amphotericin-b and Respiratory-Distress-Syndrome

Pulmonary blastomycosis is a respiratory disease that is caused by the fungus Blastomyces spp, which is acquired through inhalation of the fungal spores. Blastomycosis is relatively uncommon, with yearly incidence rate of 1-2 cases per 100 000 people. Blastomycosis is a disease that is endemic to the midwest and southern regions of the USA, most commonly affecting immunocompromised patients. About 50% of patients are asymptomatic, but for those who progress to acute respiratory distress syndrome (ARDS) mortality can be as high as 80%. Patients with severe blastomycosis are initially treated with intravenous amphotericin B, followed by long-term itraconazole maintenance therapy. In this Grand Round, we present the case of an immunocompetent 35-year-old man diagnosed with chronic pulmonary blastomycosis who had a poor response to 10 days of intravenous liposomal amphotericin B (L-AmB). He was endotracheally intubated and eventually cannulated for extracorporeal membrane oxygenation (ECMO), due to worsening respiratory function. L-AmB was replaced with a continuous infusion of intravenous amphotericin B deoxycholate (AmB-d). He improved significantly and was decannulated from ECMO on day 9 of AmBd continuous infusion and extubated on day 12 Although L-AmB is considered first-line treatment for blastomycosis, mortality remains high for patients with ARDS associated with blastomycosis. This case highlights the importance of considering AmB-d continuous infusions for patients with severe blastomycosis who might have poor clinical responses to L-AmB.

Topics: Adult; Amphotericin B; Antifungal Agents; Blastomycosis; Humans; Male; Respiratory Distress Syndrome

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

Blastomycosis is an endemic mycosis that occurs predominantly in North America in the north central United States and provinces of Canada, southern states, and those midwestern states that border the Mississippi River basin. It causes acute and chronic pneumonias and disseminated infection with cutaneous lesions as the major extrapulmonary manifestation. However, the vast majority of infected persons are asymptomatic or have mild respiratory symptoms that are not diagnosed as being caused by a fungal infection. Rarely, patients develop severe pulmonary infection that progresses to acute respiratory distress syndrome (ARDS), which has a high mortality rate. A urinary antigen test is now available to aid in diagnosis, but it is not specific and is positive in patients who have histoplasmosis as well as blastomycosis. Antibody assays remain nonspecific and insensitive, and the confirmatory diagnostic test is still growth of the organism in culture. Updated guidelines from the Infectious Diseases Society of America are available to aid clinicians in the management of the various forms of blastomycosis.

Topics: Amphotericin B; Antifungal Agents; Antigens, Fungal; Blastomyces; Blastomycosis; Central Nervous System Infections; Chronic Disease; Humans; Immunocompromised Host; Itraconazole; Lung Diseases, Fungal; Radiography; Respiratory Distress Syndrome; Sensitivity and Specificity; Skin Ulcer

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

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

Torulopsis glabrata is a yeast ordinarily considered nonpathogenic. Systemic infection with this yeast occurs in patients who are debilitated, immunosuppressed, diabetic, or receiving multiple antibiotics. We have presented a case of fungemia due to T glabrata in a previously healthy person. The predisposing condition resulting in debility and predisposition to fungemia was major vascular surgery. Treatment with amphotericin B eradicated the fungemia.

Topics: Acute Kidney Injury; Amphotericin B; Aortic Aneurysm; Aortic Dissection; Candida; Candidiasis; Causality; Fungemia; Humans; Male; Middle Aged; Postoperative Complications; Prognosis; Respiratory Distress Syndrome

Topics: Adult; Amphotericin B; COVID-19; Extracorporeal Membrane Oxygenation; Female; Humans; Hypoxia; Mucormycosis; Postpartum Period; Pregnancy; Respiratory Distress Syndrome; Salvage Therapy

