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Amphotericin B (amphotericin + b)
Kinds of Amphotericin B Terms modified by Amphotericin B Selected AbstractsDisseminated cutaneous Fusarium moniliforme infections in a leukemic childINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 5 2007Ching-Chi Chi MD A 5-year-old boy had a 10-month remission of acute lymphocytic leukemia (ALL) after chemotherapy. Re-induction chemotherapy was performed for relapse of ALL. Thereafter, he suffered from an episode of neutropenic fever with pneumonia. One week following control of the condition with antibiotics, a 1 × 1-cm, red, painful nodule appeared on the left thigh, which was initially suspected to be Pseudomonas infection. Parenteral ceftazidime and amikacin were administered, but persistent high fever, mild cough, and a few painful erythematous papulonodules on the face and lower extremities appeared several days later (Fig. 1). These lesions increased insidiously in diameter up to 2,5 cm with central necrosis. Hemogram showed neutropenia with a shift to the left [white blood cell (WBC) count, 2.1 × 109/L; neutrophil count, 0.21 × 109/L]. A skin biopsy showed heavy growth of hyaline branching septate hyphae in the deep dermis and subcutis, together with fat necrosis (Fig. 2). Invasion of molds into vessels and sweat glands was also seen. A culture from a lesion yielded Fusarium moniliforme, but no fungi were isolated from blood specimens. Only mild infiltrations on bilateral lower lung fields were detected by chest roentgenography. The skin lesions gradually healed and the fever subsided 2 weeks after the initiation of therapy with amphotericin B 30 mg and itraconazole 200 mg daily. Figure 1. A few painful erythematous papulonodules appeared on the face and lower extremities Figure 2. Skin biopsy showed heavy growth of hyaline branching septate hyphae in the deep dermis and subcutis along with fat necrosis (hematoxylin and eosin, ×400) Meanwhile, relapse of leukemia was detected by hemogram showing atypical leukocytosis (WBC count of 24,400 × 109/L, with blast cells representing 78%). A course of chemotherapy with cytarabine, mitoxantrone, and VP-16 was prescribed, subsequently resulting in neutropenia (WBC count, < 0.1 × 109/L; neutrophil count, 0/L) and spiking fever. Although the aforementioned antifungal therapy was continued, the centers of the originally healed lesions turned dusky red, swollen, necrotic, and ulcerative. There were more than 10 such ecthymiform lesions. After administration for 22 days, itraconazole was discontinued because of no appreciable effects. Granulocyte colony-stimulating factor (G-CSF) salvage was used, and the neutropenia gradually subsided 20 days later. In addition, the ecthymiform lesions gradually resolved. Amphotericin B was discontinued 1 week following neutrophil recovery. The patient died of Acinetobacter baumannii and Stenotrophomonas maltophilia sepsis 8 months later. [source] Cutaneous leishmaniasis: successful treatment with itraconazoleINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 1 2006Javier Consigli MD Background, Leishmaniasis is a disease produced by several species of protozoa of the Leishmania genus. These protozoa are injected into the human bloodstream by sandflies. The symptomathology, either cutaneous, mucocutaneous or visceral, depends on the infective species and the immune status of the patient. Antimonial drugs are the mainstay treatment for all the clinical forms of the disease. Amphotericin B is the second-choice drug. Methods We report two clinical cases of cutaneous leishmaniasis treated with itraconazole. One case was a relapsing form unresponsive to conventional therapy. Results, Both patients achieved fast resolution of their lesions with no secondary effects. Conclusions, Itraconazole may be a valid option for the treatment of cutaneous leishmaniasis, mainly in those cases unresponsive to conventional drugs. [source] Amphotericin B removal by plasma exchangeJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 1 2009S. Q. Lew MD FACP FASN Summary This case report adds pharmacokinetic knowledge regarding amphotericin B. Amphotericin B is highly protein bound. Plasma exchange removes 50,75% of a substance in plasma within 1,2 h, corresponding to an elimination half-life of 30,40 min. Amphotericin B reduction ratio by plasma exchange was 40% in this patient who had both liver and renal failure. [source] Particulate contamination of lyophilized amphotericin B preparation during reconstitution processJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2001T. Sendo Objective:,To investigate the effect of the reconstitution methods for the commercial amphotericin B preparation with respect to particulate contamination. Methods:,The particle counts in amphotericin B solutions reconstituted according to three different methods and amphotericin B fluids made with intravenous fluids after reconstitution were performed using a light extinction method. The particle contaminants were identified with X-ray emission spectrometry attached to a scanning electron microscope. Results:,Amphotericin B in a vial induced particle contamination during the reconstitution process, and the contamination was especially marked by shaking vigorously after injecting water into the vial. From the X-ray analysis, it appeared that the increased number of particles was derived from the amphotericin