amphotericin-b and Syndrome

Orbital apex syndrome as a result of invasive fungal sinusitis is a disease entity most commonly found in immunocompromised patients. Infectious invasion affecting the orbital apex can have devastating visual and life-threatening consequences.

Topics: Aged; Alternaria; Alternariosis; Amphotericin B; Combined Modality Therapy; Debridement; Eye Infections, Fungal; Follow-Up Studies; Fungemia; Humans; Immunocompromised Host; Injections, Intralesional; Male; Orbital Diseases; Risk Assessment; Sinusitis; Syndrome; Tomography, X-Ray Computed; Treatment Outcome

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Azoles; Candidiasis; Catheters, Indwelling; Diagnosis, Differential; Flucytosine; Fusarium; Humans; Iatrogenic Disease; Immunocompromised Host; Mycoses; Opportunistic Infections; Syndrome; Trichosporon

Pythium infection (pythiosis) in humans has not previously been described, even in areas endemic for animal pythiosis. We report five patients with a unique presentation of fungal arteritis. The medium- to large-sized arteries were involved, and in some cases this involvement led to gangrene of the limbs, aneurysm formation, and ultimately fatal arterial leakage. All five patients were farmers. All patients, with the possible exception of one who had hemoglobin typing performed after receiving a blood transfusion, had thalassemia hemoglobinopathy syndrome. Fungal isolation was difficult. Amphotericin B treatment seemed to be ineffective. Radical surgical removal of infected tissues and oral administration of a saturated solution of potassium iodide are proposed therapy. In the tropics, where Pythium is ubiquitous, one should actively look for this fungal infection in patients with unexplained arterial occlusion, especially in the case of patients with thalassemia hemoglobinopathy syndrome.

Topics: Amphotericin B; Chytridiomycota; Female; Humans; Middle Aged; Mycoses; Pythium; Syndrome; Thalassemia

Topics: Amphotericin B; Coccidioides; Coccidioidomycosis; Female; Humans; Lung; Lung Diseases, Fungal; Pneumonia; Prognosis; Radiography; Serologic Tests; Syndrome

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

Gastrointestinal (GI) mucormycosis is a rare and often deadly form of mucormycosis. Delayed diagnosis can lead to an increased risk of death. Here, we report a case of GI mucormycosis following streptococcal toxic shock syndrome in a virologically suppressed HIV-infected patient.. A 25-year-old Thai woman with a well-controlled HIV infection and Grave's disease was admitted to a private hospital with a high-grade fever, vomiting, abdominal pain, and multiple episodes of mucous diarrhea for 3 days. On day 3 of that admission, the patient developed multiorgan failure and multiple hemorrhagic blebs were observed on all extremities. A diagnosis of streptococcal toxic shock was made before referral to Siriraj Hospital - Thailand's largest national tertiary referral center. On day 10 of her admission at our center, she developed feeding intolerance and bloody diarrhea due to bowel ischemia and perforation. Bowel resection was performed, and histopathologic analysis of the resected bowel revealed acute suppurative transmural necrosis and vascular invasion with numerous broad irregular branching non-septate hyphae, both of which are consistent with GI mucormycosis. Peritoneal fluid fungal culture grew a grayish cottony colony of large non-septate hyphae and spherical sporangia containing ovoidal sporangiospores. A complete ITS1-5.8S-ITS2 region DNA sequence analysis revealed 100% homology with Rhizopus microsporus strains in GenBank (GenBank accession numbers KU729104 and AY803934). As a result, she was treated with liposomal amphotericin B. However and in spite of receiving appropriate treatment, our patient developed recurrent massive upper GI bleeding from Dieulafoy's lesion and succumbed to her disease on day 33 of her admission.. Diagnosis of gastrointestinal mucormycosis can be delayed due to a lack of well-established predisposing factors and non-specific presenting symptoms. Further studies in risk factors for abdominal mucormycosis are needed.