The aim of the study was to report clinical features, contributing factors and outcome of patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM).. A cross-sectional descriptive multicentre study was conducted on patients with biopsy-proven mucormycosis with RT-PCR-confirmed COVID-19 from April to September 2020. Demographics, the time interval between COVID-19 and mucormycosis, underlying systemic diseases, clinical features, course of disease and outcomes were collected and analysed.. Fifteen patients with COVID-19 and rhino-orbital mucormycosis were observed. The median age of patients was 52 years (range 14-71), and 66% were male. The median interval time between COVID-19 disease and diagnosis of mucormycosis was seven (range: 1-37) days. Among all, 13 patients (86%) had diabetes mellitus, while 7 (46.6%) previously received intravenous corticosteroid therapy. Five patients (33%) underwent orbital exenteration, while seven (47%) patients died from mucormycosis. Six patients (40%) received combined antifungal therapy and none that received combined antifungal therapy died.. Clinicians should be aware that mucormycosis may be complication of COVID-19 in high-risk patients. Poor control of diabetes mellitus is an important predisposing factor for CAM. Systematic surveillance for control of diabetes mellitus and educating physician about the early diagnosis of CAM are suggested.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Caspofungin; Coinfection; Comorbidity; COVID-19; COVID-19 Drug Treatment; Cross-Sectional Studies; Diabetes Complications; Diabetes Mellitus; Drug Therapy, Combination; Female; Humans; Iran; Male; Middle Aged; Mucormycosis; Respiratory Distress Syndrome; Triazoles; Young Adult

The use of autologous hematopoietic stem cell transplantation (AHSCT) for autoimmune diseases has become the first indication for transplant in nonmalignant disease. Mucormycosis is a rare invasive infection with increasing incidence in patients treated with AHSCT. We report the first case of pulmonary mucormycosis following AHSCT for systemic sclerosis (SSc).. A 24-year-old woman with rapidly progressive diffuse cutaneous SSc presented with an acute respiratory distress syndrome 6 days after AHSCT.. The results of clinical and computed tomography scan were consistent with pulmonary mucormycosis and the diagnosis was confirmed by a positive Mucorales Polymerase Chain Reaction on a peripheral blood sample.. Early antifungal therapy by intravenous amphotericin B provided rapid improvement within 4 days and sustained recovery after 2 years of follow-up.. With the progressively increasing use of AHSCT and other stem cell therapy for treatment of severe SSc and other autoimmune diseases, the potential onset of rare post-transplant fungal infections, such as mucormycosis, requires careful patient monitoring and better awareness of early initiation of adequate therapy.

Topics: Acute Disease; Administration, Intravenous; Aftercare; Amphotericin B; Antifungal Agents; Female; Hematopoietic Stem Cell Transplantation; Humans; Lung Diseases, Fungal; Mucorales; Mucormycosis; Respiratory Distress Syndrome; Scleroderma, Diffuse; Scleroderma, Systemic; Transplantation, Autologous; Treatment Outcome; Young Adult

Topics: Adult; Amphotericin B; Antifungal Agents; Antigens, Fungal; Area Under Curve; Bronchoalveolar Lavage Fluid; Extracorporeal Membrane Oxygenation; Female; Galactose; Humans; Invasive Pulmonary Aspergillosis; Liposomes; Mannans; Respiratory Distress Syndrome

Blastomycosis-associated acute respiratory distress syndrome (ARDS) has a rare incidence. We report the case of a 29-year-old man with blastomycosis-associated ARDS receiving extracorporeal membrane oxygenation and managed with high-dose liposomal amphotericin B. This case illustrates the importance of timely diagnosis of pulmonary blastomycosis and appropriate dosing of antifungal therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Blastomycosis; Extracorporeal Membrane Oxygenation; Humans; Lung Diseases; Male; Respiratory Distress Syndrome

Histoplasmosis is a fungal infection caused by a dimorphic fungus, Histoplasma capsulatum. We report a first case of disseminated histoplasmosis in a 34-year-old woman, infected with human immunodeficiency virus (HIV), originating from Ivory Coast and living in Tunisia for 4 years. She was complaining from fever, chronic diarrhoea and pancytopenia. The Histoplasma capsulatum var. capsulatum was identified by direct microscopic examination of the bone marrow. She was treated by Amphotericin B, relayed by itraconazole. Even though a regression of symptoms and normalization of blood cell count (BCC), the patient died in a respiratory distress related to CMV hypoxemic pneumonia.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Bone Marrow; Communicable Diseases, Imported; Cote d'Ivoire; Fatal Outcome; Female; Histoplasma; Histoplasmosis; HIV Infections; Humans; Itraconazole; Microscopy; Respiratory Distress Syndrome; Tunisia

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; Brazil; Humans; Lung; Male; Paracoccidioidomycosis; Respiratory Distress Syndrome; Tomography, X-Ray Computed

