amphotericin-b and Spinal-Diseases

Topics: Amphotericin B; Antifungal Agents; Back Pain; Coccidioidomycosis; Diagnosis, Differential; Female; Follow-Up Studies; Fungemia; Humans; Itraconazole; Magnetic Resonance Imaging; Middle Aged; Osteomyelitis; Physical Examination; Severity of Illness Index; Spinal Diseases; Thoracic Vertebrae; Treatment Outcome

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Child; Granulocytes; Granulomatous Disease, Chronic; Humans; Itraconazole; Male; Osteomyelitis; Spinal Diseases

Nervous system infections by Cryptococcus neoformans may occur not only in congenital or acquired immunodeficiency syndromes, but also in immunocompetent hosts. Neurological manifestations of C. neoformans infection include meningitis and, less commonly, parenchymal CNS granulomatous disease. This paper provides detailed clinical descriptions of highly unusual neurological manifestations of cryptococcal nervous system infections. Medical records and diagnostic data including magnetic resonance imaging, histopathology, serology, and CSF analysis were reviewed. A conus medullaris abscess was found in a patient infected with the human immunodeficiency virus (HIV). A patient with Hodgkin's disease was diagnosed with cryptococcal meningitis and dermatitis mimicking ophthalmic zoster. An immunocompetent patient presented with recurrent cerebral infarctions in the setting of cryptococcal meningitis. Cryptococcal infections of the nervous system can cause severe neurological disability when diagnosis is delayed. Sensitive and specific tests are readily available and should be considered when an unusual clinical presentation is encountered.

Topics: Abscess; Adult; Aged; Amphotericin B; Anticoagulants; Antifungal Agents; Brain; Central Nervous System Fungal Infections; Cryptococcosis; Cryptococcus neoformans; HIV Infections; Hodgkin Disease; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Spinal Diseases; Tomography, X-Ray Computed; Warfarin

We report the case of a 67-year-old patient who presented with a myelodysplastic syndrome and who developed a pulmonary mucormycosis with a rare extension to the dorsal spine. A decompressive laminectomy was attempted after failure of broad-spectrum antifungal treatment (Cancidas, V-Fend). The diagnosis was obtained after surgical biopsy. The scheduled lobectomy could not be performed because of altered clinical condition. The patient eventually died despite adapted antifungal treatment (Abelcet, Posaconazole). Pulmonary mucormycosis is a rare cause of mycotic infection that reaches most of the time immunocompromised patients. The pathogenic agent is part of zygomyces that have angio-invasive ability. Perineural propagation was recently described. Immunodepression, late diagnosis and lack of response to new generation antifungal drugs (V-Fend, Cancidas) are responsible for therapeutic failure in this disease. This case emphasizes the risk inherent to empirical antifungal treatment and the need of early biopsy in cases that do not respond to treatment.

Topics: Aged; Amphotericin B; Antifungal Agents; Drug Therapy, Combination; Fatal Outcome; Humans; Immunocompromised Host; Laminectomy; Lung Diseases, Fungal; Male; Mucormycosis; Myelodysplastic Syndromes; Spinal Diseases; Thoracic Vertebrae; Triazoles

Cryptococcal spinal arachnoiditis occurs in patients with meningitis and usually when they are immunocompromised. Spinal symptoms in cryptococcosis are rare and a very exceptional entity in the immunocompetent population. We present a young immunocompetent male who developed progressively increasing paraparesis due to primary cryptococcal arachnoiditis, who showed significant improvement after antifungal therapy. Although extremely rare, spinal arachnoiditis in an immunocompetent individual can be caused due to cryptococcus, as in our case. This case illustrates and emphasizes the necessity for an exhaustive and complete investigation, with a high index of suspicion for fungal etiology in patients presenting with spinal arachnoiditis or other disabling, progressive spinal cord syndromes of unknown etiology. Awareness of this presentation is necessary to avoid delay in diagnosis and management of this potentially curable condition.

