amphotericin-b and Pleural-Diseases

Topics: Administration, Inhalation; Amphotericin B; Antifungal Agents; Aspergillus fumigatus; Bronchial Fistula; Empyema; Humans; Male; Middle Aged; Pleural Diseases; Pulmonary Aspergillosis

We report a case of bronchopleural fistula in a patient with allergic bronchopulmonary aspergillosis. A 25-year-old man was admitted with high fever and chest pain. Although his chest CT in a previous hospital showed pulmonary infiltrate suggesting the existence of a mucous plug, a mass shadow in the right upper lobe was recognized on admission to our hospital. Based on the presence of eosinophilia, elevated levels of total IgE and Aspergillus-specific IgE, positive precipitating antibody to Aspergillus, and detection of A. fumigatus in bronchial washing fluid, we diagnosed this case as ABPA complicated with lung abscess. Although we treated by antibiotics and antifungal drugs, the lung abscess did not improve and led to bronchopleural fistula. After addition of nebulised liposomal amphotericin B, his symptoms improved and treatment was successful.

Topics: Administration, Inhalation; Adult; Amphotericin B; Antifungal Agents; Aspergillosis, Allergic Bronchopulmonary; Bronchial Fistula; Fistula; Humans; Liposomes; Lung Abscess; Male; Pleural Diseases; Treatment Outcome

Zygomycosis is usually an invasive mycotic disease caused by fungi in the class Zygomycetes. It often occurs in immunocompromised patients, but sporadic cases without apparent immune impairment have been described. This report presents the first case of pleural zygomycosis caused by Rhizomucor pusillus, an uncommon pathogen of human infection. A 19-year-old man was found to have pleuritis several days after a drainage catheter was implanted to cure a pneumothorax caused by a ruptured bulla. Local pneumonectomy to resect the ruptured bulla and vacuuming of the pleural fluid was performed. Rhizomucor pusillus was cultured from the pleural fluid and irregular broad sparsely septate hyphae, consistent with zygomycetes, were histologically detected in the thickened pleura of the resected bulla. The catheter was suspected of having been contaminated with the fungus, but no evidence could be obtained. His fungal pleuritis subsided without any antifungal medical therapy and his immunocompetence seemed to contribute to limiting the infection.

Topics: Amphotericin B; Antifungal Agents; DNA, Fungal; Humans; Immunocompetence; Immunohistochemistry; Lung; Male; Microbial Sensitivity Tests; Pleural Diseases; Polymerase Chain Reaction; Radiography; Rhizomucor; Spores, Fungal; Young Adult; Zygomycosis

We present serial radiographic and CT findings of spontaneous reversibility of "pleural thickening" in a patient with proved semi-invasive pulmonary aspergillosis who developed bilateral intracavitary aspergillomas. To the best of our knowledge, this is the first report in the literature of this feature. Radiologists should be aware that pleural thickening in patients with semi-invasive aspergillosis does not necessarily indicate irreversible pleural fibrosis.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Bronchoalveolar Lavage Fluid; Bronchoscopy; Fibrosis; Follow-Up Studies; Humans; Itraconazole; Lung Diseases, Fungal; Male; Pleura; Pleural Diseases; Remission, Spontaneous; Tomography, X-Ray Computed

We report two cases of empyema as a complication of the percutaneous instillation of antifungal drugs for pulmonary and pleural aspergillosis. Case 1 underwent percutaneous administration of amphotericin B and fluconazole for 2 months. Six months later, the patient was found to have an Aspergillus empyema with a bronchopleural fistula. Case 2 with pulmonary and pleural aspergillosis underwent percutaneous administration of amphotericin B for one month. Four months later, the patient underwent pleural drainage due to empyema. Pleural biopsy revealed pleural aspergillosis. In both cases, it was suggested that the preceding Aspergillus infection and percutaneous instillation of antifungals resulted in the development of empyema.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Empyema; Fluconazole; Humans; Injections; Lung Diseases, Fungal; Male; Middle Aged; Pleural Diseases

Seven diverse cases of pulmonary blastomycosis were recently diagnosed at this institution. It is our purpose to review the unique features in the spectrum of this systemic illness as illustrated by these cases. The wide range of radiographic findings included parenchymal disease, mass-like lesions, and pleural effusions. One patient had endobronchial blastomycosis. Although significant pleural effusions have been uncommonly reported, we note this finding in two of our seven cases. Both of these patients had thoracentesis, which yielded markedly elevated pleural fluid total protein. These seven cases emphasize the marked variability of pulmonary and pleural blastomycosis.

Topics: Adult; Amphotericin B; Blastomycosis; Child; Female; Humans; Ketoconazole; Lung Diseases, Fungal; Male; Middle Aged; Pleural Diseases; Pleural Effusion; Prognosis; Radiography

Amphotericin is a powerful antifungal agent of high toxicity. Encapsulation in liposomes has led to new perspectives although clinical experience is still slight. Four patients, who were neither carriers of antibodies against the human immunodeficiency virus nor neutropenic, diagnosed of meningeal cryptococcosis, pleural aspergillosis, cerebral aspergillosis and ophthalmic candidiasis, respectively and treated with liposomal amphotericin are reported. The treatment was effective and well tolerated. Clinical improvement was observed in the patient with cerebral aspergillosis but magnetic resonance demonstrated persistence of the lesions. Only slight deterioration in renal function was observed in one case and in the other two renal failure improved upon substitution of conventional amphotericin by liposomal amphotericin. The slight systemic toxicity and the absence of local intolerance allowed the administration of high doses and shortening of the therapeutic schedule.

