amphotericin-b and Skin-Ulcer

Sporotrichosis is a rare fungal infection in transplant patients; among these patients, it occurs mostly in renal transplant patients. Sporothrix schenkii is the primary pathogen responsible. A high index of suspicion is required to make the diagnosis keeping important differential diagnoses in mind. History of trauma through recreational or occupational exposure to the fungus may assist in making the diagnosis. Treatment is difficult, with long-term use of potentially nephrotoxic and cytochrome P450 inhibitor antifungal agents leading to potential calcineurin inhibitors toxicity. We describe two renal transplant patients presenting with distinct sporotrichosis infection: "Case 2" being only the second reported case ever of meningeal sporotrichosis. We subsequently review the general aspects of sporotrichosis, specifically in renal transplant patients as described in the medical literature.. Case 1, a 43-year-old mixed ancestry male patient presented with a non-healing ulcer on the left arm for 1 year, he was diagnosed with cutaneous sporotrichosis and was successfully treated with itraconazole monotherapy. Case 2, a 56-year-old mixed ancestry male patient presented with a slow decline in functions, confusion, inappropriate behavior, rigors and significant loss of weight and appetite over the past 4 months, he was diagnosed with meningeal sporotrichosis and was successfully treated with a combination of deoxycholate amphotericin B and itraconazole.. Physicians taking care of renal transplant patients should have a high index of suspicion for sporotrichosis infection particularly when conventional therapy for common conditions fails. Susceptibility testing is recommended to identify the most effective antifungal agent and its dose. The slow nature of growth of Sporothrix schenkii necessitates patients to be on amphotericin B until the time results are available. Finally, there is a need to be aware of potential drug-drug interactions of the azoles with calcineurin inhibitors and the required dose adjustments to prevent therapy related adverse events.

Topics: Adult; Amphotericin B; Antifungal Agents; Deoxycholic Acid; Drug Combinations; Humans; Itraconazole; Kidney Transplantation; Male; Meningitis, Fungal; Middle Aged; Opportunistic Infections; Skin Ulcer; Sporotrichosis; Transplant Recipients

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

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

Primary cutaneous mucormycosis is an unusual mycotic infection associated to immunosupression. We present a 34 year-old woman with HIV infection with a necrotic primary mucormycosis of the skin associated to a venous catheter. She was treated with amphotericin B and surgical debridement.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Catheterization; Combined Modality Therapy; Debridement; Drug Therapy, Combination; Fasciitis, Necrotizing; Female; Forearm; Humans; Klebsiella Infections; Mucormycosis; Occlusive Dressings; Pneumonia, Pneumocystis; Skin Ulcer

Two patients with cutaneous alternaria infection are presented. In both patients the skin lesions were characterized by multiple non-healing ulcers covered with dry crusts. Although the skin changes were macroscopically alike in the two patients, differences in the histology were seen. Both patients had primary debilitating diseases. A review of the literature is presented and revealed an additional ten cases of cutaneous alternariosis. Methods for the isolation of Alternaria and the susceptibility of the fungus to antimycotic drugs are presented.

Topics: Adolescent; Adult; Alternaria; Amphotericin B; Child, Preschool; Chlorquinaldol; Dermatomycoses; Female; Flucytosine; Gentian Violet; Griseofulvin; Humans; Male; Middle Aged; Mitosporic Fungi; Nystatin; Potassium Permanganate; Skin Ulcer

Topics: Adult; Amphotericin B; Antifungal Agents; Cryptococcus neoformans; Diagnosis, Differential; Fluconazole; Flucytosine; Humans; Male; Meningitis, Cryptococcal; Necrosis; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Skin Ulcer; Thigh

Topics: Aged; Amphotericin B; Antifungal Agents; Female; Humans; Infections; Prototheca; Skin Diseases, Infectious; Skin Ulcer

Primary cutaneous mucormycosis is a very uncommon manifestation occurring most often in diabetics or following trauma.. We herein present a case of primary cutaneous mucormycosis of the hand caused by Rhizopus microsporus in an immunocompetent patient.. This is the second such reported case in the literature.

