amphotericin-b and Shock--Septic

Coccidioidomycosis is a fungal infection endemic to the southwestern United States and regions of Latin America. Disseminated disease occurs in < 1% of cases. Septic shock is even rarer, with high mortality despite therapy. We describe two cases of coccidioidal septic shock. Both patients were older men of Filipino ancestry presenting with respiratory failure and vasopressor-dependent shock. Antifungal drugs were initiated after failure to improve with empiric antibiotics; in both, Coccidioides was isolated from respiratory cultures. Despite aggressive care, both patients ultimately died of their infections. We provide a review of the published literature on this topic.. Most of the 33 reported cases of coccidioidal septic shock occurred in men (88%) of non-white race and ethnicity (78%). The overall mortality rate was 76%. All survivors received amphotericin B as part of their treatment. Coccidioidomycosis-related septic shock is a rare disease with poor outcomes; delays in diagnosis and treatment are common. Improved diagnostic testing for coccidioidomycosis could enhance recognition of this disease in the future. Although data are limited, early treatment with amphotericin B in cases of coccidioidal septic shock may reduce mortality.

Topics: Aged; Amphotericin B; Antifungal Agents; Coccidioides; Coccidioidomycosis; Humans; Male; Shock, Septic

A case of cavitary pulmonary sporotrichosis without mucocutaneous involvement caused by Sporothrix schenckii is reported in a sexagenarian woman with a long smoking history. The patient was hospitalized for septic shock with multiorgan failure from a respiratory focus. The diagnosis was delayed due to the fungal etiological agent was not initially considered in the differential diagnosis. A good clinical and radiological evolution was obtained with the antifungal therapy. Occasional cases of primary pulmonary sporotrichosis have been reported in the literature. Due to its low incidence, this is a less-known and underestimated clinical form. Both clinical suspicion and microbiological studies are needed to reach pulmonary sporotrichosis diagnosis.

Topics: Aged; Amphotericin B; Antifungal Agents; Female; Humans; Itraconazole; Lung Diseases, Fungal; Pneumonia; Shock, Septic; Smoking; Sporothrix; Sporotrichosis

Fusarium species are ubiquitously present in environment and are well known as human pathogens with high mortality rate in immunocompromised patients. We report here two cases where immunocompromised patients developed fatal bloodstream infections by this organism. Isolates were further identified by ITS1 region sequencing which confirmed them as Fusarium solani. Antifungal susceptibility testing was done following CLSI M38-A2 guidelines to amphotericin B, fluconazole, itraconazole, voriconazole, posaconazole, caspofungin, and micafungin. Both patients had a fatal outcome and expired of septic shock. Therefore, identification up to species level is of utmost importance as that helps in directing the management of the patient thereby leading to a favourable outcome.

Topics: Adolescent; Aged; Amphotericin B; Antifungal Agents; Base Sequence; DNA, Intergenic; Fluconazole; Fungemia; Fusariosis; Fusarium; Humans; Immunocompromised Host; India; Male; Microbial Sensitivity Tests; Sequence Analysis, DNA; Shock, Septic

Rhino-sinusal infections are serious diseases and possibly lethal. When they are invasive, we easily discuss apergilloses and mucormycoses. The confirmation of the diagnosis of mucormycosis need an extensive surgery for precise histopathological and mycological evaluation. The pathologist may be faced to other rare mycoses such as phaeohyphomycoses, which present different morphological features than mucormycoses and Aspergillus. Once the diagnosis is established, an appropriate antifungal treatment is quickly started. The aim of our work is to report two observations of phaeohyphomycoses, to describe their histopathological features, to discuss complementary diagnostic methods and to present the main differential diagnoses.

Topics: Adult; Alternaria; Alternariosis; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diagnosis, Differential; Early Diagnosis; Fatal Outcome; Female; Humans; Liposomes; Mastoiditis; Phaeohyphomycosis; Postoperative Complications; Retrospective Studies; Rhinitis; Shock, Septic; Sinusitis

The urinary tract is a common source for life-threatening infections. Most patients with sepsis or septic shock from a urinary source have complicated urinary tract infection. This article explains the epidemiology, risk factors, and treatment. Effective management, appropriate collection of microbiology specimens, prompt initiation of antimicrobial therapy, source control, and supportive therapy are described.

