amphotericin-b and Substance-Related-Disorders

Candida species, including Candida dubliniensis, are a rare cause of meningitis. Herein, we report the second case of C. dubliniensis meningitis in a 49-year-old man with a history of hepatitis C virus-related cirrhosis, substance use disorder, and recent exposure to intravenous antibiotic therapy, presenting with confusion, abnormal gait, and urinary incontinence. Magnetic resonance imaging (MRI) of the brain showed marked hydrocephalus and leptomeningeal enhancement. Initial cerebrospinal fluid (CSF) studies were concerning for bacterial meningitis, although cultures were negative. Despite empiric treatment with broad-spectrum antibiotics, the patient's mental status declined. The diagnosis of C. dubliniensis meningitis was not made until the third lumbar puncture. The patient was treated with liposomal amphotericin B and flucytosine. Despite improvement of hydrocephalus on MRI of the brain and sterilization of CSF, the patient's mental status declined and he expired. This case highlights the difficulty in the diagnosis of C. dubliniensis meningitis as multiple lumbar punctures may be necessary. C. dubliniensis meningitis should be considered in the differential diagnosis for a patient with risk factors such as end-stage liver disease, human immunodeficiency virus infection, recent chemotherapy, substance use disorders, and recent broad-spectrum antibiotic use. A high index of suspicion is necessary as delay in initiation of therapy is associated with high mortality. The optimal treatment strategy has not been determined.

Topics: Amphotericin B; Antifungal Agents; Brain; Candida; Candidiasis; Cerebrospinal Fluid; Fatal Outcome; Flucytosine; Hepatitis C, Chronic; Humans; Liver Cirrhosis; Magnetic Resonance Imaging; Male; Meningitis; Middle Aged; Substance-Related Disorders

A case is reported of isolated native tricuspid calve Candida parapsilosis endocarditis (INTVCE) in a male patient with no history of drug abuse or heart disease. The patient had received hyperalimentation and antibiotics for four months via a central venous catheter after abdominal surgery. He underwent successful treatment with tricuspid valve debridement, liposomal amphotericin (AmBisome) and fluconazole, and remained without relapse during an eight-year follow up. A literature review of 12 similar cases (including the present patient) without history of drug abuse or heart disease, dating from 1970, is included.

Topics: Amphotericin B; Antifungal Agents; Candidiasis; Debridement; Echocardiography; Endocarditis; Fluconazole; Humans; Male; Middle Aged; Parenteral Nutrition, Total; Substance-Related Disorders; Tomography, X-Ray Computed; Tricuspid Valve

Topics: Adolescent; Adult; Aged; Amphotericin B; Brain Diseases; Child; Child, Preschool; Corticosterone; Diabetes Complications; Female; Humans; Infant; Infant, Newborn; Leukemia; Lung Diseases, Fungal; Male; Meningoencephalitis; Middle Aged; Mucormycosis; Postoperative Complications; Sinusitis; Substance-Related Disorders; Syndrome; Transplantation, Homologous

We report a case of a male patient with drug abuse in his medical history who was hospitalized because of a community acquired pneumonia. Subsequently the patient developed an acute lung injury (ARDS) and a fulminant purulent pericarditis accompanied by a pericardial effusion. Caused by the pericardial tamponade cardiac function was severely restricted. Due to fast diagnosis and immediate adequate therapy such as systemic anti-fungal treatment, pericardiocentesis, percutaneous drainage, and later surgical intervention the patient was treated successfully. This article describes etiology, pathophysiology and symptoms of purulent Candida-pericarditis and gives a review of existing literature regarding this extremely rare disease. In addition therapeutic options are discussed.

