amphotericin-b and Tuberculosis--Pulmonary

Invasive fungal infections are rare in immunocompetent hosts, and diagnosis may be missed or delayed due to our lack of understanding of the particular clinical signs, disease progression, and treatment outcome. Here, we present a case of pulmonary invasive aspergillosis that arose in an immunocompetent and previously healthy patient. The patient presented with a several-week history of remittent high fever, cough, and expectoration. These symptoms were unresponsive to treatments for tuberculosis and pulmonary bacterial infection. Computed tomography images revealed the characteristic bronchiolitis tree-in-bud pattern in the airways. Lung biopsy specimens were culture-positive for Aspergillus fumigatus. Treatment with voriconazole and caspofungin followed by amphotericin B cleared the infection and resolved the symptoms.

Topics: Amphotericin B; Antifungal Agents; Aspergillus fumigatus; Biopsy; Bronchiolitis; Bronchoscopy; Caspofungin; Diagnosis, Differential; Drug Therapy, Combination; Echinocandins; Humans; Immunocompetence; Invasive Pulmonary Aspergillosis; Itraconazole; Lipopeptides; Lung; Male; Pyrimidines; Sputum; Tomography, X-Ray Computed; Triazoles; Tuberculosis, Pulmonary; Voriconazole; Young Adult

Four culture-documented cases of pulmonary sporotrichosis, three primary infections and one with multisystem involvement, are presented. Two of these patients are the first reported cases of primary lung disease treated with ketoconazole. This antifungal agent appears to be ineffective in eradicating this infection. The four cases, as well as a review of the literature, illustrate several important aspects of this rare disease. Pulmonary sporotrichosis is most commonly found in males with a history of alcohol abuse who are between the ages of 30 and 60. The infection is usually confined to the parenchyma of the lung but can involve hilar and mediastinal lymph nodes, pleura, skin, subcutaneous tissue, and joints. All but two cases have been reported in the United States, and the majority reside within states bordering the Missouri or Mississippi rivers. Direct occupational or environmental exposure appears to be an important predisposing risk factor. The onset of the disease is insidious, presenting in a manner similar to many other granulomatous or neoplastic diseases. Tuberculosis is the most common suspected diagnosis before confirmation of sporotrichosis. The chest radiograph most commonly demonstrates upperlobe cavitary disease with surrounding parenchymal infiltrates. The diagnosis can be suspected with high serologic titers or skin-test positivity, but needs to be confirmed by culture. The organism can usually be grown from sputum, as well as routine bronchoscopic procedures, open-lung biopsy specimens or pleural fluid. Histologic examination shows granulomas of both the caseating and noncaseating varieties. Frequently, organisms can be seen in necrotic areas of the lung tissue by diastase-modified GMS or PAS staining. Staining by direct fluorescent antibody technique can also be done and appears to be highly specific. Treatment is controversial, but total surgical resection of diseased lung as well as a perioperative regimen of SSKI or amphotericin B appears to be the most efficacious therapy. Medical therapy alone with SSKI or amphotericin B may be useful in selected cases but has been disappointing in the majority of reports. The imidazoles are usually ineffective, and the search for more effective medical therapy continues.

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Humans; Ketoconazole; Lung; Lung Diseases, Fungal; Male; Middle Aged; Pneumonectomy; Radiography; Sporotrichosis; Tuberculosis, Pulmonary

Current management of infections in thoracic surgery is reviewed. The selection of patients for the use of antibiotics prophylactically, the diagnosis and treatment of pulmonary infection in immunosuppressed patients, indications for operation in patients with fungal infections, bronchiectasis, lung abscess, and empyema, and the management of mediastinitis after sternotomy and of postpneumonectomy space infections is described.

Topics: Amphotericin B; Anti-Bacterial Agents; Antitubercular Agents; Bronchiectasis; Empyema; Humans; Infection Control; Lung Abscess; Lung Diseases, Fungal; Pneumonectomy; Pneumonia; Postoperative Complications; Sternum; Surgical Wound Infection; Thoracic Surgery; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Complement Fixation Tests; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Tuberculosis, Pulmonary

Here, we describe an invasive infection due to Trichosporon coremiiforme in an HIV positive patient with neutropenia. The strain was first erroneously identified as Trichosporon asahii by conventional methods, but correctly identified by mass spectrometry using matrix-assisted laser desorption/ionization time-of-flight technology (MALDI-TOF MS) and ribosomal DNA sequencing. The infection was successfully resolved after antifungal treatment with amphotericin B and fluconazole. This case report is a contribution to the study of T. coremiiforme infections and reinforces its relevance as a species capable of causing invasive human infection in immunocompromised patients and also contributes to the study of its susceptibility profile against antifungal drugs.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antitubercular Agents; Bacteremia; Catheter-Related Infections; Central Venous Catheters; Drug Therapy, Combination; Female; Fluconazole; HIV; HIV Infections; Humans; Immunocompromised Host; Middle Aged; Neutropenia; Trichosporon; Trichosporonosis; Tuberculosis, Pulmonary

