nystatin-a1 and Aspergillosis

Fungemia is a serious problem within neonatal intensive care units around the world. Premature infants are at high risk for this complication, which is often fatal. Prophylaxis for invasive fungal infection has been practiced worldwide in different settings and with various patient groups. Both oral and intravenous drugs have been used with some success. In the population of preterm infants, oral nystatin, intravenous fluconazole, and intravenous amphotericin B have all been cited as possible drugs for prophylactic use. Intravenous fluconazole has emerged as the best choice for chemoprophylaxis in premature infants.

Topics: Administration, Intravenous; Administration, Oral; Amphotericin B; Antifungal Agents; Aspergillosis; Candidemia; Fluconazole; Fungemia; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Malassezia; Nystatin; Zygomycosis

RISING INCIDENCE: In the past two decades, systemic fungal infections, essentially invasive candidiasis, but also invasive aspergillosis, has increased substantially. Despite the currently available antifungal drugs, amphotericin B (AmB), azole compounds (fluconazole or FLU, itraconazole or ITR), these infections are associated with significant morbidity and mortality. AmB remains the drug of choice for treatment of most fungal diseases because of its broad spectrum and potent fungicidal activity, but significant side effects limit its clinical utility. The azole antifungal agents are easier to take, less toxic than AmB, but their use is limited by multiazole-resistant strains. NEW ANTIFUNGAL AGENTS: Lipid formulations have recently attracted much attention due to a significantly lower toxicity: this concerns lipid formulations of AmB and perhaps nystatin in the future. New triazoles (voriconazole, ravuconazole, posaconazole) have shown a wide spectrum of action including against azole-resistant isolates. A new class of antifungal agents, lipopeptides (MK-0991, LY303366, FK463), with an original mechanism of action are being developed. These new compounds are reported to possess a large fungicidal activity against most isolates including AmB and azole-resistant strains.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Drug Resistance, Microbial; Humans; Immunocompromised Host; Incidence; Nystatin; Risk Factors; Triazoles

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Bone Marrow Transplantation; Candidiasis; Candidiasis, Chronic Mucocutaneous; Clinical Trials as Topic; Cryptococcosis; Double-Blind Method; Fluconazole; Humans; Itraconazole; Ketoconazole; Mucormycosis; Mycoses; Neutropenia; Nystatin; Primary Prevention; Recurrence; Retrospective Studies

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Blastomycosis; Candicidin; Candidiasis; Coccidioidomycosis; Colistin; Cryptococcosis; Dermatomycoses; Drug Resistance, Microbial; Emetine; Flucytosine; Griseofulvin; Histoplasmosis; Humans; Imidazoles; Minocycline; Natamycin; Nystatin; Polyenes; Tolnaftate

Topics: Actinomycosis; Adolescent; Adult; Amphotericin B; Animals; Aspergillosis; Basidiomycota; Blastomycosis; Candidiasis; Cephalosporins; Child; Chromoblastomycosis; Coccidioidomycosis; Conjunctiva; Cryptococcosis; Drug Synergism; Eye Diseases; Female; Fungi; Geotrichosis; Guinea Pigs; Histoplasmosis; Humans; Male; Mucor; Mycetoma; Mycoses; Natamycin; Nystatin; Penicillium; Pityriasis; Rabbits; Rhinosporidiosis; Sporotrichosis; Tinea

Topics: Actinomycosis; Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Candidiasis; Cryptococcosis; Griseofulvin; Histoplasmosis; Humans; Nystatin; Penicillins

Topics: Actinomycosis; Amphotericin B; Anti-Bacterial Agents; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Cryptococcosis; Griseofulvin; Histoplasmosis; Humans; Iodides; Mucormycosis; Mycoses; Nocardia Infections; Nystatin; Penicillins; Sporotrichosis; Stilbamidines; Sulfadiazine; Surgical Procedures, Operative; Toxicology

To compare the efficacy and adverse effects of triamcinolone acetonide econazole cream and nystatin suspension in the treatment of otomycosis, and to determine the clinical features, predisposing factors, and etiology of otomycosis.. A prospective study.. A prospective clinical trial was conducted on 786 patients diagnosed with otomycosis. The study population was randomly divided into two treatment groups of triamcinolone acetonide econazole cream (TAEC) and nystatin suspension in a 1:1 ratio. After clearing all fungal deposits in the external auditory canal, the antimycotic drugs were locally applied for at least 2 weeks. The efficacy and adverse effects were compared between the two antifungal reagents by statistical analysis. Meanwhile, patient clinical data were collected to find out the clinical features, predisposing factors, and etiology.. Pruritis was the most common symptom and Aspergillus niger was the leading fungal pathogen. There was high association (44.5%) of otomycosis with a history of unclean ear picking. The cure rate was 97.6% in the TAEC group and 73.5% in the nystatin group (P < .01). Treatment with TAEC resulted in 2.4% of patients complaining of discomforts (irritant dermatitis, otalgia, or headache) versus 59.8% of patients complaining discomforts treated with nystatin (P < .01). The residue rate of antifungals was 1.9% in the TAEC group and 89.9% in the nystatin group (P < .01) at the end of treatment.. Thoroughly cleaning of the external auditory canal followed by local use of TAEC under endotoscope is an effective, convenient, and well-tolerated treatment for otomycosis.. 1 Laryngoscope, 131:E1640-E1646, 2021.