B,deoxycholate complex containing substances such as silicone released from the vial components. Amphotericin B fluid made with intravenous fluids after reconstitution also contained particles over the acceptable limits according to the Japanese or US pharmacopoeia. Conclusion:,These findings suggest that reconstituted solutions should be filtered with membrane filters and diluted fluids with in-line filters. [source] Discordant influence of amphotericin B on epirubicin cytotoxicity in primary hepatic malignant cells collected by a new primary culture techniqueJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2 2006ZU-YAU LIN Abstract Background:, The purpose of this prospective study was to investigate whether amphotericin B (AmB) had any potential role in the systemic chemotherapy of primary hepatic malignancy using cancer cells collected by the authors' method of primary culture. Methods:, The specimens obtained by ultrasound-guided fine-needle aspiration biopsy (22 G) from 15 patients with hepatocellular carcinoma (HCC) and one with cholangiocarcinoma were plated into culture flask without disaggregation by trypsin-ethylenediamine tetra-acetic acid solution. Six patients with HCC and one patient with cholangiocarcinoma (7/16, 44%) had successful culture and the cancer cells at the 4th passage were continuously exposed to therapeutic ranges of epirubicin (0, 0.5, 1.0, 1.5, 2.0 µg/mL) with or without the combination of 2.5 µg/mL AmB for 24 h. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was applied to evaluate the effects of the drugs. A human HCC cell line (HA 22T/VGH) was studied for comparison. Results:, Addition of AmB showed no influence on epirubicin cytotoxicity in two patients (one partial resistant HCC and one epirubicin-sensitive cholangiocarcinoma; 25%), augmentation of the epirubicin cytotoxicity in two patients (one total resistant HCC, partial resistant HA 22T/VGH cell line and one epirubicin-sensitive HCC; 37.5%), and decrease of epirubicin cytotoxicity in the remaining three (one partial resistant and two epirubicin-sensitive HCC; 37.5%). Conclusions:, Amphotericin B has a discordant influence on epirubicin cytotoxicity in primary cultured hepatic malignant cells. Application of AmB in the systemic chemotherapy of primary hepatic malignancy should be limited to patients with positive AmB effect evaluated by an in vitro sensitivity test such as the present method. [source] Amphotericin B formulations and drug targetingJOURNAL OF PHARMACEUTICAL SCIENCES, Issue 7 2008J.J. Torrado Abstract Amphotericin B is a low-soluble polyene antibiotic which is able to self-aggregate. The aggregation state can modify its activity and pharmacokinetical characteristics. In spite of its high toxicity it is still widely employed for the treatment of systemic fungal infections and parasitic disease and different formulations are marketed. Some of these formulations, such as liposomal formulations, can be considered as classical examples of drug targeting. The pharmacokinetics, toxicity and activity are clearly dependent on the type of amphotericin B formulation. New drug delivery systems such as liposomes, nanospheres and microspheres can result in higher concentrations of AMB in the liver and spleen, but lower concentrations in kidney and lungs, so decreasing its toxicity. Moreover, the administration of these drug delivery systems can enhance the drug accessibility to organs and tissues (e.g., bone marrow) otherwise inaccessible to the free drug. During the last few years, new AMB formulations (AmBisome®, Abelcet®, and Amphotec®) with an improved efficacy/toxicity ratio have been marketed. This review compares the different formulations of amphotericin B in terms of pharmacokinetics, toxicity and activity and discusses the possible drug targeting effect of some of these new formulations. © 2007 Wiley-Liss, Inc. and the American Pharmacists Association J Pharm Sci 97:2405,2425, 2008 [source] Non-invasive monitoring of commonly used intraocular drugs against endophthalmitis by raman spectroscopyLASERS IN SURGERY AND MEDICINE, Issue 4 2003K. Hosseini MD Abstract Purpose To develop a non-contact and non-invasive method for quantification of the local concentration of certain antibiotic and antifungal drugs in the eye. Study Design/Materials and Methods An integrated CCD-based Raman spectroscopic system designed specifically for ophthalmic applications was used to non-invasively detect the presence of ceftazidime and amphotericin B in ocular media. Specific Raman signatures of the above named drugs were determined for various concentrations that were injected through a needle in the aqueous humor of rabbit eyes in vivo. Raman spectra were subsequently acquired by focusing an argon laser beam within the anterior chamber of the eye. Results Compared to ocular tissue, unique spectral features of ceftazidime appeared near 1,028, 1,506, 1,586, and 1,641 cm,1. Amphotericin B exhibited its characteristic peaks at 1,156.5 and 1,556 cm,1. The amplitude of the spectral peak corresponding to these drugs (acquired by 1 second exposure time and 25 mW of laser power) were determined to be linearly dependent on their local concentration in the anterior chamber of the eye. Conclusions Raman spectroscopy may offer an effective tool to non-invasively assess the local concentration of the delivered drugs within the ocular media. This technique potentially could be