A 41-year-old man left for Mexico in May 2015. Right pulmonary nodule was detected at a health examination in May 2016, and he subsequently showed headache and slight fever. Contrast-enhanced magnetic resonance imaging of the brain revealed basilar meningitis, so he was admitted to our hospital. We considered imported mycosis due to his travel history to Mexico. We diagnosed histoplasmosis based on the presence of antibodies against Histoplasma in both serum and cerebrospinal fluid. Symptoms almost completely recovered with a liposomal formulation of amphotericin B. Central nervous system histoplasmosis is very rare in Japan. Immunocompetent hosts can develop histoplasmosis, and this pathology is important to consider in patients presenting with basilar meningitis and a positive travel history.

Topics: Adult; Amphotericin B; Antibodies, Fungal; Antifungal Agents; Biomarkers; Brain Stem; Cerebellum; Chronic Disease; Early Diagnosis; Histoplasma; Histoplasmosis; Humans; Immunocompetence; Itraconazole; Magnetic Resonance Imaging; Male; Meningitis, Fungal; Treatment Outcome; Tuberculosis, Pulmonary

Cryptococcus neoformans is an important opportunistic pathogen that causes serious mortality and morbidity in AIDS patients. Although its incidence has decreased with proper antiretroviral treatment (ART), it is still a major concern in areas with low socioeconomic HIV endemic countries with poor sources of therapy. In our country, pediatric HIV infection and so, HIV-related opportunistic infections are very rare. In order to pay attention to this unusual collaboration; herein, we presented a pediatric case who was diagnosed with HIV and disseminated cryptococcus infection concomitantly. A 6.5-year-old previously healthy girl has admitted to our hospital with the complaints of prolonged fever, cough and hemoptysis. On her physical examination she had oral candidiasis, generalized lymphadenopathy and hepatosplenomegaly. Laboratory findings were as follows; white blood cell count: 3170 µL (neutrophil: 2720 µL, lymphocyte: 366 µL), hemoglobin level: 7.8 gr/dl, hematocrit: 25.5% platelets: 170.000 µL, CRP: 15.2 mg/L and serum IgG level: 1865 mg/dl. Her anti-HIV test yielde,d positive result and confirmed by Western blot assay, together with a high viral load (HIV-RNA: 3.442.000 copies/ml). She was started ART (lamivudine, zidovudine and lopinavir/ritonavir combination) with the diagnosis of stage 3 HIV infection (AIDS). Posteroanterior chest radiograph showed mediastinal extension and nodular parenchyma. Since the patient was suspected to have pulmonary tuberculosis based on the clinical and radiological findings, empirical antituberculosis therapy was started. Because of the insistance of fever, three different blood specimens, bone marrow and gastric aspirates were collected for culture, in which all of them yielded C.neoformans growth. She was then diagnosed as disseminated cryptococcosis and treated with liposomal amphotericin B and fluconazole successfully. Although pediatric HIV infection is usually diagnosed secondary to maternal disease, it can rarely be presented later in life with opportunistic infections. In the case of unusual infectious diseases, in addition to primary immune deficiency syndromes, HIV infection should also be kept in mind. Herein, we discussed a pediatric case with two rare infectious agents reported in our country and wanted to focus on secondary immune deficiency related with pediatric HIV infection.

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Anti-Retroviral Agents; Antifungal Agents; Child; Cryptococcosis; Diagnosis, Differential; Drug Therapy, Combination; Female; Fluconazole; HIV Infections; Humans; Tuberculosis, Pulmonary

Clinical deterioration during the treatment of tuberculosis remains a diagnostic challenge. We describe the case of a 46-year-old man with a history of oral cancer status after a radical operation who had pulmonary tuberculosis with pleura and neck lymph node involvement. The clinical condition improved after antituberculosis therapy. However, the patient suffered from low-grade fever, progressive dyspnea, and cough after 7 weeks of the therapy. The findings of chest plain films were relapse and progression of left lung haziness. The deterioration was caused by disseminated Penicillium marneffei infection. Disseminated P. marneffei in a non-HIV patient with tuberculosis is rarely seen, and the manifestations are similar to a paradoxical response and relapse of pulmonary tuberculosis, thereby making it difficult to establish a diagnosis.

