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Rev. Hosp. Ital. B. Aires (2004) ; 41(1): 26-30, mar. 2021. ilus
Article in Spanish | LILACS | ID: biblio-1178336


El pioderma gangrenoso ampollar es una variedad infrecuente de pioderma gangrenoso, que se asocia en el 50-70% de los casos con trastornos oncohematológicos. Se comunica el caso de una paciente de 59 años, que consultó por fiebre y ampollas purpúricas de rápida progresión, con compromiso cutáneo mucoso. Con sospecha de una enfermedad neutrofílica, ampollar, o infección por gérmenes oportunistas, se realizó biopsia de piel para estudio histopatológico, inmunofluorescencia directa y cultivo. Los cultivos y la inmunofluorescencia directa fueron negativos, y la anatomía patológica reveló un denso infiltrado inflamatorio con predominio neutrofílico en dermis. Ante el diagnóstico de pioderma gangrenoso ampollar, se realizó una punción-aspiración de médula ósea cuyo resultado fue compatible con leucemia mieloide aguda. Se instauró tratamiento con corticosteroides sistémicos, a pesar de lo cual la paciente evolucionó desfavorablemente y falleció a los 15 días de su ingreso hospitalario. Este caso ilustra la asociación de esta enfermedad cutánea con trastornos oncohematológicos y el mal pronóstico que esto implica a corto plazo. (AU)

Bullous pyoderma gangrenosum is an infrequent type of pyoderma gangrenosum, associated with onco hematological diseases in 50-70% of cases. We present the case of a 59-year-old patient with fever and mucocutaneous hemorrhagic bullous of rapid progression. A biopsy for histopathology, direct immunofluorescence (DIF) and skin culture was made, considering the possibility of neutrophilic dermatoses, bullous dermatosis or an opportunistic infection. The results of both the culture and the DIF were negative. The histopathological examination of the specimen revealed a dense dermal polymorphic infiltrate composed primarily of neutrophils. Considering bullous pyoderma gangrenosum as a potential diagnosis, a bone-marrow biopsy was performed. This study revealed an acute myeloid leukemia. Although systemic corticosteroid therapy was begun, the patient presented an unfavorable evolution that led to her death 15 days after her admission at the hospital. This case shows the association between bullous pyoderma gangrenosum and onco hematological diseases. In addition, it highlights the poor prognosis related to these diseases in the short term. (AU)

Humans , Female , Middle Aged , Leukemia, Myeloid, Acute/pathology , Pyoderma Gangrenosum/diagnosis , Paraneoplastic Syndromes/pathology , Respiration, Artificial , Azacitidine/therapeutic use , Myelodysplastic Syndromes/pathology , Acyclovir/administration & dosage , Methylprednisolone/administration & dosage , Vancomycin/administration & dosage , Cardiotonic Agents/therapeutic use , Ceftazidime/administration & dosage , Amphotericin B/administration & dosage , Imipenem/administration & dosage , Sweet Syndrome/etiology , Pyoderma Gangrenosum/etiology , Pyoderma Gangrenosum/pathology , Pyoderma Gangrenosum/drug therapy , Adrenal Cortex Hormones/therapeutic use , Meropenem/administration & dosage
Rev. Soc. Bras. Med. Trop ; 53: e20180463, 2020. tab, graf
Article in English | LILACS | ID: biblio-1057304


