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Kato H, Hagihara M, Yamagishi Y, Shibata Y, Kato Y, Furui T, Watanabe H, Asai N, Koizumi Y, Mikamo H. The evaluation of frequency of nephrotoxicity caused by liposomal amphotericin B. J Infect Chemother 2018; 24:725-728. [PMID: 29773439 DOI: 10.1016/j.jiac.2018.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 04/04/2018] [Accepted: 04/23/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Liposomal amphotericin B (L-AmB) was developed to reduce nephrotoxicity and maximize the therapeutic utility of amphotericin B in the treatment of invasive fungal infections. However, there is little investigation into the safety of L-AmB in patients with several renal functions. Therefore, we retrospectively evaluated the clinical safety of L-AmB among patients with several renal functions. METHODS We divided patients treated with L-AmB from April 2014 to September 2016 into 4 groups (estimated glomerular filtration rate (eGFR)≥60, 60 > eGFR≥30, eGFR<30 and hemodialysis). The main endpoint was the incidence of nephrotoxicity and the difference in the serum creatinine values at the end of L-AmB treatment as compared with baseline. RESULTS The incidence of nephrotoxicity was not significantly different among four groups (eGFR≥60; 27.0%, 60 > eGFR≥30; 30.8%, eGFR<30; 50.0%, hemodialysis; 40.0%, p = 0.56).Only one group of patients with eGFR≥60 admitted the significant increase of serum creatinine value after L-AmB treatment started (p < 0.01). Patients admitted 0.5 mg/dL or more of increase in serum creatinine values until 9 days from the L-AmB therapy started (eGFR≥60; 5.0 days [3.0-8.0 days], 60 > eGFR≥30; 5.0 days [4.0-9.0 days], eGFR<30; 4.5 days [3.0-5.0 days], hemodialysis; 5.5 days [4.0-7.0 days], p = 0.46). CONCLUSION Take previous clinical study results together, our data suggested that L-AmB is safer agent than amphotericin B for the treatment of fungal infections in patients with eGFR<60 and hemodialysis patients at the start of treatment. Also, especially, we should use L-AmB more carefully until 9 days from the treatment started.
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Affiliation(s)
- Hideo Kato
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | - Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yuichi Shibata
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | - Yukiko Kato
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | - Tatsuro Furui
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | - Hiroki Watanabe
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Yusuke Koizumi
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan; Department of Infection Control and Prevention, Aichi Medical University Hospital, Japan.
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Heimann SM, Vehreschild MJGT, Cornely OA, Heinz WJ, Grüner B, Silling G, Kessel J, Seidel D, Vehreschild JJ. Healthcare burden of probable and proven invasive mucormycosis: a multi-centre cost-of-illness analysis of patients treated in tertiary care hospitals between 2003 and 2016. J Hosp Infect 2018; 101:339-346. [PMID: 30423409 DOI: 10.1016/j.jhin.2018.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 11/05/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Invasive mucormycosis (IM) is a rare invasive fungal infection with a high mortality rate. However, data concerning the clinical and economic burden of IM are scarce. AIM To evaluate the direct treatment costs and additional expenditures of patients with IM. METHODS A retrospective cost-of-illness analysis of cases with IM extracted from FungiScope - Global Registry for Emerging Fungal Infections, accessible through the epidemiological research platform www.ClinicalSurveys.net, was undertaken. Results of patients with IM were compared with those of matched patients with similar underlying conditions based on the German Diagnosis Related Group (G-DRG) coding. FINDINGS Out of 46 patients with probable/proven IM, 31 (67%) patients were male and the median age was 53 years (range 11-88 years). Forty-two patients (92%) had haematological diseases as the most common risk factor. Analysis of cost factors identified antifungal treatment due to IM as the primary cost driver [€22,816, 95% confidence interval (CI) €15,036-32,346], with mean overall direct treatment costs of €53,261 (95% CI €39,660-68,825). Compared with matched patients, patients with IM were treated in hospital for 26.5 additional days (standard deviation 31.8 days; P < 0.001), resulting in mean additional costs of €32,991 (95% CI €21,558-46,613; P < 0.001). Probable IM, as well as absence of chemotherapy, surgical measures due to IM, and antifungal prophylaxis were associated with lower overall costs. Nineteen patients (41.3%) died during hospitalization. CONCLUSION This study demonstrates the considerable healthcare burden of IM. The choice of antifungal agent for treatment of IM had no impact on overall cost.
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Affiliation(s)
- S M Heimann
- University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany.
| | - M J G T Vehreschild
- University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
| | - O A Cornely
- University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany; Clinical Trials Centre Cologne, ZKS Köln, and Cluster of Excellence, Cellular Stress Responses in Aging-Associated Diseases, University of Cologne, Cologne, Germany
| | - W J Heinz
- University of Würzburg Medical Centre, Med. Clinic II, Würzburg, Germany
| | - B Grüner
- University Medical Centre Ulm, Comprehensive Infectious Disease Centre, Ulm, Germany
| | - G Silling
- Department of Haematology, Oncology, Haemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Aachen, Germany
| | - J Kessel
- University Hospital of Frankfurt, Department II of Internal Medicine, Infectiology, Frankfurt/Main, Germany
| | - D Seidel
- University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany
| | - J J Vehreschild
- University Hospital of Cologne, Department I of Internal Medicine, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany
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Adamczick C, Dierig A, Welzel T, Schifferli A, Blum J, Ritz N. Double trouble: visceral leishmaniasis in twins after traveling to Tuscany - a case report. BMC Infect Dis 2018; 18:495. [PMID: 30285634 PMCID: PMC6167882 DOI: 10.1186/s12879-018-3394-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 09/18/2018] [Indexed: 12/05/2022] Open
Abstract
Background Leishmaniasis is endemic in many countries worldwide, with a prevalence of 12 million people infected, and an estimated annual incidence of 500 000 visceral leishmaniasis cases. In Europe visceral leishmaniasis is considered endemic mainly in the Mediterranean countries and cases in non-endemic European countries north of the Alps have primarily been reported in returning travellers. The incubation period is typically described between 6 weeks to 6 months. The cases presented highlight the occurrence of longer incubation periods and illustrate the individual variability for progression from infection to disease. Case presentation We report the cases of 18-months-old twin girls living at the German-Swiss border, who developed visceral leishmaniasis 7 and 15 months after travelling to Tuscany. They presented with fever of unknown origin and pancytopenia. Both had splenomegaly and in the first case haemophagocytic lymphohistiocytosis or leukaemia was initially included in the differential diagnosis. Diagnosis of visceral leishmaniasis was confirmed by presence of intracytoplasmic localised leishmania parasites on bone marrow aspirate and/or positive leishmania serology. Both girls responded well to treatment with liposomal amphotericin B. The mother and two older siblings remained uninfected, while the father was diagnosed to be an asymptomatic carrier. Conclusion Visceral leishmaniasis is an important differential diagnosis for fever of unknown origin and pancytopenia in young children living in countries with endemic disease and highlights the importance of obtaining a detailed travel history. Hemophagocytic lymphohistiocytosis and acute leukaemia present with similar symptoms and consequently are important differential diagnoses. Factors determining progression from infection to disease are not fully understood but younger age seems to be an important risk factor. Screening of siblings from affected individuals therefore may be warranted.
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Affiliation(s)
- Charlotte Adamczick
- German Association for Tropical Paediatrics and International Child Health, Frankfurt, Germany
| | - Alexa Dierig
- University Children's Hospital Basel, Paediatric Infectious Diseases and Vaccinology, University of Basel, Basel, Switzerland
| | - Tatjana Welzel
- University Children's Hospital Basel, Department of Haematology/Oncology, University of Basel, Basel, Switzerland.,University Children's Hospital Basel, Paediatric Pharmacology, University of Basel, Basel, Switzerland
| | - Alexandra Schifferli
- University Children's Hospital Basel, Department of Haematology/Oncology, University of Basel, Basel, Switzerland
| | - Johannes Blum
- Swiss Public Health and Tropical Institute, University of Basel, Basel, Switzerland
| | - Nicole Ritz
- University Children's Hospital Basel, Paediatric Infectious Diseases and Vaccinology, University of Basel, Basel, Switzerland. .,University Children's Hospital Basel, Paediatric Pharmacology, University of Basel, Basel, Switzerland. .,Department of Paediatrics, The University of Melbourne, Parkville, Australia. .,Infectious Diseases and Vaccinology, University Children's Hospital Basel, Spitalstrasse 33, CH-4031, Basel, Switzerland.
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Abstract
Mucormycoses were difficult-to-manage infections owing to limited diagnostic tools and therapeutic options. We review here advances in pathology understanding, diagnostic tools including computed tomography, and serum polymerase chain reaction and therapeutic options.
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Affiliation(s)
- Benoit Pilmis
- Paris Descartes University, Sorbonne Paris Cité, Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Imagine Institute, Paris, France.,Antimicrobial Stewardship Team, Microbiology Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Alexandre Alanio
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Parasitologie-Mycologie, Hôpital Saint-Louis, Groupe Hospitalier Lariboisière, Saint-Louis, Fernand Widal, AP-HP, Paris, France.,Molecular Mycology Unit, Institut Pasteur, CNRS UMR2000, Paris, France.,Centre National de Référence Mycoses invasives et Antifongiques, Institut Pasteur, Paris, France
| | - Olivier Lortholary
- Paris Descartes University, Sorbonne Paris Cité, Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Imagine Institute, Paris, France.,Molecular Mycology Unit, Institut Pasteur, CNRS UMR2000, Paris, France.,Centre National de Référence Mycoses invasives et Antifongiques, Institut Pasteur, Paris, France
| | - Fanny Lanternier
- Paris Descartes University, Sorbonne Paris Cité, Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Imagine Institute, Paris, France.,Molecular Mycology Unit, Institut Pasteur, CNRS UMR2000, Paris, France.,Centre National de Référence Mycoses invasives et Antifongiques, Institut Pasteur, Paris, France
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Mosimann V, Neumayr A, Paris DH, Blum J. Liposomal amphotericin B treatment of Old World cutaneous and mucosal leishmaniasis: A literature review. Acta Trop 2018; 182:246-50. [PMID: 29550282 DOI: 10.1016/j.actatropica.2018.03.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/20/2018] [Accepted: 03/10/2018] [Indexed: 11/22/2022]
Abstract
Old World cutaneous and mucosal leishmaniasis is a potentially serious disease. Systemic treatment approaches with pentavalent antimonials, liposomal amphotericin B, fluconazole and miltefosine are increasingly used despite the absence of supportive evidence - to date, no prospective clinical trials have been conducted for systemic treatment of these diseases. We performed a literature search to delineate the contemporary evidence for the use of liposomal amphotericin B, and found that although cure rates of 17/20 (85%) were achieved in immune competent patients with Old World cutaneous leishmaniasis and cure rates of 10/13 (77%) for Old World mucosal leishmaniasis due to L. infantum, the available data is highly limited with high variation in total treatment dosages. The presented findings reflect a lack of consensus on the optimal treatment dosage and on the schedule of application.