used to investigate the pharmacokinetics of intraocular drugs in vivo either from a releasing implant or a direct injection. Lasers Surg. Med. 32:265,270, 2003. © 2003 Wiley-Liss, Inc. [source] Invasive rhino-orbital fungal sinusitis following dental manipulationMYCOSES, Issue 4 2009Hemant Chopra Summary Rhinocerebral mucormycosis is a fulminant fungal infection of the nose and paranasal sinuses in immunocompromised patients. But mucormycosis following dental manipulation in immunocompetent patients leading to orbital involvement is rare. The objective of this study was to highlight the variable presentations of mucormycosis. We had two immunocompetent patients, who had undergone some dental treatment by quacks, later developed fulminant mucormycosis of the paranasal sinuses and blindness. The endoscopic sinus surgery and Amphotericin B chemotherapy resulted in a good outcome. This disease requires an aggressive approach of combined endoscopic sinus surgery and Amphotericin B to increase the chances of survival in these patients. [source] Zygomycosis , a case report and overview of the disease in IndiaMYCOSES, Issue 4 2007Amit Diwakar Summary A case of zygomycosis caused by Rhizopus oryzae in a diabetic patient previously misdiagnosed as invasive pulmonary aspergillosis and an overview of the disease in India are presented. The case was diagnosed by direct microscopy, histopathologic examination and culture. Following surgical resection of pulmonary cavity under cover of amphotericin B administration, the patient recovered completely. Of 461 cases reported to-date, approximately 70% had been diagnosed at the Postgraduate Institute of Medical Education and Research, Chandigarh, in north India. This may be attributed to better awareness, expertise and infrastructural facilities for mycological diagnosis than to any particular regional preponderance of the disease. Rhino-orbito-cerebral manifestations were the most common feature of zygomycosis (269 cases), followed by cutaneous disease (66 cases), which is in conformity with the pattern prevalent worldwide. The etiologic agents encountered were Rhizopus oryzae, Apophysomyces elegans, Saksenaea vasiformis, Cunninghamella bertholletiae, Absidia corymbifera, Basidiobolus ranarum and Conidiobolus coronatus. In contrast to cases from the developed world where transplant recipients and patients with haematological malignancies seem to be most vulnerable to zygomycosis, the most common risk factor in India was uncontrolled diabetes mellitus. Amphotericin B was the mainstay of various treatment modalities employed. The relevance of a strong clinical suspicion and early diagnosis of zygomycosis for favourable prognosis can hardly be over-emphasised. [source] Agar sublimation test for the in vitro determination of the antifungal activity of morpholine derivativesMYCOSES, Issue 5-6 2004A. Polak Antimykotische Aktivität; Morpholine; Sublimation Summary We studied the in vitro antifungal activities of a wide range of antimycotic agents, including amorolfine, terbinafine, naftifine, five morpholine derivatives, ciclopiroxolamine, bifonazole, clotrimazole, ketoconazole, itraconazole, fluconazole, voriconazole, flucytosine, amphotericin B, nystatin, and caspofungin, against Candida albicans and Trichophyton rubrum by conventional agar diffusion tests and by a novel sublimation method. For the sublimation method, 6 mm filter paper disks were soaked with defined amounts of antimycotic drugs, air dried, placed in the center of the lids of 9 cm Petri dishes, and incubated upside down with inoculated agar plates 10 mm above the disks. The conventional disk diffusion tests produced inhibition zones as previously described. The disk sublimation tests produced large inhibition zones with amorolfine, five amorolfine derivatives, and terbinafine, but with none of the other antifungal agents. Possible therapeutic advantages of agents, which are able to overcome air cavities in mycotic lesions, e.g. in onychomycosis, are discussed. Zusammenfassung Wir untersuchten in vitro die antimykotische Aktivität eines breiten Spektrums von Antimykotika, einschließlich Amorolfin, Terbinafin, Naftifin, fünf Morpholin-Derivaten, Ciclopiroxolamin, Bifonazol, Clotrimazol, Ketoconazol, Itraconazol, Fluconazol, Voriconazol, 5-Fluorcytosin, Amphotericin B, Nystatin und Caspofungin, gegenüber Candida albicans und Trichophyton rubrum mit konventionellen Agardiffusionstesten und mit einer neuartigen Sublimationsmethode. Für die Sublimationsmethode wurden 6 mm-Filterpapier-Blättchen mit definierten Mengen von Antimykotika getränkt, luftgetrocknet, in die Mitte der Deckel von 9 cm-Petrischalen gelegt und mit der inokulierten Agarplatte 10 mm über den Blättchen umgedreht inkubiert. Die konventionellen Agardiffusionsteste produzierten Hemmhöfe wie früher beschrieben. Die Blättchen-Sublimationsteste produzierten große Hemmhöfe mit Amorolfin, fünf Morpholin-Derivaten und Terbinafin, nicht jedoch mit den anderen Antimykotika. Mögliche therapeutische Vorteile von Agentien, die luftgefüllte Hohlräume in mykotischen Läsionen überbrücken können, z. B. im Nagel bei Onychomykose, werden diskutiert. [source] Trichophyton rubrum showing deep dermal invasion directly from the epidermis in immunosuppressed patientsBRITISH JOURNAL OF DERMATOLOGY, Issue 2 2001K.J. Smith Trichophyton rubrum is the most widely encountered dermatophyte infection, and is usually regarded as