Topics: Amphotericin B; Antifungal Agents; Candida glabrata; Candidiasis; Caspofungin; Community-Acquired Infections; Critical Care; Drainage; Echinocandins; Emergency Medical Services; Humans; Lipopeptides; Male; Middle Aged; Pericardiocentesis; Pericarditis; Prognosis; Respiratory Distress Syndrome; Substance-Related Disorders; Treatment Outcome

In recent decades the incidence of Candida endocarditis has increased dramatically. Despite the application of surgery and antifungal therapy, Candida endocarditis remains a life-threatening infection with significant morbidity and mortality. We report a 37-year-old male drug abuser presenting with high fever, chest pain, loss of appetite and cardiac failure. His echocardiography revealed mobile large tricuspid valve vegetations. Fungal endocarditis was confirmed by culturing of the resected vegetation showing mixed growth of Candida albicans and Candida tropicalis, although three consecutive blood cultures were negative for Candida species. Phenotypic identification was reconfirmed by sequencing of the internal transcribed spacer (ITS rDNA) region. The patient was initially treated with intravenous fluconazole (6 mg kg(-1) per day), followed by 2 weeks of intravenous amphotericin B deoxycholate (1 mg kg(-1) per day). Although MICs were low for both drugs, the patient's antifungal therapy combined with valve replacement failed, and he died due to respiratory failure.

Topics: Adult; Amphotericin B; Antifungal Agents; Candida albicans; Candida tropicalis; Candidiasis; Coinfection; Deoxycholic Acid; DNA, Fungal; DNA, Ribosomal Spacer; Drug Combinations; Drug Users; Echocardiography; Endocarditis; Fatal Outcome; Fluconazole; Humans; Male; Molecular Sequence Data; Mycological Typing Techniques; Sequence Analysis, DNA; Substance-Related Disorders; Tricuspid Valve

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Aortic Valve; Endocarditis, Bacterial; Gentamicins; Humans; Male; Mitral Valve; Substance-Related Disorders; Vancomycin

Topics: Acquired Immunodeficiency Syndrome; Adult; Amphotericin B; Histoplasmosis; Humans; Injections, Intravenous; Male; Skin; Substance-Related Disorders

Endogenous Aspergillus flavus endophthalmitis with layering of inflammatory cells in the subretinal space and vitreous infiltration developed in a 35-year-old female intravenous drug abuser. The patient underwent a diagnostic and therapeutic vitrectomy within 48 hours of presentation, receiving intravitreal amphotericin B. Intravenous amphotericin also was administered several days later. Despite extensive retinal and vitreous involvement, the patient recovered useful vision because of the aggressive diagnostic and therapeutic approach.

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus flavus; Endophthalmitis; Female; Fundus Oculi; Humans; Injections, Intravenous; Retinitis; Substance-Related Disorders; Visual Acuity; Vitrectomy

A rare case of primary cerebral zygomycosis in an Italian drug addict is described. The diagnosis was based on the histologic detection of broad, aseptate, hyaline mycelium in fluid aspirated from a brain mass detected by computerized axial tomography. The zygomycete isolated from the clinical specimen was identified as Rhizopus arrhizus var arrhizus. The patient had no known predisposing condition that would have suppressed his immunological defenses. Once the diagnosis was established, treatment with amphotericin B was initiated, but the patient died during the first day of treatment.

Topics: Adult; Amphotericin B; Brain Diseases; Humans; Italy; Male; Mucormycosis; Rhizopus; Substance-Related Disorders

In addition to the well-known infectious complications of intravenous narcotic abuse, a much rarer and more recently recognized association between intravenous narcotic addiction and mucormycotic abscesses of the central nervous system has been described. Only four cases have been cited in the literature, with a mortality rate of 100 percent in this group. This report describes a narcotic abuser who presented with obstructive hydrocephalus and a mucormycotic abscess of the brain stem, and recovered. Central nervous system mucormycosis should be included in the differential diagnosis of drug abusers who present with a rapid deterioration in neurologic status.

Topics: Adult; Amphotericin B; Brain Abscess; Brain Stem; Female; Humans; Hydrocephalus; Mucormycosis; Pentazocine; Substance-Related Disorders; Tripelennamine

The presentation and management of 10 cases of proven or presumptive fungal endophthalmitis in narcotic-drug abusers is described. Miconazole was found to be an effective agent in some patients when administered in a dosage of 2400 mg/day. Eight patients received treatment with a combination of miconazole and flucytosine (5-fluorocytosine). Regression of the infection with preservation of the eye was observed in each case. However, visual acuity in the affected eye improved only in four of the eight patients; it was unchanged in two and had deteriorated in the other two. In two patients, who received amphotericin B and flucytosine as initial treatment, control of the infection was achieved, but vision remained unchanged. Vitrectomy was performed in three patients to remove residual sites of infection. However, vision remained unchanged in two of these patients and worsened in the third. The selection of individual modalities of therapy and responses to treatment are discussed.