Topics: Adult; Amphotericin B; Antifungal Agents; Hand Dermatoses; Humans; Immunocompetence; Male; Mucormycosis; Rhizopus; Skin Ulcer

A 28-year-old man undergoing treatment for hemophagocytic syndrome developed Paecilomyces lilacinus infection in skin ulcers on the face and in the tracheotomy stoma. While his bone marrow was suppressed by chemotherapy with dexamethasone, cyclosporin and etoposide for hemophagocytic syndrome, dental infection led to subacute necrotizing fasciitis caused by Pseudomonas aeruginosa on the right side of the face, resulting in a large area of soft tissue defects. Etoposide was discontinued, and prophylactic treatment with itraconazole was initiated. The ulcers resulting from necrotizing fasciitis were treated conservatively using trafermin and alprostadil alfadex ointment 0.003 %, and near-complete re-epithelialization occurred, except on the right lower eyelid, right buccal mucosa and perioral area. However, 6 weeks later, pustules/crusts started to form and break down repeatedly, leading to expansion of tissue defects on the face. Direct microscopic examination revealed fungal elements, and fungal culture identified Paecilomyces lilacinus suspicious twice some other day. Based on DNA extraction from the isolated fungus, this fungal strain was identified as Paecilomyces lilacinus. Cyclosporin and itraconazole were discontinued, and treatment with liposomal amphotericin B and a tapering dose of steroids was initiated. Cure was achieved in approximately 2.5 months after treatment initiation, and no relapse has been observed. The most important factor that ultimately contributed to the resolution of fungal infection might have been release of immunosuppression by discontinuing cyclosporin and tapering steroids.

Topics: Adult; Amphotericin B; Antifungal Agents; Cyclosporine; Dexamethasone; Face; Fasciitis, Necrotizing; Humans; Immune Tolerance; Lymphohistiocytosis, Hemophagocytic; Male; Mycoses; Paecilomyces; Pseudomonas aeruginosa; Pseudomonas Infections; Skin Ulcer; Surgical Stomas; Tracheotomy; Treatment Outcome

The frequency of histoplasmosis among solid organ transplant (SOT) recipients appears to be low where there are only a few case series, mostly among renal and liver transplant recipients. Herein we report a case of a 44-year-old woman who underwent a living-related renal transplant 18 years prior to evaluation, developed a nodule after followed by ulceration upon her posterior right leg and a second one upon her left leg 3 months and 2 months before her hospitalisation, respectively. The biopsy of lesion revealed the presence of Histoplasma spp. Bone marrow aspiration was performed and also revealed the same organism. She had initially received itraconazole without improvement of lesions, while a new lesion appeared on her left arm. Healing of all lesions could be observed after 40 days of liposomal amphotericin B when she was submitted to skin grafts on the legs and a surgical treatment on the arms, and the myelosuppression improved simultaneously. Histoplasmosis seems to be very uncommon among patients who underwent to organ solid transplantation. Most cases occur within 12-18 months after transplantation, although unusual cases have been presented many years post-transplant. There are cases reported in the literature, occurring from 84 days to 18 years after organ transplantation, but without cutaneous involvement. Our patient developed lesions on limbs and myelosuppression after 18 years of chronic immunosuppression medication. This case suggests that besides cutaneous histoplasmosis is an uncommon infection following iatrogenic immunosuppression and even rarer over a long period after the transplantation. Clinicians who care SOT recipient patients must bear in mind histoplasmosis infection as differential diagnosis in any case of cutaneous injury with prolonged fever and try to use as many tools as possible to make the diagnosis, once this disease presents a good prognosis if it is diagnosed and treated promptly.

Topics: Adult; Allografts; Amphotericin B; Antifungal Agents; Bone Marrow; Bone Marrow Diseases; Dermatomycoses; Female; Histoplasma; Histoplasmosis; Humans; Immunocompromised Host; Kidney Transplantation; Skin Transplantation; Skin Ulcer; Transplant Recipients; Treatment Outcome

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Biopsy; Dermatomycoses; Histoplasma; Histoplasmosis; HIV Infections; Humans; Male; Middle Aged; Skin Ulcer; Treatment Outcome

Mucormycosis is a fungal infection caused by order Mucorales in humans. It commonly affects immunocompromised individuals, usually following trauma, and is associated with high rates of mortality despite the use of modern antifungal therapy and debridement. This report describes a case of the mucormycosis that presented as a non-healing ulcer over the chest wall (an extremely rare site for this lesion) which appeared to be a soft tissue tumour. The patient was immunocompetent and had no history of trauma. Repeated biopsies suggested there were only inflammatory changes but a fungal culture confirmed Rhizopus microsporus. The ulcer was managed successfully with high doses of intravenous Amphotericin B and aggressive surgical debridement.

