amphotericin-b and Soft-Tissue-Infections

Rhinocerebral or sinopulmonary mucromycosis is a well-recognized human fungal infection found among immunocompromised and diabetic patients. However, the infection is rare among immunocompetent hosts. We are reporting the case of an adult immunocompetent male patient working as an air-conditioning technician. The patient was a victim of a road traffic accident (RTA) and sustained multiple fractures in the proximal part of the left tibia, distal femur, and scapula. Two weeks postoperatively, Rhizopus microspores were isolated from an infected traumatic wound over the distal femur. Surgical debridement was performed, and the patient was started on amphotericin B. Occupational exposure history and workplace environmental sanitation are crucial for the prevention of this potentially fatal yet preventable infection.

Topics: Adult; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Humans; Male; Mucormycosis; Rhizopus; Soft Tissue Infections; Wound Infection

Apophysomyces elegans is an environmental fungus related to other well-known agents of zygomycosis. We report a case of locally invasive A elegans soft tissue infection resulting from the application of a skin patch to test for snapdragon sensitivity. The infection was limited to skin and soft tissue, and treatment consisted of local debridement and liposomal amphotericin B. Outcome was successful.

Topics: Aged; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Dermatomycoses; Humans; Male; Mucormycosis; Patch Tests; Soft Tissue Infections

Topics: Accidents, Traffic; Adult; Amphotericin B; Antifungal Agents; Brain Diseases; Debridement; Humans; Immunocompetence; Male; Mucormycosis; Orbit Evisceration; Orbital Diseases; Paranasal Sinus Diseases; Soft Tissue Infections

The antimicrobial management of patients in the critical care unit is complex. Not only must the clinician be familiar with a number of clinical, microbiological, pharmacological, and epidemiological observations but also fundamental pharmacodynamic concepts. It is an understanding of these concepts that forms the basis for the design of dosing strategies that maximize clinical efficacy and minimize toxicity. Antimicrobial selection is further complicated by the plethora of new antimicrobial agents available with varying clinical utility. Nowhere is this more evident than in the quinolone class of antibiotics. To aid the clinician in differentiating between quinolones it now seems reasonable to create a classification system akin to the generation grouping applied to the cephalosporins. Our classification is based upon the pharmacodynamic principles discussed within this article.

Topics: Aminoglycosides; Amphotericin B; Anti-Bacterial Agents; Anti-Infective Agents; Antifungal Agents; Community-Acquired Infections; Cross Infection; Fluoroquinolones; Humans; Intensive Care Units; Mycoses; Pneumonia, Bacterial; Skin Diseases, Bacterial; Soft Tissue Infections; United States; Urinary Tract Infections

Cutaneous mucormycosis is an unusual fungal infection that continues to occur. It needs aggressive surgical debridement and timely administration of antifungals due to its high fatality rate. High clinical suspicion on the part of a surgeon is required to prevent the same.. We present two cases of cutaneous mucormycosis in which the patients succumbed to death, highlighting the seriousness of the condition. One patient had a lower leg ulcer and was diabetic, and the other patient had a gluteal abscess following an intramuscular injection. Tissue samples grew Rhizopus arrhizus and Apophysomyces sp., respectively. Both patients were treated with amphotericin B, and extensive debridement was performed.. Cutaneous mucormycosis can be reported in immunocompetent people, and there is a need for early recognition of the entity as a differential diagnosis of any nonhealing necrotic ulcer.. Proper training and education of technical and clinical staff should be done at peripheral primary and secondary care centres so as not to miss out on cases of mucormycosis and for better prognosis in a cutaneous variety of mucormycosis in surgical patients.

Topics: Amphotericin B; Antifungal Agents; Humans; Mucormycosis; Skin; Soft Tissue Infections

Topics: Amphotericin B; Aortic Aneurysm, Abdominal; Aortic Dissection; Disease Progression; Fatal Outcome; Female; Humans; Marfan Syndrome; Mesenteric Ischemia; Middle Aged; Mucormycosis; Multiple Organ Failure; Polymethyl Methacrylate; Postoperative Complications; Risk Assessment; Soft Tissue Infections

An 81-year-old man from rural Australia presented with right pretibial cellulitis 7 days after minor trauma against furniture. He failed to improve despite antibiotics and surgical debridement. Subsequent cultures grew the rare fungus

Topics: Aged, 80 and over; Amphotericin B; Antifungal Agents; Australia; Debridement; Humans; Leg Injuries; Male; Mucormycosis; Soft Tissue Infections; Treatment Outcome; Triazoles