exclusively keratinophilic often leading to chronic cutaneous and nail infections, even in healthy individuals. We present three patients with acute leukaemias, with ill-defined pre-existent cutaneous eruptions that were treated with a potent topical corticosteroid. All three patients received aggressive marrow toxic chemotherapy. These patients had progression of their cutaneous disease, which showed deep dermal invasion of T. rubrum, invading directly from the epidermis with no evidence of systemic spread. We conclude that systemic pancytopenia, in association with prolonged local immunosuppression, may increase the risk of direct dermal invasion of dermatophyte infections. However, even in these patients, the risk of systemic spread still appears very low. Amphotericin B did not appear effective in treating these dermatophyte infections. [source] ChemInform Abstract: Asymmetric Synthesis of the C(33),C(37) Fragment of Amphotericin B.CHEMINFORM, Issue 25 2001Joakim Tholander Abstract ChemInform is a weekly Abstracting Service, delivering concise information at a glance that was extracted from about 100 leading journals. To access a ChemInform Abstract of an article which was published elsewhere, please select a "Full Text" option. The original article is trackable via the "References" option. [source] Neonatal liver abscesses due to Candida infection effectively treated with caspofunginACTA PAEDIATRICA, Issue 5 2009Luca Filippi Abstract Candidiasis is relatively frequent in neonatal and pediatric intensive care units (ICUs), particularly in preterm infants less than 28 weeks of gestational age. Neonatal candidiasis shows high mortality and is often associated to poor neurodevelopmental prognosis in survivor patients. Amphotericin B and fluconazole are the first choice drugs for the treatment of neonatal candidiasis. Caspofungin is an alternative antifungal agent, which is recommended for invasive candidiasis in adults, but has been poorly experienced in neonates and infants as far as now. We report the first two infants with Candida liver abscesses treated with caspofungin. In the first infant bloodstream and liver lesions were cleared by combination therapy with fluconazole, liposomal amphotericin and caspofungin, while in the second one by caspofungin alone. Conclusion: Our observations confirm the efficacy and tolerability of caspofungin in the treatment of neonatal candidiasis refractory to conventional antifungal drugs. More extensive data are recommended in order to asses a specific neonatal schedule. [source] Correlation between the procedure for antifungal susceptibility testing for Candida spp. of the European Committee on Antibiotic Susceptibility Testing (EUCAST) and four commercial techniquesCLINICAL MICROBIOLOGY AND INFECTION, Issue 6 2005M. Cuenca-Estrella Abstract The correlation between results obtained with the European Committee on Antibiotic Susceptibility Testing (EUCAST) antifungal susceptibility testing procedure (document 7.1) and four commercial systems was evaluated for a collection of 93 clinical isolates of Candida spp. Overall, agreement between the EUCAST procedure and the Sensititre YeastOne and Etest methods was 75% and 90.4%, respectively. The correlation indices (p < 0.01) between the EUCAST and commercial methods were 0.92 for Sensititre YeastOne, 0.89 for Etest, ,,0.90 for Neo-Sensitabs, and 0.95 for Fungitest. Amphotericin B MICs obtained by Sensititre YeastOne were consistently higher than with the EUCAST method and, although very major errors were not observed, 91% of MICs were misclassified. Amphotericin B- and fluconazole-resistant isolates were identified correctly with Sensititre YeastOne, Etest and Fungitest. Neo-Sensitabs identified amphotericin B-resistant isolates, but misclassified >,5% of fluconazole-resistant isolates as susceptible. The commercial methods, particularly Etest and Fungitest, appeared to be suitable alternatives to the EUCAST procedure for antifungal susceptibility testing of clinical isolates of Candida. [source] Pseudallescheria: An underdiagnosed fungus?DIAGNOSTIC CYTOPATHOLOGY, Issue 3 2001Ann E. Walts M.D. Abstract Pseudallescheria has been identified as one of the "clinically significant emerging mycoses" but has received little attention in the cytology literature. Recognition of this fungus is of particular importance clinically, because unlike most other fungi (including Aspergillus, with which it is most frequently confused), Pseudallescheria is not effectively treated with amphotericin B, the most frequently and often the only antifungal agent administered. Features helpful in the diagnosis of Pseudallescheria in cytologic material are presented. Diagn. Cytopathol. 