amphotericin-b and Weight-Loss

We report here the first case of disseminated Emmonsia pasteuriana infection in a patient with AIDS in India. The patient presented with weight loss, dyspnoea, left-sided chest pain and multiple non-tender skin lesions over face and body for 3 months. Disseminated emmonsiosis was diagnosed on microscopic examination and fungal culture of skin biopsy and needle aspirate of lung consolidation. It was confirmed by sequencing internal transcribed spacer region of rDNA, beta tubulin, actin, and intein PRP8. The patient responded to amphotericin B and itraconazole therapy.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Biopsy, Needle; Chest Pain; Chrysosporium; Diagnostic Errors; DNA, Fungal; DNA, Ribosomal; Dyspnea; Female; Humans; India; Itraconazole; Mycoses; Phylogeny; Weight Loss

We describe 16 HIV-infected patients with disseminated histoplasmosis (14 men, mean age 28 +/- 7.84 years), diagnosed at Hospital Eva Perón in Argentina during the period of October 1993 to July 2000. Disseminated histoplasmosis occurred in 5.3% of HIV-infected patients over the study period. The main symptoms included fever, weight loss and hepatosplenomegaly in 93.8%. Other relevant findings were respiratory compromise (56.3%), digestive symptoms (43.8%), mucocutaneous lesions (75%) and multiple lymphadenopathy (69%). Treatment consisted of amphotericin B 1 mg/kg/day up to a total dose of 1 g, followed by 400 mg/day of oral itraconazole. Mortality in the acute phase was 19% and 37.5% of patients relapsed.

Topics: Adolescent; Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Argentina; Female; Fever; Fluconazole; Hepatomegaly; Histoplasmosis; Humans; Itraconazole; Male; Recurrence; Respiration Disorders; Splenomegaly; Weight Loss

A 53-year-old man presented with a number of hospital admissions for investigation of fever of unknown origin. He became gradually weaker with significant weight loss, pancytopenia and progressive splenomegaly over a 6-month period of extensive investigation. This was undertaken at different NHS hospitals with involvement of multiple medical specialists. Clinical criteria for haemophagocytic lymphohistiocytosis were met. Following investigation, this was felt likely secondary to a low-grade lymphoma of the spleen, necessitating splenectomy for diagnostic and therapeutic purposes. Ultimately, this risky surgical procedure was avoided when positive

Topics: Amphotericin B; Antiprotozoal Agents; Diagnosis, Differential; Fever of Unknown Origin; Humans; Leishmaniasis, Visceral; Lymphohistiocytosis, Hemophagocytic; Male; Middle Aged; Pancytopenia; Splenomegaly; Treatment Outcome; Weight Loss

A wide differential diagnosis must be entertained in patients with unusual oral and pharyngeal ulcerations. A mucosal biopsy is essential. We retrospectively reviewed 10 cases from the Infectious Diseases Division at Mayo Clinic Rochester (MN, USA), in which the diagnosis proved to be Histoplasma capsulatum infection. Between 1995 and 2016, 10 patients were diagnosed with oropharyngeal histoplasmosis. Common presenting symptoms included weight loss, weakness and oropharyngeal pain with ulcerations. Despite specialty evaluation at other facilities, diagnostic delay occurred in six patients due to lack of biopsy or fungal staining. Yeast forms consistent with H. capsulatum were identified in the biopsy specimens of all our patients. Treatment included intravenous amphotericin B and prolonged courses of azoles. Oral histoplasmosis occurred in both immunocompetent and immunosuppressed patients, and was a manifestation of disseminated infection. Severe pain involving all areas of the mouth was typical. Diagnostic delay may be avoided by early biopsy using fungal stains.