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56
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Navarro-Rodríguez P, Guevara-Suarez M, Paredes K, Celis A, Guarro J, Capilla J. Lack of correlation of ECV and outcome in an in vivo murine model of systemic fusariosis. Diagn Microbiol Infect Dis 2018; 92:124-6. [PMID: 30201117 DOI: 10.1016/j.diagmicrobio.2018.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/17/2018] [Accepted: 05/23/2018] [Indexed: 01/30/2023]
Abstract
The efficacy of liposomal amphotericin B and voriconazole was evaluated against the systemic infection by Fusarium oxysporum species complex or Fusarium keratoplasticum. Although MIC values were within the epidemiological cutoff values (ECVs) recently stablished for Fusarium spp., no efficacy was obtained, indicating that ECVs for Fusarium are not relevant for in vivo efficacy.
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Dias Tourinho B, Figueiredo Amâncio F, Lencine Ferraz M, Carneiro M. Prognostic factors for death from visceral leishmaniasis in patients treated with liposomal amphotericin B in an endemic state in Brazil. Trans R Soc Trop Med Hyg 2018; 111:163-171. [PMID: 28673017 DOI: 10.1093/trstmh/trx029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/31/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To characterize the clinical and epidemiological profiles of patients with visceral leishmaniasis (VL) treated with liposomal amphotericin B (LAmB) and to identify prognostic factors for death from VL in 2008-2012 in the state of Minas Gerais, Brazil. Methods A historical cohort study was conducted using data obtained from treatment requests forms, Brazilian Notifiable Disease Information System and the Mortality Information System. Case-fatality rates of patients with VL treated with LAmB were compared with patients treated with other therapies. Logistic regression analysis was used to identify prognostic factors for death. Results The overall case-fatality rate of the 577 patients treated with LAmB was 19.4%. Prognostic factors for death from VL were age between 35 and 49 years (OR 2.7; 95% CI 1.3-5.4) and above 50 years (OR 2.6; 95% CI 1.3-4.9), jaundice (OR 2.2; 95% CI 1.2-3.7), kidney disease (OR 2.8; 95% CI 1.6-4.9), presence of other infections (OR 2.4; 95% CI 1.5-4.1), edema (OR 2.0; 95% CI 1.1-3.4), platelet count below 50.000/mm3 (OR 3.6; 95% CI 2.1-6.0), AST higher than 100 U/L (OR 2.2; 95% CI 1.3-3.8), and assistance in non-specialized institutions (OR 1.9; 95% CI 1.0-3.5). Conclusions Case-fatality rates were higher than that observed among patients with VL treated with other therapies. Identification of prognostic factors of death from VL may allow early diagnosis of patients prone to such outcome and prompt an expeditious and appropriate management of VL to reduce fatality rates.
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Affiliation(s)
- Bruna Dias Tourinho
- Programa de Pós Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130 Belo Horizonte, Brazil.,Diretoria de Vigilância Ambiental, Superintendência de Vigilância Epidemiológica, Ambiental e Saúde do Trabalhador, Subsecretaria de Vigilância em Saúde, Secretaria de Estado de Saúde de Minas Gerais, 30130 Belo Horizonte, Minas Gerais, Brazil.,Laboratório de Epidemiologia de Doenças Infecciosas e Parasitárias, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, 30130 Belo Horizonte, Minas Gerais, Brazil
| | | | - Marcela Lencine Ferraz
- Diretoria de Vigilância Ambiental, Superintendência de Vigilância Epidemiológica, Ambiental e Saúde do Trabalhador, Subsecretaria de Vigilância em Saúde, Secretaria de Estado de Saúde de Minas Gerais, 30130 Belo Horizonte, Minas Gerais, Brazil
| | - Mariângela Carneiro
- Programa de Pós Graduação em Ciências da Saúde, Infectologia e Medicina Tropical, Faculdade de Medicina, Universidade Federal de Minas Gerais, 30130 Belo Horizonte, Brazil.,Laboratório de Epidemiologia de Doenças Infecciosas e Parasitárias, Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, 30130 Belo Horizonte, Minas Gerais, Brazil
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58
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Stewart ER, Eldridge ML, McHardy I, Cohen SH, Thompson GR. Liposomal Amphotericin B as Monotherapy in Relapsed Coccidioidal Meningitis. Mycopathologia 2018; 183:619-622. [PMID: 29340909 DOI: 10.1007/s11046-017-0240-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/18/2017] [Indexed: 02/01/2023]
Abstract
Coccidioidal meningitis remains a difficult clinical problem, and despite life-long therapy with triazole antifungals, relapses of disease and medication intolerance occur necessitating salvage treatment. We report two patients with recurrent coccidioidal meningitis who improved following a 2-week course of liposomal amphotericin B monotherapy and discuss potential advantages of this treatment option.
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Affiliation(s)
- Ethan R Stewart
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, 4150 V Street, Suite G500, Sacramento, CA, 95817, USA
| | - Matthew L Eldridge
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, 4150 V Street, Suite G500, Sacramento, CA, 95817, USA
| | - Ian McHardy
- Department of Medical Microbiology and Immunology, Department of Medicine, Division of Infectious Diseases, University of California - Davis, One Shields Ave, Tupper Hall, Rm 3138, Davis, CA, 95616, USA
| | - Stuart H Cohen
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, 4150 V Street, Suite G500, Sacramento, CA, 95817, USA
| | - George R Thompson
- Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, 4150 V Street, Suite G500, Sacramento, CA, 95817, USA. .,Department of Medical Microbiology and Immunology, Department of Medicine, Division of Infectious Diseases, University of California - Davis, One Shields Ave, Tupper Hall, Rm 3138, Davis, CA, 95616, USA.
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59
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Grazziotin LR, Moreira LB, Ferreira MAP. COMPARATIVE EFFECTIVENESS AND SAFETY BETWEEN AMPHOTERICIN B LIPID-FORMULATIONS: A SYSTEMATIC REVIEW. Int J Technol Assess Health Care 2018; 34:343-351. [PMID: 29897025 DOI: 10.1017/s026646231800034x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES It is not yet established the advantages between amphotericin B lipid complex (ABLC) and liposomal (L-AmB) in patients with invasive fungal infections refractory to usual doses of conventional AmB (d-AmB), previous renal impairment, or unacceptable d-AmB renal toxicity. This systematic review aims to compare ABLC and L-AmB effectiveness and safety outcomes in these subgroups of patients. METHODS The search was performed on Medline, Cochrane Library, EMBASE, and LILACS databases. INCLUSION CRITERIA treatment comparing L-AmB with ABLC; patients who had (i) refractory infection after being treated with d-AmB, (ii) previous renal impairment, or (iii) unacceptable d-AmB toxicity. Two investigators independently screened the search results, assessed trial quality, and extracted data. A total of 1,054 articles were identified in the literature. Among those, eleven were selected for full-text reading and five met the inclusion criteria. RESULTS The five articles included reported on four separate observational studies. Overall, no significant difference was found in clinical relevant outcomes as new-onset dialysis, length of hospital stay, or mortality when comparing both lipid formulations. The studies reported a trend toward lower nephrotoxicity in patients treated with L-AmB. However, the results were imprecise and heterogeneous and the studies presented important methodological biases. CONCLUSIONS The studies included in this systematic review pointed toward less nephrotoxicity events in the L-AmB group. However, due to low quality of evidence and no statistically significant differences in other clinical relevant outcomes, there is no definitive evidence of overall superiority in effectiveness or safety outcomes regarding one lipid formulation or another in this population subgroup.
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Karigane D, Sakurai M, Matsuyama E, Ide K, Yamamoto-Takeuchi S, Inazumi T, Kohashi S. Successful treatment of breakthrough disseminated Trichosporon asahii fungemia in a patient with acute myeloid leukemia receiving itraconazole prophylaxis. Med Mycol Case Rep 2017; 20:1-3. [PMID: 29264110 PMCID: PMC5726745 DOI: 10.1016/j.mmcr.2017.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 11/26/2017] [Indexed: 11/15/2022] Open
Abstract
We encountered a case of a 73-year-old man with acute myeloid leukemia who developed Trichosporon asahii systemic infection while on itraconazole prophylaxis during severe neutropenia. Cryptococcal antigen was useful for diagnosis. Although itraconazole was ineffective in protecting against trichosporonosis, treatment was successful with voriconazole following liposomal amphotericin B.