Topics: Amphotericin B; Anti-Bacterial Agents; Combined Modality Therapy; Humans; Male; Middle Aged; Mucormycosis; Skin Ulcer; Soft Tissue Neoplasms; Thoracic Wall; Wound Healing

Cutaneous leishmaniasis (CL) is rarely seen in the United States, and the social and geographic context of the infection can be a key to its diagnosis and management. Four Somali and one Ethiopian, in U.S. Border Patrol custody, came to the United States by the same human trafficking route: Djibouti to Dubai to Moscow to Havana to Quito; and then by ground by Columbia/Panama to the United States-Mexico border where they were detained. Although traveling at different times, all five patients simultaneously presented to our institution with chronic ulcerative skin lesions at different sites and stages of evolution. Culture of biopsy specimens grew Leishmania panamensis. Soon thereafter, three individuals from East Africa traveling the identical route presented with L. panamensis CL to physicians in Tacoma, WA. We document here the association of a human trafficking route and new world CL. Clinicians and public health officials should be aware of this emerging infectious disease risk.

Topics: Adult; Africa, Eastern; Amphotericin B; Cluster Analysis; Disease Outbreaks; Humans; Leishmania; Leishmaniasis, Mucocutaneous; Male; Panama; Skin Ulcer; Social Problems; Travel; United States; Young Adult

Topics: Adrenal Cortex Hormones; Amphotericin B; Cryptococcosis; Enzyme-Linked Immunosorbent Assay; Female; Follow-Up Studies; Graft Survival; Humans; Middle Aged; Pemphigus; Preoperative Care; Risk Assessment; Severity of Illness Index; Skin Transplantation; Skin Ulcer; Tissue and Organ Harvesting; Transplantation, Autologous; Treatment Outcome; Wound Healing

Topics: Adult; Agricultural Workers' Diseases; Amphotericin B; Antifungal Agents; Blastomyces; Blastomycosis; Brain; Cognition Disorders; Contrast Media; Deoxycholic Acid; Disasters; Drug Combinations; Encephalitis; Facial Dermatoses; Gadolinium; Humans; Itraconazole; Louisiana; Lung Diseases, Fungal; Magnetic Resonance Imaging; Male; Phosphatidylcholines; Phosphatidylglycerols; Skin Ulcer

Primary cutaneous aspergillosis is a rare cutaneous disease that usually affects immunodepressed patients of any age. The most common associated disorders in children are leukemias and lymphomas although it can also occur in neonates and preterms due to their intrinsic immunological immaturity. We report the case of a 4-year-old boy diagnosed of acute lymphoblastic leukemia that, during chemotherapy, developed an ulceronecrotic inflammatory cutaneous lesion in the venopuncture area of the left forearm, and whose microbiological culture was positive for Aspergillus flavus.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Combined Chemotherapy Protocols; Aspergillosis; Aspergillus flavus; Child, Preschool; Dermatomycoses; Humans; Immunocompromised Host; Male; Neutropenia; Opportunistic Infections; Phlebotomy; Precursor B-Cell Lymphoblastic Leukemia-Lymphoma; Skin Ulcer; Wound Infection

Among bone lesions of African histoplasmosis, those affecting the jaw are relatively rare and concern, with other facial involvements, particularly infants and adolescent patients with an usual uncompromised immunologic status. As clinical and radiologic features are not specific, the differential diagnosis to other mandibular diseases is difficult. We report on a case of African histoplasmosis that involved the right mandibula of a 17-year-old Congolese boy with a persistent and fungiform cutaneous ulceration. As mycologic tests had not been carried out initially, the disease was histologically diagnosed on the basis of the presence of numerous intra-cytoplasmic large yeasts in a granulomatous lesion containing giant cells. As it is impossible to confront the histologic diagnosis with mycologic tests in such a situation, the problems of the differential diagnosis to other deep fungus infections and to some yeast-like foreign body-granulomas encountered at the microscopical level underline the importance of culturing organisms from lesions to confirm the histologic diagnosis. It is worth considering this pathology at least for three reasons: it usually mimicks a malignant jaw tumor; it may constitute a migrant pathology; and prognosis is commonly favorable with amphotericin B treatment.

