amphotericin-b and Pneumonia

Blastoschizomyces capitatus infection is a rare fungal infection; mainly occurring in immunodeficient patients, which can cause multiple organ involvement. At present, there is no clear designated treatment regimen. This case was a rare example of Blastoschizomyces capitatus lung infection in patient with normal immune function, which was effectively controlled by combined antifungal therapy.. We report a 67-year-old male smoker, who, after cleaning a small bungalow for a long period, without any protective measures, developed cough with expectoration, fever and dyspnea. Pre-admission anti-infective medication (amoxicillin and roxithromycin) had little effect, and the patient's condition worsened. He had a past history of pulmonary tuberculosis with pleurisy 6 years before. Chest computed tomography (CT) showed evidence of old tuberculosis in the right upper lobe and inflammation in both lower lobes. White blood cell count was 14.51×109/L, neutrophils was 13.39×109/L and C-reactive protein (CRP) was 170 mg/L. Broad-spectrum antibiotics piperacillin sodium 4.0 g and tazobactam sodium 0.5 g q8h were administered empirically for 5 days. Blastoschizomyces capitatus infection was confirmed by next generation of macro genome sequencing (NGS) of bronchoalveolar lavage fluid and mass spectrum analysis of sputum. He was then switched to voriconazole antifungal therapy combined with aerosol inhalation of amphotericin B. His temperature normalized, expectoration and dyspnea were relieved. Total white cell count fell to 8.10×109/L, neutrophils to 5.81×109/L, and CRP to 76.8 mg/L.. This case demonstrates that Blastoschizomyces capitatus infection can occur in patients with normal immune function. Mass spectrometry and metagenomic NGS methods may have an advantage over traditional methods in identifying this fungal infection. In addition, the combination of voriconazole and nebulized amphotericin B can be employed as a novel regimen for treating Blastoschizomyces capitatus infection. For pulmonary infection with a history of environmental exposure, early pathogen identification and culture, and appropriate antibiotic treatment are key to optimizing outcome.

Topics: Aged; Amphotericin B; Antifungal Agents; Dyspnea; Humans; Lung; Male; Mycoses; Pneumonia; Voriconazole

BACKGROUND Prototheca spp. are common and found in various environments, including animal and human intestines, on the skin and in respiratory tissues, and colonizing fingernails. Few strains pathogenic for humans have been discovered. Here, we describe an infection by the pathogenic fungus species Prototheca zopfii in a patient. The infection was initially classified as a fungus based on colony morphology, fungal staining results, and growth in some fungi culture media (Sabouraud dextrose agar [SDA]). Reports of Prototheca spp. infections are increasing, often with poor outcomes. The use of matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS) technique for identification has been widely described. Phenotypic identification depends on microscopic examination of the direct wet mount and after subculturing in blood and SDA using different stains that show a typical morphological characteristic of Prototheca spp. CASE REPORT A 48-year-old woman was diagnosed with a P. zopfii infection after 22 days of hospitalization in the critical care unit. The patient had profound febrile neutropenia and absolute neutrophil count (ANC) was zero, associated with hypotension and disseminated intravascular coagulation (DIC) 10 days after receiving the first cycle of chemotherapy for metastatic breast adenocarcinoma. Unfortunately, the patient died within 2 days of the initiation of treatment with amphotericin B. CONCLUSIONS This case report highlights algae infections as a possible opportunistic infection type in patients with profound neutropenia, and we discuss the use of MALDI-TOF MS-based technology in detecting such infections and predicting poor prognosis, especially in patients with the disseminated form with underlying febrile neutropenia.

Topics: Amphotericin B; Animals; Febrile Neutropenia; Female; Humans; Middle Aged; Pneumonia; Prototheca; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization

The genus Blastobotrys consists of at least 20 species. Disease in humans has been reported with B adeninivorans, B raffinosifermentans, B proliferans and B serpentis, mostly in immunocompromised patients and those with cystic fibrosis.. We report a lung infection secondary to B raffinosifermentans in a cystic fibrosis patient successfully treated with isavuconazole and review the literature of invasive infections caused this genus. We also evaluated clinical isolates in our laboratory for species identification and antifungal susceptibility.. Phylogenetic analysis was performed on a collection of 22 Blastobotrys isolates in our reference laboratory, and antifungal susceptibility patterns were determined for nine clinically available antifungals against 19 of these isolates.. By phylogenetic analysis, 21 of the 22 isolates in our collection were identified as B raffinosifermentans and only 1 as B adeninivorans. Most were cultured from the respiratory tract, although others were recovered from other sources, including CSF and blood. Isavuconazole, caspofungin and micafungin demonstrated the most potent in vitro activity, followed by amphotericin B. In contrast, fluconazole demonstrated poor activity. The patient in this case responded to isavuconazole treatment for breakthrough infection due to B raffinosifermentans that was cultured from pleural fluid while on posaconazole prophylaxis post-bilateral lung transplantation for cystic fibrosis.. Blastobotrys species are rare causes of infections in humans and primarily occur in immunocompromised hosts. In our collection, the majority of isolates were identified as B raffinosifermentans. To our knowledge, this is the first report of successful treatment of such an infection with isavuconazole.

Topics: Adult; Amphotericin B; Antifungal Agents; Cystic Fibrosis; Female; Fluconazole; Genes, Fungal; Humans; Immunosuppression Therapy; Microbial Sensitivity Tests; Mycoses; Nitriles; Phylogeny; Pneumonia; Pyridines; Saccharomycetales; Triazoles

Histoplasmosis is a global disease endemic to regions of all six inhabited continents. The areas of highest endemicity lie within the Mississippi and Ohio River Valleys of North America and parts of Central and South America. As a result of climate change and anthropogenic land utilization, the conditions suitable for

Topics: Amphotericin B; Antifungal Agents; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Itraconazole; Pneumonia; Radiography

A case of cavitary pulmonary sporotrichosis without mucocutaneous involvement caused by Sporothrix schenckii is reported in a sexagenarian woman with a long smoking history. The patient was hospitalized for septic shock with multiorgan failure from a respiratory focus. The diagnosis was delayed due to the fungal etiological agent was not initially considered in the differential diagnosis. A good clinical and radiological evolution was obtained with the antifungal therapy. Occasional cases of primary pulmonary sporotrichosis have been reported in the literature. Due to its low incidence, this is a less-known and underestimated clinical form. Both clinical suspicion and microbiological studies are needed to reach pulmonary sporotrichosis diagnosis.

Topics: Aged; Amphotericin B; Antifungal Agents; Female; Humans; Itraconazole; Lung Diseases, Fungal; Pneumonia; Shock, Septic; Smoking; Sporothrix; Sporotrichosis

To explore the clinical characteristics, imaging manifestation, diagnosis and treatment for histoplasmosis and to improve therapeutic level, we retrospectively analyzed the clinical data of 8 patients with biopsy-confirmed histoplasmosis from 2004 to 2014 in the Second Xiangya Hospital of Central South University and reviewed relevant literatures. The main clinical symptoms of histoplasmosis included fever, cough, expectoration, chest pain, blood-stained sputum, lymphadenectasis, etc. The major lung imaging features were mass, node or pneumonia-like performance. No case was diagnosed as histoplasimosis firstly. Four patients whose imaging manifestations were focal pulmonary lesion received lobectomy of lung lesions or wedge resection. Clinical and imaging manifestations in 3 patients, who treated with amphotericin B or its liposomal, itraconazole or fluconazole, were improved. The clinical symptoms and imaging findings of histoplasmosis are nonspecific. It is easy for the physicians to misdiagnose histoplasmosis as bacterial infection, lung cancer, tuberculosis lymphoma, etc. Therefore, it is significant and necessary to carry out multiple biopsies combined with multiple etiological examinations for patients with difficult diagnosis.. 为探讨组织胞浆菌病(histoplasmosis，HP)的临床特点、影像学表现和诊疗方法，以提高该疾病的诊治率，回顾性分析了中南大学湘雅二医院2004年至2014年经病理组织学确诊的8例住院HP患者的临床资料。8例HP患者的临床表现主要有发热、咳嗽、咳痰、胸痛、痰中带血、淋巴结肿大等；肺部影像学表现主要为团块状、结节样或肺炎型改变。无1例患者首诊考虑肺部真菌病。4例表现为局灶肺部病变的患者均采用手术切除，3例患者采用两性霉素脂质体、伏立康唑、伊曲康唑抗真菌治疗，均获有效治疗。HP的临床症状及影像学表现无特异性，易误诊为细菌感染、肺癌、结核、淋巴瘤等，早期积极地多次多部位的病理活检联合多次病原学检查对提高疾病的诊断率和预后有重要的意义。.

Topics: Amphotericin B; Biopsy; Diagnostic Errors; Histoplasmosis; Humans; Lung; Lung Neoplasms; Pneumonia; Retrospective Studies; Sputum

Fusarium species are frequent agents of onychomycosis and fungal keratitis, and occasional agents of invasive disease. The clinical spectrum of fusariosis in the lungs includes allergic disease (allergic bronchopulmonary fusariosis), hypersensitivity pneumonitis, colonization of a preexisting cavity, and pneumonia. Fusarial pneumonia occurs almost exclusively in severely immunocompromised patients, especially acute leukemia patients and recipients of allogeneic cell transplantation. In such patients, invasive fusariosis is usually disseminated, and pneumonia occurs in almost 50% of cases. The radiologic picture is similar to invasive aspergillosis, with alveolar infiltrates, nodules with or without halo sign, ground-glass infiltrates, and pleural effusions. Different from aspergillosis is the frequent occurrence of disseminated nodular and papular skin lesions and positive blood cultures. The drug of choice for the treatment of invasive fusariosis is either voriconazole or liposomal amphotericin B. The outcome is usually poor, and largely dependent on the recovery of the immune status of the host, particularly neutropenia.

Topics: Amphotericin B; Antifungal Agents; Fusariosis; Fusarium; Humans; Immunocompromised Host; Pneumonia; Risk Factors; Transplant Recipients; Voriconazole

Blastomyces dermatitidis, the etiologic agent of blastomycosis, is a thermally dimorphic fungus that grows as a filamentous mold in the environment and as budding yeast in human tissue. This pathogen is endemic to North America, particularly in the states bordering the Mississippi and Ohio rivers, the Great Lakes, and the St. Lawrence Seaway. Infection with B. dermatitidis causes a broad array of clinical manifestations ranging from asymptomatic infection to fulminant sepsis with acute respiratory distress syndrome and death. B. dermatitidis can infect almost any organ in the body, but has a predilection for lungs and skin. There have been recent advances in the understanding of the pathogenesis, diagnosis, and treatment of this fungus. The Infectious Diseases Society of America published updated guidelines in 2008 to guide clinicians in the treatment of this important pathogen.

Topics: Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Female; Geography; Humans; Immunocompromised Host; Itraconazole; North America; Pneumonia; Practice Guidelines as Topic; Pregnancy; Pregnancy Complications; Respiratory Distress Syndrome

Histoplasmosis is the most common endemic mycosis in the North America, Central America, and many countries of South America and also occurs in China, India, Southeast Asia, Africa, Australia, and Europe. Clinical syndromes are not specific and histoplasmosis often is overlooked in the evaluation of patients with community-acquired pneumonia, chronic cavitary pneumonia resembling tuberculosis or anaerobic infection, granulomatous inflammatory diseases such as sarcoidosis or Crohn disease, and malignancy. The diagnosis depends on understanding the geographic distribution, common clinical presentations, and tests used for diagnosis of histoplasmosis. While histoplasmosis resolves without treatment in most patients, treatment is indicated in all immunocompromised patients and those with progressive disseminated disease or chronic pulmonary disease. Treatment is appropriate in most patients with acute pulmonary disease but rarely in those with other pulmonary or mediastinal manifestations. The preferred agents include liposomal amphotericin B for more severe cases and itraconazole for milder cases and "step-down" therapy following response to amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Geography, Medical; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Itraconazole; Lung; Mediastinal Diseases; Pneumonia; Radiography

We present a case of a patient with hairy cell leukemia and pulmonary aspergillosis who developed a cycotic pulmonary artery aneurysm despite prolonged antifungal therapy. A review of the literature in regards to incidence, etiology, clinical manifestations and treatment options is included.

Topics: Abscess; Acyclovir; Amphotericin B; Aneurysm, Infected; Anti-Bacterial Agents; Antifungal Agents; Antineoplastic Agents; Antiviral Agents; Aspergillus; Caspofungin; Ceftazidime; Clindamycin; Echinocandins; Fluconazole; Humans; Leukemia, Hairy Cell; Lipopeptides; Male; Middle Aged; Mouth; Ofloxacin; Pneumonia; Pulmonary Artery; Pulmonary Aspergillosis; Valacyclovir; Valine; Vancomycin

This review summarizes recent developments in the diagnosis and treatment of fungal pneumonia, with an emphasis on invasive pulmonary aspergillosis.. Improvements in nonculture-based fungal diagnostics, early implementation of pulmonary high resolution, or spiral computed tomography scanning and a recent expansion of the antifungal armamentarium have greatly improved the outcome of immunocompromised patients with invasive aspergillosis. However, the field is changing: new pathogens (such as Zygomycetes) are emerging, and novel risk groups (ICU patients in particular) are being identified.. Galactomannan antigen detection is a valuable tool for evaluating patients at risk for invasive aspergillosis (as a screening assay on serum samples from neutropenic patients or as a confirmatory assay on bronchoalveolar lavage fluid samples, in general), but should be used in conjunction with modern imaging techniques. beta-D-Glucan and PCR assays are still investigational. Voriconazole is the drug of choice for invasive aspergillosis, whereas liposomal amphotericin B at 3 mg/kg per day is the preferred alternative in case of contraindication, drug-related side-effects, or intolerance. Whenever possible, optimal antifungal therapy should be complemented by surgical debridement of necrotic tissue. The added value of combination therapy is still unproven. Therapeutic drug monitoring of mold-active azoles should be implemented in order to minimize toxicity and maximize efficacy. Lipid-based formulations of amphotericin B, and to a lesser extent voriconazole, are the drugs of choice for non-Aspergillus related fungal pneumonia. Although active in prophylaxis, the efficacy of posaconazole in confirmed infections remains controversial.

