amphotericin-b and Sepsis

The combined infection of actinomyces odontolyticus sepsis and cryptococcal encephalitis is rare in routine clinical practice. Thus, we presented this case report and literature review to provide clues to improve such patients' diagnoses and treatment processes.. The main clinical manifestations of the patient were high fever and intracranial hypertension. Then, we completed the routine cerebrospinal fluid examination, biochemical detection, cytological examination, bacterial culture, and India ink staining. Firstly, the blood culture suggested actinomyces odontolyticus infection, considering the possibility of actinomyces odontolyticus sepsis and intracranial actinomyces odontolyticus infection. Accordingly, the patient was administered penicillin for treatment. Although the fever was slightly relieved, the symptoms of intracranial hypertension did not relieve. After 7 days, the characteristics of brain magnetic resonance imaging and the results of pathogenic metagenomics sequencing and cryptococcal capsular polysaccharide antigen suggested that cryptococcal infection. Based on the above results, the patient was diagnosed with a combined infection of cryptococcal meningoencephalitis and actinomyces odontolyticus sepsis. Anti-infection therapy with 'penicillin, amphotericin, and fluconazole' was provided, improving the clinical manifestations and objective indexes.. The combined infection of Actinomyces odontolyticus sepsis and cryptococcal encephalitis is first reported in this case report, and combined antibiotics with 'penicillin, amphotericin, and fluconazole' are effective.

Topics: Actinomyces; Actinomycosis; Amphotericin B; Antifungal Agents; Cryptococcus neoformans; Fluconazole; Humans; Intracranial Hypertension; Meningitis, Cryptococcal; Meningoencephalitis; Penicillins; Sepsis

Geotrichum capitatum is a rare fungal pathogen that has infrequently affected immunocompromised patients with onco-hematologic diseases. Geotrichum capitatum invasive infection has been associated with poor prognosis, with a mortality rate ranging from 50% to 90%. Here, we report the first case of Geotrichum capitatum invasive fungal infection in a liver transplant recipient from an unrelated deceased donor, who was effectively treated with amphotericin B and voriconazole. We also reviewed the available literature in the field.

Topics: Amphotericin B; Antifungal Agents; Fatal Outcome; Humans; Immunocompromised Host; Immunosuppressive Agents; Invasive Fungal Infections; Liver Transplantation; Male; Middle Aged; Multiple Organ Failure; Opportunistic Infections; Saccharomycetales; Sepsis; Treatment Outcome; Voriconazole

Geotrichum capitatum is an uncommon cause of invasive infections in immunocompromised patients, particularly those with hematological malignancies and severe neutropenia. The aim of this study was to report the cases of invasive geotrichosis in our hospital. It is a retrospective study of invasive geotrichosis diagnosed in the Laboratory of Parasitology-Mycology of the UH Habib Bourguiba, Sfax, from January 2005 to August 2013. Six cases of invasive Geotrichum infections were diagnosed. There were three men and three women. The mean age was 35 years. Five patients have acute myeloid leukemia with a profound neutropenia, and one patient was hospitalized in the intensive care unit for polytraumatism. Clinically, the prolonged fever associated with pulmonary symptoms was the predominant symptom (n = 5). Geotrichum capitatum was isolated in one or more blood culture. Two patients had urinary tract infections documented by multiple urine cultures positive for G. capitatum. Five patients received conventional amphotericin B alone or associated with voriconazole. The outcome was fatal in four cases. Invasive geotrichosis is rare, but particularly fatal in immunocompromised patients. Approximately, 186 cases have been reported in the literature. The prognostic is poor with mortality over 50 %. So, early diagnosis and appropriate management are necessary to improve prognosis.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Fatal Outcome; Female; Geotrichosis; Geotrichum; Hospitals, University; Humans; Male; Middle Aged; Retrospective Studies; Sepsis; Tunisia; Voriconazole

Emerging fungal pathogens, such as Geotrichum capitatum, are often associated with poor prognosis and represent a new challenge in modern medicine. Invasive Geotrichum capitatum infection is rare and has been reported exclusively in patients who showed signs of severe immunodeficiency, particularly those affected by haematological malignancies. The optimal therapy against systemic geotricosis has not yet been identified due to limited data about its antifungal susceptibility. The use of several therapeutic strategies and the low number of cases treated does not allow identification of specific therapeutic protocols. Furthermore, in spite of antifungal therapy, mortality rates reach very high levels. We report a case of systemic Geotrichum capitatum infection in a 78-year-old male treated with salvage therapy after acute myeloid leukaemia (AML) relapse. Geotrichum capitatum was isolated from his blood culture and identified by using Vitek 2 and Maldi time-of-flight system (MALDI-TOF). The infection was unsuccessfully treated, despite in vitro susceptibility, with micafungin and liposomal amphotericin B.

Topics: Aged; Amphotericin B; Antifungal Agents; Coma; Drug Therapy, Combination; Echinocandins; Fatal Outcome; Geotrichum; Humans; Immunocompromised Host; Leukemia, Myeloid, Acute; Lipopeptides; Male; Micafungin; Recurrence; Sepsis; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Treatment Failure

Candida infections represent challenging causes of severe sepsis and/or of septic shock in the critically ill patients. Knowledge of current pharmacological concepts may promote a more wise use of echinocandins in the management of Candida infections in this setting. Echinocandins have some advantages over azoles, both pharmacodynamically (rapid fungicidal activity, anti-biofilm activity, unmodified activity against Candida isolates with decreased susceptibility to azoles and anti-cytokine/anti-chemokine activity) and pharmacokinetically (low interindividual variability, low potential for drug-drug interactions), that may influence the timing and the choice of therapy of Candida diseases in the critically ill patients. However, concerns exist in regards to the feasibility of fixed dosing regimens of echinocandins in all of the different patient populations and in regards to the effectiveness of echinocandin monotherapy in some clinical settings. In presence of deep-seated infections, voriconazole or liposomal amphotericin B may be valuable alternatives or add-on therapy.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Critical Illness; Drug Administration Schedule; Drug Dosage Calculations; Drug Therapy, Combination; Echinocandins; Humans; Practice Guidelines as Topic; Pyrimidines; Sepsis; Triazoles; Voriconazole

Paracoccidioidomycosis (PCM) is a systemic mycosis caused by Paracoccidioides brasiliensis, which is endemic in many regions of Latin America. We describe the case of a 60-year-old man from a region endemic for PCM who presented with a long history of left hip pain. He had been treated over the past 3 years with immunosuppressive drugs (methotrexate, leflunomide, and adalimumab) for rheumatoid arthritis (RA). A hip radiograph showed lytic bone lesions, and a chest radiograph showed an expansive excavated lesion in the left lung, suggestive of a lung cancer with bone metastases. A left hip joint biopsy was inconclusive, but histological analysis of a surgical lung biopsy specimen was consistent with P. brasiliensis infection. Treatment with intravenous amphotericin B (50 mg/day) and hydrocortisone (25 mg/day) was initiated. However, increasing hip pain resulted in the amputation of the left lower limb, and the analysis of the surgical specimen revealed a diagnosis of bone sarcoma. Postoperatively, the patient developed sepsis and died approximately 1 month later. To our knowledge, this is the first report of PCM in a patient with RA who had been treated with immunosuppressive drugs, in particular TNF-α blocking agents. The atypical presentation (left hip pain alone) emphasizes the importance of considering PCM in the differential diagnosis of patients with pulmonary lesions and osteolytic lesions who live in a region endemic for PCM. This case report also demonstrates that health professionals in these regions must pay close attention to patients receiving immunosuppressive drugs because of the possibility of reactivating quiescent P. brasiliensis lesions.

Topics: Adult; Amphotericin B; Antifungal Agents; Arthritis, Rheumatoid; Bone Neoplasms; Fatal Outcome; Female; Humans; Immunocompromised Host; Immunosuppressive Agents; Latin America; Lung; Lung Neoplasms; Male; Middle Aged; Paracoccidioides; Paracoccidioidomycosis; Postoperative Complications; Sarcoma; Sepsis

Right atrial thrombus formation is a rare complication of central venous catheterization in adults. Infection of this thrombus is exceptional. A case of a right atrial thrombus associated with Candida albicans infection is described. Surgical thrombectomy, withdrawal of the catheter, and long-term antiinfectious therapy seem the only appropriate treatment. The literature on this unusual condition is reviewed.

Topics: Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Catheterization, Central Venous; Coronary Thrombosis; Female; Heart Atria; Humans; Middle Aged; Sepsis; Thrombectomy; Ultrasonography

Seven cases of successfully treated Candida albicans cerebrospinal fluid shunt infections are reported. Treatment consisted of shunt removal and intravenous Amphotericin B in all cases and intraventricular Amphotericin B in 4 cases. Serious underlying medical illness, recent antibiotic therapy, indwelling intravascular and/or Foley catheters, coincident candidiasis and low birth weight prematurity are major risk factors for candida shunt infection. Candida shunt infection appears to occur by either contamination at the time of shunt placement or by hematogenous dissemination.

Topics: Adolescent; Aged; Amphotericin B; Anti-Bacterial Agents; Candidiasis; Catheters, Indwelling; Cerebrospinal Fluid Shunts; Equipment Contamination; Female; Humans; Infant, Newborn; Infant, Premature; Male; Opportunistic Infections; Risk Factors; Sepsis; Surgical Wound Infection

Patients with severe neutropenia are at increased risk for systemic infection with bacteria or fungi. This risk is in proportion to both the degree and duration of the neutropenic process. Although granulocyte transfusion as a means of augmenting host defenses would appear to be a logical therapeutic intervention in clinical contexts involving severe and prolonged neutropenia, several features of granulocyte physiology and collection complicate such considerations. These include the large numbers of granulocytes normally produced by healthy hosts, the short survival of the granulocyte in the circulation after transfusion, the relatively small number of granulocytes which can be collected using currently available pheresis techniques, problems associated with alloimmunization, and the possibility of transferring disease (CMV, toxoplasmosis, hepatitis) by means of these transfusions. In the mid-1970s, well-designed clinical studies strongly suggested that patients with documented Gram-negative sepsis or tissue infection that failed to respond to appropriate antibiotics were significantly benefited by granulocyte transfusions. With recent advances in potent, broad-spectrum antibiotic availability, some have questioned whether these observations remain valid. Several studies regarding the prophylactic use of granulocyte transfusions in patients undergoing allogeneic bone marrow transplantation and/or induction therapy for leukemia have failed to reveal therapeutic benefits and suggested the possibility of significant side effects. These studies are reviewed.

Topics: Agranulocytosis; Amphotericin B; Anti-Bacterial Agents; Blood Transfusion; Bone Marrow Transplantation; Cell Separation; Clinical Trials as Topic; Cytomegalovirus Infections; Granulocytes; Humans; Infant, Newborn; Infant, Newborn, Diseases; Leukapheresis; Lung Diseases; Neutropenia; Sepsis; Transfusion Reaction

It appears that the use of antibiotic combinations, especially synergistic ones, is indicated for the management of gram-negative bacillary sepsis in granulocytopenic patients. Synergism is a valuable factor in increasing the serum bactericidal activity, which is highly likely to be important for a favorable outcome in these infections. The potential side effects of antimicrobial combinations should not deter clinicians from their use. The most frequently used combinations for gram-negative bacillary infections are those involving beta-lactams and aminoglycosides. Other potentially synergistic combinations exist as well; however, the clinical experience with these combinations is limited, and, as with double beta-lactam combinations, their potential for antagonism necessitates care when using them. Besides gram-negative bacillary sepsis in granulocytopenic patients, severe staphylococcal infections might represent an indication for the use of combination therapy, especially in patients with compromised mechanisms of defense against infection.

Topics: Agranulocytosis; Aminoglycosides; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Blood Bactericidal Activity; Drug Resistance, Microbial; Drug Synergism; Drug Therapy, Combination; Fever; Humans; Lactams; Mycoses; Sepsis; Staphylococcal Infections

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Age Factors; Aged; Amphotericin B; Anti-Bacterial Agents; Candidiasis; Child; Child, Preschool; Endophthalmitis; Eye; Female; Humans; Immunosuppressive Agents; Infant; Infusions, Parenteral; Male; Middle Aged; Postoperative Complications; Racial Groups; Sepsis; Sex Factors

Topics: Amphotericin B; Anti-Bacterial Agents; Antibiotics, Antineoplastic; Burns; Candida albicans; Candidiasis; Catheterization; Central Nervous System Diseases; Diabetes Complications; Diagnosis, Differential; Fluorescent Antibody Technique; Fluorouracil; Hemagglutination Inhibition Tests; Humans; Hydrogen-Ion Concentration; Immunologic Deficiency Syndromes; Immunosuppression Therapy; Lung Diseases, Fungal; Nystatin; Pneumonia, Pneumocystis; Pyelonephritis; Respiratory Hypersensitivity; Sepsis; Serologic Tests

Topics: Amphotericin B; Ampicillin; Antifungal Agents; Bacterial Infections; Blood Transfusion; Bone Marrow Transplantation; Carbenicillin; Cephalothin; Diagnosis, Differential; Fever; Gentamicins; Humans; Infections; Leukemia; Leukocytes; Lymphoma; Methicillin; Mycoses; Patient Isolators; Penicillin Resistance; Pneumonia, Pneumocystis; Polymyxins; Sepsis; Toxoplasmosis; Virus Diseases

To study the effect of enterally administered polymyxin E, tobramycin, and amphotericin B (selective flora suppression) on bacterial colonization, infection, resistance, and mortality rate.. Prospective, consecutive crossover controlled study.. Two surgical ICUs in a university hospital; ICU I with ten beds, ICU II with eight beds.. Two hundred patients entered the 1-yr trial. Fifty of 111 patients received selective flora suppression during the first 6 months in ICU I (test group), while 61 of 111 patients served as the control group in the following 6 months. In ICU II, 49 of 89 patients received no selective flora suppression in the first 6 months (control group), followed by 40 of 89 patients receiving selective flora suppression during the second 6-month period (test group).. The test group got a mixture of nonabsorbable antibiotics (paste and suspension) in the digestive tract. The control group received paste and suspension without antimicrobial agents. All 200 patients received cefotaxime during the first 4 days.. With the use of selective flora suppression, colonization with aerobic Gram-negative bacilli was significantly (p less than .01) reduced. There was also a significant reduction in nosocomial bronchopulmonary (ICU I and II; p less than .001) and urinary tract (ICU II; p less than .001) infections. The difference in mortality was not significant. There was no development of resistance against the antibiotics used during the limited period evaluated.. Selective flora suppression is effective in reducing secondary colonization by aerobic Gram-negative bacilli. Reduction of bronchopulmonary and urinary tract infections most likely occurs with colonization prevention.