We describe the laboratory-confirmed etiologies of illness among participants in a hospital-based febrile illness cohort study in northern Tanzania who retrospectively met Integrated Management of Adolescent and Adult Illness District Clinician Manual (IMAI) criteria for septic shock, severe respiratory distress without shock, and severe pneumonia, and compare these etiologies against commonly used antimicrobials, including IMAI recommendations for emergency antibacterials (ceftriaxone or ampicillin plus gentamicin) and IMAI first-line recommendations for severe pneumonia (ceftriaxone and a macrolide). Among 423 participants hospitalized with febrile illness, there were 25 septic shock, 37 severe respiratory distress without shock, and 109 severe pneumonia cases. Ceftriaxone had the highest potential utility of all antimicrobials assessed, with responsive etiologies in 12 (48%) septic shock, 5 (14%) severe respiratory distress without shock, and 19 (17%) severe pneumonia illnesses. For each syndrome 17-27% of participants had etiologic diagnoses that would be non-responsive to ceftriaxone, but responsive to other available antimicrobial regimens including amphotericin for cryptococcosis and histoplasmosis; anti-tuberculosis therapy for bacteremic disseminated tuberculosis; or tetracycline therapy for rickettsioses and Q fever. We conclude that although empiric ceftriaxone is appropriate in our setting, etiologies not explicitly addressed in IMAI guidance for these syndromes, such as cryptococcosis, histoplasmosis, and tetracycline-responsive bacterial infections, were common.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Ampicillin; Anti-Infective Agents; Bacterial Infections; Ceftriaxone; Child; Cohort Studies; Cryptococcosis; Emergencies; Female; Gentamicins; Histoplasmosis; Humans; Infections; Macrolides; Male; Microbial Sensitivity Tests; Middle Aged; Pneumonia, Bacterial; Respiratory Distress Syndrome; Shock, Septic; Tanzania; Tetracycline; Young Adult

Topics: Adult; Amphotericin B; Antifungal Agents; Azoles; Communicable Diseases, Emerging; Fatal Outcome; Febrile Neutropenia; Humans; Induction Chemotherapy; Leukemia, Myeloid, Acute; Lung Diseases, Fungal; Male; Pyrimidines; Respiratory Distress Syndrome; Tomography, X-Ray Computed; Triazoles; Voriconazole

We report a case of a male patient with drug abuse in his medical history who was hospitalized because of a community acquired pneumonia. Subsequently the patient developed an acute lung injury (ARDS) and a fulminant purulent pericarditis accompanied by a pericardial effusion. Caused by the pericardial tamponade cardiac function was severely restricted. Due to fast diagnosis and immediate adequate therapy such as systemic anti-fungal treatment, pericardiocentesis, percutaneous drainage, and later surgical intervention the patient was treated successfully. This article describes etiology, pathophysiology and symptoms of purulent Candida-pericarditis and gives a review of existing literature regarding this extremely rare disease. In addition therapeutic options are discussed.

Topics: Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Caspofungin; Community-Acquired Infections; Critical Care; Drainage; Echinocandins; Emergency Medical Services; Humans; Lipopeptides; Male; Middle Aged; Pericardiocentesis; Pericarditis; Prognosis; Respiratory Distress Syndrome; Substance-Related Disorders; Treatment Outcome

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Dermatomycoses; Fatal Outcome; Fever; Flucytosine; HIV Infections; Humans; Male; Multiple Organ Failure; Respiratory Distress Syndrome

Topics: Amphotericin B; Biopsy, Needle; Blastomycosis; Bronchoalveolar Lavage Fluid; Bronchoscopy; Diagnosis, Differential; Fatal Outcome; Fever; Humans; Lung Diseases, Fungal; Male; Middle Aged; Multiple Organ Failure; Respiratory Distress Syndrome; Tomography, X-Ray Computed

Topics: Adult; Amphotericin B; Animal Husbandry; Animals; Animals, Wild; Antifungal Agents; Argentina; Chrysosporium; Coccidioidomycosis; Diagnosis, Differential; Granuloma; Humans; Lung Diseases, Fungal; Male; Radiography; Respiratory Distress Syndrome; Rodent Diseases

Topics: Adult; Amphotericin B; Antifungal Agents; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Fatal Outcome; Humans; Lung Diseases, Fungal; Male; Mucormycosis; Respiratory Distress Syndrome

