amphotericin-b and Respiratory-Tract-Diseases

We conducted an open label, randomised clinical trial to compare amphotericin B colloidal dispersion (ABCD, Amphocil) 2 mg/kg/day intravenously with fluconazole 200 mg/day orally, for the prevention of fungal disease in neutropenic patients with haematological malignancies. In the event of unresolved fever after 4 days of empirical antibacterial therapy, patients in both treatment groups were to receive ABCD, 4 mg/kg/day. However, the study had to be stopped in an early phase, due to severe side-effects of ABCD. A total of 24 patients were enrolled, 12 patients were randomly assigned to receive prophylactic ABCD, which was administered for a mean of 13.9 days. Fluconazole prophylaxis was given to 12 patients for a mean of 21.2 days. Therapeutic ABCD, 4 mg/kg, was initiated in four patients because of suspected fungal infection, all of whom had initially received fluconazole. A high rate of infusion-related toxicity of ABCD was observed. Chills occurred in 15/16 ABCD recipients (94%), accompanied by a temperature rise of >/=2 degrees C in 4/16 patients and of >/=1 degrees C but <2 degrees C in 10/16 patients. Other ABCD-related adverse events were hypotension (4/16), nausea with vomiting (5/16), tachycardia (7/16), headache (3/16) and dyspnoea (3/16). For premedication patients received: antihistamines (12/16), hydrocortisone (9/16) and/or morphine (6/16). ABCD was discontinued in 8/16 patients (50%) due to side-effects, which ultimately dictated early termination of the study. We conclude that ABCD is not suitable for antifungal prophylaxis in neutropenic patients due to severe infusion-related side-effects. Subject numbers were too low for conclusions on variables of antifungal efficacy.

Topics: Adolescent; Adult; Aged; Amphotericin B; Bilirubin; Consumer Product Safety; Contraindications; Female; Fluconazole; Hematologic Neoplasms; Hematopoietic Stem Cell Transplantation; Humans; Infusions, Intravenous; Male; Middle Aged; Morphine; Mycoses; Neutropenia; Respiratory Tract Diseases; Shivering; Survival; Time Factors; Transaminases

To investigate diagnostic aspects of invasive aspergillosis (IA) in allogeneic BMT recipients, the charts of 22 consecutive patients with IA transplanted in 1989-1995 were reviewed. IA was diagnosed 69-466 days (median 131 days) post BMT. In 16 patients (73%), a definite or probable diagnosis of IA was made during life. Respiratory symptoms were the presenting feature in half of the patients followed by neurological symptoms (27%). Chest X-ray revealed single or multiple nodular lesions in 10 patients; cavitation was observed in five patients. Tissue biopsy was the most common method of diagnosis (nine patients: lungs 6, liver 1, subcutaneous tissue 1, brain 1). Five IA cases were detected by nine guided fine needle lung biopsies in eight patients and without complications. Bronchoalveolar lavage was performed in 14 patients with findings suggestive of invasive pulmonary aspergillosis in eight cases. Lungs were the most common organ affected (90%) followed by central nervous system (41%). The diagnosis of IA is still difficult, and a large number of patients have advanced infection at diagnosis. Methods for early diagnosis are needed. Patients with a clinical suspicion of IA should be treated vigorously with antifungal agents during the diagnostic work-up.

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Aspergillus flavus; Aspergillus fumigatus; Aspergillus niger; Autopsy; Biopsy, Needle; Bone Marrow Transplantation; Bronchoalveolar Lavage Fluid; C-Reactive Protein; Cohort Studies; Female; Fever; Graft Survival; Graft vs Host Disease; Hematologic Neoplasms; Hemoptysis; Humans; Lung; Male; Middle Aged; Nervous System Diseases; Neutropenia; Radiography, Thoracic; Respiratory Tract Diseases; Tomography, X-Ray Computed; Transplantation, Homologous

The case of a 15 year old white man, diabetic in cetoacidosis, with a orbit-rhino-cerebral phycomycosis is reported. The illness had an acute onset and the treatment was iniciated early with Amphotericin-B and unilateral osteotomy of maxillary and ethmoidal sinus. With this treatment the patient did well with residuals of ophtalmoplegia and amaurosis on the right. Interesting investigation aspects are the occluded internal carotid on the same side of the affected orbit and the CAT-SCAN finding of moderated ventricular dilatation (two months after hospital admission). Mycology, pathophysiology, histopathology, clinical aspects, diagnosis and therapy are discussed, comparing the findings of this case with avaliable literature. An increased number of survivors can be expected with earlier recognition and more aggressive therapy. Treatment of the underlying debilitating disease, Amphotericin-B and surgical debridement of necrotic tissue, are frequently necessary such as observed in the case reported. The favorable results obtained with the proposed managment are stressed.

Topics: Acidosis; Adolescent; Amphotericin B; Brain Diseases; Diabetes Complications; Ethmoid Sinus; Humans; Male; Mucormycosis; Orbit; Respiratory Tract Diseases

Topics: Aerosols; Air Sacs; Amphotericin B; Animal Nutritional Physiological Phenomena; Animals; Bird Diseases; Birds; Blood Proteins; Bronchitis; Canaries; Enteral Nutrition; Hematocrit; Incubators; Mite Infestations; Respiratory Tract Diseases; Sinusitis; Sneezing; Thyroid Diseases; Vocalization, Animal