Topics: Administration, Oral; Adult; Aged; Amphotericin B; Bacterial Infections; Bronchopneumonia; Colistin; Critical Care; Cross Infection; Female; Gram-Negative Aerobic Bacteria; Humans; Intensive Care Units; Male; Middle Aged; Mortality; Mouth; Ointments; Prospective Studies; Sepsis; Suspensions; Tobramycin; Urinary Tract Infections

The question to be answered in this study was: Is prophylactic selective florasuppression advantageous compared to conventional antibiotic policy as far as microbial colonisation, infection, mortality and development of resistance are concerned? A prospective, consecutive, placebo-controlled study in two ICU's was carried out during four 6-months periods. 200 patients who were intubated for at least 3 days, required intensive care for a minimum of 5 days, and belonged to either class III or IV according to the "Therapeutic Intervention Scoring System" were included in the study. They received either placebo or the prophylaxis regimen described by Stoutenbeek et al., consisting of polymyxin E, tobramycin and amphotericin B. Oropharyngeal, tracheobronchial and rectal colonisation with aerobic gram-negative bacilli markedly decreased in the test groups. The rates of nosocomial bronchopulmonary infections (ICU I and II) and urinary tract infections (ICU II) were significantly reduced. There was no significant reduction in wound infection, septicaemia and mortality rates. No development of resistance and no increase of multi-resistant strains occurred. Selective florasuppression is effective in reducing infection rates in critically ill patients without development of resistant strains.

Topics: Adult; Aged; Amphotericin B; Bacterial Infections; Bronchopneumonia; Clinical Trials as Topic; Colistin; Cross Infection; Drug Therapy, Combination; Female; Humans; Intensive Care Units; Male; Prospective Studies; Risk Factors; Sepsis; Surgical Wound Infection; Tobramycin; Urinary Tract Infections

Patients with severe neutropenia are at increased risk for systemic infection with bacteria or fungi. This risk is in proportion to both the degree and duration of the neutropenic process. Although granulocyte transfusion as a means of augmenting host defenses would appear to be a logical therapeutic intervention in clinical contexts involving severe and prolonged neutropenia, several features of granulocyte physiology and collection complicate such considerations. These include the large numbers of granulocytes normally produced by healthy hosts, the short survival of the granulocyte in the circulation after transfusion, the relatively small number of granulocytes which can be collected using currently available pheresis techniques, problems associated with alloimmunization, and the possibility of transferring disease (CMV, toxoplasmosis, hepatitis) by means of these transfusions. In the mid-1970s, well-designed clinical studies strongly suggested that patients with documented Gram-negative sepsis or tissue infection that failed to respond to appropriate antibiotics were significantly benefited by granulocyte transfusions. With recent advances in potent, broad-spectrum antibiotic availability, some have questioned whether these observations remain valid. Several studies regarding the prophylactic use of granulocyte transfusions in patients undergoing allogeneic bone marrow transplantation and/or induction therapy for leukemia have failed to reveal therapeutic benefits and suggested the possibility of significant side effects. These studies are reviewed.

Topics: Agranulocytosis; Amphotericin B; Anti-Bacterial Agents; Blood Transfusion; Bone Marrow Transplantation; Cell Separation; Clinical Trials as Topic; Cytomegalovirus Infections; Granulocytes; Humans; Infant, Newborn; Infant, Newborn, Diseases; Leukapheresis; Lung Diseases; Neutropenia; Sepsis; Transfusion Reaction

Topics: Amphotericin B; Critical Illness; Humans; Intraabdominal Infections; Propensity Score; Renal Insufficiency; Retrospective Studies; Sepsis

Topics: Amphotericin B; Communicable Diseases; Critical Illness; Humans; Intraabdominal Infections; Propensity Score; Renal Insufficiency; Retrospective Studies; Sepsis

Continuous infusion of conventional amphotericin B (CCAB) is used in ICUs for pre-emptive treatment of invasive fungal infections. Amphotericin B has previously been associated with nephrotoxicity.. To investigate if CCAB with therapeutic drug monitoring (TDM) results in renal impairment over time in critically ill patients with abdominal sepsis.. The study was conducted at mixed medical-surgical ICUs of two large teaching hospitals in the Netherlands. Consecutive patients who were treated on the ICUs between 2006 and 2019 for abdominal sepsis, with or without CCAB, were included. CCAB dosing was guided by TDM. Serum creatinine concentrations and renal failure scores of patients with CCAB treatment were compared with those without CCAB treatment. Excluded were: (i) patients treated with CCAB for less than 72 h; and (ii) patients with renal replacement therapy.. A total of 319 patients were included (185 treated with CCAB and 134 controls). A multiple linear regression model showed that the serum creatinine concentration was independent of CCAB treatment (β = -0.023; 95% CI = -12.2 to 7.2; P = 0.615). Propensity score matching resulted in 134 pairs of CCAB-treated and non-treated patients. Again, the analysis of these pairs showed that the cumulative CCAB dose was not associated with serum creatinine concentration during intensive care treatment (β = 0.299; 95% CI = -0.38 to 0.98; P = 0.388).. CCAB with TDM did not result in renal impairment over time in critically ill patients with abdominal sepsis.

Topics: Amphotericin B; Critical Illness; Humans; Propensity Score; Renal Insufficiency; Retrospective Studies; Sepsis

Prophylactic antifungal therapy is widely adopted clinically for critical patients and effective in reducing the morbidity of invasive fungal infection and improves outcomes of those diagnosed patients; however, it is not associated with higher overall survival. As intestinal commensal fungi play a fundamental role in the host immune response in health and disease, we propose that antifungal therapy may eliminate intestinal fungi and aggravate another critical syndrome, sepsis. Here, with murine sepsis model, we found that antifungal therapy with fluconazole dismissed intestinal fungal burden and aggravated endotoxin-induced but no gram-positive bacteria-induced sepsis. Nevertheless, antifungal therapy did not exert its detrimental effect on germ-free mice. Moreover, colonizing more commensal fungi in the mouse intestine or administration of fungal cell wall component mannan protected the mice from endotoxin-induced sepsis. On the molecular level, we demonstrated that antifungal therapy aggravated endotoxin sepsis through promoting Gasdermin D cleavage in the distal small intestine. Intestinal colonization with commensal fungi inhibited Gasdermin D cleavage in response to lipopolysaccharide challenge. These findings show that intestinal fungi inhibit Gasdermin D-mediated pyroptosis and protect the mice from endotoxin-induced sepsis. This study demonstrates the protective role of intestinal fungi in the pathogenesis of endotoxin-induced sepsis in the laboratory. It will undoubtedly prompt us to study the relationship between antifungal therapy and sepsis in critical patients who are susceptible to endotoxin-induced sepsis in the future.

Topics: Amphotericin B; Animals; Antifungal Agents; Disease Models, Animal; Dysbiosis; Feces; Fluconazole; Fungi; Gastrointestinal Microbiome; Lipopolysaccharides; Mannans; Methicillin-Resistant Staphylococcus aureus; Mice, Inbred C57BL; Mice, Knockout; Phosphate-Binding Proteins; Pore Forming Cytotoxic Proteins; Sepsis; Staphylococcal Infections

BACKGROUND Fusarium spp. is a rare cause of opportunistic life-threatening fungal infections. It has a remarkably high resistance profile with few effective antifungal agents, mostly limited to voriconazole and liposomal amphotericin B. Drug-induced liver injury (DILI) by 1 of these 2 antifungal agents further complicates the management of these infections. CASE REPORT A 38-year-old woman with short bowel syndrome presented to the hospital with concerns of abdominal pain and loose stools. An abdominal CT was negative for inflammatory or ischemic bowel disease, and there was no evidence of liver disease. She tested positive for SARS-CoV-2 and required transfer to the ICU due to hypotension requiring fluid resuscitation and vasopressors. On day 43 of her admission, the patient developed a low-grade fever, for which she underwent central-line and peripheral-blood cultures that were positive for Fusarium dimerum. The central line was removed and i.v. voriconazole started. After 3 days of treatment, the patient's liver enzymes rose abruptly. Voriconazole was discontinued and replaced with liposomal amphotericin B, and the liver enzymes improved significantly. The patient completed 14 days of therapy and was discharged from the hospital. CONCLUSIONS This is a case of F. dimerum infection followed by DILI from voriconazole treatment. Her infection was resolved after switching to liposomal amphotericin B, with improvement in liver enzymes on day 1 after discontinuing voriconazole. This observation demonstrates that altering antifungal classes may be an appropriate strategy when confronted with DILI.

Topics: Adult; Amphotericin B; Antifungal Agents; Chemical and Drug Induced Liver Injury; COVID-19; Female; Fusarium; Humans; SARS-CoV-2; Sepsis; Voriconazole

Primary cutaneous mucormycosis (PCM) is a fungal infection of the skin that can affect compromised hosts. Skin lesions evolve from an indurated area to a necrotic ulcer. Preterm neonates are at increased risk due to poorly developed skin, immature immune function, and invasive devices. Antifungals and debridement with grafting have been reported as primary treatments.. The authors report allografting in addition to systemic antifungals as an option for critically ill preterm neonates to decrease blood loss and risk of donor site infection. A female triplet was born to a 35-year-old G1P0211 mother; the triplet developed PCM (Rhizopus genus) and was treated with systemic liposomal amphotericin B in addition to debridement and allografting. Surgery was delayed initially, given concerns over the depth of invasion into the chest. As the wound began to contract and separate over the next few weeks, the decision was made to excise the lesion and reconstruct the chest wall with an allograft. The graft had good take and remained in place for 11 weeks until the patient succumbed to a third recurrence of bacterial sepsis.. While PCM can be fatal for many preterm infants, debridement with allografting may serve as a valuable treatment option with fewer associated complications for neonates as they are stabilizing clinically.

Topics: Amphotericin B; Combined Modality Therapy; Debridement; Disease Progression; Fatal Outcome; Female; Humans; Infant, Newborn; Infant, Premature; Mucormycosis; Sepsis; Severity of Illness Index; Transplantation, Homologous; Triplets

Invasive candidiasis is an important cause of sepsis in extremely low birth weight infants (ELBW, < 1000 g), is often fatal, and frequently results in neurodevelopmental impairment (NDI) among survivors. We sought to assess the antifungal minimum inhibitory concentration (MIC) distribution for Candida in ELBW infants and evaluate the association between antifungal resistance and death or NDI.. This was a secondary analysis of a National Institute of Child Health and Human Development Neonatal Research Network study. MIC values were determined for fluconazole, amphotericin B and micafungin. NDI was assessed at 18-22 months adjusted age using the Bayley Scales of Infant Development. An infant was defined as having a resistant Candida isolate if ≥ 1 positive cultures from normally sterile sites (blood, cerebrospinal fluid, or urine) were resistant to ≥ 1 antifungal agent. In addition to resistance status, we categorized fungal isolates according to MIC values (low and high). The association between death/NDI and MIC level was determined using logistic regression, controlling for gestational age and Bayley Scales of Infant Development (II or III).. Among 137 ELBW infants with IC, MICs were determined for 308 isolates from 110 (80%) infants. Three Candida isolates from 3 infants were resistant to fluconazole. None were resistant to amphotericin B or micafungin. No significant difference in death, NDI, or death/NDI between groups with low and high MICs was observed.. Antifungal resistance was rare among infecting Candida isolates, and MIC level was not associated with increased risk of death or NDI in this cohort of ELBW infants.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis, Invasive; Cohort Studies; Drug Resistance, Fungal; Female; Fluconazole; Gestational Age; Humans; Infant; Infant, Extremely Low Birth Weight; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Male; Micafungin; Microbial Sensitivity Tests; Neurodevelopmental Disorders; Prospective Studies; Sepsis; Treatment Outcome

To demonstrate the feasibility and safety of weekly high-dose liposomal amphotericin B (L-AmB) (as a pre-emptive antifungal treatment) for 2 weeks in patients with septic shock and Candida colonization.. Pilot, multicentre, open-label, prospective study conducted in seven French ICUs. Non-immunocompromised patients, receiving mechanical ventilation were eligible if they presented ICU-acquired severe sepsis requiring newly administered antibacterial agents and Candida colonization in at least two sites. Exclusion criteria included the need for antifungal therapy and creatinine > 220 μmol/L. All patients were to receive a high-dose L-AmB (10 mg/kg/week) for two weeks. A follow-up period of 21 days following the second administration of L-AmB was conducted. Treated patients were compared to 69 matched untreated controls admitted in the same ICUs before the study period.. Twenty-one patients were included in the study, of which 20 received at least one infusion of high-dose L-AmB. A total of 24 adverse events were identified in 13(61%) patients. Fourteen adverse events were categorized as serious in 8(38%) patients. In four cases the adverse events were considered as potentially related to study drug administration and resulted in L-AmB discontinuation in one patient. Few patients experienced severe renal toxicity since no patient presented with severe hypokalemia. No patients required renal replacement therapy. Compared to matched controls, no significant increase in serum creatinine levels in patients receiving high-dose L-AmB was reported.. Weekly administration of high-dose L-AmB has a manageable safety profile and is feasible in patients with ICU-acquired sepsis and multiple Candida colonization. Trials of L-AmB versus other antifungal agents used as pre-emptive antifungal therapy are warranted.. ClinicalTrials.gov NCT00697944.

