scholarly journals Mucormycosis: Effect of Comorbidities and Repeated Debridement on the Outcome

2019 ◽  
Vol 27 (1) ◽  
pp. 8-14
Author(s):  
Harshavardhan N Reddy ◽  
Sanjay B Patil ◽  
Chandrakiran Channegowda ◽  
Aiswarya Muralidharan
Keyword(s):  
Diabetes Mellitus ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
Invasive Infection ◽  
Comorbid Conditions ◽  
Tissue Necrosis ◽  
Immunocompromised Hosts ◽  
Vessel Thrombosis

Introduction: Mucormycosis is an aggressive, invasive infection caused by ubiquitous filamentous fungibelonging to the subphylum Mucormycotina, order Mucorales. Mucormycosis most commonly affects immunocompromised hosts, but are rarely reported in immunocompetent hosts as well. The most common reported sites of invasive mucormycosis have been the sinuses (39%), lungs (24%), and skin (19%). The hallmark of mucormycosis is angioinvasion resulting in vessel thrombosis and hence, tissue necrosis.   Materials and Methods: Ambispective study of 20 cases with mucormycosis seen and treated in our hospital between 2009 and 2015 and followed up to 2017 to compare the prognosis of the cases of repeated debridement with that of single debridement and effect of comorbidities in the outcome of patients mortality .   Results: Out of 20 patients 19 (95%) received Liposomal Amphotericin B. 11 (55%) were male and 9 (45%) were female. All the 7 (35%) who underwent repeated debridement survived. Out of 13 (65%) patients who underwent single debridement, 5 (25%) did not survive. 2 (10%) patients were lost for follow up. The survival amongst the patients undergoing multiple debridement and single debridement was statistically significant (p=0.042) Conclusion: The chances of survival are better in cases with better controlled comorbid conditions like diabetes mellitus. Repeated debridement with Liposomal Amphotericin B is the most effective mode of management.

Assessing the Efficacy and Safety of Liposomal Amphotericin B and Miltefosine in Combination for Treatment of Post Kala-Azar Dermal Leishmaniasis

2019 ◽  
Vol 221 (4) ◽  
pp. 608-617 ◽  
Author(s):  
V Ramesh ◽  
Keerti Kaumudee Dixit ◽  
Neha Sharma ◽  
Ruchi Singh ◽  
Poonam Salotra
Keyword(s):  
Combination Therapy ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Quantitative Polymerase Chain Reaction ◽  
Treatment Options ◽  
Parasite Load ◽  
Liposomal Amphotericin B ◽  
Rapid Decline ◽  
Kala Azar

Abstract Background No satisfactory canonical treatment is available for post-kala-azar dermal leishmaniasis (PKDL), clinical sequela of visceral leishmaniasis. Confined treatment options and substantial increase in relapse rate after miltefosine (MIL) treatment warrant the need to adapt resilient combination therapies. In this study, we assessed the safety and efficacy of combination therapy using liposomal amphotericin B (LAmB) and MIL for treating PKDL. Methods Thirty-two PKDL patients, confirmed by microscopy or quantitative polymerase chain reaction (qPCR), were included in the study. An equal number of cases (n = 16) were put on MIL monotherapy (100 mg/day for 90 days) or MIL and LAmB combination for 45 days (3 injections of LAmB, 5 mg/kg body weight, and 100 mg/day MIL). Parasite load in slit aspirate was monitored using qPCR. Results Patients treated with combination therapy demonstrated a rapid decline in parasite load and achieved 100% cure, with no reports of relapse. Those treated with MIL monotherapy attained clinical cure with a gradual decrease in parasite load; however, 25% relapsed within 18 months of follow-up. Conclusions Liposomal amphotericin B and MIL combination for treating PKDL is efficacious and safe, with high tolerability. Furthermore, this study established the utility of minimally invasive slit aspirate method for monitoring of parasite load and assessment of cure in PKDL.

Invasive Fungal Rhinosinusitis Caused by Curvularia in a Patient With Type 1 Diabetes Mellitus: A Case Report

2020 ◽  
pp. 089719002096619
Author(s):  
Victoria Marinucci ◽  
Elias B. Chahine ◽  
Larry M. Bush
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Sinus Surgery ◽  
Liposomal Amphotericin B ◽  
Fungal Rhinosinusitis ◽  
Invasive Fungal Rhinosinusitis

