainage; Female; Humans; Imipenem; Male; Pancreatic Diseases; Pancreatitis; Radiography; Thienamycins

The experience with 52 episodes of visceral leishmaniasis diagnosed in 43 patients is reported. The most common symptoms were fever (81%), splenomegaly (65%), hepatomegaly (63%), and pancytopenia (73%). In 79% of the patients, CD4+ cell counts were < 100 cells/mm3. Prior or simultaneous diagnosis of AIDS was made in 29 (67%) patients. Diagnosis was considered fortuitous in 19% of the episodes. In 27% of the episodes, the diagnosis was made on the basis of demonstration of parasites outside the reticuloendothelial system, chiefly blood (7 cases) and gastrointestinal mucosa (5 cases). Parasites were frequently observed or cultured from blood (22/37 episodes) or the digestive tract (8/9 episodes). High antimony doses were more effective than low doses in achieving clinical or parasitological cure (rate of cure, 80% vs. 40%, p = 0.11). Severe toxicity was observed in six (11.7%) of the 51 treated episodes. Severe AIDS-related diseases [odds ratio (OR) 10, p < 0.05] and CD4+ counts (OR 12, p < 0.05) were independent factors for early death. Prophylaxis with monthly pentamidine was not useful in reducing relapses of visceral leishmaniasis.

Topics: AIDS-Related Opportunistic Infections; Allopurinol; Amebicides; Amphotericin B; Analysis of Variance; Anti-HIV Agents; Antimetabolites; Antimony; Antiprotozoal Agents; Blood; Bone Marrow; CD4-Positive T-Lymphocytes; Cerebrospinal Fluid; Didanosine; Digestive System; Dose-Response Relationship, Drug; Drug Therapy, Combination; Female; Follow-Up Studies; Hepatic Encephalopathy; HIV; Humans; Intestinal Mucosa; Leishmaniasis, Visceral; Lymphocyte Count; Male; Myocarditis; Neutrophils; Pancreatitis; Pentamidine; Renal Insufficiency; Spain; Zidovudine

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

Topics: Acute Disease; Adult; Amphotericin B; Antimony Sodium Gluconate; Female; HIV Infections; Humans; Leishmaniasis, Visceral; Pancreatitis

Torulopsis glabrata, a fungus commensal with the human gastrointestinal tract, so far has not been recognized as a cause of pancreatic sepsis. We report the cases of two patients with pancreatic pseudocysts that became infected with T. glabrata. A 20-year-old woman 6 weeks postpartum had acute gallstone pancreatitis complicated by pseudocyst formation and pancreatic sepsis. Pseudocyst fluid obtained at cystogastrostomy showed a pure culture of T. glabrata. A 52-year-old man with multiple medical problems showed signs of an infected pseudocyst 9 days after he was hospitalized for alcoholic pancreatitis. Computed tomography (CT)-guided aspiration of the the pseudocyst fluid confirmed T.glabrata as the infecting organism. Neither patient had a history of endoscopic or surgical manipulation. Prolonged therapy with broad-spectrum antibiotics and parenteral hyperalimentation were implicated as risk factors, and other possible pathogenic mechanisms were considered. Both patients were treated successfully with a combination of percutaneous or surgical drainage and amphotericin B, which appears to be the most active drug in vitro. The efficacy of other antifungal agents is discussed. In the context of pancreatitis and/or pseudocysts, empiric therapy with broad-spectrum antibiotics should be minimized because it predisposes patients to superinfection by opportunistic pathogens.

Topics: Adult; Amphotericin B; Candidiasis; Female; Humans; Male; Middle Aged; Pancreatic Pseudocyst; Pancreatitis; Puerperal Infection

Between 1984 and 1986 six patients with acute respiratory failure (requiring ventilation for at least 3 days) complicating acute pancreatitis were managed on the intensive care unit (median ventilation period 6 days; range 3-41 days). Between 1987 and 1989 nine similar patients were managed (median ventilation period 35 days, range 4-69 days), and a regimen of enteral tobramycin, polymyxin and amphotericin to selectively decontaminate the digestive tract (SDD) was introduced. Five of six patients treated before 1987 had serious infections (three Gram-negative, one fungal), compared with only one of nine patients treated with SDD (P < 0.05). Clinical signs of sepsis were evident for 62% of the pre-SDD period, compared with 39% of the period during SDD therapy (P < 0.001). Systemic antibiotic prescribing was reduced in the SDD group; however, mortality remained unaffected with only two patients surviving pre-SDD and three during SDD treatment. SDD reduces infection rates and sepsis in patients with acute pancreatitis and may help to improve the prognosis of this life-threatening condition.

Topics: Acute Disease; Adult; Aged; Amphotericin B; Bacteremia; Bacterial Infections; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Pancreatitis; Polymyxins; Tobramycin

Over a 2-year period, all surgical patients from whom Candida was isolated from intra-abdominal specimens were evaluated. All but 1 of the 49 evaluable patients had either a spontaneous perforation (57%) or a surgical opening of the gastrointestinal tract (41%). Candida caused infection in 19 patients (39%), of whom 7 had an intra-abdominal abscess and 12 peritonitis. In the other 30 patients (61%), there were no signs of infection and specific surgical or medical treatment was not required. Candida was more likely to cause infection when isolated in patients having surgery for acute pancreatitis than in those with either gastrointestinal perforations or other surgical conditions. The development of a clinical infection was significantly associated with a high initial or increasing amount of Candida in the semiquantitative culture. Surgery alone failed in 16 of 19 patients (84%), of whom 7 died and 9 recovered after combined antifungal and surgical treatment. The overall mortality and the mortality related to infections were significantly higher in the patients with intraabdominal candidal infections than in those without such infections.

Topics: Abscess; Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Candida; Candidiasis; Child; Child, Preschool; Combined Modality Therapy; Drainage; Female; Humans; Infant; Intestinal Perforation; Male; Middle Aged; Pancreatitis; Peritoneum; Peritonitis; Postoperative Complications; Prospective Studies; Retrospective Studies; Time Factors