Topics: Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Antifungal Agents; Aspergillosis; Aspergillus niger; Child; Child, Preschool; Dermatitis, Irritant; Drug Combinations; Ear Canal; Earache; Econazole; Female; Headache; Humans; Infant; Male; Middle Aged; Nystatin; Otomycosis; Prospective Studies; Suspensions; Treatment Outcome; Triamcinolone Acetonide; Young Adult

We assessed the activity and safety of liposomal nystatin, a broad-spectrum antifungal agent, for invasive aspergillosis in patients refractory to or intolerant of amphotericin B. Thirty-three patients were enrolled, received at least one dose of the study drug, and were evaluable for safety. Twenty-six patients had confirmed probable or definite aspergillosis and were fully eligible. Most patients had a hematological malignancy (53.8%) or hematopoietic stem cell transplantation (23.0%), were neutropenic (61.5%), and were refractory to previous amphotericin B (92.3%). The median duration of previous amphotericin B treatment was 16.5 days (range, 5 to 64 days). Aspergillosis was definite in 3 cases and probable in 23 cases. Liposomal nystatin was initiated at a dose of 4 mg/kg of body weight/day. Twenty-five patients were evaluable for response: a complete response was achieved for one patient, and a partial response was achieved for six. Thus, the overall response rate is 7 of 25 (28%; 95% confidence interval, 12 to 49%). Seventeen (68.0%) of the 25 evaluable patients died during therapy or within 1 month after the end of therapy. The primary cause of death was invasive aspergillosis for nine patients and underlying malignancy for eight patients. The most frequent side effects included chills, shivering, and fever, leading to discontinuation of therapy for two patients. Grade 1 decline in renal function was seen for 10 (30.3%) patients, and hypokalemia was seen for 13 (39.4%). We conclude that liposomal nystatin can be effective for salvage therapy of invasive aspergillosis. Infusion-related adverse events have been observed frequently.

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Cause of Death; Child; Drug Resistance, Fungal; Female; Follow-Up Studies; Humans; Liposomes; Male; Middle Aged; Neutropenia; Nystatin; Salvage Therapy; Survival; Treatment Outcome

The prevention of fungal infections in granulocytopenic patients seems necessary to improve the final outcome of neoplastic patients. In particular, aspergillosis and candidiasis represent common life-threatening infections among the patients with acute hematological malignancies. Despite extensive investigations during this last decade, the optimal approaches to prevent these complications are still controversial. This situation probably reflects and stresses the numerous factors which predispose to these opportunistic fungal infections. Therefore, the effective prophylaxis of candidiasis and aspergillosis should result from the use of basic and specific approaches. General and simple measures including well trained personnel (physicians, nurses but also individuals in charge of the housekeeping, etc.), careful patient teaching of personal hygiene and control of the food intake (limited to cooked food diet), will reduce the acquisition of potential fungal pathogens. Moreover, the isolation in a laminar air flow room seems to be the optimal specific technique to prevent the colonization as well as the development of pulmonary aspergillosis. The meticulous evaluation of the respiratory sinus status as well as surveillance cultures obtained from the nose have been shown to be helpful to predict patients at high risks. Until now, there is no systemic chemoprophylaxis available to decrease the incidence of invasive aspergillosis. However, the topical application of antifungal agent using nasal spray or aerosols should be further investigated. Exogenous candidiasis such as catheter or TPN products related yeast infections can be avoided by aseptic manipulations. Endogenous candidiasis, resulting from the dissemination of the yeasts from the gastro-intestinal tract (which represents the major reservoir), are still much more difficult to prevent.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Agranulocytosis; Amphotericin B; Aspergillosis; Candidiasis; Clinical Trials as Topic; Humans; Ketoconazole; Neoplasms; Neutropenia; Nystatin; Patient Isolation

Black aspergilli (section Nigri) are predominate etiologic agents of otomycosis, however, there is controversy in the exact differentiation of species. For several decades Aspergillus niger is considered the main otomycosis etiologic agent. Recently calmodulin gene has been accepted as a more suitable gene for the accurate assignment of Aspergillus species. Therefore, it is found that A. welwitschiae and A. tubingensis are the main otomycosis agents based on calmodulin gene sequencing.. The objective of the study was to isolate and identify black aspergilli from otomycosis using the calmodulin gene and their susceptibility was evaluated against several antifungals.. 134 clinically confirmed patients with otomycosis were sampled and specimens were cultured on Sabouraud dextrose agar (SDA) at ambient temperature. Black aspergilli were screened based on colony morphology on SDA and microscopy features and then subjected to sequencing using calmodulin primers. Moreover, antifungal susceptibility for isolates was applied based on CLSI M38 3rd edition.. 132 (98.5%) of patients had positive cultures for different species of molds or yeasts. Most of the patients (30.3%) ranged from 31 to 40 years, and 56.1% of them were female. Aspergillus section Nigri was the most prevalent fungal pathogen and of 86 isolates, 60.5% isolates were identified as A. welwitschiae, A. tubingensis, 31 (36.0%), A. niger (sensu stricto), 2 (2.3%), and A. neoniger 1 (1.2%). According to the maximum likelihood method, all isolates of A. tubingensis and one isolate of A. neoniger were included in the A. tubingensis clade. On the other hand, the clade of A. niger/A. welwitschiae contains, all isolates of A. welwitschiae, two A. niger (sensu stricto) isolates, and 36 isolates from other countries. Aspergillus welwitschiae was more sensitive to luliconazole, voriconazole, and amphotericin B compared to A. tubingensis. 78.8% of A. welwitschiae strains were classified as non-wild type to nystatin compared to 35.5% of A. tubingensis. Moreover, 3.2% of A. tubingensis strains were non-wild type against amphotericin B. The isolates of A. tubingensis were more sensitive to itraconazole than A. welwitschiae.. It is concluded that in contrast, to the previous study A. welwitschiae from section Nigri is the most causative agent of otomycosis followed by A. tubingensis. In addition, the isolates of A. welwitschiae were more sensitive to luliconazole, voriconazole, and amphotericin B compared to A. tubingensis. Whereas, the isolates of A. tubingensis were more sensitive to itraconazole than A. welwitschiae. On the other hand, 78.8% and 35.5% of A. welwitschiae and A. tubingensis strains were classified as a non-wild type against nystatin. Also, 3.2% of A. tubingensis strains were non-wild type against amphotericin B. All A. welwitschiae were included in the A. niger/A. welwitschiae clade, associated with different clinical and environmental species from different countries.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus niger; Calmodulin; Female; Humans; Iran; Itraconazole; Male; Microbial Sensitivity Tests; Nystatin; Otomycosis; Voriconazole