Topics: Adult; Amphotericin B; Antifungal Agents; DNA, Fungal; Fatal Outcome; Female; Gastrointestinal Tract; Graves Disease; HIV Infections; Humans; Mucormycosis; Rhizopus; Shock, Septic; Streptococcal Infections; Streptococcus pyogenes; Syndrome; Thailand

Pseudogymnoascus destructans is the fungal pathogen responsible for White-nose Syndrome (WNS), a disease that has killed millions of bats in North America over the last decade. A major obstacle to research on P. destructans has been the lack of a tractable infection model for monitoring virulence. Here, we establish a high-throughput model of infection using larvae of Galleria mellonella, an invertebrate used to study host-pathogen interactions for a wide range of microbial species. We demonstrate that P. destructans can kill G. mellonella larvae in an inoculum-dependent manner when infected larvae are housed at 13°C or 18°C. Larval killing is an active process, as heat-killed P. destructans spores caused significantly decreased levels of larval death compared to live spores. We also show that fungal spores that were germinated prior to inoculation were able to kill larvae 3-4 times faster than non-germinated spores. Lastly, we identified chemical inhibitors of P. destructans and used G. mellonella to evaluate these inhibitors for their ability to reduce virulence. We demonstrate that amphotericin B can effectively block larval killing by P. destructans and thereby establish that this infection model can be used to screen biocontrol agents against this fungal pathogen.

Topics: Amphotericin B; Animals; Antifungal Agents; Ascomycota; Chiroptera; Host-Pathogen Interactions; Hot Temperature; Insecta; Larva; Moths; Mycoses; North America; Spores, Fungal; Syndrome; Virulence

A 2.5-year-old girl was admitted due to splenomegaly and pancytopenia. Laboratory analysis revealed pancytopenia and hypergammaglobulinemia, and due to the absence of fever and the relevant clinical and hematological presentation the child was initially suspected for acute lymphoblastic leukemia. Bone marrow aspiration displayed macrophages and extracellular space containing Leishmania amastigotes. Visceral leishmaniasis diagnosis due to Leishmania infantum was confirmed by the presence of high titers of Leishmania antibodies and by PCR. The patient was successfully treated with liposomal amphotericin B but during the third post-treatment day significant increases in the levels of serum uric acid, blood urea nitrogen, and phosphate were registered. The child was successfully treated with hydration and urine alkalization and resulted in full recovery of the metabolic abnormalities.

Topics: Amphotericin B; Child, Preschool; Female; Humans; Leishmania infantum; Leishmaniasis, Visceral; Neoplasms; Pancytopenia; Splenomegaly; Syndrome

Liposomal amphotericin-B (Ambisome(®)) is widely used antifungal drug for treatments of invasive fungal infections. The use of liposomal amphotericin-B is increasing in medical setting because of its tolerability and potent antifungal activity.. In a case of a 76 year-old Japanese female was admitted with subarachnoid hemorrhage, the ethnicity of the patient is Asian, we experienced that liposomal amphotericin-B was the culprit drug for Drug-induced hypersensitivity syndrome, also known as drug rash with eosinophilia and systemic symptoms in view of a clear temporal relationship between liposomal amphotericin-B administration and the onset of symptoms, the remission of the symptomatological pattern after liposomal amphotericin-B withdrawal.. The present case report shows that prolonged liposomal amphotericin-B treatment can be associated with drug rash with eosinophilia and systemic symptoms. We recommend careful monitoring of neutrophil counts in a prolonged treatment course with liposomal amphotericin-B.

Topics: Aged; Amphotericin B; Anti-Bacterial Agents; Arm; Drug Hypersensitivity; Female; Humans; Syndrome

Cryptococcus neoformans is a common agent of fungal meningoencephalitis in immunocompromised patients. Cerebral salt-wasting syndrome is one of the rare causes of severe hyponatremia in patients with CNS diseases. The paper describes the first clinical case of a patient, whose onset of chronic lymphocytic leukemia was complicated by cryptococcal meningoencephalitis presenting with mental disorders and severe electrolytic imbalance. Antifungal treatment with amphotericin B and fluconazole could alleviate an infectious process and metabolic disturbances.. Cryptococcus neoformans - частый возбудитель грибкового менингоэнцефалита у пациентов с иммунодефицитом. Церебральный сольтеряющий синдром - одна из редких причин тяжелой гипонатриемии у пациентов с заболеваниями центральной нервной системы. В статье описано первое клиническое наблюдение больного, у которого дебют хронического лимфоцитарного лейкоза осложнился криптококковым менингоэнцефалитом с психическими расстройствами и тяжелыми нарушениями водно-электролитного баланса. Проведение антимикотической терапии амфотерицином В и флуконазолом позволило купировать инфекционный процесс и метаболические нарушения.

