amphotericin-b and Pancytopenia

Case report We report the case of a young Cameroonian woman who presented with cough, hyperthermia, weight loss, pancytopenia, and hepatosplenomegaly. A positive HIV serology was discovered and a chest radiography revealed a 'miliary pattern'. Bone marrow aspiration pointed out yeast inclusions within macrophages. Given the morphological aspect, the clinical presentation and immunosuppression, histoplasmosis was retained as a working hypothesis. Antiretroviral and amphotericin B treatments were promptly initiated. Review Given the immigration wave that Europe is currently experiencing, we think it is important to share experience and knowledge, especially in non-endemic areas such as Europe, where clinicians are not used to face this disease. Histoplasmosis is due to Histoplasma capsulatum var. capsulatum, a dimorphic fungus. Infection occurs by inhaling spores contained in soils contaminated by bat or bird droppings. The clinical presentation depends on the immune status of the host and the importance of inoculum, varying from asymptomatic to disseminated forms. AIDS patients are particularly susceptible to develop a severe disease. Antigen detection, molecular biology techniques, and microscopic examination are used to make a rapid diagnosis. However, antigen detection is not available in Europe and diagnosis needs a strong clinical suspicion in non-endemic areas. Because of suggestive imagery, clinicians might focus on tuberculosis. Our case illustrates the need for clinicians to take histoplasmosis in the differential diagnosis, depending on the context and the patient's past history.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Retroviral Agents; Antifungal Agents; Bone Marrow Cells; Female; Histoplasma; Histoplasmosis; HIV Infections; Humans; Pancytopenia

Topics: Adolescent; Adult; Aged; Amphotericin B; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Candidiasis; Child; Child, Preschool; Female; Humans; Humerus; Infant; Infant, Newborn; Male; Middle Aged; Osteomyelitis; Pancytopenia; Ribs; Tibia

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Cameroon; Female; Histoplasmosis; Humans; Pancytopenia

Visceral leishmaniasis (VL) is an endemic infection in different regions of Italy and Europe caused by protozoan parasites of the genus Leishmania, transmitted to humans through sandflies bites. Reactivation after Solid Organ Transplantation was reported and could be a risk of organ rejection. A 48 years old woman was admitted to our hospital, complaining about low-grade fever, loss of weight and new onset pancytopenia in a known cirrhosis due to active HBV/HDV co-infection. Clinical, microbiological and anatomo-pathological elements were pivotal to define the diagnosis of VL and started an appropriate anti-infective treatment. After that she underwent liver transplantation and a therapy for VL was set. No signs of reactivation were reported in the 14 months of follow-up.

Topics: Amphotericin B; Antiprotozoal Agents; Biopsy; Bone Marrow; Coinfection; Female; Hepatitis B; Hepatitis D; Humans; Italy; Leishmania; Leishmaniasis, Visceral; Liver Transplantation; Middle Aged; Pancytopenia; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Debridement; Drug Substitution; Humans; Male; Mouth Diseases; Mucormycosis; Nose Diseases; Orbital Diseases; Palate; Pancytopenia; Triazoles

A 35-year-old patient with a previous history of persistent episodic fever, sore throat, myalgia, and cephalgia presented for evaluation of pancytopenia. He had no recent travel history, except for a stay in Italy 1 year prior to admission and in Spain several years in the past.. Laboratory evaluation confirmed pancytopenia, agranulocytosis, and elevated infection parameters without indicative serological results en par with lymphadenitis colli. Computed tomography scanning revealed cervical lymphadenopathy, hepatosplenomegaly, and colitis with occult perforation of the sigmoid colon. Bone marrow biopsy showed an infiltration of polyclonal plasma cells. Lymph node biopsy was compatible with necrotizing lymphadenitis.. Polymerase chain reaction analysis of a lymph node specimen confirmed the presence of Leishmania species, thereby enabling the diagnosis of visceral Leishmania.. Treatment with liposomal amphotericin B was initiated. Both fever and lymphadenopathy quickly resolved.. VL is a clinically pleiotropic, severe disease with fatal outcome if left untreated. It often presents with distinct similarities to hematologic malignancies. Exacerbation can occasionally occur as fulminant macrophage activation syndrome. Disease incidence is globally increasing and has not peaked as yet. A complex interplay between pathogen and the immune system is the key pathophysiological mechanism.

