amphotericin-b and Ureteral-Obstruction

Obstructive uropathy caused by upper urinary tract fungal ball formation is an uncommon but well recognized clinical entity. The clinical course and management of an infant with unilateral fungal ball obstruction is described. Ultrasound and Tc-diaminotetraethylpentacetic acid (DTPA) renal scan contributed significantly to the diagnosis and management of this patient. Complete resolution of the obstruction was achieved by treatment with intravenous amphotericin B and oral 5-fluorocytosine. The clinical course and management of 35 patients described in the literature indicate that prematurity, use of broad spectrum antibiotics, prolonged hospital stay and the use of intravascular catheters are predisposing factors. The mortality rate is 34%. Young age, small size, the presence of candidaemia and withholding antifungal therapy are poor prognostic factors. A rational plan of treatment, extrapolated from the literature, is presented which may help to reduce the mortality rate in this condition.

Topics: Amphotericin B; Candidiasis; Drug Therapy, Combination; Flucytosine; Humans; Hydronephrosis; Infant; Infant, Newborn; Kidney Diseases; Kidney Pelvis; Male; Ureteral Obstruction

Topics: Acidosis, Renal Tubular; Aldosterone; Amiloride; Amphotericin B; Animals; Carbon Dioxide; Disease Models, Animal; Hydrogen; Hydrogen-Ion Concentration; Kidney Tubules, Distal; Lithium; Partial Pressure; Ureteral Obstruction

Invasive candidiasis is a serious pathogen of late-onset sepsis in very low birth weight infants. Kidney is the most common organ involved, and it causes morbidity and mortality, especially when fungal balls are formed. We report a 34-day-old female infant (born at 28 weeks' gestation, 1152 g) with systemic fungal infection complicated obstructive uropathy. On sonography, the fungal balls filled the entire pelvis without hydronephrosis. Percutaneous nephrostomy was not feasible. In addition to systemic antifungals, we successfully performed cystoscopy-assisted retrograde ureteral catheterization to decompress the pelvis, which also provided a route for local amphotericin B irrigation to achieve therapeutic concentration without nephrotoxicity.

Topics: Amphotericin B; Antifungal Agents; Anuria; Candidiasis; Caspofungin; Female; Flucytosine; Humans; Infant; Infant, Very Low Birth Weight; Kidney Diseases; Therapeutic Irrigation; Ultrasonography; Ureteral Obstruction; Urinary Catheterization

Primary renal aspergillosis, though a rare entity, is still seen in immune compromised individuals. Renal aspergillosis may lead to formation of focal abscesses, fungal bezoars and may cause ureteric obstruction. Treatment involves stabilization of patient and removal of fungal bezoars along with administration of anti-fungal agents. This report describes the case of localized primary renal aspergillosis with fungal bezoars formation in a 55 years old female, diabetic, hypertensive, who presented with upper urinary tract obstruction and was successfully managed by endoscopic removal of fungal bezoars and intravenous amphotericin followed by oral itraconazole.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Bezoars; Female; Humans; Itraconazole; Kidney; Kidney Diseases; Middle Aged; Treatment Outcome; Ultrasonography; Ureteral Obstruction; Ureteroscopy

In kidney transplant recipients, acute renal failure resulting from a ureteral obstruction by fungus balls is uncommon. We report a 60-year-old man diagnosed with ureteral obstruction caused by Candida albicans fungus balls early after transplant. Diagnosis was made by a T2-weighted magnetic resonance image, which demonstrated fungus balls as a low-intensity mass in the pelvis and microscopic examination findings in the urine. The patient was treated successfully with an antifungal agent and direct irrigation. It should be noted that fungus balls may cause ureteral obstruction of transplanted kidneys, possibly resulting in graft failure. Imaging of the kidneys and collecting system and aggressive debridement that adds to systemic therapy are necessary for early diagnosis and are central to a successful outcome.

Topics: Administration, Oral; Amphotericin B; Antifungal Agents; Bezoars; Candida albicans; Candidiasis; Fluconazole; Humans; Kidney Transplantation; Magnetic Resonance Imaging; Male; Middle Aged; Predictive Value of Tests; Therapeutic Irrigation; Treatment Outcome; Ureteral Obstruction

To explore the management of fungal pyelonephritis in infants.. Data from 5 cases with fungal pyelonephritis, including the clinical situation, laboratory examination, feature of imaging, and treatment were analyzed.. All the 5 cases were preterm and low birth weight infants. In 3 cases the disease was unilateral, in 2 cases were bilateral, and acute renal failure occurred. Fungus balls presented on imaging. Urine culture was positive of Candida albicans. Treatment with percutaneous nephrostomy, irrigation and antifungal agent were associated with good prognosis. Only 1 case died. The surviving patients were followed up for 10 - 20 months and the results showed normal growth and development. B-mode ultrasound examination did not show any malformation of the urinary system.. Fungal pyelonephritis was commom in preterm infants. Candida albicans was the major pathogenic microorganism. Percutaneous nephrostomy and drainage were effective in patients with urinary obstruction in relief of obstruction, early diagnosis and control of infection.

