amphotericin-b and Subarachnoid-Hemorrhage

Infections due to non-neoformans cryptococci are rare. We report the first case of a human infection caused by Cryptococcus uniguttulatus. Ventriculitis caused by this organism developed in a 65-year-old woman who had had repair of an internal carotid aneurysm. In vitro sensitivity testing showed the Cryptococcus species sensitive to amphotericin B and itraconazole. Treatment with amphotericin led to resolution of the infection.

Topics: Aged; Amphotericin B; Antifungal Agents; Carotid Artery, Internal, Dissection; Cerebral Ventricles; Craniotomy; Cross Infection; Cryptococcus; Drainage; Encephalitis; Fatal Outcome; Female; Humans; Meningitis, Cryptococcal; Microbial Sensitivity Tests; Recurrence; Serotyping; Subarachnoid Hemorrhage; Ventriculostomy

The third reported case of prosthetic valvular endocarditis caused by the fungus Paecilomyces is presented. The clinical course of the patient is discussed. The distinctive morphology of the fungus is described, together with the histologic and cytologic features found in the excised prosthetic valve and in the tissues at autopsy. Prosthetic valvular endocarditis presents a serious antibiotic and surgical problem in therapy. Despite antifungal antibiotics and valve replacement this patient died as a result of metastatic cerebral microabscesses and subarachnoid hemorrhage.

Topics: Amphotericin B; Autopsy; Brain Abscess; Candidiasis; Cytosine; Endocarditis; Heart Valve Prosthesis; Humans; Male; Middle Aged; Mitosporic Fungi; Subarachnoid Hemorrhage

Of two patients who had acute neurologic damage from cisternal punctures, one died 17 hours following a tap which produced major subarachnoid hemorrhage, the other patient recovered from probable brain stem infarction associated with cisterna magna amphotericin injection. Subarachnoid hemorrhage is the commonest major complication of cisternal puncture, with at least 30 reported fatalities. Other serious complications result from direct puncture of brain substance.Cisternal puncture is not an appropriate alternative to a difficult lumbar puncture, and indications for its use are limited. The occasional required cisternal tap should be performed only by persons carefully trained in the technique, preferably utilizing fluoroscopic guidance, and only where neurosurgical assistance is readily available.Post-puncture subarachnoid hemorrhage accompanied by progressive obtundation requires emergency evaluation and consideration of posterior fossa decompression.

Topics: Adult; Amphotericin B; Brain Stem; Cisterna Magna; Coccidioidomycosis; Female; Humans; Infarction; Injections, Spinal; Male; Meningitis; Middle Aged; Punctures; Subarachnoid Hemorrhage

Topics: Amphotericin B; Aneurysm, Infected; Angiography; Autopsy; Carotid Arteries; Cerebral Arteries; Child; Eosinophils; Glucose Tolerance Test; Humans; Intracranial Aneurysm; Lymphocytes; Male; Orbit; Paranasal Sinuses; Penicillium; Rupture; Sinusitis; Subarachnoid Hemorrhage