Aspergillus niger is the most commonly reported etiology of otomycosis based on morphological characteristics. This fungus is a member of Aspergillus section Nigri, a set of morphologically indistinguishable species that can harbor various antifungal susceptibility patterns. The aim of this study was to accurately identify and determine the susceptibility pattern of a set of black aspergilli isolated from otomycosis patients.. Forty-three black Aspergillus isolates from otomycosis patients were identified by using the PCR-sequencing of the β-tubulin gene. Furthermore, the susceptibility of isolates to three antifungal drugs, including fluconazole (FLU), clotrimazole (CLT) and nystatin (NS), were tested according to CLSI M38-A2. The data were analyzed using the SPSS software (version 15).. The majority of isolates were identified as A. tubingensis (32/43, 74.42%) followed by A. niger (11/43, 25.58%). The lowest minimum inhibitory concentration (MIC) values were observed for NS with geometric means (GM) of 4.65μg/mL and 4.83μg/mL against A. tubingensis and A. niger isolates, respectively. CLT showed wide MIC ranges and a statistically significant inter-species difference was observed between A. tubingensis and A. niger isolates (P<0.05). FLU was inactive against both species with GMs>64μg/mL.. Species other than A. niger can be more frequent as observed in our study. In addition, considering the low and variable activity of tested antifungal drugs, empirical treatment can result in treatment failure. Accurate identification and antifungal susceptibility testing of isolates is, however, recommended.

Topics: Adolescent; Adult; Aged; Antifungal Agents; Aspergillosis; Aspergillus niger; Clotrimazole; Female; Fluconazole; Fungal Proteins; Humans; Iran; Male; Microbial Sensitivity Tests; Middle Aged; Nystatin; Otomycosis; Phylogeny; Polymerase Chain Reaction; Tubulin; Young Adult

Fungal otitis (otomycosis) is a common infection encountered by otolaryngologists. Nevertheless, its management can be challenging because of its high recurrence rate and of the limited therapeutic options. A 45-year-old woman suffered from recurrent otomycosis. The ineffectiveness of successive antibiotic cures and repeated topical treatments with nystatin and then with econazole cream led to perform microbiological analyses. Culture of ear swab grew Aspergillus niger. The use of a 1% voriconazole sterile solution previously validated for treatment of eye infections was considered after ensuring the absence of known ototoxic effects of the antifungal and of the excipients. The patient was advised to apply locally this voriconazole solution daily for 14 days (3 drops, 3-4 times a day). Full recovery was obtained at the end of the treatment, and no relevant side effects were noticed. More than one year after completion of therapy, there was no recurrence. Our observation shows that voriconazole 1% solution is an interesting option for treating otomycosis which failed to respond to usual therapeutic options. Further prospective studies are now warranted to confirm these findings.

Topics: Administration, Topical; Antifungal Agents; Aspergillosis; Aspergillus niger; Cerumen; Female; Humans; Middle Aged; Nystatin; Otomycosis; Prospective Studies; Treatment Outcome; Voriconazole

Nystatin (NYS) is a polyene macrolide with broad antifungal spectrum restricted to topical use owing to its toxicity upon systemic administration. The aims of this work were the design, development, and optimization of NYS-loaded lipid emulsion for intravenous administration. A closed circuit system was designed to apply ultrasound during the elaboration of the lipid intravenous emulsions (LIEs). Additionally, a comparison with the commercially available Intralipid(®) 20% was also performed. Manufacturing conditions were optimized by factorial design. Formulations were evaluated in terms of physicochemical parameters, stability, release profile, and antimicrobial activity. The average droplet size, polydispersity index, zeta-potential, pH, and volume distribution values ranged between 192.5 and 143.0 nm, 0.170 and 0.135, -46 and -44 mV, 7.11 and 7.53, 580 and 670 nm, respectively. The selected NYS-loaded LIE (NYS-LIE54) consisted of soybean oil (30%), soybean lecithin (2%), solutol HS(®) 15 (4%), and glycerol (2.25%) was stable for at least 60 days. In vitro drug release studies of this formulation suggested a sustained-release profile. Equally, NYS-LIE54 showed the best antimicrobial activity being higher than the free drug. Thus, it could be a promising drug delivery system to treat systemic fungal infections.

Topics: Antifungal Agents; Aspergillosis; Aspergillus; Candida albicans; Candidiasis; Delayed-Action Preparations; Emulsions; Glycerol; Humans; Injections, Intravenous; Nystatin; Phospholipids; Polyethylene Glycols; Soybean Oil; Stearic Acids

Topics: Accidents, Traffic; Adult; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Female; Humans; Multiple Trauma; Nystatin; Powders; Surgical Wound Infection

Omiganan, a bactericidal and fungicidal cationic peptide being developed as a topical gel for prevention of catheter-associated infections, inhibited commonly occurring fungal pathogens including Candida spp. (106 isolates) at

Topics: Antifungal Agents; Antimicrobial Cationic Peptides; Aspergillosis; Aspergillus; Candida; Candidiasis; Catheterization, Central Venous; Dose-Response Relationship, Drug; Drug Resistance, Fungal; Fungemia; Fungi; Humans; Microbial Sensitivity Tests