Topics: Acute Kidney Injury; Amphotericin B; Antifungal Agents; Candida albicans; Candidiasis; Chymotrypsin; Female; Humans; Infant; Infant, Newborn; Infant, Premature; Male; Nephrostomy, Percutaneous; Pyelonephritis; Treatment Outcome; Ultrasonography, Doppler, Color; Ureteral Obstruction; Urine

We report a case of disseminated infection due to Bipolaris australiensis in a 21-year-old immunocompetent Pakistani man. He presented with fever and jaundice. Examination revealed a mass in the right lung, mediastinal lymphadenopathy, a pericardial effusion, and abdominal masses obstructing and invading the common bile duct and right ureter. Histological examination and culture of a biopsy specimen of the hilar mass yielded the fungal pathogen B. australiensis. The patient was treated successfully with amphotericin B and itraconazole.

Topics: Adult; Amphotericin B; Antifungal Agents; Cholestasis; Drug Therapy, Combination; Humans; Itraconazole; Lung Diseases, Fungal; Lymphatic Diseases; Male; Mediastinal Diseases; Mitosporic Fungi; Mycoses; Pericardial Effusion; Ureteral Obstruction

We report two cases of urinary obstruction by fungal bezoars in full-term neonates who presented a uropathy detected antenatally. Early percutaneous urinary diversion was performed to relieve renal impairment secondary to a primary megaureter in the first case and to bilateral pelvi-ureteral obstruction in the second. Acute fungal obstruction occurred first on the side of the primary megaureter and then on the healthy side in the first patient. Symptoms of infection and impaired renal function led to a diagnosis of fungal bezoar. In the second patient the development of the bezoar was more insidious and occurred after surgical correction of the obstructive pelvi-ureteral junction on the left side. Candiduria was the first sign in both cases. Ultrasonography is the best method to visualize fungal masses within the collecting system. In most cases, percutaneous nephrostomy allows relief of the obstruction, sampling of urine for culture and irrigation with amphotericin B. However, additional surgical intervention may be necessary. Systemic antifungal treatment using mainly 5-flucytosine is also given.

Topics: Amphotericin B; Bezoars; Candidiasis; Humans; Infant, Newborn; Male; Nephrostomy, Percutaneous; Postoperative Complications; Ureteral Obstruction

We describe three severe clinic cases due to fungus balls of Candida albicans in hospitalized risky patients which presented a quickly clinical evolution. Because of their different local presentations medical and surgical management was needed. In the first case a intestinal fungus ball was found whereas in the other two cases were localized in the urinary tract. Here we present their clinical findings rather than their evolution after a medical and surgical management.

Topics: Adolescent; Amphotericin B; Candidiasis; Fluconazole; Humans; Infant; Infant, Newborn; Intestinal Obstruction; Jejunal Diseases; Kidney Diseases; Male; Ultrasonography; Ureteral Obstruction

Fungus balls have rarely been implicated as a cause of urinary tract obstruction. Approximately 50 cases of fungus balls of the urinary tract have been reported previously; the majority of cases were characterized by unilateral ureteral involvement or bladder involvement, and Candida albicans has been the organism most frequently isolated. We report, to our knowledge, the first case of bilateral ureteral obstruction caused by Candida tropicalis fungus balls.

Topics: Acute Kidney Injury; Amphotericin B; Candidiasis; Combined Modality Therapy; Humans; Male; Middle Aged; Nephrostomy, Percutaneous; Ureteral Obstruction

A case is presented of renal candidiasis complicated by obstructive uropathy in a 4 month old infant. Management was successful with surgical decompression combined with peri-operative amphotericin B, followed by 3 weeks of oral ketoconazole and subsequently 6 weeks of oral fluconazole. Fluconazole was substituted for ketoconazole owing to persistent candiduria, and achieved rapid urinary sterilization. Fluconazole is an effective and less toxic alternative to prolonged courses of amphotericin B in the treatment of neonatal renal candidiasis.

Topics: Amphotericin B; Candidiasis; Diagnostic Imaging; Drug Therapy, Combination; Fluconazole; Humans; Infant; Ketoconazole; Male; Pyelonephritis; Ureteral Obstruction

Unilateral renal obstruction secondary to fungus balls is described in a premature infant. Noninvasive medical management, which included amphotericin B and 5-flucytosine therapy and forced diuresis, resulted in disappearance of fungus balls and resolution of the obstruction.

