amphotericin-b and Synovitis

Prototheca spp. are ubiquitous achlorophyllous algae that produce disease in humans and animals. In the past years infections with Prototheca have obtained increasing importance in human medicine. The cases have been classified into three clinical forms: cutaneous and/or subcutaneous infection, synovitis of olecranon bursa or other fibrous tissue and systemic infection. Patients with a mild degree of immunosuppression may become colonized by Prototheca spp. with a subsequent worsening of their immune surveillance and spread of the disease. Among the numerous pharmacologic agents tried, amphotericin B is the most promising. Successful treatment of protothecosis involves radical excision of the involved structures.

Topics: Amphotericin B; Anti-Bacterial Agents; Humans; Immunocompromised Host; Infections; Prototheca; Public Health; Skin Diseases; Synovitis

Fungal infections of total joint arthroplasties are extremely rare with only 21 previous reported cases in the literature. In 19 of these cases, the offending organism has been a member of the candida species. In all of these cases, the patients had no clinical evidence of disseminated fungal infection. All previously reported cases of total joint fungal infections required removal of the primary prosthesis to eradicate the infection. There has also been a great reluctance to reimplant these patients. In fact, reimplantation has been successful in only one reported case. We report the first case of successful salvage of an arthroplasty infected with candida.

Topics: Abscess; Amphotericin B; Antifungal Agents; Arthritis, Infectious; Candidiasis; Combined Modality Therapy; Hip Prosthesis; Humans; Male; Middle Aged; Osteoarthritis, Knee; Reoperation; Surgical Wound Infection; Synovectomy; Synovitis

To characterize amphotericin B-induced lameness in cattle and to ascertain the analgesic effects of flunixin meglumine by use of multimodal assessment.. 10 healthy Holstein steers free from musculoskeletal disease.. Steers were randomly allocated to a treatment or negative control group. Amphotericin B was injected into the distal interphalangeal joint of the lateral claw of the left hind limb of all steers. Treatment steers received flunixin meglumine at the time of synovitis-arthritis induction and at 12 hours after induction. Control steers received no medication. Multimodal analysis included vital parameters, visual lameness score, behavioral monitoring with accelerometers, pressure mat analysis, and plasma cortisol determination before and after induction. Data were analyzed by use of linear mixed models with treatment and time designated as fixed effects, accounting for repeated measures on individual calves.. Amphotericin B injection induced moderate, transient lameness. Control steers were more than twice as likely to be lame as treatment steers (mean ± SD lameness score, 92.2 ± 8.1 % vs 40.7 ± 2.5%). Treatment steers placed significantly greater force and contact area on the affected foot and greater force, impulse, and contact area on the paired claw, compared with control steers. Furthermore, treatment steers spent considerably less time in recumbency than controls.. Amphotericin B successfully induced synovitis-arthritis in dairy steers that was transient in nature. Flunixin meglumine was efficacious in providing analgesia for these steers.

Topics: Amphotericin B; Animals; Anti-Inflammatory Agents, Non-Steroidal; Arthritis; Cattle; Cattle Diseases; Clonixin; Hydrocortisone; Injections, Intra-Articular; Injections, Intravenous; Lameness, Animal; Least-Squares Analysis; Male; Random Allocation; Synovitis; Treatment Outcome

This study examined the efficacy of sodium salicylate for providing analgesia in an amphotericin B-induced bovine synovitis-arthritis model using 10 male Holstein calves, 4 to 6 mo old and weighing approximately 250 kg. The study used a repeated measures partial crossover design with 2 phases, consisting of 3 treatment periods within each phase. Calves were blocked by body weight and randomly assigned to the sodium salicylate (50 mg/kg i.v.) or placebo group for phase 1. In period 1, lameness induction was simulated with a needle prick of the coronary band, followed by drug or placebo administration. At predetermined time points, serial blood samples for cortisol and salicylate concentrations, electrodermal activity measurements, heart rates, and pressure mat data were collected. Visual lameness scores were recorded by an observer blinded to treatments. In period 2, lameness was induced with injection of amphotericin B into the distal interphalangeal joint, followed by drug or placebo administration, with sample collection as described previously. In period 3, the drug or placebo was administered to the respective calves with sample collection. After a 10-d washout period, phase 2 was conducted with treatments crossed over between groups. Cortisol and salicylate samples were analyzed by competitive chemiluminescent immunoassay and fluorescence polarization immunoassay, respectively. The pharmacokinetic data were analyzed using compartmental analysis. Mean intravenous salicylate apparent volume of distribution was 0.2 +/- 0.005 L/kg, total body clearance was 4.3 +/- 0.2 mL/min.kg, and elimination half-life was 36.9 +/- 1.2 min. The repeated measures data were analyzed based on a univariate split-plot approach with a random effects-mixed model. Differences in stance phase duration and serum cortisol concentration values were seen both between periods and between treatment group x periods; differences in heart rate, contact surface area, and contact pressure values were seen between periods, suggesting that our lameness model was effective. No differences were seen between treatment groups. When analyzed by visual lameness score, differences were seen in heart rate, contact surface area, contact pressure, and cortisol concentrations. Area under the time-effect curves, determined by using the trapezoidal rule, had results similar to the repeated measures data, except for a difference in period for electrodermal activity. This amphotericin B-induced synovitis-