Abstract INTRODUCTION: The therapeutic efficacy of daily amphotericin B infusion is related to its maximum concentration in blood; however, trough levels may be useful in intermittent regimens of this antifungal drug. METHODS : High performance liquid chromatography (HPLC) was used to determine the minimum concentration (Cmin) of amphotericin B in the serum of patients receiving deoxycholate (D-Amph) or liposomal amphotericin B (L-AmB) for the treatment of cryptococcal meningitis (n=28), histoplasmosis (n=8), paracoccidioidomycosis (n=1), and leishmaniasis (n=1). RESULTS: Daily use of D-Amph 30 to 50 mg or L-AmB 50 mg resulted in a similar Cmin, but a significant increase ocurred with L-AmB 100 mg/day. The geometric mean Cmin tended to decrease with a reduction in the dose and frequency of intermittent L-AmB infusions: 357 ng/mL (100 mg 4 to 5 times/week) > 263 ng/mL (50 mg 4 to 5 times/week) > 227 ng/mL (50 mg 1 to 3 times/week). The impact on Cmin was variable in patients whose dose or therapeutic scheme was changed, especially when administered the intermittent infusion of amphotericin B. The mean Cmin for each L-AmB schedule of intermittent therapy was equal or higher than the minimum inhibitory concentration of amphotericin B against Cryptococcus isolates from 10/12 patients. The Cmin of amphotericin B in patients with cryptococcal meningitis was comparable between those that survived or died. CONCLUSIONS: By evaluating the Cmin of amphotericin B, we demonstrated the therapeutic potential of its intermittent use including in the consolidation phase of neurocryptococcosis treatment, despite the great variability in serum levels among patients.

Humans , Amphotericin B/blood , Deoxycholic Acid/blood , Antifungal Agents/blood , Paracoccidioidomycosis/drug therapy , Leishmaniasis/drug therapy , Amphotericin B/administration & dosage , Amphotericin B/pharmacokinetics , Chromatography, High Pressure Liquid , Meningitis, Cryptococcal/drug therapy , Deoxycholic Acid/administration & dosage , Deoxycholic Acid/pharmacokinetics , Histoplasmosis/drug therapy , Antifungal Agents/administration & dosage , Antifungal Agents/pharmacokinetics
Rev. Soc. Bras. Med. Trop ; 52: e20180272, 2019. tab, graf
Article in English | LILACS | ID: biblio-1041550


Abstract INTRODUCTION: Visceral leishmaniasis (VL) is fatal if not diagnosed and treated. This study aimed to estimate the cost-effectiveness of diagnostic-therapeutic alternatives for VL in Brazil. METHODS: A decision model estimated the life expectancy and costs of six diagnostic-therapeutic strategies. RESULTS: IT LEISH + liposomal amphotericin B emerged the best option, presenting lower costs and higher effectiveness. DAT-LPC + liposomal amphotericin B showed an incremental cost-effectiveness ratio of US$ 326.31 per life year. CONCLUSIONS: These findings indicate the feasibility of incorporating DAT and designating liposomal amphotericin B as the first-line drug for VL in Brazil.

Humans , Amphotericin B/economics , Cost-Benefit Analysis/statistics & numerical data , Leishmaniasis, Visceral/economics , Meglumine/economics , Antiprotozoal Agents/economics , Brazil , Coombs Test/economics , Amphotericin B/administration & dosage , Sensitivity and Specificity , Fluorescent Antibody Technique, Indirect/economics , Leishmaniasis, Visceral/diagnosis , Leishmaniasis, Visceral/drug therapy , Meglumine/administration & dosage , Antiprotozoal Agents/administration & dosage
Rev. méd. Chile ; 146(12): 1481-1485, dic. 2018. graf
Article in Spanish | LILACS | ID: biblio-991360


We report a 45-year-old male with AIDS who had a Cryptococcus neoformans central nervous system infection. He was treated with amphotericin B deoxycholate subsequently changed to voriconazole due to systemic toxicity of the former. Plasma levels of voriconazole were insufficient with a standard dose (0.7 μg/mL), therefore, the dose was increased thereafter to reach appropriate levels (4.5 μg/mL). Anti-retroviral therapy was started five weeks after voriconazole initiation with non-interacting drugs and he was discharged after a favorable evolution. He was re-admitted three months later due to seizures; a brain magnetic resonance showed new sub-cortical nodules. After excluding alternative causes and demonstrating fungal eradication, an immune reconstitution inflammatory syndrome (IRIS) event was suspected and treated with a short course of steroids. His evolution was satisfactory.