Topics: Adolescent; Africa; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Histoplasma; Histoplasmosis; Humans; Injections, Intravenous; Jaw Neoplasms; Male; Maxilla; Maxillary Diseases; Skin Ulcer

A rare case of protothecosis in a 40-year-old Japanese woman with systemic lupus erythematosus, under long-term prednisolone treatment is presented. The patient developed extensive ulcerative skin lesions after injury. The characteristic histopathological findings and biochemical sugar assimilation tests indicated infection by Prototheca wicherhamii. The lesions improved following treatment with amphotericin B. The immunodeficient state of this patient seemed to contribute to the infection with Prototheca.

Topics: Abscess; Adult; Amphotericin B; Elbow Injuries; Female; Humans; Immunity, Cellular; Immunocompromised Host; Infections; Lupus Erythematosus, Systemic; Prednisolone; Prototheca; Skin Diseases, Infectious; Skin Ulcer

A 65-year-old man with stage I testicular seminoma, treated with surgery and radiation, had fever of unknown origin, adrenal insufficiency, and an isolated perianal ulcer. Tissue diagnosis of disseminated histoplasmosis was established by biopsy of the perianal ulcer, an unusual cutaneous manifestation of the disease. Treatment with amphotericin B resulted in rapid clinical improvement and complete healing of the perianal ulcer.

Topics: Aged; Amphotericin B; Anus Diseases; Histoplasma; Histoplasmosis; Humans; Immune Tolerance; Male; Skin Ulcer

Topics: Adult; Amphotericin B; Blastomyces; Blastomycosis; Humans; Male; Skin Ulcer

With the setting up of a rural-medical post in the region of Pachitea-Pichis river, affluent of the Alto Ucayali, in the year 1973, the authors made the diagnosis of 120 cases of pigmentary Leishmaniasis (1,2 % of the total population). 55 % of this series corresponded to pure cutaneous forms and 65 were of the muco-cutaneous type, 21 of the latter being mutilating. Sixty per cent were young males working as wood labourers or farmers. The treatment with Repodral (Etilofen) was useful only in the initial froms. Brezilian Pemhigus foliaceous which is considered endemic in the same geographical area responded wery well to treatment with prednisolone.

Topics: Administration, Topical; Adolescent; Adult; Aged; Amphotericin B; Anti-Inflammatory Agents; Child; Child, Preschool; Dermatitis, Occupational; Humans; Infant; Leishmaniasis, Mucocutaneous; Male; Middle Aged; Pemphigus; Peru; Prednisolone; Skin Ulcer; Wood

Topics: Amphotericin B; Cryptococcosis; Cryptococcus neoformans; Humans; Male; Middle Aged; Ointments; Skin Ulcer

Topics: Amphotericin B; Candidiasis; Diabetes Complications; Diabetic Angiopathies; Foot Diseases; Glucose; Griseofulvin; Humans; Injections, Intramuscular; Nystatin; Pyoderma; Skin Diseases; Skin Manifestations; Skin Ulcer; Tolnaftate; Xanthomatosis

Topics: Amphotericin B; Foot Dermatoses; Humans; Injections, Intravenous; Skin Ulcer; Thigh; Yeasts

Topics: Amphotericin B; Bone Diseases; Brain Diseases; Cryptococcosis; Female; Humans; India; Middle Aged; Skin Diseases, Infectious; Skin Ulcer

Topics: Actinomycosis; Adult; Amphotericin B; Biopsy; Blastomycosis; Coccidioidomycosis; Cryptococcosis; Diagnosis, Differential; Female; Histoplasmosis; Humans; Male; Middle Aged; Mycoses; Nystatin; Respiratory Tract Infections; Skin; Skin Diseases; Skin Ulcer; South America; Sputum

Topics: Amphotericin B; Diagnosis, Differential; Hexachlorophene; Humans; Male; Middle Aged; Potassium Iodide; Prednisolone; Pyoderma; Silver Nitrate; Skin Ulcer; Sporothrix; Sporotrichosis

Topics: Amphotericin B; Cryptococcosis; Epidemiologic Methods; Female; Humans; Middle Aged; Skin Ulcer

Topics: Actinomycosis; Adrenal Cortex Hormones; Amphotericin B; Anti-Bacterial Agents; Antineoplastic Agents; Cardiac Surgical Procedures; Cats; Classification; Dogs; Epidemiology; Hematology; Hospitals; Hospitals, General; Infarction; Lung Diseases; Lymphatic System; Metabolic Diseases; Mycoses; Nocardia Infections; Pathology; Periodontal Diseases; Rodentia; Skin Ulcer; Thoracic Surgery; Toxicology; United Kingdom