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Affiliation(s)
- Daiki Karigane
- Department of Hematology, Tachikawa Hospital, Tokyo 190-8531, Japan
| | | | - Emiko Matsuyama
- Department of Hematology, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Kentaro Ide
- Department of Hematology, Tachikawa Hospital, Tokyo 190-8531, Japan
| | | | - Toyoko Inazumi
- Department of Dermatology, Tachikawa Hospital, Tokyo 190-8531, Japan
| | - Sumiko Kohashi
- Department of Hematology, Tachikawa Hospital, Tokyo 190-8531, Japan
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Yamazaki H, Kondo T, Aoki K, Yamashita K, Takaori-Kondo A. Occurrence and improvement of renal dysfunction and serum potassium abnormality during administration of liposomal amphotericin B in patients with hematological disorders: A retrospective analysis. Diagn Microbiol Infect Dis 2017; 90:123-131. [PMID: 29203252 DOI: 10.1016/j.diagmicrobio.2017.10.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 08/16/2017] [Accepted: 10/27/2017] [Indexed: 12/19/2022]
Abstract
Liposomal amphotericin B (L-AMB) has the potential to cause two major adverse events, renal dysfunction and serum potassium abnormality; however, appropriate clinical management of these events remains unclear. We retrospectively analyzed data regarding 128 hematology patients who received L-AMB in our institute and examined the association between clinical characteristics and renal dysfunction or serum potassium abnormality. We found that the median weight-normalized dose of L-AMB was 2.69mg/kg and the median administration period was 16days. The overall occurrence rates of renal dysfunction and hypokalemia were 55.7% and 76.6%, respectively. Multivariate analysis revealed that pre-existing renal dysfunction (P=0.017) and concomitant use of nephrotoxic (P<0.0001) or antifungal drugs (P=0.012) were independent risk factors for renal dysfunction. A higher infusion volume did not mitigate the risk of renal dysfunction. Hypokalemia occurred significantly less often in men (P=0.028) and in patients who concomitantly used nephrotoxic drugs (P=0.013). Approximately 40% of the adverse events were improved at 30days after L-AMB termination and there was no significant association between these adverse events improvement and L-AMB dosage or infusion volume. Of note, hyperkalemia was observed in more patients who received allogeneic hematopoietic stem cell transplantation (P=0.0303) and concomitant treatment with nephrotoxic drugs (P=0.0281). These results suggest that imprudent reduction of L-AMB dose or redundant intravenous infusion may have minimal benefit for critical patients with suspected invasive fungal infection.
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Affiliation(s)
- Hiroyuki Yamazaki
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadakazu Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan..
| | - Kazunai Aoki
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kouhei Yamashita
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akifumi Takaori-Kondo
- Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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62
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Mays JA, Greene DN, Poon A, Merrill AE. Pseudohypophosphatemia associated with high-dose liposomal amphotericin B therapy. Clin Biochem 2017; 50:967-971. [PMID: 28578095 DOI: 10.1016/j.clinbiochem.2017.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/17/2017] [Accepted: 05/25/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hypophosphatemia is commonly observed in critically ill patients. Inorganic phosphorus is quantified by spectrophotometric measurement of a phosphomolybdate complex, a method with multiple documented interferents. Our clinical laboratory was contacted to investigate a case of asymptomatic hypophosphatemia in a patient receiving high-dose liposomal amphotericin B therapy (L-AMB). METHODS In vitro experiments were performed by spiking L-AMB into residual plasma specimens. Phosphate was measured on the Beckman Coulter AU and Ortho Diagnostics Vitros instruments. RESULTS When measured on the AU, phosphate in plasma with approximately 250mcg/mL of L-AMB demonstrated a median negative bias of 3.45mg/dL relative to unspiked samples. In contrast, Vitros phosphate measurements demonstrated excellent agreement for specimens with and without L-AMB (median bias -0.2mg/dL). CONCLUSIONS High L-AMB concentrations induced a significant negative bias on phosphate measured by the AU assay, but did not affect the Vitros assay. Laboratorians and clinicians should be aware of this phenomenon in patients receiving L-AMB who develop unexplained hypophosphatemia.
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Affiliation(s)
- James A Mays
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Dina N Greene
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA, United States
| | - Anne Poon
- Department of Pharmacy, University of Washington School of Pharmacy, Seattle, WA, United States
| | - Anna E Merrill
- Department of Laboratory Medicine, University of Washington School of Medicine, Seattle, WA, United States.
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Nishioka H, Takegawa H, Kamei H. Disseminated cryptococcosis in a patient taking tocilizumab for Castleman's disease. J Infect Chemother 2018; 24:138-41. [PMID: 29021093 DOI: 10.1016/j.jiac.2017.09.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 01/10/2023]
Abstract
Infections occur more frequently in patients receiving biologics. However, cryptococcal infection is uncommon in patients receiving tocilizumab, an interleukin-6 inhibitor, in contrast to patients receiving tumor necrosis factor-α inhibitors. In this report, we describe a case of disseminated cryptococcosis in a 55-year-old man who was receiving tocilizumab every 2 weeks along with daily prednisolone and cyclosporine for Castleman's disease. He initially developed cellulitis on both upper limbs, and his condition worsened despite antibacterial therapy. Chest X-ray scanning and computed tomography demonstrated bilateral pulmonary infiltration. Cryptococcus neoformans was detected in blood, skin, and sputum cultures. He was diagnosed with disseminated cryptococcosis, and successfully treated with liposomal amphotericin B for a week followed by oral fluconazole for 11 months. The findings of this study indicate that cryptococcosis should be considered during the differential diagnosis of infection in patients receiving tocilizumab, especially in the presence of other risk factors for infections or a short tocilizumab dosing interval.
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Ochi T, Katayama Y, Okatani T, Imanaka R, Kyo K, Itagaki M, Katsutani S, Iwato K, Asaoku H. Successful haploidentical stem cell transplantation with prophylactic administration of liposomal amphotericin B after invasive pulmonary zygomycosis. Med Mycol Case Rep 2017; 18:1-4. [PMID: 28725544 PMCID: PMC5501889 DOI: 10.1016/j.mmcr.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 07/03/2017] [Indexed: 11/02/2022] Open
Abstract
A 54-year-old woman with acute myeloid leukemia (AML) achieved complete remission by induction chemotherapy, but developed zygomycosis after consolidation therapy. As zygomycosis could not be cured by liposomal amphotericin B and micafungin, left lower lobectomy was performed. As AML relapsed 7 months after onset, she received haploidentical stem cell transplantation under administration of liposomal amphotericin B. Despite experiencing severe acute graft-versus-host disease, she remains alive with no relapse of either zygomycosis or AML.
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Affiliation(s)
- Testuro Ochi
- Department of Hematology and Rheumatology, Tohoku University Hospital, 1-1, Seiryomachi, Aoba-ku Sendai-shi, Miyagi 980-0872, Japan
| | - Yuta Katayama
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Takeshi Okatani
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Ryota Imanaka
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Kohei Kyo
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Mitsuhiro Itagaki
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Shinya Katsutani
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Koji Iwato
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
| | - Hideki Asaoku
- Department of Hematology, Hiroshima Red Cross & Atomic-bomb Survivors' Hospital, 1-9-6, Sendamachi, Naka-ku Hiroshima-shi, Hiroshima 730-0052, Japan
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Bellmann R, Smuszkiewicz P. Pharmacokinetics of antifungal drugs: practical implications for optimized treatment of patients. Infection 2017; 45:737-779. [PMID: 28702763 PMCID: PMC5696449 DOI: 10.1007/s15010-017-1042-z] [Citation(s) in RCA: 196] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 06/25/2017] [Indexed: 02/08/2023]
Abstract
Introduction Because of the high mortality of invasive fungal infections (IFIs), appropriate exposure to antifungals appears to be crucial for therapeutic efficacy and safety. Materials and methods This review summarises published pharmacokinetic data on systemically administered antifungals focusing on co-morbidities, target-site penetration, and combination antifungal therapy. Conclusions and discussion Amphotericin B is eliminated unchanged via urine and faeces. Flucytosine and fluconazole display low protein binding and are eliminated by the kidney. Itraconazole, voriconazole, posaconazole and isavuconazole are metabolised in the liver. Azoles are substrates and inhibitors of cytochrome P450 (CYP) isoenzymes and are therefore involved in numerous drug–drug interactions. Anidulafungin is spontaneously degraded in the plasma. Caspofungin and micafungin undergo enzymatic metabolism in the liver, which is independent of CYP. Although several drug–drug interactions occur during caspofungin and micafungin treatment, echinocandins display a lower potential for drug–drug interactions. Flucytosine and azoles penetrate into most of relevant tissues. Amphotericin B accumulates in the liver and in the spleen. Its concentrations in lung and kidney are intermediate and relatively low myocardium and brain. Tissue distribution of echinocandins is similar to that of amphotericin. Combination antifungal therapy is established for cryptococcosis but controversial in other IFIs such as invasive aspergillosis and mucormycosis.
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Affiliation(s)
- Romuald Bellmann
- Clinical Pharmacokinetics Unit, Division of Intensive Care and Emergency Medicine, Department of Internal Medicine I, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Piotr Smuszkiewicz
- Department of Anesthesiology, Intensive Therapy and Pain Treatment, University Hospital, Poznań, Poland
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Abstract
Prototheca wickerhamii rarely causes systemic infection in humans but when it occurs, there are coexisting comorbidities. This case illustrated shows the manifestation of this opportunistic microorganism in an immunosuppressed patient. The patient was successfully treated with Liposomal amphotericin B with complete resolution of the lesions.
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de Carvalho Santana R, Schiave LA, Dos Santos Quaglio AS, de Gaitani CM, Martinez R. Fluconazole Non-susceptible Cryptococcus neoformans, Relapsing/Refractory Cryptococcosis and Long-term Use of Liposomal Amphotericin B in an AIDS Patient. Mycopathologia 2017; 182:855-61. [PMID: 28656554 DOI: 10.1007/s11046-017-0165-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 06/17/2017] [Indexed: 01/01/2023]
Abstract
The treatment of cryptococcosis is hampered by inefficacy or intolerance to the recommended antifungal agents. A patient diagnosed with AIDS had multiple relapses of cryptococcal infection, which became refractory to antifungal agents during the course of therapy. During the follow-up, the patient developed renal toxicity due to amphotericin B use and non-susceptibility of isolated Cryptococcus neoformans to fluconazole was detected. Thereafter, antifungal treatment was performed exclusively with liposomal amphotericin B, reaching a cumulative dose of 19,180 mg over 46 months. The final relapse of cryptococcosis occurred during the maintenance phase with liposomal formulation in a once-weekly dose. Measurement of the minimum serum concentrations of amphotericin B, determined sequentially before and after this relapse, suggested the importance of monitoring drug levels when the liposomal formulation is used for a long period.