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Diagnosis, Differential; Fever; Hepatomegaly; Humans; Leishmania donovani; Leishmaniasis, Visceral; Liposomes; Male; Pancytopenia; Splenomegaly; Tomography, X-Ray Computed; Treatment Outcome

Febrile illness is a common clinical problem and frequently caused by bacterial and viral infections. When blood cultures are negative and symptoms persist despite empirical antibiotic treatment, clinicians must consider other differential diagnoses including malignancy, rheumatologic disease and parasitic infections.. A Norwegian male in his eighties experienced febrile illness during a stay in Southern Spain. Upon return to Norway, he was hospitalized with fever, weight-loss, enlarged spleen, pancytopenia and hypergammaglobulinemia. After failing to respond to broad-spectrum antibiotics and antifungals, he was diagnosed with visceral leishmaniasis and Leishmania infantum was confirmed by PCR and sequencing of spleen biopsy and blood.. With increasing migration and tourism, doctors in non-endemic countries should be familiar with visceral leishmaniasis.

Topics: Aged, 80 and over; Amphotericin B; Antiprotozoal Agents; Arthritis; Fever; Humans; Leishmania infantum; Leishmaniasis, Visceral; Male; Pancytopenia; Spain; Splenomegaly; Tomography, X-Ray Computed; Travel-Related Illness

A 53-year-old man presented with a number of hospital admissions for investigation of fever of unknown origin. He became gradually weaker with significant weight loss, pancytopenia and progressive splenomegaly over a 6-month period of extensive investigation. This was undertaken at different NHS hospitals with involvement of multiple medical specialists. Clinical criteria for haemophagocytic lymphohistiocytosis were met. Following investigation, this was felt likely secondary to a low-grade lymphoma of the spleen, necessitating splenectomy for diagnostic and therapeutic purposes. Ultimately, this risky surgical procedure was avoided when positive

Topics: Amphotericin B; Antiprotozoal Agents; Diagnosis, Differential; Fever of Unknown Origin; Humans; Leishmaniasis, Visceral; Lymphohistiocytosis, Hemophagocytic; Male; Middle Aged; Pancytopenia; Splenomegaly; Treatment Outcome; Weight Loss

Leishmaniasis is a neglected disease that is prevalent in tropical and subtropical regions of the world. Even though cutaneous leishmaniasis is the most common form, visceral leishmaniasis is associated with high mortality. The case presented herein is a 39 year-old bed-ridden female who presented with fever of unknown origin, tachypnea and pancytopenia. She was initially misdiagnosed as having autoimmune pancytopenia elsewhere and treated with corticosteroids and intravenous immunoglobulin. She had also received wide-spectrum antibiotics for febrile neutropenia. We performed a leishmania rK39 dipstick test which turned out to be positive along with visualisation of amastigote forms of leishmania on bone marrow biopsy. Thus, we made a diagnosis of visceral leishmaniasis and treated her with liposomal amphotericin B. Her clinical course was complicated by respiratory failure necessitating invasive mechanical ventilation. She responded well to treatment and was later extubated, shortly before being discharged. At 6 months of follow-up, no sign of recurrence was observed.

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Autoimmune Diseases; Biopsy; Bone Marrow; Cerebral Palsy; Chromatography, Affinity; Diagnosis, Differential; Female; Fever of Unknown Origin; Humans; Leishmaniasis, Visceral; Pancytopenia; Recurrence; Respiration, Artificial; Respiratory Insufficiency; Tachypnea; Turkey

Histoplasmosis is an endemic mycosis with global distribution, primarily reported in immunocompromised individuals. A 29-year old immunocompetent male presented with fever, hepatosplenomegaly and pancytopenia. His peripheral blood showed features suggestive of intravascular hemolysis and echocardiography showed features suggestive of pulmonary arterial hypertension. Bone marrow showed yeast with morphology suggestive of

Topics: Adult; Amphotericin B; Antifungal Agents; Fever; Heart Failure; Hemolysis; Hepatomegaly; Histoplasmosis; Humans; Immunocompetence; Itraconazole; Lymphohistiocytosis, Hemophagocytic; Male; Pancytopenia; Splenomegaly

Topics: Amphotericin B; Antiprotozoal Agents; Child, Preschool; Europe; Fever; Herpesvirus 4, Human; Humans; Leishmaniasis, Visceral; Pancytopenia; Travel

Topics: Aged; Amphotericin B; Antifungal Agents; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Lung Diseases; Male; Mucormycosis; Nose Diseases; Pancytopenia; Treatment Outcome; Triazoles

