amphotericin-b and Seizures

Severely immunocompromised patients such as those with haematological malignancies and haematopoietic stem cell transplant recipients are at an increased risk of acquiring invasive mould infections. Fusarium, a ubiquitous fungus, can cause potentially fatal infections in such hosts. It usually manifests as skin lesions, fevers and sino-pulmonary infections. Brain abscesses have been reported, but are relatively uncommon. We report a case of a 50-year-old patient with acute lymphocytic leukaemia and failed autologous peripheral stem cell transplant that presented with new onset seizures and was found to have Fusarium solani brain abscess. Nasal route was the presumed mode of entry of the fungus into the cerebrum. Treatment comprised surgical excision of the lesion, and antimycotic therapy with liposomal amphotericin B and voriconazole. Despite aggressive therapy, patient succumbed to the disease. We have provided an overview of infections secondary to Fusarium, along with a review of the central nervous system involvement by this pathogenic mould.

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Central Nervous System Fungal Infections; Fatal Outcome; Female; Fusariosis; Fusarium; Humans; Immunocompromised Host; Middle Aged; Peripheral Blood Stem Cell Transplantation; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Radiography; Seizures; Voriconazole

Globally, early initiation of antiretroviral therapy for HIV led to a reduction in the estimated mortality from cryptococcal meningitis (CCM) from 624,700 in 2009 to 181,100 in 2014. However, CCM remains one of the leading causes of mortality among HIV infected patients especially in sub-Saharan Africa where 75% of the deaths occur. Most of the studies evaluating mortality have reported short-term mortality (at or before 10 weeks of therapy). We determined mortality and associated factors among patients treated for CCM in the CryptoDex trial (ISRCTN59144167) in Uganda, and the effect of dexamethasone adjunctive therapy on mortality at two years. We conducted a retrospective cohort study between May 2017 and July 2017 to determine the long term survival (up to 2 years post-randomization) of all patients who had been enrolled into the CryptoDex trial in Uganda. The CryptoDex trial recruited between April 2013 and February 2015. We estimated mortality rates and determined factors affecting mortality at two years using Cox regression. The study followed up 211 participants, 127 (60.2%) of whom were male. Sixteen participants (7.58%) were diagnosed with HIV at the same admission when CCM was diagnosed. By two years following randomization 127 (60%) participants had died, a mortality rate of 67 deaths per 100 person-years. Mortality was associated with Glasgow coma score (GCS) below 15 (adjusted Hazard ratio (aHR) 1.77, 95% CI: 1.02-2.44), p = 0.040; weight (aHR 0.97, per 1 Kg increase; 95% CI: 0.94-0.99), p = 0.003; and presence of convulsions (aHR 2.31, 95% CI: 1.32-4.04), p = 0.004, while dexamethasone use and fungal burden had no effect. Long-term mortality in CCM patients remains high even among patients receiving recommended therapy. Strategies to improve long-term survival in CCM patients are urgently needed, especially targeting those with reduced GCS, low weight, and convulsions.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Inflammatory Agents; Antifungal Agents; Body Weight; Cohort Studies; Coma; Dexamethasone; Female; Fluconazole; Humans; Male; Meningitis, Cryptococcal; Retrospective Studies; Risk Factors; Seizures; Uganda

Topics: Amphotericin B; Antifungal Agents; Brain Abscess; Diagnosis, Differential; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Mucormycosis; Rhizomucor; Seizures; Stem Cell Transplantation; Temporal Lobe; Tomography, X-Ray Computed

Opportunistic fungi are dispersed as airborne, ground and decaying matter. The second most frequent extra-pulmonary disease by Aspergillus is in the central nervous system.. The case subject was 55 years old, male, mulatto, and an assistant surveyor residing in Teresina, Piauí. He presented with headache, seizures, confusion, fever and left hemiparesis upon hospitalization in 2006 at Hospital São Marcos. Five years previously, he was diagnosed with diabetes mellitus, and 17 months previously he had acne margined by hyperpigmented areas and was diagnosed with leprosy. Laboratory tests indicated leukocytosis and magnetic resonance imaging showed an infarction in the right cerebral hemisphere. Cerebrospinal fluid examination showed 120 cells/mm(3) and was alcohol-resistant bacilli negative. Trans-sphenoidal surgery with biopsy showed inflammation was caused by infection with Aspergillus fumigatus. We initiated use of parenteral amphotericin B, but his condition worsened. He underwent another surgery to implant a reservoir of Ommaya-Hickmann, a subcutaneous catheter. We started liposomal amphotericin B 5 mg/kg in the reservoir on alternate days. He was discharged with a prescription of tegretol and fluconazole.. This report has scientific interest because of the occurrence of angioinvasive cerebral aspergillosis in a diabetic patient, which is rarely reported. In conclusion, we suggest a definitive diagnosis of cerebral aspergillosis should not postpone quick effective treatment.

Topics: Amphotericin B; Anticonvulsants; Antifungal Agents; Aspergillus fumigatus; Biopsy; Carbamazepine; Cerebrum; Diabetes Mellitus; Fluconazole; Humans; Leprosy, Lepromatous; Magnetic Resonance Imaging; Male; Middle Aged; Neuroaspergillosis; Predictive Value of Tests; Seizures; Treatment Outcome

Aspergillosis of the central nervous system is uncommon. It is encountered mainly in the immunocompromised. We describe an unusual case of cerebral aspergillosis in a young but immunocompetent patient. Despite delayed diagnosis, specific anti-fungal therapy lead to a good recovery. Unfortunately, non-adherence with the costly drugs for an adequate period of time was followed by a fatal relapse.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Brain Edema; Female; Humans; Muscle Weakness; Pyrimidines; Seizures; Treatment Outcome; Triazoles; Voriconazole