Humans , Male , Middle Aged , Amphotericin B/adverse effects , Meningitis, Cryptococcal/drug therapy , AIDS-Related Opportunistic Infections/drug therapy , Deoxycholic Acid/adverse effects , Immune Reconstitution Inflammatory Syndrome/chemically induced , Voriconazole/administration & dosage , Antifungal Agents/adverse effects , Amphotericin B/administration & dosage , Meningitis, Cryptococcal/diagnostic imaging , AIDS-Related Opportunistic Infections/diagnostic imaging , Deoxycholic Acid/administration & dosage , Drug Combinations , Antifungal Agents/administration & dosage
Rev. méd. Maule ; 33(2): 35-39, sept. 2018. ilus
Article in Spanish | LILACS | ID: biblio-1292514


Mucormycosis is an infrequent fungal infection This infection is difficult to diagnose and treat and have a high morbility and mortality and affects immunocompromised patients, especially those patients with decompensated diabetes mellitus. We report the case of a 60 years old diabetic patient with poor metabolic control who was admitted for diabetic ketoacidosis and days later present right periorbital swelling and pain, is diagnosed of mucomycosis and is successfully treated with amphoterin B and surgery.

Humans , Male , Middle Aged , Rhizopus/isolation & purification , Rhinitis/diagnosis , Meningitis, Fungal/diagnosis , Diabetic Ketoacidosis/diagnosis , Mucormycosis/diagnosis , Tomography, X-Ray Computed , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Clinical Laboratory Techniques
Rev. Soc. Bras. Med. Trop ; 51(3): 393-396, Apr.-June 2018. tab, graf
Article in English | LILACS | ID: biblio-957422


Abstract Visceral leishmaniasis is a systemic disease that is potentially severe and endemic in Brazil. It clinically manifests as fever, weight loss, swelling, hepatosplenomegaly, paleness, and edema. In this study, we discuss a case of a 1-year-old child diagnosed with refractory visceral leishmaniasis after being treated with liposomal amphotericin B in two distinct occasions. Considering the persistent clinical features and weak response to conventional treatment, a combination therapy with liposomal amphotericin B (ambisome), n-methylglucamine antimoniate (glucantime), and pentamidine isethionate was initiated, and response to treatment was good.

Humans , Male , Infant , Organometallic Compounds/administration & dosage , Pentamidine/administration & dosage , Amphotericin B/administration & dosage , Leishmaniasis, Visceral/drug therapy , Meglumine/administration & dosage , Antiprotozoal Agents/administration & dosage , Drug Therapy, Combination , Meglumine Antimoniate
Rev. Nac. (Itauguá) ; 10(1): 17-35, 20180600.
Article in Spanish | LILACS, BDNPAR | ID: biblio-914219


Introducción En las últimas décadas, el agente de elección para el tratamiento de la mayoría de las micosis sistémicas ha sido la anfotericina B que, a pesar de los efectos tóxicos, sigue teniendo un papel importante en el tratamiento de las infecciones micóticas. Objetivo Determinar los efectos adversos asociados al empleo de anfotericina B en neonatos del Servicio de Neonatología del Hospital Nacional de Itauguá, en el periodo 2013 - 2015. Materiales y métodos Estudio de serie de casos, retrospectivo, de recién nacidos con tratamiento con anfotericina B. Resultados: Entre 28 recién nacidos tratados con anfotericina B, hubo mayor prevalencia en el sexo masculino. Con respecto a la edad más de la mitad de los recién nacidos fueron pre-término en el grupo estudiado. Hubo predominio de bajo peso al nacer (32,14%). Los factores de riesgo arrojaron que 53,5% no contaba con antecedentes de sepsis. La edad media de inicio de anfotericina fue 19±9 días, más de la mitad de los neonatos utilizó dosis progresiva de 0,5 mg/kp/día a 1 mg/kp/día, en 24 hs.El 96,4% recibió infusión de anfotericina B de 4 horas, 1 caso requirió 6 horas. Entre los efectos secundarios, 35,7% de los pacientes presentó anemia, el disturbio hidroelectrolítico más frecuente fue la hipokalemia, entre los signos se destacaron la taquicardia e hipotensión. Conclusiones Los efectos secundarios más llamativos encontrados durante el tratamiento con anfotericina B fueron la anemia, alteraciones de Sodio y Potasio