Leishmaniasis is endemic in many countries worldwide, with a prevalence of 12 million people infected, and an estimated annual incidence of 500 000 visceral leishmaniasis cases. In Europe visceral leishmaniasis is considered endemic mainly in the Mediterranean countries and cases in non-endemic European countries north of the Alps have primarily been reported in returning travellers. The incubation period is typically described between 6 weeks to 6 months. The cases presented highlight the occurrence of longer incubation periods and illustrate the individual variability for progression from infection to disease.. We report the cases of 18-months-old twin girls living at the German-Swiss border, who developed visceral leishmaniasis 7 and 15 months after travelling to Tuscany. They presented with fever of unknown origin and pancytopenia. Both had splenomegaly and in the first case haemophagocytic lymphohistiocytosis or leukaemia was initially included in the differential diagnosis. Diagnosis of visceral leishmaniasis was confirmed by presence of intracytoplasmic localised leishmania parasites on bone marrow aspirate and/or positive leishmania serology. Both girls responded well to treatment with liposomal amphotericin B. The mother and two older siblings remained uninfected, while the father was diagnosed to be an asymptomatic carrier.. Visceral leishmaniasis is an important differential diagnosis for fever of unknown origin and pancytopenia in young children living in countries with endemic disease and highlights the importance of obtaining a detailed travel history. Hemophagocytic lymphohistiocytosis and acute leukaemia present with similar symptoms and consequently are important differential diagnoses. Factors determining progression from infection to disease are not fully understood but younger age seems to be an important risk factor. Screening of siblings from affected individuals therefore may be warranted.

Topics: Amphotericin B; Antiprotozoal Agents; Diagnosis, Differential; Diseases in Twins; Endemic Diseases; Female; Fever; Humans; Infant; Italy; Leishmaniasis, Visceral; Lymphohistiocytosis, Hemophagocytic; Male; Pancytopenia; Splenomegaly; Travel

Topics: Adolescent; Amphotericin B; Bone Marrow; Female; Humans; Italy; Leishmania donovani; Leishmaniasis; Pancytopenia; Splenomegaly; Travel

Topics: Adolescent; Amphotericin B; Antifungal Agents; Fever; Graft Rejection; Histoplasma; Histoplasmosis; Humans; Immunosuppression Therapy; Invasive Fungal Infections; Kidney Transplantation; Lymph Nodes; Male; Pancytopenia; Transplant Recipients; Urogenital Abnormalities

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Antifungal Agents; Fever; Humans; Itraconazole; Lymphohistiocytosis, Hemophagocytic; Male; Pancytopenia; Splenomegaly

Visceral Leishmaniasis (VL) is an endemic parasitic disease and remains as a major health concern in southwestern Iran. The current study describes clinico-hematological, epidemiological and therapeutic features of VL cases, admitted to university-affiliated hospitals, during 1999-2014 in Fars province, southwestern Iran. A total of 380 VL cases were recorded during a 16 years period, giving an average annual admission of 23.75 cases/year in which 217 (57.1%) were male and 163 (42.9%) were female. Mean age of the patients was 3.7 years. The majority of the cases (91.5%) were ≤ 5 years old. Bone-marrow aspiration detected Leishmania amastigotes only in 26.6% of cases. Fever (98.1%), abdominal protrusion (65.1%) and hepatosplenomegaly (63.7%) were the most common clinical presentations of the patients. Pancytopenia was noted in 43.1, anemia in 87.3 and thrombocytopenia in 64% of cases. Increase in the level of AST (aspartate aminotransferase), ALT (alanine aminotransferase), alkaline phosphatase, LDH (lactate dehydrogenase) and CRP (C-Reactive Proteins) were seen in 84.9, 53.6, 44.4, 72.5 and 83.1% of cases, respectively. Mortality was noted in 5.3% of cases. Deranged haemato-biochemical parameters including total and direct bilirubin, PLT (platelet) and pancytopenia were significantly contributed to mortality from VL. Moreover, clinical features such as severe splenomegaly as well as bacterial infections were meaningfully contributed to death from VL. The majority of patients (74.9%) were treated with meglumine antimoniate. Amphotericin B was administrated in 59 of cases, 11 of them were initially treated with meglumine antimoniate with a shift to amphotericin B, because of treatment failure. Findings of the current study demonstrated that VL is present in southwest of Iran with a fairly continual rate during the last 16 years period. Deranged haemato-biochemical parameters along with severe splenomegaly contributed to mortality from VL.

Topics: Adolescent; Adult; Aged; Amphotericin B; Bone Marrow Cells; C-Reactive Protein; Child; Child, Preschool; Female; Hospitalization; Humans; Infant; Iran; Leishmania; Leishmaniasis, Visceral; Male; Meglumine; Meglumine Antimoniate; Middle Aged; Organometallic Compounds; Pancytopenia; Retrospective Studies; Thrombocytopenia; Young Adult

A 2.5-year-old girl was admitted due to splenomegaly and pancytopenia. Laboratory analysis revealed pancytopenia and hypergammaglobulinemia, and due to the absence of fever and the relevant clinical and hematological presentation the child was initially suspected for acute lymphoblastic leukemia. Bone marrow aspiration displayed macrophages and extracellular space containing Leishmania amastigotes. Visceral leishmaniasis diagnosis due to Leishmania infantum was confirmed by the presence of high titers of Leishmania antibodies and by PCR. The patient was successfully treated with liposomal amphotericin B but during the third post-treatment day significant increases in the levels of serum uric acid, blood urea nitrogen, and phosphate were registered. The child was successfully treated with hydration and urine alkalization and resulted in full recovery of the metabolic abnormalities.