Topics: Amphotericin B; Antifungal Agents; Fungi; Galactose; Humans; Mannans; Mycoses; Pneumonia; Pulmonary Aspergillosis; Pyrimidines; Radiography, Thoracic; Triazoles; Voriconazole

Although cryptococcal infections due to Cryptococcus neoformans are frequently reported in the immunosuppressed patients, infections related to other Cryptococcus spp. are rarely reported. We are reporting a case of pulmonary infection and ARDS due to C. albidus in a patient receiving immunosuppressive therapy because of Still's disease. The diagnosis was made by tissue biopsy and culture. The patient responded to treatment with amphotericin B lipid complex 400 mg/day. The case is significant in that it reminds of yeasts as a cause of community acquired infection in the immunosuppressed patients.

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; Cryptococcosis; Cryptococcus; Drug Combinations; Humans; Lung; Male; Phosphatidylcholines; Phosphatidylglycerols; Pneumonia; Respiratory Distress Syndrome

Invasive fungal infections are an important cause of morbidity and mortality in patients with hematological malignancies. In particular, patients with neutropenia and those who have undergone allogeneic hematopoietic stem cell transplantation are at highest risk, with fungal pneumonia being the main clinical manifestation in these patients. The most common pathogens associated with fungal pneumonia are Aspergillus spp. and Zygomycetes. However, other pathogens have also been observed in fungal pneumonia, including Cryptococcus spp., Pneumocystis jirovecii, and Candida spp. This comprehensive review will focus on the important practical aspects relevant to the epidemiology, clinical diagnosis, and therapeutic management of pneumonia due to filamentous fungi in patients affected by hematological malignancies.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Drug Therapy, Combination; Hematologic Neoplasms; Humans; Lung Diseases, Fungal; Pneumonia; Zygomycosis

Topics: Amphotericin B; Animals; Antifungal Agents; Columbidae; Cryptococcosis; Humans; Immunocompromised Host; Lung Diseases, Fungal; Pneumonia; Zoonoses

Topics: Amiodarone; Amphotericin B; Bronchoconstriction; Drug-Related Side Effects and Adverse Reactions; Female; Finland; Humans; Incidence; Lung Diseases; Male; Nitrofurantoin; Penicillamine; Pneumonia; Pulmonary Edema; Risk Assessment; Salicylic Acid

During the past decade, an increasing spectrum of pathogenic Zygomycetes fungi have caused infections in humans. The preponderance of these deeply invasive infections have been caused by members of the order Mucorales. However, deeply invasive zygomycoses due to genera of the order Entomophthorales (Conidiobolus species and Basidiobolus species) have seldom been reported. We describe a granulocytopenic patient with pulmonary and pericardial zygomycosis due to Conidiobolus incongruus, describe this organism's susceptibility to antifungal agents, characterize its diagnostic microbiological characteristics, and review previously reported cases of deeply invasive zygomycosis due to Conidiobolus species. In immunocompromised patients, C. incongruus is an uncommon but highly invasive fungal pathogen that may be resistant to amphotericin B and can be distinguished from other Zygomycetes fungi by characteristic mycological features.

Topics: Adult; Amphotericin B; Cardiac Tamponade; Drug Resistance, Microbial; Fatal Outcome; Female; Fungi; Humans; Immunocompromised Host; Mucormycosis; Pneumonia; Radiography

Topics: Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Ganciclovir; Humans; Immunocompromised Host; Mycoses; Pneumonia; Pneumonia, Pneumocystis; Pneumonia, Viral; Trimethoprim, Sulfamethoxazole Drug Combination

Few cases of overwhelming pulmonary blastomycosis associated with the adult respiratory distress syndrome have been reported. We describe 10 patients with this condition who were treated at one center in Wisconsin.. All 10 patients presented with fever, cough, and dyspnea; radiographic evidence of diffuse pulmonary infiltrates; and marked impairment of oxygenation. The mean alveolar-arterial oxygen gradient was 616 mm Hg. Six of the patients had no underlying disease associated with altered immunity, and two had no recent exposure to environmental reservoirs of Blastomyces dermatitidis. In all 10 patients, large numbers of broad-based budding yeasts were seen on microscopical examination of tracheal secretions. All patients were treated with intravenous amphotericin B (0.7 to 1.0 mg per kilogram per day). Of the five survivors, four received full doses of amphotericin B in the first 24 hours, and four required mechanical ventilatory support for 7 to 151 days. Long-term follow-up of three survivors showed good recovery of pulmonary function.. Overwhelming infection with B. dermatitidis can cause diffuse pneumonitis and the adult respiratory distress syndrome, even in immunocompetent hosts. With prompt diagnosis by microscopical examination of tracheal secretions, intensive therapy with amphotericin B, and ventilatory support, good recovery of pulmonary function is possible.

Topics: Adult; Aged; Amphotericin B; Blastomycosis; Female; Follow-Up Studies; Humans; Lung Diseases, Fungal; Male; Middle Aged; Pneumonia; Respiratory Distress Syndrome

Mycotic pneumonias are common problems seen in small companion animals because of the wide environmental distribution of fungi and their use of airborne spores for reproduction. This article outlines the important clinical features and pathogenesis of mycotic pneumonias and includes a detailed discussion of the therapeutic approach to patients with these infections.

Topics: Amphotericin B; Animals; Aspergillosis; Blastomycosis; Cat Diseases; Cats; Coccidioidomycosis; Cryptococcosis; Dog Diseases; Dogs; Histoplasmosis; Ketoconazole; Lung Diseases, Fungal; Pneumonia

Current management of infections in thoracic surgery is reviewed. The selection of patients for the use of antibiotics prophylactically, the diagnosis and treatment of pulmonary infection in immunosuppressed patients, indications for operation in patients with fungal infections, bronchiectasis, lung abscess, and empyema, and the management of mediastinitis after sternotomy and of postpneumonectomy space infections is described.

Topics: Amphotericin B; Anti-Bacterial Agents; Antitubercular Agents; Bronchiectasis; Empyema; Humans; Infection Control; Lung Abscess; Lung Diseases, Fungal; Pneumonectomy; Pneumonia; Postoperative Complications; Sternum; Surgical Wound Infection; Thoracic Surgery; Tuberculosis, Pulmonary

Topics: Amphotericin B; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Aspergillus niger; Humans; Immunodiffusion; Lung Diseases, Fungal; Pneumonia; Radiography

Topics: Amphotericin B; Coccidioides; Coccidioidomycosis; Female; Humans; Lung; Lung Diseases, Fungal; Pneumonia; Prognosis; Radiography; Serologic Tests; Syndrome

Topics: Amphotericin B; Aspergillosis; Candida; Candidiasis; Child; Child, Preschool; Coccidioidomycosis; Coccidiosis; Cryptococcosis; Endocarditis; Granuloma; Histoplasmosis; Humans; Infant; Kidney; Kidney Function Tests; Meningitis; Mycoses; Pneumonia

To compare the feasibility of treatment, safety, and toxicity of intravenous amphotericin B deoxycholate prepared in either glucose or intralipid for empirical antimycotic treatment of neutropenic cancer patients.. Single centre stratified, randomised non-blinded phase II study.. University hospital providing tertiary clinical care.. 51 neutropenic patients (leukaemia (35), lymphoma (11), solid tumours (5)) with refractory fever of unknown origin (24) or pneumonia (27).. Amphotericin B 0.75 mg/kg/day in 250 ml glucose 5% solution or mixed with 250 ml intralipid 20%, given on eight consecutive days then alternate days, as a 1-4 hour infusion.. Feasibility of treatment, subjective tolerance (questionnaire), and objective toxicity (common toxicity criteria of the National Cancer Institute).. Study arms were balanced for age, sex, underlying malignancy, renal and liver function, and pre- and concomitant treatment with antibiotics and nephrotoxic agents. No statistically significant or clinically relevant differences were found between the treatment groups for: daily or cumulative dose and duration of treatment with amphotericin B; incidence and time of dose modifications or infusion duration changes related to toxicity; dose or duration of symptomatic support with opiates, antipyretics, or antihistamines; renal function; subjective tolerance; most common toxicity scores; course of infection; and incidence of treatment failures. Patients treated with amphotericin B in intralipid were given fewer diuretics (P<0.05) and therefore had more peripheral oedema (P<0.01) and needed less potassium supplementation (P<0.05) than patients given amphotericin in glucose. Acute respiratory events were more common in the intralipid arm (P<0.05).. Amphotericin B 0.75 mg/kg/day in intralipid given on eight consecutive days then alternate days provides no benefit and is associated with potential pulmonary side effects possibly because of fat overload or an incompatibility of the two drugs.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Drug Carriers; Drug Compounding; Fat Emulsions, Intravenous; Feasibility Studies; Female; Fever of Unknown Origin; Glucose; Humans; Infusions, Intravenous; Male; Middle Aged; Neutropenia; Pneumonia; Prospective Studies

To determine the influence of selective oropharyngeal decontamination (SOD) on the rate of colonization and infection of the respiratory tract in intensive care patients requiring mechanical ventilation for more than 4 days. A financial assessment was also performed.. Randomized, prospective, controlled study using amphotericin B, colistin sulfate (polymyxin E), and tobramycin applied to the oropharynx and systemic cefotaxime prophylaxis.. Anesthesiology intensive care unit (ICU) of a 1500-bed hospital.. A total of 88 patients admitted as emergencies and intubated within less than 24 h were enrolled. Fifty-eight patients received SOD and 30 patients served as controls. Randomization was in the proportion of 2 : 1 study patients to controls.. Microbiological samples from the oropharynx and other infected sites were taken at the time of admission, then twice a week and after extubation.. With the use of SOD, colonization was significantly reduced. Furthermore, the infection rate decreased from 77% in the controls to 22% in the study patients. Staphylococcus aureus was the main potential pathogen causing colonization and pneumonia. Number of days in the ICU, duration of ventilation, and mortality were not significantly decreased. The total cost of antibiotics was reduced. Development of resistance was not observed.. The use of SOD significantly reduced the colonization and pneumonia and the total charge for antibiotics. The length of stay in the ICU, duration of ventilation, and mortality were similar. No resistance was observed. Staphylococcus aureus was selected by SOD in some patients and the clinical relevance needs further observation.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Colistin; Cross Infection; Drug Resistance, Microbial; Female; Humans; Intensive Care Units; Male; Microbial Sensitivity Tests; Middle Aged; Oropharynx; Pneumonia; Respiration, Artificial; Tobramycin

Reduction of potential pathogens by selective intestinal decontamination has been proposed to improve intensive care. Despite large scientific interest in this method, little is known about its benefit in homogeneous trauma populations.. In a prospective, controlled study, we enrolled non-infected trauma patients (age over 18 years, mechanical ventilation > or = 48 hours, intensive care for more than 3 days) who primarily were admitted to our university medical center. We randomized patients to be treated with two different topical regimens (polymyxin, tobramycin, and amphotericin (PTA) or polymyxin, ciprofloxin, amphotericin (PCA)) or the carrier only (placebo), administered four times daily both to the oropharynx and to the gastrointestinal tract. All patients received intravenous ciprofloxacin (200 mg, bd) for 4 days.. Of 357 enrolled patients, 310 (age 38.0 +/- 16.5 years, Injury Severity Score 35.2 +/- 12.7) met all inclusion criteria. Selective decontamination successfully reduced intestinal bacterial colonization. However, we did not identify significant differences between groups regarding pneumonia (PTA 47.5%, PCA 39.0%, placebo 45.3%), sepsis (PTA 47.5%, PCA 37.8%, placebo 42.6%), multiple organ failure (PTA 56.3%; PCA 52.4%, placebo 58.1%), and death (PTA 11.3%, PCA 12.2%, placebo 10.8%). Total costs per patient were highest with the PTA regimen.. We found no benefit of selective decontamination in trauma patients. Apparently, bacterial overgrowth in the intestinal tract is not the sole link between trauma, sepsis, and organ failure.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Anti-Infective Agents; Bacterial Translocation; Ciprofloxacin; Colistin; Double-Blind Method; Drug Therapy, Combination; Female; Humans; Intestines; Male; Multiple Trauma; Pneumonia; Prospective Studies; Respiration, Artificial; Tobramycin

Selective decontamination of the digestive tract with topical nonabsorbable antibiotics has been reported to prevent nosocomial infections in patients receiving mechanical ventilation, and the procedure is used widely in Europe. However, it is unclear whether selective decontamination improves survival.. We conducted a randomized, double-blind multicenter study in which 445 patients receiving mechanical ventilation in 15 intensive care units were given either prophylactic nonabsorbable antibiotics (n = 220) or a placebo (n = 225). Topical antibiotics (tobramycin, colistin sulfate, and amphotericin B) or a placebo was administered through a nasogastric tube and applied to the oropharynx throughout the period of ventilation. The main end points were the mortality rate in the intensive care unit and within 60 days of randomization.. A total of 142 patients died in the intensive care unit; 75 (34 percent) in the treatment group and 67 (30 percent) in the placebo group (P = 0.37). Mortality within 60 days of randomization was similar in the two groups (P = 0.40), even after adjustment for factors that were either unbalanced or individually predictive of survival in the two groups (P = 0.70). Pneumonia developed in 59 patients (13 percent) in the intensive care unit within 30 days of enrollment in the study (33 in the placebo group and 26 in the treatment group, P = 0.42). Pneumonia acquired in the intensive care unit and due to gram-negative bacilli was less frequent (P = 0.01) in the treatment group than in the placebo group. The total charges for antibiotics were 2.2 times higher in the treatment group.. Selective decontamination of the digestive tract does not improve survival among patients receiving mechanical ventilation in the intensive care unit, although it substantially increases the cost of their care.