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Ota H, Yamamoto H, Kimura M, Araoka H, Fujii T, Umeyama T, Ohno H, Miyazaki Y, Kaji D, Taya Y, Nishida A, Ishiwata K, Tsuji M, Takagi S, Asano-Mori Y, Yamamoto G, Uchida N, Izutsu K, Masuoka K, Wake A, Yoneyama A, Makino S, Taniguchi S. Successful Treatment of Pulmonary Mucormycosis Caused by Cunninghamella bertholletiae with High-Dose Liposomal Amphotericin B (10 mg/kg/day) Followed by a Lobectomy in Cord Blood Transplant Recipients. Mycopathologia 2017; 182:847-853. [PMID: 28577122 DOI: 10.1007/s11046-017-0149-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 05/13/2017] [Indexed: 02/06/2023]
Abstract
Infection caused by Cunninghamella bertholletiae carries one of the highest mortality rates among mucormycosis, and there are no reported cases that survived from the infection in allogeneic hematopoietic stem cell transplantation recipients occurring before neutrophil engraftment. Here, we present two cases of pulmonary mucormycosis caused by C. bertholletiae occurring before neutrophil engraftment after cord blood transplantation. Both were successfully treated with high-dose liposomal amphotericin B (10 mg/kg/day) combined with micafungin, which was then followed by neutrophil recovery, reduction in immunosuppressive agents, and a subsequent lobectomy. The intensive antifungal therapy immediately administered upon suspicion of mucormycosis greatly suppressed the infection in its early stage and was well tolerated despite its prolonged administration and simultaneous use of nephrotoxic agents after transplantation. Although the synergic effect of micafungin remains unclear, these cases highlight the importance of prompt administration of high-dose lipid polyene when suspecting mucormycosis in highly immunocompromised patients, which enables subsequent diagnostic and therapeutic interventions, resulting in a favorable outcome.
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Affiliation(s)
- Hikari Ota
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
- Department of Transfusion Medicine, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Hisashi Yamamoto
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Muneyoshi Kimura
- Department of Infectious Diseases, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Hideki Araoka
- Department of Infectious Diseases, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Takeshi Fujii
- Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Takashi Umeyama
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Hideaki Ohno
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, Japan
- Department of Infectious Diseases and Infection Control, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo, Japan
| | - Daisuke Kaji
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yuki Taya
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Aya Nishida
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kazuya Ishiwata
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Masanori Tsuji
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Shinsuke Takagi
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Yuki Asano-Mori
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Go Yamamoto
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Naoyuki Uchida
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Koji Izutsu
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Kazuhiro Masuoka
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Atsushi Wake
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Akiko Yoneyama
- Department of Infectious Diseases, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Shigeyoshi Makino
- Department of Transfusion Medicine, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | - Shuichi Taniguchi
- Department of Hematology, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, 105-8470, Japan
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Adler-Moore JP, Proffitt RT, Olson JA, Jensen GM. Tissue pharmacokinetics and pharmacodynamics of AmBisome® (L-AmBis) in uninfected and infected animals and their effects on dosing regimens. J Liposome Res 2017; 27:195-209. [PMID: 28480760 DOI: 10.1080/08982104.2017.1327543] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
By selecting a unique combination of lipids and amphotericin B, the liposome composition for AmBisome® (L-AmBis) has been optimized resulting in a formulation that is minimally toxic, targets to fungal cell walls, and distributes into and remains for days to weeks in various host tissues at drug levels above the MIC for many fungi. Procedures have been standardized to ensure that large scale production of the drug retains the drug's low toxicity profile, favorable pharmacokinetics and antifungal efficacy. Tissue accumulation and clearance with single or multiple intravenous administration is similar in uninfected and infected animal species, with tissue accumulation being dose-dependent and the liver and spleen retaining the most drug. The efficacy in animals appears to be correlated with drug tissue levels although the amount needed in a given organ varies depending upon the type of infection. The long-term tissue retention of bioactive L-AmBis in different organs suggests that for some indications, prophylactic and intermittent drug dosing would be efficacious reducing the cost and possible toxic side-effects. In addition, preliminary preclinical studies using non-intravenous routes of delivery, such as aerosolized L-AmBis, catheter lock therapy, and intravitreal administration, suggest that alternative routes could possibly provide additional therapeutic applications for this antifungal drug.
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Affiliation(s)
- J P Adler-Moore
- a Department of Biological Sciences , California State Polytechnic University , Pomona , CA , USA
| | | | - J A Olson
- a Department of Biological Sciences , California State Polytechnic University , Pomona , CA , USA
| | - G M Jensen
- c Gilead Sciences Inc. , San Dimas , CA , USA
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Baptista MI, Nona J, Ferreira M, Sampaio I, Abrantes M, Tomé MT, Neto MT, Barroso R, Serelha M, Virella D. Invasive fungal infection in neonatal intensive care units: a multicenter survey. J Chemother 2017; 28:37-43. [PMID: 25365503 DOI: 10.1179/1973947814y.0000000222] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study assesses the epidemiology of invasive fungal infection (IFI) in Portuguese Neonatal Intensive Care Units (NICUs) and compares the effectiveness and safety of antifungal therapies. A survey concerning the period 2005-2010 was carried out in NICUs of Greater Lisbon. Among 10 473 admitted neonates, 44 cases were identified, 29 among extreme low birth weight neonates (65.9%). Cumulative incidence rate was 0.42% (95%CI 0.309-0.559). A central vascular catheter was present before IFI in all cases. Candida albicans and Candida parapsilosis were the most frequent isolates. The initial antifungic was fluconazole in 22 cases and liposomal amphotericin B (L-AmB) in 18. Therapy was switched in 10 patients on fluconazole and 3 on L-AmB. Case fatality rate was 11.4% (95%CI 4.39-23.91). No serious adverse drugs reactions (SADRs) or clinical side effects were observed. The knowledge of the local epidemiology helps to identify adequate prophylactic and treatment strategies.
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Affiliation(s)
- Monica Isabel Baptista
- a Neonatology Department, Maternidade Dr. Alfredo da Costa , Centro Hospitalar Lisboa Central , Portugal
| | - José Nona
- a Neonatology Department, Maternidade Dr. Alfredo da Costa , Centro Hospitalar Lisboa Central , Portugal
| | - Marta Ferreira
- b Neonatology Department , Hospital Fernando da Fonseca , Lisbon , Portugal
| | - Isabel Sampaio
- c Neonatology Department , Hospital de Santa Maria , Centro Hospitalar Lisboa Norte , Portugal
| | - Margarida Abrantes
- c Neonatology Department , Hospital de Santa Maria , Centro Hospitalar Lisboa Norte , Portugal
| | - Maria Teresa Tomé
- a Neonatology Department, Maternidade Dr. Alfredo da Costa , Centro Hospitalar Lisboa Central , Portugal
| | - Maria Teresa Neto
- d Neonatology Department , Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central , Portugal
| | - Rosalina Barroso
- b Neonatology Department , Hospital Fernando da Fonseca , Lisbon , Portugal
| | - Micaella Serelha
- d Neonatology Department , Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central , Portugal
| | - Daniel Virella
- e Epidemiology and Statistics Office of the Research Unit of Centro Hospitalar de Lisboa Central , Portugal
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Tamiru A, Tigabu B, Yifru S, Diro E, Hailu A. Safety and efficacy of liposomal amphotericin B for treatment of complicated visceral leishmaniasis in patients without HIV, North-West Ethiopia. BMC Infect Dis 2016; 16:548. [PMID: 27724891 PMCID: PMC5057416 DOI: 10.1186/s12879-016-1746-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 08/03/2016] [Indexed: 11/24/2022] Open
Abstract
Background Visceral leishmaniasis (VL) is a protozoan disease that is invariably fatal if left untreated. The disease is found in 70 countries with incidence of 0.2 – 0.4 million cases. The mainstay of treatment in resource limited countries like Ethiopia is antimonials, while use of liposomal amphotericin B is reserved for treatment of complicated VL cases. The aim of this study was to assess the safety and efficacy of liposomal amphotericin B in HIV negative VL patients diagnosed with complications. Methods A retrospective chart review was conducted involving records of patients admitted between January 2009 and December 2014. Baseline sociodemographic, clinical, and treatment outcome data were collected. The doses of liposomal amphotericin B and adverse events related to treatment were retrieved. Categorical and continuous variables respectively were analyzed by Chi-square and Mann–Whitney U tests. A p-value of less than 0.05 was considered statistically significant. Results A total of 147 patients with severe VL were treated with liposomal amphotericin B in total dose ranges of 20 mg/kg to 35 mg/kg. In the overall treatment outcome analysis, initial cure (30 days after start of treatment) was observed in 128 (87.1 %), treatment failures in 10 (6.8 %), interruptions in 2(1.4 %) and deaths in 7 (4.8 %) patients. Initial cure rate at high dose (24-35 mg/kg total dose) was 96.7 % (59/61) versus 80.2 % (69/86) at lower doses (<24 mg/kg); which was significantly higher (P < 0.01), OR = 4.56: 95 %, Confidence Interval (CI) = 1.17 – 20.78). Ten cases (11.8 %) of treatment failure occurred in the low dose treatment group. The most common adverse events (AEs) were hypokalemia in 39 cases (26.5 %) and infusion related reactions in 16 (10.9 %). The frequency of hypokalemia and infusion related reactions were not significantly different between the low and high dose liposomal amphotericin B. Conclusion In HIV negative complicated VL patients, high dose of liposomal amphotericin B was found to have high cure rate at the end of treatment. The appropriate dose for better efficacy needs to be determined. Monitoring serum potassium level during treatment with liposomal amphotericin B should be an essential component of the clinical management of VL.
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Affiliation(s)
- Aschalew Tamiru
- Leishmaniasis Research and Treatment Center, University of Gondar, College of Medicine and Health Science, Gondar, Ethiopia.
| | - Bethlehem Tigabu
- Tuberculosis Clinic, University of Gondar, College of Medicine and Health Science, Gondar, Ethiopia
| | - Sisay Yifru
- Department of Pediatrics, University of Gondar, College of Medicine and Health Science, Gondar, Ethiopia
| | - Ermias Diro
- Department of Internal Medicine, University of Gondar, College of Medicine and Health Science, Gondar, Ethiopia
| | - Asrat Hailu
- Department of Microbiology, Immunology and Parasitology, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Mpakosi A, Siopi M, Falaina V, Siafakas N, Roilides E, Kimouli M, Theodoraki M, Karle P, Meletiadis J. Successful therapy of Candida pulcherrima fungemia in a premature newborn with liposomal amphotericin B and micafungin. Med Mycol Case Rep 2016; 12:24-7. [PMID: 27642562 DOI: 10.1016/j.mmcr.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 07/14/2016] [Accepted: 08/03/2016] [Indexed: 12/28/2022] Open
Abstract
New Candida species may cause bloodstream infections challenging current therapeutic approaches because of unpredictable susceptibility and virulence. In the present report, we describe a fungemia case due to Candida pulcherrima in a premature neonate. After full in vitro diagnostic workup, the neonate was successfully treated with liposomal amphotericin B and micafungin achieving rapid fungal eradication from blood.