Topics: Amphotericin B; Humans; Male; Middle Aged; Mycoses; Penicillium; Recurrence; Tuberculosis, Pulmonary

Mycetoma is defined as a fungus ball that fills a preexisting lung cavity, most frequently being of tuberculous or sarcoid etiology. The most frequently isolated fungus is the species of Aspergillus, but other fungi such as Fusarium or Zygomycetes can also be present. Most patients lack symptoms. However, presentation may also be with hemoptysis, which can be massive and life-threatening. We describe the case of a 50-year-old man with a history of prior pulmonary tuberculosis, with recurrent episodes of cough and hemoptysis. He was diagnosed to have mycetoma in the left upper lobe cavity. The mycetoma was extracted through bronchoscopy under general anesthesia using a cryoprobe. Treatment was completed with amphotericin B instilled in the cavity and the patient was placed on oral itraconazole. This is the first case report to date in which cryotherapy was used to remove a mycetoma.

Topics: Amphotericin B; Antifungal Agents; Bronchoscopy; Cough; Cryotherapy; Fusariosis; Hemoptysis; Humans; Instillation, Drug; Lung Diseases, Fungal; Male; Middle Aged; Mycetoma; Radiography; Recurrence; Tuberculosis, Pulmonary

Zygomycosis can manifest as severe infections, particularly in immunocompromised patients, which can be nosocomial in nature resulting from complications of invasive procedures. We report the case of a 65-year-old woman with a medical history of unclassified inflammatory rheumatism who underwent arteriovenous extracorporeal membrane oxygenation because of a myocardial failure following the drainage of a tuberculous tamponade. This procedure was complicated by a superinfection of the scarpa which revealed a disseminated zygomycosis with renal involvement. A favorable outcome was achieved after 15 months of antifungal therapy involving the use of liposomal amphotericin B followed with posaconazole which involved the close monitoring of the concentrations of this antifungal. Extracorporeal membrane oxygenation is a frequent procedure which could be complicated with severe fungal nosocomial infections such as zygomycosis. The outcome of such complication can be favorable with the utilization of new antifungal therapies.

Topics: Acute Kidney Injury; Aged; Amphotericin B; Antifungal Agents; Cross Infection; Extracorporeal Membrane Oxygenation; Female; France; Heart Failure; Humans; Immunocompromised Host; Kidney; Mucormycosis; Rheumatic Fever; Rhizopus; Treatment Outcome; Triazoles; Tuberculosis, Pulmonary

We assessed the effect of a double concentration of supplemental polymyxin B, amphotericin B, nalidixic acid, trimethoprim and azlocillin (PANTA) added to the Mycobacterial Growth Indicator Tube (MGIT) on contamination and positivity rates in 216 sputum cultures. Contamination rates were respectively 12.9% and 5.5% for samples processed using standard and double PANTA concentrations (P = 0.0001, McNemar's test). Thirty-five per cent of cultures performed using standard PANTA and 36.5% of those performed using two-fold PANTA concentrations were positive for Mycobacterium tuberculosis, compared to 25.9% of cultures inoculated on Ogawa medium. These results suggest that the use of MGIT with 2× PANTA may be useful in reducing culture contamination without reducing the diagnostic yield.

Topics: Amphotericin B; Anti-Bacterial Agents; Azlocillin; Bacteriological Techniques; Culture Media; Disposable Equipment; Dose-Response Relationship, Drug; Equipment Contamination; Humans; Mycobacterium tuberculosis; Nalidixic Acid; Polymyxin B; Predictive Value of Tests; Prospective Studies; Sputum; Trimethoprim; Tuberculosis, Pulmonary

A 58-year-old Japanese man was admitted with high fever, productive cough, marked leukocytosis, and chest X-ray findings of infiltration and fluid levels within lung cysts. He had been treated for pulmonary tuberculosis for 6 months. He was also receiving home oxygen therapy for chronic obstructive pulmonary disease and 10 mg prednisolone daily for rheumatoid arthritis. Aspergillus fumigatus was cultured from bronchial washing fluid and we diagnosed chronic necrotizing pulmonary aspergillosis (CNPA). Micafungin was initially effective but 9 weeks later the symptoms recurred. Micafungin was stopped and after combination therapy of intravenous liposomal amphotericin B and oral itraconazole capsule was started his symptoms and laboratory data markedly improved. Fifteen weeks later his medication was switched to oral voriconazole and he was discharged. CNPA is a chronic infectious disease with poor prognostic and no standard therapy has been confirmed. Each antifungal drug has different mechanisms and sites of action. In the case of treatment failure with several drugs, combination therapy to achieve drug interaction can be a treatment option.