Introduction In recent decades, the agent of choice for the treatment of most systemic mycoses has been amphotericin B which, despite the toxic effects, continues to play an important role in the treatment of fungal infections. Objective To determine the adverse effects associated with the use of amphotericin B in neonates of the Neonatology Service of the National Hospital of Itauguá, in the period 2013 - 2015. Materials and methods: retrospective case series study of newborns treated with amphotericin B. Results Among 28 newborns treated with amphotericin B, there was a higher prevalence in males. With regard to age, more than half of the newborns were pre-term in the group studied. There was a predominance of low birth weight (32.14%). The risk factors showed that 53.5% did not have a history of sepsis. The mean age of onset of amphotericin was 19 ± 9 days, more than half of the infants used progressive dose from 0.5 mg / kp / day to 1 mg / kp / day, in 24 hours. 96.4% received infusion of amphotericin B for 4 hours, 1 case required 6 hours. Among the side effects, 35.7% of the patients presented anemia, the most frequent water and electrolyte disturbance was hypokalemia, among the signs were tachycardia and hypotension. Conclusions The most striking side effects found during treatment with amphotericin B were anemia, Sodium and Potassium alterations.

Humans , Male , Female , Infant, Newborn , Amphotericin B/adverse effects , Deoxycholic Acid/adverse effects , Mycoses/drug therapy , Antifungal Agents/adverse effects , Infant, Low Birth Weight , Infant, Premature , Amphotericin B/administration & dosage , Retrospective Studies , Deoxycholic Acid/administration & dosage , Antifungal Agents/administration & dosage
Rev. Hosp. Ital. B. Aires (2004) ; 37(4): 142-145, dic. 2017. ilus
Article in Spanish | LILACS | ID: biblio-1095740


La infección diseminada por Fusarium se ha convertido en un problema creciente en las personas con neoplasias hematológicas malignas, principalmente en pacientes con leucemias agudas; se describen cada vez más casos en aquellos sometidos a un trasplante de médula ósea. No existe un tratamiento óptimo establecido para la fusariosis diseminada. La mortalidad global comunicada de esta infección oscila entre el 50 y el 80%. Se presenta a continuación el caso de un paciente de sexo masculino de 29 años, con diagnóstico de leucemia mieloide aguda, que presenta como complicación una fusariosis diseminada, y logra sobrellevar un trasplante alogénico de médula ósea en el Hospital Italiano de San Justo (Argentina) de forma exitosa. (AU)

Disseminated fusariosis has become an increasing problem in people with hematopoietic neoplasms, mainly in patients affected by acute leukemias, and even more in those who undergo hematopoietic cell transplantation. There is not an optimal treatment for disseminated fusariosis. The global mortality described in the literature is between 50% and 80%. We introduce a case of a 29 year old patient with diagnosis of acute myeloid leukemia complicated with disseminated fusariosis, who copes with an allogeneic hematopoietic cell transplantation with a successful outcome in the "Hospital Italiano de San Justo" (Argentina). (AU)

Humans , Male , Adult , Leukemia, Myeloid, Acute/surgery , Bone Marrow Transplantation/trends , Fusariosis/therapy , Azacitidine/adverse effects , Tobacco Use Disorder , Transplantation, Homologous , Leukemia, Myeloid, Acute/complications , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Mitoxantrone/administration & dosage , Mitoxantrone/therapeutic use , Adrenal Cortex Hormones/therapeutic use , Cytarabine/administration & dosage , Cytarabine/therapeutic use , Positron-Emission Tomography , Drug Therapy , Fever , Fusariosis/microbiology , Fusariosis/mortality , Fusariosis/epidemiology , Fusariosis/diagnostic imaging , Myalgia , Voriconazole/administration & dosage , Voriconazole/therapeutic use , Filgrastim/therapeutic use , Marijuana Use , Cocaine Smoking , Terbinafine/therapeutic use , Melphalan/administration & dosage , Melphalan/therapeutic use , Anti-Bacterial Agents/therapeutic use
Rev. Soc. Bras. Clín. Méd ; 15(2): 124-126, 20170000. ilus
Article in Portuguese | LILACS | ID: biblio-875612


