amphotericin-b and Pleural-Effusion

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Facial Dermatoses; Female; Hepatomegaly; Humans; Itraconazole; Lung Diseases, Fungal; Molluscum Contagiosum; Paracoccidioides; Paracoccidioidomycosis; Paraguay; Pleural Effusion; Spores, Fungal; Young Adult

Cryptococcus neoformans infection usually presents as chronic meningitis and is increasingly being recognized in immunocompromised patients. Presentation with pleural effusion is rare in cryptococcal disease; in fact, only 4 cases of pleural effusion as the initial clinical presentation in cryptococcosis have been reported in English-language literature to date. We report the first case of pleural effusion as the initial clinical presentation in a renal transplant recipient who was initially misdiagnosed with tuberculous pleuritis but who then developed fungaemia and disseminated cryptococcosis. The examination of this rare manifestation and the accompanying literature review will contribute to increased recognition of the disease and a reduction in misdiagnoses.. We describe a 63-year-old male renal transplant recipient on an immunosuppressive regimen who was admitted for left pleural effusion and fever. Cytological examinations and pleural fluid culture were nonspecific and negative. Thoracoscopy only found chronic, nonspecific inflammation with fibrosis in the pleura. After empirical anti-tuberculous therapy, the patient developed an elevated temperature, a severe headache and vomiting and fainted in the ward. Cryptococci were specifically found in the cerebrospinal fluid following lumbar puncture. Blood cultures were twice positive for C. neoformans one week later. He was transferred to the respiratory intensive care unit (RICU) immediately and was placed on non-invasive ventilation for respiratory failure for 2 days. He developed meningoencephalitis and fungaemia with C. neoformans during hospitalization. He was given amphotericin B liposome combined with 5-flucytosine and voriconazole for first 11 days, then amphotericin B liposome combined with 5-flucytosine sustained to 8 weeks, after that changed to fluconazole for maintenance. His condition improved after antifungal treatment, non-invasive ventilation and other support. Further pathological consultation and periodic acid-Schiff staining revealed Cryptococcus organisms in pleural sections, providing reliable evidence for cryptococcal pleuritis.. Pleural effusion is an unusual manifestation of cryptococcosis. Cryptococcal infection must be considered in the case of patients on immunosuppressives, especially solid-organ transplant recipients, who present with pleural effusion, even if pleural fluid culture is negative. Close communication between the pathologist and the clinician, multiple special biopsy section stains and careful review are important and may contribute to decreasing misdiagnosis.

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Fluconazole; Flucytosine; Fungemia; Humans; Immunosuppressive Agents; Kidney Transplantation; Male; Middle Aged; Pleural Effusion; Voriconazole

We have described a patient with invasive pulmonary penicilliosis, documented by thoracotomy and cured with amphotericin B. Penicillium sp isolates in immunosuppressed patients should not be disregarded without a thorough investigation, especially if normally sterile sites are involved. Amphotericin B therapy may be successful, especially if accompanied by a reversal or moderation of immunosuppression.

Topics: Amphotericin B; Combined Modality Therapy; Humans; Lung Diseases, Fungal; Male; Middle Aged; Penicillium; Pleural Effusion

Topics: Amphotericin B; Angiography; Bronchography; Child; Female; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Pleural Effusion; Pulmonary Edema; Pulmonary Fibrosis; Tomography

The penetration of the amphotericin B (AMB) lipid formulations (liposomal AMB, AMB colloidal dispersion, and AMB lipid complex formulations) into pleural effusions in seven critically ill patients was assessed. AMB was detected in all pleural effusion samples at concentrations ranging from 0.02 to 0.43 microg/ml. The penetration ratio was 3 to 44%.

Topics: Adult; Aged; Amphotericin B; Antifungal Agents; Critical Illness; Drug Combinations; Female; Humans; Male; Middle Aged; Phosphatidylcholines; Phosphatidylglycerols; Pleural Effusion

Cases of empyema associated with

Topics: Amphotericin B; Empyema, Pleural; Female; Histoplasma; Histoplasmosis; Humans; Injections, Intravenous; Middle Aged; Pleural Effusion; Therapeutic Irrigation; Thoracoscopy

