amphotericin-b and Pulmonary-Fibrosis

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

The authors report 30 cases of the percutaneous treatment of symptomatic pulmonary aspergilloma by injection of amphotericine paste in patients who were not considered to be operable. The treated aspergillomas had developed as a sequel to bacilliary infection and pulmonary fibrosis. Surgery was contraindicated in these patients on account of severe respiratory failure. The authors specify the technique for the preparation of the paste and for the type of percutaneous injection, the aim being to obtain complete filling of the cavity and creating an anaerobic environment for the aspergillus. The contribution of this technique for the non-surgical treatment of patients appears interesting but should be carried on a larger series to identify the exact indications and the interaction with other new treatments which have just appeared.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Bronchial Arteries; Contraindications; Embolization, Therapeutic; Female; Hemoptysis; Humans; Injections; Lung Diseases, Fungal; Male; Middle Aged; Ointments; Palliative Care; Pneumonectomy; Pulmonary Fibrosis; Radiography, Interventional; Respiratory Insufficiency; Tomography, X-Ray Computed; Tuberculosis, Pulmonary

We present here three AIDS patients with disseminated cryptococcal infection and lung involvement. Two patients presented with respiratory symptoms and in the third one, pulmonary disease was only a radiologic finding. Chest X-ray films showed an interstitial pattern in two cases and pulmonary cavitation in one case. One patient has also simultaneous infection by P. carinii. Diagnosis was established by culture from bronchoalveolar lavage in all cases and also by non-induced sputum exam in two cases. All patients were treated with amphotericin B, with good clinical outcome, and without relapses under maintenance therapy with fluconazole. Cryptococcosis must be included in differential diagnosis of AIDS patients with diffuse interstitial lung infiltrates. The presence of C. neoformans in respiratory samples does not rule out the existence of other opportunistic infections, and therefore bronchoalveolar lavage is advisable.

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Cryptococcosis; Diagnosis, Differential; Fluconazole; Humans; Incidence; Lung Diseases, Fungal; Male; Pulmonary Fibrosis; Trimethoprim, Sulfamethoxazole Drug Combination

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

Cyclosporin-A (CsA) was given to 22 patients who received allogeneic bone marrow transplants as therapy for aplastic anemia and hematologic malignancies. The drug was given daily for 180 days starting with the day of marrow infusion. Engraftment was not impaired and myelotoxicity was not observed. Cutaneous graft-versus-host disease (GVHD) developed in five patients and all either spontaneously resolved or promptly responded to therapy with steroids. Five patients developed systemic GVHD and all responded to therapy with steroids, but only two survived. Interstitial pneumonia was seen in six patients and was fatal in all of them. Liver function abnormalities were seen in 14 patients but could not positively be correlated with CsA administration. Renal function abnormalities were seen in 17 patients. Amphotericin-B therapy contributed significantly to the renal failure. Serum levels of CsA, measured by radioimmunoassay, could not be correlated with the presence of liver or renal function abnormalities. Overall survival so far has been 50.0%. Second malignancies were not observed, but one patient relapsed with leukemia at 343 days.

Topics: Adolescent; Adult; Amphotericin B; Bone Marrow Transplantation; Chemical and Drug Induced Liver Injury; Child; Cyclophosphamide; Cyclosporins; Female; Graft Survival; Graft vs Host Reaction; Humans; Kidney; Kidney Failure, Chronic; Liver; Male; Pulmonary Fibrosis

Topics: Aged; Amphotericin B; Bronchi; Female; Fever of Unknown Origin; Histoplasma; Histoplasmosis; Humans; Lung; Pulmonary Fibrosis; Radiography