Present study was performed to evaluate the efficacy, toxicity and pharmacokinetics of antifungal drug nystatin incorporated in immunomodulator tuftsin-bearing liposomes. In vitro toxicity of free nystatin and nystatin incorporated in tuftsin-free or tuftsin-loaded liposomes was assessed by incubation of nystatin formulations with human erythrocytes. The toxicity profile of free nystatin and liposomal formulations of nystatin with or without tuftsin was also analyzed by monitoring the level of blood urea nitrogen (BUN) and serum creatinine in the treated BALB/c mice. The results of the present work showed that tuftsin-loaded nystatin liposomes like conventional nystatin liposomes exerted less toxicity to human erythrocytes as compared with free nystatin. Moreover, mice treated with tuftsin-loaded nystatin liposomes showed insignificant elevation in the biochemical values of serum creatinine and blood urea. The stability of nystatin liposomes upon incorporation of tuftsin was evaluated by monitoring the leakage of the entrapped drug in human serum. Tuftsin-loaded liposomes held nystatin for longer duration in the presence of serum than identical nystatin liposomes without tuftsin. Pharmacokinetics of the both tuftsin-free or tuftsin-loaded liposomal formulations nystatin was analyzed by determining the level of nystatin in the systemic circulation of mice at different time points. Mice injected with tuftsin-loaded nystatin liposomes showed higher level of the drug in the systemic circulation compared with those treated with conventional nystatin liposomes. The efficacy of tuftsin-loaded nystatin liposomes against A. fumigatus was evaluated by assessing the fungal burden in the lungs of treated mice. Treatment with tuftsin-loaded nystatin liposomes was most effective in eliminating fungal burden from lung tissues of infected mice compared to those treated with free nystatin or nystatin liposomes without tuftsin. The immunopotentiating activity, increased stability and less toxicity of tuftsin-incorporated nystatin liposomes, supports the idea for its prophylactic and therapeutic use in the clinical setting.

Topics: Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Disease Models, Animal; Humans; Immunologic Factors; Liposomes; Male; Mice; Microbial Sensitivity Tests; Nystatin; Treatment Outcome; Tuftsin

Invasive aspergillosis seems to be on the rise, especially in immunocompromised children. Historically, only systemic amphotericin B has been effective against Aspergillus. Development of newer antifungal agents, such as voriconazole and caspofungin, has improved the treatment options available for aspergillosis, although no definitive management strategy has been established. Here we describe the use of topical voriconazole combined with systemic antifungal agents for cutaneous aspergillosis in a pediatric patient after bone marrow transplant.

Topics: Administration, Cutaneous; Adult; Amphotericin B; Anemia, Aplastic; Antifungal Agents; Aspergillosis; Aspergillus flavus; Bone Marrow Transplantation; Combined Modality Therapy; Debridement; Dermatomycoses; Disease Susceptibility; Female; Graft vs Host Disease; Humans; Immunocompromised Host; Injections, Subcutaneous; Nystatin; Postoperative Complications; Pyrimidines; Skin; Transplantation, Homologous; Triazoles; Voriconazole

To report otomycosis in a retrospective study and correlate clinical, epidemiological and therapeutic factors.. This study comprises 97 cases of clinically and mycologically proven otomycosis or fungal otitis externa gathered during a 12-year period.. Most cases were unilateral (90.7%) and the main predisposing factors associated with the disease were trauma (secondary to the constant scratching) and the use of topical antibiotics. Major causal agents were several species of Aspergillus (63.9%), of which Aspergillus flavus was commonest (26%), followed by Candida albicans (26.8%) and Aspergillus niger (21%).. The treatment of choice is mainly local toilet of the external auditory canal and the use of systemic antifungal agents to prevent re-infection and the spread of disease.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Antifungal Agents; Aspergillosis; Aspergillus flavus; Aspergillus niger; Child; Ear Diseases; Female; Humans; Male; Merbromin; Middle Aged; Mycoses; Nystatin; Retrospective Studies

The objective of this research was the evaluation of the activity of admixtures of amphotericin B (AMB)--intralipid (AMB-IL) and nystatin (Ny)--intralipid (Ny-IL) against experimental systemic aspergillosis in immunocompromised mice. ICR mice were transiently immunosuppressed by intraperitoneal (i.p.) administration of cyclophosphamide (CY). Three days post CY administration the mice were inoculated intravenously (i.v.) with Aspergillus fumigatus conidia. The animals were treated with various doses of AMB-IL or Ny-IL admixtures administered i.v. for 5 consecutive days, starting 2 h after infection. The mean survival rate (MSR) and mean survival time (MST) were evaluated during an observation period of 30 days in comparison to untreated infected mice and to animals treated with conventional formulations of these drugs. These experiments showed that AMB-IL increased significantly the MSR. Specifically, the MSR ranged in dependence of dose, between 48 and 65.7% vs. 0% of the untreated (P < 0.001, anova analysis) and 39.7% of AMB-treated animals (P < 0.01). The MSR of the Ny-IL-treated mice ranged between 16.2 and 40% in comparison to 0% of the untreated group (P < 0.001). Treatment with both admixtures prolonged the MST of the mice (AMB-IL: 17.3-23.07 days; Ny-IL: 8.61-16.8 days) in comparison to either untreated (6.13 days) or AMB treated animals (15.23 days). The data obtained in this study show that both AMB-IL and Ny-IL formulations, particularly AMB-IL at the highest dose, were effective in the treatment of experimental systemic aspergillosis.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Disease Models, Animal; Drug Combinations; Drug Therapy, Combination; Fat Emulsions, Intravenous; Female; Immunocompromised Host; Immunosuppressive Agents; Mice; Mice, Inbred ICR; Nystatin; Phosphatidylcholines; Phosphatidylglycerols; Polyenes

The aim of the present study was to assess the efficacy of amphotericin B (AMB), AMB-intralipid admixture (AMB-IL) or nystatin-IL formulation (Ny-IL) in combination with granulocyte colony stimulating factor (G-CSF) in treatment of experimental murine aspergillosis. ICR mice were immunosuppressed by cyclophosphamide and 3 days later inoculated intravenously (i.v.) with Aspergillus fumigatus. Treatment was initiated 2 h later and administered for 5 consecutive days (polyenes, i.v.; G-CSF, intraperitoneally). Combination therapy, particularly G-CSF with AMB or AMB-IL, significantly increased the survival rate (up to 87.3%) and prolonged the mean survival time (MST) (up to 28.8 days) in comparison to untreated controls (0% survival, MST 6.7 days) and to treatment with polyenes alone (up to 51.5% survival, MST 18.4 days). These data indicate that combination therapy could be beneficial for management of disseminated aspergillosis in humans.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Cyclophosphamide; Drug Combinations; Drug Therapy, Combination; Female; Granulocyte Colony-Stimulating Factor; Immunocompromised Host; Immunosuppressive Agents; Kidney; Lung; Mice; Mice, Inbred ICR; Nystatin; Phosphatidylcholines; Phosphatidylglycerols; Survival Analysis