Invasive fungal rhinosinusitis (IFRS) is a serious illness requiring early diagnosis, surgical debridement, and administration of antifungals. We report a case of an acute IFRS caused by Curvularia in a patient with diabetes mellitus. An 18-year-old female presented to the emergency department with an acute onset of fever, headache, facial discomfort, and a blood glucose reading of 500 mg/dL. The patient was admitted for the management of hyperosmolar hyperglycemia. Her past medical history includes uncontrolled type 1 diabetes mellitus and a recent toothache. A computed tomography scan of the facial maxillary region revealed sinus disease with bony erosion. Empiric therapy with liposomal amphotericin B 400 mg i.v. every 24 hours, piperacillin/tazobactam 4.5 g i.v. every 6 hours and vancomycin 1 g i.v. every 12 hours was started. A functional endoscopic sinus surgery revealed invasive rhinosinusitis and cultures were positive for fungal elements. The patient was discharged on liposomal amphotericin B 400 mg i.v. daily and cefuroxime 500 mg orally twice daily. However, she was readmitted for the management of acute kidney injury and was discharged on itraconazole capsules 200 mg orally twice daily. Sinus cultures grew Curvularia and itraconazole was prescribed for 6 weeks, but the patient discontinued treatment after 3 weeks and had no signs or symptoms of rhinosinusitis when she was last seen in the clinic. The possibility of IFRS should be explored in patients with diabetes and signs and symptoms of rhinosinusitis.

Liposomal amphotericin B (AmBisome): efficacy and safety of low-dose therapy in pulmonary fungal infections

2002 ◽  
Vol 49 (suppl_1) ◽  
pp. 49-50 ◽  
Author(s):  
Cosimo Lequaglie
Keyword(s):  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Low Dose ◽  
Fungal Infections ◽  
Liposomal Amphotericin B ◽  
Deep Mycosis ◽  
Pulmonary Fungal Infections ◽  
A Prospective Study ◽  
Thoracic Malignancies

Abstract A prospective study of the treatment of fungal infections with low-dose AmBisome enrolled 36 of 52 patients with thoracic malignancies who developed pulmonary fungal infections in the National Cancer Centre, Milan, over a 3.5 year period. Thirty-three high-risk patients had received standard prophylaxis with iv fluconazole. In these patients, symptoms indicating deep mycosis were detected after 7–9 days of primary prophylactic therapy. Another three patients, not treated with fluconazole, showed similar symptoms. Bronchoalveolar lavage, blood culture and/or CT scan of chest diagnosed invasive aspergillosis in 29 patients and deep invasive Candida infection in seven. AmBisome was given at 1–2.2 mg/kg/day iv for 10 days to avoid or decrease toxicity normally induced by amphotericin B. The fungal infection was eradicated in all 36 patients. Negative cultures were obtained after 5 or 6 days of antifungal treatment. No adverse reactions attributed to AmBisome were detected. After a follow up of 5–48 months, 30 patients were still alive. Six patients had died, two due to adult respiratory distress syndrome and four due to progression of cancer. No mycotic relapses or reinfections were detected during follow up. In a subset of critically ill patients with thoracic malignancies, the administration of low-dose liposomal amphotericin B (AmBisome) resulted in complete eradication of pulmonary Aspergillus and Candida infections, and was remarkably well tolerated.

“Mucormycosis” The Emerging Global Threat – A Complete Review

2021 ◽  
Vol 8 (6) ◽  
pp. 193-198
Author(s):  
A R Shabaraya ◽  
Nypunya K
Keyword(s):  
Diabetes Mellitus ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Solid Organ Transplantation ◽  
Secondary Prophylaxis ◽  
Liposomal Amphotericin B ◽  
High Dose ◽  
Solid Organ ◽  
Life Threatening ◽  
Global Threat

Mucormycosis is a life-threatening invasive fungal infection that affects people who are immunocompromised (haematological malignancies, solid organ transplantation, diabetes mellitus). Pulmonary, rhinocerebral, cutaneous, and disseminated infections are the most common. Controlling mucormycosis requires reversing the underlying problems. Treatment for mucormycosis also includes quick and vigorous surgery. Extensive surgical debridement of necrotic tissues is required. Finally, an antifungal treatment is required. High-dose liposomal amphotericin B (5 mg/kg/day) is the first-line treatment for mucormycosis. Antifungal chemotherapy has no set length; instead, it is determined by the remission of all related symptoms and results (usually 6-8 weeks). Posaconazole maintenance therapy/secondary prophylaxis should be recommended in patients who have a persistently weakened immune system. Keywords: Mucormycosis, Diabetes mellitus, Liposomal Amphotericin B.

Mucormycosis Peritonitis: More Than 2 Years of Disease-Free Follow-up After Posaconazole Salvage Therapy After Failure of Liposomal Amphotericin B

2008 ◽  
Vol 51 (2) ◽  
pp. 302-306 ◽  
Author(s):  
Martin Sedlacek ◽  
John G. Cotter ◽  
Arief A. Suriawinata ◽  
Thomas M. Kaneko ◽  
Richard A. Zuckerman ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Salvage Therapy ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
Disease Free

Cryptococcosis in Australasia and the treatment of cryptococcal and other fungal infections with liposomal amphotericin B

2002 ◽  
Vol 49 (suppl_1) ◽  
pp. 57-61 ◽  
Author(s):  
Sharon C. A. Chen
Keyword(s):  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Fungal Infections ◽  
Randomized Study ◽  
Initial Therapy ◽  
Liposomal Amphotericin B ◽  
Lipid Complex ◽  
Reduced Toxicity ◽  
Main Barrier ◽  
Immunocompromised Hosts