Topics: Administration, Topical; Amphotericin B; Anti-Bacterial Agents; Colistin; Critical Care; Cross Infection; Digestive System; Double-Blind Method; Female; Gram-Negative Bacterial Infections; Humans; Intensive Care Units; Male; Middle Aged; Multiple Organ Failure; Pneumonia; Respiration, Artificial; Survival Rate; Time Factors; Tobramycin

In a prospective randomised study, the effects of two different colonisation prophylaxis techniques on colonisation and pulmonary infection were investigated in 40 critically ill patients with long-term ventilatory support (greater than or equal to 4 days). 20 patients were selectively decontaminated with 4 x 100 g polymyxin E, 4 x 80 mg tobramycin and 4 x 500 mg amphotericin B, administered through the gastric tube and with an antimicrobial sticky paste in the oropharynx (group I). 20 patients received 50 mg of polymyxin B and 80 mg of gentamicin dissolved in 10 ml of 0.9% saline at 6 h intervals into nose, oropharynx and stomach as well as 300 mg of amphotericin B in the oropharynx only (group II). All patients received cefotaxime systemically in the first 3 days. In group I gram-negative aerobic bacteria in the pharynx decreased from 35% to 0%, in group II from 40% to 10% and in the rectum from 80% to 61% (10% in the second week) in Group I and from 100% to 73% (33% in the second week) in group II. The decrease in gram-negative microorganisms was accompanied by an increase in the frequency of Staphylococcus epidermidis. In group I, two patients developed pneumonia and two patients urinary tract infections, in group II two patients suffered from pneumonia and 3 patients urinary tract infections. Both regimes are effective methods of prophylaxis for lowering colonisation with gram-negative aerobic bacteria and the frequency of pneumonia in patients requiring long-term mechanical ventilation. A possible selection of gram-positive bacteria must be appropriately monitored.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Cefotaxime; Colistin; Critical Care; Female; Gentamicins; Humans; Male; Middle Aged; Pneumonia; Polymyxin B; Prospective Studies; Respiration, Artificial; Time Factors; Tobramycin

A double blind, placebo-controlled trial was performed to test the efficacy of prevention of nosocomial infections by selective digestive decontamination. Placebo or tobramycin (80 mg) and colistin (100 mg) was given four times daily via the gastric tube. Amphotericin B (500 mg/6 h) was administered to all patients. As our ICU is divided into two separate subunits, intestinal decontamination or placebo was administered alternatively to patients of the two subunits during two 3-month periods, separated by a 2-month period without prevention. The decontamination (n = 97) and placebo groups (n = 84) were similar with respect to age, sex, severity score and diagnostic categories on admission. Intestinal decontamination alone failed to significantly reduce the number of infected patients (26% vs 34.5%, p = 0.20), but was effective on ICU-acquired infections (0.33 vs 0.60, p = 0.02) especially gram-negative infection rates (0.17 vs 0.43, p = 0.01). The onset of the first ICU-acquired infection was delayed (9 vs 13 days, p less than 0.001) and incidence of pneumonia (2 vs 13 cases, p less than 0.01) including bacterial pneumonia (0 vs 8 cases, p less than 0.01) was significantly decreased. However, mean ICU stay and mortality were not significantly modified by intestinal decontamination.

Topics: Amphotericin B; Clinical Protocols; Colistin; Cross Infection; Double-Blind Method; Female; Humans; Intensive Care Units; Intestinal Diseases; Length of Stay; Male; Middle Aged; Pneumonia; Prospective Studies; Tobramycin

From August 1977 to October 1978, 23 patients with acute myelogenous leukemia (AML) received induction therapy at Vanderbilt University Hospital. Six patients died of documented fungal infection, predominantly aspergillus pneumonia; the complete remission rate was only 40%. Based on this experience we began using amphotericin B empirically in any AML patient remaining febrile or having recurrent fever after a week of broad spectrum antibiotics. Of 22 patients treated from October 1978 to August 1980, none died of fungal infection during induction therapy; the remission rate increased significantly to 77%. Chemotherapy and supportive care were otherwise unchanged during this period. While the first group was older, the improvement in remission rate was also seen in patients younger than 60 years of age. Since fungal infection may be difficult to document, this study suggests that empirical amphotericin B is reasonable therapy in leukemic patients remaining febrile or having a recurrent fever following a week of broad spectrum antibiotics, if the institution has a high incidence of fungal infections.

Topics: Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Clinical Trials as Topic; Cytarabine; Daunorubicin; Drug Therapy, Combination; Female; Follow-Up Studies; Humans; Leukemia, Myeloid, Acute; Male; Middle Aged; Mycoses; Pneumonia

The incidence of fungal pulmonary infections is known to be on the increase, and yet there is an alarming gap in terms of marketed antifungal therapies that are available for pulmonary administration. Amphotericin B (AmB) is a highly efficient broad-spectrum antifungal only marketed as an intravenous formulation. Based on the lack of effective antifungal and antiparasitic pulmonary treatments, the aim of this study was to develop a carbohydrate-based AmB dry powder inhaler (DPI) formulation, prepared by spray drying. Amorphous AmB microparticles were developed by combining 39.7 % AmB with 39.7 % γ-cyclodextrin, 8.1 % mannose and 12.5 % leucine. An increase in the mannose concentration from 8.1 to 29.8 %, led to partial drug crystallisation. Both formulations showed good in vitro lung deposition characteristics (80 % FPF < 5 µm and MMAD < 3 µm) at different air flow rates (60 and 30 L/min) when used with a DPI, but also during nebulisation upon reconstitution in water.

Topics: Administration, Inhalation; Amphotericin B; Antifungal Agents; Dry Powder Inhalers; Humans; Lung; Macrophages, Alveolar; Mannose; Particle Size; Pneumonia; Powders; Respiratory Aerosols and Droplets

Coronavirus disease 2019 (COVID-19), which is attributable to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been causing a worldwide health issue. Airways colonization by Candida spp. is prevalent among patients on automatic ventilation in intensive care units (ICUs). This research aimed to ascertain the risk factors and roles of Candida spp. respiratory tract colonization, and Candida lung infection during the progression of COVID-19 pneumonia in critically ill patients. In total, Candida spp. were recovered in 69 from 100 immunosuppressed patients with COVID-19. Bronchoscopy was used to collect the Bronchoalveolar lavage (BAL) specimens. For the identification of Candida spp. PCR sequencing was done using the ITS1 and ITS4 primers. The amplification of the HWP1 gene was conducted to identify the Candida albicans complex. The antifungal activities of fluconazole, itraconazole, voriconazole, amphotericin B and caspofungin against Candida spp. were evaluated using the Clinical and Laboratory Standards Institute M60. In 63.77% of the patients, Candida respiratory colonization at D0 and D14 had no impact on the severity of COVID-19. In comparison to C. albicans strains, Candida respiratory disorder with C. glabrata had influenced the severity of COVID-19 for critically ill patients following adjustment for the risk factors of COVID-19 (P < 0.05). Amphotericin B and caspofungin showed superior activity against all Candida spp. All antifungal agents showed 100% sensitivity against the two C. africana strains. Our observation on patients who used automatic ventilation, respiratory colonization by Candida spp. was not seen to influence the infection or death caused by COVID-19. Amphotericin B and caspofungin showed superior activity against all Candida spp. and were recommended for the treatment regime of pulmonary candidiasis associated with COVID-19 infection. Although "Candida pneumonia" is rarely being reported in critically ill patients, Candida airway colonization mainly by Candida albicans is common especially among patients with diabetes, malignancies, and kidney disorders.

Topics: Amphotericin B; Antifungal Agents; Candida; Candida albicans; Candida glabrata; Candidiasis; Caspofungin; COVID-19; Critical Illness; Fluconazole; Humans; Lung; Microbial Sensitivity Tests; Pneumonia; SARS-CoV-2

Topics: Amphotericin B; Anti-Bacterial Agents; Brain; Cryptococcus neoformans; Female; Flucytosine; Humans; Kidney Transplantation; Magnetic Resonance Imaging; Meningitis, Cryptococcal; Middle Aged; Piperacillin, Tazobactam Drug Combination; Pneumonia; Polycystic Kidney Diseases; Treatment Outcome

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

Topics: Aminopyridines; Amphotericin B; Animals; Antifungal Agents; Coccidioides; Disease Models, Animal; Female; Fluconazole; Isoxazoles; Mice; Mice, Inbred C57BL; Microbial Sensitivity Tests; Pneumonia; Prodrugs; Triazoles

Topics: Alternaria; Alternariosis; Amphotericin B; Antifungal Agents; Ascomycota; Fatal Outcome; Humans; Immunocompromised Host; Invasive Fungal Infections; Kidney Transplantation; Knee; Lung Diseases, Fungal; Male; Middle Aged; Pneumonia; Risk Factors; Voriconazole

Pseudallescheria boydii is a fungal organism known to affect immunocompromised patients. This organism is known to cause, in severe cases, invasive infection of various organs such as the central nervous, cardiovascular, and respiratory systems. We report an unusual case of pulmonary P. boydii pneumonia in an immunocompromised critically ill patient with a co-infection of Aspergillus fumigatus and Aspergillus terreus with ARDS. This case highlights the importance of a high index of suspicion for superimposed fungal infections in patients who are critically ill and immunocompromised. Uncommon fungal pathogens should be considered in the differential diagnosis of respiratory failure, especially if diagnostic markers such as galactomannan (from BAL and serum) or 1,3-beta-D-glucan are elevated. Further diagnostic interventions are warranted when insufficient clinical improvement is observed to prevent treatment failure and adverse outcomes.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; beta-Glucans; Clarithromycin; Coinfection; Critical Illness; Extracorporeal Membrane Oxygenation; Galactose; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Linezolid; Male; Mannans; Meropenem; Pneumonia; Pseudallescheria; Severe Acute Respiratory Syndrome; Thienamycins; Transplant Recipients; Voriconazole

To compare clinical features, diagnosis and therapeutic effect between pulmonary histoplasmosis and progressive disseminated histoplasmosis.
 Methods: A retrospective analysis for 12 cases of hospitalized patients with histoplasmosis, who was admitted in Xiangya Hospital, Central South University during the time from February 2009 to October 2015, was carried out. Four cases of pulmonary histoplasmosis and 8 cases of progressive disseminated histoplasmosis were included. The differences of clinical features, imaging tests, means for diagnosis and prognosis were analyzed between the two types of histoplasmosis.
 Results: The clinical manifestations of pulmonary histoplasmosis were mild, such as dry cough. However, the main clinical symptoms of progressive disseminated histoplasmosis were severe, including recurrence of high fever, superficial lymph node enlargement over the whole body, hepatosplenomegaly, accompanied by cough, abdominal pain, joint pain, skin changes, etc.Laboratory examination showed pancytopenia, abnormal liver function and abnormal coagulation function. One pulmonary case received the operation of left lower lung lobectomy, 3 cases of pulmonary histoplasmosis and 6 cases of progressive disseminated histoplasmosis patients were given deoxycholate amphotericin B, itraconazole, voriconazole or fluconazole for antifungal therapy. One disseminated case discharged from the hospital without treatment after diagnosis of histoplasmosis, and 1 disseminated case combined with severe pneumonia and active tuberculosis died ultimately.
 Conclusion: As a rare fungal infection, histoplasmosis is easily to be misdiagnosed. The diagnostic criteria depends on etiology through bone marrow smear and tissues biopsy. Liposomeal amphotericin B, deoxycholate amphotericin B and itraconazole are recommended to treat infection for histoplasma capsulatum.. 目的：比较肺型与进展播散型组织胞浆菌病的临床特点、诊断及预后差异。 方法：回顾性分析中南大学湘雅医院2009年2月至2015年10月期间收治的组织胞浆菌病住院患者12例，其中肺型4例，进展播散型8例。从临床表现、影像学、确诊途径及预后等方面分析两者之间的差异性。 结果：肺型组织胞浆菌病临床表现轻微，干咳多见。进展播散型患者全身症状明显，极易出现反复高热、全身浅表淋巴结肿大、肝脾肿大，可合并咳嗽、腹痛、关节痛、皮肤改变等。实验室检查示全血细胞减少、肝功能异常、凝血功能异常等。1例肺型患者给予了左下肺切除术，其余3例肺型及6例进展播散型患者分别给予两性霉素B脱氧胆酸盐、伊曲康唑、伏立康唑或氟康唑抗真菌感染治疗，好转出院，1例播散型确诊后暂未治疗即出院，1例播散型因合并重症肺炎及活动性肺结核治疗无效死亡。结论：组织胞浆菌病临床少见，极易漏诊或误诊，依靠骨髓涂片、病理组织切片特殊染色明确病原学是目前确诊的主要依据，推荐两性霉素B脂质体、两性霉素B脱氧胆酸盐及伊曲康唑抗感染治疗。.