2001;25:153,157. © 2001 Wiley-Liss, Inc. [source] Diagnosis and management of Candida utilis infectious arthritis in a Standardbred fillyEQUINE VETERINARY EDUCATION, Issue 7 2008J. M. Cohen Summary A 3-year-old Standardbred filly was admitted to the hospital for evaluation and management of previously diagnosed infectious arthritis of the right metacarpophalangeal joint (MCPJ). Candida utilis was isolated from multiple synovial samples submitted for bacterial culture and susceptibility. Following treatment with systemic and intra-articular fluconazole and regional limb perfusion with amphotericin B and a second arthroscopic debridement the lameness improved and subsequent cultures were negative for bacterial or fungal growth. Infectious fungal arthritis should be a differential diagnosis for atypical or unresponsive joint infections especially in horses previously treated with a combination of intra-articular corticosteroids and antibiotics. [source] A cost-effectiveness analysis of caspofungin vs. liposomal amphotericin B for treatment of suspected fungal infections in the UKEUROPEAN JOURNAL OF HAEMATOLOGY, Issue 6 2007Karin Bruynesteyn Abstract Objective:, To evaluate the cost-effectiveness of caspofungin vs. liposomal amphotericin B in the treatment of suspected fungal infections in the UK. Methods:, The cost-effectiveness of caspofungin vs. liposomal amphotericin B was evaluated using a decision-tree model. The decision tree was populated using both data and clinical definitions from published clinical studies. Model outcomes included success in terms of resolution of fever, baseline infection, absence of breakthrough infection, survival and quality adjusted life years (QALYs) saved. Discontinuation due to nephrotoxicity or other adverse events were included in the model. Efficacy and safety data were based on additional analyses of a randomised, double blind, multinational trial of caspofungin compared with liposomal amphotericin B. Information on life expectancy, quality of life, medical resource consumption and costs were obtained from peer-reviewed published data. Results:, The caspofungin mean total treatment cost was £9762 (95% uncertainty interval 6955,12 577), which was £2033 (,2489; 6779) less than liposomal amphotericin B. Treatment with caspofungin resulted in 0.40 (,0.12; 0.94) additional QALYs saved in comparison with liposomal amphotericin B. Probabilistic sensitivity analysis found a 95% probability of the incremental cost per QALY saved being within the generally accepted threshold for cost-effectiveness (£30 000). Additional analyses with varying dose of caspofungin and liposomal amphotericin B confirmed these findings. Conclusion:, Given the underlying assumptions, caspofungin is cost-effective compared with liposomal amphotericin B in the treatment of suspected fungal infections in the UK. [source] Co-administration of immunomodulator tuftsin and liposomised nystatin can combat less susceptible Candida albicans infection in temporarily neutropenic miceFEMS IMMUNOLOGY & MEDICAL MICROBIOLOGY, Issue 3 2004Masood A Khan Abstract In order to develop a prospective chemotherapeutic agent against opportunistic infections, it is important to know that host factors such as degree of immunological debility as well as recovery of immune functions to normality may contribute significantly to a successful elimination of the pathogens. We demonstrated previously that concomitant delivery of antimicrobial agents and immunomodulators to the pathogen harbouring-host contributes to the complete elimination of the deep-seated fungal infections (aspergillosis and candidiasis) in animals with normal immune status. Considering that neutropenic hosts are the main targets of such infections, it can be argued about the potential of the immunomodulator-based therapy in subjects with non-functional immune system. To resolve the hypothesis, we studied the role of immunomodulator tuftsin against experimental murine candidiasis in temporarily neutropenic Balb/c mice. The neutropenic mice were challenged with an isolate of Candida albicans that was showing less susceptibility to both free and liposomised-amphotericin B. The co-administration of tuftsin increased the efficiency of liposomised-polyene antibiotics (nystatin and amphotericin B) against experimental murine candidiasis in immunocompromised Balb/c mice. Pretreatment with liposomised tuftsin prior to C. albicans infection clearly enhanced protection against candidiasis, suggesting a prophylactic role of tuftsin in normal and temporarily neutropenic animals. [source] In Candida albicans, resistance to flucytosine and terbinafine is linked to MAT locus homozygosity and multilocus sequence typing clade 1FEMS YEAST RESEARCH, Issue 7 2009Frank C. Odds Abstract A panel of 637 isolates of Candida albicans that had been typed by multilocus sequence typing (MLST) and tested for susceptibility to amphotericin B, caspofungin, fluconazole, flucytosine, itraconazole, ketoconazole, miconazole, terbinafine and voriconazole was the material for a statistical analysis of possible associations between antifungal susceptibility and other properties. For terbinafine and flucytosine, the greatest proportion of low-susceptibility isolates, judged by two resistance breakpoints, was found in MLST clade 1 and among isolates homozygous at the MAT locus, although only three isolates showed cross-resistance to the two agents. Most instances of low susceptibility to azoles, flucytosine and terbinafine were among oropharyngeal isolates from HIV-positive individuals. Statistically significant correlations were found between terbinafine and azole minimal inhibitory concentrations (MICs), while correlations between flucytosine MICs and azole MICs were less strong. It is concluded that a common regulatory mechanism may operate to generate resistance to the two classes of agent that inhibit ergosterol biosynthesis, terbinafine and the azoles, but that flucytosine resistance, although still commonly associated with MAT homozygosity, is differently regulated. [source] High-dose methylprednisolone influences the physiology and virulence of