Topics: Acute Disease; Aminoglycosides; Amphotericin B; Anti-Infective Agents; Antifungal Agents; Catheters, Indwelling; Community-Acquired Infections; Cross Infection; Deoxycholic Acid; Drug Combinations; Female; Fluconazole; Humans; Male; Prognosis; Risk Factors; Shock, Septic; Urinary Tract; Urinary Tract Infections

Systemic infection with Aspergillus fumigatus is an opportunistic disease that affects mainly immunocompromised hosts and is associated with a high mortality rate. We report a case of A. fumigatus endocarditis after an episode of thrombotic thrombocytopenic purpura. Diagnosis was established after sudden rupture of posterior papillary muscle of the normal native mitral valve. Soon after mitral valve replacement, Aspergillus endocarditis recurred, associated with multiple peripheral emboli, which necessitated a second operation.

Topics: Amphotericin B; Anti-Infective Agents; Aspergillosis; Aspergillus fumigatus; Candidiasis; Drug Resistance, Fungal; Embolism; Endocarditis; Fatal Outcome; Female; Heart Valve Prosthesis Implantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Itraconazole; Lung Diseases, Fungal; Middle Aged; Mitral Valve Insufficiency; Opportunistic Infections; Papillary Muscles; Postoperative Complications; Prednisolone; Pseudomonas Infections; Purpura, Thrombotic Thrombocytopenic; Recurrence; Rupture, Spontaneous; Shock, Septic; Sputum; Ultrasonography; Urinary Tract Infections

Liposomal amphotericin B (L-AMB), a broad spectrum anti-fungicidal drug, is often administered to treat invasive fungal infections (IFIs). However, the most suitable time to initiate treatment in septic shock patients with IFI is unknown.. Patients with septic shock treated with L-AMB were identified from the Japanese Diagnosis Procedure Combination national database and were stratified according to L-AMB treatment initiation either at septic shock onset (early L-AMB group) or after the onset (delayed L-AMB group) to determine their survival rates following septic shock onset and the shock cessation period.. We identified 141 patients administered L-AMB on the day of or after septic shock onset: 60 patients received early treatment, whereas 81 patients received delayed treatment. Survival rates after septic shock onset were higher in the early L-AMB group than in the delayed L-AMB group (4 weeks: 68.4% vs 57.9%, P = 0.197; 6 weeks: 62.2% vs 44.5%, P = 0.061; 12 weeks: 43.4% vs 35.0%, P = 0.168, respectively). The septic shock cessation period was shorter in the early L-AMB group than in the delayed L-AMB group (7.0 ± 7.0 days vs 16.5 ± 15.4 days, P < 0.001), with a significant difference confirmed after adjusting for confounding factors with propensity score matching (7.1 ± 7.2 days vs 16.7 ± 14.0 days, P = 0.001).. Early L-AMB administration at septic shock onset may be associated with early shock cessation.

Topics: Amphotericin B; Antifungal Agents; Humans; Shock, Septic

Mucormycosis is rare, life-threatening fungal infection. Frequently observed in those patients having underlying immunosuppression such as, diabetes, organ transplantation, Human immunodeficiency virus (HIV) infection, and elevated serum iron. However, invasive intestinal mucormycosis occurring in immunocompetent individuals without the traditional risk factors is extremely rare clinical phenomenon.. We report a 40-year-old male patient who presented with 1 week history of diffuse abdominal pain and high grade fever, associated with vomiting and frequent loose stools. Has history of chronic alcohol ingestion. Otherwise, no past history of chronic medical illness, nor he had contact with individuals with similar illness. He was in a septic shock with multiple organ failure up on presentation to emergency room. Physical examination revealed icterus sclera with abdominal tenderness. He was immediately resuscitated using crystalloids, supported with inotrope, and antibiotics. Histopathological examination of tissue sample from colonic ulcer biopsy revealed invasive intestinal mucormycosis. Patient showed full clinical and histopathological resolution after course of parenteral Liposomal Amphotercin B.. This case highlights the fact that, despite its life-threatening nature, it's possible to treat patients with invasive intestinal mucormycosis with aggressive antifungal and supportive care without surgical intervention, provided that all the necessary supportive care were initiated early and the disease was diagnosed early and appropriate medical management was initiated timely. In addition, it's important to consider intestinal mucormycosis even in patients who are immunocompetent without traditional risk factors.