Mucormycosis, also known as phycomycosis or zygomycosis, is caused by common Zygomycete fungi frequently found in soil and decaying vegetation. These mainly infect immunocompromised patients and cause an acute fulminating fungal disease; mucormycosis rarely affects otherwise healthy people. Mucormycosis is a fatal infection with a poor prognosis. Of the different types of mucormycosis, the rhinocerebral type is the most severe one, and its type 2 subtype, the rhino-orbital-cerebral form is the deadliest variety. Here, we report a case of mucormycosis presenting with extensive necrosis of the maxilla with extension into the retrobulbar and infrabulbar region in an otherwise healthy patient. He underwent extensive debriding surgery followed by amphotericin B first and then oral antifungal therapy, but unfortunately, even after extensive surgery and medical treatment, he did not survive.

Topics: Adult; Amphotericin B; Antifungal Agents; Bone Diseases, Infectious; Debridement; Fatal Outcome; Humans; Immunocompetence; Male; Maxilla; Mucormycosis; Nose Diseases; Orbital Diseases; Soft Tissue Infections

We describe a 69-year-old female farmer with diabetes mellitus who developed subcutaneous infection due to a plant pathogen, Corynespora cassiicola. The organism was identified based on characteristic morphotypes and confirmed by sequence analysis of the internal transcribed spacer (ITS) regions. The patient was treated successfully with amphotericin B therapy.

Topics: Aged; Amphotericin B; Antifungal Agents; Ascomycota; Dermatomycoses; Diabetes Complications; DNA, Fungal; DNA, Ribosomal Spacer; Female; Humans; Sequence Analysis, DNA; Soft Tissue Infections; Treatment Outcome

Soft-tissue masses are rarely associated with Histoplasma capsulatum infection. We describe a heart transplant patient who presented with a large right-sided chest wall mass as a manifestation of disseminated histoplasmosis. A successful clinical outcome was achieved upon recognition of the fungal pathogen.

Topics: Aged; Amphotericin B; Antifungal Agents; Biopsy; Debridement; Diagnosis, Differential; Drug Administration Schedule; Drug Therapy, Combination; Graft Rejection; Heart Transplantation; Histoplasma; Histoplasmosis; Humans; Immunosuppressive Agents; Itraconazole; Male; Mycophenolic Acid; Soft Tissue Infections; Tacrolimus; Thoracic Wall; Tomography, X-Ray Computed; Transplantation Conditioning

Topics: Amphotericin B; Antifungal Agents; Combined Modality Therapy; Cryptococcosis; Debridement; Fasciitis, Necrotizing; Fatal Outcome; Humans; Male; Middle Aged; Soft Tissue Infections; Subcutaneous Tissue; Thigh

We describe a case of primary cutaneous Absidia corymbifera infection in an AIDS patient with renal complications. The Sensititre YeastOne panel was adopted to determine antifungal susceptibility and liposomial amphotericin B was used which initially produced a significant clinical response.

Topics: Absidia; Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Female; Humans; Injections, Intravenous; Kidney Diseases; Leg Injuries; Mucormycosis; Soft Tissue Infections

Topics: Administration, Oral; Adult; Amphotericin B; Antifungal Agents; Blood Vessels; Diabetes Complications; Fatal Outcome; Gangrene; Hand; Humans; Injections, Intravenous; Itraconazole; Male; Microscopy; Middle Aged; Necrosis; Soft Tissue Infections; Thorax; Thrombosis; Zygomycosis

Conidiobolus entomophthoromycosis is a rare mycosis due to an ubiquitary telluric fungus. Although the organism is found around the world, it is more concentrated in warm, wet climates. Cases have been described in West Africa, Australia, South America and India. Conidiobolus spp was also to be found in animal like horse. The transmission mode of Conidiobolus has not been established but probably occurs via inhalation of fungal spores covering the nasal mucous membrane or from a minor trauma such as an insect bite. The clinical syndromes include intranasal tumour, nasal obstruction, broadening of the nose bridge, paranasal sinuses, cheeks and upper lip. Diagnostic is made by demonstrating distinctive non-septate hyphea with surrounding eosinophilic sleeve (Splendore-Hoeppli phenomenom) in tissue sections. We report here two cases contracted in Comoro Islands. The first one was a 26 year-old man treated by amphotericin B during six weeks and then by itraconazole, with a clear improvement. The second one was a 37 year-old woman. She has been treated by amphotericin B, subsequently by imidazoles. There was a clear benefit on life duration, but the results for aesthetic aspect are not satisfactory. In the discussion, we review treatment efficacy and failure; in fact, surgery which includes removal of infected tissue and reconstructive procedures, is seldom curative. Several combinations of drugs have been used with different degrees of success. Nevertheless imidazoles remain more efficient than amphotericin B.