Topics: Aged; Amphotericin B; Antifungal Agents; Comorbidity; Fluconazole; Humans; Hyponatremia; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Meningitis, Cryptococcal; Syndrome

Topics: Adult; Amphotericin B; Anti-Inflammatory Agents; Drug Combinations; Erythema Multiforme; Female; Fluconazole; Humans; Lupus Erythematosus, Systemic; Neck; Prednisolone; Syndrome

Nebulized liposomal amphotericin B (20-15 mg twice daily by nebulizer) was combined with high dose intravenous liposomal amphotericin B (10 mg/kg/day) and high dose caspofungin (100 mg/m(2)) for the treatment of severe, recurrent pulmonary aspergillosis following allogeneic hematopoietic stem cell transplantation from alternative donor in a patient with mitochondrial disease (Pearson's syndrome). This combined treatment was administered for 8 days. Nebulized liposomal amphotericin B was well tolerated. Since severe transplant complications developed, nebulized administration was withdrawn and intravenous doses of liposomal amphotericin B and caspofungin were tapered to usual schedules. Pulmonary aspergillosis responded well to 45 days of combined intravenous antifungal therapies which were maintained for 2 years with secondary prophylaxis, because of persistent immunosuppressive treatment.

Topics: Administration, Inhalation; Amphotericin B; Antifungal Agents; Aspergillosis; Caspofungin; Drug Combinations; Drug Therapy, Combination; Echinocandins; Female; Hematopoietic Stem Cell Transplantation; Humans; Injections, Intravenous; Lipopeptides; Lung Diseases, Fungal; Mitochondrial Diseases; Peptides, Cyclic; Phosphatidylcholines; Phosphatidylglycerols; Syndrome; Transplantation, Homologous

Topics: Aged; Amphotericin B; Antifungal Agents; Anxiety Disorders; Arthritis, Infectious; Candida glabrata; Candidiasis; Chest Pain; Diagnosis, Differential; Dyspnea; Female; Humans; Infusions, Intravenous; Knee Prosthesis; Liposomes; Prosthesis-Related Infections; Recurrence; Syndrome

A 47-year-old diabetic man with chronic renal failure presented with a 1-month history of complete ptosis of the left upper eyelid, left proptosis, and left-sided headache. During the course of the patient's care, other significant diagnoses were excluded, such as orbital inflammatory syndrome, carotid-cavernous syndrome, and cavernous sinus thrombosis. Neuroimaging revealed only minimal left sphenoid sinus disease. Sphenoid biopsy revealed the presence of septate hyphae on Gram staining and produced a fungal culture characteristic of Schizophyllum commune. Minimal sphenoid sinus infection in a patient with chronic medical issues and probable immunosuppression predisposed this patient to fungal rhino-orbital infection. Several weeks of intravenous liposomal amphotericin treatment on an outpatient basis yielded resolution of clinical symptoms.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Eye Infections, Fungal; Glucocorticoids; Humans; Injections, Intravenous; Magnetic Resonance Imaging; Male; Methylprednisolone; Middle Aged; Mycoses; Orbital Diseases; Schizophyllum; Sphenoid Sinus; Sphenoid Sinusitis; Syndrome; Tomography, X-Ray Computed; Treatment Outcome

A case of mucormycosis causing palatal necrosis and orbital apex syndrome is reported successfully treated with systemic antifungal therapy, surgical debridement and control of underlying disease process. After one year of follow-up patient is blind with anatomically preserved right eye and ptosis as well as having palatal obturator. Mucormycosis should be considered in differential diagnosis of palatal necrosis and orbital apex syndrome.