Topics: Amphotericin B; Antifungal Agents; Arthritis, Rheumatoid; Aspergillosis; Aspergillus fumigatus; Chronic Disease; Drug Therapy, Combination; Humans; Itraconazole; Liposomes; Lung Diseases, Fungal; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Treatment Outcome; Tuberculosis, Pulmonary

This case report describes the history of a patient with pulmonary tuberculosis. As part of the diagnostic work-up a transthoracic biopsy was performed which resulted in a lung collapse. After one month of standard therapy for tuberculosis, the patient was admitted to our hospital for a clinical and surgical re-evaluation. Microbiological examination showed the presence of Aspergillus niger and Pseudomonas aeruginosa. Treatment with AmBisome, ciprofloxacin and imipenem was started: the patient responded well with good clinical improvement. After 5 months of anti-tuberculous therapy, culture of pleural fluid was negative; the right lung remained collapsed but sterilization of the pleura will allow future surgery.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Humans; Lung Diseases, Fungal; Male; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Antifungal Agents; Antitubercular Agents; Aspergillosis; Aspergillus; Brain; Female; Humans; Immunoglobulin G; Immunoglobulin M; Magnetic Resonance Imaging; Mycobacterium tuberculosis; Polymerase Chain Reaction; Radiography; Tuberculosis, Central Nervous System; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Azithromycin; Cysts; Drug Therapy, Combination; Humans; Itraconazole; Lung Diseases, Fungal; Male; Mycobacterium fortuitum; Mycobacterium Infections, Nontuberculous; Treatment Outcome; Tuberculosis, Pulmonary

We retrospectively evaluated 61 cases with pulmonary aspergilloma representing patients admitted to Nagasaki University Hospital between January 1991 to June 1998.. Fifty-two (85%) were males and 9 (15%) were females, aged between 14 to 80 years (average, 65 years). Forty-four (72%) patients had history of old pulmonary tuberculosis. Chest radiographs showed "fungus ball" in the cavities in 42 (67%) cases while 16 (26%) cases showed thickening of the cavity wall. Aspergillus fumigatus was isolated in 24 (39%) patients. Aspergillus antigen or antibody was positive in 8 (13%) and 43 (70%) patients, respectively. Oral itraconazole was used in 16 (26%) of patients, and surgical excision was performed in 15 (25%) patients. During hospitalization or after discharge, 19 (31 %) patients died.. Pulmonary aspergilloma usually occurs in elderly patients with old tuberculosis and respiratory failure. Many cases did not respond to antifungal therapy with itraconazole or amphotericin B. Our analysis indicates that more effective and appropriate therapeutic regimens are needed for the treatment of patients with pulmonary aspergilloma.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Amphotericin B; Antibodies, Fungal; Antifungal Agents; Aspergillosis; Aspergillus; Female; Humans; Itraconazole; Lung Diseases, Fungal; Male; Middle Aged; Pneumonectomy; Retrospective Studies; Survival Rate; Treatment Outcome; Tuberculosis, Pulmonary

Almost all (98%) of 1593 visceral leishmaniasis (VL) patients treated with sodium stibogluconate (Pentostam; Wellcome) in Sudan between 1989 and 1995 and follow-up responded well to treatment. However, the other 33 patients, all of whom were seronegative for HIV, showed partial or no response. The two main causes of unresponsiveness were primary drug resistance (39.3%) and low drug dosages given at peripheral dispensaries (30.3%). All of those who had been sub-optimal doses were cured when adequate doses of the drug were given. A third cause was concurrent disease, particularly pulmonary tuberculosis (18%). With treatment of the concurrent disease, patients responded well to Pentostam. Eight patients who failed to respond to repeated courses of Pentostam did not benefit from pentamidine or sterol inhibitors. Three of these patients responded to liposomal amphotericin B, two responded to splenectomy in association with Pentostam therapy, and three died. Pentostam, given in adequate doses, still appears to be the drug of choice for the treatment of VL in the Sudan Liposomal amphotericin B is a suitable second-line drug.

Topics: Adolescent; Adult; Amphotericin B; Antimony Sodium Gluconate; Antiprotozoal Agents; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Resistance; Female; Humans; Leishmaniasis, Visceral; Male; Splenectomy; Sudan; Tuberculosis, Pulmonary

A case of Kartagener's syndrome associated with multiple pulmonary complication was presented. A 19-year-old man was admitted to our hospital because of pulmonary tuberculosis in May 1972. He had been diagnosed as Kartagener's syndrome because of the presence of chronic parasinusitis, bronchiectasis and complete situs inversus. His chest radiographs in Dec 1972 revealed left pneumothorax. Chest radiographs in Aug 1975 appeared aspergilloma in the right middle lung field. He was administrated intravenous and oral anti-fungal agent and transbronchial installation of Amphotericin-B because of hemoptysis. Chest radiographs in July 1980 resolved the aspergilloma and his symptom were also resolved. In 1996, he had no pulmonary symptoms and respiratory failure. We consider that the Kartagener's syndrome was good prognosis with adequate pulmonary therapy.