Topics: Amphotericin B; Child, Preschool; Female; Humans; Leishmania infantum; Leishmaniasis, Visceral; Neoplasms; Pancytopenia; Splenomegaly; Syndrome

Topics: Adolescent; Amphotericin B; Antifungal Agents; Bone Marrow; Diagnosis, Differential; Fever of Unknown Origin; Fungemia; Histoplasma; Histoplasmosis; Humans; Infusions, Intravenous; Kidney Transplantation; Lung Diseases, Interstitial; Lymphohistiocytosis, Hemophagocytic; Male; Pancytopenia; Transplant Recipients

Infantile visceral leishmaniasis associated hemophagocytic lymphohistiocytosis (HLH) is a rare clinicopathological entity, difficult to diagnose and fatal if untreated. The diagnosis should be considered in young infants with fever and splenomegaly. We report two cases of HLH caused by visceral leishmaniasis. In the first case, a 3-month-old boy was admitted with fever and pancytopenia, leading to the diagnosis of HLH based on complete clinical and biological features including hemophagocytosis on bone marrow smears. Investigations for an underlying genetic, metabolic disease and an infectious trigger were negative. Primary or genetic hemophagocytic syndrome was suspected and immunosuppressive treatment (steroids and cyclosporin) was instituted. A second bone marrow examination performed 1 month later revealed leishmania. The boy was treated with liposomal amphotericin and recovered rapidly. In the second case, a 10-year-old child was hospitalized with fever, pancytopenia, and a tumoral syndrome. He had a history of recurrent infections. The bone marrow biopsy showed leishmania and treatment with liposomal amphotericin was delivered. After 3 days of treatment, the improvement was judged inadequate and the boy presented biological signs of HLH. He was treated with steroids. An underlying primary immunodeficiency (interleukin-12/interferon-γ axis disorder) was secondarily diagnosed.

Topics: Amphotericin B; Antiprotozoal Agents; Child; Cyclosporine; Fever; Glucocorticoids; Humans; Immunosuppressive Agents; Infant; Leishmaniasis, Visceral; Lymphohistiocytosis, Hemophagocytic; Male; Pancytopenia

We report a case of visceral leishmaniasis in a patient from northern Norway with psoriatic arthritis treated with a combination of etanercept and methotrexate. The patient resided extensively in southern Spain, a zone endemic for leishmania.

Topics: Aged; Amphotericin B; Antiprotozoal Agents; Antirheumatic Agents; Arthritis, Psoriatic; Etanercept; Female; Humans; Immunoglobulin G; Leishmaniasis, Visceral; Methotrexate; Norway; Pancytopenia; Receptors, Tumor Necrosis Factor; Spain; Treatment Outcome

Topics: Adrenal Cortex Hormones; Aged; Amphotericin B; Antiprotozoal Agents; Azathioprine; Biopsy; Colitis, Ulcerative; Colon; Colonic Polyps; Diagnosis, Differential; Female; Fever; Humans; Immunocompromised Host; Immunosuppressive Agents; Leishmaniasis, Visceral; Pancytopenia

Visceral leishmaniasis (VL, kala-azar) is caused by Leishmania spp, a parasite that is commonly encountered in Mediterranean countries. Leishmaniasis usually presents with fever, hepatosplenomegaly, lymphadenopathy, and pancytopenia.. The aim of the study was to prospectively examine the characteristics of cytopenia associated with VL and compare it with other post-infectious cytopenias observed in children with febrile illnesses.. We studied 112 children, aged (mean) 4.0 (SD, 3.8) years (range, 0-14 years), who were admitted to the pediatric ward because of febrile cytopenia associated with infections, during a 2-year period (March 2005 to June 2007). Study participants were investigated with measurement of acute-phase reactants, bacterial cultures, and serologic tests.. Pancytopenia was detected in 9 (8%) of 112 patients (5 boys), with a mean age of 4.5 (SD, 3.0) years.The mean value of white blood cell was 3827 (SD, 1455)/mL; absolute neutrophil count, 1229 (SD, 655)/mL; hemoglobin, 8.3 (SD, 1.1) g/dL; and platelet count, 88,200 (SD, 20,186)/mL. All patients with pancytopenia had fever (mean duration, 8.9 [SD, 8.7] days) (maximum temperature, 39.5°C [SD, 0.6°C]) and hepatosplenomegaly (9/9), whereas 2 of 9 had lymphadenopathy. In these patients, a bone marrow aspiration was performed, and VL was detected in all 9 samples. They were treated with liposomal amphotericin B and had an excellent response rate. Pancytopenia resolved within a mean period of 17.6 (SD, 17.3) days (range, 8-60 days), and there was no relapse during a 2 years' follow-up.. In endemic countries, leishmaniasis is the main cause of febrile pancytopenia among children in whom hematologic malignancy has been ruled out.