Topics: Aged; Amphotericin B; Antifungal Agents; Candida; Candidiasis; Critical Illness; Cross Infection; Female; Humans; Intensive Care Units; Male; Middle Aged; Pilot Projects; Prospective Studies; Sepsis; Treatment Outcome

Primary amoebic meningoencephalitis (PAM) is a fulminant disease of the brain caused by Naegleria fowleri. Although the disease is rare, the case fatality rate is very high. In this report, we describe the first case of PAM in Zambia.. The patient presented with sudden onset of seizures and fever on admission. On physical examination he was febrile, comatose and with a stiff neck. Cerebral spinal fluid (CSF) collected on admission did not reveal any organism on microscopy or culture but showed elevated white cell count. A working diagnosis of severe septicemia with acute meningoencephalitis was then made and the patient was started on IV Cephtriaxone (2 g) twice daily. Despite receiving treatment, his condition deteriorated. A second CSF sample collected on day 3 was also negative for bacteria and other organisms. However, a repeat CSF sample collected on day 8 revealed numerous motile organisms that were identified as Naegleria on microscopy and confirmed to be N. fowleri on polymerase chain reaction. The patient died on day 8 of hospital admission after having received one dose of Amphotericin B (50 mg). Features consistent with PAM were detected on autopsy.. The isolation of N. fowleri in this patient calls for increased awareness among clinical and laboratory staff on suspected PAM cases to promptly diagnose and effectively manage the disease.

Topics: Amphotericin B; Animals; Anti-Bacterial Agents; Cefuroxime; Central Nervous System Protozoal Infections; Fatal Outcome; Fever; Humans; Male; Naegleria fowleri; Sepsis; Young Adult; Zambia

In Brazil, the rates of mother-to-child-transmission (MTCT) of human immunodeficiency virus (HIV) decreased from 20% to 1-2% in some regions. However, the country contains 90% of individuals infected with visceral leishmaniasis (VL) in Latin America, and the west region of São Paulo state faces an alarming expansion of the disease. We describe the epidemiological aspects of the expanding infection of VL and a case report of an HIV-VL-co-infected child from the west region of São Paulo state. The patient was an AIDS-C3 with low levels of CD4, high viral load, severe diarrhea, oral and perineal candidiasis, severe thrombocytopenia, and protein-caloric malnourishment. She evolved with sepsis, renal and cardiac failure. An rK rapid diagnosis test, indirect fluorescent antibody test (IFAT), and bone marrow aspirate were performed for VL. Her symptoms improved significantly after liposomal amphotericin B administration. From the 45 municipalities that compose the Regional Health Department of Presidente Prudente, Lutzomyia longipalpis vectors were found in 58% of them. VL infected dogs were found in 33% of those municipalities, infected dogs and humans were found in 29%, 20% are starting and 33% of the municipalities are preparing VL investigation. It is likely, in this patient, that VL advanced the clinical progression of the HIV disease and the development of AIDS severity. Supported by favorable conditions, the region becomes a new frontier of VL in Brazil.

Topics: Amphotericin B; Animals; Antiparasitic Agents; Brazil; Child; Coinfection; Dog Diseases; Dogs; Female; HIV Infections; Humans; Leishmaniasis, Visceral; Psychodidae; Sepsis; Treatment Outcome

Invasive aspergillosis is a life-threatening infectious complication in immunocompromised patients, especially with malignancy, and in some cases, it causes extensive tissue destruction and subsequent systemic illness, leading to multiorgan failure and death. Skin involvement and amphotericin B resistance are very rare findings of aspergillosis. Herein, we report the case of a primary hemophagocytic syndrome patient who developed subcutaneous nodules in the 3(rd) month of bone marrow transplantation from which Aspergillus fumigatus was cultivated despite the fact that she was under antifungal therapy. In immunocompromised patients with prolonged fever, atypical presentations of invasive mycosis should be kept in mind, and early appropriate therapy should be initiated promptly to decrease morbidity and mortality.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Bone Marrow Transplantation; Drug Resistance, Fungal; Female; Humans; Immunocompromised Host; Sepsis

To study the clinical characteristics, antibiotics sensitivity, outcome and risk factors of neonatal septicemia caused by Candida haemulonii.. A retrospective analysis was performed on clinical characteristics and antibiotics sensitivity after 8 cases of neonatal septicemia caused by Candida haemulonii were identified; each of these patients had at least one positive result of bacterial culture for Candida haemulonii.. The 8 cases born at gestational age of 178-260 d, weighing 835-2 055 g, developed the infection from May to July at 10-34 d after hospitalization. Among the 8 patients, 7 were cured, 1 died during hospitalization after the treatments were given up because of serious complications. The 8 patients with septicemia caused by Candida haemulonii had similar clinical chariacteristics to those of other neonatal candidemia, such as apnea, fever, abdominal distension, jaundice etc. They had abnormal auxiliary examination with increased C-reactive protein (CRP), declined platelet (PLT) count to different degrees. All of the 8 patients had peripherally inserted central catheter (PICC) and broad-spectrum antibiotics were applied. C. haemulonii as an emergent fungal pathogen had varying degrees of resistance to fluconazole, amphotericin B, itraconazole, or ketone, but was susceptible to voriconazole.. The characteristics of neonatal septicemia caused by Candida haemulonii were similar to those caused by other candida, and the main risk factors are the low birth weight, PICC, and usage of broad-spectrum antibiotics. It mainly occurred in May to July which is hot and humid season.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; C-Reactive Protein; Candida; Candidiasis; Fluconazole; Gestational Age; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Microbial Sensitivity Tests; Retrospective Studies; Sepsis

Candida species has become the seventh most frequent causal microorganisms of nosocomial sepsis. Prematurity and low birth weights are strongly associated with the development of neonatal nosocomial bloodstream infections. Candida albicans has been the species most often associated with neonatal infections, but recently, there has been a changing pattern in the isolates recovered from neonates with invasive candidiasis, which poses resistance to the existing class of azoles such as fluconazole antifungals along with cross resistance to newer triazoles, which results in a therapeutic challenge in invasive fungal infections causing high incidence of mortality. Candida species was isolated from blood of neonates and children younger than 15 years admitted to hospital and susceptible for Candida-induced sepsis. Polymerase chain reaction-based identification and confirmation of individual Candida species were done using DNA sequencing. Antibiotic susceptibility assay and resistance pattern for fluconazole, voriconazole, and amphotericin were done for all the isolates. Furthermore, the change in free radical, cytokine release, and nitric oxide synthase expression and nitric oxide release from polymorphonuclear leukocytes isolated from control and pediatric sepsis cases were also performed. The present study probably for the first time reports the change in increasing incidence of nonalbicans Candida-induced sepsis in neonates and children admitted to the intensive care unit of hospital, and current antibiotics load posing resistance for antifungal treatment strategy and provide serious threats in future treatment. The increase in free radicals in polymorphonuclear leukocytes and increase in expression of nitric oxide synthase expression and nitric oxide release in Candida-infected pediatric sepsis cases underlie the role of host factor in dissemination and invasiveness of infection from exogenous sources and pathogenesis of systemic inflammation during sepsis.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Candida; Candidemia; Candidiasis; Child; Child, Preschool; Cross Infection; Cytokines; Female; Fluconazole; Free Radicals; Humans; Incidence; India; Infant; Infant, Newborn; Intensive Care Units; Interleukin-10; Interleukin-1beta; Male; Microbial Sensitivity Tests; Nitric Oxide; Nitric Oxide Synthase; Sepsis; Tumor Necrosis Factor-alpha; Voriconazole

Amphotericin B (Ampho B) isa fungicidal drug that causes cell wall injury. Pharmacological ascorbate induces the extracellular prooxidants, which might enter the Ampho B-induced cell wall porosity and act synergistically.W e tested low-dose Ampho B with a short course of pharmacological ascorbate using a mouse model of sepsis preconditioned with an injection of Candida albicans 6 h prior to cecal ligation and puncture (CLP). In this model, candidemia reappeared as early as 6 h after CLP with a predictably high mortality rate. This characteristic mimics sepsis in the phase of immunosuppression inpatients. Using the model, at 12- and 18-h post-CLP, we administered isotonic (pH neutralized) pharmacological ascorbate intravenously with low-dose Ampho B or sodium deoxycholate, vehicle-controlled, administered IP. The survival rate of low-dose Ampho B plus ascorbate was 53%, compared with < 11% for low-dose Ampho B or high-dose Ampho B alone. In addition, a beneficial effect was demonstrated in terms of kidney damage,liver injury, spleen histopathology, and serum markers at 24 h after CLP. Kidney injury was less severe in low-dose Ampho B plus ascorbate combination therapy due to less severe sepsis. Moreover, ascorbate enhanced the effectiveness of phagocytosis against C. albicans in human phagocytic cells. Taken together, the data indicate that the new mouse model simulates sepsis-induced immunosuppression and that the combination of pharmacological ascorbate with an antifungal drug is a potentially effective treatment that may reduce nephrotoxicity, and perhaps also increase fungicidal activity in patients with systemic candidiasis caused by Candida albicans.

Topics: Amphotericin B; Animals; Ascorbic Acid; Candidemia; Disease Models, Animal; Drug Combinations; Kidney; Liver; Male; Mice, Inbred BALB C; Sepsis; Spleen

We report a cluster of three extremely-low birth weight (ELBW), preterm neonates who developed late-onset sepsis (LOS) by Trichosporon asahii within a span of 1 week period. Two of these cases had the initial diagnosis of respiratory distress syndrome and the third one was admitted for low birth weight and prematurity. Initial sepsis screen was negative and blood culture was sterile in all. Late-onset sepsis was developed after the first week of life and the presenting features were lethargy, feeding intolerance, bleeding manifestations, positive sepsis screen and severe thrombocytopaenia. The isolates were sensitive to voriconazole but resistant to both amphotericin-B and fluconazole on all occasions. All the infants were treated with liposomal amphotericin-B before the availability of culture reports but the clinical deterioration was rapid and all three neonates succumbed to death before we could procure voriconazole. The source of the outbreak could not be identified from multiple surface cultures from the unit and screening of the health care staffs. We emphasise the need for high index of suspicion for unusual fungal pathogens, resistant to conventional antifungal drugs while treating preterm neonates with LOS.

Topics: Amphotericin B; Antifungal Agents; Communicable Diseases; Drug Administration Schedule; Drug Resistance, Fungal; Fatal Outcome; Guideline Adherence; Humans; Infant; Infant, Newborn; Infant, Premature; Sepsis; Trichosporon; Trichosporonosis; Voriconazole

The incidence of secondary systemic fungal infections has sharply increased in bacterial septic patients. Antimycotics exhibit immunomodulatory properties, yet these effects are incompletely understood in secondary systemic fungal infections following bacterial sepsis. We investigated a model of systemic inflammation to determine whether antimycotics (liposomal amphotericin B (L-AMB), itraconazol (ITC), and anidulafungin (ANI)) modulate the gene and protein expression as well as the phagocytic activity of lipopolysaccharide (LPS)-stimulated human monocytes.. THP-1 monocytes were incubated with L-AMB, ITC or ANI and LPS. Gene expression levels of cytokines (TNF-, IL-1, IL-6, and IL-10) were measured after 2h, 6h, and 24h. Cytokine protein levels were evaluated after 24h and phagocytic activity was determined following co-incubation with Escherichia coli.. All antimycotics differentially modulated the gene and protein expression of cytokines in sepsis-like conditions. In the presence of LPS, we identified L-AMB as immunosuppressive, whereas ITC demonstrated pro-inflammatory properties. Both compounds induced remarkably less phagocytosis.. Our study suggests that antimycotics routinely used in septic patients alter the immune response in sepsis-like conditions by modulating cytokine gene and protein expression levels and phagocytic activity. Future treatment strategies should consider the immune status of the host and apply antimycotics accordingly in bacterial septic patients with secondary fungal infections.

Topics: Amphotericin B; Anidulafungin; Antifungal Agents; Cells, Cultured; Cytokines; Echinocandins; Gene Expression; Humans; Immunosuppressive Agents; Inflammation; Itraconazole; Monocytes; Phagocytosis; Sepsis

Mucormycosis is an uncommon opportunistic fungal infection caused by Zygomycetes. It usually affects immunocompromised, diabetic and trauma patients with infected wounds. We report a case of disseminated infection secondary to facial cutaneous mucormycosis caused by Saksenaea vasiformis in a diabetic patient who had a farming accident causing him severe head injury. The patient was treated with a combination of surgical debridement and antifungal therapy with liposomal amphotericin B, but he had a slow and fatal outcome. In cases of tissue necrosis following trauma involving wound contact with soil (i.e., potential fungal contamination), testing for the presence of Zygomycetes fungi such as S. vasiformis in both immunocompetent and immunocompromised patients is crucial. The reason is that this infection usually has a rapid progression and may be fatal if appropriate treatment is not administered.