Topics: Adult; Aged; Amphotericin B; Aspergillosis; Brain Diseases; Candidiasis; Drug Carriers; Eye Infections, Fungal; Humans; Immunosuppression Therapy; Liposomes; Male; Meningitis, Cryptococcal; Middle Aged; Pleural Diseases

To determine the incidence and significance of pleural disease in blastomycosis, we reviewed the chest roentgenograms and medical records of 26 consecutive patients with biopsy- or culture-proved Blastomyces dermatitidis infection. Twenty-three of the 26 (88 percent) had radiographic evidence of blastomycotic pleural disease. Pleural reaction that regressed on therapy was mild (less than 1.0 cm thickening on EPA chest film) in 12. More extensive pleural thickening (1.5 to 3.0 cm) was observed in five, while four had effusions, and two had pneumothoraces. The 15 patients with mild or no visible pleural thickening were considered to have minor pleural involvement, while the 11 patients with greater than 1.5 cm pleural reaction, effusions, or pneumothoraces were considered to have major pleural disease. The ages, incidence of serious underlying disorders, and extra-thoracic dissemination were similar in both groups. Chest pain was more frequent in those with major pleural involvement (8/11 vs 4/15, p = 0.02), and their white blood cell count (14,300 +/- 1,200 c/mm3) was significantly higher than that of those with minor pleural involvement (10,600 +/- 1400, p less than 0.05). All of the patients with minor pleural disease responded to amphotericin therapy, but four of 11 (36 percent) with major pleural disease had an unfavorable outcome (relapse = two, death = two) (p = 0.02). In these patients with blastomycosis, pleural involvement was extremely common. Major pleural disease was associated with an adverse prognosis and may be an indication for prolonged therapy.

Topics: Adult; Amphotericin B; Blastomycosis; Female; Humans; Lung Diseases, Fungal; Male; Middle Aged; Pleural Diseases; Prognosis; Radiography

Topics: Amphotericin B; Antitubercular Agents; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Bronchial Fistula; Empyema; Empyema, Tuberculous; Fistula; Humans; Male; Middle Aged; Pleural Diseases; Radionuclide Imaging; Xenon Radioisotopes

Bronchopulmonary infections with Aspergillus give rise to three different pathological entities. Allergic bronchopulmonary aspergillosis, found in patients with an atopic predisposition, is marked by dyspnea of the asthmatic type associated with labile radiologically detectable infiltrates, blood hypereosinophilia, enhanced total IgE levels, specific IgG fractions, and positive immediate reactions to skin tests. The long-term risk is the development of proximal bronchiectasis. Dosage and duration of corticotherapy are function of eosinophilia and total IgE levels. Pathogenicity is similar to that of extrinsic allergic alveolitis, probably involving disturbances in immune complexes from a type I reaction. Intracavital pulmonary aspergillosis involves mycotic development within a cavity or a complicating parenchymatous lesion. Severe hemoptysis may occur. Medical treatment is ineffective, and radical surgery is necessary in patients able to support operative procedures, which vary as a function of the condition of the patient. Diffuse aspergillosis occurs in immunodeficient patients, usually during the acute phase of chemotherapy induction. Spread of the disease is either from the upper respiratory tract or through the blood as septicemia. A nosocomial origin is frequent. Diagnosis depends more on the presence of hyphae in tissue biopsy specimens than cultures or serological tests which are too unreliable. Treatment is with amphotericin B preferably associated with 5 fluorocytosin.

Topics: Adrenal Cortex Hormones; Amphotericin B; Aspergillosis, Allergic Bronchopulmonary; Diagnosis, Differential; Drug Therapy, Combination; Humans; Immunoglobulin E; Immunoglobulin G; Immunoglobulin M; Intradermal Tests; Lung Volume Measurements; Pleural Diseases

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Drug Therapy, Combination; Follow-Up Studies; Humans; Natamycin; Nystatin; Pleura; Pleural Diseases

We report the successful treatment of a patient with a bronchopleural fistual and pleural aspergilloma. Treatment consisted of intrapleural instillation of amphotericin B and nystatin followed by creation of an Eloesser flap.

Topics: Amphotericin B; Aspergillosis; Bronchial Fistula; Drainage; Female; Fistula; Humans; Middle Aged; Nystatin; Pleural Diseases; Radiography

Topics: Adrenal Cortex Hormones; Adult; Aged; Amphotericin B; Aspergillosis; Asthma; Cromolyn Sodium; Female; Humans; Lung Diseases, Fungal; Male; Pleural Diseases; Spondylitis, Ankylosing

Topics: Amphotericin B; Bronchial Fistula; Fistula; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Pleural Diseases; Skin Diseases

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Benzene Derivatives; Female; Germany, West; Humans; Imidazoles; Male; Middle Aged; Pleural Diseases; Radiography

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Humans; Lung Diseases, Fungal; Middle Aged; Natamycin; Nystatin; Pleural Diseases

Topics: Amphotericin B; Autopsy; Cryptococcosis; Cryptococcus neoformans; Cytosine; Fluorine; Hodgkin Disease; Humans; Male; Middle Aged; Pleura; Pleural Diseases; Pleural Effusion