A criptococose é uma doença fúngica sistêmica causada por Cryptococcus neoformans, que acomete principalmente indivíduos imunocomprometidos, podendo eventualmente acometer imunocompetentes. Existem duas variedades da espécie (neoformans e gattii), com características diferentes, mas clinicamente semelhantes, sendo possível sua distinção apenas por do teste de identificação da espécie. O tratamento preconizado é constituído por anfotericina B e fluconazol endovenosos, com duração de meses, existindo pouco relato na literatura sobre resistência à terapêutica habitual ou tratamento alternativo. Neste trabalho, é relatado um caso de neurocriptococose por C. gattii resistente a fluconazol em imunocompetente, no qual foi realizada anfotericina B endovenosa associada a intratecal sem sucesso, evoluindo o paciente a óbito por provável complicações da hidrocefalia obstrutiva.(AU)

Cryptococcosis is a systemic fungal disease caused by Cryptococcus neoformans, which primarily affects immunocompromised individuals, but may occasionally affect immunocompetent individuals. There are two varieties of the species, with different, but clinically similar characteristics, with their distinction being possible only through the species identification test. The recommended treatment consists of intravenous amphotericin B and fluconazole, for some months. There are few reports in the literature on resistance to standard therapy, or an alternative treatment. In this study, we describe a case of fluconazole-resistant neurocryptococcosis by Cryptococcus gattii in immunocompetent individuals, who unsuccessfully received intravenous and intrathecal amphotericin B , with the patient progressing to death from probable complications of obstructive hydrocephalus.(AU)

Humans , Male , Adult , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Fluconazole/administration & dosage , Fluconazole/therapeutic use , Meningitis, Cryptococcal , Immunity
Lima; s.n; nov. 2016.
Non-conventional in Spanish | LILACS, BRISA | ID: biblio-848414


INTRODUCCIÓN: Antecedentes: Se evaluó la eficacia y seguridad del uso de posaconazol en pacientes adultos con mucormicosis y respuesta inadecuada o eventos adversos al uso de amfotericina B. En el referido Dictamen, se apueba el uso de posaconazol en base a la opinión de expertos en consenso documentada en alguunas de práctica clínica y series de casos, así como base en base a la experiencia clínica observada por los especialistas de EsSalud. Aspectos Generales: La mucormicosis (también conocida como zygomicosis) es una infección oportunista poco frecuente, potencialmente mortal causada por hongos del orden Morales. Aunque es una infección por hongos relativamente poco común en la población general, en comparación con la candidiasis y aspergilosis; los casos de mucormicosis han sido en aumento durante la última década. El aumento global, puede deberse al aumento del uso de la quimioterapia y los esteroides, asociado a un estado inmunocomprometido prolongado. Tecnología Sanitaria de Interés: El posaconazol pertenece a la familia de los antifúngicos azoles, e inhibe la producción de ergosterol en el hongo mediante la unión y la inhibición de la lanosterol-14alpha-desmetilasa, que se encuentra presente en casi todos los hongos, excepto Pneumocystis y Pythium. Tiene una estructura química diferente de fluconazol y voriconazol, que le permite interactuar con un dominio adicional de la diana, de modo que puede inhibir incluso cepas mutadas resistentes a fluconazol y voriconazol. Además puede permanecer activo cuando otros azoles ya están inactivos. METODOLOGÍA: Estrategia de Búsqueda: Se utilizó el motor de búsqueda empleando el algoritmo mostrado en la sub-sección B y los filtros correspondientes a meta-análisis, revisiones sistemáticas y ensayos clínicos, en línea con los criterios de elegibilidad. Se llevó a cabo una búsqueda sistemática de la literatura con respecto a la eficcia y seguridad de posaconazol en pacientes pediáricos con mucormicosis que hayan recibido previamente tratamiento con Amfotericina B. La búsqueda se inicio revisando la información sobre el uso del medicamento de acuerdo con entidades reguladoras como la Food and Druga Administration de los Estados Unidos (FDA), la European Medicines Agency (EMA) y la Dirección General de Medicamentos y Drogas (DIGEMID). RESULTADOS: Sinopsis de la Evidencias: A la fecha aún no existe una indicación de etiqueta para el uso de posaconazol en niños con mucormicosis, por lo que su aplicación en casos pediátricos se basa únicamente en decisión y criterio clínico del caso. Debido a esto, la literatura científica disponible se refiere a la eficacia y seguridad de posaconazol en adultos con mucormicosis. En la presente sinopsis se describe toda la evidencia considerada para el presente dictamen (tanto la evidencia nueva encontrada como la evidencia utilizada en el Dictamen previo). y se explica cómo esta evidencia falla en responder de manera precisa la pregunta PICO de interés. CONCLUSIONES: El presente dictamen expone la evaluación de tecnologia sanitaria de la eficacia y seguridad de posaconazol en pacientes pediátricos con mucormicosis que hayan recibido Amfotericina B. Posaconazol ha sido propuesto como un medicamento de segunda línea de tratamiento en pacientes pediátricos con mucormicosis que presentan falla al tratamiento, son intolerantes por eventos adversos, o vienen recibiendo tratamiento por largos periodos de tiempo, dado que al momento no existe una segunda línea de tratamiento definida para este tipo de pacientes. El Instituto de Evaluación de Tecnologías en Salud e Investigación_IETSI aprueba el uso de posaconazol en pacientes pediátricos con mucormicosis que hayan recibido Amfotericina B. La vigencia del presente Dictamen Premilimiar es de un año. Asimismo, se establece que el efecto de posaconazol se evaluará con datos de los pacientes que usen medicamento para determinar su impacto en desenlaces clínicos. Esta información servirá para una re-evaluación del medicamento al terminar la vigencia del presente dictamen preliminar.

