amphotericin-b and Tracheitis

Fungal infections are a frequent cause of morbidity an mortality in transplant recipients. Aspergillus spp. is an ubiquitous fungus capable of producing diverse clinical entities with varying severity.. To study the incidence and severity of Aspergillus spp. infections in lung transplantation, analysing the different clinical presentations and response to antifungal drugs.. A review was made of the clinical histories of all patients undergoing lung transplantation who developed positive Aspergillus spp. cultures in our centre between June 1991 and December 1996.. Eleven of 49 transplanted patients (22%) developed Aspergillus spp. infections. Four patients presented invasive aspergillosis forms and 7 tracheobronchitis. In spite of antifungal treatment 3 patients (30%) died of invasive aspergillosis as a direct consequence of the infection. Of the 7 patients with tracheobronchitis, 2 were ulcerative and 1 pseudomembranous, all responded to antifungal treatment. Three patients (10.3%) developed Aspergillus spp. infections despite prophylaxis with itraconazole.. Invasive aspergillosis in the immediate posttransplant period was mortal despite treatment. As opposed, aspergillar tracheobronchitis have been overcome using combined treatments of liposomal or lipidic amphotericin, itraconazole and nebulised amphotericin.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Bronchitis; Drug Therapy, Combination; Female; Humans; Immunocompromised Host; Immunosuppression Therapy; Incidence; Itraconazole; Lung Diseases, Fungal; Lung Transplantation; Male; Middle Aged; Postoperative Complications; Premedication; Retrospective Studies; Spain; Tracheitis; Treatment Outcome

Topics: Adenocarcinoma; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Biopsy; Bronchitis; Bronchoscopy; Chemoradiotherapy; Humans; Immunocompromised Host; Lung Neoplasms; Male; Tomography, X-Ray Computed; Tracheitis; Ulcer

Pseudomembranous aspergillus tracheobronchitis is an uncommon form of invasive pulmonary aspergillosis, and it is generally seen in immunocompromised patients. We report about a mildly immunocompromised case with pseudomembranous aspergillus tracheobronchitis, which caused tracheal perforation, and Horner's syndrome. A 44-year-old female with uncontrolled diabetes mellitus, complaining of fever and dyspnea, was admitted to the hospital. She was hospitalized with community-acquired pneumonia and diabetic ketoacidosis. Insulin infusion and empirical antibiotics were firstly commenced. Bronchoscopy showed left vocal cord paralysis with extensive whitish exudative membranes covering the trachea and the main bronchi. Liposomal amphotericin B was added due to the probability of fungal etiology. Mucosal biopsy revealed aspergillus species. Second bronchoscopic examination demonstrated a large perforation in the tracheobronchial system. Despite all treatments, respiratory failure developed on the 25th day and the patient died within 2 days. Pseudomembranous aspergillus tracheobronchitis is fatal in about 78 % of all cases despite appropriate therapy. Early diagnosis and efficient antifungal therapy may improve the prognosis.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus; Biopsy; Bronchitis; Fatal Outcome; Female; Horner Syndrome; Humans; Spontaneous Perforation; Trachea; Tracheitis

Invasive fungal infections are a major cause of morbidity and mortality in allogeneic stem cell transplant recipients. They can occasionally involve the tracheobronchial tree with serious clinical consequences. Tracheobronchial involvement is often an unexpected finding during diagnostic bronchoscopy. Herein, we report a case of pseudomembranous tracheobronchitis caused by Rhizopus sp. in an allogeneic stem cell transplant recipient.

Topics: Amphotericin B; Antifungal Agents; Biopsy; Bronchitis; Bronchoscopy; Fatal Outcome; Graft vs Host Disease; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Middle Aged; Mucormycosis; Nausea; Respiratory Insufficiency; Rhizopus; Stem Cell Transplantation; Tracheitis; Transplantation, Homologous

Localised fungal infection of the larynx and tracheobronchial tree is extremely uncommon. We report the case of a 6-year-old girl with acute lymphocytic leukaemia, who developed symptoms of upper airways obstruction 6 months after a cord blood transplant. Bronchoscopy showed a pale plaque lesion in the larynx and tracheobronchial tree. Aspergillus fumigatus was cultured from a biopsy of the lesion. The patient was treated successfully with a prolonged course of amphotericin B and assessed with multiple surveillance bronchoscopies.

Topics: Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Aspergillus fumigatus; Biopsy; Bone Marrow Transplantation; Bronchitis; Child; Female; Humans; Laryngitis; Larynx; Postoperative Complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Respiratory Tract Infections; Tracheitis

A case of aspergillus tracheobronchitis following influenza A infection in an immunocompetent 35 year old woman is described that required prolonged mechanical ventilation for airways obstruction. Treatment included liposomal amphotericin, inhaled amphotericin, gamma interferon and GM-CSF. Liposomal amphotericin therapy was associated with reversible hepatosplenomegaly. Inhaled corticosteroids with continued antifungal therapy were used for the management of severe recurrent airway obstruction. After a prolonged course of treatment she survived with fixed airways obstruction unresponsive to corticosteroids.

Topics: Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus niger; Bronchitis; Female; Humans; Influenza, Human; Interferon-gamma; Tracheitis

Topics: Adult; Aerosols; Amphotericin B; Anastomosis, Surgical; Antifungal Agents; Aspergillosis; Bronchitis; Female; Follow-Up Studies; Humans; Itraconazole; Lung Transplantation; Male; Middle Aged; Surgical Wound Infection; Tracheitis; Ulcer

Invasive aspergillosis is a serious opportunistic infection in immunocompromised patients. The case history is described of a 44 year old patient with peripheral T cell lymphoma who developed hoarseness and stridor after chemotherapy. Aspergillus fumigatus was isolated repeatedly from the sputum. Bronchoscopic examination showed symmetrical creamy-white exophytic lesions involving both vocal cords and the supraglottic area. There was diffuse tracheobronchitis with multiple raised cream-coloured plaques in the trachea which histologically consisted of numerous septate branching hyphae consistent with Aspergillus species. The lesions responded to systemic treatment with amphotericin B.

Topics: Adult; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Bronchitis; Humans; Itraconazole; Laryngitis; Lymphoma, T-Cell, Peripheral; Male; Respiratory Sounds; Respiratory Tract Infections; Tracheitis

The use of corticosteroids to reduce the morbidity associated with laryngotracheobronchitis (croup) has been a controversial issue for many years. Recent literature, however, does support a decreased morbidity and increased clinical response when short-term steroids are used. As a prophylactic measure against bacterial superinfection, antibiotics are commonly utilized in the treatment of croup. We present the case of an otherwise healthy infant with severe croup who was hospitalized and treated with both steroids and antibiotics. A relapse in her symptoms led to the diagnosis of candida laryngotracheitis. We recommend close monitoring of patients with croup treated aggressively with steroids and antibiotics. Steroid use should be limited to 24 h with antibiotics reserved for patients with signs of bacterial infection.

Topics: Amphotericin B; Candidiasis; Candidiasis, Oral; Cefaclor; Cefuroxime; Croup; Dexamethasone; Female; Humans; Infant; Ketoconazole; Laryngitis; Tracheitis