amphotericin-b and Parkinson-Disease

We present two cases of nosocomial urinary tract infection due to Trichosporon asahii in intensive care unit patients with bladder catheter from two hospitals in Santiago, Chile. Both patients had an several catheters and bacterial infections that required the use of antibiotic therapy. One strain showed in vitro resistance to amphotericin B. Both strains were susceptible to fluconazole, but presented MIC with dose-dependent susceptibility to ketoconazole and itraconazole. This is the first report showing T. asahii as urinary tract infection agent in Chile.

Topics: Amphotericin B; Antifungal Agents; Chile; Communicable Diseases, Emerging; Cross Infection; Drug Resistance, Fungal; Fatal Outcome; Fluconazole; Humans; Immunocompromised Host; Intensive Care Units; Itraconazole; Ketoconazole; Male; Microbial Sensitivity Tests; Middle Aged; Multiple Myeloma; Mycoses; Opportunistic Infections; Parkinson Disease; Postoperative Complications; Trichosporon; Urinary Catheterization; Urinary Tract Infections; Ventriculoperitoneal Shunt

Topics: Amphotericin B; Antifungal Agents; Bone Marrow Transplantation; Brain; Child; Humans; Magnetic Resonance Imaging; Male; Parkinson Disease; Transplantation Conditioning

Encephalopathy, leukoencephalopathy, and secondary parkinsonism occurred in 3 children with refractory leukemia undergoing allogenic bone marrow transplantation (BMT) who were treated with high-dose amphotericin B for pulmonary aspergillosis or sinus aspergillosis that did not involve the nervous system. Treatment included high-dose cytosine arabinoside, cyclophosphamide, and total body irradiation prior to the BMT. The children developed a progressively worsening encephalopathy and parkinsonian features, characterized by resting tremor, cogwheel rigidity, and masklike facies. Neuroimaging studies showed cerebellar, cerebral, and basal ganglia atrophy, as well as frontal and temporal lobe white matter involvement. Two of the 3 patients recovered, although 1 has residual intellectual impairment. The third succumbed to non-central nervous system Epstein-Barr virus-lymphoproliferative disease and had autopsy-confirmed leukoenephalopathy.

Topics: Adolescent; Amphotericin B; Antineoplastic Agents; Aspergillosis; Bone Marrow Transplantation; Brain Diseases; Child; Cyclophosphamide; Cytarabine; Humans; Leukemia, Myeloid, Acute; Lung Diseases; Male; Methotrexate; Parkinson Disease; Radiation Injuries

The subacute onset of parkinsonism in a patient with cryptococcal meningoencephalitis is described. The prompt resolution of the extrapyramidal dysfunction with antifungal agents suggests direct involvement of basal ganglia structures by the cryptococcal infection. Rapid development of parkinsonism in immunocompromised individuals should prompt investigation for an infectious etiology.

Topics: Aged; Aged, 80 and over; Amphotericin B; Basal Ganglia Diseases; Cryptococcosis; Flucytosine; Humans; Male; Meningoencephalitis; Parkinson Disease