amphotericin-b and Pythiosis

BACKGROUND Pythium insidiosum keratitis is a rare but sight-threatening disease with a high morbidity rate. It can be misdiagnosed as fungal keratitis in clinic settings. We report a case of severe Pythium insidiosum keratitis in a Chinese child, treated with combined approaches. CASE REPORT A 7-year-old boy from Hainan province in the south of China developed a suppurative corneal ulcer after being in a forest. A mass of hyphae was detected by confocal imaging in vivo, fungal smear test, and histochemical examination. Treatment with Natamycin, fluconazole, and Voriconazole for 1 month was unsuccessful, and a penetrating keratoplasty with anterior vitrectomy was performed. The infection reappeared 1 day after surgery, immediately after which anterior chamber irrigation with 0.02% Fluconazole and amphotericin B solution was performed. Finally, the globe was saved and there was no further recurrent infection. A cultured mycelial organism, which was hard to identify by biomorphology, was confirmed by PCR to be Pythium insidiosum. The zoospores were observed in water environments. The imaging characteristics of P. insidiosum in confocal microscopy are described herein. CONCLUSIONS This is the first case of Pythium insidiosum keratitis reported in China. It can be misdiagnosed as fungal keratitis in the clinic. Improving the awareness of clinicians, promoting early diagnosis, and a multidisciplinary approach, especially early surgery, improve the prognosis.

Topics: Amphotericin B; Animals; Antifungal Agents; Child; China; Corneal Transplantation; Corneal Ulcer; Diagnosis, Differential; Fluconazole; Humans; Male; Prognosis; Pythiosis; Pythium; Treatment Outcome; Vitrectomy

Treatment for horses with pythiosis of a limb is challenging. This study aims to evaluate the effects of administering amphotericin B in a 10 % solution of dimethylsulfoxide by intravenous regional limb perfusion (IRLP) to treat horses for cutaneous pythiosis of a limb.. All 15 of the horses treated had complete resolutions of their lesion between 6 to 9 weeks after a single IRLP treatment. No complications were observed at the site of venipuncture for IRLP. Before initiation of treatment, there was anemia and marked leucocytosis which resolved following treatment. Serum biochemistry showed no significant changes.. IRLP administration of amphotericin B in a 10 % DMSO solution was easily performed, relatively inexpensive and an effective treatment for treating horses for pythiosis of a limb and resolved the infection with no complications.

Topics: Amphotericin B; Animals; Anti-Infective Agents; Dimethyl Sulfoxide; Drug Therapy, Combination; Female; Forelimb; Hindlimb; Horse Diseases; Horses; Injections, Intravenous; Male; Pythiosis; Pythium

To evaluate the effects of intravenous regional limb perfusion (IRLP) administration of amphotericin B in horses to treat pythiosis after surgical excision and thermocautery.. Case series.. Horses (n = 12) with Pythium insidiosum infection of the distal aspect of the thoracic or pelvic limbs.. After surgical excision of granulation tissue and thermocautery, 50 mg amphotericin B was administered by IRLP through a catheter placed in a superficial vein of the affected limb next to the lesion after placing a tourniquet above the injection site. The lesions and locomotor system were evaluated before treatment and at 7, 14, 21, 28, 35, and 60 days.. Ninety-two percent of horses treated with amphotericin B had complete lesion resolution 35 or 60 days after 1 or 2 IRLP treatments, respectively. IRLP induced limb edema and pain during regional palpation in 42%, and inflammation of the injection site in 33% of horses; however these signs resolved after 14 days.. IRLP administration of amphotericin B was effective for treating pythiosis in equine limbs, resolving infection with manageable side effects.

Topics: Amphotericin B; Animals; Anti-Infective Agents; Female; Forelimb; Hindlimb; Horse Diseases; Horses; Injections, Intravenous; Male; Pythiosis; Pythium