Topics: Adult; Amphotericin B; Antifungal Agents; Biopsy; Colitis; Disease Susceptibility; Early Diagnosis; Emergency Service, Hospital; Humans; Male; Mucormycosis; Multiple Organ Failure; Risk Factors; Shock, Septic; Time-to-Treatment

Gastrointestinal (GI) mucormycosis is a rare and often deadly form of mucormycosis. Delayed diagnosis can lead to an increased risk of death. Here, we report a case of GI mucormycosis following streptococcal toxic shock syndrome in a virologically suppressed HIV-infected patient.. A 25-year-old Thai woman with a well-controlled HIV infection and Grave's disease was admitted to a private hospital with a high-grade fever, vomiting, abdominal pain, and multiple episodes of mucous diarrhea for 3 days. On day 3 of that admission, the patient developed multiorgan failure and multiple hemorrhagic blebs were observed on all extremities. A diagnosis of streptococcal toxic shock was made before referral to Siriraj Hospital - Thailand's largest national tertiary referral center. On day 10 of her admission at our center, she developed feeding intolerance and bloody diarrhea due to bowel ischemia and perforation. Bowel resection was performed, and histopathologic analysis of the resected bowel revealed acute suppurative transmural necrosis and vascular invasion with numerous broad irregular branching non-septate hyphae, both of which are consistent with GI mucormycosis. Peritoneal fluid fungal culture grew a grayish cottony colony of large non-septate hyphae and spherical sporangia containing ovoidal sporangiospores. A complete ITS1-5.8S-ITS2 region DNA sequence analysis revealed 100% homology with Rhizopus microsporus strains in GenBank (GenBank accession numbers KU729104 and AY803934). As a result, she was treated with liposomal amphotericin B. However and in spite of receiving appropriate treatment, our patient developed recurrent massive upper GI bleeding from Dieulafoy's lesion and succumbed to her disease on day 33 of her admission.. Diagnosis of gastrointestinal mucormycosis can be delayed due to a lack of well-established predisposing factors and non-specific presenting symptoms. Further studies in risk factors for abdominal mucormycosis are needed.

Topics: Adult; Amphotericin B; Antifungal Agents; DNA, Fungal; Fatal Outcome; Female; Gastrointestinal Tract; Graves Disease; HIV Infections; Humans; Mucormycosis; Rhizopus; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes; Syndrome; Thailand

Surgical-site mucormycosis infections in solid-organ transplant recipients are rare conditions, with only 15 previously reported cases. We describe a case of a 49-year-old man who received a liver transplant due to alcoholic cirrhosis. On postoperative day 14, necrosis was noticed at the surgical site. After mucormycosis was diagnosed, monotherapy with amphotericin was started along with surgical debridements. Due to continued clinical deterioration, triple antifungal therapy was started with amphotericin, micafungin and posaconazole. Treatment with a granulocyte-macrophage colony-stimulating factor was also started. Despite therapy, the patient expired on postoperative day 31. We review the risk factors for mucormycosis infection in solid-organ transplant recipients as well as evidence for current treatment options. We also review the 15 previously reported cases of surgical-site mucormycosis infections in solid-organ transplant recipients, including time to infection, infecting organisms, mortality and treatments.

Topics: Amphotericin B; Antifungal Agents; Debridement; Fatal Outcome; Humans; Immunosuppressive Agents; Liver Transplantation; Male; Middle Aged; Mucormycosis; Shock, Septic; Surgical Wound Infection; Transplant Recipients; Triazoles

Mucormycosis is an aggressive invasive fungal infection that occurs rarely in immunocompetent but frequently in immunocompromised patients. We present a case of a 68-year-old patient with cutaneous mucormycosis due to Rhizopus pusillus. He was initially hospitalized for invasive pulmonary aspergillosis and diabetes mellitus secondary to acute graft-versus-host treatment with glucocorticoids after allogeneic hematopoietic stem cell transplantation for acute myeloid leukemia. Treatment with liposomal amphotericin B and posaconazole was initiated but the patient developed septic shock with multiple organ failure and died 5 days later. The risk factors, clinical presentation, treatment, and prognosis of cutaneous mucormycosis in hematopoietic stem cell and solid organ transplant patients are discussed.