Candida albicans ambiguously and enhances the candidacidal activity of the polyene antibiotic amphotericin B and the superoxide-generating agent menadioneFEMS YEAST RESEARCH, Issue 2 2007Ágnes Gyetvai Abstract Although exposure of Candida albicans cells to high-dose (4 mM) methylprednisolone stimulated microbial growth, germination rate in serum and phospholipase release, it also promoted the recognition of C. albicans cells by polymorphonuclear leukocytes. Pretreatment of C. albicans cells with methylprednisolone did not result in any increase in the pathogenicity of the fungus in intraperitoneal and intravenous mouse assays. Therefore, the virulence of C. albicans is unlikely to increase in patients treated with comparably high-dose methylprednisolone on skin and mucosal membranes. Methylprednisolone treatments also increased the production of conjugated dienes and thiobarbituric acid-reactive substances, and the menadione sensitivity of C. albicans cells, which can be explained by a significant decrease in the specific activities of several antioxidant enzymes. The combination of methylprednisolone with oxidants, e.g. in topical applications, may be of clinical importance when the predisposition to candidiasis is high. Methylprednisolone treatments negatively affected membrane fluidity and decreased the antifungal effects of both the polyene antibiotic nystatin and the ergosterol biosynthesis inhibitor lovastatin, and also enhanced the deleterious effects of the polyene antimycotic amphotericin B on C. albicans cells. These corticosteroid,polyene drug interactions should be considered in the treatment of C. albicans infections in patients with prolonged topical application of corticosteroids. [source] A case of mucormycosis limited to the parotid glandHEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 12 2005Arun Chandu BDSc, FDSRCS(Eng), MBBS(Hons) Abstract Background. Mucormycosis is a rare fungal infection commonly affecting structures in the head and neck such as air sinuses, orbits, and the brain. Common predisposing factors include diabetes and immunosuppression. To date, only one case of mucormycosis involving the parotid gland has been reported, and this infection was associated with a fatal outcome. Methods. We report a case of parotid gland mucormycosis in a 45-year-old woman with type 2 diabetes, who was successfully treated with a superficial parotidectomy and intravenous amphotericin B. Results. After initial surgical and antifungal therapy, the patient was left with a residual facial nerve palsy for which multiple sling procedures were performed. She is currently alive and well 6 years after the diagnosis of mucormycosis. Conclusions. Mucormycosis of the parotid gland is a rare form of this often-fatal infection. In this case, infection remained isolated to the parotid gland and was diagnosed soon after presentation. The patient most likely survived because of the early diagnosis, successful surgical removal of all infected tissue, use of intravenous amphotericin therapy, and the aggressive management of comorbidities such as her diabetes. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX,XXX, 2005 [source] Disseminated cutaneous Fusarium moniliforme infections in a leukemic childINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 5 2007Ching-Chi Chi MD A 5-year-old boy had a 10-month remission of acute lymphocytic leukemia (ALL) after chemotherapy. Re-induction chemotherapy was performed for relapse of ALL. Thereafter, he suffered from an episode of neutropenic fever with pneumonia. One week following control of the condition with antibiotics, a 1 × 1-cm, red, painful nodule appeared on the left thigh, which was initially suspected to be Pseudomonas infection. Parenteral ceftazidime and amikacin were administered, but persistent high fever, mild cough, and a few painful erythematous papulonodules on the face and lower extremities appeared several days later (Fig. 1). These lesions increased insidiously in diameter up to 2,5 cm with central necrosis. Hemogram showed neutropenia with a shift to the left [white blood cell (WBC) count, 2.1 × 109/L; neutrophil count, 0.21 × 109/L]. A skin biopsy showed heavy growth of hyaline branching septate hyphae in the deep dermis and subcutis, together with fat necrosis (Fig. 2). Invasion of molds into vessels and sweat glands was also seen. A culture from a lesion yielded Fusarium moniliforme, but no fungi were isolated from blood specimens. Only mild infiltrations on bilateral lower lung fields were detected by chest roentgenography. The skin lesions gradually healed and the fever subsided 2 weeks after the initiation of therapy with amphotericin B 30 mg and itraconazole 200 mg daily. Figure 1. A few painful erythematous papulonodules appeared on the face and lower extremities Figure 2. Skin biopsy showed heavy growth of hyaline branching septate hyphae in the deep dermis and subcutis along with fat necrosis (hematoxylin and eosin, ×400) Meanwhile, relapse of leukemia was detected by hemogram showing atypical leukocytosis (WBC count of 24,400 × 109/L, with blast cells representing 78%). A course of chemotherapy with cytarabine, mitoxantrone, and VP-16 was prescribed, subsequently resulting in neutropenia (WBC count, < 0.1 × 109/L; neutrophil count, 0/L) and spiking fever. Although the aforementioned antifungal therapy was continued, the centers of the originally healed lesions turned