A 73-y-old female with a history of adenocarcinoma of colon and refractory anemia developed febrile neutropenia following chemotherapy. Therapy with iv infusion of amphotericin B deoxycholate (AmBd) was initiated on day 8 of hospital admission. Premedications included acetaminophen, diphenhydramine and meperidine. Patient developed rigor, chill and elevated temperature approximately 100 min into the infusion. The infusion was temporarily discontinued and rigors subsided following administration of 25 mg meperidine im. Infusion was continued after cessation of the rigors with no further sequelae. During each infusion of AmBd over the next 3 d, the patient developed rigor, chill and elevated temperature which was managed with meperidine. However, on day 4 she developed respiratory distress, bronchospasm and visible cyanosis with oxygen saturation of 88% while on 2 L oxygen. The infusion was stopped and the symptoms subsided with administration of albuterol via nebulizer. Amphotericin lipid formulation infusion was reinstituted after 3 d because of the patient's worsening clinical status. However, the patient developed severe respiratory distress approximately 130 min into the infusion. The infusion was discontinued and she was treated with albuterol via nebulizer. Itraconazole therapy was instituted without any adverse sequelae. Clinicians should be aware of this potential adverse event since it can occur with all formulation of amphotericin.

Topics: Adenocarcinoma; Aged; Amphotericin B; Anemia; Antifungal Agents; Colonic Neoplasms; Drug Combinations; Female; Fever; Humans; Infusions, Intravenous; Leukemia, Myeloid, Acute; Neutropenia; Phosphatidylcholines; Phosphatidylglycerols; Respiratory Distress Syndrome

To describe the clinical and laboratory parameters of patients with septic shock following infection with Coccidioides immitis, estimate the incidence of septic shock from coccidioidomycosis, and outline clues that may be helpful in early diagnosis of this syndrome.. Retrospective, descriptive case series.. A 250-bed general public hospital in Kern County, CA.. Eight patients diagnosed with septic shock from infection with C. immitis from September 1991 to December 1993. Five were Hispanic, two were Filipino, and one was African-American. The diagnosis of C. immitis was made by microscopic examination and culture of the organism from sputum or other sites. Septic shock was diagnosed using criteria formulated by the American College of Chest Physicians Consensus Conference/Society of Critical Care Medicine.. No patient had traditional immunocompromising conditions. All patients had pulmonary symptoms and were symptomatic for a mean duration of 19.4 +/- 19.8 days before admission. One patient presented with septic shock and the remaining seven developed shock during their hospital course. Serology for coccidioidomycosis was positive in six patients. The mean cardiac index was 5.8 +/- 1.9 (SD) L/min/m2, the mean arterial pressure was 71.0 +/- 16.7 mm Hg, the mean pulmonary artery occlusion pressure was 16.9 +/- 3.5 mm Hg, and the mean systemic volume resistance index was 846.6 +/- 224.1 dyne-sec/cm5xm2. All patients developed acute respiratory distress syndrome. Coccidioidomycosis was recognized or considered in only five of eight patients before they developed septic shock. Despite therapy with amphotericin B, all patients died. One patient died of progressive pulmonary disease, two patients suffered an acute arrest, and five patients developed progressive multiple organ system failure and died with additional organ involvement.. Septic shock following infection with C. immitis is an ominous yet underrecognized condition. Hemodynamic parameters and cytokine concentrations were not significantly different from values seen in gram-negative septic shock. Clinical clues to the diagnosis include duration of illness and conspicuous pulmonary involvement. Patient outcome in this series was poor but may improve with increased recognition of septic shock in infections from C. immitis.

Topics: Adult; Aged; Aged, 80 and over; Amphotericin B; Antibodies, Fungal; Antifungal Agents; Case-Control Studies; Coccidioides; Coccidioidomycosis; Female; Humans; Lung Diseases, Fungal; Male; Middle Aged; Respiratory Distress Syndrome; Retrospective Studies; Shock, Septic; Sputum; Treatment Outcome

To study the epidemiologic and clinical features of blastomycosis in northeast Tennessee.. Retrospective review of blastomycosis cases in the region from 1980 through 1995.. Hospitals located in the Tri-Cities region of northeast Tennessee.. Seventy-two patients with confirmed blastomycosis infection.. None.. During the 1980 to 1995 study period, we documented 72 cases of blastomycosis. The mean age was 52 years (range, 13 to 86 years), most were male (69.4%), and nine were immunocompromised. A possible environmental exposure was noted for 28 patients. Pulmonary involvement represented the most common site of infection (61 cases), but multiorgan involvement was common (17 cases). Most patients with pulmonary blastomycosis (66%) presented with a chronic illness, and radiologic findings usually revealed local consolidation or a mass-like lesion. Nine patients developed ARDS with an associated mortality rate of 89%, compared with a 10% mortality for non-ARDS pulmonary cases. Antifungal treatment regimens varied widely, with amphotericin B often used for sicker patients. An epidemiologic evaluation revealed that the mean yearly incidence rate for blastomycosis quadrupled between 1980 and 1987 (0.31 cases/ 100,000 population) and 1988 to 1995 (1.23 cases/100,000 population) (p=0.00001). Most new blastomycosis cases in the 1988 to 1995 period occurred in three counties in the region where significant new construction projects have been underway.. Blastomycosis is endemic in northeast Tennessee and the number of cases is increasing, coinciding with major new construction in the region. Clinicians in the area must be alert to this condition.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Chronic Disease; Female; Humans; Incidence; Lung Diseases, Fungal; Male; Middle Aged; Prevalence; Respiratory Distress Syndrome; Retrospective Studies; Sputum; Survival Rate; Tennessee