Children with acute lymphoblastic leukemia (ALL) are at risk for serious electrolyte abnormalities. The authors report their experience in managing a child with ALL who developed severe hyperphosphatemia as a consequence of a large exogenous load of phosphorus from high-dose liposomal amphotericin B. Health care providers need to recognize this potentially life-threatening complication of liposomal amphotericin B, since early detection and intervention can prevent significant morbidity.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Calcium Carbonate; Candidiasis; Cellulitis; Child; Drug Carriers; Female; Headache; Humans; Hyperparathyroidism, Secondary; Immunocompromised Host; Itraconazole; Liposomes; Mucormycosis; Orbital Diseases; Parathyroid Hormone; Phosphates; Phosphatidylcholines; Phosphatidylglycerols; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Recurrence; Seizures; Sinusitis; Vitamin D

To report a case of multiple episodes of seizure activity in an AIDS patent following amphotericin B infusion.. A 46-year-old African-American man experienced recurrent grand mal seizures during intravenous infusion of amphotericin B, then petit mal seizures as the infusion was stopped and the drug concentrations decreased with time. The patients concurrent medications included didanosine, hydroxyzine, promethazine, hydrocortisone, and prochlorperazine. Despite administration of phenytoin and lorazepam, the seizures persisted and occurred only during amphotercin B administration.. AIDS and cryptococcal meningitis, both of which the patient had, can potentially cause seizures. The patient had a history of alcohol abuse; alcohol intake as well as withdrawal can also cause seizures. Didanosine also has a potential for inducing seizures. However, these other potential causes of seizure were ruled out. The time course of events suggested that amphotericin B was the cause of the seizures in this AIDS patient.. Amphotericin B seems to be the probable cause of the seizures. To date, only three cases of seizures associated with amphotericin B have been reported in the literature, but healthcare providers should be aware of the potential for this rare adverse effect.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Humans; Infusions, Intravenous; Male; Meningitis, Cryptococcal; Middle Aged; Seizures

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Humans; Male; Meningitis, Cryptococcal; Middle Aged; Seizures

A 30-year-old male and a 40-year-old female presented with Aspergillus fungal granuloma in the cerebral locations involving the gasserian-ganglion and its divisions in one case and was densely adherent to the lateral dural wall of the cavernous sinus in the other. Both patients were otherwise healthy with no evidence of immuno-suppression. The lesions resembled benign tumor on preoperative imaging and intraoperative consistency and vascularity. The lesions were successfully and completely resected. Both patients developed major cerebral arterial territory infarcts in the postoperative phase, remote from the site of operation, leading to crippling neurological deficits in one patient and death in the other. The unusual location and the unusual and similar clinical course suggests that awareness of the possibility of ischemic complications after surgical resection of intracranial aspergillomas is necessary.

Topics: Adult; Amphotericin B; Aspergillosis; Cavernous Sinus; Cerebral Infarction; Combined Modality Therapy; Craniotomy; Encephalitis; Fatal Outcome; Female; Hemiplegia; Humans; Male; Seizures

We describe a case of granulomatous encephalitis caused by Bipolaris (Drechslera) hawaiiensis in an immunocompetent patient. An 18-year-old man with a seven-month history of seizures and right leg weakness was found by computed tomographic scan to have a left frontoparietal enhancing lesion. Biopsy of the lesion revealed granulomatous inflammation and numerous septate hyphae. Culture of the biopsy specimen yielded a pure culture of B hawaiiensis in four days. Susceptibility studies revealed the organism to be sensitive to amphotericin B (minimal inhibitory concentration [MIC] equals 0.25 mg/L) and miconazole lactate (MIC equals 0.064 mg/L), but resistant to flucytosine (MIC greater than 100 mg/L). No synergy was demonstrated with amphotericin B and flucytosine in vitro. The patient was successfully treated with surgery and systemic and intrathecal amphotericin B therapy, and a negative culture was obtained from a repeated brain biopsy six weeks later.

Topics: Adolescent; Amphotericin B; Combined Modality Therapy; Encephalitis; Granuloma; Hemiplegia; Humans; Male; Miconazole; Mycoses; Seizures; Tomography, X-Ray Computed

In a one-year period (July 1, 1975, through June 30, 1976), 130 cases of suspected adverse drug reactions were reviewed in the Veterinary Medical Teaching Hospital, School of Veterinary Medicine, Davis, Ca. Sixty-six of these cases had sufficient evidence to link the reaction to the medication administered. Most of the reactions were attributed to anti-infective agents (antibiotics and parasiticides) and to anesthetics and related drugs. In 28 (42.4%) of the cases, uncomplicated recovery occurred without supportive medication. Four animals (6.1%) died as a direct result of adverse drug reactions. It was concluded that a higher degree of adverse drug reaction awareness is needed in the veterinary profession to enable the accumulation of meaningful data.

Topics: Amphotericin B; Anaphylaxis; Animals; Cat Diseases; Cats; Cattle; Cattle Diseases; Chloral Hydrate; Dextrans; Dog Diseases; Dogs; Droperidol; Drug Therapy; Drug-Related Side Effects and Adverse Reactions; Fentanyl; Fluorouracil; Horse Diseases; Horses; Ketamine; Oxytetracycline; Penicillins; Seizures; Sweating

Topics: Amphotericin B; Anaphylaxis; Anemia; Anuria; Blushing; Feeding and Eating Disorders; Fever; Headache; Heart Failure; Humans; Hypokalemia; Kidney Diseases; Liver Diseases; Meningitis; Nausea; Pain; Paralysis; Paresthesia; Phlebitis; Seizures; Thrombocytopenia; Toxicology; Ventricular Fibrillation; Vertigo; Vomiting