dusky red, swollen, necrotic, and ulcerative. There were more than 10 such ecthymiform lesions. After administration for 22 days, itraconazole was discontinued because of no appreciable effects. Granulocyte colony-stimulating factor (G-CSF) salvage was used, and the neutropenia gradually subsided 20 days later. In addition, the ecthymiform lesions gradually resolved. Amphotericin B was discontinued 1 week following neutrophil recovery. The patient died of Acinetobacter baumannii and Stenotrophomonas maltophilia sepsis 8 months later. [source] Solitary embolic cutaneous aspergillosis in the immunocompromised patient with acute myelogenous leukemia , a propos another case caused by Aspergillus flavusINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 12 2003Aleksandar L. Krunic MD A 68-year-old male with acute myelogenous leukemia was admitted for consolidation chemotherapy. The in-hospital course was complicated by neutropenia, fever and nodular pulmonary opacities suggestive of multifocal pneumonia. The patient subsequently developed a single, solitary necrotic crusted nodule on the right cheek. Skin biopsy demonstrated embolic vascular invasion with septate hyphae, dichotomous branching and minimal inflammation. Tissue culture revealed Aspergillus flavus. Despite systemic antifungal therapy with amphotericin B and granulocyte transfusions, the patient developed respiratory failure and died of disseminated aspergillosis, sepsis and renal failure. The clinical presentation of disseminated infection with Aspergillus flavus as a solitary embolic cutaneous lesion is extremely rare. We have reviewed other cases described in the literature and suggest this pattern of cutaneous involvement as more typical of disseminated infection with Aspergillus flavus. [source] Cost-effective use of liposomal amphotericin BINTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY, Issue 5 2002B. O'Connell No abstract is available for this article. [source] Particulate contamination of lyophilized amphotericin B preparation during reconstitution processJOURNAL OF CLINICAL PHARMACY & THERAPEUTICS, Issue 2 2001T. Sendo Objective:,To investigate the effect of the reconstitution methods for the commercial amphotericin B preparation with respect to particulate contamination. Methods:,The particle counts in amphotericin B solutions reconstituted according to three different methods and amphotericin B fluids made with intravenous fluids after reconstitution were performed using a light extinction method. The particle contaminants were identified with X-ray emission spectrometry attached to a scanning electron microscope. Results:,Amphotericin B in a vial induced particle contamination during the reconstitution process, and the contamination was especially marked by shaking vigorously after injecting water into the vial. From the X-ray analysis, it appeared that the increased number of particles was derived from the amphotericin B,deoxycholate complex containing substances such as silicone released from the vial components. Amphotericin B fluid made with intravenous fluids after reconstitution also contained particles over the acceptable limits according to the Japanese or US pharmacopoeia. Conclusion:,These findings suggest that reconstituted solutions should be filtered with membrane filters and diluted fluids with in-line filters. [source] Discordant influence of amphotericin B on epirubicin cytotoxicity in primary hepatic malignant cells collected by a new primary culture techniqueJOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 2 2006ZU-YAU LIN Abstract Background:, The purpose of this prospective study was to investigate whether amphotericin B (AmB) had any potential role in the systemic chemotherapy of primary hepatic malignancy using cancer cells collected by the authors' method of primary culture. Methods:, The specimens obtained by ultrasound-guided fine-needle aspiration biopsy (22 G) from 15 patients with hepatocellular carcinoma (HCC) and one with cholangiocarcinoma were plated into culture flask without disaggregation by trypsin-ethylenediamine tetra-acetic acid solution. Six patients with HCC and one patient with cholangiocarcinoma (7/16, 44%) had successful culture and the cancer cells at the 4th passage were continuously exposed to therapeutic ranges of epirubicin (0, 0.5, 1.0, 1.5, 2.0 µg/mL) with or without the combination of 2.5 µg/mL AmB for 24 h. 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay was applied to evaluate the effects of the drugs. A human HCC cell line (HA 22T/VGH) was studied for comparison. Results:, Addition of AmB showed no influence on epirubicin cytotoxicity in two patients (one partial resistant HCC and one epirubicin-sensitive cholangiocarcinoma; 25%), augmentation of the epirubicin cytotoxicity in two patients (one total resistant HCC, partial resistant HA 22T/VGH cell line and one epirubicin-sensitive HCC; 37.5%), and decrease of epirubicin cytotoxicity in the remaining three (one partial resistant and two epirubicin-sensitive HCC; 37.5%). Conclusions:, Amphotericin B has a discordant influence on epirubicin cytotoxicity in primary cultured hepatic malignant cells. Application of AmB in the systemic chemotherapy of primary hepatic malignancy should be limited to patients with positive AmB effect evaluated by an in vitro sensitivity test such as the present method. [source] Absorption of tobramycin and amphotericin