amphotericin-b and Pericardial-Effusion

Purulent pericarditis caused by Candida species is a rare and often undiagnosed disease. We recently treated a patient in whom purulent pericarditis due to Candida albicans developed following thoracic surgery. The patient survived after receiving a combination of surgical and medical therapy. A literature review revealed 24 additional cases of purulent pericarditis caused by Candida species. Twenty-one of the patients either had undergone thoracic surgery or had had disseminated candidiasis. None of the 12 patients described before 1980 survived, whereas six (46%) of the 13 patients described after 1980 survived. No patient survived without pericardiectomy (five of six survivors) or at least pericardiocentesis (one survivor). All survivors received full courses of amphotericin B therapy. An increased utilization of echocardiography, along with an increased recognition of the patient populations at risk, has been instrumental in early detection and improved outcome of purulent pericarditis. A combination of prolonged amphotericin B therapy and pericardiectomy appears to be the best approach for achieving a cure.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Echocardiography; Humans; Male; Pericardial Effusion; Pericardiectomy; Pericarditis; Thoracic Surgery

Candida pericarditis and tamponade developed in a patient with sterile purulent pericarditis secondary to systemic lupus erythematosus. Therapy with amphotericin B and properly timed surgical intervention led to a clinical and microbiological cure. This article emphasizes the importance of differentiating an infected pericardial effusion from the sterile pericarditis of systemic lupus erythematosus and provides suggested guidelines for the management of that complication.

Topics: Adolescent; Amphotericin B; Candidiasis; Cardiac Tamponade; Female; Humans; Lupus Erythematosus, Systemic; Pericardial Effusion; Pericarditis; Recurrence

We report a case of disseminated infection due to Bipolaris australiensis in a 21-year-old immunocompetent Pakistani man. He presented with fever and jaundice. Examination revealed a mass in the right lung, mediastinal lymphadenopathy, a pericardial effusion, and abdominal masses obstructing and invading the common bile duct and right ureter. Histological examination and culture of a biopsy specimen of the hilar mass yielded the fungal pathogen B. australiensis. The patient was treated successfully with amphotericin B and itraconazole.

Topics: Adult; Amphotericin B; Antifungal Agents; Cholestasis; Drug Therapy, Combination; Humans; Itraconazole; Lung Diseases, Fungal; Lymphatic Diseases; Male; Mediastinal Diseases; Mitosporic Fungi; Mycoses; Pericardial Effusion; Ureteral Obstruction

Pericarditis with effusion can occur as a complication of disseminated coccidioidomycosis. Information on management of this condition is very scanty in the medical literature. One case is described in detail. Early diagnosis and appropriate therapy with amphotericin B have been emphasized as keys to success in treating this condition.

Topics: Adult; Amphotericin B; Coccidioides; Coccidioidomycosis; Complement Fixation Tests; Echocardiography; Humans; Male; Pericardial Effusion; Radiography