amphotericin-b and Pneumothorax

Paracoccidioidomycosis (PCM) is the most important systemic mycosis in Latin America. About 80% of PCM patients are present with its chronic form. The lungs are affected in most patients with the chronic form; however, pleural involvement has rarely been reported. We describe nine cases of PCM that presented with lung involvement and spontaneous pneumothorax. All patients, except one whose condition was not investigated, were smokers. PCM was diagnosed during the pneumothorax episode in three patients, and from 3 to 16 years before the pneumothorax episode in six patients. A total of six patients underwent chest drainage and one died as a direct result of the pneumothorax. We suggest that pneumothorax, although rare, should be considered in PCM patients who present with suddenly worsening dyspnoea. PCM should also be investigated in cases of pneumothorax in adult men from mycosis-endemic areas.

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; Brazil; Drainage; Endemic Diseases; Fatal Outcome; Humans; Lung; Male; Middle Aged; Paracoccidioides; Paracoccidioidomycosis; Pneumothorax; Smoking; Trimethoprim, Sulfamethoxazole Drug Combination

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

This case report describes a 50-year-old woman with rheumatoid arthritis (RA) in whom nodular opacities were found on chest X-ray. She developed a bilateral spontaneous pneumothorax treated with surgical pleurodesis. Cultures remained negative. Histological examination of specimens confirmed the clinical diagnosis of rheumatoid granulomata. Therefore, corticosteroid therapy was started, after which the nodules decreased slightly in size and inflammatory parameters normalized. Three months later, she presented with respiratory insufficiency based on pulmonary fungus infection. Differential diagnosis between rheumatoid nodules and granulomas caused by Aspergillus is difficult in RA patients with pulmonary nodular lesions; in this case, both complications appeared subsequently.

Topics: Amphotericin B; Antifungal Agents; Antirheumatic Agents; Aspergillosis; Aspergillus fumigatus; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Immunocompromised Host; Lung Diseases, Fungal; Middle Aged; Pneumothorax; Radiography, Thoracic; Rheumatoid Nodule

The emergence of new antifungal compounds with alternative mechanisms of action and improved tolerability has opened up new therapeutic possibilities for the use of combined antifungal treatment in life-threatening systemic fungal infections. A case report of an 8-year-old allogeneic stem cell transplant recipient who developed a central venous catheter tunnel infection caused by Aspergillus flavus is presented here. In spite of conventional and subsequent liposomal amphotericin B therapy the infection progressed rapidly and the necrosis extended further to the thoracic wall, pleura and the right lung. Combined treatment consisting of liposomal amphotericin B and caspofungin was instituted. After 30 days of dual therapy the deep fungal infection resolved and the extensive soft tissue defect showed scarring. One year post-transplant, the patient is well, with normal bone marrow function and full donor chimerism. Although there is limited clinical data on the effectiveness of echinocandins in pediatric patients with documented invasive fungal infections, this case report shows that combining liposomal amphotericin B with caspofungin could be advantageous.

Topics: Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Aspergillus flavus; Bone Marrow Transplantation; Caspofungin; Catheterization, Central Venous; Child; Cicatrix; Disease Progression; Drug Synergism; Drug Therapy, Combination; Echinocandins; Equipment Contamination; Female; Hepatitis; Humans; Immunocompromised Host; Leukocyte Transfusion; Lipopeptides; Liposomes; Necrosis; Peptides, Cyclic; Pneumothorax; Postoperative Complications; Remission Induction; Salvage Therapy; Torque teno virus; Transplantation, Homologous

Topics: Amphotericin B; Antifungal Agents; Aspergillosis, Allergic Bronchopulmonary; Aspergillus niger; Fatal Outcome; Humans; Injections, Intralesional; Male; Middle Aged; Pneumothorax; Tomography, X-Ray Computed