Topics: Abdominal Pain; Amphotericin B; Antifungal Agents; Biopsy; Cough; Death; Deoxycholic Acid; Diagnostic Errors; Drug Combinations; Fever; Hepatomegaly; Histoplasma; Histoplasmosis; Humans; Invasive Fungal Infections; Itraconazole; Lung; Lung Diseases, Fungal; Pneumonia; Recurrence; Retrospective Studies; Splenomegaly; Treatment Outcome; Tuberculosis

Use of the PLEX-ID system can lead to a rapid molecular diagnosis in microbiology. To illustrate the clinical implications of this new diagnostic tool, we present the case of a 46-year-old patient admitted with severe respiratory failure and septic shock. Cryptococcal pneumonia was diagnosed by Fungi-Fluor™ staining of the bronchoalveolar lavage (BAL) and the patient tested positive for HIV. Unfortunately, he died 12h after admission despite intensive care support and treatment with broad-spectrum antibiotics, amphotericin B, and flucytosine. Retrospective use of the PLEX-ID on the BAL, bronchial aspirate, and blood yielded Cryptococcus neoformans in all fluids tested. Rapid molecular diagnosis with PLEX-ID, especially when performed on the blood of septic patients, may reduce the time to adequate treatment and limit the number of diagnostic procedures needed.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Bronchoalveolar Lavage Fluid; Coinfection; Cryptococcosis; Cryptococcus neoformans; Fatal Outcome; Female; Flucytosine; HIV Infections; Humans; Male; Middle Aged; Nucleic Acid Amplification Techniques; Pneumonia

Aspergillus pneumonia often is a fatal consequence of prolonged neutropenia in patients with acute leukemia. Despite prompt diagnosis and adequate antifungal therapy, mortality remains high among these patients. Recognizing early signs and symptoms, as well as risk factors, is the key to reducing morbidity and mortality.

Topics: Acute Disease; Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Humans; Leukemia; Pneumonia

A 49-year-old white man.. Shortness of breath, fever, and ongoing unintended weight loss.. The patient had arrived at the emergency department of a hospital in St. Augustine, Florida with coughing and progressive shortness of breath. He reported that he had been experiencing these symptoms for the past 6 weeks. He was examined by his primary physician, who had prescribed him a course of antibiotics and treated him on an outpatient basis. The patient reported no improvement in his symptoms at present, despite the antibiotics. He mentioned that he had traveled to St. Augustine, Florida approximately 10 days previously. Medical personnel in the emergency department subsequently performed a chest x-ray on the patient, as well as computed tomography (CT) scanning of his lymphadenopathy. MEDICAL AND FAMILY HISTORY: Positive for hypertension, diabetes mellitus, and osteoporosis. He reported that he has chewed 2 packs of chewing tobacco per day for the past 30 years, occasionally drinks alcohol, and is a nonsmoker with no known allergies.. Noncontributory.. The patient exhibited mild respiratory distress; however, he was awake, alert, and oriented, with a temperature of 37.3°C. He also exhibited poor respiratory effort with diffuse expiratory rhonchi. His heart rate and heart rhythm were regular, with no murmurs, gallops, or rubs. His bowel sounds were positive; he exhibited no organomegaly and no cyanosis, clubbing, or edema of his extremities.

Topics: Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Humans; Itraconazole; Male; Middle Aged; Pneumonia; Virulence

The case of a patient who experienced probable infusion-related reactions to amphotericin B lipid complex (ABLC) but tolerated continued amphotericin B therapy after a switch to an alternative lipid-based formulation is reported.. A 28-year-old immunocompromised man with pneumonia, respiratory failure, and neutropenic fever was initiated on ABLC and other antibiotics for suspected invasive aspergillosis. Due to the patient's deteriorating renal function, the use of amphotericin B was deemed preferable to the standard therapy for invasive aspergillosis (voriconazole) even though he had experienced likely infusion-related reactions to ABLC on two prior occasions. During the infusion of ABLC, significant increases in the man's temperature, respiratory rate, systolic blood pressure, and heart rate were observed. Although those symptoms were suspected to be infusion related, it was decided that continuing amphotericin B therapy with an alternative lipid-based form of the drug was the best course of action. After the patient was switched to liposomal amphotericin B one day later, no further infusion-related adverse reactions were noted for the duration of therapy. While this case suggests that adverse reactions to one type of amphotericin B might not occur with the use of an alternative formulation, further research is needed to better define the potential for cross-reactivity among various forms of amphotericin B and related safe-infusion practices.. A patient with invasive aspergillosis who experienced likely infusion- related reactions to ABLC was able to tolerate continued amphotericin B therapy after a switch to the liposomal formulation.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Comorbidity; Cross Reactions; Dosage Forms; Drug Administration Routes; Humans; Immunocompromised Host; Infusions, Intravenous; Male; Neutropenia; Pneumonia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Renal Insufficiency, Chronic; Respiratory Insufficiency

Franklin disease, or gamma heavy-chain disease, in patients with autoimmune disorders is a challenge for clinicians to diagnose due to its rarity, and recurrent infection is one of its characteristics. Within the spectrum of infections in Franklin disease patients, various fungi should always be considered. In this study, the authors describe a 57-year-old non-human immunodeficiency virus-infected systemic lupus erythematosus patient later diagnosed with Franklin disease and then developed Penicillium pneumonia. Because of the unexpected combination of Franklin disease and Penicillium infection in a non-human immunodeficiency virus-infected patient, the diagnosis of common hospital-acquired pneumonia was initially made. The laboratory examinations and cultures helped confirm the correct diagnosis of Franklin disease and Penicillium pneumonia. This is the first report of Penicillium sp. infection in a patient with Franklin disease, and it emphasizes the importance of proper preparation for biopsy, complete hematologic investigation, culture preparation and early antifungal coverage to improve the outcome.

Topics: Amphotericin B; Antifungal Agents; Diagnosis, Differential; Female; Heavy Chain Disease; Humans; Lung Diseases, Fungal; Lupus Erythematosus, Systemic; Middle Aged; Penicillium; Pneumonia; Taiwan; Treatment Outcome

Topics: Amphotericin B; Antibodies, Fungal; Antifungal Agents; Cellulitis; Cryptococcosis; Cryptococcus neoformans; Female; Fluconazole; Hepatitis C; Humans; Liver Cirrhosis; Middle Aged; Perineum; Pneumonia; Radiography; Suppuration; Vulva

Subcutaneous dematiaceous fungal infections, which include chromoblastomycosis and phaeohyphomycosis, are a heterogeneous group of clinical entities that are caused by dematiaceous or pigmented fungi found in soil. These infections have a wide spectrum of clinical presentations that depend largely on the specific causative organism and on the integrity of the host's immune response. Treatment is challenging and involves a highly individualized plan that often combines both surgical and long-term medical treatment.

Topics: Acute Kidney Injury; Aged; Amphotericin B; Antifungal Agents; Chromoblastomycosis; Combined Modality Therapy; Costa Rica; Diagnosis, Differential; Humans; Immunocompromised Host; Immunosuppressive Agents; Itraconazole; Kidney Transplantation; Leg; Male; Phaeohyphomycosis; Pneumonia; Pyrimidines; Soil Microbiology; Triazoles; Voriconazole

Antifungal prophylaxis with posaconazole (POS) has been shown to decrease the mortality associated with invasive fungal infections in high-risk patients. We report on a patient, with severe graft-versus-host disease after allogeneic stem cell transplantation, who developed proven pneumonia due to Rhizopus microsporus after 40 days of POS prophylaxis (fasting serum levels: 691-904 ng/mL). Despite combination treatment with liposomal amphotericin B and POS for 39 days, the patient died from pulmonary hemorrhage. This case highlights the need for continued awareness of breakthrough zygomycosis in patients receiving POS.

Topics: Amphotericin B; Antifungal Agents; Chemoprevention; Drug Therapy, Combination; Fatal Outcome; Graft vs Host Disease; Humans; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Pneumonia; Rhizopus; Stem Cell Transplantation; Transplantation, Homologous; Triazoles

A 4-year-old castrated male domestic ferret from central Massachusetts was evaluated for weight loss over a 1.5-month period and for 2 days of retching, diarrhea, and signs of lethargy. It had been housed indoors, with 2 other ferrets, 2 cats, and humans that lacked signs or symptoms of disease.. Physical examination revealed a thin body condition, tachypnea, an increase in respiratory effort, and retching. Splenomegaly was detected during abdominal palpation. Clinicopathologic analysis revealed lymphopenia, lactic acidosis, hypoglycemia, hypocalcemia, hypoalbuminemia, and hyperglobulinemia. A pulmonary bronchointerstitial pattern was evident on radiographs, and abdominal ultrasonography revealed a suspected pancreatic mass and mesenteric lymphadenopathy.. After 2 weeks of medical treatment and once clinical signs resolved, an exploratory laparotomy was performed and a lymph node biopsy specimen was collected. Histologic evaluation of the specimen revealed Cryptococcus-like organisms. Antifungal treatment was initiated with itraconazole (PO) and amphotericin B (IV). The ferret died after 2 days of treatment. A full necropsy was performed, revealing multicentric cryptococcosis affecting the lungs, brain, spleen, and multiple lymph nodes. Paraffin-embedded, formalin-fixed lung tissue was submitted for DNA extraction, and the organism was identified as Cryptococcus neoformans var grubii.. To the authors' knowledge, this is the first report of disseminated cryptococcosis in a North American ferret. This case is unique in that the ferret lived indoors, in a geographic region in which reports of cryptococcosis are rare. The genotyping technique used to identify the Cryptococcus strain can aid in better understanding the epidemiology of cryptococcosis.

Topics: Amphotericin B; Animals; Antifungal Agents; Cryptococcosis; Cryptococcus; Ferrets; Itraconazole; Male; Pneumonia

Topics: Adult; Amphotericin B; Antifungal Agents; Bronchoscopy; Combined Modality Therapy; Diabetes Mellitus, Type 1; Drainage; Female; Humans; Intraoperative Complications; Mucormycosis; Pneumonia; Pneumothorax; Tracheal Diseases

A 56 years male diabetic patient presented with recurrent left upper lobe pneumonia. Fiberoptic bronchoscopy revealed extraluminal compression of left main bronchus with an endobronchial mass obstructing the left upper lobe orifice. The lesion resembled bronchial adenoma. However histological examination revealed mucormycosis. Timely diagnosis followed by medical intervention with intravenous Amphotericin B, coupled with proper management of diabetes, ablated the tumor. Relevant literature on the subject is reviewed.

Topics: Amphotericin B; Antifungal Agents; Bronchoscopy; Diabetes Mellitus; Humans; Injections, Intravenous; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Pneumonia

Rhizopus species is an opportunistic fungus that is contracted by inhalation of aerosolized spores. Early diagnosis is often difficult but is a necessity to prevent rapid progression of the infection that leads to blood vessel invasion by hyphae, causing fatal hemoptysis. A previous case report described the utility of cytologic examination of bronchoalveolar lavage (BAL) fluid in achieving a prompt diagnosis of Rhizopus species in an adolescent patient with diabetic ketoacidosis. The author presents a case that further describes the benefit of performing BAL fluid cytology to help identify fungal morphology characteristics in order to reach an expeditious diagnosis of Rhizopus species in a leukemia patient.

Topics: Amphotericin B; Bronchoalveolar Lavage; Child; Cross Infection; Drug Combinations; Female; Humans; Lung Diseases, Parasitic; Mucormycosis; Phosphatidylcholines; Phosphatidylglycerols; Pneumonia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Rhizopus; Tobramycin

We report a case of pulmonary zygomycosis in an adult male diabetic patient who presented with fever and altered sensorium initially and later developed streaky haemoptysis. Bronchoscopy showed picture of necrotizing pneumonia. Sputum was negative for fungal elements on admission but later bronchial wash and repeat sputum samples were positive by microscopy and culture showed growth of Rhizopus species. Immediately the patient was put on amphotericin B but had a bout of massive haemoptysis and succumbed. A high index of suspicion is needed for an early diagnosis and aggressive treatment of this infection in view of the high mortality rate.

Topics: Amphotericin B; Bronchoalveolar Lavage Fluid; Diabetes Complications; Fatal Outcome; Hemoptysis; Humans; Hydroxides; Lung Diseases, Fungal; Male; Middle Aged; Mucormycosis; Pneumonia; Potassium Compounds; Rhizopus; Sputum

This report describes the case of fungal sinusitis in severely immunocompromised 32-year-old male with common-type acute lymphoblastic leukemia who relapsed after autologous peripheral blood transplantation. Empirical therapy with antibiotics and conventional amphotericin B failed to resolve the infection. Following therapy with AmBisome his symptoms abated and significantly improved scan picture was seen.