Topics: Adolescent; Amphotericin B; Antiprotozoal Agents; Child; Child, Preschool; Communicable Diseases; Endemic Diseases; Female; Greece; Humans; Infant; Infant, Newborn; Leishmaniasis, Visceral; Male; Pancytopenia; Prospective Studies

Topics: Amphotericin B; Anti-Bacterial Agents; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Pancytopenia; Prognosis

A 15 month-old girl was admitted after a couple of months' history of illness with remittent fever, increasing pallor and a swollen abdomen. On admission she was highly febrile, with palpably enlarged liver and spleen. Blood tests revealed pancytopenia, a high CRP level and a high serum ferritin level. We describe the diagnostic evaluation, interpretation and treatment.

Topics: Amphotericin B; Antiprotozoal Agents; Bone Marrow; Diagnosis, Differential; Female; Fever; Humans; Infant; Insect Bites and Stings; Leishmaniasis, Visceral; Lymphohistiocytosis, Hemophagocytic; Mediterranean Region; Pancytopenia; Travel

Leishmaniasis is a zoonotic disease which may be difficult to diagnose in children. Successful results have been achieved with amphotericin B in treatment. Here, we present a 7 month old girl who lives in Istanbul. She was given a diagnosis of kala-azar and treated with liposomal amphotericin B. Our case, born in Istanbul, had had fatigue for 3 weeks and pallor and abdominal distention for 2 days. History of travel was absent. In physical examination, paleness, malaise and hepatosplenomegaly were found. In laboratory findings there was pancytopenia and her albumin level was low. A peripheric smear and other laboratory findings were normal. Her first bone marrow aspiration was normal. Because of persistent fever and increase in hepatosplenomegaly, a second bone marrow aspiration was done on the tenth day after admission and Leismania amastigotes were seen. She was given a diagnosis of kala-azar and, clinical and microbiological responses were achieved by treatment with amphotericin B. In our country, visceral leishmaniasis should be considered in all age groups who live in western regions and have no history of travel and contact, that present with pancytopenia or bicytopenia, even if massive splenomegaly is absent.

Topics: Amphotericin B; Antiprotozoal Agents; Bone Marrow; Diagnosis, Differential; Fatigue; Female; Hepatomegaly; Humans; Infant; Leishmaniasis, Visceral; Liposomes; Pancytopenia; Splenomegaly; Turkey

Visceral leishmaniasis is one of the world's most neglected diseases. Over 90% of the 500,000 annual new cases occur in only five countries: India, Nepal, Bangladesh, Sudan and North-Eastern Brazil, but the disease remains endemic in Southern Europe. We report a case of visceral leishmaniasis in an immunocompetent serviceman after a seven-day stay in the Marseilles region of South-Eastern France. This case is intended to alert clinicians to the possibility of visceral leishmaniasis in patients who develop a febrile illness after returning from travel in Southern European countries.

Topics: Amphotericin B; Antiprotozoal Agents; Fever; Hepatomegaly; Humans; Immunocompetence; Leishmaniasis, Visceral; Male; Middle Aged; Military Personnel; Pancytopenia; Splenomegaly; Travel

A transplant recipient presented with fever and pancytopenia. Bone marrow biopsy showed Leishmania parasites. Travel history revealed a trip to Greece 17 months prior to admission. This case illustrates the importance of considering leishmaniasis as a cause of pancytopenia, especially in the immunocompromised, even in the absence of recent travel to an endemic area. Acknowledgment of this infection is vital as the outcome can be fatal if left untreated.

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Diagnosis, Differential; Female; Humans; Immunocompromised Host; Kidney Transplantation; Leishmaniasis, Visceral; Pancreas Transplantation; Pancytopenia

Topics: Adrenal Cortex Hormones; Amphotericin B; Animals; Communicable Diseases; Cyclosporine; Diagnosis, Differential; Female; Fever; Hepatomegaly; Humans; Immunosuppressive Agents; Leishmania infantum; Leishmaniasis, Visceral; Liposomes; Lymphohistiocytosis, Hemophagocytic; Macrophages; Middle Aged; Neoplasms; Opportunistic Infections; Pancytopenia; Polymerase Chain Reaction; Splenomegaly