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73
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Peçanha PM, de Souza S, Falqueto A, Grão-Veloso TR, Lírio LV, Ferreira CUG, Santos AR, Costa HG, de Souza LRM, Tuon FF. Amphotericin B lipid complex in the treatment of severe paracoccidioidomycosis: a case series. Int J Antimicrob Agents 2016; 48:428-30. [PMID: 27612594 DOI: 10.1016/j.ijantimicag.2016.06.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/17/2016] [Accepted: 06/10/2016] [Indexed: 11/27/2022]
Abstract
Amphotericin B deoxycholate is the main option for intravenous (i.v.) treatment of severe paracoccidioidomycosis (PCM). This is the first report of amphotericin B lipid complex (ABLC) in the treatment of PCM. Among 28 patients, cure was achieved in all patients (100%) using ABLC. Mean and median daily doses of ABLC were 3.39 mg/kg/day and 3.35 mg/kg/day, respectively. ABLC may be a choice in the treatment of severe forms of PCM or when i.v. options are required.
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Affiliation(s)
- Paulo Mendes Peçanha
- Division of Infectious Diseases, Universidade Federal do Espírito Santo, Vitoria, ES, Brazil
| | - Stella de Souza
- Division of Infectious Diseases, Universidade Federal do Espírito Santo, Vitoria, ES, Brazil
| | - Aloísio Falqueto
- Division of Infectious Diseases, Universidade Federal do Espírito Santo, Vitoria, ES, Brazil
| | | | - Ludmila Ventura Lírio
- Division of Infectious Diseases, Universidade Federal do Espírito Santo, Vitoria, ES, Brazil
| | | | - Aline Rocha Santos
- Division of Infectious Diseases, Universidade Federal do Espírito Santo, Vitoria, ES, Brazil
| | - Hélbia Garcia Costa
- Division of Infectious Diseases, Universidade Federal do Espírito Santo, Vitoria, ES, Brazil
| | | | - Felipe Francisco Tuon
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil; Division of Infectious Diseases, Universidade Federal do Parana, Curitiba, PR, Brazil.
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Faucher JF, Morquin D, Reynes J, Chirouze C, Hoen B, Le Moing V. Serial use of pentamidine and miltefosine for treating Leishmania infantum-HIV coinfection. Parasitol Int 2016; 65:444-6. [PMID: 27353022 DOI: 10.1016/j.parint.2016.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 11/17/2022]
Abstract
Liposomal amphotericin B (LAmb) may fail to heal Leishmania infantum visceral leishmaniasis (VL) in the immunodeficient host. There are currently no guidelines on how to treat such patients and efficacy of miltefosine monotherapy seems limited in this indication. We present 2 cases of patients with VL and AIDS for which LAmb had to be interrupted (one because of toxicity, one because of treatment failure) and who were treated effectively with pentamidine followed by miltefosine.
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Affiliation(s)
- Jean-François Faucher
- Service des maladies infectieuses et Tropicales, CHRU de Besançon, 25030 Besançon cedex, France.
| | - David Morquin
- Service des maladies infectieuses et Tropicales, CHU de Montpellier, 34295 Montpellier cedex 5, France.
| | - Jacques Reynes
- Service des maladies infectieuses et Tropicales, CHU de Montpellier, 34295 Montpellier cedex 5, France.
| | - Catherine Chirouze
- Service des maladies infectieuses et Tropicales, CHRU de Besançon, 25030 Besançon cedex, France.
| | - Bruno Hoen
- Service des maladies infectieuses et Tropicales, CHRU de Besançon, 25030 Besançon cedex, France.
| | - Vincent Le Moing
- Service des maladies infectieuses et Tropicales, CHU de Montpellier, 34295 Montpellier cedex 5, France.
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Vivas R, Beltran C, Munera MI, Trujillo M, Restrepo A, Garcés C. Fungemia due to Kodamaea ohmeri in a young infant and review of the literature. Med Mycol Case Rep 2016; 13:5-8. [PMID: 27630816 PMCID: PMC5013248 DOI: 10.1016/j.mmcr.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 06/08/2016] [Accepted: 06/20/2016] [Indexed: 11/19/2022] Open
Abstract
Fungal infections have become an important cause of morbidity and mortality in hospitalized children due to many complicating and underlying conditions. We present the case of a newborn infant with fungemia due to Kodamaea ohmeri who had a good outcome of the infection after using the combination of antifungal treatment and central venous catheter removal.
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Affiliation(s)
- Rosalba Vivas
- CES University, Medellin, Antioquia 050035, Colombia
- Corresponding author.
| | | | | | - Monica Trujillo
- CES University, Medellin, Antioquia 050035, Colombia
- Hospital Pablo Tobon Uribe, Medellin, Antioquia, Colombia
| | - Andrea Restrepo
- CES University, Medellin, Antioquia 050035, Colombia
- Hospital Pablo Tobon Uribe, Medellin, Antioquia, Colombia
| | - Carlos Garcés
- Hospital Pablo Tobon Uribe, Medellin, Antioquia, Colombia
- Antioquia University, Medellin, Antioquia, Colombia
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Della Pepa R, Picardi M, Sorà F, Stamouli M, Busca A, Candoni A, Delia M, Fanci R, Perriello V, Zancanella M, Nosari A, Salutari P, Marchesi F, Pane F, Pagano L. Successful management of chronic disseminated candidiasis in hematologic patients treated with high-dose liposomal amphotericin B: a retrospective study of the SEIFEM registry. Support Care Cancer 2016; 24:3839-45. [PMID: 27075673 PMCID: PMC4967093 DOI: 10.1007/s00520-016-3208-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 04/03/2016] [Indexed: 12/29/2022]
Abstract
Purpose Chronic disseminated candidiasis (CDC) is a complication of Candida infection in immunocompromised patients, involving the liver and spleen, and rarely other organs. The aim of the study is to identify the best antifungal drug for hematologic immunocompromised patients with CDC. Methods In this multicentric retrospective study, the charts of 20 patients with CDC following cytotoxic agent protocols for hematological malignancies, diagnosed from 2003 to 2013, were analyzed. The response to systemic antifungal therapy within 90 days from CDC diagnosis and the possible delay in chemotherapy plan, due to the infection, were evaluated. Results Six patients were treated with high-dose (HD; 5 mg/kg/daily) liposomal amphotericin B (L-AmB), whereas three received standard-dose (SD) L-AmB (3 mg/kg/daily). Azoles were given to six patients; the remaining five were treated with echinocandins. All patients treated with HD L-AmB (6/6—100 %) achieved complete resolution of CDC; one of them had to interrupt the chemotherapy program for the infection. In the SD L-AmB group, treatment failed in the 100 % of cases and one patient had to delay chemotherapy for the infection. Of the six patients who received azoles, two achieved complete resolution of the infection, four experienced treatment failure, and only three performed chemotherapy as planned. Echinocandins treatment resulted in complete resolution of the infection in 2/5 cases, partial response in 2/5 cases, and failure in one case. In this group, 3/5 patients completed chemotherapy as planned. Conclusions This study shows that HD L-AmB was particularly effective against CDC in hematologic patients, allowing most patients to continue cytotoxic agent program.
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Affiliation(s)
- Roberta Della Pepa
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy.
| | - M Picardi
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy
| | - F Sorà
- Hematology Catholic University Sacro Cuore, Rome, Italy
| | - M Stamouli
- Hematology Catholic University Sacro Cuore, Rome, Italy
| | - A Busca
- Hematology Le Molinette Hospital, Torino, Italy
| | - A Candoni
- Hematology University of Udine, Udine, Italy
| | - M Delia
- Hematology University of Bari, Bari, Italy
| | - R Fanci
- Hematology University of Firenze, Florence, Italy
| | - V Perriello
- Hematology University of Perugia, Perugia, Italy
| | | | - A Nosari
- Hematology Niguarda Hospital, Milan, Italy
| | - P Salutari
- Hematology Pescara Hospital, Pescara, Italy
| | - F Marchesi
- Haematology, Istituti Fisioterapici Ospitalieri (IFO), Rome, Italy
| | - F Pane
- Department of Clinical Medicine and Surgery, Hematology, Federico II University, via Sergio Pansini, 5, Naples, 80131, Italy
| | - L Pagano
- Hematology Catholic University Sacro Cuore, Rome, Italy
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Ueda S, Miyamoto S, Kaida K, Chizuka A, Kojima R, Takano J, Ogasawara T, Miyamoto K, Miyakoshi S, Kanda Y. Safety and efficacy of treatment with liposomal amphotericin B in elderly patients at least 65 years old with hematological diseases. J Infect Chemother 2016; 22:287-91. [PMID: 26908230 DOI: 10.1016/j.jiac.2016.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/12/2016] [Accepted: 01/15/2016] [Indexed: 11/25/2022]
Abstract
The safety and efficacy of treatment with liposomal amphotericin B (L-AMB) in elderly patients has not been clarified, especially in Japanese patients. Therefore, we retrospectively analyzed 33 elderly patients with hematological diseases of at least 65 years old who received L-AMB between 2009 and 2012. Their clinical outcomes were compared to those of 21 patients who were younger than 65 years. L-AMB was administered for empirical therapy (n = 2) or target therapy for possible (n = 14) or probable/proven (n = 17) invasive fungal infection. There was no discontinuation of L-AMB due to adverse events. More than 2-fold increases from the baseline Cre, AST, and ALT values were observed in 21.2%, 39.4%, and 45.5% of the older group and 38.1%, 61.9%, and 52.4% of the younger group, respectively. The concurrent use of nephrotoxic antibiotics was the only risk factor for the development of a 2-fold increase in the serum Cre level. The duration of L-AMB was significantly longer in patients who developed grade III-IV hypokalemia. A partial or complete response was observed in 54.8% and 62.5% of the elderly and younger groups, respectively. In conclusion, L-AMB therapy appeared to be acceptably safe as empirical therapy or treatment for invasive fungal infection.