Topics: Amphotericin B; Arachnoiditis; Biopsy; Cerebrospinal Fluid; Cryptococcosis; Cryptococcus neoformans; Diagnosis, Differential; Granuloma; Humans; Infusions, Intravenous; Low Back Pain; Magnetic Resonance Imaging; Male; Sacrum; Spinal Diseases; Tuberculosis, Spinal

Blastomycosis is an unusual fungal infection in children. It is often a chronic infection characterized by granulomatous and suppurative lesions. Clinical manifestations include either pulmonary findings or disseminated disease. Disseminated blastomycosis usually begins with a lung infection that spreads to the skin, bones, and central nervous system. This is a case report of a child with chronic blastomycosis presenting with chronic paronychia, fever, cough, malaise, and back pain. The child underwent surgical drainage of a paravertebral abscess and administration of intravenous amphotericin B. He was discharged in good condition on oral therapy with ketoconazole. The literature on blastomycosis, with particular emphasis on clinical presentations and management, is reviewed. When the history and physical examination suggest a chronic granulomatous or disseminated disease, such as tuberculosis, the physician must include blastomycosis in the differential.

Topics: Abscess; Amphotericin B; Antifungal Agents; Blastomycosis; Child; Chronic Disease; Humans; Ketoconazole; Male; Osteomyelitis; Paronychia; Spinal Diseases

We report the first case of vertebral aspergillosis in a child with a primary defect in monocyte killing, an extremely rare immunodeficiency The diagnosis of defective monocyte killing was made by an in vitro assay that showed normal killing of Staphylococcus aureus by the patient's neutrophils but impaired killing by his monocytes. Importantly, the extensive granulomatous infection that involved the vertebral column, posterior mediastinum, pleura, and lung was not responsive to aggressive treatment with a combination of liposomal amphotericin B. intralesional amphotericin B. itraconazole, and granulocyte transfusions. Dramatic clinical and radiological improvement was only seen after the addition of granulocyte macrophage-colony stimulating factor (GM-CSF) to his treatment regimen. The use of GM-CSF in the treatment of invasive aspergillosis in immunocompromised patients requires further evaluation.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Biopsy, Needle; Child, Preschool; Flucytosine; Granulocyte-Macrophage Colony-Stimulating Factor; Histocytochemistry; Humans; Immunocompromised Host; Itraconazole; Leukocyte Count; Magnetic Resonance Imaging; Male; Monocytes; Osteomyelitis; Radiography, Thoracic; Spinal Diseases; Spine; Tomography, X-Ray Computed

A rare case of cryptococcosis of sixth thoracic vertebra (T6) along with pulmonary involvement in an old diabetic patient is presented. The infection resulted in lytic lesion of T6 vertebra and girdle pain. A computerized tomographic (CT) guided fine-needle aspiration biopsy (FNAB) cytology was performed, which showed encapsulated fungal spores of Cryptococcus neoformans with granulomatous reaction, later confirmed by fungal culture.

Topics: Aged; Amphotericin B; Antifungal Agents; Antitubercular Agents; Biopsy, Needle; Cryptococcosis; Diagnosis, Differential; Humans; Spinal Diseases; Thoracic Vertebrae; Tomography, X-Ray Computed; Tuberculosis

Topics: Adult; Amphotericin B; Antifungal Agents; Candidiasis; Female; Humans; Osteomyelitis; Spinal Diseases; Time Factors

Topics: Abscess; Amphotericin B; Analgesia, Epidural; Antifungal Agents; Epidural Space; Equipment Contamination; Exophiala; Female; Humans; Middle Aged; Mycoses; Spinal Diseases

A 67-year-old previously healthy woman presented with low back pain of 2 months duration and daily fever of 39 degrees C for 3 weeks. CT scan showed a lytic lesion in the third lumbar vertebra and a small right lower lobe lung infiltrate with mediastinal lymphadenopathy. Culture of material obtained from open biopsy of the vertebra grew Cryptococcus neoformans var. neoformans, which was also demonstrated on histology. Cryptococcal antigen was detected in the patient's serum. Treatment with amphotericin B (1000 mg total dose) and oral 5-fluorocytosine, resulted in complete recovery and resolution of the chest X-ray findings with a follow-up of 2 years. Since this case, as well as most of the previously described cases of cryptococcal osteomyelitis, were in normal hosts, cryptococcal osteomyelitis should be considered in the differential diagnosis even in a normal host, and therefore, prior to possible invasive diagnostic procedures, cryptococcal antigen in the serum should be determined.