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Craniocerebral Trauma; Dermatomycoses; Diabetes Complications; Diabetes Mellitus; Humans; Immunocompromised Host; Male; Middle Aged; Molecular Sequence Data; Mucorales; Mucormycosis; Sepsis

Topics: Amphotericin B; Antifungal Agents; Blood Chemical Analysis; Candida; Candidiasis; Fluconazole; Humans; Hyperphosphatemia; Male; Middle Aged; Sepsis

A comprehensive comparative analysis of the structure-antifungal activity relationships for the series of biosynthetically engineered nystatin analogues and their novel semisynthetic derivatives, as well as amphotericin B (AMB) and its semisynthetic derivatives, was performed. The data obtained revealed the significant influence of the structure of the C-7 to C-10 polyol region on the antifungal activity of these polyene antibiotics. Comparison of positions of hydroxyl groups in the antibiotics and in vitro antifungal activity data showed that the most active are the compounds in which hydroxyl groups are in positions C-8 and C-9 or positions C-7 and C-10. Antibiotics with OH groups at both C-7 and C-9 had the lowest activity. The replacement of the C-16 carboxyl with methyl group did not significantly affect the in vitro antifungal activity of antibiotics without modifications at the amino group of mycosamine. In contrast, the activity of the N-modified derivatives was modulated both by the presence of CH3 or COOH group in the position C-16 and by the structure of the modifying substituent. The most active compounds were tested in vivo to determine the maximum tolerated doses and antifungal activity on the model of candidosis sepsis in leukopenic mice (cyclophosphamide-induced). Study of our library of semisynthetic polyene antibiotics led to the discovery of compounds, namely, N-(L-lysyl)-BSG005 (compound 3n) and, especially, L-glutamate of 2-(N,N-dimethylamino)ethyl amide of S44HP (compound 2j), with high antifungal activity that were comparable in in vitro and in vivo tests to AMB and that have better toxicological properties.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida albicans; Candidiasis; Cyclophosphamide; Drug Evaluation, Preclinical; Leukopenia; Male; Mice; Mice, Inbred C57BL; Mice, Inbred DBA; Nystatin; Polyenes; Sepsis; Small Molecule Libraries; Structure-Activity Relationship

A recent large outbreak of fungal infections by Exserohilum rostratum from contaminated compounding solutions has highlighted the need to rapidly screen available pharmaceuticals that could be useful in therapy. The present study utilized two newly-developed high throughput assays to screen approved drugs and pharmaceutically active compounds for identification of potential antifungal agents. Several known drugs were found that have potent effects against E. rostratum including the triazole antifungal posaconazole. Posaconazole is likely to be effective against infections involving septic joints and may provide an alternative for refractory central nervous system infections. The anti-E. rostratum activities of several other drugs including bithionol (an anti-parasitic drug), tacrolimus (an immunosuppressive agent) and floxuridine (an antimetabolite) were also identified from the drug repurposing screens. In addition, activities of other potential antifungal agents against E. rostratum were excluded, which may avoid unnecessary therapeutic trials and reveals the limited therapeutic alternatives for this outbreak. In summary, this study has demonstrated that drug repurposing screens can be quickly conducted within a useful time-frame. This would allow clinical implementation of identified alternative therapeutics and should be considered as part of the initial public health response to new outbreaks or rapidly-emerging microbial pathogens.

Topics: Adenosine Triphosphate; Amphotericin B; Antifungal Agents; Ascomycota; Bithionol; Cell Line, Tumor; Drug Evaluation, Preclinical; Drug Repositioning; Floxuridine; Humans; Hyphae; Sepsis; Spores, Fungal; Tacrolimus; Triazoles

Topics: Accidents, Traffic; Amphotericin B; Biopsy; Debridement; Face; Fatal Outcome; Female; Humans; Mucormycosis; Multiple Trauma; Necrosis; Sepsis; Young Adult

Systemic Candidia infections are of major concern in neonates, especially in those with risk factors such as longer use of broad spectrum antibiotics. Recent studies showed that also term babies with underlying gastrointestinal or urinary tract abnormalities are much more prone to systemic Candida infection. We report a very rare case of candidiasis caused by Candida kefyr in a term neonate.. Renal agenesis on the left side was diagnosed antenatally and anal atresia postnatally. Moreover, a vesico-ureteral-reflux (VUR) grade V was detected by cystography. The first surgical procedure, creating a protective colostoma, was uneventful. Afterwards our patient developed urosepsis caused by Enterococcus faecalis and was treated with piperacillin. The child improved initially, but deteriorated again. A further urine analysis revealed Candida kefyr in a significant number. As antibiotic resistance data about this non-albicans Candida species are limited, we started liposomal amphotericin B (AMB), but later changed to fluconazole after receiving the antibiogram. Candiduria persisted and abdominal imaging showed a Candida pyelonephritis. Since high grade reflux was prevalent we instilled AMB into the child's bladder as a therapeutic approach. While undergoing surgery (creating a neo-rectum) a recto-vesical fistula could be shown and subsequently was resected. The child recovered completely under systemic fluconazole therapy over 3 months.. Candidiasis is still of major concern in neonates with accompanying risk factors. As clinicians are confronted with an increasing number of non-albicans Candida species, knowledge about these pathogens and their sensitivities is of major importance.

Topics: Amphotericin B; Antifungal Agents; Anus, Imperforate; Candida; Candidiasis; Congenital Abnormalities; Enterococcus faecalis; Fluconazole; Gram-Positive Bacterial Infections; Humans; Infant, Newborn; Kidney; Kidney Diseases; Sepsis; Treatment Outcome; Urinary Tract Infections; Urine; Vesico-Ureteral Reflux

Liposomal amphotericin B (LAMB) is frequently administered in NICU to preterm infants <1500 g at birth (VLBW) for treatment of systemic fungal infections (SFI). Concerns exist on safety and tolerability of such drug in patients who are at risk for renal function impairment due to their prematurity.. To assess the occurrence of renal function impairment related to LAMB in a 10-year cohort of VLBW neonates treated with this drug.. Through database search of clinical charts, all VLBW neonates admitted to a 3(rd) level NICU in the years 1998-2007 and undergoing treatment with LAMB were identified. The occurrence of LAMB-attributable renal toxicity was investigated; infants withdrawn from treatment for development of adverse effects or toxicity were identified.. In the study period, 71 of 792 admitted VLBW neonates (8.9%) underwent antifungal treatment with LAMB administered at the recommended dosages (3-to-5 mg/kg/day). Mean duration of treatment was 14 (±9) days, mean cumulative dose given was 58 (±25) mg/kg per infant. Renal compromise, defined as hypokalaemia, and/or elevated creatinine serum levels, and/or decreased urine output, occurred in 2 of 71 (2.8%) treated patients, by 5 (±3) mean days after treatment initiation. In both patients LAMB was withdrawn; renal function impairment was only mild and transient, and normal renal function was restored at discharge. No other significant adverse effects were recorded in any treated neonate.. LAMB is generally safe and well tolerated in VLBW neonates. The occurrence of LAMB-related nephrotoxicity appears to be uncommon, mild and transient.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Cohort Studies; Creatinine; Fluconazole; Humans; Hypokalemia; Infant, Newborn; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Kidney; Kidney Diseases; Kidney Function Tests; Mycoses; Premature Birth; Retrospective Studies; Sepsis

Penicillium marneffei (P. marneffei) infection usually occurs with skin, bone marrow, lung or hepatic involvement. However, no cases of P. marneffei infection with chylous ascites have been reported thus far. In this report, we describe the first case of acquired immune deficiency syndrome (AIDS) which has been complicated by a P. marneffei infection causing chylous ascites. We describe the details of the case, with an emphasis on treatment regimen. This patient was treated with amphotericin B for 3 mo, while receiving concomitant therapy with an efavirenz-containing antiretroviral regimen, but cultures in ascitic fluid were persistently positive for P. marneffei. The infection resolved after treatment with high-dose voriconazole (400 mg every 12 h) for 3 mo. P. marneffei should be considered in the differential diagnosis of chylous ascites in human immunodeficiency virus patients. High-dose voriconazole is an effective, well-tolerated and convenient option for the treatment of systemic infections with P. marneffei in AIDS patients on an efavirenz-containing antiretroviral regimen.

Topics: Acquired Immunodeficiency Syndrome; AIDS-Related Opportunistic Infections; Alkynes; Amphotericin B; Anti-Retroviral Agents; Antifungal Agents; Benzoxazines; Chylous Ascites; Cyclopropanes; Diagnosis, Differential; Humans; Male; Middle Aged; Mycoses; Penicillium; Pyrimidines; Sepsis; Triazoles; Voriconazole

Post-sternotomy infectious complications, including superficial and deep wound infections, sternal osteomyelitis and mediastinitis, are rarely caused by fungi. Trichosporon asahii is the main Trichosporon species that causes systemic infection in humans. Most cases involved neutropenic patients with hematologic malignancies. We report a unique case of a non-cancer, non-neutropenic but severely ill patient who developed an ultimately lethal T. asahii infection after sternotomy. We speculate that our patient had been colonized with the fungus and his surgical site infection may have been related to his emergency revascularization surgery. Therapy with liposomal amphotericin failed to sterilize the bloodstream despite in vitro susceptibility results. The addition of voriconazole helped sterilizing the bloodstream without changing the outcome. Physicians must be aware of the continuously expanding spectrum of infections with this emerging difficult-to-treat fungal pathogen.

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Fatal Outcome; Humans; Male; Mediastinitis; Mycoses; Osteomyelitis; Sepsis; Sternotomy; Surgical Wound Infection; Trichosporon

We evaluated the efficacy of amphotericin B (1.5mg/kg/day), voriconazole (60mg/kg/day) and posaconazole (60mg/kg/day) in a murine model of systemic infection caused by Neoscytalidium dimidiatum. All the treatments were able to prolong survival and to reduce the tissue burden in the spleen and kidneys of infected mice. Neither voriconazole nor posaconazole improved the results achieved with amphotericin B.

Topics: Amphotericin B; Animals; Antifungal Agents; Ascomycota; Colony Count, Microbial; Disease Models, Animal; Kidney; Male; Mice; Mycoses; Neutropenia; Pyrimidines; Sepsis; Spleen; Survival Analysis; Treatment Outcome; Triazoles; Voriconazole

Skin lesions associated with Candida septicaemia occur only in a minority of patients, who are usually immunocompromised, but they can help to establish a diagnosis rapidly. The lesions form a characteristic maculopapular or nodular rash at the onset of the infection. We report three cases of systemic candidiasis (SC) with cutaneous manifestations in immunocompromised patients. In these patients, the lesions started as asymptomatic or slightly pruriginous macules, papules or nodules localized on the trunk and extremities. The patients' general condition was very poor and they presented a high fever at the onset of the illness. Candida spp. were isolated from blood in all cases, and histology showed yeasts in two of them. Most of the lesions resolved with antifungal treatment. The diagnosis of SC is often delayed or missed because of the absence of useful diagnostic tools, the varying clinical manifestations and the frequent negativity (50-75%) of blood cultures for Candida. Fluconazole is the treatment of choice for Candida albicans, but treatment response is unknown for other Candida spp., which may require treatment with amphotericin B.

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; Candidiasis, Cutaneous; Female; Fluconazole; Humans; Immunocompromised Host; Male; Middle Aged; Risk Factors; Sepsis

To report a case of fungal sepsis treated prospectively with liposomal amphotericin, caspofungin, and a novel monoclonal antibody specific for candidal heat shock protein 90 (Mycograb, Neutec Pharma, Manchester, UK).. Case report.. Pediatric intensive care unit in a tertiary care children's hospital.. A 7-yr-old male with a history of global developmental delay, epilepsy, and gastroesophageal reflux, who presented to the emergency department with a transdiaphragmatic herniation of bowel and subsequent Candida glabrata infection.. Efungumab 1 mg/kg twice daily for 5 days.. C-reactive protein fell from 225 mg/L to 99 mg/L, and physiological monitoring parameters improved when Mycograb was used in conjunction with high-dose antifungals.. Mycograb therapy was well tolerated, but further experience with this therapy in children is needed.

Topics: Amphotericin B; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antifungal Agents; Candida glabrata; Candidiasis; Caspofungin; Child; Critical Illness; Drug Therapy, Combination; Echinocandins; Hernia, Diaphragmatic; HSP90 Heat-Shock Proteins; Humans; Lipopeptides; Male; Postoperative Complications; Recombinant Proteins; Sepsis

Neonatal infection due to Cryptococcus neoformans is extremely rare. We report a case of a 21-day-old neonate diagnosed with cryptococcal septicemia who was successfully treated with amphotericin B. He was born to a human immunodeficiency virus (HIV) seronegative mother. This report alerts general pediatricians and neonatologists to consider Cryptococcus neoformans infection as a possible cause of sepsis in newborn infants.

Topics: Amphotericin B; Antifungal Agents; Cryptococcosis; Cryptococcus neoformans; Humans; Immunocompetence; Infant, Newborn; Male; Sepsis

This is a case of mucormycosis complicated by necrotizing fasciitis in a renal transplant recipient on immunosuppressive therapy treated with posaconazole. Mucormycosis occurs most commonly as an opportunistic infection in the immunocompromised host. This patient, with predisposing risk factors for infection, including diabetes mellitus status post cadaveric renal transplantation on immunosuppressive therapy, is the first reported case of successful treatment of Mucor involving an extremity which was neither fatal nor required extremity amputation.