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Affiliation(s)
- Satomi Ueda
- Department of Hematology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaemachi, Itabashi-ku, Tokyo 173-0015, Japan; Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanumacho, Omiya-ku, Saitama-shi, Saitama 330-8503, Japan
| | - Shunichi Miyamoto
- Department of Pharmacy, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaemachi, Itabashi-ku, Tokyo 173-0015, Japan
| | - Kosuke Kaida
- Department of Pharmacy, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaemachi, Itabashi-ku, Tokyo 173-0015, Japan
| | - Aki Chizuka
- Department of Hematology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaemachi, Itabashi-ku, Tokyo 173-0015, Japan
| | - Rie Kojima
- Department of Hematology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaemachi, Itabashi-ku, Tokyo 173-0015, Japan
| | - Junichiro Takano
- Department of Hematology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaemachi, Itabashi-ku, Tokyo 173-0015, Japan
| | - Toshie Ogasawara
- Department of Hematology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaemachi, Itabashi-ku, Tokyo 173-0015, Japan
| | - Ko Miyamoto
- Department of Chemotherapy, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaemachi, Itabashi-ku, Tokyo 173-0015, Japan
| | - Shigesaburo Miyakoshi
- Department of Hematology, Tokyo Metropolitan Geriatric Hospital, 35-2 Sakaemachi, Itabashi-ku, Tokyo 173-0015, Japan
| | - Yoshinobu Kanda
- Division of Hematology, Saitama Medical Center, Jichi Medical University, 1-847 Amanumacho, Omiya-ku, Saitama-shi, Saitama 330-8503, Japan.
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78
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Ohata Y, Tomita Y, Suzuki K, Maniwa T, Yano Y, Sunakawa K. Pharmacokinetic evaluation of liposomal amphotericin B (L-AMB) in patients with invasive fungal infection: Population approach in Japanese pediatrics. Drug Metab Pharmacokinet 2015; 30:400-9. [PMID: 26645511 DOI: 10.1016/j.dmpk.2015.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 07/16/2015] [Accepted: 08/13/2015] [Indexed: 11/26/2022]
Abstract
UNLABELLED The pharmacokinetic characteristics of liposomal amphotericin B (L-AMB; AmBisome(®)) in patients with invasive fungal infection were investigated. A population pharmacokinetic (PK) model in Japanese pediatric patients was developed based on 159 serum amphotericin B (AMPH-B) concentrations obtained in a post-marketing clinical study. The subjects were 39 patients with a mean age of 8.4 years (SD 4.5) and mean body weight of 27.1 kg (SD 14.1). A two-compartment PK model with zero-order input and first-order elimination was fitted to serum AMPH-B concentrations for L-AMB doses of 1.0, 2.5, and 5.0 mg/kg/day. Body weight showed significant correlations with PK parameters, such as clearance (CL) and distribution volume of the central compartment (Vc). The predicted Cmax/dose and AUC0-24/dose in Japanese pediatric patients were similar to those in non-Japanese pediatric patients and Japanese adult patients. Extremely large increases in Ctrough compared with predicted values were observed in some Japanese pediatric patients, but no relationships with demographic characteristics, clinical laboratory test values, or representative adverse drug reaction (decreased potassium) were found. The population PK parameters in this study are useful for simulating PK profiles of L-AMB and will be helpful for PK exposure comparisons among different populations and in investigations of pharmacokinetic-pharmacodynamic characteristics in patients. CHEMICAL COMPOUNDS Amphotericin B Deoxycholate (PubChem CID:23668620); amphotericin B (PubChem CID:5280965); 3-nitrophenol (PubChem CID:11137); methanol (PubChem CID:887).
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Affiliation(s)
- Yuka Ohata
- Drug Development Division, Sumitomo Dainippon Pharma Co., Ltd, 33-94 Enoki-cho, Suita, Osaka 564-0053, Japan.
| | - Yoshiko Tomita
- Drug Development Division, Sumitomo Dainippon Pharma Co., Ltd, 33-94 Enoki-cho, Suita, Osaka 564-0053, Japan.
| | - Kota Suzuki
- Drug Development Division, Sumitomo Dainippon Pharma Co., Ltd, 13-1 Kyobashi 1-chome, Chuo-ku, Tokyo 104-8536, Japan.
| | - Takashi Maniwa
- Drug Development Division, Sumitomo Dainippon Pharma Co., Ltd, 33-94 Enoki-cho, Suita, Osaka 564-0053, Japan.
| | - Yoshitaka Yano
- Education and Research Center for Clinical Pharmacy, Kyoto Pharmaceutical University, 5-Nakauchi-cho, Misasagi, Yamashina-ku, Kyoto 607-8414, Japan.
| | - Keisuke Sunakawa
- Kitasato Institute for Life Sciences and Graduate School of Infection Control Sciences, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan.
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Kang H, Takahashi Y, Nishimura K, Yamagishi Y, Mikamo H, Kakizaki H. Invasive Fungal Sinusitis Involving the Orbital Apex in a Patient with Chronic Renal Failure. Neuroophthalmology 2015; 39:183-186. [PMID: 27928353 DOI: 10.3109/01658107.2015.1050113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 04/20/2015] [Accepted: 05/07/2015] [Indexed: 11/13/2022] Open
Abstract
An 82-year-old man with chronic renal failure presented with invasive fungal sinusitis involving the right orbital apex. Intravenous liposomal amphotericin B was immediately administered with an intravenous sodium supplement. Subsequently, endoscopic sinus surgery was performed. Aspergillus fumigatus was detected in nasal discharge culture on day 12. Because the patient's renal function had deteriorated by this time, therapy was changed to nasal inhalation of amphotericin B, which was discontinued after 1 month, and oral administration of voriconazole, which was discontinued after 2 months. During 6-month follow-up, the patient did not show recurrence of sinusitis or further decrease in renal function.
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Affiliation(s)
- Hyera Kang
- Department of Ophthalmology, ; Department of Ophthalmology, University of Seonam College of Medicine, Presbyterian Medical Center, Jeonju, Korea
| | | | | | - Yuka Yamagishi
- Department of Infection Control and Prevention, Aichi Medical University , Aichi, Japan , and
| | - Hiroshige Mikamo
- Department of Infection Control and Prevention, Aichi Medical University , Aichi, Japan , and
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Yoshida H, Seki M, Umeyama T, Urai M, Kinjo Y, Nishi I, Toyokawa M, Kaneko Y, Ohno H, Miyazaki Y, Tomono K. Invasive pulmonary aspergillosis due to Aspergillus lentulus: Successful treatment of a liver transplant patient. J Infect Chemother 2015; 21:479-81. [PMID: 25828927 DOI: 10.1016/j.jiac.2015.02.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/19/2015] [Accepted: 02/24/2015] [Indexed: 11/29/2022]
Abstract
We report a patient with severe invasive pulmonary fungal infection caused by Aspergilllus lentulus, which was identified by genetic analysis, following liver transplantation. The patient was initially suspected to have Aspergilllus fumigatus infection, but worsened clinically despite antifungal therapy appropriate for that species. The patient survived after accurate diagnosis, and detailed drug susceptibility testing led to adequate therapy, demonstrating the importance of performing these investigations for severely immunocompromised patients, including organ transplant recipients.
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Affiliation(s)
- Hisao Yoshida
- Division of Infection Control and Prevention, Osaka University Hospital, Suita City, Osaka, Japan
| | - Masafumi Seki
- Division of Infection Control and Prevention, Osaka University Hospital, Suita City, Osaka, Japan.
| | - Takashi Umeyama
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Toyama, Tokyo, Japan
| | - Makoto Urai
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Toyama, Tokyo, Japan
| | - Yuuki Kinjo
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Toyama, Tokyo, Japan
| | - Isao Nishi
- Department of Laboratory Medicine, Osaka University Hospital, Suita City, Osaka, Japan
| | - Masahiro Toyokawa
- Department of Laboratory Medicine, Osaka University Hospital, Suita City, Osaka, Japan
| | - Yukihiro Kaneko
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Toyama, Tokyo, Japan; Department of Bacteriology, Osaka City University, Osaka, Japan
| | - Hideaki Ohno
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Toyama, Tokyo, Japan; Division of Infectious Diseases, Saitama Medical University Kawagoe Hospital, Kawagoe, Japan
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Toyama, Tokyo, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, Suita City, Osaka, Japan
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Luu Tran H, Mahmoudjafari Z, Rockey M, Henry D, Grauer D, Aljitawi O, Abhyankar S, Ganguly S, Lin T, McGuirk J. Tolerability and outcome of once weekly liposomal amphotericin B for the prevention of invasive fungal infections in hematopoietic stem cell transplant patients with graft-versus-host disease. J Oncol Pharm Pract 2014; 22:228-34. [PMID: 25471252 DOI: 10.1177/1078155214560920] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Invasive fungal infections remain problematic in immunosuppressed allogeneic stem cell transplant recipients and the use of corticosteroids for the treatment of graft-versus-host-disease can increase the risk threefold. Although antifungal prophylaxis has been shown to decrease the incidence of infection, the optimal antifungal prophylactic regimen in this patient population has yet to be identified.Since early diagnosis of fungal infections might not be possible and the treatment of established fungal infections might be difficult and associated with high infection-related mortality, prevention has become an important strategy in reducing overall morbidity and mortality. While triazoles are the preferred agents, some patients are unable to tolerate them and an alternative drug is warranted. OBJECTIVES To assess the tolerability of once weekly liposomal amphotericin B as a prophylactic strategy in patients undergoing stem cell transplantation by evaluating any adverse events leading to its discontinuation. In terms of efficacy, to also compare the outcome and incidence of invasive fungal infections in patients who received amphotericin B, triazoles, and echinocandins. RESULTS A total of 101 allogeneic transplant recipients receiving corticosteroids for the treatment of graft-versus-host-disease and antifungal prophylaxis were evaluated from August 2009 to September 2012. Liposomal amphotericin B 3 mg/kg intravenous once weekly was found to be well tolerated. The incidence of invasive fungal infections was 19%, 17%, and 7% in the liposomal amphotericin B, echinocandin, and triazole groups, respectively. Two deaths occurred in the liposomal amphotericin B group and one death occurred in the echinocandin group. None of the deaths were fungal infection related. CONCLUSION Antifungal prophylaxis with liposomal amphotericin B was well tolerated, but the incidence of invasive fungal infections in patients receiving liposomal amphotericin B was higher than other antifungal agents in this study. The optimal dose and schedule of liposomal amphotericin B for antifungal prophylaxis in this patient population are still not known and considering its broad spectrum activity, prospective trials in comparison to triazoles are warranted.