Topics: Aged; Aged, 80 and over; Amphotericin B; Antifungal Agents; Biopsy; Complement Fixation Tests; Delayed Diagnosis; Female; Histoplasmosis; Humans; Immunocompromised Host; Male; Middle Aged; Oropharynx; Pharyngeal Diseases; Retrospective Studies; Smoking; Tongue; Weight Loss

Histoplasma microconidia when inhaled are presented in antigenic form to T cells, limiting the extent of infection; however, defects in cellular immunity results in disseminated disease. Chronic lymphocytic leukaemia (CLL) is a lymphoproliferative disorder resulting in functionally impaired lymphocytes, predisposing patients to various opportunistic infections. The author reports a recently treated patient with CLL presenting with constitutional symptoms accompanied by hepatosplenomegaly and diffuse adenopathy. Considering the recent diagnosis and treatment of CLL, initial suspicion was relapsed disease. However, considering the immune deficiency associated with CLL and its treatment, infectious aetiologies were strongly considered. Further investigation revealed a case of disseminated histoplasmosis mimicking CLL in this reported patient. Considering appropriate diagnosis and timely therapy, the reported patient had good prognosis despite being diagnosed with disseminated histoplasmosis. This case highlights consideration of disseminated histoplasmosis in patients presenting with diffuse adenopathy along with hepatomegaly and/or splenomegaly in the right clinical setting.

Topics: Aged; Amphotericin B; Antifungal Agents; Farmers; Fever; Hepatomegaly; Histoplasmosis; Humans; Itraconazole; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Opportunistic Infections; Radionuclide Imaging; Splenomegaly; Tomography, X-Ray Computed; Treatment Outcome; Urinalysis; Weight Loss

Topics: AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Colonoscopy; Dyspepsia; Endoscopy, Digestive System; Gastrointestinal Diseases; Histoplasma; Histoplasmosis; Humans; Male; Middle Aged; Tomography Scanners, X-Ray Computed; Weight Loss

A 59-year-old patient with multiple myeloma on maintenance chemotherapy presented with fever, weight loss, and night sweats. An F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) computed tomography (CT) showed intra-abdominal lymphadenopathy with a mesenteric mass that led to further workup and diagnosis of histoplamosis. The patient was treated with amphotericin B and subsequently switched to itraconazole. This exemplifies the usefulness of FDG PET CT in diagnosis of infectious complications.

Topics: Amphotericin B; Antifungal Agents; Antineoplastic Agents; beta-Glucans; Colonoscopy; Fever; Fluorodeoxyglucose F18; Gastrointestinal Diseases; Hematopoietic Stem Cell Transplantation; Histoplasma; Histoplasmosis; Humans; Ileum; Intestinal Obstruction; Itraconazole; Lymphadenopathy; Male; Middle Aged; Multiple Myeloma; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed; Weight Loss

Acute renal injury may occur after amphotericin B (AmB) administration. The hypothesized injury mechanism is renal vasoconstriction and direct toxic damage. Hyperbaric oxygen therapy (HBO) is indicated for treatment of many ischemic events but not for acute renal failure (ARF). The aim of this study was to investigate the role of HBO therapy in AmB induced ARF.. ARF was induced in 41 Sprague-Dawley rats by a single dose of 75 mg/kg AmB. The rats were randomly divided into two groups; one group was treated with daily HBO for 3 consecutive days. The control group received no HBO treatment. Parameters of renal function were taken on the 5th day after AmB administration.. Forty-one rats were treated with AmB, 21 received HBO and 20 served as controls. Body weight loss following the administration of AmB was 13.5+14.7% in the HBO treated rats, as opposed to 24.6+5% in the control group (P=0.004). Serum creatinine and urea were 0.49+0.13 mg/dL and 200.63+87.82 mg/dL in the treatment group and 0.70+0.22 mg/dL and 368.01+169.35 mg/dL, respectively in the control (P=0.001).. In this model of AmB-induced ARF, HBO treatment alleviated renal injury as reflected by changes in serum creatinine and urea levels.