In recent years, some rare fungi have been increasingly recognized as new human pathogens. Here we reported the first fatal case of human severe pneumonia complicated by multiple organ dysfunction caused by Acrophialophora levis infection. However, its pathogenic mechanism and risk factors are unknown. Acrophialophora genus has only reported in six cases of human infection worldwide, but it has not been reported previously in China.. A 71-year-old male patient with severe pneumonia complicated with multiple organ dysfunction caused by A. levis infection. The fungal identification was based on micromorphology and sequence analysis of the internal transcriptional spacer (ITS) of ribosomal RNA genes recovered from lower respiratory tract secretions. The microbial characteristics, sensitivity to antifungal drugs of this isolated A. levis were studied. Anti-infective regimen, liposomal amphotericin B combined with tegacycline, was used to prevent infection. The next day, the fever decreased, body temperature fluctuated between 36.5 and 37.8 degree, cough and sputum decreased, and sputum volume decreased, with oxygen uptake for 5 L/min, blood oxygen saturation over 95%. After 17 days of treatment, CT reexamination showed that the lesions in the right lung and left upper lung were absorbed and pleural effusion was reduced. The next 8 days, the patient asked to return to the local hospital for treatment. The local hospital stopped using liposomal amphotericin B because of the absence of liposomal amphotericin B, and died of respiratory failure 2 days later.. This study is the first to report the occurrence, risk factors, molecular determinants, microbial characteristics and susceptibility to antifungal agents of A. levis infection in China. In addition, six published cases of human infection with Acrophialophora were reviewed.

Topics: Aged; Amphotericin B; Antifungal Agents; Ascomycota; Humans; Male; Pleural Effusion; Pneumonia; Severity of Illness Index; Tomography, X-Ray Computed

Blastomycosis is caused by a fungus endemic to states and providences bordering the Lawrence Rivers and the Great Lakes. It can lead to significant pathology in both immunocompetent and immunocompromised hosts. This case report describes disseminated blastomycosis in an otherwise healthy 16-year-old patient.. A 16-year-old male presented with a chief complaint of flank pain. In the Emergency Department he described additional symptoms of emesis, cough, and weight loss. His vitals were appropriate; however, he had absent lung sounds in the left lower lung field, splenomegaly, a left thigh abscess, and lower-extremity edema. Imaging studies showed a left pleural effusion, mediastinal shift to the right, splenomegaly, a left psoas abscess, and undifferentiated bony involvement of L1 transverse process and the left 12th rib. Abscess cultures grew Blastomyces dermatitides. He was treated with amphotericin B, demonstrated clinical improvement, and was discharged on itraconazole. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The case fatality rate of blastomycosis is estimated at between 4.3% and 6.4%. Patients with solid organ transplant and associated immune suppression had a mortality of 33-38%. Given the nonspecific nature of this condition, a high level of suspicion is required for diagnosis, and early diagnosis is essential, as end organ damage in disseminated disease can include high-severity illness, including acute respiratory distress syndrome and central nervous system dysfunction. If any patient presents with symptomatology involving both skin and pulmonary systems, blastomycosis must be entertained as a possible diagnosis. Prompt diagnosis and treatment will significantly improve morbidity and mortality.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Emergency Service, Hospital; Flank Pain; Humans; Immunocompromised Host; Itraconazole; Male; Pleural Effusion; Radiography, Thoracic; Splenomegaly; Vomiting; Wisconsin

We report the penetration of liposomal amphotericin B into the pleural fluid of a patient with pulmonary zygomycosis and empyema. The ratio of area under the concentration-versus-time curve in pleural fluid (AUC(pleural fluid)) to that in serum (AUC(serum)) for liposomal amphotericin B over 24 h was 9.4%, with pleural fluid concentrations of 2.12 to 4.91 microg/ml. Given the relatively low level of intrapleural penetration of liposomal amphotericin B, chest tube drainage may be warranted for successful treatment of zygomycotic empyema.

Topics: Amphotericin B; Antifungal Agents; Empyema, Pleural; Female; Humans; Liposomes; Lung Diseases, Fungal; Middle Aged; Mucormycosis; Pleural Effusion

Topics: Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Child; Humans; Itraconazole; Male; Pleural Effusion; Radiography, Thoracic; Tomography, X-Ray Computed

A 61-yr-old liver transplant recipient presented with abdominal cramping and nonbloody diarrhea resulting in orthostasis. Multiple ulcerations throughout the colon were seen during endoscopy, and biopsies from the ulcer edges revealed histoplasmosis. Treatment with a course of itraconazole improved the diarrhea. The patient later presented with pericarditis and symptomatic pleural effusions, the latter of which was confirmed to be a result of disseminated histoplasmosis. Treatment with amphotericin B led to resolution. Histoplasmosis should be considered in liver transplant patients with diarrhea and large ulcers in the colon. The presence of disseminated histoplasmosis should be ruled out once colonic histoplasmosis has been diagnosed.