Topics: Adult; Amphotericin B; Anti-Infective Agents; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Bacterial Infections; Combined Modality Therapy; Cytarabine; Cytomegalovirus Infections; Enterococcus faecalis; Fatal Outcome; Humans; Idarubicin; Immunocompromised Host; Immunoglobulins, Intravenous; Liposomes; Male; Mycoses; Peripheral Blood Stem Cell Transplantation; Pneumonia; Postoperative Complications; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Pseudomonas putida; Pulmonary Edema; Pyrimidines; Sinusitis; Staphylococcus epidermidis; Transplantation, Autologous; Triazoles; Voriconazole

To determine the independent risk factors for late-onset ventilator-associated pneumonia (VAP) in trauma patients receiving selective digestive decontamination (SDD).. A 4-year, prospective cohort study of trauma patients meeting the following criteria: injury severity score >15, and duration of mechanical ventilation >5 days. Predictors of late-onset VAP occurrence were assessed by logistic regression analysis.. All patients received SDD consisting of polymixin E, gentamicin, and amphotericin B applied in nostrils, mouth, and gut with a 3-day course of parenteral cefazolin. VAP was suspected on clinical and radiological signs, and confirmed by the presence of at least one microorganism at a concentration of at least 10(4) CFU/ml on the broncho-alveolar lavage.. Independent risk factors for late-onset VAP.. A late-onset VAP was diagnosed in 90 (56%) out of 159 patients. Predicting factors for late-onset VAP were: use of non-depolarizing muscle relaxant agents for intubation [3.4 (CI 1.08-10.73)], duration of intubation [1.06 (CI 1.01-1.17)], length of intensive care unit (ICU) stay [1.05 (CI 1.02-1.09)], and prior tracheal colonization [1.03 (CI 1.02-1.21)]. Exposure to prior antimicrobial treatment, except SDD, conferred protection [0.3 (0.12-0.74)].. This study confirms the role of duration of intubation, length of ICU stay, and prior tracheal colonization in the development of late-onset VAP. The results also highlight the importance of the initial management on the development of late-onset VAP. The type of neuromuscular blocking agents to intubate trauma patients should be evaluated in future studies.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Female; Gentamicins; Hospital Mortality; Humans; Injury Severity Score; Intensive Care Units; Logistic Models; Male; Pneumonia; Prospective Studies; Respiration, Artificial; Risk Factors; Wounds and Injuries

The administration of antimicrobial agents encapsulated in long-circulating sterically stabilized liposomes results in a considerable enhancement of therapeutic efficacy compared with the agents in the free form. After liposomal encapsulation, the pharmacokinetics of the antimicrobial agents is significantly changed. An increase in circulation time and reduction in toxic side effects of the agents are observed. In contrast to other types of long-circulating liposomes, an important characteristic of these sterically stabilized liposomes is that their prolonged blood circulation time is, to a high degree, independent of liposome characteristics such as liposome particle size, charge and lipid composition (rigidity) of the bilayer, and lipid dose. This provides the opportunity to manipulate antibiotic release from these liposomes at the site of infection, which is important in view of the differences in pharmacodynamics of different antibiotics and can be done without compromising blood circulation time and degree of target localization of these liposomes. Depending on the liposome characteristics and the agent encapsulated, antibiotic delivery to the infected site is achieved, or the liposomes act as a micro-reservoir function for the antibiotic. In experimental models of localized or disseminated bacterial and fungal infections, the sterically stabilized liposomes have successfully been used to improve antibiotic treatment using representative agents of various classes of antibacterial agents such as the beta-lactams, the aminoglycosides, and the quinolones or the antifungal agent amphotericin B. Extensive biodistribution studies have been performed. Critical factors that contribute to liposome target localization in infected tissue have been elucidated. Liposome-related factors that were investigated were poly(ethylene glycol) density, particle size, bilayer fluidity, negative surface charge, and circulation kinetics. Host-related factors focused on the components of the inflammatory response.

Topics: Ammonium Sulfate; Amphotericin B; Animals; Anti-Infective Agents; Ceftazidime; Ciprofloxacin; Drug Carriers; Gentamicins; Humans; Infections; Liposomes; Molecular Structure; Pneumonia; Rats; Solubility

Topics: Amphotericin B; Anti-Bacterial Agents; Gentamicins; Humans; Neuromuscular Nondepolarizing Agents; Pneumonia; Respiration, Artificial; Risk Factors; Wounds and Injuries

We present a full-term female infant with congenital candidiasis characterized by extensive vesicular and pustular skin lesions associated with pneumonia and severe respiratory distress that appeared during the first hours after birth. The patient was born by cesarean section with no history of rupture of membranes. The mother had a vaginal discharge 3 weeks before delivery. The diagnosis was made by culture of pustular fluid, which grew Candida albicans. Systemic cultures were negative. The infant required a very brief course of conventional mechanical ventilation in spite of impressive and extensive lung infiltrates on the chest radiograph. She made a very quick clinical recovery although it is remarkable that antifungal treatment with amphotericin B was begun very late in her clinical course at the time when she was showing obvious signs of major improvement. Current management guidelines strongly recommend specific therapy for infants with invasive congenital candidiasis or with burn-like extensive dermatitis even without lung involvement. We are not suggesting any change in these recommendations; however, at least in our patient, when amphotericin B was started, she was clearly recovering; it seems possible that her disease although extensive might have experienced an unusual spontaneous regression. This case can provide further insights into this unusual neonatal infection.

Topics: Amphotericin B; Candidiasis; Candidiasis, Cutaneous; Female; Humans; Infant, Newborn; Lung Diseases, Fungal; Pneumonia; Remission, Spontaneous

Caspofungin, in association with other antifungal drugs, was administered as rescue therapy in two cases of documented and one case of possible invasive fungal infection in children with acute leukaemia or undergoing allogeneic bone marrow transplant. The combined therapy was well-tolerated and seemed to be effective in all three patients. A combination antifungal therapy including caspofungin could represent an effective therapy for children with invasive mycoses refractory to single-agent antifungal therapy.

Topics: Adolescent; Amphotericin B; Bone Marrow Transplantation; Caspofungin; Child; Drug Therapy, Combination; Echinocandins; Humans; Leukemia; Lipopeptides; Liposomes; Male; Peptides; Peptides, Cyclic; Pneumonia; Pyrimidines; Transplantation, Homologous; Triazoles; Voriconazole

A 20-year-old Welsh Mountain Pony (212 kg) mare was initially presented for a chronic cough, fever, weight loss and low grade abdominal pain. She later developed dyspnoea, tachypnoea and exercise intolerance. The presence of multiple masses (up to 17 cm diameter) in the pulmonary parenchyma was established using lateral thoracic radiography and transthoracic ultrasonography. Encapsulated, budding yeasts were observed in smears made from transtracheal washings and needle aspirates of the pulmonary lesions. Cryptococcus gattii (synonym: Cryptococcus neoformans variety gattii; Cryptococcus bacillisporus) was cultured from the transtracheal washings and aspirates of the lung masses. The pony was successfully treated using daily intravenous infusions of amphotericin B (typically 0.5 mg/kg in 1 L 5% dextrose in water over 1 h, following premedication with 50 mg flunixin intravenously) over a 1 month period, until a cumulative dose of 3 g had been administered. Treatment was considered to be successful on the basis of progressive improvement in clinical signs, reduction in the size of pulmonary cryptococcomas, 48 kg weight gain and a reduction in the cryptococcal antigen titre from 4096 to 256, 1 year after cessation of treatment.

Topics: Amphotericin B; Animals; Antifungal Agents; Cough; Cryptococcosis; Diagnosis, Differential; Female; Horse Diseases; Horses; Infusions, Intravenous; Pneumonia; Radiography; Ultrasonography

To report the development of nephrogenic diabetes insipidus (NDI) associated with the use of high-dose liposomal amphotericin B.. A 38-year-old white man with relapsed acute myelogenous leukemia underwent a matched unrelated donor allogeneic bone marrow transplant with adequate engraftment and mild graft-versus-host disease responding to corticosteroids. Approximately 11 months after transplant, the patient was admitted to the hospital with suspected fungal pneumonia and started on liposomal amphotericin B (baseline serum creatinine 1.4-1.5 mg/dL). The dose was increased due to his immunosuppression and poor response, as the fungal etiology was identified as Torulopsis glabrata. The patient required mechanical ventilation due to biopsy-proven bronchiolitis olbiterans organizing pneumonia. Additionally, he developed diffuse alveolar hemorrhage and received intravenous desmopressin, with a reduction in bloody secretions. He also developed hypernatremia (serum sodium 155 mEq/L) on day 3 of the desmopressin and had an inappropriately increased urine output consistent with NDI. The most likely etiology for the NDI was liposomal amphotericin B and its associated hypokalemia.. The observation of worsening hypernatremia (serum sodium increased from 135 to 164 mEq/L) with polyuria was associated with an increasing cumulative dosage of liposomal amphotericin B for fungal pneumonia despite the concurrent use of intravenous desmopressin. Aggressive water replacement was an effective treatment option in this patient. The Naranjo probability scale classified this as a possible adverse reaction because of the temporal sequence of NDI after high-dose liposomal amphotericin B and previously reported cases of NDI associated with amphotericin B desoxycholate.. Amphotericin B desoxycholate has been implicated as an etiology for NDI, and the use of the newer liposomal amphotericin B reportedly avoids this rare complication. We observed the development of NDI despite the use of liposomal amphotericin B in a critically ill patient with bone marrow transplant.

Topics: Adult; Amphotericin B; Antifungal Agents; Bone Marrow Transplantation; Candida glabrata; Diabetes Insipidus, Nephrogenic; Dose-Response Relationship, Drug; Humans; Injections, Intravenous; Leukemia, Myeloid, Acute; Male; Pneumonia

Pulmonary aspergillosis and other invasive fungal infections (IFIs) commonly complicate the management of patients with acute leukemia. Standard amphotericin-based therapies may be ineffective for many patients and the available salvage agents (itraconazole and caspofungin) are reported to possess only moderate activity against resistant infections. Laboratory evidence suggests a synergistic interaction between amphotericin and caspofungin. The authors treated a group of patients with amphotericin-refractory IFIs with the combination of caspofungin and amphotericin (or liposomal amphotericin).. A retrospective evaluation of patients with amphotericin-resistant IFIs was conducted. Diagnosis was based on clinical, radiographic, and when available, microbiologic data. Response to combination antifungal therapy was graded as either favorable or unfavorable. Favorable responses included improvement of both clinical and radiographic signs of fungal pneumonia. All other responses were graded as unfavorable.. Thirty patients were included in this analysis. Twenty-six patients had acute leukemia. Based on recently published criteria, the IFIs were classified as proven in 6 patients, probable in 4 patients, and possible in 20 patients. The median duration and dose of amphotericin monotherapy were 12 days (range, 4-65 days) and 7.8 mg/kg (range, 4.2-66.1 mg/kg), respectively. The median duration of combination therapy was 24 days (range, 3-74 days). Eighteen patients (60%) experienced a favorable antifungal response. Twenty patients with acute leukemia received combination therapy for fungal pneumonias arising during intensive chemotherapy treatments. Favorable responses were observed in 15 of these patients (75%), and antifungal response did not depend on the response of the underlying leukemia. Survival to hospital discharge was significantly better (P < 0.001) in patients having a favorable response. Mild to moderate nephrotoxicity was noted in 50% of patients, necessitating the substitution of liposomal amphotericin. Mild elevation of alkaline phosphatase levels occurred in 30% of patients. Caspofungin was temporarily withheld from one patient who developed moderate but reversible biochemical hepatotoxicity.. The antifungal combination of caspofungin and amphotericin can be administered safely to high-risk patients with hematologic malignancies. Although an absolute assessment of efficacy is limited by the design of this study, encouraging outcomes were noted for many patients. The authors plan to evaluate this regimen further in a randomized clinical trial.

Topics: Acute Disease; Adult; Aged; Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Caspofungin; Drug Therapy, Combination; Echinocandins; Female; Humans; Leukemia; Lipopeptides; Lung Diseases, Fungal; Male; Middle Aged; Peptides; Peptides, Cyclic; Pneumonia; Retrospective Studies

We describe a 12-year-old boy with acute myeloid leukemia who developed pleuropericarditis while he was neutropenic and was receiving intravenously administered antibiotic and antifungal therapy for pneumonia. A KOH preparation of the purulent material from an extensive diagnostic and therapeutic pleuropericardial drainage procedure revealed multiple irregularly septate hyphae, and cultures yielded the organism Pythium insidiosum. After completing a 12-month course of intravenously administered liposomal amphotericin B (AmBisome; Fujisawa Healthcare) and itraconazole, the patient remained alive, in clinical remission, and symptom free.