Topics: Aged; Amphotericin B; Antifungal Agents; Fatal Outcome; Hematopoietic Stem Cell Transplantation; Humans; Immunocompromised Host; Invasive Fungal Infections; Male; Mucormycosis; Multiple Organ Failure; Rhizopus; Shock, Septic; Skin; Triazoles

A 51-year-old man with a medical history of coronary artery disease and dyslipidaemia presented with acute myocardial infarction resulting in cardiogenic shock, necessitating intra-aortic balloon pump placement and extracorporeal membrane oxygenation (ECMO). His hospital course was complicated by several infectious complications including ECMO circuit

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Ciprofloxacin; Cryptococcosis; Cryptococcus neoformans; Extracorporeal Membrane Oxygenation; Fluconazole; Flucytosine; Heart-Assist Devices; Humans; Immunocompetence; Intra-Aortic Balloon Pumping; Male; Middle Aged; Shock, Septic; ST Elevation Myocardial Infarction

AbstractReported herein is the first case of

Topics: Adult; Amphotericin B; Antiprotozoal Agents; Coinfection; Cytochromes b; Fatal Outcome; HIV; HIV Infections; Humans; Leishmania guyanensis; Leishmaniasis, Diffuse Cutaneous; Male; Meglumine; Meglumine Antimoniate; Organometallic Compounds; Protozoan Proteins; Sequence Analysis, DNA; Shock, Septic; Skin; Treatment Failure

Topics: Administration, Intravesical; Aged; Amphotericin B; Antifungal Agents; Candidiasis; Device Removal; Female; Humans; Intraabdominal Infections; Intrauterine Devices; Multiple Organ Failure; Postoperative Care; Shock, Septic; Uterine Diseases

Topics: Amphotericin B; Antifungal Agents; Drug Therapy, Combination; Fatal Outcome; Humans; Invasive Pulmonary Aspergillosis; Male; Middle Aged; Near Drowning; Shock, Septic; Voriconazole

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

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

Cryptococcus arboriformis (C. arboriformis) is a novel Cryptococcus species belonging to the genus Trichosporonales. This novel species was identified definitively in 2007 using D1/D2 26S ribosomal DNA gene sequencing. In this article, we present a rare case of central line-associated bloodstream infection caused by C. arboriformis with successful treatment of this infection.

Topics: Aged; Amphotericin B; Antifungal Agents; Catheter-Related Infections; Catheterization, Central Venous; Cryptococcosis; Cryptococcus; DNA, Fungal; Female; Humans; Phylogeny; RNA, Ribosomal; Shock, Septic; Treatment Outcome

Mucormycosis is a life threatening condition caused by invasion of fungi of the order Mucorales. Gastrointestinal invasion is very rare and often lethal, particularly in disseminated mucormycosis. We present the case of a 26-year-old woman from North Africa with type 2 diabetes who, after a cholecystectomy, developed unexplained septic shock and haematemesis due to gastric necrosis. Computed tomography (CT) revealed a disseminated fungal invasion of the lungs, kidney and paranasal sinuses. A gastrectomy and subsequent amphotericin B treatment resolved her condition. The number of patients with mucormycosis is increasing. Early diagnosis of high risk patients with CT and biopsies from which fungi are directly isolated must be followed by surgery and systemic amphotericin B infusion.

Topics: Adult; Amphotericin B; Antifungal Agents; Female; Gastrectomy; Hematemesis; Humans; Kidney Diseases; Lung Diseases, Fungal; Mucormycosis; Necrosis; Paranasal Sinus Diseases; Shock, Septic; Stomach; Stomach Diseases; Tomography, X-Ray Computed

Cutaneous mucormycosis (zygomycosis), with subcutaneous spreading and dissemination, in immunocompetent patients is an uncommon disease caused by species belonging to the fungal genera Apophysomyces, Rhizopus and Saksenaea, among others.. A case of necrotising fasciitis by Saksenaea vasiformis in an immunocompetent woman is described. The infection was acquired through a car accident resulting in multiple injuries affecting mainly her right arm. After the surgical reduction of fractures, skin lesions worsened and led to necrosis. The patient quickly developed a severe necrotising fasciitis with negative cultures at first. Despite the extensive surgical debridement and the aggressive antifungal treatment, the patient died. The histopathological study showed a fungal infection due to a fungus belonging to the Mucorales order, which was confirmed by culturing the clinical sample on Sabouraud agar, and identifying the species by cultures on Czapek-Dox agar, and sequencing of the ITS region of the ribosomal DNA.. This case confirm the presence of this fungus in Spain, the value of histopathology for the mucormycosis diagnosis, as well as the need to perform special cultures to facilitate their isolation and identification to the species level by the combined use of Czapek-Dox agar and sequencing of the ITS region.