Topics: Adult; Amphotericin B; Anti-Bacterial Agents; Antifungal Agents; Antitubercular Agents; Aspergillosis; Humans; Kartagener Syndrome; Lung Diseases, Fungal; Male; Pneumothorax; Tuberculosis, Pulmonary

A 52-year-old man with chronic necrotizing pulmonary aspergillosis complicated by a residual tuberculous cavity was admitted to the hospital because of fever and a new infiltration shadow in the right lower lobe. Aspergillus was isolated repeatedly from his sputum, though he had been treated with itraconazol for 9 months. Combination therapy with itraconazol (200 mg) and inhaled amphotericin B (AMPC, 10 mg, 4 times a day) was begun. The infiltration shadow gradually resolved. The concentration of AMPC in serum was measured by high-performance liquid chromatography, and was found to be 0.09 micrograms/ml, which is equal to the AMPC concentration obtained with daily oral administration of 2400 mg. This case shows that, contrary to previous opinion, AMPC can be effectively administered by inhalation. We know of no previous reports of similar cases. In addition, itraconazol and inhaled AMPC may have had a synergistic effect in this case.

Topics: Administration, Inhalation; Administration, Oral; Amphotericin B; Antifungal Agents; Aspergillosis; Chronic Disease; Drug Therapy, Combination; Humans; Itraconazole; Lung Diseases, Fungal; Male; Middle Aged; Necrosis; Tuberculosis, Pulmonary

The authors report 30 cases of the percutaneous treatment of symptomatic pulmonary aspergilloma by injection of amphotericine paste in patients who were not considered to be operable. The treated aspergillomas had developed as a sequel to bacilliary infection and pulmonary fibrosis. Surgery was contraindicated in these patients on account of severe respiratory failure. The authors specify the technique for the preparation of the paste and for the type of percutaneous injection, the aim being to obtain complete filling of the cavity and creating an anaerobic environment for the aspergillus. The contribution of this technique for the non-surgical treatment of patients appears interesting but should be carried on a larger series to identify the exact indications and the interaction with other new treatments which have just appeared.

Topics: Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Bronchial Arteries; Contraindications; Embolization, Therapeutic; Female; Hemoptysis; Humans; Injections; Lung Diseases, Fungal; Male; Middle Aged; Ointments; Palliative Care; Pneumonectomy; Pulmonary Fibrosis; Radiography, Interventional; Respiratory Insufficiency; Tomography, X-Ray Computed; Tuberculosis, Pulmonary

A 52-year-old man, who had undergone right upper lobectomy because of active tuberculosis 29 years before, was admitted with complaints of severe cough and expectation. Two years ago, he had pulmonary aspergillosis and was successfully treated with some anti-mycotic agents. This time his chest X-P showed fungus ball in a residual tuberculous cavity in the right upper field and he was diagnosed as pulmonary aspergilloma from the results of radiological findings, sputum culture, and serologic test. By bronchofiberscopy fungus ball was observed. With transbronchial infusion of Amphotericin B, intravenous administration of Miconazole and oral administration of Flucytosine, clinical symptoms have improved and lysis of fungus ball was observed. Sputum culture revealed Aspergillus flavipes group. Bronchopulmonary aspergillosis, which was incurable by surgical treatment because of underlying disease, was successfully treated with transbronchial infusion of Amphotericin B and administration of some anti-mycotic agents.

Topics: Amphotericin B; Aspergillosis, Allergic Bronchopulmonary; Humans; Male; Middle Aged; Recurrence; Tuberculosis, Pulmonary

A case of blastomycosis from Zaria, Nigeria is reported. The clinical features were indistinguishable from those of tuberculosis which is very common in this environment. Lack of response to anti-tuberculosis therapy within eight weeks prompted the search for other organisms which resulted in the isolation of Blastomyces dermatitidis. Compatible histological evidence was obtained. Subsequent favourable response to amphotericin B was evident. Infection with this organism should be included in the differential diagnosis of pulmonary and pleural lesions simulating tuberculosis in West Africa.