In invasive aspergillosis, the duration of neutropenia is an accepted risk factor, and recovery from neutropenia is generally associated with a favourable outcome. However, the rapidity of granulocyte recovery may rarely be associated with adverse sequelae. The purpose of this study was to define the relationship between neutrophil (polymorphonuclear, PMN) recovery after chemotherapy-induced bone marrow aplasia and the occurrence of severe pulmonary complications (haemoptysis, pneumothorax and death) in patients with haematological malignancies who developed invasive fungal pneumonias.. Twenty consecutive patients were retrospectively studied; eight of them had developed pulmonary events between 5 and 11 days after neutrophil recovery that followed deep neutropenia (PMN < 100 microL-1).. Five patients had haemoptysis (one of these also had pneumothorax) and three had pneumothorax. According to the multiplicative logistic model, the odds of occurrence of a pulmonary event increased significantly with increasing PMN count on the fifth day (P < 0.001). Five of the eight patients who had pulmonary complications died. Also, the risk of death was larger in the presence of rapid neutrophil recovery, although the difference was not statistically significant (P = 0.111). Analysis of clinical and laboratory data showed that the risk of pulmonary complications significantly increased when the neutrophil concentration was > 4500 microL-1 on day 5 after deep granulocyte neutropenia (PMN < 100 microL-1). There was no correlation between pulmonary complications, dosage of amphotericin B and deaths.. The occurrence of life-threatening complications in patients with invasive fungal pneumonia is closely related to rapid PMN recovery.

Topics: Adolescent; Adult; Aged; Amphotericin B; Aspergillosis; Female; Granulocytes; Hemoptysis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Neutropenia; Neutrophils; Pneumothorax; Retrospective Studies; Risk Factors; Time Factors; Treatment Outcome

A case of Kartagener's syndrome associated with multiple pulmonary complication was presented. A 19-year-old man was admitted to our hospital because of pulmonary tuberculosis in May 1972. He had been diagnosed as Kartagener's syndrome because of the presence of chronic parasinusitis, bronchiectasis and complete situs inversus. His chest radiographs in Dec 1972 revealed left pneumothorax. Chest radiographs in Aug 1975 appeared aspergilloma in the right middle lung field. He was administrated intravenous and oral anti-fungal agent and transbronchial installation of Amphotericin-B because of hemoptysis. Chest radiographs in July 1980 resolved the aspergilloma and his symptom were also resolved. In 1996, he had no pulmonary symptoms and respiratory failure. We consider that the Kartagener's syndrome was good prognosis with adequate pulmonary therapy.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Antitubercular Agents; Aspergillosis; Humans; Kartagener Syndrome; Lung Diseases, Fungal; Male; Pneumothorax; Tuberculosis, Pulmonary

We report a case of primary pulmonary cryptococcosis. A 20-year-old woman was admitted to the hospital complaining of coughing, fever, and dyspnea on exertion. She had no underling disease or immunological abnormality. Chest X-ray film revealed bilateral diffuse infiltrative shadows, which were first believed to have been caused by a community-acquired pneumonia. Pulmonary cryptococcosis was diagnosed from the results of a transbronchial lung biopsy. After 2.5 years of anti-mycotic chemotherapy with amphotericin B and flucytosine, pneumothorax occurred in the left lung. Thoracotomy and open lung biopsy were done. Histological findings of the open lung biopsy specimens showed numerous broken cryptococcal organisms within alveolar macrophages. Diffuse fibrosis accompanied by multiple bullae may have punctured bullae or blebs and thus led to pneumothorax.

Topics: Adult; Amphotericin B; Cryptococcosis; Female; Flucytosine; Humans; Lung Diseases, Fungal; Pneumothorax

Topics: Adult; Amphotericin B; Coccidioidomycosis; Fear; Humans; Lung Abscess; Lung Diseases, Fungal; Male; Patient Care Planning; Pneumothorax; Sick Role

Topics: Administration, Oral; Adolescent; Amphotericin B; Anorexia; Blood Platelets; Blood Transfusion; Candidiasis; Drug Eruptions; Humans; Infusions, Parenteral; Injections, Intramuscular; Leucovorin; Methotrexate; Nausea; Osteosarcoma; Pneumothorax; Stomatitis; Vomiting

Topics: Amphotericin B; Candida; Candidiasis; Humans; Leukemia, Myeloid, Acute; Lung Abscess; Lung Diseases, Fungal; Male; Middle Aged; Pneumothorax

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