amphotericin-b and Peptic-Ulcer-Perforation

Sixty-two cases of peritonitis due to peptic ulcer perforation were diagnosed between January 2000 and December 2000. Of these 62 cases, 23 isolates of Candida in 23 cases (CP) were cultured from peritoneal fluid. Cultures of peritoneal fluid of 10 (BP) of the remaining 39 cases was positive for bacteria only. Cultures of peritoneal fluid of the remaining 29 cases was negative. Comparison of CP, BP and culture-negative cases did not reveal any significant risk factor. Of the 23 Candida isolates, the Candida species and 48-h MICs of fluconazole and amphotericin B (mean, range ug/ml) were C. albicans 18 (0.688, 0.125-1.0; 0.297, 0.031-0.5), C. glabrata 3 (0.542, 0.125-1.0; 0.25, 0.125-0.5), C. tropicalis 1 (0.25; 0.5), C. intermedia 1 (1.0; 0.125) respectively. Mortality rates of CP, BP and culture-negative peritonitis due to infection were 5/23(21.7%), 0/10 and 1/29(3.4%) respectively. Without effective antifungal therapy, the mortality rate of CP was not low.

Topics: Adult; Age Distribution; Aged; Amphotericin B; Ascitic Fluid; Candida; Cohort Studies; Female; Fluconazole; Humans; Incidence; Male; Microbial Sensitivity Tests; Middle Aged; Peptic Ulcer Perforation; Peritonitis; Probability; Prospective Studies; Risk Factors; Sex Distribution; Statistics, Nonparametric; Survival Rate; Taiwan

Three children with the rare occurrence of zygomycosis are descibed: two had involvement of a solitary lesion of gangrenous cellulitis on the buttocks, and th third was a neonate with gastric performation and a gangrenous appendicitis. All three patients were compromised hosts (two with leukemia and one a premature infant with respiratory distress syndrome). All three patients appeared to have acquired the same organism. Rhizopus oryzae, from the same fomites, elastic bondages (Elastoplast). The Center for Disease Control has received several other reports of zygomycosis traceable to the same material. Alll three of our patients were cured of their infections. Early diagnosis and a combined surgical and chemotherapeutic approach appear to prevent death from zygomycosis.

Topics: Amphotericin B; Appendicitis; Bandages; Cellulitis; Child; Female; Humans; Infant, Newborn; Leukemia, Lymphoid; Male; Mucormycosis; Peptic Ulcer Perforation; Respiratory Distress Syndrome, Newborn; Rhizopus; Stomach Ulcer

A case is presented of ascites infected with candida in a cirrhotic patient. Candida infection of the ascitic fluid and candidemia were found 24 hours after perforation of a gastric ulcer. Combined intravenous therapy with Amphotericin B and 5-Fluorocytosine eradicated the infection within two weeks. The need for comprehensive therapeutic approach in the debilitated patient prone to fungal and bacterial infection is emphasized.

Topics: Aged; Amphotericin B; Ascites; Candidiasis; Flucytosine; Humans; Male; Peptic Ulcer Perforation; Stomach Ulcer

Topics: Adult; Amphotericin B; Ascites; Candida; Candidiasis; Diagnosis, Differential; Diagnostic Errors; Humans; Liver Cirrhosis; Male; Peptic Ulcer Perforation; Peritonitis; Radiography; Stomach Ulcer