Topics: Adult; Amphotericin B; Blastomyces; Blastomycosis; Diagnosis, Differential; Humans; Male; Pleural Effusion; Sputum; Tuberculosis, Pulmonary

We give a thorough report on coccidioidomycosis, a systemic mycosis only occurring in the New World. We present microorganism, geography, epidemiology, diagnostic procedures, and therapy. A pilot study on German soldiers trained in the endemic areas of the USA demonstrated by means of a positive skin test that 3.73% of them had been infected.

Topics: Adrenal Cortex Hormones; Adult; Amphotericin B; Coccidioidin; Coccidioidomycosis; Diagnosis, Differential; Germany, West; Humans; Ketoconazole; Lung; Male; Military Medicine; Sarcoidosis; Skin Tests; Transfer Factor; Tuberculosis, Pulmonary; United States

Topics: Aged; Amphotericin B; Aspergillosis; Aspergillus fumigatus; Diagnosis, Differential; Empyema; Empyema, Tuberculous; Female; Humans; Lung Diseases, Fungal; Postoperative Complications; Recurrence; Thoracoplasty; Time Factors; Tuberculosis, Pulmonary

Topics: Administration, Topical; Adult; Amphotericin B; Aspergillosis; Humans; Lung Diseases, Fungal; Male; Pulmonary Emphysema; Tuberculosis, Pulmonary

The first documented cure of cryptococcosis with cryptococcemia is reported. The patient had systemic lupus erythematosis and had received corticosteroids and immunosuppressive drugs for diffuse proliferative nephritis. She had additional poor prognostic factors including high serum cryptococcal antigen titer, low cerebrospinal leukocyte count, and absence of anticryptococcal antibody. Pulmonary tuberculosis was diagnosed concurrently and subsequently she developed disseminated herpes zoster. During amphotericin B therapy, renal function worsened. Cure of cryptococcosis with cryptococcemia was accomplished despite multiple concurrent infections and transient worsening of renal function.

Topics: Adult; Amphotericin B; Cryptococcosis; Female; Herpes Zoster; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Nephritis; Pneumonia, Viral; Tuberculosis, Pulmonary

Sporotrichosis is frequently primary in the lungs, caused by inhalation or aspiration of spores of Sporothrix schenckii. The clinical features and roentgenographic changes are nonspecific and usually indistinguishable from reactivated pulmonary tuberculosis. Therefore, pulmonary sporotrichosis should be considered when the tuberculin test and sputum cultures for Mycobacterium tuberculosis are persistently negative. Direct fluorescent antibody is a reliable, rapid, and specific method of identifying organisms in specimens and tissue biopsies. While the agglutination test is very sensitive in detecting sporotrichosis, it does not differentiate active disease from inactive disease. The complement fixation test, when positive, may suggest the presence of systemic sporotrichosis. Potassium iodide may be used initially in the nonimmunocompromised host with limited, noncavitary pulmonary disease. Amphotericin B should be given to patients who fail to respond to potassium iodide. Initial amphotericin B therapy is indicated in immunocompromised patients, in patients with multifocal systemic sporotrichosis. and in those with cavitary pulmonary sporotrichosis. Resectional surgery with perioperative medical therapy is indicated in patients with persistent cavitary disease unresponsive to amphotericin B, or when cavitary disease is associated with bleeding.

Topics: Adult; Amphotericin B; Diagnosis, Differential; Humans; Lung; Lung Diseases, Fungal; Male; Middle Aged; Potassium Iodide; Radiography; Sporotrichosis; Tuberculosis, Pulmonary

During the period 1969 to 1974, 41 patients having cultures positive for aspergillus were seen on the thoracic surgical services of the University of Maryland and Mt. Wilson State Hospitals. Intracavitary mycetoma was present in 36 patients. In 32 the underlying disease was chronic cavitary tuberculosis, 5 had decreased immunity due to other diseases, and in 3 no underlying disease was noted. One final patient developed a mycetoma following repair of tetralogy of Fallot. Hemoptysis, the predominant symptom, occurred in 23 patients, all of whom were from the group with intracavitary mycetoma. Hemoptysis was life-threatening in 8 patients, severe but not life-threatening in 12, and minimal in 3. Fifteen patients underwent pulmonary resection with 2 deaths. Both patients who died had undergone emergency resection for life-threatening hemoptysis; the fungus ball had developed following a previous resection for tuberculosis, and both had poor pulmonary reserve. Of 10 patients with hemoptysis who were not treated surgically, chiefly because they were poor operative risks, 4 died. This study suggests that pulmonary aspergillosis, particularly of the intracavitary type, is a potentially life-threatening disease. Because of the suddenness with which massive hemoptysis may occur, pulmonary resection is recommended for all patients with intracavitary mycetoma who do not constitute prohibitive operative risks.

