amphotericin-b and Vaginitis

Emergence of resistance to triazoles and amphotericin B in Candida glabrata vaginal isolates is documented by Etest. During the 18-month follow-up of a case of vaginitis, 14 consecutive isolates of C. glabrata were examined. The isolates exhibited development of in vitro resistance beginning with itraconazole (>32 microg/ml), followed by fluconazole (>256 microg/ml), amphotericin B (>32 microg/ml), and voriconazole (>32 microg/ml). The DNA sequence analyses and finger printing of the isolates strongly suggest that our patient remained colonized with a single strain. The report underscores the propensity of C. glabrata to acquire resistance during antifungal therapy and the importance of susceptibility testing in the management of infections caused by this species.

Topics: Amphotericin B; Antifungal Agents; Candida glabrata; DNA Fingerprinting; DNA, Fungal; Drug Resistance, Fungal; Female; Humans; Recurrence; Sequence Analysis, DNA; Triazoles; Vaginitis

In this study the molecular identification and susceptibility profile of 21 clinical isolates, from a Brazilian hospital, belongs to six different species of Trichosporon were described. Trichosporon asahii was the predominant species and corresponded to 43% of isolates. Eighty three percent of the strains isolated from deep sites were identified as T. asahii, while only 17% belong to a non-T. asahii species (Trichosporon inkin). In general, the MICs were high and independent of the species of Trichosporon as well as the clinical origin of strain. Amphotericin B and fluconazole were less effective against Trichosporon spp. and high MIC values of voriconazole, posaconazole and ravuconazole were observed. Fifty-six percent (5/9) of T. asahii strains were isolated from deep sites, whereas 8% (1/12) of non-T. asahii species were isolated from those sites. A total of 89% of T. asahii isolates exhibited resistance to amphotericin B in vitro.

Topics: Amphotericin B; Antifungal Agents; Brazil; Cross Infection; Dermatomycoses; Drug Resistance, Fungal; Echinocandins; Female; Flucytosine; Fungemia; Hospitals, University; Humans; Mycological Typing Techniques; Mycoses; Onychomycosis; Opportunistic Infections; Organ Specificity; Triazoles; Trichosporon; Urine; Vaginitis

Although Zygomycetes cause life-threatening, opportunistic infections in immunocompromised hosts, the first case of vaginitis caused by Mucor species in a healthy woman is reported. Mucor vaginitis, which caused mild symptoms only, was refractory to conventional azole therapy and resistant to flucytosine. Cure was achieved with topical amphotericin B.

Topics: Amphotericin B; Antifungal Agents; Female; Humans; Middle Aged; Mucor; Mucormycosis; Vaginitis

The chronically recidivist vulvo-vaginal candidiasis is one of the most stubborn problematic diagnosis in the dermatology and gynaecology ward. Prognosis and therapy are primarily determined by the causative micro-organism and the interaction of the fungal species with the currently available antifungal agents. Objective of the study was the investigation of vaginal yeast isolates from patients with chronically recidivist vaginal candidiasis against 8 antifungal agents with the aim of optimising the standard therapy with azole antifungal agents and assessment of alternative therapy schemes. 55 clinical isolates (Dermatology, Charité) of 40 patients were tested by microdilution according to DIN 58940-84. Species differentiation and identification was performed by Fourier-Transform Infrared Spectroscopy (FTIR). In the result Candida glabrata was the predominant causative agent for the recidivist vaginal candidiasis. MIC-mode values for C. glabrata were: fluconacole 32 micrograms/ml, itraconacole 1 microgram/ml, ketoconacole 1 microgram/ml, amphotericine B, voriconacole 0.03 microgram/ml, amphotericin B 0.5 microgram/ml, terbinafine 128 micrograms/ml, cicloproxolamine 4 micrograms/ml, 5-fluorocytosine 0.03 microgram/ml. Some strains of Patients with suboptimal introductory low doses of fluconacole showed increasing of MIC in course of therapy. Parallel resistance with itraconacole was observed in all these cases. Consecutively isolated strains could be clearly and reliably identified by FTIR. In conclusion of most importance is the initial dose adapatation of the drug used, e.g. for fluconacole 800/d p.o., when C. glabrata is the causative agent. Low dose fluconacole therapy is always unsuccessful in recurrent vaginal candidiasis and induces secondary resistance. Demonstrated high susceptibility of voriconacole, amphotericine B an 5-fluorocytosine particularly for C. glabrata may indicate of an anitmycotic therapy potential unconsidered regarding to dermatological indication up to now.

Topics: Amphotericin B; Antifungal Agents; Candida; Candidiasis; Chronic Disease; Ciclopirox; Female; Fluconazole; Flucytosine; Humans; Itraconazole; Microbial Sensitivity Tests; Naphthalenes; Pyridones; Pyrimidines; Terbinafine; Triazoles; Vaginitis; Voriconazole

In a woman of 26, who suffered from a vulvovaginal infection and had previously been treated for Candida vaginitis, Saccharomyces cerevisiae was cultured and identified. At her work she sold baking yeast. Topical treatment with amphotericin B 100 mg suppositories was successful. Microscopic examination (1000 x) of the discharge in saline showed haloed yeast cells. For treatment, oral ketoconazole or topical administration of amphotericin B or clotrimazole, in relatively high doses, may be applied. This yeast might be the cause of 'chronic candidiasis' more often than suspected, notably in women working in a bakery or a brewery.