Topics: Amphotericin B; Antifungal Agents; Child; Humans; Leukemia, Myeloid, Acute; Male; Pericarditis; Pneumonia; Pythium

To document the first successful treatment of a patient with Hansenula anomala pneumonia.. A healthy 32-year-old white man who underwent splenectomy and aortic repair following a motor vehicle accident developed a life-threatening infection 2 days after admission into the intensive care unit (ICU). A rare fungus, H. anomala, was isolated from his lungs, blood, and urine. Lipid complex amphotericin B (ABLC) was initiated following worsening signs of infection complicated by renal failure. The patient received ABLC for 17 days, eventually making a full recovery, allowing ICU discharge 1 month after admission.. This case represents the first successful treatment of H. anomala pneumonia reported in the literature. H. anomala infections typically occur in immunocompromised, neonatal, or pediatric populations in extrapulmonary sites. All 6 cases of H. anomala pneumonia reported in the literature were fatal, and all preceded the availability of ABLC. This case of H. anomala pneumonia is unique because our adult patient survived possibly due to the availability of aggressive treatment.. ABLC may be the agent of choice for treatment of H. anomala infections, particularly in patients with acute renal failure.

Topics: Adult; Amphotericin B; Antifungal Agents; Aorta; Humans; Liposomes; Male; Pichia; Pneumonia; Postoperative Complications; Splenectomy; Sputum

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Chorioretinitis; Cryptococcosis; Cryptococcus neoformans; Drug Resistance, Multiple, Fungal; Fluconazole; Flucytosine; Humans; Itraconazole; Meningitis, Cryptococcal; Pneumonia; Prednisolone; Pyrimidines; Triazoles; Voriconazole

Cryptococcal meningitis (CM) is common in the immunocompromised (especially due to AIDS), but also occurs in immunocompetent subjects. CM can complicate cryptococcal pneumonia (CP) not only in the immunocompromised but also in the immunocompetent. We describe a healthy 26-year-old man who developed a prolonged lung infection. Diagnosis of cryptococcal pneumonia was established from bronchoscopic washings. He recovered spontaneously, so no antifungal treatment was given. 4 months later he was admitted with cryptococcal meningitis and was treated successfully with amphotericin B. An extensive immunologic study revealed no abnormalities. Since CM can complicate cryptococcal pneumonia, it is recommended that patients with CP be followed, even if recovery is apparently complete.

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcosis; Humans; Immunocompetence; Lung Diseases, Fungal; Male; Meningitis, Cryptococcal; Pneumonia; Treatment Outcome

Topics: Amphotericin B; Antifungal Agents; Coccidioidomycosis; Fluconazole; Humans; Immunocompromised Host; Itraconazole; Lung Diseases, Fungal; Pneumonia

We report a case of maternal brain death at 25 weeks gestation in which aggressive maternal hemodynamic, respiratory, and metabolic support and tocolytic drug therapy resulted in prolongation of pregnancy for 25 days. The indication for delivery was torulopsis giabrata amnionitis, which may have occurred due to transmembrane or transplacental route. The baby was treated for fungal sepsis, and did well. Premature labor may occur spontaneously after maternal brain death, and may be precipitated by infection or by maternal drug therapy. The myriad of hemodynamic and endocrine issues associated with maternal brain death complicate the choice of tocolytic drugs, but this case illustrates that uterine activity can be successfully blocked, potentially diminishing risks to the newborn, following the tragedy of maternal brain death during pregnancy.

Topics: Adult; Amphotericin B; Brain Death; Candidiasis; Cerebral Hemorrhage; Disease-Free Survival; Fatal Outcome; Female; Fungemia; Humans; Infant, Newborn; Infant, Newborn, Diseases; Male; Obstetric Labor, Premature; Pneumonia; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Pregnancy Trimester, Second; Tocolysis

Although opportunistic infections after bone marrow transplantation (BMT) are very common, only five cases of Pseudallescheria boydii infection have been reported in the literature, two of which were autopsy findings. A case of Scedosporium apiospermum infection after BMT, treated initially with amphotericin B (total dose of 2.5 g) and then with itraconazole (for 25 days), is reported here. When the patient failed to improve, Scedosporium apiospermum pneumonia was diagnosed and therapy was changed. The patient was treated successfully with miconazole (600 mg/8h for 32 days) and ketoconazole (200 mg/8h for 7 days) plus surgery.

Topics: Adult; Amphotericin B; Antifungal Agents; Bone Marrow Transplantation; Female; Humans; Itraconazole; Mycetoma; Pneumonia; Pseudallescheria

To describe the incidence of acute renal insufficiency and identify potential risk factors associated with this adverse medical event.. A cohort analytic study of patients with documented or suspected bacterial pneumonia.. Nationwide survey of 74 acute care hospitals across the US.. A total of 1822 adult patients with documented or suspected bacterial pneumonia who were receiving a cephalosporin, penicillin, or an aminoglycoside were enrolled. Patients were excluded if the duration of antimicrobial therapy was < 3 days or if the pneumonia was judged to be nonbacterial.. Clinical pharmacists completed standardized data collection forms on all patients enrolled in the study. Information regarding patient demographics, concurrent illnesses and medications, antibiotic administration, representative laboratory data, and the occurrence of any adverse clinical event was specifically captured. Information regarding the development of acute renal insufficiency was targeted as an event to be captured.. Univariate and multivariate analyses were performed to identify significant risk factors for acute renal insufficiency. A subset analysis was similarly performed to identify risk factors associated with aminoglycoside-related acute renal insufficiency.. Of the patients enrolled in this study, 8.2 percent developed acute renal insufficiency. Risk factors for acute renal insufficiency included renal disease, aminoglycoside therapy, nosocomial pneumonia, elevated estimated creatinine clearance prior to study entry, cardiac arrest/shock, congestive heart failure, total duration of antibiotics > 7 days, clindamycin therapy, liver disease, and first-generation cephalosporin usage. Risk factors for aminoglycoside-related acute renal insufficiency identified via multiple logistic regression included amphotericin B, congestive heart failure, aminoglycoside trough concentration > 1.5 mg/L, and clindamycin therapy.. The risk factors identified for acute renal insufficiency suggest that severity of illness strongly influences the development of renal insufficiency. Theoretically, the results of this study could serve as a framework for developing risk prevention programs within individual hospitals. Specific risk factors could be identified for a patient population and risk factors that could be modified could then be targeted for intervention. This type of information can also assist clinicians in predicting the probability of the adverse event for a particular patient and subsequently minimizing this risk by initiating intense monitoring or modifying the drug regimen.

Topics: Acute Kidney Injury; Aged; Aged, 80 and over; Aminoglycosides; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Cohort Studies; Female; Heart Failure; Humans; Incidence; Male; Middle Aged; Pneumonia; Population Surveillance; Risk Factors; United States

We have experienced a case with A. niger aspergilloma who developed Aspergillus pneumonia after bacterial pulmonary infection. Examinations of sputum cytology and detection of serum Aspergillus antigen were useful for an early diagnosis of his condition. Early and intensive antifungal chemotherapy mainly with intravenous amphotericin B brought about his complete remission.

Topics: Amphotericin B; Aspergillosis; Aspergillus niger; Humans; Lung Diseases, Fungal; Male; Middle Aged; Pneumonia

Topics: Adult; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Transplantation; Combined Modality Therapy; Female; Humans; Lung Diseases, Fungal; Mucormycosis; Pneumonia; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma

A case of asymptomatic intraamniotic infection with Candida albicans in a woman presenting with preterm premature rupture of membranes is reported. Active prenatal diagnostic procedures and prompt and accurate neonatal treatment (Amphotericin B) improved significantly the usually poor outcome of these pregnancies.

Topics: Adult; Amniotic Fluid; Amphotericin B; Candida albicans; Candidiasis; Chorioamnionitis; Female; Fetal Membranes, Premature Rupture; Humans; Infant, Newborn; Infant, Premature, Diseases; Ketoconazole; Male; Mediastinal Emphysema; Pneumonia; Pregnancy

to evaluate the effect of the prolonged systematic use of topical SDD (tobramycin 80 mg, polymyxin E 100 mg, amphotericin B 500 mg) on ICU ecology as expressed by changes in tracheal colonization and bacterial resistances.. Prospective microbiological survey.. Polyvalent ICU of a 2000 beds general hospital.. Data concerning bacterial strains isolated from the tracheo-bronchial aspirates of all the patients admitted to a polyvalent ICU over 3 consecutive periods of 12 months ('88, '89, '90) were prospectively entered in a database and subsequently analyzed. During a 3-year period 502 patients required artificial ventilation for more than 72 h and 332 of them ('89 and '90) were treated with SDD. All samples collected within 72 h from ICU admission were excluded as well as duplicate samples from the same patients.. All the patients admitted to the ICU in '89 and '90 and submitted to artificial ventilation for at least 24 h were routinely treated with topical SDD without i.v. antibiotic prophylaxis; in '88 SDD was not employed.. Criteria for collecting sputum samples and microbiological procedures remained unchanged throughout the study-time. Positive sputum were significantly less in '89 (80.8% versus 92.3% p < 0.001) and this was due to a very sharp decrease in the isolation of Gram-negative strains from 43-28% (-64% p < 0.0001) involving both: Enterobacteriaceae (-45%) and Pseudomonaceae (-77%). In 1990; however, a new increase in Gram negative was observed, although the overall amount of Gram-negative was still 49% lower in '90 if compared to '88 (p < 0.0001). A dramatic increase in Pseudomonas isolation was the only factor responsible for the "rebound" observed. An increasing percentage of Pseudomonas developed a resistance towards tobramycin and only 45% of Pseudomonas strains turned out to be sensible to tobramycin in '90 against 79% in '88. A similar trend was registered for all aminoglycosides with the exception of amikacin. Gram-positive colonizations tended to increase (+63%) (p < 0.0001) and this was mainly due to Coagulase negative Staphylococci (+290% p < 0.0001) and S. pneumoniae, whereas S. aureus isolations decreased (-18%) but not significantly.. Our data suggest that the prolonged use of SDD is associated with dramatic changes in ICU ecology: the incidence of Gram negative colonization is significantly diminished by SDD whereas Gram positive tend to increase. Pseudomonas developed an increasing resistance towards tobramycin one of the components of the SDD formula we used.

Topics: Administration, Oral; Administration, Topical; Amphotericin B; Bronchi; Colistin; Colony Count, Microbial; Cross Infection; Drug Resistance, Microbial; Drug Therapy, Combination; Gram-Negative Bacteria; Gram-Positive Bacteria; Humans; Incidence; Infection Control; Intensive Care Units; Intubation, Gastrointestinal; Pneumonia; Respiration, Artificial; Sputum; Tobramycin; Trachea

Inhaled amphotericin was administered to 29 patients with prolonged neutropenia and toxicity was analyzed. Treatment consisted of 30 mg of amphotericin B administered by nebulizer once daily via either a hand-held nebulizer or face mask. The mean duration of treatment was 16 days. Toxicity was minimal and patient had significant toxic reaction to the inhaled medication. This study documents that nebulized amphotericin B has less than 10% incidence of severe toxicity with 95% confidence level. Guidelines for future trials and use are suggested.

Topics: Administration, Inhalation; Adult; Amphotericin B; Humans; Middle Aged; Mycoses; Neutropenia; Opportunistic Infections; Pneumonia

Nocardia nova, a newly established species of the Nocardia asteroides complex, has recently been characterized as a human pathogen. This report of a case of pneumonia caused by Nocardia nova and Aspergillus fumigatus in a patient after cardiac transplantation is the first reported infection caused by Nocardia nova following its detailed description. Accurate identification and susceptibility testing of the Nocardia nova isolate allowed successful oral therapy with clarithromycin when therapy with sulfisoxazole was not tolerated.

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Bronchoalveolar Lavage Fluid; Clarithromycin; Drug Therapy, Combination; Heart Transplantation; Humans; Immunocompromised Host; Lung Diseases, Fungal; Male; Microbial Sensitivity Tests; Middle Aged; Nocardia; Nocardia Infections; Pneumonia; Postoperative Complications; Sulfisoxazole

Topics: Acetylmuramyl-Alanyl-Isoglutamine; Adjuvants, Immunologic; Amphotericin B; Animals; Aspergillosis; Aspergillus fumigatus; Cefmenoxime; Disease Models, Animal; Immunocompromised Host; Klebsiella Infections; Klebsiella pneumoniae; Lung Diseases, Fungal; Male; Mice; Pneumonia; Rats

The epidemiological, clinical and therapeutical findings are described in a case of recurrent pulmonary histoplasmosis due to Histoplasma capsulatum. The patient, a bulldozer-operator, worked in Africa for a long period in extremely dusty conditions without any protection. Three different episodes of H. capsulatum pneumonia recurred during eighteen months after his return from Africa. A full dose treatment by Amphotericin B failed to eliminate disease recurrence on three occasions. The high concentration of airborne H. capsulatum spores inhaled could have been the main cause of the difficulty obtaining a rapid sterilization of the microorganism by Amphotericin B and disease recurrence. The late start of the treatment or the unexplained ability of some persons to develop repeated infections even with normal immunological parameters could be another explanation for the reported phenomenon.