Topics: Adult; Amphotericin B; Antifungal Agents; Conidiobolus; Face; Female; Fluconazole; Humans; Itraconazole; Male; Nose Diseases; Soft Tissue Infections; Treatment Outcome; Zygomycosis

Dematiaceous fungi such as Dactylaria gallopava are becoming more prevalent in transplant patients, with 50% of outcomes being fatal. In this report, we describe a 32-year-old woman who presented with swelling in the right shoulder area and right lateral neck. On further investigation with a CT scan, a fluid collection in the shoulder was identified, drained, and subsequently grew D gallopava. We report the successful treatment of an invasive Dactylaria infection in a lung transplant patient predominantly by medical chemotherapy, although surgical incision and drainage was performed on one of the fungal lesions.

Topics: Adult; Amphotericin B; Antifungal Agents; Ascomycota; Drainage; Female; Humans; Immunocompromised Host; Itraconazole; Lung Transplantation; Mycoses; Postoperative Complications; Soft Tissue Infections

A 24-year-old female diabetic patient was hospitalized because of ketoacidosis and a necrotic wound on the hand. Debridement and antibiotic therapy failed to halt the process. After demonstration of Mucor in cultures from the wound, the patient underwent extensive surgery and amphotericin B was administered. When the necrotic process continued despite these measures, adjunctive hyperbaric oxygen (100% O2 at 2.5 ATA for 90 minutes) was administered daily for a total of 21 treatment sessions. She gradually improved, and at 2 months follow-up most of the wound had healed. Although the mortality rate of cutaneous/soft-tissue zygomycosis is markedly lower than that of the rhinocerebral form, morbidity is still considerably high. Successful use of hyperbaric oxygen has been reported in rhinocerebral zygomycosis, and it may have been of benefit in this high-risk patient by preventing local and systemic spreading of the fungus. This report is the first case of the use of hyperbaric oxygen for cutaneous/soft-tissue zygomycosis. It is suggested that hyperbaric oxygen be considered for this indication in diabetic patients as an adjunct to surgery and amphotericin B.

Topics: Adult; Amphotericin B; Antifungal Agents; Combined Modality Therapy; Debridement; Diabetes Mellitus, Type 1; Diabetic Ketoacidosis; Female; Fingers; Humans; Mucormycosis; Opportunistic Infections; Soft Tissue Infections

Blastomyces is a pathogen that may infect healthy and immunocompromised hosts. Frequently entering the lungs, the initial pneumonitis usually is followed by skin and bony involvement secondary to hematogenous spread. Infection of the synovium without bone or skin involvement in the pediatric population has not been reported previously. A soft tissue mass of the forearm in a 9-year-old boy was the initial manifestation of blastomycosis. Radiographic images, ultrasound, and magnetic resonance imaging of the forearm could not distinguish inflammation from sarcoma. Frozen section during open biopsy revealed a granulomatous process and several budding yeasts. There was no evidence of a malignancy. Cultures of the tissue grew Blastomyces dermatitidis. The patient was treated successfully with surgical debridement of the mass and amphotericin B followed by itraconazole, for a total therapeutic course of 18 weeks. Although rarely diagnosed in children, blastomycosis must be included in the differential diagnosis of any soft tissue mass.

Topics: Amphotericin B; Blastomycosis; Child; Forearm; Humans; Joint Diseases; Male; Soft Tissue Infections; Synovial Membrane

We describe the clinical course and successful treatment of a previously healthy man who, after experiencing trauma, presented with severe cutaneous mucormycosis due to Apophysomyces elegans and subsequently developed secondary renal infection. A multidisciplinary approach employing aggressive surgical debridement and therapy with hyperbaric oxygen, liposomal amphotericin B, and interferon-gamma was successful in controlling his infection, obviating the need for nephrectomy.

Topics: Adult; Amphotericin B; Humans; Hyperbaric Oxygenation; Interferon-gamma; Kidney Diseases; Liposomes; Male; Mucorales; Mucormycosis; Soft Tissue Infections; Soft Tissue Injuries; Tomography, X-Ray Computed