A 71-year-old woman had suffered for 6 weeks from fatigue, dry cough and fever. Five years previously breast cancer had been diagnosed and had been successfully treated with subtotal mastectomy and postoperative radiotherapy, as well as aromatase inhibitor until shortly before the present admission. There was no history of travel to tropical countries, but during the last summer she had spent two weeks in Northern Italy. [corrected]. On admission the body temperature was 38,5 C with a mild tachycardia (108/min). Laboratory findings revealed a pancytopenia and slightly elevated liver enzymes. The ultrasound showed a hepatosplenomegaly. The investigation of the bone marrow showed a great amount of parasitic forms due to visceral leishmaniasis [corrected] TREATMENT, COURSE AND DIAGNOSIS: Treatment with liposomal amphotericin B brought about rapid improvement, the dry cough subsided and the laboratory results became normal.. Pancytopenia, fever, dry cough and hepatosplenomegaly after travelling to Mediterranean countries should raise suspicion of visceral leishmaniasis. This diagnosis is confirmed by direct detection of the parasite in the bone marrow. Administration of liposomal amphotericin B is efficacious and safe, bringing about full recovery in up to 90% of cases.

Topics: Aged; Amphotericin B; Antiprotozoal Agents; Aromatase Inhibitors; Breast Neoplasms; Chemotherapy, Adjuvant; Cough; Diagnosis, Differential; Fatigue; Female; Fever; Hepatomegaly; Humans; Italy; Leishmaniasis, Visceral; Liposomes; Mastectomy, Segmental; Pancytopenia; Prognosis; Radiotherapy, Adjuvant; Splenomegaly; Tachycardia; Travel

Suspected of having a systemic malignancy a 22-month-old boy was admitted to hospital with fever, pancytopenia and hepatosplenomegaly. The boy was of ethnically German origin and no travel abroad was reported.. Intensive search for a focus of infection, laboratory tests and bone marrow microscopy failed to be diagnostic. Serological findings and detection of Leishmania DNA in bone marrow by polymerase chain reaction (PCR) led to the diagnosis of visceral leishmaniasis. On explicit questioning the child's parents reported a stay in Greece 18 months before onset of symptoms.. On the fourth day of i.v. therapy with liposomal amphotericin B, 3mg/kg/d for 10 days, the fever subsided. Platelets and leukocytes regained normal levels. The child was discharged after 10 days of treatment and received two more doses on days 14 and 21.. Negative results on microscopic bone marrow inspection do not rule out visceral leishmaniasis. Detection of anti-Leishmania antibodies may support the suspected diagnosis and provide the indication for PCR technique.

Topics: Amphotericin B; Animals; Antibodies, Protozoan; Antiprotozoal Agents; Bone Marrow; Child, Preschool; Diagnosis, Differential; DNA, Protozoan; Fever; Greece; Humans; Leishmania; Leishmaniasis, Visceral; Liposomes; Male; Pancytopenia; Polymerase Chain Reaction; Splenomegaly; Travel

Cases of visceral leishmaniasis (VL) in the course of human immunodeficiency virus (HIV) infection have regularly been recorded, mainly in southern Europe. HIV infection can increase the risk of VL development by 10-100 times in endemic areas. We describe the occurrence of this co-infection in 15 patients from Brazil. The mean age of the patients was 38 +/- 8.8 yr, with 86.6% males. The mean time between HIV diagnosis and the onset of visceral leishmaniasis was 44 +/- 39 mo. The main signs and symptoms presented at admission were splenomegaly (73%), weight loss (73%), cough (67%), fever (67%), asthenia (60%), and diarrhea (60%). The mean T CD4+ lymphocyte count was 173.7 +/- 225.6 cells/mm3, and viral load was 51,030 +/- 133,737/mm3. Treatment consisted of pentavalent antimonials (67% of cases). Most (87%) patients recovered from VL infection; death occurred in 1 patient due to septic shock. VL is an important opportunistic infection in HIV patients, which is potentially fatal, even when correct treatment is completed. Treatment should be done with pentavalent antimonials or amphotericin B in the case of relapse. Although there is no consensus, secondary prophylaxis should be considered in severe cases.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antiprotozoal Agents; Antiretroviral Therapy, Highly Active; Asthenia; Bone Marrow; Brazil; CD4 Lymphocyte Count; Cough; Diarrhea; Female; Fever; HIV Infections; Humans; Leishmaniasis, Visceral; Male; Meglumine; Meglumine Antimoniate; Middle Aged; Organometallic Compounds; Pancytopenia; Retrospective Studies; Splenomegaly; Time Factors; Weight Loss

Invasive fungal infections in immunocompromised children suffering from hematological malignancies have been a major cause of morbidity and mortality. In recent years fungi other than aspergillus and candida are gaining importance. These emerging fungal infections have distinct epidemiological features and management issues especially in immunocompromised patients. Here we report the isolation of Conidiobolus coronatus, a rarely reported zygomycetes infection in a patient suffering from acute lymphoblastic leukemia. Conidiobolus generally causes indolent infection in the sino-respiratory tract. They are known to be angioinvasive and can disseminate. There is no consensus regarding appropriate antifungal treatment for Conidiobolus infection.