Topics: Amphotericin B; Antifungal Agents; Cholangitis, Sclerosing; Histoplasmosis; Humans; Itraconazole; Liver Transplantation; Male; Middle Aged; Pericarditis; Pleural Effusion; Postoperative Complications; Reoperation; Treatment Outcome

Systemic fungal infections have high mortality, and therapy is often toxic. Caspofungin acetate, a new antifungal agent with minimal toxicity, may provide a better alternative to typical therapy for Candida krusei.. Case report.. Multidisciplinary intensive care unit (ICU) of a community teaching hospital.. A 22-yr-old male with acute lymphoblastic leukemia and Candida krusei fungemia failed therapy with fluconazole and amphotericin B.. Caspofungin acetate given intravenously as a 70-mg loading dose, followed up by 50 mg daily along with standard ICU care.. Survival without toxicity from therapy.. Efficacy of caspofungin acetate in a patient with life-threatening Candida Krusei infection.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Candida; Candidiasis; Caspofungin; Echinocandins; Fluconazole; Fungemia; Humans; Infusions, Intravenous; Lipopeptides; Male; Neutropenia; Opportunistic Infections; Peptides; Peptides, Cyclic; Pleural Effusion; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Tomography, X-Ray Computed; Treatment Outcome

We report the case of a 36-year-old man with a pleural effusion that complicates the postoperative period after the implantation of a ventricular assist device (VAD). The epidemiological, etiologic and therapeutic features of Fusarium infections were reviewed. Complete recovery of the infection was obtained after a treatment by liposomal amphotericine B (AmBisome) and 5 fluorocytosine.

Topics: Adult; Amphotericin B; Antifungal Agents; Fusarium; Heart-Assist Devices; Humans; Male; Mycoses; Pleural Effusion; Prosthesis Implantation; Prosthesis-Related Infections

Cryptococcal infection uncommonly presents with pulmonary manifestations and even more rarely so as massive bilateral effusions. Pleural involvement is usually associated with underlying pulmonary parenchymal lesions and is unusual while on antifungal therapy. We report a patient with cryptococcal meningitis who, while on intravenous 5-flucytosine and amphotericin B, developed life-threatening bilateral massive pleural effusions with evidence of spontaneous resolution, consistent with prior hypothesis of antigenic stimulation as the cause of pleural involvement.

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcosis; Female; Flucytosine; Humans; Meningitis, Cryptococcal; Pleural Effusion

Purulent pericarditis caused by Candida species is rare and is associated with very high mortality. Immunosuppressed transplant patients are particularly susceptible to fungal infections. We report a case of Candida purulent constrictive pericarditis in an immunocompromised heart transplant patient who was treated successfully with antifungal agents, surgical drainage, and pericardiectomy.

Topics: Amphotericin B; Anti-Infective Agents; Antifungal Agents; Candidiasis; Ciprofloxacin; Disease Susceptibility; Drainage; Heart Transplantation; Humans; Immunocompromised Host; Immunosuppression Therapy; Male; Middle Aged; Opportunistic Infections; Pericardiectomy; Pericarditis, Constrictive; Pleural Effusion; Pseudomonas aeruginosa; Pseudomonas Infections; Suppuration

A 52-year-old woman with a seven-year history of rheumatoid arthritis (RA) was transferred to our department with chronic renal failure to undergo hemodialysis. She had been treated with prednisolone for a long time, and had renal amyloidosis secondary to RA. During her hospitalization, a left pleural effusion developed. Pleural fluid cultured positive for Cryptococcus neoformans (CN), and the CN antigen was detected in both pleural fluid and serum. Chest computerized tomography revealed an infiltrate shadow in the left lower lung field suggestive of CN infection. This was successfully treated with anti-fungal agents. Pleural effusion is an unusual manifestation of pulmonary cryptococcosis. We should consider a diagnosis of CN infection when pleural effusion is observed in compromised patients such as those receiving a long-term corticosteroid treatment.