Topics: Adolescent; Adult; Amphotericin B; Antifungal Agents; Aspergillosis; Child; Female; Fluconazole; Humans; Liposomes; Lung Diseases, Fungal; Male; Middle Aged; Neoplasms; Nystatin; Treatment Failure; Treatment Outcome

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Candidiasis; Fluconazole; Humans; Immunocompromised Host; Itraconazole; Mycoses; Nystatin; Pyrimidines; Triazoles; Voriconazole

The activity of liposomal nystatin against invasive pulmonary aspergillosis was investigated in persistently neutropenic rabbits. Treatment groups included liposomal nystatin at dosages of 1, 2 and 4 mg/kg/day intravenously, or amphotericin B deoxycholate 1 mg/kg/day administered intravenously after normal saline loading. As compared with untreated controls, liposomal nystatin administered at 2 and 4 mg/kg/day prolonged survival and reduced fungus-mediated tissue injury and excess lung weight at post-mortem in a similar manner to amphotericin B. Although amphotericin B was superior in clearing infected lung tissue, treatment with all regimens of liposomal nystatin led to a significant reduction in pulmonary fungal tissue burden. During treatment, ultrafast CT-scan demonstrated ongoing resolution of pulmonary lesions at 2 and 4 mg/kg/day, but not at 1 mg/kg/day. With the exception of mild increases in blood urea nitrogen (BUN) and serum creatinine values during treatment at 2 and 4 mg/kg/day, which were similar to those found in amphotericin B-treated rabbits, liposomal nystatin was well tolerated. Preliminary pharmacokinetic studies in non-infected animals established linear drug disposition of liposomal nystatin in plasma over the investigated dosage range and peak plasma levels above the MIC for the test strain after multiple daily dosing for 7 days. Liposomal nystatin increased survival and provided reduced tissue injury, effective microbiological clearance and tolerable side effects in experimental pulmonary aspergillosis in persistently neutropenic rabbits, thus providing a rational basis for further investigations in clinical trials.

Topics: Amphotericin B; Animals; Antifungal Agents; Area Under Curve; Aspergillosis; Blood Urea Nitrogen; Creatinine; Drug Carriers; Female; Half-Life; Liposomes; Lung; Lung Diseases, Fungal; Neutropenia; Nystatin; Organ Size; Rabbits; Radiography; Survival Rate

Using an isolate of Aspergillus fumigatus that is less susceptible in vivo to amphotericin B than most other isolates, we compared different doses of liposomal nystatin (L-nystatin), liposomal amphotericin B (L-amphotericin), and amphotericin B lipid complex (ABLC) with amphotericin B deoxycholate. Four experiments with intravenously infected neutropenic mice were conducted. A dose of L-nystatin at 10 mg/kg of body weight was toxic (the mice had fits or respiratory arrest). The optimal dosage of L-nystatin was 5 mg/kg daily on days 1, 2, 4, and 7 (90% survival). This was superior to L-amphotericin (5 mg/kg [P = 0.24] and 1 mg/kg [P < 0.0001]), ABLC (5 mg/kg [P = 0.014] and 1 mg/kg [P < 0.0001]), and amphotericin B deoxycholate (5 mg/kg [P = 0.008]). In terms of liver and kidney cultures, L-nystatin (5 mg/kg) was superior to all other regimens (P = 0.0032 and <0.0001, respectively). Higher doses of L-amphotericin (25 and 50 mg/kg) in one earlier experiment were more effective (100% survival) than 1 mg of L-amphotericin per kg and amphotericin deoxycholate (5 mg/kg) in terms of mortality and both liver and kidney culture results and to L-amphotericin (5 mg/kg) in terms of liver and kidney culture results only. ABLC (25 mg/kg) given daily for 7 days was superior to ABLC (50 mg/kg [P = 0.03]) but not to ABLC at 5 mg/kg or amphotericin B deoxycholate in terms of mortality, although it was in terms of liver and kidney culture results. No dose-response for amphotericin B (5 and 1 mg/kg) was demonstrable. In conclusion, in this stringent model, high doses of L-amphotericin and ABLC could overcome reduced susceptibility to amphotericin B deoxycholate, but all were inferior to 5- to 10-fold lower doses of L-nystatin.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Colony Count, Microbial; Cyclophosphamide; Deoxycholic Acid; Drug Carriers; Drug Combinations; Drug Resistance, Microbial; Immunosuppressive Agents; Liposomes; Mice; Neutropenia; Nystatin

The purpose of this study was to examine the activity of liposomal nystatin against a disseminated Aspergillus fumigatus infection in neutropenic mice. Mice were made neutropenic with 5-fluorouracil and were administered the antifungal drug intravenously for 5 consecutive days beginning 24 h following infection. Liposomal nystatin, at doses as low as 2 mg/kg of body weight/day, protected neutropenic mice against Aspergillus-induced death in a statistically significant manner at the 50-day time point compared to either the no-treatment, the saline, or the empty-liposome group. This protection was approximately the same as that for free nystatin, a positive control. Histopathological results showed that liposomal nystatin cleared the lungs, spleen, pancreas, kidney, and liver of Aspergillus and that there was no organ damage at the day 5 time point, which was after only three doses of liposomal nystatin. Based on these results in mice, it is probable that liposomal nystatin will be effective against Aspergillus infection in humans.