Topics: Adult; Amphotericin B; Combined Modality Therapy; Debridement; Follow-Up Studies; Humans; Infusions, Intravenous; Male; Mouth Diseases; Mucormycosis; Necrosis; Orbital Diseases; Palate; Risk Assessment; Severity of Illness Index; Syndrome; Treatment Outcome

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Anti-HIV Agents; Antifungal Agents; Antiretroviral Therapy, Highly Active; CD4-Positive T-Lymphocytes; Fluconazole; Flucytosine; HIV Infections; Humans; Immunologic Memory; Lamivudine; Lopinavir; Male; Meningitis, Cryptococcal; Pyrimidinones; Recurrence; Ritonavir; Syndrome; T-Lymphocyte Subsets; Zidovudine

Topics: Acquired Immunodeficiency Syndrome; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Animals; Antiretroviral Therapy, Highly Active; Humans; Immunocompromised Host; Leishmania major; Male; Syndrome; Uveitis

A 62-year-old man with untreated diabetes complained of diplopia and headache. Neurological examination demonstrated left abducens nerve palsy. MRI showed a mass lesion in the left orbital apex. Total left ophthalmoplegia and visual loss rapidly developed in the next two weeks. A craniotomy was performed to decompress the orbital apex and remove the mass. The optic nerve was tightly encased by fibrous tissue. The pathological diagnosis was mucormycosis. Systemic administration of amphotericin B and fluconazole was started immediately. But the lesion rapidly invaded the cavernous sinus and occluded the left internal carotid artery. Finally, the patient died with intracranial extension of mucormycosis four months after the operation. Rhinocerebral mucormycosis is a rapidly progressive fatal disease. Successful treatment seems to be based on early diagnosis, control of the underlying disease, radical surgical resection, and systemic administration of amphotericin B. Mucormycosis should be considered as a differential diagnosis of orbital apex syndrome.

Topics: Amphotericin B; Antifungal Agents; Combined Modality Therapy; Craniotomy; Diagnosis, Differential; Fluconazole; Gadolinium DTPA; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Mucormycosis; Orbital Diseases; Paranasal Sinus Diseases; Syndrome

A 66-year-old woman with a history of non insulin-dependent diabetes mellitus, hypertension, and hypothyroidism presented with a painless orbital apex syndrome without any sign of orbital cellulitis or acute systemic disease. Her blood glucose was mildly elevated, but there was no diabetic ketoacidosis. Neuroimaging revealed only mild sinus disease. Transnasal sphenoidal mucosal biopsy showed an inflammatory mass with cellular atypia on frozen sections, suggesting squamous cell carcinoma. However, review of the permanent sections showed broad, nonseptate hyphae consistent with mucormycosis. The patient was treated with a 3-month course of intravenous amphotericin B and no further surgery. Examination 3 months after presentation revealed complete resolution of her ocular motility deficits and partial resolution of her optic neuropathy. Mucormycosis should be suspected in any case of orbital apex syndrome, especially in the diabetic patient.

Topics: Aged; Amphotericin B; Antifungal Agents; Eye Infections, Fungal; Female; Humans; Magnetic Resonance Imaging; Mucormycosis; Ocular Motility Disorders; Optic Nerve Diseases; Orbital Diseases; Paranasal Sinus Diseases; Sphenoid Sinus; Syndrome; Tomography, X-Ray Computed

The use of high dose chemotherapy in the treatment of solid tumors is associated with prolonged neutropenia and, consequently, in some patients, systemic candidiasis. The authors describe their experience with a clinicoradiologic syndrome developing after high dose chemotherapy was administered to patients with breast cancer.. The authors evaluated the clinical and radiologic records of 12 patients in whom hepatic, splenic, or renal candidiasis developed.. Three patients had positive blood cultures for candida tropicalis. One of these patients and two others had fungal organisms identified with special stains of an organ aspirate. Most patients were asymptomatic, and most of them were treated successfully with antifungal agents, although untreated patients also recovered. There were no fatalities due to the candidiasis.. A radiographic syndrome resembling hepatic, splenic, or renal candidiasis is described, which occurred after high dose chemotherapy was administered and autologous bone marrow transplantation was performed on patients with breast cancer. This syndrome has a favorable prognosis. Conclusions as to the more indolent nature of this syndrome cannot be made; however, this topic warrants further investigation.