Topics: Alcaligenes; Amphotericin B; Amputation, Surgical; Antifungal Agents; Cefazolin; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 2; Diabetic Nephropathies; Drug Combinations; Drug Resistance, Multiple, Fungal; Escherichia coli Infections; Fatal Outcome; Fluconazole; Gangrene; Graft Rejection; Gram-Negative Bacterial Infections; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Transplantation; Leg; Leg Ulcer; Male; Middle Aged; Mucor; Mucormycosis; Penicillanic Acid; Phosphatidylcholines; Phosphatidylglycerols; Piperacillin; Postoperative Complications; Pyrimidines; Renal Dialysis; Reoperation; Sepsis; Skin Transplantation; Tazobactam; Triazoles; Voriconazole

We report one case of severe Candida glabrata chorioamnionitis and septicemy occurring in a twin pregnancies achieved by in vitro fertilization techniques which resulted in pregnancy loss after preterm rupture of the membrane at 22 weeks of gestation despite a treatment with amphotericin B.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Candida glabrata; Candidiasis; Chorioamnionitis; Female; Fertilization in Vitro; Fetal Death; Fetal Membranes, Premature Rupture; Humans; Pregnancy; Pregnancy, Multiple; Sepsis; Twins

Candidal endocarditis is an uncommon and serious complication of invasive Candida infection in neonates. The aim of this study was to further characterise candidal endocarditis in neonates. Between 1995 and 2000, 56 patients were diagnosed with Candida bloodstream infections (CBSI) in the Neonatal Intensive Care Unit of Schneider Children's Medical Center of Israel. Five of them (9%) developed mycetoma of the right atrium. None of the patients had congenital heart disease or a central venous catheter in the right heart at the time of diagnosis. All were treated with amphotericin B alone or in combination with other antifungals, without surgical intervention. One patient died of the disease and one died later of polymicrobial sepsis and necrotizing enterocolitis. A review of the literature since 1980 yielded an additional 25 cases of candidal endocarditis. For the whole sample (n = 30) survival rate was 73.1%. Six of the 10 patients treated with antifungal agents and surgery survived (60%), compared with 13 of the 20 patients treated only medically (65%) (P = 1.0). Candida endocarditis in neonates differs from fungal endocarditis in adults in risk factors, clinical presentation and outcome. As the outcome of surgical and medical treatment are comparable, antifungal therapy alone may be a valid therapeutic option in high-risk cases.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Drug Therapy, Combination; Endocarditis; Enterocolitis; Fatal Outcome; Female; Fungemia; Heart Atria; Humans; Infant, Newborn; Mycetoma; Premature Birth; Review Literature as Topic; Risk Factors; Sepsis; Thinness; Thoracic Surgery; Treatment Outcome

Invasive aspergillosis is an emerging infection mainly affecting immunocompromised patients. This report details a case of Aspergillus fumigatus tricuspid native valve endocarditis complicated by recurrent septic pulmonary emboli in a young, non-intravenous drug user. He was treated by surgical resection of the posterior leaflet of the tricuspid valve and the vegetations, as well as by valvuloplasty, which was followed by a combination of liposomal amphotericin B and voriconazole as acute-phase therapy and voriconazole alone as suppression therapy.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Combined Modality Therapy; Endocarditis; Heart Valve Diseases; Humans; Male; Pulmonary Embolism; Pyrimidines; Sepsis; Triazoles; Tricuspid Valve; Voriconazole

Topics: Accidents, Occupational; Aged; Agriculture; Amphotericin B; Antifungal Agents; Caspofungin; Drug Therapy, Combination; Echinocandins; Fatal Outcome; Humans; Lipopeptides; Male; Multiple Organ Failure; Mycoses; Peptides, Cyclic; Sepsis; Species Specificity; Trichosporon

Blastoschizomyces capitatus (formerly known as Geotrichum capitatum and Trichosporon capitatum) is a rare, yet an emerging, cause of invasive infections in immunosuppressed patients. Profound and prolonged neutropenia is the crucial predisposing factor for this yeast infection. Blastoschizomyces capitatus was isolated from peripheral blood cultures of a profoundly neutropenic patient with acute myeloid leukemia (M2 FAB). Despite administration of antifungal chemotherapy with liposomal amphotericin B at 4.5 mg kg(-1) daily, the patient succumbed 4 days after initiation of treatment. Infections attributed to B. capitatus have generally a poor prognosis, although the yeast shows in vitro susceptibility to antifungal agents. Low flucytosine, caspofungin acetate, voriconazole and amphotericin B minimum inhibitory concentration values were also recorded with our isolate. The clinical relevance of the in vitro susceptibility testing against the isolate and the current antifungal chemotherapy regimens against B. capitatus systemic infections are discussed.

Topics: Aged; Amphotericin B; Antifungal Agents; Blood; Fatal Outcome; Fungemia; Geotrichosis; Geotrichum; Greece; Humans; Leukemia, Myeloid, Acute; Male; Neutropenia; Sepsis

Fusarium species are hyaline moulds belonging to the hyalohyphomycosis group that are usually found in the soil and plants. This organism has emerged as a cause of disseminated invasive disease. The correlation between in vitro value and clinical efficacy is low and many patients remain unresponsive to treatment despite in vitro susceptibility. We determined growth control for Fusarium solani using the BioCell-Tracer system that measures the growth rate of a single fungal hypha, and the effect of different concentrations of amphotericin B and itraconazole. The MIC for these two drugs was also determined by a broth microdilution technique, using RPMI 1640. Different MICs for amphotericin B were obtained by the two different methods. This paper describes a case of infection due to Fusarium solani in an allogeneic bone marrow transplanted patient, the microbiological diagnostic, antifungal susceptibility tests for conidia and hypha and clinical correlation.

Topics: Adult; Amphotericin B; Antifungal Agents; Bone Marrow Transplantation; DNA, Fungal; Fatal Outcome; Female; Fusarium; Humans; Immunocompromised Host; Mycoses; Pregnancy; Pregnancy Complications, Infectious; Sepsis

A 62-year-old man diagnosed with acute myelogenous leukemia which had developed from myelodysplastic syndrome received cytarabine and idarubicine as an induction therapy. The patient developed pneumonia and bacterial sepsis during profound neutropenia. Fever and sepsis improved by using many anti-bacterials and anti-fungals but he became febrile again and complained of severe lumbar pain. 67Ga scintigram showed abnormal uptake in the lumbar vertebra and left sternoclavicular joint, suggesting a diagnosis of discitis and osteomyelitis in the lumbar vertebra and sternoclavicular arthritis. We biopsied the site several times but culture of the biopsy specimen could not isolate any pathogens, and high fever persisted for about 10 months despite administration of various anti-bacterials and anti-fungals. Finally we inserted a catheter into the abscess at the iliopsoas muscle and Scedosporium apiospermum was isolated in the bloody pus obtained from the catheter. Itraconazole and amphotericin B were restarted, and the high fever and lumbar pain improved rapidly. The findings of S. apiospermum infection in this patient emphasizes the importance of being aware of this pathogen in patients with hematologic malignancy during the neutropenic phase.

Topics: Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Discitis; Drug Therapy, Combination; Humans; Itraconazole; Leukemia, Myeloid, Acute; Male; Middle Aged; Opportunistic Infections; Osteomyelitis; Scedosporium; Sepsis

A 54-year-old farmer with moderate mitral valve regurgitation was admitted to hospital because of suspected infective endocarditis.. Echocardiography revealed a large mitral valve vegetation as the source of multifocal septic emboli to the central nervous system, spleen, mesenteric and femoro-popliteal arteries, eyes, and kidneys. Eventually an embolus removed from the femoro-popliteal artery and vegetations on the replaced mitral valve grew C. albicans.. Despite treatment with amphotericin B and valve replacement the patient died of septicemia due to E. coli.. Endocarditis due to C. albicans is commonly associated with severe complications. Diagnosis of this rare disease is often delayed because of negative blood cultures. Large cardiac vegetations and embolization of major arterial vessels should raise the suspicion of fungal endocarditis.

Topics: Amphotericin B; Candida albicans; Candidiasis; Echocardiography; Embolism; Endocarditis; Escherichia coli Infections; Fatal Outcome; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Sepsis

Trichosporon asahii causes white piedra, an infection of hair shafts and onychomycosis in immunocompetent patients, as well as various localized or disseminated invasive infections in immunodeficient hosts. We describe a 26-week gestation 890-g vaginally delivered female neonate who had severe respiratory distress syndrome and on the sixth day of life developed Klebsiella pneumoniae sepsis. At the same time two blood cultures were positive for T. asahii. The neonate was also colonized with T. asahii in the pharynx and perineum. The infant was successfully treated with conventional amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Klebsiella Infections; Klebsiella pneumoniae; Mycoses; Respiratory Distress Syndrome, Newborn; Sepsis; Trichosporon

Topics: Amphotericin B; Aspergillosis; Aspergillus flavus; Aspergillus niger; Bandages; Dermatomycoses; Fatal Outcome; Female; Humans; Infant, Newborn; Infant, Premature; Intubation, Intratracheal; Male; Respiratory Insufficiency; Sepsis

Bacterial sepsis remains a frequent complication after liver transplantation. We previously reported the results of a pilot study that suggested that low expression of HLA-DR on monocytes is a predictive marker for the occurrence of sepsis. We have studied the value of this marker in an additional cohort of patients, and have analyzed the relation of HLA-DR expression with the use of immunosuppressive agents. 20 adult liver transplantation patients were prospectively monitored during the first 4 weeks after transplantation. All were treated according to standard protocols. The percentage of monocytes expressing HLA-DR was measured by flow cytometry. In addition, the effects of incubation of monocytes with prednisolone in vitro on the expression of HLA-DR was determined in 7 healthy volunteers. Seven patients developed bacterial sepsis after a median 15 (range 10-20) days after transplantation. HLA-DR expression was significantly lower in these patients on days 7, 14, 21, and 28 after transplantation compared with non-septic patients. The percentage of HLA-DR positive monocytes was 30% or less, 3 (1-8) days before onset of sepsis. On day 7 after transplantation, HLA-DR expression on 50% or less of monocytes had a positive predictive value for sepsis of 71%, whereas the negative predictive value was 85%. Patients who developed sepsis received significantly more prednisolone. Incubation with prednisolone in vitro lowered the expression of HLA-DR in a dose-dependent manner. We conclude that low HLA-DR expression on monocytes is a marker for a high risk of subsequent sepsis in liver transplantation patients. This high risk may be (at least partly) related to the dose of prednisolone.

Topics: Adolescent; Adult; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Biomarkers; Drug Therapy, Combination; Female; HLA-DR Antigens; Humans; Immunosuppression Therapy; Immunosuppressive Agents; Liver Transplantation; Lymphocytes; Male; Middle Aged; Monitoring, Immunologic; Postoperative Complications; Predictive Value of Tests; Prospective Studies; Sepsis

Our objective was to carry-out a prospective study of newborns with systemic candidiasis admitted to our Neonatology Unit in a teritiary hospital during the period of March 1994-September 1997.. To be included in the study the patient had to have Candida sp recovered from a normally sterile body fluid and clinical signs of sepsis. We analyzed perinatal and neonatal antecedents, risk factors, clinical course, diagnosis, treatment and outcome.. The incidence of systemic candidiasis was 0.62% (14 newborns). Two were term infants and 12 preterm infants, 9 of which weighed less than 1500 g. All of the patients had as predisposing factors the use of broad spectrum antibiotics, prolonged intravascular catheterization and parenteral nutrition, while 64% had mechanical ventilation. The mean age at onset of sepsis was 22 days, with non-specific clinical presentation. Four infants were treated with intravenous amphotericin B and 9 with liposomal amphotericin B in association with fluconazole in one patient and with flucytosine and fluconazole in another. No adverse effects were observed. Mortality was 21%. C. parapsilosis was isolated in 7 cases and C. albicans in another 7 patients, with an important increase in C. parapsilosis in the last few years.. Clinical suspicion of invasive candidiasis requires the removal of indwelling catheters and early initiation of systemic ungal therapy to reduce mortality. The increased incidence of species with more epidemic presentation like C. parapsilosis reinforce the importance of control measures such as handwashing for all personnel and aseptic management of intravascular catheters and solutions in order to prevent infections.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Drug Therapy, Combination; Fluconazole; Humans; Infant, Newborn; Prospective Studies; Sepsis

Two imported cases of Penicillium marneffei infection in Belgium are reported. Both patients are Thai women co-infected with HIV. P. marneffei infection should be suspected in immunocompromised patients originating or travelling from South-East Asia with unexplained fever (> 38 degrees C), weight loss, a generalised lymphadenopathy, hepatomegaly, splenomegaly, skin lesions, cough and anaemia. Diagnosis is made by culture and/or histopathological examination. Mild to moderate infections are treated with itraconazole 400 mg/day as first choice. Amphotericin B parenteral therapy may be required for seriously ill patients. Maintenance therapy with itraconazole 200 mg/day is necessary to prevent relapses.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Belgium; Dermatomycoses; Fatal Outcome; Female; Fever; Humans; Immunocompromised Host; Itraconazole; Lymphatic Diseases; Mycoses; Penicillium; Sepsis; Thailand; Travel; Weight Loss

We report the occurrence of invasive Candida albicans infection with disseminated cutaneous Candida granulomas in a patient with aplastic anaemia after viral hepatitis. Fungal elements in a skin biopsy specimen were detected by PAS stain and identified as Candida sp. by immunohistochemistry directed against the C. albicans mannan surface antigen. Based on rapid diagnosis of Candida granuloma and by Candida-positive cultures of blood and swabs, systemic treatment with liposomal amphotericin B led to survival of the patient.

Topics: Adult; Amphotericin B; Anemia, Aplastic; Antibodies, Fungal; Antibodies, Monoclonal; Antifungal Agents; Antigens, Fungal; Antigens, Surface; Candida albicans; Candidiasis; Dermatomycoses; Granuloma; Hepatitis, Viral, Human; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Immunocompromised Host; Immunohistochemistry; Male; Mannans; Polysaccharides, Bacterial; Sepsis

Trichosporon beigelii is an uncommon cause of sepsis in low-birth-weight infants. We present two cases of neonatal trichosporonosis and two cases of neonatal trichosporon colonization to familiarize neonatologists with this entity and to discuss management considerations. A 23-week-gestation male developed clinical evidence of sepsis on day 10 and was found to have "yeast" growing in a blood culture on day 12. Despite receiving amphotericin B, he expired within 2 days, at which time the organism was identified as T. beigelii. A 23-week gestation female developed fungal septicemia in the second week of life, while being treated for persistent bacterial sepsis. Candida albicans grew from blood culture, while T. beigelii grew from suprapubic urine, tracheal aspirate, and umbilical catheter tip cultures. She died 2 days later despite therapy with amphotericin B, at which time the fungal isolates were correctly identified. Two other infants were found to have colonization of central vascular catheters, without evidence of invasive disease. Trichosporon infections in neonates have been almost uniformly fatal. Most strains of T. beigelii are relatively resistant to amphotericin B and may be confused with Candida sp. on initial culture examinations. Therefore, delays in appropriate treatment may occur. We discuss treatment options, including alternative antifungal drugs, as well as possibilities for combination therapy.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Catheterization, Central Venous; Catheterization, Peripheral; Diagnosis, Differential; Drug Combinations; Drug Resistance, Microbial; Equipment Contamination; Fatal Outcome; Female; Fungemia; Humans; Infant, Low Birth Weight; Infant, Newborn; Male; Methicillin Resistance; Mycoses; Sepsis; Staphylococcal Infections; Staphylococcus epidermidis; Trachea; Trichosporon; Urine

We report on a 32-year old HIV-infected male patient who was admitted to the hospital in a comatose state. A cryptococcus neoformans septicemia with meningoencephalitis was diagnosed. Intravenous treatment with amphotericin B was initiated and replaced three weeks later by fluconazole per os. With this therapy the patient recovered quite well. However, following two grand mal epileptic seizures he suddenly fell into a deep coma 22 days after admission to the hospital. The cause of the encephalopathy remained unclear, and the patient died 2 days later. Autopsy revealed a severe meningoencephalitis and a pneumonia due to cryptococcus neoformans. Departing from this case we discuss diagnosis, clinical presentation and treatment of cryptococcus meningoencephalitis.