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Affiliation(s)
- Huong Luu Tran
- Department of Pharmacy, The University of Kansas Hospital, Kansas City, KS, USA
| | - Zahra Mahmoudjafari
- Department of Pharmacy, The University of Kansas Hospital, Kansas City, KS, USA
| | - Michelle Rockey
- Department of Pharmacy, The University of Kansas Hospital, Kansas City, KS, USA
| | - Dave Henry
- School of Pharmacy, University of Kansas, Lawrence, KS, USA
| | - Dennis Grauer
- School of Pharmacy, University of Kansas, Lawrence, KS, USA
| | - Omar Aljitawi
- Department of Blood and Marrow Transplant, University of Kansas Medical Center, Kansas City, KS, USA
| | - Sunil Abhyankar
- Department of Blood and Marrow Transplant, University of Kansas Medical Center, Kansas City, KS, USA
| | - Siddhartha Ganguly
- Department of Blood and Marrow Transplant, University of Kansas Medical Center, Kansas City, KS, USA
| | - Tara Lin
- Department of Blood and Marrow Transplant, University of Kansas Medical Center, Kansas City, KS, USA
| | - Joseph McGuirk
- Department of Blood and Marrow Transplant, University of Kansas Medical Center, Kansas City, KS, USA
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Bhattacharya P, Ali N. Treatment of visceral leishmaniasis: anomalous pricing and distribution of AmBisome and emergence of an indigenous liposomal amphotericin B, FUNGISOME. J Parasit Dis 2016; 40:1094-5. [PMID: 27605844 DOI: 10.1007/s12639-014-0607-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 10/18/2014] [Indexed: 01/19/2023] Open
Abstract
Visceral leishmaniasis (VL) is one of the severest forms of parasite borne diseases worldwide with a mortality rate second only to malaria. Treatment of VL patients with currently available chemotherapeutic agents poses problems of large scale failure, toxicity, prolonged hospitalization time, high treatment cost and drug resistance. However, most of these problems can be overcome by the use of liposomal formulations of Amphotericin B (L-AmB). Of the two L-AmBs currently available in Indian market, AmBisome is imported and FUNGISOME is indigenous. Initially AmBisome remained exorbitantly costly and therefore inaccessible to most of the VL patients. However, with the launch of FUNGISOME in India, Gilead in agreement with WHO started a donation program of AmBisome in developing countries through a slashed price of US $18 per vial. The price reduction is, however, restricted to clinical trials thus eluding majority of the VL patients. In fact, India was not included in this program and AmBisome was sold in Indian market at prices higher than the WHO proposed price of US $18 per vial. FUNGISOME, on the other hand, produced consistently good results against VL both clinically and experimentally. In the context of unavailability and price anomaly of AmBisome, successful emergence of FUNGISOME could mark it as the major L-AmB against VL.
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Chen J, Chen F, Wang Y, Yang LY, Miao M, Han Y, Wu DP. Use of combination therapy to successfully treat breakthrough Trichosporon asahii infection in an acute leukemia patient receiving voriconazole. Med Mycol Case Rep 2014; 6:55-7. [PMID: 25383317 PMCID: PMC4223824 DOI: 10.1016/j.mmcr.2014.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 09/12/2014] [Accepted: 09/26/2014] [Indexed: 12/04/2022] Open
Abstract
Trichosporon species is an important life-threatening opportunistic systemic pathogen, especially in leukemia patients. Voriconazole is proved to be a promising agent in past decade. However, recently we observed a case of breakthrough Trichosporon asahii infection while receiving voriconazole, which calls for an alternative treatment strategy. A combination therapy of liposomal amphotericin B (AmB) plus caspofungin – in which liposomal AmB dose was reduced due to renal toxicity – was administered to successfully treat this patient.
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Affiliation(s)
- Jia Chen
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China ; Collaborative Innovation Center of Hematology, Soochow University, Suzhou 215006, China
| | - Feng Chen
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China ; Collaborative Innovation Center of Hematology, Soochow University, Suzhou 215006, China
| | - Ying Wang
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China ; Collaborative Innovation Center of Hematology, Soochow University, Suzhou 215006, China
| | - Ling-Yi Yang
- Respiratory Department, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Miao Miao
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China ; Collaborative Innovation Center of Hematology, Soochow University, Suzhou 215006, China
| | - Yue Han
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China ; Collaborative Innovation Center of Hematology, Soochow University, Suzhou 215006, China
| | - De-Pei Wu
- Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China ; Collaborative Innovation Center of Hematology, Soochow University, Suzhou 215006, China
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Barberán J, Mensa J. [Invasive pulmonary aspergillosis in patients with chronic obstructive pulmonary disease]. Rev Iberoam Micol 2014; 31:237-41. [PMID: 25481431 DOI: 10.1016/j.riam.2014.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 07/28/2014] [Indexed: 10/24/2022] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is a common infection in immunocompromised patients with hematological malignancies or allogenic stem cell transplantation, and is less frequent in the context of chronic obstructive pulmonary disease (COPD). Mucociliary activity impairment, immunosuppression due to the inhibition of alveolar macrophages and neutrophils by steroids, and receiving broad-spectrum antibiotics, play a role in the development of IPA in COPD patients. Colonized patients or those with IPA are older, with severe CODP stage (GOLD≥III), and have a higher number of comorbidities. The mortality rate is high due to the fact that having a definitive diagnosis of IPA in COPD patients is often difficult. The main clinical and radiological signs of IPA in these types of patients are non-specific, and tissue samples for definitive diagnosis are often difficult to obtain. The poor prognosis of IPA in COPD patients could perhaps be improved by faster diagnosis and prompt initiation of antifungal treatment. Some tools, such as scales and algorithms based on risk factors of IPA, may be useful for its early diagnosis in these patients.
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Affiliation(s)
- José Barberán
- Servicio de Medicina Interna, Hospital Universitario Montepríncipe, Universidad San Pablo-CEU, Madrid, España.
| | - José Mensa
- Servicio de Enfermedades Infecciosas, Hospital Clínic, Barcelona, España
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Yamasaki M, Harada E, Tamura Y, Lim SY, Ohsuga T, Yokoyama N, Morishita K, Nakamura K, Ohta H, Takiguchi M. In vitro and in vivo safety and efficacy studies of amphotericin B on Babesia gibsoni. Vet Parasitol 2014; 205:424-33. [PMID: 25260334 DOI: 10.1016/j.vetpar.2014.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Revised: 09/04/2014] [Accepted: 09/07/2014] [Indexed: 11/23/2022]
Abstract
Babesia gibsoni is a causative pathogen of canine babesiosis, which is commonly treated with anti-babesial drugs; however, the development of novel, more effective anti-babesial drugs is necessary because the currently used drugs cannot remove the parasites from dogs. Therefore we investigated the anti-babesial effect of amphotericin B (AmB), a membrane-active polyene macrolide antibiotic. The interaction of such compounds with sterols in bilayer cell membranes can lead to cell damage and ultimately cell lysis. AmB exhibits in vitro activity against B. gibsoni in normal canine erythrocytes within 12h. We also studied liposomal AmB (L-AmB), a liposomal formulation of AmB that required a longer incubation period to reduce the number of parasites. However, L-AmB completely inhibited the invasion of free parasites into erythrocytes. These results indicated that free parasites failed to invade erythrocytes in the presence of L-AmB. Both AmB and L-AmB induced mild hemolysis of erythrocytes. Moreover, the methemoglobin level and the turbidity index of erythrocytes were significantly increased when erythrocytes were incubated with AmB, suggesting that AmB induced oxidative damage in erythrocytes. Finally, the anti-babesial activity of AmB in vivo was observed. When experimentally B. gibsoni-infected dogs were administered 0.5 and 1mg/kg AmB by the intravenous route, the number of parasites decreased; however, recurrence of parasitemia was observed, indicating that AmB did not eliminate parasites completely. Blood urea nitrogen and creatinine of dogs were abnormally elevated after the administration of 1mg/kg AmB. These results indicate that AmB has in vivo activity against B. gibsoni; however, it does not eliminate parasites from infected dogs and affects kidney function at a high dose.
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Pozo Laderas JC, Pontes Moreno A, Pozo Salido C, Robles Arista JC, Linares Sicilia MJ. [Disseminated mucormycosis in immunocompetent patients: A disease that also exists]. Rev Iberoam Micol 2014; 32:63-70. [PMID: 25543322 DOI: 10.1016/j.riam.2014.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 01/01/2014] [Accepted: 01/21/2014] [Indexed: 11/28/2022] Open
Abstract
Mucormycosis is usually an acute angioinvasive infections, which leads to non-suppurative necrosis and significant tissue damage. It represents 1.6% of all the invasive fungal infections and predominates in immunosuppressed patients with risk factors. Incidence has been significantly increased even in immunocompetent patients. Due to finding a case of disseminated mucormycosis caused by Rhizomucor pusillus in a young immunocompetent patient, a systematic review was carried out of reported cases in PubMed of mucormycosis in immunocompetent adults according to the main anatomic locations, and especially in disseminated cases. A review of the main risk factors and pathogenicity, clinical manifestations, techniques of early diagnosis, current treatment options, and prognosis is presented. Taxonomy and classification of the genus Mucor has also been reviewed.
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Affiliation(s)
- Juan Carlos Pozo Laderas
- Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España; Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Córdoba, España.
| | | | - Carmen Pozo Salido
- Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España
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87
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Brazzola P, Rossi MR. High weekly doses of liposomal amphotericin B as secondary prophylaxis after cerebral aspergillosis in a paediatric patient. Med Mycol Case Rep 2014; 3:1-3. [PMID: 24567890 PMCID: PMC3930963 DOI: 10.1016/j.mmcr.2013.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 10/23/2013] [Indexed: 11/19/2022] Open
Abstract
A paediatric patient treated for acute lymphoblastic leukaemia developed cerebral abscesses caused by Aspergillus fumigatus. After surgical draining voriconazole treatment was started. The patient developed a Steven-Johnson syndrome and treatment was switched to L-AmB. The patient developed no new fungal lesions and L-AmB treatment was continued until the end of the therapy. Complete remission was achieved without neurological consequences. High dose L-AmB represents an alternative for secondary prophylaxis of invasive fungal infections in patients intolerant to azoles.