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Drug Carriers; Liposomes; Male; Mice; Mice, Inbred Strains; Microbial Sensitivity Tests; Neutropenia; Nystatin; Organ Culture Techniques

The clinicopathologic characteristics of invasive oral aspergillosis in 16 immunocompromised patients who developed this infection during antileukemic chemotherapy are described. The primary site of the infection was the marginal gingiva, there was severe spontaneous pain, and the patients developed spiking fever and granulocytopenia. Necrotic ulceration of the gingiva rapidly extended to the contiguous mucosa, muscle, and bone. Microscopically, the necrotic tissue contained thrombotic vascular infarcts and there were hyphae that showed frequent transverse septa and dichotomous branching. The invasive organisms were not responsive to amphotericin B in the absence of remission of the leukemia and restoration of the depressed host defenses. In 15 patients who showed improvement of hematologic status, oral aspergillosis was controlled by the combination of antifungal chemotherapy and debridement of necrotic tissues.

Topics: Adult; Aged; Agranulocytosis; Amphotericin B; Aspergillosis; Female; Humans; Immunocompromised Host; Leukemia; Male; Middle Aged; Mouth Diseases; Necrosis; Nystatin

Symptoms of bronchopneumonia developed over 4 months in a 63-year-old woman in previously good health. The symptoms worsened despite treatment with tetracycline (500 mg twice daily for 10 days). Middle-lobe pneumonia was diagnosed both clinically and radiologically, but monotherapy with ofloxacin (200 mg twice daily) was ineffective, as well as combined treatment with gentamycin (80 mg), oxacillin (1 g) and azlocillin (5 g), each three times daily intravenously. Bronchoscopy revealed obstruction of the lumen of the right middle lobe bronchus by viscous purulent secretion which contained a high count of Aspergillus fumigatus, previously found in several sputum samples. The inflammatory process regressed completely within 12 days on itraconazole (200 mg twice daily), combined with nystatin inhalation (100,000 IU five times daily). The only possible aetiologically significant risk factor in this immunocompetent woman could have been her frequent use of a bio-waste container.

Topics: Administration, Inhalation; Aspergillosis; Aspergillus fumigatus; Azlocillin; Bronchi; Bronchoscopy; Drug Therapy, Combination; Female; Gentamicins; Humans; Immunocompetence; Itraconazole; Lung Diseases, Fungal; Medical Waste Disposal; Middle Aged; Nystatin; Ofloxacin; Oxacillin; Risk Factors; Sputum; Tetracycline

Three horses were referred for investigation of a unilateral foul smelling scanty nasal discharge, complicated in one case by intermittent epistaxis. Thick purulent material or a mycotic plaque was identified by an endoscopic examination of the middle meatus but in two horses this had to be repeated under general anaesthesia before the abnormalities were detected. Aspergillus fumigatus was cultured from all three cases and septate hyphae were identified on smears from lesions. Histological examination of the lesion in one case revealed a fungal mycelium. Topical treatment with natamycin solution in all cases plus nystatin in two of the horses resulted in complete recovery from the condition in two cases but in one case the problem recurred. The aetiology of nasal aspergillosis remains uncertain.

Topics: Animals; Aspergillosis; Aspergillus fumigatus; Epistaxis; Horse Diseases; Horses; Natamycin; Nose Diseases; Nystatin

Topics: Animal Feed; Animals; Aspergillosis; Ducks; Nystatin; Poultry Diseases

Topics: Amphotericin B; Aspergillosis; Aspergillus fumigatus; Drug Therapy, Combination; Follow-Up Studies; Humans; Natamycin; Nystatin; Pleura; Pleural Diseases

Since 1969, 79 cases of fungal maxillary sinusitis have been diagnosed. Forty-nine were due to Aspergillus fumigatus. There were no underlying diseases which depressed cellular immunity and no patient was receiving immunosuppressive drugs or corticosteroids. Most patients had received antibacterial therapy before the appearance of FMS. Treatment was by surgery, nystatin and econazole.

Topics: Aspergillosis; Aspergillus; Econazole; Female; Humans; Male; Maxillary Sinus; Nystatin; Sinusitis; Therapeutic Irrigation

Invasive pulmonary aspergillosis is a common fungal infection in the compromised host. The outcome has been generally poor and, until recently, most reports are derived from autopsy series. We report nine patients with leukemia and the characteristic clinical presentation of pulmonary infarction. There is histological evidence that infarction is due to fungal invasion of the pulmonary arterial system with distal hemorrhagic infarction, cavitation, and mycetoma formation. This complete evolution was detected in six patients, none of whom had previous cavitary pulmonary disease. Therapy included amphotericin B (9 patients), aerosolized nystatin (6 patients), and 5-fluorocytosine (5 patients). Complete resolution of the pulmonary lesions occurred in six patients with a subsequent median survival of 13.5 months (range: 5-32+ months). Three patients died with continuing pulmonary infiltrate. Despite the antifungal chemotherapy, resolution seemed to correlate best with recovery of circulating neutrophils.

Topics: Adult; Aged; Amphotericin B; Aspergillosis; Female; Flucytosine; Humans; Leukemia; Lung Diseases, Fungal; Male; Middle Aged; Nystatin; Sputum

Repeated transthoracic intracavitary injections of amphotericin B, nystatin and pimaricine proved a simple and safe method in the treatment of bilateral pulmonary aspergillomas in a patient with large cavities caused by lung disease in ankylosing spondylitis. Both large mycetomas were dissolved by this treatment in combination with peroral corticosteroid medication, and the patient's general condition improved markedly.

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Humans; Injections; Lung; Lung Diseases, Fungal; Male; Middle Aged; Natamycin; Nystatin; Spondylitis, Ankylosing; Sputum

Topics: Animals; Aspergillosis; Aspergillus fumigatus; Dog Diseases; Dogs; Male; Nasal Cavity; Nose Diseases; Nystatin; Tetracycline

We report the successful treatment of a patient with a bronchopleural fistual and pleural aspergilloma. Treatment consisted of intrapleural instillation of amphotericin B and nystatin followed by creation of an Eloesser flap.