Humans , Child , Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Mucormycosis/drug therapy , Technology Assessment, Biomedical , Treatment Outcome
Braz. j. infect. dis ; 20(4): 342-348, July-Aug. 2016. graf
Article in English | LILACS | ID: biblio-828118


Abstract A natural and biocompatible fibrin microsphere is one of the most promising dual delivery vehicle as compared to other traditionally designed delivery modalities. It represents sustained delivery of encapsulated drug and is easily biodegradable in the blood circulation. In the present study, we evaluated the systemic augmentation of the antifungal activity of amphotericin B loaded in fibrin microsphere (AMB-fibrin microsphere) against cryptococcosis in Swiss albino mice. Mice infected with Cryptococcus neoformans were treated with 0.5 mg/kg AMB-fibrin microsphere that was given alternately for 7 days. The antifungal potential of AMB-fibrin microsphere was assessed on the basis of reduction of cfu count in the systemic circulation and various vital organs of infected mice. The formulation was found to be highly effective in reducing intracellular pathogen from the experimental animals where fibrin microsphere significantly controlled the release of amphotericin B for longer time duration. The AMB-fibrin microsphere chemotherapy was significantly more effective than free amphotericin B in reducing the fungal burden and showed better survival efficacy (p < 0.05). The current study demonstrating the use of novel amphotericin B loaded fibrin microsphere not only imparts protection to the encapsulated amphotericin B but also offers an effective strategy to decrease the drug associated toxicities.

Animals , Female , Rats , Fibrin/administration & dosage , Amphotericin B/administration & dosage , Cryptococcosis/drug therapy , Cryptococcus neoformans , Antifungal Agents/administration & dosage , Time Factors , Disease Models, Animal , Microspheres
Rev. Soc. Bras. Med. Trop ; 48(3): 235-242, May-Jun/2015. tab, graf
Article in English | LILACS | ID: lil-749870


Leishmaniasis is one of the six major tropical diseases targeted by the World Health Organization. It is a life-threatening disease of medical, social and economic importance in endemic areas. No vaccine is yet available for human use, and chemotherapy presents several problems. Pentavalent antimonials have been the drugs of choice to treat the disease for more than six decades; however, they exhibit high toxicity and are not indicated for children, for pregnant or breastfeeding women or for chronically ill patients. Amphotericin B (AmpB) is a second-line drug, and although it has been increasingly used to treat visceral leishmaniasis (VL), its clinical use has been hampered due to its high toxicity. This review focuses on the development and in vivo usage of new delivery systems for AmpB that aim to decrease its toxicity without altering its therapeutic efficacy. These new formulations, when adjusted with regard to their production costs, may be considered new drug delivery systems that promise to improve the treatment of leishmaniasis, by reducing the side effects and the number of doses while permitting a satisfactory cost-benefit ratio.