Topics: Accidents, Traffic; Amphotericin B; Antifungal Agents; Arm Injuries; Bacterial Infections; Coinfection; Combined Modality Therapy; Fasciitis, Necrotizing; Fatal Outcome; Female; Fractures, Open; Humans; Immunocompetence; Middle Aged; Mucorales; Mucormycosis; Multiple Trauma; Mycology; Radius Fractures; Shock, Septic; Wound Infection

Topics: Adult; Amphotericin B; Antifungal Agents; Dermatomycoses; Histoplasma; Histoplasmosis; HIV Infections; Humans; Immunocompromised Host; Male; Shock, Septic; Silver Staining

Topics: Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Cytarabine; Digestive System Surgical Procedures; Enterococcus faecium; Fatal Outcome; Female; Gram-Positive Bacterial Infections; Humans; Idarubicin; Leukemia, Myeloid, Acute; Middle Aged; Mucormycosis; Neutropenia; Rhinitis; Shock, Septic; Sinusitis; Typhlitis

Zygomycosis is an infection caused by opportunistic fungi of the Zygomycetes class, specifically those from the Mucorales and Entomophthorales orders. It is an uncommon disease, mainly restricted to immunocompromised patients. We report a case of a 73-year-old male patient with a history of fever (39 degrees C) lasting for 1 day, accompanied by shivering, trembling, and intense asthenia. The patient was admitted to the intensive care unit with complex partial seizures, and submitted to orotracheal intubation and mechanical ventilation under sedation with midazolam. The electroencephalogram showed evidence of non-convulsive status epilepticus. There is no fast specific laboratory test that permits confirmation of invasive fungal disease. Unless the physician suspects this condition, the disease may progress rapidly while the patient is treated with broad-spectrum antibiotics. Differential diagnosis between fungal and bacterial infection is often difficult. The clinical presentation is sometimes atypical, and etiological investigation is not always successful. In the present case, the histopathological examination of the biopsy obtained from the right temporal lobe indicated the presence of irregular, round, thick-walled fungi forming papillae and elongated structures of irregular diameter, with no septa, indicative of zygomycete (Basidiobolus). Treatment with liposomal amphotericin B and fluconazole was initiated after diagnosis of meningoencephalitis by zygomycete, with a successful outcome.

Topics: Aged; Amphotericin B; Antifungal Agents; Entomophthorales; Fluconazole; Follow-Up Studies; Humans; Immunocompromised Host; Male; Meningoencephalitis; Shock, Septic; Treatment Outcome; Zygomycosis

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Arthritis, Rheumatoid; Colitis, Ulcerative; Combined Modality Therapy; Drainage; Fatal Outcome; Gastrointestinal Diseases; Humans; Ileal Diseases; Intestinal Perforation; Intraoperative Complications; Jejunal Diseases; Liposomes; Male; Mucormycosis; Peritonitis; Postoperative Complications; Shock, Septic; Triazoles

Invasive fungal infection (IFI) caused by Lecythophora mutabilis occasionally occurs in patients with impaired host immunity; such patients had eosinophilia at onset, and surviving patients were treated with fungal cell-membrane-targeted drugs. An 18-year-old man with mitochondrial encephalomyopathy accompanied with refractory anaemia and chronic renal failure developed septic shock caused by L. mutabilis, which was detected from a blood culture, and was identified morphologically and genetically. During the course of the infection, he had eosinophilia, although beta-d-glucan levels were within the normal range. He was treated with micafungin, but deteriorated and died, despite his treatment being changed to liposomal amphotericin B. On the basis of this we suggest that IFI caused by L. mutabilis should be suspected when a compromised host develops infection and eosinophilia, and that antifungal drugs that target beta-d-glucan are not advisable.

Topics: Adolescent; Amphotericin B; Antifungal Agents; Ascomycota; Echinocandins; Humans; Insomnia, Fatal Familial; Lipopeptides; Male; Micafungin; Mitochondrial Encephalomyopathies; Mycoses; Pneumonia, Aspiration; Shock, Septic

A case of visceral leishmaniasis (VL) in a 77-year-old woman, with renal failure on haemodialysis, admitted in the intensive care unit (ICU) with vascular instability requiring vassopressor treatment, is presented. Initially, no co-infection could be detected. The patient initially responded well when liposomal amphotericin B was administered, after bone marrow demonstrated multiple intra-cellular Leishmania amastigotes and extra-cellular promastigotes. However, the patient died from uncontrolled septic shock from a secondary bacterial infection, the tenth day of admission. To our knowledge, vascular instability has not been reported in VL. Moreover, non-vector transmission was also suspected in this case. The patient had undergone cholecystectomy three months earlier, during which two blood units had been transfused; IgG anti-Leishmania antibodies at a high titer were detected in one of the two healthy blood donors, later.