Topics: Adult; Aged; Amphotericin B; Aspergillosis; Female; Hemoptysis; Humans; Immunologic Deficiency Syndromes; Lung Diseases, Fungal; Male; Middle Aged; Mycetoma; Pneumonectomy; Postoperative Complications; Radiography; Tuberculosis, Pulmonary

Two patients with chronic mucocutaneous candidiasis and a defect in cellular immunity received a single injection of dialysable transfer factor from Candida-positive donors in an effort to reconstitute immunologic function. The transfer of cellular hypersensitivity was successful in one of the two patients and was monitored by skin tests and MIF production; however, the effect was temporary and did not change the clinical course of the patient's infection. The other patient did not respond eitherimmunologically or clinically to transfer factor at this time, although she did respond subsequently to repeated doses of transfer factor and amphotericin B therapy (Pabst and Swanson: Brit. med. J. 2:442, 1972). In another instance transfer factor from tuberculin-positive donors was used successfully to eradicate an infection in a patient with progressive primary tuberculosis and an acquired defect in cellular immunity. The patient had not responded clinically or bacteriologically after 7 1/2 months of antituberculous therapy, although the organism was shown to be sensitive in vitro to the drugs she was receiving. She received 6 doses of dialysable transfer factor over a 3-month period and during this time she responded clinically, bacteriologically and roentgenographically.

Topics: Adult; Amphotericin B; Antigens, Fungal; Candida albicans; Candidiasis, Cutaneous; Cell Migration Inhibition; Cells, Cultured; Child; Chronic Disease; Female; Humans; Hypersensitivity, Delayed; Immunity, Cellular; Immunologic Deficiency Syndromes; Immunotherapy; Lymphocyte Activation; Lymphocytes; Macrophage Migration-Inhibitory Factors; Male; Phagocytosis; Skin Tests; Streptodornase and Streptokinase; Transfer Factor; Tuberculin Test; Tuberculosis, Pulmonary

Topics: Amphotericin B; Blastomyces; Blastomycosis; Diagnostic Errors; Humans; Isoniazid; Male; Middle Aged; Mycobacterium tuberculosis; Osteomyelitis; Sacrum; Scalp; Tuberculosis, Osteoarticular; Tuberculosis, Pulmonary

Topics: Aged; Amphotericin B; Aspergillosis; Female; Humans; Lung Diseases, Fungal; Male; Middle Aged; Radiography; Remission, Spontaneous; Sputum; Tuberculosis, Pulmonary

Topics: Adult; Age Factors; Amphotericin B; Aspergillosis; Bronchopneumonia; Cross Infection; Diagnosis, Differential; Disseminated Intravascular Coagulation; Humans; Male; Perfusion; Pleural Effusion; Prognosis; Sepsis; Sex Factors; Tuberculosis, Pulmonary

Topics: Adult; Aminosalicylic Acids; Amphotericin B; Cryptococcosis; Cryptococcus neoformans; Humans; Isoniazid; Lung Diseases, Fungal; Male; Mycobacterium tuberculosis; Radiography; Tuberculosis, Pulmonary

Topics: Adult; Aircraft; Amphotericin B; Arizona; Coccidioidomycosis; Complement Fixation Tests; Diagnosis, Differential; Germany, West; Humans; Lung Diseases, Fungal; Lymph Nodes; Male; Radiography; Skin Tests; Tuberculosis, Pulmonary

Topics: Aged; Amphotericin B; Aspergillosis; Female; Humans; Lung; Lung Diseases, Fungal; Male; Middle Aged; Radiography; Serologic Tests; Tomography; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Cuba; Diagnosis, Differential; Disease Outbreaks; Histoplasmosis; Humans; Lung; Male; Radiography; Sarcoidosis; Tuberculosis, Pulmonary

Topics: Aged; Amphotericin B; Aspergillosis; Humans; Intubation; Iodides; Lung Diseases, Fungal; Male; Methods; Skin; Sodium; Tuberculosis, Pulmonary

Topics: Adolescent; Adult; Aged; Amphotericin B; Chronic Disease; Coccidioides; Coccidioidomycosis; Complement Fixation Tests; Diagnosis, Differential; Female; Histoplasmosis; Humans; Lung Diseases, Fungal; Male; Middle Aged; Radiography; Skin Tests; Sputum; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Coccidioidomycosis; Diagnosis, Differential; Humans; Lung Diseases, Fungal; Male; Radiography; Skin Tests; Texas; Time Factors; Tuberculosis, Pulmonary