Topics: Administration, Oral; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Cryptococcus neoformans; Epilepsy, Tonic-Clonic; Fatal Outcome; Fluconazole; HIV Infections; Humans; Injections, Intravenous; Male; Meningoencephalitis; Pneumonia, Bacterial; Sepsis

A 58-year-old patient suffered from persistent Candida glabrata fungaemia. Transoesophageal echocardiography detected a central venous catheter-related intracardiac thrombosis. Cardiotomy permitted the removal of the catheter and its adherent clot. Candida glabrata was cultured from the thrombus.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Cardiac Surgical Procedures; Catheterization, Central Venous; Female; Humans; Middle Aged; Sepsis; Thrombosis

Invasive Trichosporon capitatum infections are seldom reported. We present here five cases of septicemia. All patients had an acute myeloblastic leukemia and were severely neutropenic. They have also been treated before the onset of the fungal infection with broad-spectrum antibiotherapy and also with an oral azole antifungal agent. The role of this antifungal therapy in the development of T. capitatum infection is discussed. The prognosis of T. capitatum infections is severe. Eight of the 10 published cases had a fatal outcome and one of our patients died of the fungal infection in spite of the treatment.

Topics: Adult; Amphotericin B; Bone Marrow Transplantation; Female; Graft vs Host Disease; Humans; Immunocompromised Host; Leukemia, Myeloid; Male; Middle Aged; Mycoses; Neutropenia; Prognosis; Sepsis; Trichosporon

Topics: Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Drug Therapy, Combination; gamma-Globulins; Granulocyte Colony-Stimulating Factor; Granulocytes; Hematologic Diseases; Humans; Leukopenia; Mycoses; Sepsis

A case of lethal pulmonary infection after catheter septicaemia with demonstration of C. lusitaniae in the blood is reported in a 73 year old patient with terminal Crohn's disease receiving long-term parenteral nutrition.

Topics: Aged; Amphotericin B; Candidiasis; Catheterization, Central Venous; Flucytosine; Humans; Male; Parenteral Nutrition, Total; Sepsis

Topics: Acute Disease; Adult; Agranulocytosis; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Ciprofloxacin; Combined Modality Therapy; Drug Evaluation; Drug Therapy, Combination; Humans; Leukemia; Roxithromycin; Sepsis; Streptococcal Infections

A 58-year-old, alcoholic, diabetic man presented with multiple, ulcerated skin lesions and polymicrobial septicemia. Sporothrix schenckii was recovered from blood cultures and was resistant to amphotericin B by in vitro testing. Amphotericin B therapy failed, but the patient responded dramatically to itraconazole therapy, only to relapse 3 months after therapy was stopped. Reinstitution of itraconazole therapy has produced another dramatic response. This report is noteworthy for three reasons. First, to our knowledge, it represents only the second reported instance of fungemia with S schenckii that responded to medical therapy. Second, it illustrates that in vitro antifungal susceptibility tests may predict clinical infection response to drug therapy. Third, it suggests that itraconazole has significant promise in treating systemic sporotrichosis.

Topics: Amphotericin B; Antifungal Agents; Drug Resistance, Microbial; Humans; Itraconazole; Ketoconazole; Male; Middle Aged; Sepsis; Sporothrix; Sporotrichosis

To assess the incidence, risk factors, and course of acute renal failure (ARF) following bone marrow transplantation (BMT), a retrospective analysis of 272 patients receiving transplants at the Fred Hutchinson Cancer Research Center during 1986 was undertaken. The patients were divided into three groups: group 1, hemodialysis requiring ARF; group 2, mild renal insufficiency (doubling of serum creatinine, Scr, but no dialysis); group 3, relatively normal post-BMT renal function (no doubling of Scr). Fifty-three percent of patients at least doubled their Scr (Groups 1 and 2), and 24% required dialysis. The degree of renal functional impairment had a dramatic impact on patient mortality rates (84%, 37%, and 17% in groups 1, 2, and 3, respectively). Jaundice (bilirubin greater than or equal to 2.0 mg/dL), weight gain (greater than or equal to 2.0 kg), amphotericin B use, and a pretransplant Scr greater than or equal to 0.7 mg/dL were independently associated with the subsequent development of dialysis-requiring ARF (P less than 0.001; relative risks, 3.0 to 7.7). Neither aminoglycoside/vancomycin/cyclosporine A use nor acute graft v host disease correlated with the development of ARF. A mismatched graft was a significant risk factor for ARF by univariate but not by multivariate analysis. Within 48 hours before doubling the Scr, 63% of group 1 patients had positive blood cultures and 39% developed hypotension. Of the 26 group 1 patients who had urine Na concentrations measured, 85% had values less than or equal to 40 mEq/L. Autopsy kidney specimens provided no clear explanation for ARF in the vast majority of patients in group 1.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acute Kidney Injury; Amphotericin B; Body Weight; Bone Marrow Transplantation; Creatinine; Histocompatibility Testing; Humans; Jaundice; Postoperative Complications; Prognosis; Renal Dialysis; Retrospective Studies; Risk Factors; Sepsis

Topics: Amphotericin B; Female; Humans; Miconazole; Middle Aged; Mycoses; Myelodysplastic Syndromes; Sepsis; Trichosporon

The frequency, mode of occurrence, diagnostic criteria and main features of systemic and visceral candidiasis have been evaluated in a retrospective study of all cases managed in St Louis Hospital, Paris, during the [June 1, 1985-May 31, 1986] period. During this one year period 23 patients suffered from systemic or visceral candidiasis and Candida spp. accounted for 9.6% of all positive blood cultures, fourth in number after Enterobacteriaceae, Staphylococcus and Pseudomonas. Abnormal underlying condition was present in all patients, mainly haematologic malignancies, serious abdominal surgery and AIDS. In patients with haematologic malignancies C. tropicalis was the main species involved in contrast with surgical patients in whom the dominant responsible species was C. albicans. No Candida oesophagus was common. Therapeutic regimens included amphotericin B in all patients with systemic disease. We conclude that in an institution mainly oriented toward management of cancer and surgical patients, systemic and visceral candidiasis are common and represent a serious problem.

Topics: Adolescent; Adult; Aged; Amphotericin B; Blood; Candidiasis; Child; Child, Preschool; Cross Infection; Female; Hospitals, General; Humans; Infant; Ketoconazole; Male; Middle Aged; Paris; Retrospective Studies; Sepsis

This report reviews 48 episodes of hospital-acquired fungemia that occurred over a four-year period at a large community teaching hospital. The incidence of hospital-acquired fungemia increased eightfold during the study period. Candida albicans (58%), Candida tropicalis (25%), and Candida parapsilosis (15%) were the most common fungal pathogens isolated from blood cultures. Twenty-one patients (44%) had concomitant bacteremia. Intravascular catheters (100%), antibiotic administration (98%), urinary catheters (81%), surgical procedures (65%), parenteral alimentation (60%), and corticosteroid administration (54%) were the most common predisposing factors. The overall mortality rate was 75%. Hospitalization on the medical service, age greater than 60 years, and hospital stay less than 100 days were associated with a significantly increased mortality rate.

Topics: Adult; Amphotericin B; Candidiasis; Cross Infection; Hematologic Diseases; Hospitals, Community; Hospitals, Teaching; Humans; Middle Aged; Retrospective Studies; Sepsis

Eighty-three patients with 117 episodes of candidemia were reviewed to examine the clinically significant variables and the results of treatment for this problem. Mortality was 52%. Patients who had bacteremia either synchronously or metachronously in association with Candida species had poorer survival rates. Staphylococcal and enterococcal species were the most frequently associated bacteria. Patients with Candida parapsilosis had better survival rates than patients with other species. Portals of entry for fungemia were catheters, wounds, the urinary tract, and the peritoneal cavity, but were undefined in 54% of patients. Antifungal chemotherapy could not be identified as affecting the outcome in these patients. It is suggested that candidemia in most patients represents a failure of host defense, and that septicemia of either bacteria or fungi may arise from the gastrointestinal tract in critically ill, immunocompromised patients.

Topics: Adolescent; Adult; Aged; Amphotericin B; Candidiasis; Child; Enterobacteriaceae Infections; Female; Humans; Immunocompetence; Male; Middle Aged; Nystatin; Sepsis; Staphylococcal Infections

Candida septic thrombosis of the great central veins is rarely diagnosed during life, and reports of survival with this condition are exceedingly rare. Eight patients with Candida septic thrombosis of the central veins, with six survivors, are reported. Seven of eight patients had multiple organ system failure following surgery or trauma. All patients had received broad spectrum antibiotics and total parenteral nutrition via a central catheter. Every patient showed features of venous thrombosis with localizing extremity edema and high grade candidemia. Intensive amphotericin B therapy (mean daily dose: 0.7 mg/kg) in all patients, combined with 5-fluorocytosine in five cases, resulted in cure and long-term survival in six patients who received 1600 to 3435 mg (mean: 26 mg/kg) total dose. None of these patients developed renal failure, while four showed improving renal function during treatment. In contrast to Candida endocarditis, septic central vein thrombosis caused by Candida appears to be curable medically in the majority of cases with intensive amphotericin B therapy (total dose: greater than or equal to 22 mg/kg), combined when feasible with 5-fluorocytosine.

Topics: Adult; Aged; Amphotericin B; Candidiasis; Catheterization; Cytosine; Female; Flucytosine; Humans; Male; Middle Aged; Sepsis; Surgical Wound Infection; Thrombophlebitis

The laboratory diagnosis and therapeutic management of disseminated sporotrichosis can present many problems to the clinical laboratory and the clinician. Culturing of clinical specimens is necessary because the direct microscopic examination of specimens for Sporothrix schenckii often is not useful. Although this organism has been recovered from many specimen sites, recovery from blood has been rare. This report summarizes data concerning recovery of S. schenckii from clinical specimens and the use of serologic and fungal antimicrobial susceptibility data. It appears to be the first antemortem recovery of S. schenckii from blood reported since 1909.

Topics: Amphotericin B; Female; Humans; Ketoconazole; Middle Aged; Sepsis; Sporothrix; Sporotrichosis

Three patients with Candida parapsilosis septicemia, secondary to large burns, are reported. All patients sustained large burns with inhalation injuries and were treated with various topical antibiotics. All had sepsis with various bacterial organisms and had received treatment with systemic antibiotics prior to the development of the Candida episode. Once a positive blood culture for Candida parapsilosis was obtained, treatment was carried out with amphotericin-B. Sensitivity data indicated that this was the appropriate systemic agent. All patients recovered uneventfully after a 10-day course of amphotericin-B therapy.

Topics: Amphotericin B; Burns; Candida; Candidiasis; Child; Female; Humans; Male; Sepsis

Five yeast strains, causally associated with septicemia and death in a patient after peritonitis, were identified as Candida lusitaniae van Uden et do Carmo-Sousa by standard methods. The organism was initially susceptible to 5-fluorocytosine but strongly resistant to amphotericin B, requiring 50 micrograms/ml for complete inhibition at 48 h.

Topics: Amphotericin B; Candida; Candidiasis; Drug Resistance, Microbial; Humans; Sepsis

Topics: Amphotericin B; Candidiasis; Humans; Leukopenia; Male; Middle Aged; Sepsis; Shock, Septic

The natural history of candidiasis in general surgical patients has been poorly documented, and the toxicity of amphotericin B is widely heralded. For these reasons therapy for candidiasis is frequently withheld in situations where antimicrobial treatment seems indicated on clinical grounds. The clinical courses of 47 general surgical patients who received amphotericin therapy for presumed Candida infection were reviewed. Nineteen patients had had solid tumors, but 12 were either localized or resected tumors. Only nine patients had received prior cancer themotherapy. Twenty-one patients were treated for fungemic disease, 10 for Candida in peritonitis fluid, and 16 for apparent colonization associated with fever and organ failure syndromes. Pre-existing renal or other organ failure was the primary determinant of survival with 4/22 survivors (18%) in patients with renal failure compared with 17/25 (78%) survivors in patients without such organ failure. In patients with serum creatinine values less than 2.5 mg/dl, amphotericin therapy was associated with a transient 30% fall in creatinine clearance and a proportionate rise in serum creatinine. Dose response curves were determined and revealed substantial sterilization of cultures in both fungemic and nonfungemic patients receiving greater than or equal to 6 mg/kg. This was confirmed by autopsy material. We suggest that in this acutely ill patient popoulation uncontrolled infection is the primary determinant of organ failure. Short-term limited dosing with amphotericin B (6-8 mg/kg total dose) in conjunction with appraisal of clinical response is adequate therapy for most presumed Candida infections. Long-term high dose therapy, such as that recommended in immuodepressed patients, is not a routine necessity.

Topics: Acute Kidney Injury; Amphotericin B; Candidiasis; Creatinine; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Neoplasms; Peritonitis; Postoperative Complications; Sepsis; Surgical Procedures, Operative

Topics: Adolescent; Adult; Aged; Amphotericin B; Catheters, Indwelling; Female; Humans; Male; Middle Aged; Parenteral Nutrition; Sepsis; Staphylococcal Infections; Staphylococcus aureus

Amphotericin B is used increasingly in high-risk patients with profound neutropenia and suspected sepsis. We have observed serious pulmonary reactions characterized by acute dyspnea, hypoxemia, and interstitial infiltrates on chest films in patients receiving amphotericin B and leukocyte transfusions. We reviewed 6 1/2 years of experience at the National Institutes of Health to determine whether this combination was associated with pulmonary toxicity not characteristic of either therapy alone. Amphotericin was used during 22 of 57 leukocyte-transfusion courses. Acute respiratory deterioration occurred during 14 (64 per cent) of these courses but in only two (6 per cent) of 35 courses without amphotericin (P less than 0.01). In seven cases, respiratory deterioration began during or immediately after amphotericin infusion, and it contributed to death in five patients. Diffuse intraalveolar hemorrhage was found when lung biopsy or autopsy was performed. Acute respiratory deterioration was not observed in comparably neutropenic patients given amphotericin but not leukocyte transfusions during the same period. It was mot common when amphotericin was begun with or after institution of daily leukocyte transfusions. Leukocyte transfusions may cause changes in the lungs that amplify the acute toxicity of amphotericin, thereby permitting severe pulmonary reactions.