Animals , Dogs , Humans , Amphotericin B/administration & dosage , Antiprotozoal Agents/administration & dosage , Drug Delivery Systems , Leishmaniasis, Visceral/drug therapy , Chemistry, Pharmaceutical , Nanoparticles , Nanotechnology
Yonsei Medical Journal ; : 1453-1456, 2015.
Article in English | WPRIM | ID: wpr-39968


Invasive aspergillosis (IA), generally considered an opportunistic infection in immunocompromised hosts, is associated with high morbidity and mortality. IA commonly occurs in the respiratory tract with isolated reports of aspergillosis infection in the nasal sinuses, central nervous system, skin, liver, and urinary tract. Extra-pulmonary aspergillosis is usually observed in disseminated disease. To date, there are a few studies regarding primary and disseminated gastrointestinal (GI) aspergillosis in immunocompromised hosts. Only a few cases of primary GI aspergillosis in non-immunocompromised hosts have been reported; of these, almost all of them involved the upper GI tract. We describe a very rare case of IA involving the lower GI tract in the patient without classical risk factors that presented as multiple colon perforations and was successfully treated by surgery and antifungal treatment. We also review related literature and discuss the characteristics and risk factors of IA in the immunocompetent hosts without classical risk factors. This case that shows IA should be considered in critically ill patients, and that primary lower GI aspergillosis may also occur in the immunocompetent hosts without classical risk factors.

Amphotericin B/administration & dosage , Antifungal Agents/administration & dosage , Aspergillosis/diagnosis , Aspergillus/isolation & purification , Colon/microbiology , Colonic Diseases/diagnosis , Combined Modality Therapy , Humans , Immunocompetence , Laparotomy , Male , Middle Aged , Treatment Outcome , Voriconazole/administration & dosage
Colomb. med ; 45(4): 186-189, Oct.-Dec. 2014. ilus, tab
Article in English | LILACS | ID: lil-747585


Laryngeal histoplasmosis is a fungal infection that is frequent in Colombia. Laryngeal histoplasmosis usually occurs in immunocompromised patients through the dissemination of the fungus from the lungs to other organs. Histoplasmosis isolated laryngeal (primary) is rare. If a patient presents with a history of immunosuppression by renal transplant, primary laryngeal histoplasmosis with supraglottic granulomatous inflammation that was treated with amphotericin B and Itraconazole, with complete resolution of laryngeal lesions.

Histoplasmosis es una infección fúngica que es frecuente en Colombia. La histoplasmosis laríngea por lo general se presenta en pacientes inmunocomprometidos por la difusión del hongo desde los pulmones a otros órganos. La enfermedad laríngea aislada (primaria) es rara. Se presenta el caso de un paciente con antecedente de inmunosupresión por trasplante renal, con histoplasmosis laríngea primaria que produjo inflamación granulomatosa supraglótica, tratado con Anfotericina B e Itraconazol, con resolución completa de las lesiones laríngeas.

Child , Humans , Male , Antifungal Agents/therapeutic use , Histoplasmosis/diagnosis , Laryngeal Diseases/microbiology , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antifungal Agents/administration & dosage , Colombia , Histoplasmosis/drug therapy , Itraconazole/administration & dosage , Itraconazole/therapeutic use , Laryngeal Diseases/drug therapy
Rev. Soc. Bras. Med. Trop ; 46(6): 669-677, Nov-Dec/2013. tab, graf
Article in English | LILACS | ID: lil-698068


We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fill in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making.