Topics: Adult; Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Bone Marrow Purging; Bone Marrow Transplantation; Breast Neoplasms; Candidiasis; Combined Modality Therapy; Female; Fluconazole; Fungemia; Granulocyte Colony-Stimulating Factor; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Kidney Diseases; Liver Diseases; Middle Aged; Neutropenia; Retrospective Studies; Splenic Diseases; Syndrome; Tomography, X-Ray Computed; Transplantation, Autologous

A pilot study was conducted to evaluate the role of granulocyte-macrophage colony-stimulating factor (GM-CSF) as adjuvant therapy for fungal infections in patients with cancer. GM-CSF was added to amphotericin B in the treatment of cancer patients with proven major-organ or disseminated fungal infection. The dose of GM-CSF ranged from 100 to 750 micrograms/(m2.d). Of eight evaluable patients, six had a neutrophil response to GM-CSF. Four of these patients were completely cured of the fungal infection, and two had a partial response. However, a capillary-leak syndrome developed in three patients, an adverse effect suggesting that the dose of GM-CSF was excessive.

Topics: Adult; Aged; Amphotericin B; Capillary Permeability; Female; Granulocyte-Macrophage Colony-Stimulating Factor; Humans; Immunocompromised Host; Leukocyte Count; Male; Middle Aged; Mycoses; Neoplasms; Neutrophils; Pilot Projects; Recombinant Proteins; Syndrome

In a 70-year-old male patient with untreated diabetes a febrile orbital apex syndrome of rapid onset revealed a rhino-orbito-cerebral zygomycosis. Biopsies of the ethmoidal mucosa showed numerous colonies of the Rhizopus genus. Despite medical treatment (amphotericin B) and surgery (ethmoidectomy), the patient died within one week. Rhino-cerebral zygomycosis is a rare disease which occurs in diabetic and immunocompromised patients.

Topics: Aged; Amphotericin B; Diabetic Neuropathies; Ethmoid Bone; Ethmoid Sinusitis; Humans; Male; Mucormycosis; Orbital Diseases; Syndrome

A 54-year-old woman entered the hospital for induction chemotherapy for acute lymphocytic leukemia. On hospital day 23, while the patient was neutropenic, an erosive lesion appeared on the left side of the tongue. During the next several days the lesion extended over the dorsum of the tongue and was golden orange. Surface scrapings were obtained; the involved site underwent a biopsy and was cultured. Branching septate mycelia of varying diameters were seen on microscopic examination of direct mounts and a biopsy specimen of the tongue. Eight to ten colonies of a fungus grew out in culture. The fungus was golden orange on Sabouraud's glucose agar and brown-gray on corn-meal agar, and was identified as Ramichloridium schulzeri. The lesion regressed during the next two weeks while the patient received amphotericin B therapy and showed an increased granulocyte count. This case seems to be the first authenticated infection caused by this uncommonly encountered soil saprophyte.

Topics: Amphotericin B; Antineoplastic Combined Chemotherapy Protocols; Female; Humans; Leukemia, Lymphoid; Middle Aged; Mitosporic Fungi; Mycoses; Syndrome; Tongue Diseases

Of 38 heroin addicts treated for systemic candidal infections, 36 had metastatic cutaneous lesions (deep-seated scalp nodules and pustulosis in hairy zones), 15 had ocular localizations (mainly chorioretinitis), and 10 had osteoarticular involvement (vertebrae, costal cartilage, knees, and sacroiliac). Such cutaneous lesions have not previously been described in classical systemic candidiasis; we also observed hair invasion by candidal hyphae. Candida albicans was the exclusive species isolated, in contrast to other visceral candidiases in heroin addicts. All isolates were sensitive to amphotericin B, flucytosine, and ketoconazole. Thirty-one visceral localizations were treated only with ketoconazole. Results were favorable in 15 of 18 cutaneous, 6 of 6 ocular, and 4 of 7 osteoarticular cases of involvement. This outbreak coincided with introduction of a new heroin on the drug market in the Paris area. C. albicans was not isolated from the drug. Pathogenesis of this syndrome is unclear.

Topics: Adult; Aged; Amphotericin B; Bone Diseases; Candida albicans; Candidiasis; Candidiasis, Cutaneous; Eye Diseases; Female; Flucytosine; France; Heroin Dependence; Humans; Joint Diseases; Ketoconazole; Male; Middle Aged; Osteoarthritis; Scalp; Syndrome

Topics: Amphotericin B; Diagnosis; Drug Therapy; Humans; Potassium Iodide; Rosa; Sporotrichosis; Syndrome; Tendon Injuries; Tendons; Wrist Joint