Topics: Amphotericin B; Aspergillosis; Bronchial Fistula; Drainage; Female; Fistula; Humans; Middle Aged; Nystatin; Pleural Diseases; Radiography

Topics: Aerosols; Amphotericin B; Aspergillosis; Emetine; Humans; Injections, Intramuscular; Iodides; Lung Diseases, Fungal; Mycetoma; Natamycin; Nystatin; Prognosis

Topics: Adult; Amphotericin B; Aspergillosis; Biopsy; Cataract; Cell Nucleus; Conjunctiva; Corneal Ulcer; Cytoplasm; Histiocytes; Humans; Injections; Male; Nystatin; Staining and Labeling; Vision, Ocular; Visual Acuity

Topics: Amphotericin B; Animals; Aspergillosis; Candidiasis; Eye Diseases; Humans; Keratitis; Mycoses; Natamycin; Nystatin; Rabbits

Topics: Aspergillosis; Aspergillus fumigatus; Bacteriological Techniques; Cloxacillin; Humans; Male; Middle Aged; Nystatin; Skin; Skin Diseases; Staphylococcus; Streptococcus; Tuberculosis, Pulmonary

Topics: Aspergillosis; Candidiasis; Child, Preschool; Female; Hepatitis; Humans; Hydrocortisone; Neomycin; Nystatin

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Cryptococcosis; Flucytosine; Histoplasmosis; Humans; Iodides; Mycoses; Nystatin; Sporotrichosis

Topics: Agranulocytosis; Amphotericin B; Antineoplastic Agents; Aspergillosis; Candidiasis; Cryptococcosis; Cytosine; Diabetes Complications; Glucocorticoids; Humans; Immunosuppression Therapy; Mucormycosis; Mycoses; Nystatin

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Humans; Lung Diseases, Fungal; Middle Aged; Natamycin; Nystatin; Pleural Diseases

Topics: Adult; Aspergillosis; Aspergillus; Aspergillus fumigatus; Corneal Ulcer; Humans; Male; Microbial Sensitivity Tests; Natamycin; Nystatin; Ophthalmic Solutions; Suppuration

Topics: Adolescent; Adult; Aged; Amphotericin B; Antifungal Agents; Aspergillosis; Bronchial Diseases; Child; Female; Humans; Lung Diseases, Fungal; Male; Middle Aged; Nystatin

Topics: Acremonium; Adult; Amphotericin B; Aspergillosis; Candidiasis; Conjunctiva; Cornea; Corneal Transplantation; Corneal Ulcer; Curettage; Eye Diseases; Eye Injuries; Female; Fusarium; Humans; Male; Mycoses; Nystatin; Potassium Iodide

Topics: Abscess; Adrenal Cortex Hormones; Adult; Amphotericin B; Aspergillosis; Aspergillus; Chloramphenicol; Cornea; Corneal Transplantation; Dexamethasone; Eye Diseases; Eye Injuries; Humans; Male; Natamycin; Nystatin; Ophthalmic Solutions; Oxacillin; Sulfacetamide; Transplantation, Homologous

Topics: Animals; Aspergillosis; Aspergillus fumigatus; Bird Diseases; Birds; Nystatin; Vitamin B Complex

Topics: Adult; Amphotericin B; Aspergillosis; Cytarabine; Female; Humans; Leukemia, Myeloid; Lung Diseases, Fungal; Nystatin; Pulmonary Embolism; Remission, Spontaneous

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Diagnosis, Differential; Female; Humans; Maxillary Sinus; Middle Aged; Natamycin; Nystatin; Radiography; Respiratory Tract Infections; Rhinitis; Sinusitis

Topics: Amphotericin B; Animals; Aspergillosis; Candidiasis; Cornea; Iritis; Keratitis; Natamycin; Nystatin; Potassium; Potassium Iodide; Rabbits; Sodium

Topics: Adolescent; Adult; Amphotericin B; Aspergillosis; Chlorambucil; Dyspnea; Female; Hemoptysis; Humans; Lung Diseases, Fungal; Male; Nystatin; Prednisone; Radiography; Respiratory Hypersensitivity

Topics: Adolescent; Aspergillosis; Child; Conjunctivitis; Female; Humans; Nystatin

Topics: Adult; Aged; Aspergillosis; Empyema, Tuberculous; Female; Humans; Male; Middle Aged; Nystatin; Pleural Diseases; Radiography; Tuberculosis, Pulmonary

Topics: Amphotericin B; Aspergillosis; Contrast Media; Hemoptysis; Humans; Injections; Lung Diseases, Fungal; Nystatin; Radiography; Suspensions

Topics: Actinomycosis; Africa; Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Farmer's Lung; France; Histoplasmosis; Humans; Hypersensitivity; Lung Diseases, Fungal; Nystatin; Sputum; United States

Topics: Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus; Caseins; Culture Media; Drug Resistance, Microbial; Fluorescence; Glucose; Griseofulvin; Humans; Microbial Sensitivity Tests; Natamycin; Nystatin; Rabbits; Spores; Vitamins

Topics: Aspergillosis; Humans; Hypersensitivity; Immunoelectrophoresis; Lung Diseases, Fungal; Male; Middle Aged; Nystatin

Topics: Amphotericin B; Aspergillosis; Humans; Laryngeal Diseases; Male; Middle Aged; Nystatin; Respiratory Tract Infections

Topics: Adult; Air; Animals; Aspergillosis; Aspergillus; Bronchial Diseases; Bronchoscopy; Dogs; Female; Humans; Iodine; Lung Diseases, Fungal; Male; Nystatin; Radiography; Sputum

Topics: Adult; Aged; Amphotericin B; Aspergillosis; Aspergillus; Brain; Central Nervous System; Female; Humans; Male; Middle Aged; Nystatin; Orbit; Paranasal Sinuses

Topics: Aerosols; Aspergillosis; Aspergillus; Child; Child, Preschool; Female; Granuloma; Humans; Leukocytes; Lung; Lung Diseases, Fungal; Nystatin; Radiography; Skin Diseases, Infectious