Topics: Acute Kidney Injury; Amphotericin B; Animals; Anti-Bacterial Agents; Biomarkers; Creatinine; Disease Models, Animal; Hyperbaric Oxygenation; Kidney Function Tests; Random Allocation; Rats; Rats, Sprague-Dawley; Urea; Weight Loss

In Western French Guiana, there was a dramatic increase in HIV prevalence between 1990 and 2000. The present study describes the causes of fever among HIV patients hospitalized in the medical ward of the only hospital in the western part of French Guiana. A retrospective descriptive study was conducted between 1 January 2008 and 30 June 2010 in the department of medicine of Saint Laurent du Maroni Hospital. The main characteristics of 67 patients having presented with fever in the first 48 hours of hospitalization were described. Among patients with CD4 <200/mm(3)the main febrile opportunistic infection was disseminated histoplasmosis (41.1%). Among patients with CD4 counts <50/mm(3)and fever without focal points 85.7% had disseminated histoplasmosis. Three patients died and all had disseminated histoplasmosis. Disseminated histoplasmosis is the most common febrile opportunistic infection in western French Guiana. Primary prophylaxis with itraconazole among immunocompromised patients seems warranted.

Topics: Adolescent; Adult; Age Distribution; Aged; AIDS-Related Opportunistic Infections; Amphotericin B; CD4 Lymphocyte Count; Coinfection; Female; Fever; French Guiana; Histoplasma; Histoplasmosis; HIV Infections; Hospitalization; Humans; Immunocompromised Host; Itraconazole; Male; Middle Aged; Prevalence; Retrospective Studies; Sex Distribution; Weight Loss; Young Adult

Clinicians have usually considered malignancies during follow up of patients who have infectious diseases as a pre-diagnosis. However, malignancy and an infectious disease are seen together more rarely, with the exception of immunosuppressed patients. This presentation is a case report followed up for fever of unknown origin. The patient was admitted to the hospital with the symptoms of fever, weight loss, abdominal pain and weakness. Anemia and hypergamaglobulinemia by biochemical analyses and splenomegaly by total body computed tomography were detected. Amastigotes were seen in bone marrow aspiration smears and promastigotes were isolated in NNN medium. At the end of the Liposomal Amphotericin B treatment, control bone marrow aspiration was applied. Leishmania amastigotes were not seen, while patient was diagnosed as diffuse B cell lymphoma pathologically.

Topics: Abdominal Pain; Amphotericin B; Anemia; Anticestodal Agents; Bone Marrow; Female; Fever of Unknown Origin; Humans; Hypergammaglobulinemia; Leishmania; Leishmaniasis, Visceral; Lymphoma, Large B-Cell, Diffuse; Middle Aged; Splenomegaly; Tomography, X-Ray Computed; Weight Loss

Cases of visceral leishmaniasis (VL) in the course of human immunodeficiency virus (HIV) infection have regularly been recorded, mainly in southern Europe. HIV infection can increase the risk of VL development by 10-100 times in endemic areas. We describe the occurrence of this co-infection in 15 patients from Brazil. The mean age of the patients was 38 +/- 8.8 yr, with 86.6% males. The mean time between HIV diagnosis and the onset of visceral leishmaniasis was 44 +/- 39 mo. The main signs and symptoms presented at admission were splenomegaly (73%), weight loss (73%), cough (67%), fever (67%), asthenia (60%), and diarrhea (60%). The mean T CD4+ lymphocyte count was 173.7 +/- 225.6 cells/mm3, and viral load was 51,030 +/- 133,737/mm3. Treatment consisted of pentavalent antimonials (67% of cases). Most (87%) patients recovered from VL infection; death occurred in 1 patient due to septic shock. VL is an important opportunistic infection in HIV patients, which is potentially fatal, even when correct treatment is completed. Treatment should be done with pentavalent antimonials or amphotericin B in the case of relapse. Although there is no consensus, secondary prophylaxis should be considered in severe cases.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antiprotozoal Agents; Antiretroviral Therapy, Highly Active; Asthenia; Bone Marrow; Brazil; CD4 Lymphocyte Count; Cough; Diarrhea; Female; Fever; HIV Infections; Humans; Leishmaniasis, Visceral; Male; Meglumine; Meglumine Antimoniate; Middle Aged; Organometallic Compounds; Pancytopenia; Retrospective Studies; Splenomegaly; Time Factors; Weight Loss

Topics: Aged; Amphotericin B; Antifungal Agents; Biopsy; Bone Marrow; Diagnosis, Differential; Fatigue; Fever; Histoplasmosis; Humans; Male; Pancytopenia; Weight Loss

A voluminous trichobezoar was discovered in an 11-year-old girl without major clinical implications. The diagnosis was made by endoscopy and surgery was performed without complications.