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88
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Takeda T, Itano H, Kakehashi R, Fukita S, Saitoh M, Takeda S. Direct transbronchial administration of liposomal amphotericin B into a pulmonary aspergilloma. Respir Med Case Rep 2014; 11:7-11. [PMID: 26029520 PMCID: PMC3969609 DOI: 10.1016/j.rmcr.2013.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 12/25/2013] [Accepted: 12/27/2013] [Indexed: 11/28/2022] Open
Abstract
Pulmonary aspergillomas usually occur in pre-existing lung cavities exhibiting local immunodeficiency. As pulmonary aspergillomas only partially touch the walls of the cavities containing them, they rarely come into contact with the bloodstream, which makes it difficult for antifungal agents to reach them. Although surgical treatment is the optimal strategy for curing the condition, most patients also have pulmonary complications such as tuberculosis and pulmonary fibrosis, which makes this strategy difficult. A 72-year-old male patient complained of recurrent hemoptysis and dyspnea, and a chest X-ray and CT scan demonstrated the existence of a fungus ball in a pulmonary cavity exhibiting fibrosis. Although an examination of the patient's sputum was inconclusive, his increased 1-3-beta-D-glucan level and Aspergillus galactomannan antigen index were suggestive of pulmonary aspergilloma. Since the systemic administration of voriconazole for two months followed by itraconazole for one month was ineffective and surgical treatment was not possible due to the patient's poor respiratory function, liposomal amphotericin B was transbronchially administered directly into the aspergilloma. The patient underwent fiberoptic bronchoscopy, and a yellow fungus ball was observed in the cavity connecting to the right B(2)bi-beta, a biopsy sample of which was found to contain Aspergillus fumigatus. Nine transbronchial administrations of liposomal amphotericin B were conducted using a transbronchial aspiration cytology needle, which resulted in the aspergilloma disappearing by seven and a half months after the first treatment. This strategy could be suitable for aspergilloma patients with complications because it is safe and rarely causes further complications.
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Affiliation(s)
- Takayuki Takeda
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 86, Kasuganomori, Ogura-cho, Uji City, Kyoto 611-0042, Japan
| | - Hideki Itano
- Division of Thoracic Surgery, Department of General Surgery, Uji Tokushukai Medical Center, 86, Kasuganomori, Ogura-cho, Uji City, Kyoto 611-0042, Japan
| | - Ryouhei Kakehashi
- Department of Pharmacology, Uji Tokushukai Medical Center, 86, Kasuganomori, Ogura-cho, Uji City, Kyoto 611-0042, Japan
| | - Shinichi Fukita
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 86, Kasuganomori, Ogura-cho, Uji City, Kyoto 611-0042, Japan
| | - Masahiko Saitoh
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 86, Kasuganomori, Ogura-cho, Uji City, Kyoto 611-0042, Japan
| | - Sorou Takeda
- Division of Respiratory Medicine, Department of Internal Medicine, Uji Tokushukai Medical Center, 86, Kasuganomori, Ogura-cho, Uji City, Kyoto 611-0042, Japan
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89
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Desoubeaux G, Leperlier M, Chaussade H, Schneider C, Roriz M, Houssin C, Rogez C, De Muret A, García-Hermoso D, Bailly É, Le Fourn É, Machet L, Chandenier J, Bernard L. [Cutaneous mucormycosis caused by Rhizopus microsporus]. Ann Dermatol Venereol 2013; 141:201-5. [PMID: 24635954 DOI: 10.1016/j.annder.2013.10.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/13/2013] [Accepted: 10/29/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Mucormycosis are rare fungal infections occurring chiefly in the lung or the rhinocerebral compartment, particularly in patients with immunodeficiency or mellitus diabetes. We report the case of an elderly patient with cutaneous mucormycosis caused by Rhizopus microsporus. PATIENTS AND METHODS An 89-year-old man presented a skin lesion of the forearm rapidly becoming inflammatory and necrotic. The patient had been treated for 2months with oral corticosteroids for idiopathic thrombocytopenia. Histological and mycological examination of the skin biopsy revealed the presence of a filamentous fungus, R. microsporus. The outcome was unfavorable, despite prescription of high-dose liposomal amphotericin B. DISCUSSION Mucormycosis are infrequent opportunistic infections caused by angio-invasive fungi belonging to the Mucorales order. Cutaneous presentations are rare, and in rare cases the species R. microsporus is isolated in clinical samples. Diagnosis is based on histological examination highlighting the characteristic mycelium within infected tissue, together with ex vivo mycological identification using morphological and molecular methods. Treatment consists of liposomal amphotericin B combined with debridement surgery. CONCLUSION R. microsporus is a marginal fungal species rarely isolated in clinical practice, and even less in dermatology departments. This clinical case report highlights the severity of infection with this fungus, particularly in the absence of early surgery.
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Affiliation(s)
- G Desoubeaux
- Service de parasitologie - mycologie - médecine tropicale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 09, France; CEPR, Inserm U1100, EA 6305, faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, BP 3223, 37032 Tours, France.
| | - M Leperlier
- Service de parasitologie - mycologie - médecine tropicale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 09, France
| | - H Chaussade
- Service de médecine interne et maladies infectieuses, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 09, France
| | - C Schneider
- Service de médecine interne et maladies infectieuses, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 09, France
| | - M Roriz
- Service de dermatologie, CHU de Tours, avenue de la République, 37170 Tours cedex 09, France
| | - C Houssin
- Service de parasitologie - mycologie - médecine tropicale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 09, France
| | - C Rogez
- Service d'anatomie et cytologie pathologiques, CHU de Tours, avenue de la République, 37170 Tours cedex 09, France
| | - A De Muret
- Service d'anatomie et cytologie pathologiques, CHU de Tours, avenue de la République, 37170 Tours cedex 09, France
| | - D García-Hermoso
- Centre national de référence des mycoses invasives et antifongiques, Institut Pasteur, 25-28, rue du Docteur-Roux, 75015 Paris, France; CNRS URA3012, Institut Pasteur, 25, rue du Docteur-Roux, 75724 Paris cedex 15, France
| | - É Bailly
- Service de parasitologie - mycologie - médecine tropicale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 09, France
| | - É Le Fourn
- Service de dermatologie, CHU de Tours, avenue de la République, 37170 Tours cedex 09, France
| | - L Machet
- Service de dermatologie, CHU de Tours, avenue de la République, 37170 Tours cedex 09, France; Inserm U930, faculté de médecine, université François-Rabelais, 2, boulevard Tonnellé, 37044 Tours cedex 09, France
| | - J Chandenier
- Service de parasitologie - mycologie - médecine tropicale, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 09, France; CEPR, Inserm U1100, EA 6305, faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, BP 3223, 37032 Tours, France
| | - L Bernard
- CEPR, Inserm U1100, EA 6305, faculté de médecine, université François-Rabelais, 10, boulevard Tonnellé, BP 3223, 37032 Tours, France; Service de médecine interne et maladies infectieuses, CHU de Tours, 2, boulevard Tonnellé, 37044 Tours cedex 09, France
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90
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Pozo-Laderas JC, Pontes-Moreno A, Robles-Arista JC, Bautista-Rodriguez MD, Candau-Alvarez A, Caro-Cuenca MT, Linares-Sicilia MJ. [Mixed invasive fungal infection due to Rhizomucor pusillus and Aspergillus niger in an immunocompetent patient]. Rev Iberoam Micol 2015; 32:46-50. [PMID: 23583263 DOI: 10.1016/j.riam.2013.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 02/23/2013] [Accepted: 03/26/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mucormycosis infections are rare in immunocompetent patients, and very few cases of mucormycosis associated with aspergillosis in non-haematological patients have been reported. CASE REPORT A 17-year-old male, immunocompetent and without any previously known risk factors, was admitted to hospital due to a seizure episode 11 days after a motorcycle accident. He had a complicated clinical course as he had a mixed invasive fungal infection with pulmonary involvement due to Aspergillus niger and disseminated mucormycosis due to Rhizomucor pusillus (histopathological and microbiological diagnosis in several non-contiguous sites). He was treated with liposomal amphotericin B for 7 weeks (total cumulative dose >10 g) and required several surgical operations. The patient survived and was discharged from ICU after 5 months and multiple complications. CONCLUSIONS Treatment with liposomal amphotericin B and aggressive surgical management achieved the eradication of a mixed invasive fungal infection. However, we emphasise the need to maintain a higher level of clinical suspicion and to perform microbiological techniques for early diagnosis of invasive fungal infections in non-immunocompromised patients, in order to prevent spread of the disease and the poor prognosis associated with it.
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91
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Abstract
Cladophialophora bantiana is a dematiaceous mold with a predilection for causing central nervous system infection, particularly in normal hosts. A case involving a 79-year-old immunocompetent woman who presented with left-sided weakness and a ring-enhancing brain lesion is reported. She underwent surgical excision, which revealed a brain abscess due to C bantiana. The patient was treated with liposomal amphotericin B for several weeks, then switched to voriconazole and flucytosine, but eventually succumbed to the infection. Therapy is not standardized for this rare mycosis, and mortality remains high, even in immunocompetent patients. Additional studies to understand the pathogenesis of this infection and to improve outcomes are needed.
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92
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Galbraith J, Preiksaitis JK, Czekanski S, Poznansky MJ, Hirji M. Successful management of sequential pulmonary infections in a cardiac transplant recipient. Can J Infect Dis 1990; 1:85-91. [PMID: 22553447 DOI: 10.1155/1990/361692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/1990] [Accepted: 07/11/1990] [Indexed: 11/17/2022] Open
Abstract
A case of a cardiac allograft recipient who had an initial combined pulmonary infection with cytomegalovirus, Aspergillus fumigatus and Nocardia asteroides, successfully treated with liposomal amphotericin B and sulfisoxazole and followed by an episode of respiratory syncytial virus pneumonitis, is presented. This case illustrates the role of computed tomographic imaging in the recognition, diagnosis and monitoring of complex opportunistic pulmonary infections and the benefits of liposomal amphotericin B in the treatment of aspergillosis.
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