Topics: Adolescent; Adult; Amphotericin B; Child; Dyspnea; Female; Humans; Hypoxia; Leukocyte Transfusion; Lung Diseases; Male; Middle Aged; Neutropenia; Sepsis; Transfusion Reaction

Topics: Amphotericin B; Humans; Leukemia; Leukocyte Transfusion; Lung Diseases; Sepsis; Transfusion Reaction

Case report on a 59-year-old woman who was affected by a Candida septicaemia after several abdominal interventions. After therapy with amphotericin B and 5-flurocytosine the disappearance of a central retinal metastasis is documented. Beside these drugs, clotrimazole, miconazole, econazole, and some combinations with amphotericin B are more recent possibilities.

Topics: Amphotericin B; Candidiasis; Cytosine; Drug Therapy, Combination; Endophthalmitis; Female; Flucytosine; Humans; Imidazoles; Sepsis

Rhodotorula glutinis var. glutinis was isolated from the blood of two patients who were seriously ill and required long-term intravenous therapy. Although both isolates were sensitive to amphotericin B and 5-fluorocytosine, neither patient received antifungal therapy. One of the two patients died, but Rhodotorula was not recovered at autopsy. Review of the literature shows that Rhodotorula septicemia is often associated with contamination of intravenous infusion equipment, resulting in toxemia and hypotension. Initial therapy for fungemia should consist of removal of infected cannulas and fluid replacement. If fungemia persists, antifungal drug therapy should be considered.

Topics: Adult; Aged; Amphotericin B; Humans; Male; Mitosporic Fungi; Mycoses; Rhodotorula; Sepsis

Topics: Adolescent; Amphotericin B; Candidiasis, Cutaneous; Female; Glucocorticoids; Humans; Lupus Erythematosus, Systemic; Sepsis

Following drug-induced agranulocytosis and antibiotic and steroid treatment, sepsis due to candida albicans together with bilateral fungal coxitis developed in a 41-year-old female patient. Satisfactory eradication of the inflammatory process was achieved with combined treatment with amphotericin B and 5-fluorocytosine, so that mobilisation was possible after surgical fitting of bilateral total endoprothesis.

Topics: Adult; Amphotericin B; Arthritis, Infectious; Candidiasis; Female; Flucytosine; Hip Joint; Humans; Joint Prosthesis; Sepsis

The new therapeutic methods based on antibiotics, corticosteroids and immunosuppressors and the new medicosurgical techniques (catheters, monitoring in intensive-care units, open-heart surgery) modify the host, favorise the adaptation and introduction f endogenous and exogenous yeast-like fungi and thus create a new pathology characterized by deep visceral or septicemic infections due to yeasts belonging to the genera Candida, Torulopsis, Cryptococcus, Trichosporon, Rhodotorula, and Saccharomyces. The pathological aspects are analyzed and therapy is suggested in the light of new findings on polyenes (nystatine, amphotericine B), 5-fluorocytosine, imidazole, derivatives (miconazole, econazole) considering their association in function of synergy or antagonism possibilities.

Topics: Amphotericin B; Candida; Candidiasis; Cryptococcosis; Dermatomycoses; Endocarditis; Flucytosine; Humans; Iatrogenic Disease; Imidazoles; Lung Diseases, Fungal; Mycoses; Nystatin; Osteitis; Sepsis; Urinary Tract Infections

The clinical findings, pathologic features, and outcome were investigated in 46 patients in whom Torulopsis glabrata was isolated in 131 specimens of blood. Nineteen of the patients had only a single positive blood culture and no evidence of systemic yeast infection, while 27 patients had a clinically significant fungemia based upon the occurrence of 2 or more positive blood cultures, or the combination of a positive blood culture and isolation of the organism from a closed body cavity or demonstration of the yeast in tissue sections. The predisposing factors to the development of fungemia included the presence of intravenous lines, indwelling Foley catheters, antibiotics and surgery, especially when the gastrointestinal tract was involved. Only 22% of patients received either steroids or cytostatic agents. Possible portals of entry were suggested by the prior isolation of the organism from urine, sputum, wounds, and central venous catheter tips in most of the patients. Twelve of 27 patients with clinically significant fungemia were treated. The initial mode of therapy in nine patients was removal of intravenous lines because of the clinical suspicion of catheter related sepsis. Seven of the patients improved rapidly and one more after amphotericin B was subsequently administered. Amphotericin B was the initial therapy in three cases. One patient was cured while another died of an unrelated infection. Five patients were not treated although the isolation of T. glabrata had been reported; the fact that the presence of the organism was felt to be unimportant was considered to be a factor in the delay of treatment. In the remaining 10 patients the organism was isolated only after the patient had died. Division of the patients into four groups based upon whether the individuals survived, died of unrelated disease, died with potentially lethal infection, or died with T. glabrata infection significantly contributing to death, revealed a spectrum of disease, certain signs of which appeared to be of predictive value as prognostic indices of survival and severity of the infection. Seven patients with transient fungemia experienced an acute episode of high spiking fever (greater than 102.5 degrees F), rigors and/or hypotension, six of whom improved after the intravenous catheter was removed, suggesting a catheter-related sepsis. In contrast, persistent low grade fever (less than 102.5 degrees F) characterized eight of the nine patients in whom T. glabrata infection

Topics: Adult; Aged; Amphotericin B; Candida; Candidiasis; Female; Humans; Male; Middle Aged; Mycoses; Sepsis

Topics: Adult; Aged; Amphotericin B; Candida albicans; Candidiasis; Female; Humans; Male; Middle Aged; Sepsis

Nosocomial Gram-negative bacillary meningitis and bacteremia occurred in a patient who was receiving intrathecal and intravenous amphotericin B. An epidemiologic investigation found the amphotericin B to be contaminated with Enterobacter agglomerans, Pseudomonas fluorescens, and P aeruginosa. These contaminants were traced to a lot ot sodium phosphate buffer that was added to all intrathecal and intravenous amphotericin B preparations. The phosphate buffer underwent prolonged storage at room temperature and was not subject to terminal sterilization nor sterility testing. This parenteral admixture prepared in the hospital is now steam autoclaved and sterility tested before use.

Topics: Adult; Amphotericin B; Cerebrospinal Fluid; Cryptococcosis; Drug Contamination; Enterobacter; Female; Humans; Hydrocephalus; Injections, Intravenous; Injections, Spinal; Meningitis; Pseudomonas aeruginosa; Pseudomonas fluorescens; Sepsis

Cure of cryptococcal meningitis accompanied by cryptococcemia was achieved with amphotericin B therapy. Cryptococcal meningitis is associated with substantial morbidity and mortality, especially when accompanied by evidence of extraneural infection. Experience with the patient reported suggests that associated cryptococcemia is not invariably associated with treatment failure.

Topics: Adult; Amphotericin B; Cryptococcosis; Humans; Male; Meningitis; Prognosis; Sepsis

Topics: Adolescent; Adult; Aged; Amphotericin B; Candidiasis; Drug Therapy, Combination; Female; Flucytosine; Humans; Male; Middle Aged; Postoperative Complications; Sepsis

Topics: Aged; Amphotericin B; Arthritis, Infectious; Candidiasis; Culture Techniques; Humans; Male; Sepsis; Synovial Fluid; Synovial Membrane

Two cases of Torulopsis glabrata fungaemia are presented. The literature on detection of micro-organisms in peripheral blood and on systemic T. glabrata infection is briefly reviewed. Microscopical examination of a buffy coat preparation, a simple and rapid procedure for diagnosing this condition, is described. A scheme of criteria which may be helpful in the diagnosis of clinically significant fungaemia is offered.

Topics: Adult; Amphotericin B; Candida; Drug Therapy, Combination; Flucytosine; Humans; Male; Middle Aged; Mycoses; Sepsis

Topics: Administration, Oral; Amphotericin B; Arthritis, Infectious; Candidiasis; Chorioretinitis; Humans; Imidazoles; Infant; Injections, Intra-Articular; Male; Miconazole; Osteomyelitis; Sepsis

Candida sepsis has become one of the most common and dangerous forms of hospital acquired infection. The recommended drug for parenteral treatment of Candida sepsis is amphotericin B, however, its toxic effects preclude its usage in many patients, particularly in the presence of renal failure. A less toxic antifungal agent is 5-fluorocytosine. A patient with Candida albicans sepsis was treated successfully with 5-fluorocytosine by intravenous administration. The fungal infection developed during the course of acute renal failure, repeated surgical intervention, intravenous hyperalimentation, gastrointestinal bleeding and five months of antibiotic therapy. The clinical symptoms receded rapidly and cultures became sterile after one week of intravenous treatment. The predisposing factors, difficulties in prevention and diagnosis of fungal infection are discussed.

Topics: Adult; Amphotericin B; Candidiasis; Cytosine; Flucytosine; Humans; Infusions, Parenteral; Male; Sepsis

Trichosporon cutaneum is a fungus known to cause superficial nodules over the distal third of hair shafts, mainly scalp hair, and to produce a clinical entity known as piedra. This superficial mycosis occurs mostly in temperate and tropical regions and is rarely seen in North America. Trichosporon cutaneum spesis is described here in a 12-year-old boy with acute lymphocytic leukemia in relapse. To our knowledge this is the first case reported in the literature. Emphasis is made of the increasing rate of fungal diseases as well as of "opportunistic" infections in this type of immunosuppressed patient.

Topics: Amphotericin B; Anti-Bacterial Agents; Bleomycin; Child; Cytarabine; Enterobacteriaceae Infections; Flucytosine; Humans; Leukemia, Lymphoid; Male; Mycoses; Sepsis; Vincristine; Yeasts

One hundred consecutive subclavian catheter insertions were performed by the surgical house staff of Martland Hospital, Newark, New Jersey, over a ten month period. The only complications were three punctures of the subclavian artery and one systemic infection. The following conclusions were drawn from these data. Maintaining a closed intravenous system with minimal manipulation of the catheter is the most important factor in avoiding infectious complication. Neither the routine use of irrigation of the catheter with amphotericin B nor insertion of the catheter under strict aseptic conditions is necessary to minimize infectious complications. The morbidity related to insertion of the catheter can be kept to a minimum if the catheters are inserted by experienced personnel.

Topics: Amphotericin B; Asepsis; Catheterization; Emergencies; Escherichia coli Infections; Humans; Neoplasms; Parenteral Nutrition; Punctures; Sepsis; Subclavian Vein; Surgical Procedures, Operative; Surgical Wound Infection; Therapeutic Irrigation; Time Factors

Since cryptococcosis is characterized by cryptococcoma formation, the antimycotic effect of amphothericin B was examined in view of such pathological-anatomical conditions. In white mice (NMRI), cryptococcoma formation was induced by intramuscular injection of Cryptococcus neoformans strain W71 into the hind leg (STAIB, 1962), using a suspension (0.2 ml) containing approximately 2.8 times 10-7 cells/ml. The mice were treated daily with 1 mg amphotericin B in 5% dimethyl sulfoxide by gastric intubation. Course of infection and effectivity of therapy were assessed by microbiological and patho-histological examination of the organs. In the present paper (2nd Communication) comparative patho-histological results in mice, treated with amphotericin B either immediately or from the 16th day p.i. or not at all, are reported. In the non-treated animals the course of infection we controlled by sacrificing 2 animals per day from the 2nd to the 25th day. Cryptococcoma found in the muscle, fat, and connective tissue in the hind leg of these animals were characterized by the two different patho-histological alterations: a) Masses of encapsulated cryptococci side by side were filling a paucireactive or non-reactive reticular structure with blood capillaries. b) Non-specific granulomatous tissue. The fungi were less abundantly found as non-encapsulated cells. On the 5th day after infection the first alterations due to dissemination were found in the lungs, then in other parenchymatous organs. Under immediate amphotericin B-therapy, no cryptococcoma was found at the place of infection; after a therapy of 30 days duration, C. neoformans could be detected in small conglomerates of non-encapsulated cells in muscle, fat and connective tissue. Histologically, a septic dissemination of the agent could not be found in this group. After a therapy of 25 days duration a shrinking of cryptococcoma was observed in animals treated from the 15th day after infection. Presumably this was caused by a loss of capsule and formation of non-specific granulomatous tissue. In the surroundings of blood vessels non-encapsulated cells were detectable. After therapy with amphotericin B, single cryptococci e.g. such disseminated into the lungs were increasingly showing morphological alterations which might be explained as forms of degeneration. The animal experiment in connection with microbiological and patho-histological follow-up studies is discussed with a view to the therapy of cryptococcosis i

Topics: Amphotericin B; Animals; Cryptococcosis; Cryptococcus neoformans; Injections, Intramuscular; Mice; Sepsis; Time Factors

21 of 41 patients developed clinically manifest or systemic Candida albicans infection 1-36 months after renal transplantation. Asymptomatic candiduria was diagnosed in all patients even before the onset of clinical symptoms. Fungal stomatitis was the most frequent clinical sign, followed by mycotic changes in the respiratory, genito-urinary (vaginitis) and gastro-intestinal tract. In five cases intrahepatic biliary stasis was diagnosed in the course of a Candida albicans septicaemia. In 12 patients with renal transplants it was possible, by treatment with nystatin, clotrimazole, flucytosine, miconazole and amphotericine B to control a generalized or clinically manifest Candida albicans infection. Three died of the septicaemia or meningoencephalitis, six as the result of bacterial superinfections. Inspection of the mouth is an important means of early diagnosing fungal infections. Antimycotic treatment should be started if fungal cultures from urine are repeatedly positive even if the clinical findings are still negative.

