amphotericin-b and Vasculitis

The knowledge of central nervous system (CNS) histoplasmosis is limited to case reports and series.. Our objective was to synthesise clinical, radiological and laboratory characteristics of CNS histoplasmosis to improve our understanding of this rare disease.. We performed a systematic review using Pubmed/MEDLINE, Embase and LILACS databases accessed on March 2023 without publication date restrictions. Inclusion criteria comprised: (1) histopathological, microbiological, antigen or serological evidence of histoplasmosis; (2) CNS involvement based on cerebrospinal fluid pleocytosis or neuroimaging abnormalities. We classified the certainty of the diagnosis in proven (CNS microbiological and histopathological confirmation), probable (CNS serological and antigen confirmation) or possible (non-CNS evidence of histoplasmosis). Metaproportion was used to provide a summary measure with 95% confidence intervals for the clinical, radiological and laboratory characteristics. Chi-squared test was used to compare mortality between pairs of antifungal drugs.. We included 108 studies with 298 patients. The median age was 31 years, predominantly male, and only 23% were immunocompromised (134/276, 95%CI: 3-71), mainly due to HIV infection. The most common CNS symptom was headache (130/236, 55%, 95%CI: 49-61), with a duration predominantly of weeks or months. Radiological presentation included histoplasmoma (79/185, 34%, 95%CI: 14-61), meningitis (29/185, 14%, 95%CI: 7-25), hydrocephalus (41/185, 37%, 95%CI: 7-83) and vasculitis (18/185, 6%, 95%CI: 1-22). There were 124 proven cases, 112 probable cases and 40 possible cases. The majority of patients presented positive results in CNS pathology (90%), serology (CSF: 72%; serum: 70%) or CSF antigen (74%). Mortality was high (28%, 56/198), but lower in patients who used liposomal amphotericin B and itraconazole. Relapse occurred in 13% (23/179), particularly in HIV patients, but less frequently in patients who used itraconazole.. Central nervous system histoplasmosis usually presents subacute-to-chronic symptoms in young adults. Neuroimaging patterns included not only focal lesions but also hydrocephalus, meningitis and vasculitis. Positive results were commonly found in CSF antigen and serology. Mortality was high, and treatment with liposomal amphotericin B followed by itraconazole may decrease mortality.

Topics: Adult; Antifungal Agents; Central Nervous System; Female; Histoplasmosis; HIV Infections; Humans; Hydrocephalus; Itraconazole; Male; Meningitis; Vasculitis; Young Adult

Coccidioidal meningitis affects between 200 to 300 persons annually within the endemic area of the United States, with much larger numbers expected in epidemic years. Because this represents a chronic disease for survivors, several thousand patients may be under treatment at any given time. Epidemiology, background, and diagnosis are reviewed. Azole therapy has replaced intrathecal amphotericin B for induction and maintenance therapy for this disease, given its ease of administration and equivalent efficacy in controlling infection even at the cost of losing the opportunity for cure. Both itraconazole and fluconazole have demonstrated efficacy, but have not been compared in randomized human studies. One of the uses of intrathecal amphotericin B is as "add on" therapy in failing azole regimens without evidence of antagonism. Details of therapeutic approach are reviewed. Approach to diagnosis and management of the two principal potentially life threatening complications, hydrocephalus and vasculitis, is also discussed.

Topics: Amphotericin B; Antifungal Agents; Coccidioidomycosis; Comorbidity; Fluconazole; Humans; Hydrocephalus; Itraconazole; Meningitis, Fungal; Treatment Outcome; Vasculitis

Topics: Acute Kidney Injury; Amphotericin B; Anti-Bacterial Agents; Cephalosporins; Glomerulonephritis; Humans; Kidney Diseases; Nephritis, Interstitial; Penicillins; Polymyxins; Tetracyclines; Vasculitis

A 37-year-old female patient was diagnosed with ulcerative colitis 8 months ago and medical treatment with oral azathioprine, low-dose corticosteroids and 5-ASA was started. Following 3 months without any symptoms, the patient had total colectomy and ileostomy. After this period, liposomal amphotericin B (3 mg kg(-1) day(-1)) was given with the diagnosis of probable fungal infection. Palpable purpuric skin lesions on the anterior surface of both legs appeared on the 55th day of amphotericin B treatment. Histological examination of a skin biopsy was consistent with leucocytoclastic vasculitis. We present a case of cutaneous leucocytoclastic vasculitis in which amphotericin B might presumably be the aetiological factor.

Topics: Adult; Amphotericin B; Biopsy; Female; Humans; Mycoses; Skin Diseases; Vasculitis

Topics: Abducens Nerve; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Fatal Outcome; Flucytosine; Humans; Ischemia; Male; Meningitis, Cryptococcal; Oculomotor Nerve; Oculomotor Nerve Diseases; Pulmonary Embolism; Vasculitis

Candida kruzei-related systemic infections are increasing in frequency, particularly in patients receiving prophylaxis with antifungal triazoles. A Caucasian male with newly diagnosed acute myeloid leukaemia (AML M1) developed severe and persistent fever associated with a micropustular eruption scattered over the trunk and limbs during induction chemotherapy. Blood cultures grew Candida kruzei, and biopsies of the skin lesions revealed a candida vasculitis. He responded to high doses of liposomal amphotericin B and was discharged well from hospital.

Topics: Acute Disease; Amphotericin B; Antifungal Agents; Candidiasis; Drug Carriers; Humans; Leukemia, Myeloid; Liposomes; Male; Middle Aged; Triazoles; Vasculitis

We studied a case in which a patient had unilateral retinal infiltrates and a retinal vasculopathy resembling frosted branch angiitis. He later admitted to injecting cocaine intravenously.. The patient underwent a pars plana vitrectomy and received intravitreal and intravenous amphotericin B.. The vitreous fluid grew Fusarium dimerium. There was rapid response to the treatment and full recovery of vision.. Fusarium species should be considered as a potential pathogen in intravenous drug abusers with endogenous endophthalmitis and in patients with unilateral frosted branch angiitis.

Topics: Adult; Amphotericin B; Antifungal Agents; Cocaine; Endophthalmitis; Eye Infections, Fungal; Fluorescein Angiography; Fundus Oculi; Fusarium; Humans; Male; Mycoses; Substance Abuse, Intravenous; Vasculitis; Vitrectomy; Vitreous Body