Topics: Adult; Aged; Amphotericin B; Blastomyces; Blastomycosis; Bone and Bones; Bone Diseases; Breast; Breast Diseases; Female; Granuloma; Histoplasmosis; Humans; Lung; Lung Diseases, Fungal; Lymph Nodes; Male; Middle Aged; Pneumonia; Skin; Skin Diseases; Smoking; Tuberculosis, Pulmonary

Topics: Agglutination Tests; Amphotericin B; Diagnosis, Differential; Humans; Lung; Lung Diseases, Fungal; Male; Middle Aged; Sporothrix; Sporotrichosis; Sputum; Stilbamidines; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Cryptococcosis; Cryptococcus; Humans; Male; Middle Aged; Tuberculosis, Pulmonary

Topics: Amphotericin B; Diagnosis, Differential; Female; Humans; Lung Diseases; Lung Diseases, Fungal; Middle Aged; Occupational Diseases; Sarcoidosis; Sporotrichosis; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Follow-Up Studies; Humans; Iodides; Leg Ulcer; Lung Diseases, Fungal; Male; Occupational Diseases; Ohio; Pneumonectomy; Radiography; Sarcoidosis; Sporothrix; Sporotrichosis; Sputum; Steroids; Tomography; Tuberculosis, Pulmonary; Vegetables

Topics: Amphotericin B; Diagnosis, Differential; Humans; Lung Diseases, Fungal; Sporotrichosis; Tuberculosis, Pulmonary

Topics: Amphotericin B; Coccidioidomycosis; Diagnosis, Differential; Female; Humans; Male; Pneumonectomy; Postoperative Complications; Radiography; Tuberculosis, Pulmonary

Topics: Adolescent; Adult; Age Factors; Aged; Amphotericin B; Black People; Blastomycosis; Child; Female; Follow-Up Studies; Humans; Iodides; Kentucky; Male; Middle Aged; Prognosis; Skin Manifestations; Stilbamidines; Tuberculosis, Pulmonary; White People

Topics: Adult; Amphotericin B; Brain Diseases; Chromoblastomycosis; Diagnosis, Differential; Female; Humans; Isoniazid; Liver; Lymph Nodes; Mitosporic Fungi; Multiple Sclerosis; Tuberculosis, Pulmonary

Topics: Adolescent; Amphotericin B; Antifungal Agents; Coccidioidomycosis; Diagnosis, Differential; Female; Humans; Lung; Lung Diseases, Fungal; Nystatin; Radiography; Tuberculosis, Pulmonary

Topics: Adult; Amphotericin B; Histoplasma; Histoplasmosis; Humans; In Vitro Techniques; Lung Diseases, Fungal; Middle Aged; Radiography, Thoracic; Tuberculosis, Pulmonary

Topics: Adrenal Cortex Hormones; Amphotericin B; Brain Diseases; Cryptococcosis; Cryptococcus; Diagnosis, Differential; Humans; Lung Diseases, Fungal; Male; Middle Aged; Radiography, Thoracic; Tuberculosis, Pulmonary

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Bronchial Diseases; Bronchial Fistula; Drug Therapy; Fistula; Humans; Lung Diseases, Fungal; Pleura; Pneumonectomy; Pulmonary Aspergillosis; Radiography, Thoracic; Tuberculosis, Pulmonary

Topics: Amphotericin B; Black People; Complement Fixation Tests; Diagnosis, Differential; Histoplasmosis; Humans; Infant; Lung Diseases; Lung Diseases, Fungal; Pathology; Radiography, Thoracic; Rest; Surgical Procedures, Operative; Tennessee; Tuberculosis; Tuberculosis, Pulmonary

Topics: Amphotericin B; Child; Drug Therapy; Histoplasmosis; Humans; Infant; Lung Diseases; Lung Diseases, Fungal; Radiography, Thoracic; Sulfonamides; Tuberculosis; Tuberculosis, Pulmonary

Topics: Amphotericin B; Cryptococcosis; Encephalitis; Humans; Isoniazid; Meningoencephalitis; Streptomycin; Tetracycline; Tuberculosis; Tuberculosis, Pulmonary

Topics: Amphotericin B; Aspergillosis; Iodides; Lung Diseases, Fungal; Pathology; Pulmonary Aspergillosis; Radiography, Thoracic; Surgical Procedures, Operative; Tuberculosis; Tuberculosis, Pulmonary

Topics: Amphotericin B; Aspergillosis; Diagnosis, Differential; Humans; Lung Diseases; Lung Diseases, Fungal; Microbiology; Nystatin; Radiography, Thoracic; Tuberculosis; Tuberculosis, Pulmonary