Topics: Aged; Amphotericin B; Animals; Antiprotozoal Agents; Fatal Outcome; Female; Humans; Leishmania; Leishmaniasis, Visceral; Shock, Septic; Transfusion Reaction

Topics: Amphotericin B; Antifungal Agents; Humans; Male; Middle Aged; Mucormycosis; Nose Diseases; Orbit; Shock, Septic

We describe a 9-yr-old boy who received the highest cumulative dose so far reported of liposomal amphotericin B. The patient underwent an allogeneic bone marrow transplantation (BMT) for adrenoleucodystrophy, after a conditioning regimen with busulfan, thiothepa and cyclophosphamide. Rabbit antithymoglobulin, cyclosporin and prednisone were used as prophylaxis against graft vs. host disease (GVHD). Post-transplant Epstein-Bar-virus-related lymphoma was diagnosed on day +68 and was treated with donor-derived lymphocytes. The patient developed a severe form of GVHD, and a progressive worsening of his neurological status because of progression of his underlying disease. Death from septic shock occurred 23 months after BMT. During prolonged hospitalization, 19,750 mg of liposomal amphotericin B, about 1000 mg/kg, were given for prophylactic or empirical therapeutic purposes without significant nephrotoxicity. This case suggests that liposomal amphotericin B is safe and well-tolerated even if is administered for long periods and a cumulative dose fivefold greater than the nephrotoxic threshold of amphotericin B deoxycholate is achieved.

Topics: Adrenoleukodystrophy; Amphotericin B; Antifungal Agents; Bone Marrow Transplantation; Candidiasis; Child; Creatinine; Disease Progression; Epstein-Barr Virus Infections; Fatal Outcome; Graft vs Host Disease; Humans; Kidney; Kidney Diseases; Liposomes; Lymphoma; Male; Pseudomonas Infections; Shock, Septic; T-Lymphocytes, Cytotoxic; Transplantation Conditioning

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Combined Modality Therapy; Disseminated Intravascular Coagulation; Fatal Outcome; Humans; Immunocompromised Host; Lung Abscess; Lung Diseases, Fungal; Lymphoma, Non-Hodgkin; Male; Middle Aged; Mucormycosis; Platelet Transfusion; Pneumonectomy; Shock, Septic; Thrombocytopenia; Tomography, X-Ray Computed

An allogeneic stem cell transplant recipient developed pulmonary infiltrates and Aspergillus antigenemia during prophylactic low-dose liposomal amphotericin B. No response to therapy was observed after increasing the dose of liposomal amphotericin B and addition of caspofungin, and breakthrough candidemia developed. Therapy switch to voriconazole did not prevent the development of lethal septic shock. Shortly before death, Scopulariopsis brevicaulis was cultured from bronchial secretions, and positive blood cultures demonstrated persistent candidemia due to Debaryomyces hansenii, teleomorph of Candida famata.

Topics: Aged; Amphotericin B; Anemia, Aplastic; Ascomycota; Aspergillosis; Body Fluids; Caspofungin; Drug Therapy, Combination; Echinocandins; Fatal Outcome; Fungemia; Hematopoietic Stem Cell Transplantation; Humans; Lipopeptides; Male; Mycoses; Peptides, Cyclic; Pyrimidines; Saccharomycetales; Shock, Septic; Triazoles; Voriconazole

Topics: Adult; Amphotericin B; Antifungal Agents; Female; Histoplasmosis; Humans; Multiple Organ Failure; Shock, Septic; Switzerland

Topics: Amphotericin B; Antifungal Agents; Aorta, Abdominal; Aspergillosis; Aspergillus flavus; Blood Vessel Prosthesis; Diagnosis, Differential; Fatal Outcome; Humans; Male; Middle Aged; Multiple Organ Failure; Prosthesis-Related Infections; Reoperation; Shock, Septic; Time Factors