Topics: Alcoholism; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Cross Infection; Fatal Outcome; Fluconazole; Humans; Infection Control; Intubation, Intratracheal; Male; Maxillary Sinusitis; Middle Aged; Respiratory Distress Syndrome; Risk Factors; Serotyping

Topics: Abortion, Missed; Adult; Amphotericin B; Blood Transfusion; Dilatation and Curettage; Female; Humans; Leukocyte Transfusion; Pregnancy; Respiratory Distress Syndrome

We describe a patient who presented with cryptococcosis and the adult respiratory distress syndrome (ARDS) as the initial manifestation of the acquired immunodeficiency syndrome. This patient represents the first reported recovery from ARDS secondary to widespread cryptococcosis. He is currently doing well as an outpatient on maintenance therapy with amphotericin B and azidothymidine.

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Antiviral Agents; Cryptococcosis; Humans; Intubation, Intratracheal; Male; Radiography; Respiratory Distress Syndrome; Thymidine; Zidovudine

A 32-year-old man with diabetes had rapid development of acute respiratory failure and severe hypoxemia. Radiologic and hemodynamic evaluation confirmed the clinical diagnosis of adult respiratory distress syndrome, and open-lung biopsy disclosed blastomycosis as the etiologic agent. The survival of this patient, after amphotericin therapy, to our knowledge is the first reported recovery from substantiated adult respiratory distress syndrome secondary to blastomycosis.

Topics: Acute Disease; Adult; Amphotericin B; Blastomycosis; Humans; Lung; Lung Diseases, Fungal; Male; Radiography; Respiratory Distress Syndrome

The use of granulocyte transfusions in profoundly neutropenic patients has increased markedly in recent years. Whenever a pulmonary infiltrate develops during the course of these transfusions, the question arises as to what role the transfusions are playing and whether the transfusions should be discontinued to prevent pulmonary deterioration. We have analyzed our recent experience of 593 granulocyte transfusions in 93 patients. 18 patients (19%) developed respiratory compromise or pulmonary infiltrates at some time during the course of granulocyte transfusion. 6 of the 18 cases were reactions to the granulocytes while the remainder were due to fluid overload or other causes. The risk of pulmonary complications did not correlate with the development of cytotoxic leukocyte antibodies, length of transfusion, or concomitant use of Amphotericin. They appeared to be more common in patients with active sepsis. Acute life-threatening pulmonary reactions were rare. Patients receiving granulocyte transfusions should be monitored carefully for pulmonary infiltrates, but other cases should be sought before the transfusions are discontinued.

Topics: Acute Disease; Agglutination; Amphotericin B; Bacterial Infections; Bronchopulmonary Sequestration; Child; Child, Preschool; Granulocytes; Humans; Infant; Lung Diseases; Respiratory Distress Syndrome; Transfusion Reaction

Three patients with acute pulmonary histoplasmosis presented with extensive, diffuse bilateral infiltrates on chest roentgenograms. Fungal elements were seen in the bronchial secretions of two patients; Histoplasma capsulatum was grown from the third patient and from soil from the patients' workplace. Two patients were severely hypoxemic and required short courses of amphotericin B therapy; in one of these two, progressive deterioration dictated corticosteroid therapy as well, with a dramatic clinical response. Radiologic resolution of disease occurred more quickly in the treated patients. Initial pulmonary function tests suggested mild restriction in each, with normal test results by the fourth month of follow-up. Our experience suggests that amphotericin B may shorten the course of acute histoplasmosis and that corticosteroid therapy may be efficacious in controlling the symptoms related to hyperresponsiveness in fulminant primary disease.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Amphotericin B; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Radiography; Respiratory Distress Syndrome