Topics: Adult; Amphotericin B; Candidiasis; Drug Therapy, Combination; Endophthalmitis; Female; Flucytosine; Heroin; Humans; Male; Miconazole; Mycoses; Substance-Related Disorders; Visual Acuity; Vitrectomy

Two cases of heroin abusers who developed disseminated candidiasis are reported. Cultures of skin lesions revealed Candida albicans, which on histology were shown to be located in and around hair shafts. Both patients recovered after treatment with amphotericin B combined with 5-fluorocytosine and either ketoconazole or dexamethasone. This unusual cutaneous syndrome of candidal infection associated with extensive folliculitis seems to be related to the use of a particular type of heroin, the so-called brown Iranian heroin.

Topics: Adult; Amphotericin B; Candidiasis; Conjunctivitis; Female; Flucytosine; Folliculitis; Heroin; Humans; Iran; Ketoconazole; Male; Substance-Related Disorders

A 30-year-old man developed endophthalmitis three weeks after an intravenous injection of hydromorphone hydrochloride. Penicillium species was recovered from a vitreous aspirate. Treatment with amphotericin B and flucytosine resulted in documented sterilization of the vitreous. At a six-month follow-up examination, the visual acuity of the involved eye was still limited to light perception.

Topics: Adult; Amphotericin B; Antifungal Agents; Humans; Injections, Intravenous; Male; Mycoses; Panophthalmitis; Penicillium; Prednisone; Substance-Related Disorders

Seven young men developed disseminated candidiasis within 10 days of a single episode of intravenous heroin abuse. Sequential development of eye and skin lesions was noted in all cases. The bone or costal cartilage was involved in five. Ocular manifestations of candidiasis included episcleritis, chorioretinitis, and endophthalmitis. A presumptive diagnosis of candida chorioretinitis was established rapidly by culture of Candida albicans from involved skin and costal cartilage. Systemic therapy with amphotericin B plus 5-fluorocytosine resulted in cure of the episcleritis, chorioretinitis, osteomyelitis, costochondritis, and skin infection. Pars plana vitrectomy with local instillation of amphotericin B was required to cure chorioretinitis associated with vitreal extension of infection.

Topics: Adult; Amphotericin B; Candidiasis; Eye Diseases; Flucytosine; Heroin; Humans; Male; Substance-Related Disorders

A case of bilateral necrotizing scleritis due to Aspergillus oryzae is reported. The patient was a former addict of intravenous narcotics treated five years previously for meningitis due to the same organism. A seeding focus in the thoracic spine was eventually found. The patient responded well to combined local and systemic therapy with amphotericin B, flucytosine, and natamycin. This represents, to the best of our knowledge, both the first reported case of ocular disease due to this species of Aspergillus and of isolated scleral, nonintraocular involvement in endogenous oculomycosis.

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Aspergillus oryzae; Child; Cocaine; Eye Diseases; Female; Flucytosine; Heroin; Humans; Inflammation; Injections, Intravenous; Meningitis; Natamycin; Sclera; Substance-Related Disorders

One of two cases of endogenous Aspergillus endophthalmitis in abusers of intravenously administered drugs was treated successfully by subtotal pars plana vitrectomy; amphotericin B administered by intravitreal, periocular, and systemic routes; and flucytosine administered systemically. Aspergillus sp should be considered a possible pathogenic organism in drug abusers with endogenous endophthalmitis. An aggressive diagnostic and therapeutic approach may result in preservation of useful vision.