Topics: Aged; Amphotericin B; Antigens, Fungal; Biopsy; Cryptococcosis; Cryptococcus neoformans; Drug Therapy, Combination; Female; Flucytosine; Humans; Osteomyelitis; Spinal Diseases

Aspergillosis involving either the vertebral body or the intervertebral disc is a rare cause of osteomyelitis of the spine. The following is a report of five cases of Aspergillus fumigatus infection of the spine treated successfully with amphotericin B and 5-flucytosine. In three patients, the diagnosis was established at closed-needle biopsy; two patients with paraplegia had an anterior decompression and fusion. The follow-up period ranged from 19 to 48 months.

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Flucytosine; Humans; Male; Middle Aged; Osteomyelitis; Radiography; Spinal Diseases

Three cases of Aspergillus fumigatas vertebral osteomyelitis failed courses of medical treatment. Each was subsequently treated with anterior vertebral debridement and posterior segmental spinal instrumentation. Despite poor nutritional and immune systems, resolution of the infection and subsequent anterior ankylosis occurred in each patient, with follow-up ranging from 1 to 3 years. If patients with aspergillus vertebral osteomyelitis do not respond to medical treatment, early surgical debridement and stabilization in combination with intravenous amphotericin B can lead to resolution and bony ankylosis.

Topics: Adult; Aged; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Debridement; Humans; Lumbar Vertebrae; Male; Orthopedic Fixation Devices; Osteomyelitis; Spinal Diseases; Thoracic Vertebrae

Aspergillus nidulans var. echinulatus was the sole agent cultured from the left lung, a paraspinal abscess, left ribs, and thoracic vertebral bodies from a patient with chronic granulomatous disease. Hyphal elements were present in histologic sections of lung, vertebral bodies, and infected ribs along with granuloma formation. The patient was treated with two debridement procedures and insertion of a Harrington rod followed by a long course of amphotericin B, flucytosine, and daily white blood cell transfusions.

Topics: Abscess; Amphotericin B; Aspergillosis; Aspergillus nidulans; Blood Transfusion; Child, Preschool; Flucytosine; Granulomatous Disease, Chronic; Humans; Leukocyte Transfusion; Lung Diseases, Fungal; Male; Spinal Diseases; Thoracic Vertebrae

Three cases of aspergillosis observed in Pavia Infectious Disease Clinic in 1983-85 are described. The cases differed both in the site of the infection (lungs, bones and liver) and in the patients' basic immunological situation. The importance of mycological investigations during diagnosis is emphasised, though they should of course be flanked by instrumental examinations and blood chemical assays. The efficacy of specific treatment with amphotericin B combined with surgery and plasma exchange is also emphasised.

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Aspergillosis, Allergic Bronchopulmonary; Female; Humans; Intervertebral Disc; Liver Diseases; Male; Middle Aged; Plasma Exchange; Spinal Diseases

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus; Aspergillus fumigatus; Heroin Dependence; Humans; Lumbar Vertebrae; Lymphocytes; Male; Neutrophils; Osteomyelitis; Phagocytosis; Spinal Diseases; Thoracic Vertebrae

Fungal osteomyelitis is rare in patients who are not immunocompromised. This report documents that Aspergillus vertebral osteomyelitis may, however, be associated with infection of an adjacent prosthetic vascular graft in the absence of overt immunosuppression. A 73-year-old man is described with a mycotic pseudoaneurysm of a Dacron aortic bypass graft and contiguous vertebral osteomyelitis due to Aspergillus fumigatus. The patient was successfully treated with resection of the infected graft and administration of amphotericin B in a total dose of 2 g. Infection may have occurred intraoperatively as a result of inoculation with airborne fungal elements.

Topics: Aged; Amphotericin B; Aneurysm, Infected; Aortic Aneurysm; Aspergillosis; Aspergillus fumigatus; Coronary Artery Bypass; Humans; Male; Osteomyelitis; Spinal Diseases

This is a case report of an unusual vascular graft infection involving an invasive Aspergillus species with associated vertebral osteomyelitis. Successful treatment was obtained by graft incision, extra-anatomic bypass, and prolonged antibiotic therapy. To our knowledge this is the first successful treatment of invasive Aspergillus of an aortic prosthetic graft.