Topics: Amphotericin B; Amyloidosis; Anti-Inflammatory Agents; Antifungal Agents; Arthritis, Rheumatoid; Cryptococcosis; Cryptococcus neoformans; Female; Humans; Kidney Failure, Chronic; Lung Diseases, Fungal; Middle Aged; Pleural Effusion; Prednisolone

Topics: Amphotericin B; Antifungal Agents; Diabetes Complications; Drainage; Female; Humans; Middle Aged; Mucormycosis; Osteolysis; Pleural Effusion; Rhizopus; Ribs; Wounds and Injuries

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

A patient with a history of alcohol abuse and pancreatitis presented with a pleural effusion resulting from a fistula between the pancreatic duct and left pleural space. Two weeks into her hospitalization, fever and persistent bloodstream infection with Erysipelothrix rhusiopathiae and Candida albicans developed. The patient had no history of exposure to animals. To our knowledge this is the first report of an E. rhusiopathiae infection presenting during hospitalization. This case suggests the possibility of a carrier state of infection and illustrates that a high index of suspicion is necessary for identification of unusual pathogens in hospitalized patients.

Topics: Adult; Amphotericin B; Bacteremia; Candidiasis; Carrier State; Cross Infection; Drug Resistance, Microbial; Erysipelothrix; Erysipelothrix Infections; Female; Humans; Microbial Sensitivity Tests; Pancreatic Fistula; Penicillin G; Pleural Effusion; Postoperative Complications

Topics: Adult; Amphotericin B; Coccidioidomycosis; Diabetes Mellitus, Type 1; Humans; Lung Diseases, Fungal; Male; Pleural Effusion

Disseminated histoplasmosis is an increasingly important opportunistic infection in patients with the acquired immunodeficiency syndrome (AIDS). We report the first case of histoplasmosis as a cause of pleural effusion in a patient with AIDS. Recognition of the typical intracellular yeast on a Wright-Giemsa stained smear of the pleural fluid cells allowed prompt initiation of amphotericin B.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Histoplasma; Histoplasmosis; Humans; Male; Opportunistic Infections; Pleural Effusion

Topics: Amiodarone; Amphotericin B; Humans; Lung; Pleural Effusion; Pulmonary Edema; Pulmonary Fibrosis

Topics: Adult; Amphotericin B; Blastomycosis; Humans; Male; Pleural Effusion

A case of blastomycosis from Zaria, Nigeria is reported. The clinical features were indistinguishable from those of tuberculosis which is very common in this environment. Lack of response to anti-tuberculosis therapy within eight weeks prompted the search for other organisms which resulted in the isolation of Blastomyces dermatitidis. Compatible histological evidence was obtained. Subsequent favourable response to amphotericin B was evident. Infection with this organism should be included in the differential diagnosis of pulmonary and pleural lesions simulating tuberculosis in West Africa.

Topics: Adult; Amphotericin B; Blastomyces; Blastomycosis; Diagnosis, Differential; Humans; Male; Pleural Effusion; Sputum; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Coccidioidomycosis; Female; Humans; Pleural Effusion; Pregnancy; Pregnancy Complications, Infectious

Topics: Adult; Age Factors; Amphotericin B; Aspergillosis; Bronchopneumonia; Cross Infection; Diagnosis, Differential; Disseminated Intravascular Coagulation; Humans; Male; Perfusion; Pleural Effusion; Prognosis; Sepsis; Sex Factors; Tuberculosis, Pulmonary

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

Topics: Adult; Amphotericin B; Humans; Lung Diseases, Fungal; Male; Penicillium; Pleural Effusion

Topics: Adolescent; Adult; Amphotericin B; Cryptococcosis; Female; Humans; Lung Diseases, Fungal; Male; Pleural Effusion; Radiography; Solitary Pulmonary Nodule

Topics: Adult; Amphotericin B; Cryptococcosis; Female; Humans; Pleural Effusion; Sarcoidosis; Skin Manifestations

Topics: Adult; Aged; Amphotericin B; Bronchi; Cryptococcosis; Cryptococcus; Female; Follow-Up Studies; Humans; Lung Diseases; Lung Diseases, Fungal; Male; Middle Aged; Pleural Effusion; Radiography; Sputum

Topics: Amphotericin B; Anti-Bacterial Agents; Candidiasis; Child, Preschool; Chylothorax; Empyema; Humans; Male; Nystatin; Pleural Effusion; Postoperative Complications; Pulmonary Artery; Radiography, Thoracic; Subclavian Artery; Surgical Wound Infection; Tetralogy of Fallot

Topics: Amphotericin B; Child; Diagnosis, Differential; Exudates and Transudates; Histoplasmosis; Humans; Lung Diseases; Pleural Effusion