Topics: Amphotericin B; Anemia, Hypochromic; Anti-Bacterial Agents; Bezoars; Child; Diagnosis, Differential; Female; Gastroscopy; Humans; Hypoalbuminemia; Madagascar; Stomach; Weight Loss

Histoplasma capsulatum (HC) infection is rare in India. We document a case of unilateral adrenal histoplasmosis in a 56 year male. The patient presented with hepatosplenomegaly, unilateral adrenal mass and significant weight loss. Since FNAC of adrenal mass was inconclusive, he underwent splenectomy, adrenalectomy and liver biopsy, histology of these specimens revealed HC only in adrenal mass. Subsequently, histoplasmin test was also performed which was also found to be positive. He responded well to parenteral amphotericin B and is under regular follow-up with no complaints now.

Topics: Adrenal Gland Diseases; Amphotericin B; Antifungal Agents; Diagnosis, Differential; Hepatomegaly; Histoplasmin; Histoplasmosis; Humans; India; Male; Middle Aged; Splenomegaly; Weight Loss

Two imported cases of Penicillium marneffei infection in Belgium are reported. Both patients are Thai women co-infected with HIV. P. marneffei infection should be suspected in immunocompromised patients originating or travelling from South-East Asia with unexplained fever (> 38 degrees C), weight loss, a generalised lymphadenopathy, hepatomegaly, splenomegaly, skin lesions, cough and anaemia. Diagnosis is made by culture and/or histopathological examination. Mild to moderate infections are treated with itraconazole 400 mg/day as first choice. Amphotericin B parenteral therapy may be required for seriously ill patients. Maintenance therapy with itraconazole 200 mg/day is necessary to prevent relapses.

Topics: Adult; AIDS-Related Opportunistic Infections; Amphotericin B; Antifungal Agents; Belgium; Dermatomycoses; Fatal Outcome; Female; Fever; Humans; Immunocompromised Host; Itraconazole; Lymphatic Diseases; Mycoses; Penicillium; Sepsis; Thailand; Travel; Weight Loss

Disseminated infection with Histoplasma capsulatum frequently involves the nervous system, but the CNS process is generally not clinically apparent. We report an unusual case of a renal transplant recipient with long-standing immunosuppression who presented with clinical evidence of mass lesions in both his cerebral cortex and his spinal cord. Findings of CSF examination were normal, but stereotaxic biopsies of his cortical lesions demonstrated yeast forms and cultures of biopsy specimens yielded H. capsulatum. Clinical defects referable to both the cortical and spinal lesions decreased in severity after the patient received antifungal therapy. Our case illustrates that disseminated histoplasmosis can present in myriad ways and that widespread disease in the CNS can be occult in immunocompromised patients.

Topics: Aged; Amphotericin B; Anorexia; Brain Diseases; Follow-Up Studies; Histoplasmosis; Humans; Immunocompromised Host; Kidney Transplantation; Magnetic Resonance Imaging; Male; Postoperative Complications; Spinal Cord Diseases; Weight Loss

A 40-year-old man with aortic stenosis and disseminated histoplasmosis did not respond to treatment with itraconazole. Though there was no haemodynamic deterioration, valvar regurgitation, or embolic phenomena a presumptive diagnosis of infective endocarditis was made. This was confirmed at aortic valve replacement. Antifungal treatment was continued for 18 months after valve replacement and serological tests for Histoplasma became progressively more negative during a three year follow up.

Topics: Adult; Amphotericin B; Aortic Valve; Aortic Valve Stenosis; Combined Modality Therapy; Deglutition Disorders; Endocarditis; Follow-Up Studies; Heart Valve Prosthesis; Histoplasmosis; Humans; Itraconazole; Male; Weight Loss