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Oral; Candidiasis, Vulvovaginal; Child; Cholestasis; Clotrimazole; Female; Humans; Kidney Transplantation; Male; Meningoencephalitis; Miconazole; Middle Aged; Nystatin; Postoperative Complications; Sepsis; Transplantation, Homologous

Opportunistic systemic fungal infections are more frequent than generally realized. Increased awareness and a high index of suspicion of fungal super-infection in the presence of sepsis is required to bring about recognition and therapy. The intravenous catheter is an important portal of entry or may act as a foreign body favoring localization of a septic process. In its presence, fungemia must be guarded against. Whenever an intravenous catheter is removed, its tip should be cultured. Removal alone may be a critical item in therapy. In febrile patients, in whom the course of fever is not established, frequent blood cultures with attention directed specifically at fungi should be obtained. Fungi are not easily isolated and identified and only by requesting special attention from the microbiologist can the diagnosis be established in the average institutional laboratory in time to permit appropriate therapy. Since available therapeutic measures are strikingly effective when instituted early, awareness and alertness on the part of the clinician constitute the key to cure.

Topics: Adult; Aged; Amphotericin B; Candida; Catheterization; Female; Humans; Intestines; Male; Middle Aged; Mycoses; Parenteral Nutrition; Postoperative Complications; Sepsis; Subphrenic Abscess; Surgical Procedures, Operative; Urinary Bladder

Topics: Adolescent; Adult; Amphotericin B; Candidiasis; Cross Infection; Female; Humans; Intensive Care Units; Male; Middle Aged; Sepsis

Topics: Adult; Aged; Amphotericin B; Candidiasis; Cross Infection; Female; Humans; Intensive Care Units; Male; Middle Aged; Postoperative Complications; Sepsis; Surgical Procedures, Operative

Topics: Amphotericin B; Antifungal Agents; Arthritis, Infectious; Candidiasis; Cytosine; Drug Resistance, Microbial; Drug Therapy, Combination; Endophthalmitis; Flucytosine; Humans; Infant, Newborn; Infant, Premature, Diseases; Meningitis; Osteomyelitis; Pyelonephritis; Radiography; Recurrence; Sepsis

Topics: Adult; Amphotericin B; Candida albicans; Candidiasis; Eye Diseases; Humans; Male; Sepsis

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Benzene Derivatives; Bronchopneumonia; Candidiasis; Catheterization; Female; Humans; Imidazoles; Intubation, Intratracheal; Lung Diseases, Fungal; Sepsis; Urea

Topics: Adult; Amphotericin B; Burns; Candida albicans; Candidiasis; Humans; Male; Sepsis

Topics: Amphotericin B; Blood; Candida; Candida albicans; Candidiasis; Catheterization; Diverticulitis, Colonic; Endophthalmitis; Female; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Postoperative Complications; Retinitis; Sepsis

Topics: Adolescent; Adult; Amphotericin B; Candidiasis; Catheterization; Chorioretinitis; Choroiditis; Female; Flucytosine; Humans; Macula Lutea; Male; Middle Aged; Ophthalmoscopy; Postoperative Complications; Retinitis; Sepsis

Topics: Adult; Age Factors; Amphotericin B; Aspergillosis; Bronchopneumonia; Cross Infection; Diagnosis, Differential; Disseminated Intravascular Coagulation; Humans; Male; Perfusion; Pleural Effusion; Prognosis; Sepsis; Sex Factors; Tuberculosis, Pulmonary

Topics: Acute Kidney Injury; Adolescent; Adult; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Colistin; Deafness; Endocarditis, Bacterial; Female; Humans; Kanamycin; Kidney; Kidney Function Tests; Male; Middle Aged; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Streptococcal Infections; Urea; Vancomycin

Topics: Adolescent; Adult; Amphotericin B; Anti-Bacterial Agents; Candida albicans; Candidiasis; Catheterization; Cytosine; Endophthalmitis; Female; Fluorine; Fundus Oculi; Humans; Male; Middle Aged; Sepsis; Uveitis

Topics: Alcoholism; Amphotericin B; Candida albicans; Candidiasis; Female; Hepatic Encephalopathy; Humans; Middle Aged; Pseudomonas Infections; Sepsis

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Candida albicans; Candidiasis; Carcinoma, Papillary; Colon; Humans; Male; Postoperative Complications; Sepsis; Urinary Bladder Neoplasms; Urinary Diversion

Topics: Amino Acids; Amphotericin B; Candida albicans; Candidiasis; Catheterization; Glucose; Humans; Parenteral Nutrition; Sepsis; Time Factors

Topics: Adolescent; Amphotericin B; Anti-Bacterial Agents; Burns; Candida; Candidiasis; Catheterization; Child, Preschool; Humans; Sepsis; Wound Infection

Topics: Adult; Amphotericin B; Antilymphocyte Serum; Azathioprine; Dactinomycin; Female; Heart Transplantation; Humans; Infections; Male; Middle Aged; Mycoses; Nystatin; Prednisone; Propylene Glycols; Protozoan Infections; Respiratory Tract Infections; Sepsis; Staphylococcal Infections; Transplantation Immunology; Transplantation, Homologous; Urinary Tract Infections; Virus Diseases

Topics: Amphotericin B; Candida; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Parenteral Nutrition; Sepsis

Topics: Adult; Aged; Amphotericin B; Ampicillin; Antibodies; Bacteriuria; Cephalothin; Chloramphenicol; Female; Gentamicins; Humans; Immunodiffusion; Kanamycin; Male; Microbial Sensitivity Tests; Middle Aged; Nalidixic Acid; Penicillins; Precipitin Tests; Sepsis; Serratia marcescens; Sputum; Streptomycin; Tetracycline

Topics: Amino Acids; Amphotericin B; Calcium; Candida; Candidiasis; Cold Temperature; Glucose; Osmolar Concentration; Parenteral Nutrition; Potassium; Sepsis; Sodium; Solutions

Topics: Acute Kidney Injury; Aged; Amphotericin B; Candidiasis; Carcinoma, Squamous Cell; Enterocolitis, Pseudomembranous; Female; Humans; Parenteral Nutrition; Radiotherapy; Sepsis; Uterine Cervical Neoplasms

Topics: Adolescent; Adult; Age Factors; Aged; Amphotericin B; Anti-Bacterial Agents; Autopsy; Azathioprine; Brain; Candida; Candidiasis; Catheterization; Child; Humans; Immunosuppressive Agents; Infant; Kidney; Liver; Lung; Middle Aged; Sepsis; Steroids; Transfusion Reaction

Topics: Abdomen; Adult; Amphotericin B; Candida; Candidiasis; Humans; Male; Postoperative Complications; Sepsis

Topics: Accidents, Traffic; Adult; Amphotericin B; Antifungal Agents; Burns; Candida; Candidiasis; Chloramphenicol; Gentamicins; Humans; Male; Oxacillin; Penicillins; Pseudomonas Infections; Sepsis; Skin Transplantation; Staphylococcal Infections; Sulfonamides; Wound Infection

Topics: Adult; Amphotericin B; Candida; Child, Preschool; Female; Humans; Infant, Newborn; Male; Middle Aged; Parenteral Nutrition; Sepsis

Topics: Aged; Amphotericin B; Candidiasis; Humans; Male; Pulmonary Embolism; Sepsis

Topics: Amphotericin B; Endocarditis; Female; Heart Valve Prosthesis; Humans; Middle Aged; Mitral Valve; Mycoses; Saccharomyces; Sepsis

Topics: Amphotericin B; Burns; Candidiasis; Child, Preschool; Humans; Male; Sepsis

Topics: Agar; Amphotericin B; Candida; Candidiasis; Endocarditis; Fluorescent Antibody Technique; France; Humans; Immunodiffusion; Immunoelectrophoresis; Nystatin; Precipitins; Sepsis

Topics: Adult; Amphotericin B; Brain; Cryptococcosis; Diagnosis, Differential; Heart Diseases; Humans; Lung; Male; Meningitis; Nephrocalcinosis; Prednisolone; Sarcoidosis; Sepsis

Topics: Adult; Amphotericin B; Candidiasis; Candidiasis, Vulvovaginal; Female; Humans; Sepsis

Within a period of only seven months three patients in one hospital under treatment with antibiotics by intravenous infusion developed secondary bloodstream infection originating from the site of insertion of the cannula. Two of these infections were fatal. Precautions suggested include strict asepsis, the skin being sterilized with iodine in spirit solution; antibiotic spray; and changing the cannula site.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Catheterization; Female; Humans; Injections, Intravenous; Iodine; Male; Middle Aged; Nystatin; Sepsis; Sterilization

Topics: Amphotericin B; Candida; Candidiasis; Humans; Infant; Injections, Spinal; Male; Sepsis

Topics: Amphotericin B; Candidiasis; Humans; Sepsis

Topics: Adolescent; Adult; Aged; Amphotericin B; Candidiasis; Catheterization; Child; Female; Humans; Infusions, Parenteral; Male; Middle Aged; Nystatin; Prognosis; Sepsis

Topics: Adolescent; Amphotericin B; Anti-Bacterial Agents; Burns; Candidiasis; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Immunosuppressive Agents; Male; Middle Aged; Sepsis; Wound Infection; Wounds, Gunshot

Topics: Amphotericin B; Bronchopneumonia; Candidiasis; Child; Colistin; Female; Humans; Iatrogenic Disease; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infusions, Parenteral; Male; Meningitis; Sepsis; Sterilization; Vaccination

Topics: Adult; Aged; Amphotericin B; Cryptococcosis; Cryptococcus; Female; Humans; Male; Pregnancy; Pregnancy Complications, Infectious; Sepsis; Urinary Tract Infections

Topics: Acute Kidney Injury; Amphotericin B; Blood Urea Nitrogen; Candidiasis; Creatinine; Humans; Injections, Intravenous; Male; Middle Aged; Sepsis

Topics: Adolescent; Amphotericin B; Complement Fixation Tests; Female; Hemagglutination Tests; Humans; Mitosporic Fungi; Myasthenia Gravis; Sepsis

Topics: Acetazolamide; Adolescent; Amphotericin B; Candidiasis; Humans; Infectious Mononucleosis; Kidney Diseases; Leukemia; Male; Mercaptopurine; Methotrexate; Nystatin; Penicillins; Peripheral Nervous System Diseases; Prednisone; Rolitetracycline; Sepsis; Uric Acid

Topics: Amphotericin B; Drug Therapy; Humans; Mycoses; Sepsis; Toxicology

Topics: Amphotericin B; Coccidioidomycosis; Dermatomycoses; Diagnosis; Drug Therapy; Foot Diseases; Hand Injuries; Humans; Lymph Nodes; Sepsis; Skin Tests; Wound Infection

Topics: Adolescent; Amphotericin B; Anti-Bacterial Agents; Cryptococcosis; Female; Humans; Postoperative Complications; Sepsis; Thymectomy

Topics: Adolescent; Amphotericin B; Anti-Bacterial Agents; Cryptococcosis; Female; Humans; Postoperative Complications; Sepsis; Thymectomy

Topics: Aged; Amphotericin B; Candidiasis; Female; Humans; Sepsis

Topics: Amphotericin B; Candidiasis; Exchange Transfusion, Whole Blood; Heart Defects, Congenital; Humans; Infant, Newborn; Infant, Premature, Diseases; Jaundice, Neonatal; Sepsis

Topics: Amphotericin B; Candidiasis; Diagnosis; Fungi; Humans; Prognosis; Sepsis

Topics: Abscess; Amphotericin B; Brain Abscess; Candidiasis; Carrier State; Child; Chloramphenicol; Colistin; Deoxyribonucleases; DNA; Empyema; Enteritis; Humans; Kanamycin; Meningitis; Methicillin; Penicillins; Peritonitis; Phlebitis; Pneumonia; Pneumothorax; Pseudomonas Infections; Sepsis; Staphylococcal Infections; Sulfadiazine; Troleandomycin

Topics: Amphotericin B; Brain Diseases; Cryptococcosis; Cryptococcus; Diagnosis; Diagnosis, Differential; Humans; Lung Diseases; Lung Diseases, Fungal; Meninges; Pathology; Physiology; Sepsis

Topics: Acute Kidney Injury; Amphotericin B; Bronchopneumonia; Burns; Candida; Candidiasis; Child; Drug Therapy; Erythroblastosis, Fetal; Female; Geriatrics; Heart Failure; Humans; Hyperbilirubinemia; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Postgastrectomy Syndromes; Renal Insufficiency; Sepsis; Toxicology; Uterine Cervical Neoplasms; Wounds, Gunshot

Topics: Adolescent; Adult; Amphotericin B; Candidiasis; Child; Humans; Sepsis

Topics: Amphotericin B; Candidiasis; Gastrointestinal Tract; Humans; Sepsis; Tongue Neoplasms

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Agents; Humans; Mycoses; Sepsis

Topics: Alopecia; Amphotericin B; Candida tropicalis; Candidiasis; Child; Haemophilus; Humans; Kidney Diseases; Liver Diseases; Meningitis; Meningitis, Haemophilus; Sepsis

Topics: Amphotericin B; Candida; Candidiasis; Endophthalmitis; Eye Infections, Fungal; Humans; Nystatin; Ophthalmology; Ophthalmoscopy; Retina; Sepsis; Vitreous Body

Topics: Amphotericin B; Bone Diseases; Fungi; Humans; Leg Ulcer; Mycoses; Organic Chemicals; Sepsis; Skull; Spinal Diseases; Zygomycosis

Topics: Amphotericin B; Antifungal Agents; Fungi; Sepsis

Topics: Amphotericin B; Antifungal Agents; Mycoses; Sepsis; Treatment Failure

Topics: Amphotericin B; Antifungal Agents; Coccidioidomycosis; Dermatomycoses; Granuloma; Humans; Sepsis

Topics: Amphotericin B; Antifungal Agents; Coccidioidomycosis; Mycoses; Sepsis

Topics: Amphotericin B; Antifungal Agents; Fungi; Fungicides, Industrial; Humans; Mycoses; Sepsis

Topics: Amphotericin B; Antifungal Agents; Fungicides, Industrial; Griseofulvin; Mycoses; Sepsis

Topics: Amphotericin B; Animals; Clostridium perfringens; Infections; Sepsis; Sheep; Sheep Diseases; Toxemia

Topics: Amphotericin B; Antifungal Agents; Fungicides, Industrial; Humans; Mycoses; Sepsis