Candida krusei is inherently resistant to fluconazole and is emerging as a frequent cause of fungemia in patients with hematologic malignant neoplasms.. To determine the risk and prognostic factors associated with C krusei fungemia in comparison with Candida albicans fungemia in patients with cancer.. Retrospective study of 57 cases of C krusei fungemia occurring at the M. D. Anderson Cancer Center, Houston, Tex, from 1989 to 1996. The C krusei cases were compared with 57 cases of C albicans fungemia with respect to demographics, underlying cancer, Acute Physiology and Chronic Health Evaluation II score, immunosuppression status, chemotherapy, and the use of central venous catheters, as well as fluconazole prophylaxis.. At our institution, C krusei accounted for 5% of fungemias during 1989 through 1992 and for 10% during 1993 through 1996. Patients with C krusei fungemia more often had leukemia than patients with C albicans (77% vs 11%; P =.02), whereas catheter-related infections were more common among patients with C albicans fungemia (42% vs 0%; P<.001). Patients with C krusei fungemia had a lower response rate (51% vs 69%; P =.05), largely because they more frequently were neutropenic and had disseminated infection. Mortality related to fungemia was 49% in the cases with C krusei vs 28% in C albicans. Multiple logistic regression analysis showed that persistent neutropenia (P =.02) and septic shock (P =.002) were predictors of poor prognosis.. In neutropenic patients, C krusei fungemia is associated with high mortality. It should be suspected in patients with leukemia who are receiving fluconazole prophylaxis and should be treated aggressively with an amphotericin B regimen.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Antineoplastic Agents; Candida albicans; Case-Control Studies; Catheterization, Central Venous; Catheters, Indwelling; Child; Child, Preschool; Drug Resistance, Microbial; Female; Fluconazole; Fungemia; Hematologic Neoplasms; Humans; Immunocompromised Host; Immunosuppressive Agents; Infant; Logistic Models; Male; Middle Aged; Neutropenia; Prognosis; Retrospective Studies; Risk Factors; Shock, Septic; Treatment Outcome

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

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

It is described a pulmonary mucormycosis in an 11-year-old child with AIDS. The diagnosis was obtained by direct examination of the bronchial aspiration. The non-septate, hyaline, dichotomous, pathognomonic cenotic hyphae of this disease were observed. The child was cured with the specific treatment with Amphotericin B, since he died a year later and this affection did not appear in the necropsy. This combination of pulmonary mucormycosis and AIDS has never been reported in Cuba.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Child; Fatal Outcome; Humans; Lung Diseases, Fungal; Lymphangitis; Male; Mucormycosis; Shock, Septic; Tibia

Mucormycosis is a rare fungal disease commonly affecting individuals with diabetes mellitus, hematological malignancy, and immune deficiency. Isolated pulmonary mucormycosis is extremely rare. This article reports a case of isolated pulmonary mucormycosis that presented as a solitary cavity infiltrate in a patient with no underlying risk factors.

Topics: Aged; Amphotericin B; Fatal Outcome; Fungemia; Humans; Lung Diseases, Fungal; Male; Mucormycosis; Radiography; Renal Insufficiency; Shock, Septic

Topics: Adult; Amphotericin B; Candidiasis; Fundus Oculi; Gastrointestinal Diseases; Humans; Male; Postoperative Complications; Shock, Septic

Identification of the cause and subsequent specific therapy are indicated for those prolonged or relapsing fevers that follow abdominal surgery. On rare occasions, these fevers can be attributed to potentially life-threatening occult infections, including maxillary sinusitis, acute cholecystitis, antibiotic-related pseudomembranous colitis, toxic shock syndrome, systemic candidiasis, and transfusion-related cytomegalovirus disease, malaria, and babesiosis. Early recognition and appropriate treatment of these infections relieve anxiety, reduce hospital costs, and increase patient survival rates.

Topics: Abdomen; Acute Disease; Amphotericin B; Anti-Bacterial Agents; Bacterial Infections; Candidiasis; Cholecystitis; Clostridium Infections; Colitis; Fever; Foreign Bodies; Humans; Intubation, Gastrointestinal; Intubation, Intratracheal; Maxillary Sinus; Postoperative Complications; Shock, Septic; Sinusitis; Staphylococcal Infections; Transfusion Reaction

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

Topics: Adult; Amphotericin B; Colistin; Diagnosis, Differential; Endocarditis, Subacute Bacterial; Humans; Hydrocortisone; Infusions, Parenteral; Injections, Intravenous; Male; Mycoses; Penicillins; Shock, Septic; Streptomycin