Abstract Cryptococcus neoformans is an important fungal pathogen in both immunocompromised and immunocompetent hosts. The mean annual incidence during 1994–1997 was 6.6 cases per million people per year in Australia, and 2.2 cases per million people per year in New Zealand. C. neoformans var. neoformans caused 85% of 312 episodes (98% of episodes in immunocompromised hosts) and C. neoformans var. gattii caused 15% (44% in immunocompetent hosts). The AIDS-specific incidence declined significantly over the 3 years. Mortality from cryptococcosis remains substantial. In trials involving small numbers of AIDS patients, liposomal amphotericin B (AmBisome) was found to be active against C. neoformans, with mycological response rates of 67–85%; however, maintenance therapy with an oral antifungal agent is required indefinitely. In a randomized study of patients with cryptococcal meningitis, AmBisome (4 mg/kg/day) produced mycological eradication in 73% of patients compared with 38% with conventional amphotericin. AmBisome resulted in significantly earlier sterilization of cerebrospinal fluid than conventional amphotericin (7–14 days versus 21 days) and was less nephrotoxic. The benefit of this reduced toxicity is denied to many patients because of an enormous cost barrier. In a survey of the practices of clinical mycologists in Australia, 11 experts responded to a questionnaire survey regarding the use of available lipid preparations. Their indications for use as initial therapy were mucormycosis (7/10), renal failure (7/10), Fusarium infection (2/10) and aspergillosis (2/10). Cryptococcosis, candidosis and febrile neutropenia were rarely regarded as an indication; failed therapy with conventional amphotericin was an indication to use AmBisome for 8/11 respondents. The majority believed that AmBisome was equivalent to conventional amphotericin, with amphotericin B lipid complex and AmBisome equivalent to each other in terms of efficacy. The main barrier to replacement of conventional amphotericin with lipid preparations was seen as an issue of cost.

scholarly journals Case Report: Facial mixed fungal infection in a poorly responding non-Hodgkin’s lymphoma patient with suspected immunodeficiency

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 1726
Author(s):  
Ali Mostafa ◽  
Mervat Gaber ◽  
Hany Abdelrahman ◽  
Noha ElAnwar ◽  
Ahmed Galal
Keyword(s):  
Blood Culture ◽  
Fungal Infection ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Hodgkin’S Lymphoma ◽  
Hodgkin's Lymphoma ◽  
Liposomal Amphotericin B ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

A male child presented with left lacrimal gland and right submandibular masses that were diagnosed as high grade B-cell non-Hodgkin's Lymphoma. Immunodeficiency was suspected, mostly due to secondary to Epstein Barr virus infection. Chemotherapy was started and gradual regression was observed in the size of the lesions forming a central necrosis and facial wound. Cultures from this wound showed mixed gram negative growth of Pseudomonas aeruginosa, and Escherichia coli. Two days later, a follow up swab of the wound was taken and showed fungal growth of mixed Candida tropicalis and Cryptococcus laurentii which was treated with two antifungals (fluconazole and liposomal amphotericin B). After a second chemotherapy cycle, the facial necrotic lesion increased in size and the patient's general condition markedly deteriorated with multi-organ system failure secondary to septic shock by candidemia. Candida glabrata, which is non-Candida albicans fungus was the fungus that appeared in the patient's blood culture. Caspofungin was prescribed in addition to liposomal amphotericin B. two days later, the follow up blood culture revealed growth of methicillin resistant Staphylococcus aureus and the pulmonary condition of the patient then deteriorated gradually. Six days later, the patient developed multi-organ dysfunction syndrome secondary to sepsis. We conclude that we mixed fungal infection in not uncommon among immunocompromised patients, candidemia is fatal even if treated with the correct antifungals.

scholarly journals Case Report: Post Kala-Azar Dermal Leishmaniasis with History of Visceral Leishmaniasis

2021 ◽  
Vol 8 (5) ◽  
pp. 69-72
Author(s):  
Pavankumar Narapaka ◽  
Kalpana Katikala
Keyword(s):  
Visceral Leishmaniasis ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
First Line ◽  
Treatment Regimens ◽  
First Line Therapy ◽  
Kala Azar ◽  
History Of

The complication of visceral leishmaniasis is post-kala-azar dermal leishmaniasis (PKDL). PKDL typically occurs as a result of treatment failure or parasite resistance to treatment regimens, as well as poor patient follow-up. In the treatment of visceral leishmaniasis and post-kala-azar dermal leishmaniasis, Liposomal Amphotericin B is considering as first-line therapy. We're going to show you a case where Liposomal Amphotericin B was used to treat it. Keywords: visceral leishmaniasis, post-kala-azar dermal leishmaniasis, PKDL, kala-azar

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