Topics: Amphotericin B; Candidiasis; Diuresis; Flucytosine; Humans; Hydronephrosis; Infant, Newborn; Infant, Premature, Diseases; Kidney; Male; Ultrasonography; Ureteral Obstruction

The effect of ureteral obstruction on the course of renal candidiasis in a rat model was studied, using both normal and diabetic Sprague-Dawley rats, and a clinical isolate of Candida albicans. Diabetes was induced by streptozotocin injection 1 week prior to inoculation and transabdominal ligation of the left ureter. On day 9 post inoculation, mean titers of Candida were similar in right and left kidneys of obstructed rats. Mean left renal titers for obstructed and control rats were similar (log10 2.68 CFU/g +/- 0.73 (SE) vs. log10 2.21 +/- 0.09, P greater than 0.01). Diabetes produced higher renal titers of Candida, regardless of the presence of ureteral obstruction (log10 5.74 CFU/g +/- 0.57 (SE) vs. log10 2.21 +/- 0.09, P less than 0.01). Animals treated for one week with amphotericin B showed a marked difference in Candida titers between obstructed and control animals (log10 4.14 CFU/g +/- 0.45 (SE) vs. 1.57 +/- 0.38) for both kidneys, and between obstructed and nonobstructed kidneys in the same animals.

Topics: Amphotericin B; Animals; Candidiasis; Diabetes Mellitus, Experimental; Kidney Diseases; Male; Rats; Rats, Inbred Strains; Ureteral Obstruction

A low birth weight premature neonate with systemic candidiasis developed complete renal obstruction by fungus balls, diagnosed by ultrasonography. The neonate was treated with temporary urinary diversion, amphotericin B, 5-fluorocytosine and survived. This case emphasizes the need for a high index of suspicion of renal obstruction by fungus balls in neonates with systemic candidiasis when renal function deteriorates. In such cases early urinary diversion can be life-saving.

Topics: Amphotericin B; Anuria; Candidiasis; Drug Therapy, Combination; Flucytosine; Humans; Infant, Newborn; Male; Ultrasonography; Ureteral Obstruction; Urography

Topics: Adult; Amphotericin B; Candidiasis; Eye Diseases; Humans; Kidney Transplantation; Male; Postoperative Complications; Ureteral Obstruction

A sixteen day old infant developed candiduria after surgery on a single functioning, hydronephrotic kidney with ureteropelvic junction stenosis. Masses of candida albicans caused obstruction of the ureter with acute anuria. Endoscopic relief of the obstruction together with aggressive antifungal therapy led to irradication of the fungal infection. This case history emphasizes the fact that candida infection in early childhood should be evaluated carefully. Unfortunately no guidelines are yet available for the indications and the preferred mode of treatment, and length of therapy of infantile renal candidiasis.

Topics: Amphotericin B; Candidiasis; Flucytosine; Humans; Infant, Newborn; Kidney; Kidney Diseases; Male; Ureteral Obstruction

In a diabetic renal transplant recipient a nephrocutaneous fistula developed after percutaneous renal graft biopsy, and ureteral obstruction due to Candida albicans fungus balls was demonstrated. Local irrigation with amphotericin B, systemic antifungal therapy, and rigid blood sugar control led to rapid clearing of the fungal infections. This cause of renal transplant insufficiency should be considered prior to renal biopsy in diabetic patients with yeast forms in the urine.

Topics: Adult; Amphotericin B; Blood Glucose; Candidiasis; Diabetic Nephropathies; Female; Fistula; Graft Rejection; Humans; Kidney Diseases; Kidney Transplantation; Skin Diseases; Ureteral Diseases; Ureteral Obstruction; Urography

Fungal infections occurred in 3 of 22 renal transplants (13.6%). Two patients developed rhinocerebral phycomycosis, and Rhizopus arrhizus was isolated from cultures of the nasal conchae. Both patients were treated with systemic amphotericin B. Three-and-a-half months after transplantation the third patient developed an acute ureteral obstruction secondary to infection with Aspergillus nidulans; this necessitated removal of the graft. There was no immediate mortality associated with these fungal infections but there was immediate loss of the grafts in the two patients.

Topics: Adult; Amphotericin B; Aspergillus; Female; Humans; Kidney Transplantation; Male; Mycoses; Rhizopus; Transplantation, Homologous; Ureteral Obstruction

Candida in the urine or surgical wound is a potentially lethal pathogen. Management of 82 patients has provided a rationale for the treatment of these infections. Urine colony counts, serologic findings and clinical observations determine therapy. Amphotericin B irrigants are effective for local infections. Disseminated infections require flucytosine and/or intravenous amphotericin B.

Topics: Amphotericin B; Candida; Candidiasis; Flucytosine; Humans; Nystatin; Radiography; Ureter; Ureteral Obstruction; Urinary Tract Infections; Urine

A patient with a single functioning kidney and anuria due to ureteropelvic obstruction by a Candida fungus ball is described. During treatment with amphotericin B administered via a nephrostomy tube the drug was not detected in the serum, indicating that absorption from urothelium was not significant. Immunological studies demonstrated a lack of cell-mediated immunity which was probably brought about by a long course of prednisone and later restored when this drug was discontinued. This immunosuppression was evident even with a relatively small dosage of prednisone (5 mg daily). The literature concerning renal candidiasis and predisposing factors is reviewed.

Topics: Acute Kidney Injury; Amphotericin B; Candidiasis; Female; Humans; Immunity, Cellular; Immunosuppression Therapy; Middle Aged; Ureteral Obstruction