Topics: Adult; Amphotericin B; Candidiasis, Vulvovaginal; Diagnosis, Differential; Female; Humans; Occupational Diseases; Saccharomyces cerevisiae; Vaginitis

Purpuromycin and its semi-synthetic derivative MDL 63,604 had in-vitro activity similar to that of amphotericin B against isolates of Candida albicans. MDL 63,604 had activity similar to that of metronidazole against Trichomonas vaginalis. Both compounds were very active against most species of Gram-positive and Gram-negative anaerobes and against Gardnerella vaginalis. MDL 63,604 had significantly lower MICs than purpuromycin against T. vaginalis and most of the bacteria, probably due to antagonism of purpuromycin's activity by medium supplements (blood or serum). Purpuromycin or related compounds may have a potential role in the topical treatment of vaginitis and vaginosis.

Topics: Amphotericin B; Animals; Antifungal Agents; Candida albicans; Female; Gardnerella vaginalis; Gram-Negative Bacteria; Gram-Positive Bacteria; Microbial Sensitivity Tests; Naphthoquinones; Spiro Compounds; Trichomonas vaginalis; Vaginitis; Vaginosis, Bacterial

Although numerous antimycotic agents are available for the treatment of yeast vaginitis there is little comparative data on the in vitro activity of these drugs. In the present two-part study, in vitro macro-broth dilution sensitivity tests were performed on a total of 377 clinical vaginal yeast isolates of nine different species. Antimycotics surveyed included amphotericin B, 5-fluorocytosine and eight azole derivatives. Results show that all vaginal Candida albicans isolates were uniformly sensitive at low concentration to all 10 antimycotics tested. However, non-albicans species, especially Candida glabrata and Saccharomyces cerevisiae, manifested several-fold increases in minimal inhibitory concentrations to all azoles tested except butoconazole. In particular, the in vitro potency of fluconazole and terconazole against species other than C. albicans was relatively poor, whereas the drugs demonstrating the best activity were itraconazole, butoconazole and saperconazole. Susceptibility testing of vaginal C. albicans isolates is not routinely indicated, even in patients with recurrent vaginitis and should be reserved for selected organisms, especially non-albicans species, in patients with clinical failure only.

Topics: Amphotericin B; Antifungal Agents; Azoles; Candida; Candida albicans; Candidiasis, Vulvovaginal; Female; Flucytosine; Humans; Incidence; Microbial Sensitivity Tests; Mycoses; Prevalence; Saccharomyces cerevisiae; Vaginitis

Topics: Adolescent; Adult; Amphotericin B; Bacterial Infections; Candidiasis, Vulvovaginal; Drug Combinations; Female; Genital Diseases, Female; Humans; Middle Aged; Pelvic Inflammatory Disease; Suppositories; Tetracycline; Vaginitis

Topics: Amphotericin B; Drug Combinations; Female; Humans; Mycoplasma Infections; Tetracycline; Vaginitis

The minimal inhibition concentration of Tetracycline was tested in 177 strains of gram positive and gram negative species of bacteria from the vagina which were found to be resistant to Tetracycline in the Agardiffusion Test. 170 of the 177 strains (96%) were inhibited with a Tetracycline concentration of 512 microgram/ml. Six Klebsiella-enterobacter strains and one proteus morgaini strain needed a minimal inhibition concentration of 1024 microgram/ml. For a successful local treatment of vaginitis by Tetracycline against species highly resistant to Tetracycline local Tetracycline levels of 1000 microgram/ml or better have to be obtained. Concomitant preventive treatment of fungi for instance, with amphotericin containing drugs such as mysteclin is indicated.

Topics: Amphotericin B; Candidiasis, Vulvovaginal; Drug Resistance, Microbial; Drug Therapy, Combination; Female; Humans; Tetracycline; Vaginitis

Topics: Administration, Oral; Administration, Topical; Amphotericin B; Animals; Antifungal Agents; Candida; Candida albicans; Candidiasis; Cricetinae; Drug Evaluation, Preclinical; Female; Guinea Pigs; Hexachlorophene; Mice; Natamycin; Nystatin; Rats; Tetracycline; Trichomonas Infections; Trichomonas vaginalis; Trichomonas Vaginitis; Vaginitis

Topics: Adolescent; Adult; Aged; Amphotericin B; Candida albicans; Candidiasis; Child; Child, Preschool; Endocarditis; Esophagitis; Female; Humans; Laryngitis; Male; Meningitis; Middle Aged; Pneumonia; Stomatitis; Vaginitis

Topics: Amphotericin B; Drug Synergism; Female; Humans; Tetracycline; Vaginitis

Topics: Age Factors; Aged; Amphotericin B; Complement Fixation Tests; Female; Histoplasmosis; Humans; Joint Diseases; Knee Joint; Skin Tests; Vaginitis

Topics: Amphotericin B; Anti-Bacterial Agents; Female; Humans; Protein Synthesis Inhibitors; Tetracycline; Trichomonas Vaginitis; Vaginitis; Vulvovaginitis

Topics: Amphotericin B; Candidiasis, Vulvovaginal; Female; Humans; Protein Synthesis Inhibitors; Tetracycline; Trichomonas Vaginitis; Vaginitis; Vulvovaginitis