Topics: Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Child; Combined Modality Therapy; Conidiobolus; Debridement; Dexamethasone; Fatal Outcome; Female; Humans; Immunocompromised Host; Maxillary Sinusitis; Methotrexate; Orbital Cellulitis; Pancytopenia; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Vincristine; Zygomycosis

Topics: Amphotericin B; Antifungal Agents; Blood; Female; Fever; Hepatomegaly; Histoplasma; Histoplasmosis; Humans; Infant; Macrophages; Pancytopenia; Splenomegaly; Urine

Visceral leishmaniasis is a rare imported infectious disease in Germany. Approximately ten to 30 cases are recorded annually. The classic symptoms are often misinterpreted as lymphoma of the spleen.. A 46-year-old patient presented with fever, malaise, night sweats, pancytopenia, and splenomegaly 8 months after a 2-week trip to Majorca Island (Spain). Bone marrow biopsy showed no evidence of malignant lymphoma. Serology confirmed the suspected clinical diagnosis of visceral leishmaniasis. Cytology and polymerase chain reaction from bone marrow aspirate were positive for Leishmania infantum. Treatment with liposomal amphotericin B was initiated and led to complete recovery.. Visceral leishmaniasis is an important differential diagnosis for the clinical triad of fever, pancytopenia, and splenomegaly. An accurate travel history is therefore of paramount importance. Without treatment, the case fatality rate is high. A complete recovery is usually achieved with adequate therapy (liposomal amphotericin B, miltefosine).

Topics: Amphotericin B; Animals; Antiprotozoal Agents; Diagnosis, Differential; Fever; Leishmania infantum; Leishmaniasis, Visceral; Liposomes; Male; Mediterranean Islands; Pancytopenia; Polymerase Chain Reaction; Spain; Splenomegaly; Travel; Treatment Outcome

Visceral leishmaniasis (VL), is a systemic disease caused by the dissemination of protozoan parasite Leishmania throughout the reticuloendothelial system. It may mimic or lead to several types of hematological disorders including hemophagocytosis. Infection associated hemophagocytic syndrome implicating Leishmania is very rare and often difficult to diagnose. Here, we describe a child with hemophagocytic lymphohistiocytosis (HLH) associated with VL.

Topics: Amphotericin B; Antiprotozoal Agents; Child, Preschool; Humans; Leishmaniasis, Visceral; Lymphohistiocytosis, Hemophagocytic; Male; Pancytopenia

We present a case of systemic lupus erythematosus complicated by pancytopenia and visceral leishmaniasis in Spain. The literature on opportunistic infection in lupus erythematosus is reviewed.Leishmaniasis is a group of infections caused by the protozoa Leishmania, which is endemic in the Mediterranean basin. These opportunistic infections are an emerging entity in immunosuppressed patients. The use of immunosuppressive treatment in systemic lupus erythematosus modifies natural defense patterns and increases the risk of visceral leishmaniasis in endemic areas.

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Female; Follow-Up Studies; Humans; Immunosuppression Therapy; Leishmaniasis, Visceral; Lupus Erythematosus, Systemic; Pancytopenia; Time Factors

Topics: Aged; Amphotericin B; Antifungal Agents; Biopsy; Bone Marrow; Diagnosis, Differential; Fatigue; Fever; Histoplasmosis; Humans; Male; Pancytopenia; Weight Loss

Although cutaneous leishmaniasis is occasionally seen in Australia in overseas travellers and migrants, visceral leishmaniasis has been reported rarely and only in people who were immunocompromised. We describe an 18-year-old immunocompetent man who presented with pancytopenia and a 2-week history of fever and lethargy a year after visiting the Greek Islands. Visceral leishmaniasis was diagnosed after a bone marrow biopsy showed protozoa, and the patient responded well to treatment with liposomal amphotericin. To our knowledge, this is the first case of visceral leishmaniasis in an immunocompetent patient in Australia.