Topics: Antifungal Agents; Aspergillosis; Humans; Natamycin; Nystatin; Respiratory Tract Infections

Topics: Abortion, Septic; Amniotic Fluid; Animals; Aspergillosis; Aspergillus; Female; Fetal Diseases; Nystatin; Postoperative Complications; Pregnancy; Sheep; Sheep Diseases

Topics: Aspergillosis; Humans; Immunodiffusion; Lung Diseases, Fungal; Nystatin; Pleural Diseases; Pneumonectomy

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Benzoates; Humans; Natamycin; Nystatin; Parabens

Topics: Adult; Anti-Bacterial Agents; Aspergillosis; Corneal Ulcer; Female; Humans; Nystatin; Pregnancy; Pregnancy Complications, Infectious

Topics: Aerosols; Animals; Antifungal Agents; Aspergillosis; Aspergillus; Diagnosis, Differential; Fungal Vaccines; Fungi; Guinea Pigs; Humans; Mice; Nystatin; Occupational Diseases; Occupations; Skin Tests; USSR

Topics: Aspergillosis; Asthma; Humans; Lung Diseases, Fungal; Male; Middle Aged; Nystatin

Topics: Adult; Aspergillosis; Female; Humans; Nystatin

Topics: Adult; Aspergillosis; Diagnosis, Differential; Humans; Leprosy; Male; Nystatin; Skin Diseases

Aspergillosis was induced experimentally in hatching chick embryos by dipping them in water containing spores of Aspergillus fumigatus or A. flavus. The addition to the dip water of antifungal compounds prevented the development of this syndrome. Of the compounds studied, amphotericin B was most effective, followed by pimaricin and nystatin. Sorbic acid was without effect.

Topics: Acids; Amphotericin B; Animals; Antifungal Agents; Aspergillosis; Aspergillus; Chick Embryo; Detergents; Natamycin; Nystatin; Poultry Diseases; Spores

Topics: Actinomycosis; Adult; Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis, Vulvovaginal; Child; Cryptococcosis; Dermatomycoses; Female; Griseofulvin; Humans; Lung Diseases, Fungal; Mycetoma; Mycoses; Nails; Nocardia Infections; Nystatin; Skin Diseases; Sporotrichosis; Stilbamidines; Thallium; Tinea Pedis

Topics: Aspergillosis; Aspergillus; Cerumen; Chlorides; Ear Diseases; Escherichia coli; Glucose; Humans; Hydrogen-Ion Concentration; Nystatin; Postoperative Complications; Pseudomonas aeruginosa; Staphylococcus; Sulfates

Topics: Aspergillosis; Bacteriological Techniques; Child, Preschool; Diagnosis, Differential; Female; Humans; Infant; Lung Diseases, Fungal; Nystatin; Sulfathiazoles

Topics: Adolescent; Anti-Bacterial Agents; Antifungal Agents; Aspergillosis; Aspergillus; Humans; Lung Diseases, Fungal; Male; Microscopy, Phase-Contrast; Natamycin; Nystatin; Radiography, Thoracic; Tomography

Topics: Animals; Aspergillosis; Cold Temperature; Cornea; Cryosurgery; Eye Diseases; Nystatin; Rabbits

Topics: Adult; Aspergillosis; Child; Eye Diseases; Female; Humans; Male; Nystatin

Topics: Amphotericin B; Aspergillosis; Drug Therapy; Humans; Nystatin; Paranasal Sinuses; Surgical Procedures, Operative

Topics: Adult; Aspergillosis; Humans; Lung Diseases, Fungal; Male; Nystatin

Topics: Adult; Aspergillosis; Humans; Lung Diseases, Fungal; Male; Nystatin; Radiography, Thoracic

Topics: Abortion, Veterinary; Animals; Aspergillosis; Diagnosis; Female; Horse Diseases; Horses; Mucormycosis; Mycoses; Nystatin; Pathology; Penicillins; Placenta; Pregnancy; Streptomycin; Therapeutic Irrigation

Topics: Amphotericin B; Aspergillosis; Bronchoscopy; Chloramphenicol; Datura stramonium; Iodides; Isoniazid; Lung Diseases; Nystatin; Penicillin G; Penicillin G Procaine; Pneumonectomy; Potassium Iodide; Procaine; Pulmonary Aspergillosis; Radiography, Thoracic; Stilbamidines; Streptomycin; Thoracoplasty; Toxicology

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Antifungal Agents; Aspergillosis; Biomedical Research; Candidiasis; Humans; Hydrocortisone; Mastoiditis; Mycoses; Nystatin; Otitis Media; Otolaryngology; Penicillium; Postoperative Complications; Surgical Procedures, Operative

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

Topics: Actinomycosis; Amphotericin B; Aspergillosis; Blastomycosis; Candidiasis; Coccidioidomycosis; Histoplasmosis; Humans; Lung Diseases, Fungal; Nocardia Infections; Nystatin; Sulfadiazine

Topics: Amphotericin B; Antifungal Agents; Aspergillosis; Candidiasis; Erythromycin; Fungi; Gentian Violet; Humans; Iodides; Mycoses; Nystatin; Penicillins; Stilbamidines; Sulfanilamide; Sulfanilamides; Sulfonamides

Topics: Antifungal Agents; Aspergillosis; Aspergillus fumigatus; Atropine; Corneal Ulcer; Drug Therapy, Combination; Eye Infections, Fungal; Humans; Male; Middle Aged; Mydriatics; Nystatin

Topics: Amphotericin B; Aspergillosis; Aspergillus flavus; Disease; Ethmoid Sinus; Humans; Nystatin; Orbit; Orbital Diseases; Otolaryngology; Paranasal Sinus Diseases; Paranasal Sinuses

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Aspergillosis; Dermatologic Agents; Humans; Nystatin

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Aspergillosis; Aspergillus fumigatus; Eye Infections, Fungal; Humans; Keratitis; Nystatin