Topics: Aged; Amphotericin B; Aorta, Abdominal; Aortic Aneurysm; Aspergillosis; Blood Vessel Prosthesis; Humans; Lumbar Vertebrae; Male; Osteomyelitis; Spinal Diseases

A single case of back pain due to Blastomyces dermatitidis infection limited solely to the skeleton is reported with a discussion of the differential diagnosis. This rare disease must be differentiated from other destructive bone lesions such as tuberculosis or tumors because of the availability of effective treatment.

Topics: Amphotericin B; Back Pain; Blastomycosis; Diagnosis, Differential; Female; Humans; Lung; Middle Aged; Osteomyelitis; Spinal Diseases; Spine; Tomography, X-Ray Computed

A 67-year old man with acute myelomonocytic leukemia had Candida albicans fungemia during induction chemotherapy. Bilateral pulmonary infiltrates and hepatic granulomata containing yeast forms and septate hyphae developed, but cultures of the hepatic tissue failed to grow a fungus. Although his pulmonary and liver disease improved following appropriate therapy, vertebral osteomyelitis due to Candida albicans developed approximately 12-15 weeks after the original fungemia. The fungal osteomyelitis was successfully treated with amphotericin B and 5-fluorocytosine. This case illustrates the need for early diagnosis and aggressive treatment of fungal infections in patients with leukemia.

Topics: Aged; Amphotericin B; Candidiasis; Flucytosine; Humans; Intervertebral Disc; Leukemia, Myeloid, Acute; Lumbar Vertebrae; Male; Osteomyelitis; Radiography; Spinal Diseases

Aspergillus terreus infection limited to the L1-2 disk space and first and second lumbar vertebrae developed in a patient not predisposed to invasive aspergillosis. The observation of morphologically distinct secondary spores (aleuriospores) on microscopic examination of open biopsy specimens permitted a preliminary identification of A terreus, which was confirmed by culture. The infection was eradicated with amphotericin B in a total dose of 3 gm. Aspergillus terreus is usually a saprophyte. The present case and four others collected from the literature establish this species as an invasive pathogen.

Topics: Adult; Amphotericin B; Aspergillosis; Biopsy; Female; Humans; Lumbosacral Region; Osteomyelitis; Spinal Diseases; Substance-Related Disorders

An extradural toruloma developed in the lumbo-sacral region of a man. Symptoms had been present for two years, but he had been diagnosed as having tuberculosis of the lung seven years before. The mass was excised and the patient treated with Amphotericin B which had to be discontinued and Sulfa Soxizole substituted. He recovered and has remained symptom free for three years.

Topics: Amphotericin B; Cryptococcosis; Humans; Lumbosacral Region; Male; Middle Aged; Spinal Diseases; Sulfisoxazole

Five cases are described in which fear of the possibly hazardous effects of giving amphotericin to patients with kidney disease resulted in death from progressive infection by an amphotericin-sensitive fungus (Cryptococcus neoformans in three cases, Blastomyces dermatitidis in one case, and Histoplasma capsulatum in one case).

Topics: Adrenal Insufficiency; Adult; Amphotericin B; Attitude of Health Personnel; Blastomycosis; Cryptococcosis; Decerebrate State; Drug Prescriptions; Female; Histoplasmosis; Hodgkin Disease; Humans; Kidney Diseases; Lung Diseases, Fungal; Male; Medication Errors; Meningitis; Meningoencephalitis; Mycoses; Phobic Disorders; Sarcoidosis; Spinal Diseases

Topics: Adult; Amphotericin B; Coccidioidomycosis; Female; Humans; Osteosclerosis; Radiography; Spinal Diseases

Topics: Amphotericin B; Autopsy; Child; Chloramphenicol; Cryptococcosis; Hodgkin Disease; Humans; Hydrocortisone; Male; Salmonella Infections; Skin Manifestations; Spinal Diseases

Topics: Amphotericin B; Cryptococcosis; Drug Therapy; Pathology; Radiography; Spinal Diseases

Topics: Adolescent; Africa; Amphotericin B; Black People; Bone Diseases; Child; Diagnosis; Fractures, Bone; Fractures, Spontaneous; Histoplasma; Histoplasmosis; Humans; Nigeria; Paraplegia; Pathology; Radiography; Ribs; Skull; Spinal Cord Compression; Spinal Diseases

Topics: Amphotericin B; Bone Diseases; Femur; Fungi; Humans; Mycoses; Radiography; Skull; Spinal Diseases; Zygomycosis

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