Topics: Adult; Amphotericin B; Aspergillosis; Endophthalmitis; Female; Flucytosine; Humans; Microbiological Techniques; Substance-Related Disorders; Visual Acuity; Vitreous Body

We diagnosed mycotic endophthalmitis by positive cultures in a 47-year-old man and a 42-year-old woman, both intravenous amphetamine users. Reinfection with a different fungal species was documented in one case. Rapid identification of the isolate, in vitro susceptibilities, selection of appropriate routes and dosages of antifungals, and the role of adjunctive corticosteroids are crucial factors in the management of these difficult cases. We prescribed antifungals and adjunctive corticosteroids, and our patients' vision improved.

Topics: Administration, Oral; Administration, Topical; Adult; Amphetamines; Amphotericin B; Antifungal Agents; Aspergillosis; Candida; Candida albicans; Candidiasis; Clotrimazole; Endophthalmitis; Female; Flucytosine; Humans; Injections, Intravenous; Male; Microbial Sensitivity Tests; Middle Aged; Prednisolone; Prednisone; Substance-Related Disorders

Topics: Amphotericin B; Candidiasis; Endophthalmitis; Humans; Substance-Related Disorders

A 34-year-old alcoholic and drug addict developed cavitary pulmonary sporotrichosis that progressed slowly during 6 years. Pulmonary resection and pre- and postoperative therapy with amphotericin B were associated with prompt clinical improvement with no evidence of relapse during a 2-year follow-up. Histologic examination of lung revealed granulomatous inflammation with organisms consistent with Sporothrix schenckii, and interstitial talc (magnesium silicate) granulomas. The latter finding was consistent with the history of intravenous drug abuse. Although the presence of silicates in lung enhances the pathogenicity of some microorganisms, the relation of these findings to the pathogenesis of sporotrichosis in our patient is unclear.

Topics: Adult; Alcoholism; Amphotericin B; Humans; Lung; Lung Diseases, Fungal; Male; Sporotrichosis; Substance-Related Disorders

A 43-year-old heroin addict with Candida albicans endophthalmitis was treated with a single 5-mug intravitreal injection of amphotericin B. The diagnosis was confirmed by smears and cultures of a vitrous aspiration. The patient's accidental death seven weeks after treatment enabled us to obtain histopathologic evidence that the infection had been cured and that the amphotericin B had had no toxic effect on the retina. Intravitral amphotericin B should be considered an important mode of treatment of Candida endophthalmitis.

Topics: Adult; Amphotericin B; Candidiasis; Endophthalmitis; Fluorescein Angiography; Humans; Male; Phenmetrazine; Substance-Related Disorders; Visual Acuity

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

Topics: Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Candidiasis; Cardiac Surgical Procedures; Endocarditis, Bacterial; Flucytosine; Humans; Injections; Postoperative Complications; Substance-Related Disorders

A 27-year-old white man had endogenous Candida endophthalmitis with fungi in the vitreous cavity, presumably caused by hematogenous spread related to drug abuse, and was treated by pars plana vitrectomy and antifungal medications administered systemically after surgery. There was no evidence of other systemic involvement, and excision of fungi from the vitreous cavity confirmed the clinical diagnosis and determined the sensitivity of this fungus to antifungal medications. The fungus was sensitive to flucytosine (5-FC), which the patient received orally since it was less toxic to body tissues than amphotericin B. The intraocular infection cleared rapidly after vitrectomy, and visual acuity returned to 6/5 (20/15).

Topics: Adult; Amphotericin B; Candida albicans; Candidiasis; Endophthalmitis; Flucytosine; Humans; Male; Microbial Sensitivity Tests; Ophthalmoscopy; Postoperative Care; Substance-Related Disorders; Vitreous Body

Topics: Adult; Amphotericin B; Aortic Valve Insufficiency; Benzene Derivatives; Candidiasis; Endocarditis; Female; Flucytosine; Follow-Up Studies; Heart Septal Defects, Ventricular; Heart Valve Prosthesis; Heroin; Humans; Imidazoles; Male; Mitral Valve Insufficiency; Oxacillin; Pacemaker, Artificial; Radiography, Thoracic; Substance-Related Disorders; Tricuspid Valve Insufficiency