Topics: Adolescent; Amphotericin B; Animals; Anti-Bacterial Agents; Antiprotozoal Agents; Bone Marrow; Diagnosis, Differential; Greece; Humans; Leishmania donovani; Leishmaniasis, Visceral; Male; Pancytopenia; Parvoviridae Infections; Travel; Treatment Outcome

Invasive fungal infections after bone marrow transplantation have an extremely poor prognosis. Surgical excision in combination with antifungal therapy is considered necessary for treatment, especially for central nervous system (CNS) infection. We describe successful medical management with lipid complex amphotericin B (ABLC) and itraconazole, without surgical excision, of disseminated fungal infection involving the lungs and CNS in a patient with pancytopenia and graft-versus-host disease.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Bone Marrow Transplantation; Drug Combinations; Drug Therapy, Combination; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Itraconazole; Lymphoma, Follicular; Male; Mucormycosis; Opportunistic Infections; Pancytopenia; Phosphatidylcholines; Phosphatidylglycerols

Topics: Amphotericin B; Animals; Antiprotozoal Agents; Diagnosis, Differential; Fissure in Ano; Hepatomegaly; Humans; Leishmania donovani; Leishmaniasis, Visceral; Male; Middle Aged; Pancytopenia; Travel

We describe a 2 year-old non-immunocompromised girl with disseminated histoplasmosis who presented with a 2-month history of fever and bloody diarrhoea. On presentation, she was severely wasted and anaemic. There were gross hepatosplenomegaly and multiple lymphadenopathy. A septic screen was negative. A subsequent stool culture isolated Salmonella enteriditis. Serial Widal-Weil Felix (WWF) titres showed serological response after 2 weeks of Ceftriaxone. However, she continued to have spiking fever, bloody diarrhoea and weight loss. She developed pancytopaenia and disseminated intravascular coagulation. A bone marrow aspirate and trephine, and lymph node biopsy showed the presence of Histoplasma capsulatum, confirmed by Gomori-Methenamine Silver staining. She responded to intravenous amphotericin B followed by fluconazole (intravenous then oral) for 6 months after discharge. Human Immunodeficiency Virus screening tests were negative. Complement and immunoglobulin levels were normal. T and B enumeration tests showed gross leucopaenia with very low T cell function with defective phagocytic function. A repeat T and B cell enumeration test and phagocytic function tests done 3 months later were normal.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Bone Marrow; Child, Preschool; Disseminated Intravascular Coagulation; Female; Fluconazole; Histoplasma; Histoplasmosis; Humans; Immune System; Pancytopenia

We reviewed the records of 106 patients with cryptococcal infections and the acquired immunodeficiency syndrome (AIDS) treated at San Francisco General Hospital. We examined four issues: the efficacy of treatment with amphotericin plus flucytosine as compared with amphotericin alone, the efficacy of suppressive therapy, the prognostic clinical characteristics, and the course of nonmeningeal cryptococcosis. In 48 of the 106 patients (45 percent), cryptococcosis was the first manifestation of AIDS. Among the 89 patients with cryptococcal meningitis confirmed by culture, survival did not differ significantly between those treated with amphotericin plus flucytosine (n = 49) and those treated with amphotericin alone (n = 40). Flucytosine had to be discontinued in over half the patients because of cytopenia. Long-term suppressive therapy with either ketoconazole or amphotericin was associated with improved survival, as compared with survival in the absence of suppressive therapy (median survival, greater than or equal to 238 vs. 141 days; P less than 0.004). The only clinical features independently associated with a shorter cumulative survival were hyponatremia and a positive culture for cryptococcus from an extrameningeal source. The 14 patients with nonmeningeal cryptococcosis had a median survival (187 days) and rate of relapse (20 percent) similar to those in the patients with meningitis (165 days and 17 percent, respectively). From this retrospective study of cryptococcal infections in patients with AIDS we conclude that the addition of flucytosine to amphotericin neither enhances survival nor prevents relapse, but long-term suppressive therapy appears to benefit these patients.

Topics: Acquired Immunodeficiency Syndrome; Adult; Aged; Amphotericin B; Cryptococcosis; Cryptococcus neoformans; Drug Therapy, Combination; Female; Flucytosine; Humans; Hyponatremia; Ketoconazole; Male; Meningitis; Middle Aged; Pancytopenia; Prognosis; Recurrence

Right maxillary sinus mucormycosis developed in a 45-year-old patient with hairy cell leukemia and pancytopenia. The patient recovered with surgical debridement, amphotericin therapy, and institution of alpha-2 interferon as therapy for his hairy cell leukemia. This may be the first case of the use of alpha-2-interferon therapy in a patient with documented systemic fungal infection and hairy cell leukemia and a rare example of recovery from this infection in a hematologic malignancy.

Topics: Amphotericin B; Combined Modality Therapy; Debridement; Humans; Interferon Type I; Leukemia, Hairy Cell; Male; Maxillary Sinus; Middle Aged; Mucormycosis; Pancytopenia; Sinusitis

Topics: Amphotericin B; Anemia; Anemia, Aplastic; Bone Marrow Examination; Diagnosis, Differential; Histoplasmosis; Humans; Leukemia; Pancytopenia; Prednisolone