Topics: Adult; Amphotericin B; Dust; Histoplasmosis; Humans; Ketoconazole; Male; Occupational Diseases; Pneumonia; Recurrence

A total of 32 patients with mycoses other than cavity-formed aspergilloma were reviewed. The main pathogenic fungi were Aspergillus in 14, Candida in 8, Cryptococcus in 4, Trichosporon in 4 and Mucor in 2. Coinfection by two species was detected in 3 cases: Trichosporon and Aspergillus in 2 and Aspergillus and Candida in 1. The underlying diseases were hematologic malignancies in all cases except 1 case of lung cancer. The hematologic malignancies were mostly leukemias of various types. Cryptococcosis developed in patients given long-term corticosteroid treatment but not in leukemic patients. All cases of aspergillosis, candidiasis and mucormycosis were due to nosocomial infection. On the other hand, 3 of 4 cases of cryptococcosis or trichosporonosis were attributable to community-acquired infection. Two of 4 trichosporonosis cases were considered to have been acquired during 2-day home stays. The diagnosis of pulmonary mycosis was made pathologically in 18 and clinically in 14 cases. Of the latter, 6 cases had an air-crescent sign on chest X-ray films and 8 cases were culture-positive. Extrapulmonary involvement was seen in all 16 cases of candidiasis, cryptococcosis and trichosporonosis but not in 10 of 14 aspergillosis cases. Severe granulocytopenia was present in all cases except 4 cases of cryptococcosis and 3 cases of aspergillosis. Chest X-ray findings of aspergillosis were of two types: one was an air-crescent sign which was noted in the recovery phase from leukopenia and the other was gradually enlarging consolidation which was bound by the interlobar fissure and progressed to lobar penumonia. A diffuse granular shadow was not characteristic of any fungus species.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Cross Infection; Female; Fungi; Humans; Imidazoles; Lung Diseases, Fungal; Male; Middle Aged; Mycoses; Pneumonia; Radiography; Triazoles

Colonization of the oropharynx with potentially pathogenic microorganisms (PPM) is a highly significant factor in the pathogenesis of bacterial pneumonia in intensive care patients. Via colonization of the oropharynx, bacteria pass into the tracheobronchial tree, where they can give rise to pneumonia after overcoming pulmonary resistance mechanisms. By a new, prophylactic antibiotic treatment schedule consisting in selective decontamination of the digestive tract (SDD) with locally applied nonabsorbable antibiotics, Stoutenbeek achieved drastic lowering of the colonization and infection rate in trauma patients. In the present study, we wanted to check whether this new prophylactic antibiotic schedule can be applied on a surgical intensive care ward in all patients with long-term ventilation, irrespective of the diagnosis, and whether it affords advantages over a conventional antibiotic schedule. MATERIALS AND METHODS. All patients on a surgical intensive care ward in whom it was expected that mechanical ventilation would be necessary for more than 4 days were included in the study. During the first 6 months 83 patients were investigated, in whom antibiotics were only administered when the presence of infection had been confirmed, in accordance with generally accepted guidelines (control group). In the second 6-month period, 82 patients were selectively decontaminated with 4 x 100 mg polymyxin E, 4 x 80 mg tobramycin and 4 x 500 mg amphotericin B, administered through the gastric tube and in an antimicrobial paste in the oropharynx (SDD group). The SDD schedule entailed systemic administration of cefotaxime in the first 3-4 days. RESULTS. In the control group, enterobacteria/Pseudomonas spp. were isolated significantly more frequently than in the SDD group (P less than 0.001): in the pharyngeal smear in up to 53%, in the tracheal secretion up to 36%, and in the rectal smear in up to 93% of the patients In the SDD group in the 1 week the frequency of gram-negative aerobic bacteria in the pharynx decreased from 33% to 5%, in the tracheal secretion from 23% to 14% and in the rectum from 86% to 52% (24% in the second week). However, the decrease in gram-negative microorganisms was accompanied by significant increase in the frequency of Staphylococcus epidermidis and enterococci. The SDD schedule proved to be effective with regard to the rate of infection. In the control group, 35 patients developed pneumonia (42%) as against 5 patients receiving SDD prophylaxi

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Anti-Bacterial Agents; Bacteria; Cefotaxime; Colistin; Critical Care; Digestive System; Female; Humans; Male; Middle Aged; Oropharynx; Pneumonia; Respiration, Artificial; Time Factors; Tobramycin

115 cases of immunocompromised patients complicated with fungal pneumonia treated during the period from April 1968 to December 1986 were retrospectively studied. 96 were male and 19 female. Their age ranged from 6 to 84. The incidence increased significantly in recent years especially after 1983. Severe liver disease was the underlying disease in 102 (88.7%) patients. 108 (93.9%) had received antibiotics and 55 (47.9%) corticosteroids. Fungi species isolated were candida in 107 (54.9%), aspergillus in 82 (36.9%), penicillium in 7 (3.6%), mucormycetes in 6 (3%) and reotrichum in 3 (1.5%). Fever, cough, expectoration, moist rales diminished breath sounds and increase of W. B. C. and neutrophils were the important clinical features. The roentgenologic findings vary with the nature and extent of the pathologic process. Disseminated mycoses were found in 9 of the 18 autopsied cases. The characteristic pathologic findings were inflammation, abscess formation, vasculitis, infarction and hemorrhage. Extrapulmonary features such as enteritis, purulent nephritis, abnormal EKG, encephalopathy and rash were present. 93 cases received antifungal therapy including garlicin, clotrimazole, amphotericin B, nystatine, miconazole, 5-fluctosine and ketoconazole. Because these drug combinations were so complex, it is difficult to evaluate their efficiency. However the survival rate was somewhat elevated in recent years. The mortality rate of this series was 80.9%.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Aspergillosis; Candidiasis; Child; Female; Humans; Lung Diseases, Fungal; Male; Middle Aged; Pneumonia; Retrospective Studies

A 21-year-old man with acute myeloid leukaemia developed cavitating pneumonia while neutropenic and on broad spectrum antibiotics following induction chemotherapy. Trichosporon beigelii was isolated from several samples of sputum. He was successfully treated with amphotericin B. Previous reports of lung infection with this organism are reviewed.

Topics: Adult; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Humans; Leukemia, Myeloid; Lung Diseases, Fungal; Male; Mitosporic Fungi; Neutropenia; Pneumonia; Sputum; Trichosporon

Twenty-two preterm infants with systemic candidiasis are reported, of which seven cases were presumed to be antenatally acquired and 15 postnatally acquired. All except one were of very low birthweight. Fifteen infants had positive cultures of blood, cerebrospinal fluid or urine and seven had candida pneumonia only. Clinical features included general instability, respiratory deterioration and a necrotizing enterocolitis-like presentation. The incidence of leukocytosis, shift to the left, eosinophilia and thrombocytopenia were not different from those with bacterial infection. The diagnosis was made after death in two infants. In the remaining 20 infants, treatment was initiated between 5 and 97 days of age, with a median delay of 4 days after the first positive cultures were taken. Complications of amphotericin and 5-flucytosine therapy which developed in five infants resolved on cessation of treatment. The mortality rate was 18% and impairment rate among the 17 very low birthweight survivors was 18%. A high index of suspicion is required for systemic candidiasis, especially in infants of less than 1000 g birthweight. If recognized early, effective and safe antifungal therapy is possible with favourable short- and long-term outcome.

Topics: Amphotericin B; Candidiasis; Developmental Disabilities; Drug Administration Schedule; Drug Therapy, Combination; Female; Flucytosine; Humans; Infant, Low Birth Weight; Infant, Newborn; Infant, Premature, Diseases; Pneumonia; Pregnancy; Pregnancy Complications, Infectious

Topics: Aged; Amphotericin B; Female; Humans; Lung Diseases, Fungal; Mitosporic Fungi; Pneumonia; Thrombocythemia, Essential

To generate hypotheses about how physicians make difficult clinical decisions, we analyzed transcripts of the "thinking aloud" behavior of expert clinicians making a testing or treatment decision with an uncertain diagnosis. We compared the clinicians' reasoning with a decision analysis of the same problem. The experts did not formulate a global outline of their decision, but chained together a sequence of decisions based on available and incomplete information. Despite effective and efficient problem solving, the clinicians used numeric terms only as symbolic representations of likelihood, used limited information in choosing among alternatives, and dismissed the possibility that a less conventional strategy, empiric therapy, might yield equivalent outcome. We describe cognitive problem-solving strategies and knowledge representations that permit persons to make successful decisions despite limited processing resources. The same cognitive procedures probably contribute to observed errors in decision-making under uncertainty.

Topics: Amphotericin B; Biopsy; Cognition; Decision Support Techniques; Decision Trees; Diagnosis; Humans; Immune Tolerance; Male; Medicine; Middle Aged; Pneumonia; Probability; Research Design; Risk; Risk Assessment; Specialization; Therapeutics; Uncertainty

Topics: Amphotericin B; Aspergillosis; Humans; Immunologic Deficiency Syndromes; Lung Diseases, Fungal; Pneumonia

The incidence of respiratory tract infections was determined in 59 multiple trauma patients requiring prolonged intensive care (greater than 5 days) and receiving no antibiotic prophylaxis. Early pneumonia (less than 48 hr) with S. aureus, S. pneumoniae, and/or H. influenzae was found in 44% of patients. Secondary colonization of the oropharynx and respiratory tract with ICU-associated Gram-negative bacilli followed by pneumonia occurred in 12 patients (20%). The overall incidence of respiratory tract infections was 59%. In a prospective open trial three prophylactic antibiotic regimens were compared: 17 patients were treated with intestinal decontamination using nonabsorbable antibiotics (polymyxin E 400 mg, tobramycin 320 mg, amphotericin B 2,000 mg/day). No difference in infection rate was found. Twenty-five patients were treated with intestinal and oropharyngeal decontamination using an ointment containing 2% of the same antibiotics. Secondary colonization and infection of the respiratory tract with Gram-negative bacilli was significantly reduced (p less than 0.001). The incidence of early (Gram-positive) infections, however, was unchanged. Another group of 63 patients was treated with systemic antibiotic prophylaxis during the first days in combination with oropharyngeal and intestinal decontamination. The incidence of early pneumonia was significantly reduced (p less than 0.001). Five patients (8%) developed an infection. Superinfections were not observed.

Topics: Administration, Topical; Adolescent; Adult; Amphotericin B; Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cross Infection; Decontamination; Female; Humans; Intestines; Male; Middle Aged; Oropharynx; Pneumonia; Pneumonia, Staphylococcal; Polymyxins; Prospective Studies; Respiratory System; Respiratory Tract Infections; Retrospective Studies; Tobramycin; Wounds and Injuries

The empirical use of amphotericin B in febrile leukemic patients not responding to antimicrobial agents has previously led to a significant decrease in fatal fungal infections and a significant increase in complete remissions. In this series of 66 patients receiving induction therapy for acute myelogenous leukemia (AML), 49 (74%) received amphotericin B. The median interval between institution of antibiotics and amphotericin B was ten days. Fifteen patients had clinical evidence of fungal infection, but only two (3%) died of fungal infection during induction therapy for AML. We discontinued amphotericin B upon granulocyte recovery (greater than 500/cu mm) unless a pulmonary infiltrate was present. Even though only five of 15 patients with probable fungal infection received more than 1,000 mg of amphotericin B, no patient had recurrent fungal disease while in remission. The incidence of clinically suspected fungal pneumonia during consolidation therapy and reinduction therapy also suggested that our therapy was adequate. An increased incidence of late fungal pneumonia in patients receiving reinduction was associated with prolonged neutropenia (greater than 50 days). This study supports the empirical use of amphotericin B during induction therapy for AML, and suggests that doses can be smaller than those generally recommended for fungal infection.

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Cytarabine; Drug Administration Schedule; Drug Evaluation; Drug Therapy, Combination; Female; Humans; Infusions, Parenteral; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Middle Aged; Neutropenia; Pneumonia; Retrospective Studies; Time Factors

We present the findings in a patient having sickle cell disease who developed multilobar pneumonia. Cultures of bronchial aspirates and histologic specimens grew Cryptococcus neoformans. There was neither spontaneous clearing of the infection nor a response to bactericidal antibiotics. The patient had no underlying malignant neoplasm or immunodeficiency as indicated by history, physical examination, and specialized tests of humoral and cell-mediated immunity.

Topics: Adult; Amphotericin B; Anemia, Sickle Cell; Anti-Bacterial Agents; Cryptococcosis; Humans; Male; Pneumonia; Radiography

Aspergilluspneumonia means a form of pulmonary aspergillus infection invading tissue and accidentally vessels of the lung. Because of lacking of typical clinical and roentgenological signs diagnose finding is realized by evidence of fungi (histology, culture, serology). From 87 aspergilloses 60 could staged as aspergillomas by the x-ray pictures. 27 cases were bronchiectases, carcinomas, bacterial pneumonias with aspergillus or pneumonias without other lung disorders and agents other than aspergillus. The difficulty to ensure the "pure" aspergilluspneumonia (invasive type) is pointed out, when histological proof is lacking. The therapeutical possibilities are discussed.

Topics: Aged; Amphotericin B; Aspergillosis; Diagnosis, Differential; Drug Therapy, Combination; Humans; Male; Pneumonia

Topics: Amphotericin B; Anti-Bacterial Agents; Antiviral Agents; Bacterial Infections; Drug Therapy, Combination; Humans; Infant, Newborn; Pneumonia; Pneumonia, Pneumococcal; Pneumonia, Staphylococcal; Pneumonia, Viral

Disseminated candidiasis is likely to become an increasing problem in cancer patients. It has occurred in patients undergoing intensive chemotherapy, thermotherapy, and bone marrow transplant. The availability of broad-spectrum cephalosporins with biliary excretion is likely to increase the problem. Although localized candidiasis responds to both topical and parenteral therapy, systemic candidiasis is often fatal, especially in neutropenic patients. A major obstacle to control of this infection is inadequate diagnostic techniques. It is to be hoped that continuing research will yield more effective diagnostic and therapeutic measures.