Topics: Amphotericin B; Animals; Arthritis; Cattle; Cattle Diseases; Hydrocortisone; Lameness, Animal; Male; Random Allocation; Salicylates; Sodium Salicylate; Synovitis; Treatment Outcome

The objective here was to evaluate the acute effects of induced arthritis on synovial fluid (SF) levels of matrix metalloproteinases (MMP) -2, -8 and -9 in horses. To evaluate MMP-2 and -9 activities and the effect of non-steroidal anti-inflammatory drug (NSAID) bufexamac during remission from acute arthritis. Aseptic arthritis was induced in 24 Standardbred horses using 20 mg of amphotericin B as a single intra-articular (IA) injection in the right intercarpal joint. After 1 week and 2 weeks, horses were treated intra-articularly with 10, 20, or 40 mg of bufexamac suspension or with sterile saline solution as control. SF was sampled prior to induction and at weekly intervals for 5 weeks. Fluids were evaluated for MMP-2 and MMP-9 activity by gelatin zymography or for MMP-8 immunoreactivity by Western Blotting. IA injection of amphotericin B consistently resulted in significant increase in the immunoreactivity of MMP-8 and activity of both the latent and the active forms of MMP-2 and -9, among which the active form of MMP-2 increased the most. MMP-9 levels declined to pre-induction levels within 2 weeks, whereas levels of MMP-2 remained still high after 5 weeks. Treatment with bufexamac did not significantly affect levels of gelatinolytic MMP. Results suggest that after acute arthritis of horses, elevated MMP activity is present in the joint, for several weeks, to a degree that could promote cartilage degradation, and treatment with the NSAID bufexamac is not likely to affect that. Furthermore, analysing levels of MMP-9 activity and especially levels of active forms of MMP-2 activity may be valuable to predict the time of occurrence of arthritis in horses.

Topics: Amphotericin B; Animals; Anti-Inflammatory Agents; Bufexamac; Female; Horse Diseases; Horses; Male; Matrix Metalloproteinase 2; Matrix Metalloproteinase 8; Matrix Metalloproteinase 9; Random Allocation; Synovial Fluid; Synovitis; Treatment Outcome

We present a case of synovitis of the wrist due to histoplasmosis, diagnosed only after extensive surgery and culturing. Treatment with amphotericin B in combination with radical surgery was effective in curing the disease. This manifestation was probably an exacerbation of a latent chronic infection with Histoplasma capsulatum, although it was unclear why the exacerbation occurred. Synovitis resistant to treatment should be assessed with great care, especially in view of the growing number of immunocompromised patients. Close collaboration between surgeon, rheumatologist, pathologist and microbiologist is paramount in such cases.

Topics: Aged; Amphotericin B; Antifungal Agents; Carpal Bones; Combined Modality Therapy; Follow-Up Studies; Histoplasmosis; Humans; Male; Osteomyelitis; Radiography; Synovitis; Treatment Outcome; Wrist Joint

Topics: Amphotericin B; Humans; Injections, Intra-Articular; Synovitis

Primary coccidioidal synovitis of the knee is a rare disorder and controversy exists in the literature over the efficacy of treatment with synovectomy and Amphotericin B therapy. Four cases are presented illustrating features of the natural history, diagnosis, and treatment of the disease.

Topics: Adult; Aged; Amphotericin B; Amputation, Surgical; Biopsy; Coccidioidomycosis; Female; Humans; Knee Joint; Male; Middle Aged; Synovitis

Topics: Aged; Amphotericin B; Arthritis, Infectious; Birefringence; Candida albicans; Candidiasis; Crystallization; Humans; Knee Joint; Male; Synovial Fluid; Synovial Membrane; Synovitis

Topics: Adult; Amphotericin B; Cryptococcosis; Female; Flucytosine; Humans; Knee Joint; Radiography; Synovial Membrane; Synovitis

Four patients are described with documented coccicioidal synovitis of the knee joint. In two of them, no previous diagnosis of coccidioidomycosis had been made prior to diagnosis of coccidioidal synovitis. The other two had active disease after courses of amphotericin B administered both parenterally and intra-articularly for disseminated coccidioidomycosis and coccidioidal synovitis. After synovectomy and limited parenteral amphotericin B therapy, none of the four patients whos evidence of active synovial infection two to seven years later. Synovectomy appears to be an important aspect of the optimal therapy of coccidioidal synovitis of the knee, and when performed, the parenteral dosage of amphotericin B can be limited. Intra-articularly administered amphotericin B is also advocated when possible.

Topics: Adult; Amphotericin B; Coccidiosis; Female; Humans; Knee; Male; Middle Aged; Synovectomy; Synovitis

Topics: Adult; Amphotericin B; Coccidioides; Coccidioidomycosis; Complement Fixation Tests; Granuloma; Humans; Injections, Intra-Articular; Knee Joint; Male; Synovitis

Topics: Adult; Amphotericin B; Coccidioides; Coccidioidomycosis; Female; Granuloma; Humans; Knee; Male; Middle Aged; Radiography; Synovial Membrane; Synovitis

Topics: Amphotericin B; Humans; Iodides; Knee; Sporotrichosis; Surgical Procedures, Operative; Synovitis