B during SDD in a patient with a bowel perforationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 3 2009D. Posthouwer No abstract is available for this article. [source] Heterogeneity in antifungal susceptibility of clones of Candida albicans isolated on single and sequential visits from a HIV-infected southern Chinese cohortJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 6 2001Y. H. Samaranayake Abstract: The increased frequency and severity of candidal infections in human immunodeficiency virus (HIV)-infected individuals has prompted the wide use of antifungals, such as amphotericin B, ketoconazole, and fluconazole, resulting in the emergence of drug-resistant strains of Candida albicans. To study this phenomenon in an ethnic Chinese cohort, we isolated multiple colonies of Candida from the oral cavities of 16 HIV-infected patients on single and subsequent sequential visits over a period of 12 months. Ten of the 16 patients had sporadic episodes of oropharyngeal candidiasis (Group A), while the remainder were asymptomatic with respect to this condition (Group B). Oral rinses were collected and immediately processed in the laboratory for the isolation of C. albicans in a standard manner. A total of 433 C. albicans isolates were tested for their susceptibility to amphotericin B, ketoconazole and fluconazole by an agar diffusion method using the commercially available E-test. All tested isolates demonstrated variable susceptibility to amphotericin B, ketoconazole and fluconazole. The minimum inhibitory concentration (MIC) of the isolates for amphotericin B, ketoconazole and fluconazole ranged from <0.002,1.5 ,g/ml, <0.002,4.0 ,g/ml and <0.016,32 ,g/ml, respectively. Sequential isolates of a few patients demonstrated variable susceptibility to all the antifungals, and no discernible MIC pattern emerged either in group A or B over time. Interestingly, significant variation in antifungal susceptibility was also noted in isolates obtained from the same patient on a single visit. Sequential yeast isolates in 9 of 16 patients (56%) demonstrated significant differences in MIC within and between visits for both amphotericin B and ketoconazole, while a lower percentage , 44% (7/16) , exhibited this trait for fluconazole. Our study demonstrates the diversity in antifungal susceptibility in either commensal or "infective" oral strains of C. albicans in HIV disease, and shows the need for vigilance for the emergence of resistant strains, and for frequent antifungal susceptibility studies. [source] Sub-therapeutic exposure to polyene antimycotics elicits a post-antifungal effect (PAFE) and depresses the cell surface hydrophobicity of oral Candida albicans isolatesJOURNAL OF ORAL PATHOLOGY & MEDICINE, Issue 5 2000H. Egusa Abstract: Post-antifungal effect (PAFE) is defined as the suppression of growth that persists following limited exposure of fungi to antimycotics and subsequent removal of the drug. The fungal pathogen Candida albicans is the major aetiologic agent of oral candidosis, and the cell surface hydrophobicity (CSH) of this yeast is considered a critical factor contributing to its colonisation potential. As the concentration of topically prescribed antifungals reach sub-therapeutic levels at dosage intervals, the study of the polyene-induced PAFE and its impact on the CSH of oral C. albicans should be of clinical relevance. Hence the aims of this investigation were to measure the PAFE and CSH of 12 isolates of C. albicans following limited exposure (1 h) to nystatin and amphotericin B and also to investigate the ultrastructural features of yeast cells following such antifungal exposure. The yeasts were exposed to sub-lethal concentrations of nystatin (×2 MIC) and amphotericin B (×2 MIC) for a period of 1 h. Following subsequent removal of the drug, the PAFE and the CSH of the isolates were assessed by a turbidometric measurement of growth and a biphasic aqueous-hydrocarbon assay, respectively. The mean duration of PAFE of nystatin and amphotericin B were 5.99 (±0.49) h and 8.73 (±0.93) h, respectively, while the reduction in CSH following exposure to these drugs were 17.32% (P<0.05 for 83% of the isolates) and 14.26% (P<0.05 for 66% of the isolates), respectively. On scanning electron microscopy the exposed cells were seen to undergo collapse of the internal cell membrane, leaving an intact cell wall, while a proportion of cells were deflated. Some cells showed intense puckering of the cell wall, resulting in a mulberry appearance. Taken together, these data elucidate additional mechanisms by which polyene antimycotics may operate in vivo to suppress candidal pathogenicity. [source] Successful treatment of cutaneous and subcutaneous zygomycosis in an immunosuppressed patient with aplastic anaemiaJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2007Yumin Chan Abstract: Zygomycosis in patients with persistent neutropenia had been associated with poor outcomes despite aggressive surgical and antifungal therapy. We describe the case of a 10-year-old girl with aplastic anaemia and persistent neutropenia who developed cutaneous and subcutaneous zygomycosis of her right thigh that was successfully treated with extensive surgical debridement, intravenous liposomal amphotericin B, later changed to oral posaconazole for long-term suppressive therapy and granulocyte colony stimulating factor. [source] | ||||||||||||||||||||||||||||||||||||||||