Topics: Amphotericin B; Antibodies, Fungal; Candidiasis; Cephalosporins; Humans; Ketoconazole; Leukemia; Miconazole; Neoplasms; Pneumonia

Disseminated histoplasmosis developed in a previously healthy man as the initial manifestation of the acquired immune deficiency syndrome. Following apparently successful therapy with intravenous amphotericin B, he presented two months later with a subacute pneumonitis syndrome diagnosed by bronchoscopy as Pneumocystis carinii pneumonia. He showed response to intravenous trimethoprim/sulfamethoxazole with resolution of his symptoms and clearing of chest radiographic findings. While he was receiving antibiotics, oral candidiasis developed and has persisted for more than two months despite topical therapy and discontinuation of all antibiotics.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Candidiasis, Oral; Histoplasmosis; Humans; Lymphocytes; Male; Pneumonia; Pneumonia, Pneumocystis; Pseudomonas Infections

Hepatotoxicity is regarded as a rare side effect of amphotericin B therapy. A patient with acute myelogenous leukemia who had normal liver function was treated with amphotericin B for fungal pneumonia. While he was receiving the drug at high dosages asymptomatic elevation of the levels of alkaline phosphatase, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, lactic dehydrogenase and bilirubin was noted. The levels returned to normal when the drug was discontinued. Rechallenge with a lower dosage prompted a rapid rise in the levels, with subsequent return to normal when the medication was withdrawn.

Topics: Amphotericin B; Chemical and Drug Induced Liver Injury; Cytarabine; Humans; Leukemia, Myeloid, Acute; Liver; Male; Middle Aged; Mycoses; Pneumonia; Thioguanine

Topics: Adult; Amphotericin B; Combined Modality Therapy; Humans; Leukemia, Lymphoid; Male; Mucormycosis; Pneumonectomy; Pneumonia

Topics: Amphotericin B; Coccidioidomycosis; Humans; Pneumonia; Skin Tests

In the 25 years since its introduction, amphotericin B has demonstrated clear value in the management of coccidioidomycosis. However, its effectiveness is less certain than in diseases due to other fungal aetiological agents, even when the loci of infection and in vitro drug susceptibilities are identical. The refractoriness of coccidioidomycosis may relate to the unique ability of each Coccidioides immitis spherule to release hundreds of endospores, thus maximally challenging host defence mechanisms. Amphotericin B is most likely to be effective where there is evidence of intact cell-mediated immunity against C. immitis (i.e. positive coccidioidin or spherulin skin test; low titre of complement fixing antibody), and structural damage to tissues. When bones and joints are involved, as is frequently the case, adjunctive surgical management is generally required. Patients with structural lung disease (i.e. cysts and/or cavities) show variable, often minimal, response to treatment. Amphotericin B has transformed coccidioidal meningitis from a routinely fatal disease to one where prolonged survival is possible. However, the drug must be given by the intrathecal route, and for periods of years, before the possibility of cure can be considered. Relapses of bone, joint and meningeal coccidioidomycosis are common and should be anticipated, especially in patients with impaired immunity.

Topics: Amphotericin B; Chronic Disease; Coccidioidomycosis; Dose-Response Relationship, Drug; Humans; Liver; Pneumonia; Tissue Distribution

An immunocompromised patient with severe hypoxemia was found by transbronchial lung biopsy to have Torulopsis glabrata as the sole pathogen in lung. An antibody response to this organism was demonstrated, confirming its role as a pathogen and indicating a role for serodiagnosis of T glabrata infection.

Topics: Adult; Amphotericin B; Candida; Drug Therapy, Combination; Histoplasmosis; Humans; Immunosuppression Therapy; Kidney Failure, Chronic; Lung Diseases, Fungal; Male; Pneumonia; Rifampin

Topics: Amphotericin B; Coccidioidomycosis; Humans; Lung; Lung Diseases, Fungal; Miconazole; Nausea; Pneumonia; Radiography; Solitary Pulmonary Nodule

The incidence of aspergillosis is increasing while the prognosis remains dismal. Standard single-drug therapy with amphotericin B offers unacceptably low cure rates. A patient with Aspergillus pneumonia was treated with a synergistic combination of amphotericin B and flucytosine. A prompt clinical response and progressive resolution of the infection were observed. Combination therapy appeared to decrease the dose of amphotericin B needed for effective therapy. It may provide improved results with decreased toxic effects.

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Cytosine; Drug Synergism; Drug Therapy, Combination; Flucytosine; Humans; Lung Diseases, Fungal; Male; Middle Aged; Pneumonia; Sputum

Chronic progressive coccidioidal pneumonitis (CPCP) is an uncommon sequela of acute pulmonary coccidiodomycosis. Six recent patients with CPCP are described, most of whom were previously healthy. The clinical presentation was indolent, resulting in long diagnostic delays. Serial chest roentgenograms showed progressive pulmonary infiltration and sputum cultures were persistently positive for Coccidioides immitis. Serum complement fixation (CF) antibody titers were high, with five of six patients having titers greater than or equal to 1:16. No patients had evidence of extrapulmonary coccidioidal spread at time of diagnosis of CPCP, although hematogenous dissemination occurred later in one patient. Five patients received amphotericin B intravenously (greater than or equal to 30 mg/kg total), resulting in rapid clinical and mycologic cure, decline in CF titers, and roentgenographic improvement or stabilization. However, two of these five patients suffered permanent physiologic impairment. One patient refused therapy and remains clinically symptomatic, with chronic positivity of sputum cultures for C immitis and high CF titers.

Topics: Adult; Amphotericin B; Chronic Disease; Coccidioidomycosis; Female; Humans; Male; Middle Aged; Pneumonia

Infection with Histoplasma capsulatum in 58 patients whose immune responses were suppressed (Immunosuppressed patients) (16 from the present series and 42 described previously) was analyzed. The most common underlying diseases were Hodgkin's disease (29 per cent), chronic lymphocytic leukemia (19 per cent) and acute lymphocytic leukemia (17 per cent). Sixty-three per cent of the patients had received cytotoxic drugs, and 57 per cent had taken corticosteroids. Widely disseminated infection occurred in 88 per cent of the patients, with predominant involvement of lungs and organs of the reticuloendothelial system. Localized pulmonary infection was present in the remaining patients. The most useful diagnostic method was bone marrow biopsy with microscopic examination for the intracellular yeast form of H. capsulatum. Biopsy of oral lesions, lung, liver and lymph node also proved diagnostically helpful. Growth of H. capsulatum in culture was frequently too slow to be beneficial in diagnosing histoplasmosis in ill patients. Serologic methods were of little diagnostic help in this population of immunosuppressed patients. The response to amphotericin B therapy was excellent (6.7 per cent mortality rate) in those patients in whom the diagnosis was established early and in whom a full course of antifungal therapy could be given. In contrast, the mortality rate in patients who received no antifungal therapy or less than 1 g of amphotericin B was 100 per cent.

Topics: Adult; Aged; Amphotericin B; Diagnosis, Differential; Female; Histoplasmosis; Hodgkin Disease; Humans; Immunosuppression Therapy; Kidney Transplantation; Leukemia, Lymphoid; Lupus Erythematosus, Systemic; Male; Middle Aged; Pneumonia; Sarcoidosis; Transplantation, Homologous

Infection continues to be a major source of morbidity and the major source of mortality in renal transplant recipients who are susceptible to opportunistic infections. We recently reviewed all renal transplant recipients who had fungi cultured during a three year period. C. albicans and T. glabrata were cultured most frequently. Deep fungal infections occurred in many patients and were frequently observed late in the course of bacterial and viral infections. Ten patients had fungemia, and primary fungal pneumonia occurred in eight patients. Three patients had fungal infection of the central nervous system. Three of eight patients with fungal pneumonia and eight of ten patients with fungemia died as a result of their fungus infections. These patients frequently had poor renal function and were receiving high steroid doses or had recently been treated for kidney rejection. One patient with fungal pneumonia and six patients with fungemia had the fungus cultured from a superficial site. Several patients developed fungal infections late in the course of viral or bacterial infections. Amphotericin-B and 5-fluorocytosine remain the mainstays of antifungal therapy.

Topics: Adolescent; Adult; Amphotericin B; Central Nervous System Diseases; Female; Humans; Kidney Transplantation; Lung Diseases, Fungal; Male; Middle Aged; Mycoses; Peritoneal Diseases; Pneumonia; Postoperative Complications; Surgical Wound Infection; Transplantation, Homologous

Topics: Aged; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Humans; Lung Diseases, Fungal; Male; Middle Aged; Pneumonia

Pulmonary aspergillosis in patients with leukemia or lymphoma is usually a fatal infection. However, difficulty in obtaining a premortem diagnosis has often prevented an adequate trial of anti-fungal chemotherapy. In this report, nine cases of aspergillus pneumonia in patients with hematologic malignancy were diagnosed during a one-year period. Five of nine patients had a premortem diagnosis (56%) and eight of nine (89%) received a premortem trial of amphotericin B. Two of nine patients survived infection, including one patient with prolonged neutropenia. Better diagnostic methods and wider use of antifungal chemotherapy may improve prognosis for aspergillus infection in patients with hematologic malignancy.

Topics: Amphotericin B; Aspergillosis; Humans; Immunosuppression Therapy; Leukemia; Lymphoma; Pneumonia

Topics: Amphotericin B; Cryptococcosis; Humans; Male; Middle Aged; Pneumonia

Topics: Adult; Aged; Amphotericin B; Aspergillosis; Female; Humans; Lung Diseases, Fungal; Lymphoma; Male; Pneumonia

Reports in the literature of patients surviving mucormycosis involving the craniofacial structures are exceedingly rare. The necessity for early diagnosis by recognition of any of the six key signs and symptoms is emphasized. The futility of standard diagnostic tools, other than biopsy, is noted. An underlying debilitating condition such as diabetic ketoacidosis can predispose the patient to an acute infection by this usually nonpathogenic organism. The requirement for prompt treatment of the debilitating condition together with treatment to eradicate the fungus is stressed.

Topics: Abscess; Adult; Amphotericin B; Cavernous Sinus; Cranial Nerves; Dental Caries; Diabetes Complications; Diabetic Coma; Diabetic Neuropathies; Diagnosis, Differential; Face; Humans; Insulin; Lung Diseases; Male; Mucormycosis; Ophthalmoplegia; Pneumonia; Sinus Thrombosis, Intracranial; Skull; Tooth Diseases; Urinary Tract Infections

Topics: Adult; Age Factors; Amphotericin B; Anti-Bacterial Agents; Candidiasis, Cutaneous; Child; Child, Preschool; Chronic Disease; Dermatomycoses; Female; Foot Dermatoses; Furunculosis; Hand Dermatoses; Herpes Zoster; Humans; Immunity, Cellular; Immunity, Maternally-Acquired; Immunotherapy; Infant; Male; Pneumonia; Pyelonephritis; Remission, Spontaneous; Skin Tests; Staphylococcal Infections

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Blood Bactericidal Activity; Blood Transfusion; Child; Digoxin; Gentamicins; Humans; Leukocytes; Male; Phagocyte Bactericidal Dysfunction; Pneumonia

Topics: Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Aspergillus; Aspergillus fumigatus; Female; Glucocorticoids; Humans; Lung Diseases, Fungal; Male; Middle Aged; Pneumonia

Topics: Adolescent; Adult; Aged; Amphotericin B; Candida albicans; Candidiasis; Child; Child, Preschool; Endocarditis; Esophagitis; Female; Humans; Laryngitis; Male; Meningitis; Middle Aged; Pneumonia; Stomatitis; Vaginitis

Topics: Adolescent; Amphotericin B; Ampicillin; Cholesterol; Diabetes Complications; Female; Histocytochemistry; Humans; Lung; Pneumonia

Topics: Adult; Aged; Amphotericin B; Blastomyces; Blastomycosis; Bone and Bones; Bone Diseases; Breast; Breast Diseases; Female; Granuloma; Histoplasmosis; Humans; Lung; Lung Diseases, Fungal; Lymph Nodes; Male; Middle Aged; Pneumonia; Skin; Skin Diseases; Smoking; Tuberculosis, Pulmonary

Topics: Abscess; Amphotericin B; Brain Abscess; Candidiasis; Carrier State; Child; Chloramphenicol; Colistin; Deoxyribonucleases; DNA; Empyema; Enteritis; Humans; Kanamycin; Meningitis; Methicillin; Penicillins; Peritonitis; Phlebitis; Pneumonia; Pneumothorax; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Sulfadiazine; Troleandomycin

Topics: Amphotericin B; Candidiasis; Geriatrics; Humans; Lung Diseases, Fungal; Nystatin; Organic Chemicals; Pneumonia; Radiography, Thoracic; Tetracycline

Topics: Adult; Amphotericin B; Candida; Candidiasis; Humans; Lung Diseases, Fungal; Pneumonia

Topics: Amphotericin B; Biopsy; Candidiasis; Chlorambucil; Diagnosis, Differential; Hodgkin Disease; Humans; Lung Diseases; Lung Diseases, Fungal; Pneumonia; Pneumonia, Pneumococcal; Prednisone; Radiography, Thoracic; Vancomycin

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Lung Diseases; Pneumonia

Topics: Amphotericin B; Animals; Pneumonia; Sheep; Sheep Diseases; Sheep, Domestic; Viruses