amphotericin-b and Precursor-T-Cell-Lymphoblastic-Leukemia-Lymphoma

Children with hematologic malignancies are at an increased risk of invasive fungal infections and a greater risk has been seen with exposure to building construction. Prophylaxis with high-dose (IV) liposomal amphotericin B (L-AmB) 10 mg/kg once weekly was initiated in our high risk children based on previous pharmacokinetic studies. This treatment regimen was associated with a 26% incidence of adverse infusion reactions.

Topics: Adolescent; Amphotericin B; Antibiotic Prophylaxis; Antifungal Agents; Child; Child, Preschool; Female; Humans; Leukemia, Lymphoid; Male; Mycoses; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma

Curvularia is a saprophytic dematiaceous mold and a rare human pathogen. Here, we report three severely immunocompromised pediatric patients who developed invasive Curvularia infection. Diagnosis was achieved or confirmed in all cases by fungal ribosome sequencing, which hastened species identification and targeted treatment for the patients reported. There are no treatment guidelines for invasive Curvularia infection, though we report three patients who were cured of their infection through a combination of surgical resection and various anti-fungal therapies, indicating a relatively low virulence and good prognosis in comparison to other angioinvasive molds.

Topics: Amphotericin B; Antifungal Agents; Ascomycota; Child; Dermatomycoses; Female; Humans; Immunocompromised Host; Male; Opportunistic Infections; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; RNA, Ribosomal, 28S; Sequence Analysis, DNA; Voriconazole

Topics: Adolescent; Amphotericin B; Antifungal Agents; Female; Fungi; Humans; Liposomes; Mucormycosis; Neutropenia; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Remission Induction; Stem Cell Transplantation; Tomography, X-Ray Computed; Triazoles

Invasive fungal infections in immunocompromised children suffering from hematological malignancies have been a major cause of morbidity and mortality. In recent years fungi other than aspergillus and candida are gaining importance. These emerging fungal infections have distinct epidemiological features and management issues especially in immunocompromised patients. Here we report the isolation of Conidiobolus coronatus, a rarely reported zygomycetes infection in a patient suffering from acute lymphoblastic leukemia. Conidiobolus generally causes indolent infection in the sino-respiratory tract. They are known to be angioinvasive and can disseminate. There is no consensus regarding appropriate antifungal treatment for Conidiobolus infection.

Topics: Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Asparaginase; Child; Combined Modality Therapy; Conidiobolus; Debridement; Dexamethasone; Fatal Outcome; Female; Humans; Immunocompromised Host; Maxillary Sinusitis; Methotrexate; Orbital Cellulitis; Pancytopenia; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Vincristine; Zygomycosis

To present a clinical report of palatal zygomycosis, its epidemiological, mycological features, and our treatment experience.. Retrospective report.. This is a 25-year long retrospective trial of clinically and mycologically proven cases of zygomycosis. Some patients underwent a biopsy of the palatal lesion and autopsy. This study reports the treatment experience with amphotericin B alone and in combination with itraconazole and fluconazole.. Twenty-one cases (18.75%) of zygomycosis with palatal involvement were included in the study, from a total of 112 cases screened. Mean age was 36.5 years, with 18 adults and three children. The associated pre-disposing factors were: ketoacidotic diabetes (five type-1 and 15 type-2), and acute leukaemia in one patient. The clinical varieties were as follows: 19 cases of rhinocerebral (RC) involvement and two disseminated cases. Palatal ulcers occurred in 3/21 early cases (14.3%) and in 16/21 cases after the nasal involvement. All patients received amphotericin B; in four patients, it was combined with itraconazole and four with fluconazole. Clinical and mycological cure was achieved in 4/21 patients (19.04%).. Zygomycosis with palatal involvement occurs in around 18% of cases, usually associated with RC modalities; it has an acute and generally lethal course.

Topics: Absidia; Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Brain Diseases; Child; Diabetic Ketoacidosis; Drug Combinations; Female; Fluconazole; Humans; Itraconazole; Male; Mouth Diseases; Mucormycosis; Nose Diseases; Opportunistic Infections; Oral Ulcer; Palate; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma; Retrospective Studies; Rhizopus; Treatment Outcome; Zygomycosis