Aged , Child , Female , Humans , Pregnancy , Antiprotozoal Agents/administration & dosage , Evidence-Based Medicine , Leishmaniasis, Cutaneous/drug therapy , Amphotericin B/administration & dosage , Chronic Disease , Immunocompromised Host , Meglumine/administration & dosage , Organometallic Compounds/administration & dosage , Pentamidine/administration & dosage , Phosphorylcholine/administration & dosage , Phosphorylcholine/analogs & derivatives , Risk Factors
Rio de Janeiro; s.n; 2013. xviii,59 p. tab, ilus.
Thesis in Portuguese | LILACS | ID: lil-762483


O objetivo deste estudo foi descrever o estado nutricional de pacientes adultos e idosos com leishmaniose tegumentar americana (LTA). Foi realizado um estudo longitudinal em 68 pacientes adultos e idosos com LTA atendidos no Laboratório de Vigilância em Leishmanioses – Instituto de Pesquisa Clínica Evandro Chagas – Fiocruz, no período de 2009 a 2012. A avaliação nutricional foi realizada através do peso, altura, Índice de Massa Corporal e albumina sérica. A evolução clínica(epitelização e cicatrização das lesões) foi avaliada até dois anos após o tratamento de LTA. A maioria da amostra era composta por homens (71%), adultos (73%), com renda familiar de 1 a 5salários mínimos (79%) e com grau de instrução fundamental incompleto (48,5%). A forma predominante da LTA foi a cutânea (72%) e 39% apresentaram comorbidades, sendo a hipertensão arterial a mais frequente (30,8%). As intercorrências clínicas e nutricionais mais prevalentes foram:redução recente na ingestão de alimentos (23,9%), obstrução nasal (22,1%), úlcera oral (14,7%),anorexia + disfagia (13,2% cada) e odinofagia (10,3%). O tempo de cicatrização foi de 145,50 ±87,84 dias para lesões cutâneas e 172,89 ± 123 dias para lesões mucosas. Foram observados baixo peso em 10% e hipoalbuminemia em 12% dos pacientes...

The objective of this study is to describe the nutritional status of adult and elderly patients with American Tegumentary Leishmaniasis (ATL). It was conducted a longitudinal study in 68 adult andelderly patients with ATL treating at the Laboratório de Vigilância em Leishmanioses (Surveillance Leishmaniasis Laboratory) at the Instituto de Pesquisa Clínica Evandro Chagas (Evandro Chagas Clinical Research Institute)-Fiocruz, from 2009 to 2012. The nutritional assessment was performedusing weight, height, the Body Mass Index (BMI) and blood albumin levels. The clinical evolution(epithelialization, and wound healing) was measured up to two years after ATL treatment. Most ofthe sample was composed of men (71%), adults (73%), with household income of 1-5 minimumwages (79%), and incomplete basic education (48.5%). The predominant ATL form was cutaneous(72%), and 39% presented comorbidities, the most frequent was hypertension (30.8%). The most prevalent clinical and nutritional events were: recent reduction in food intake (23.9%); nasal obstruction (22.1%); oral ulcer (14.7%), anorexia + dysphagia (13.2% each) and odynophagia(10.3%). The healing time was 145.50 ± 87.84 days for skin lesions, and 172.89 ± 123 days formucous membrane lesions. Low weight in 10%, and hypoalbuminemia in 12% of the patients havebeen observed...

Adult , Aged , Leishmaniasis, Cutaneous/classification , Leishmaniasis, Cutaneous/diagnosis , Leishmaniasis, Mucocutaneous/classification , Malnutrition , Amphotericin B/administration & dosage , Pentamidine/administration & dosage
Biomédica (Bogotá) ; 32(3): 386-398, jul.-set. 2012. ilus, graf, mapas, tab
Article in English | LILACS | ID: lil-663709


Introduction: A survey on cryptococcosis is being conducted regularly in Colombia since 1997. We present hereby the results corresponding to patients diagnosed from 2006 to 2010. Objective: To analyze the data obtained during this period. Materials and methods: Retrospective analysis of the corresponding surveys. Results: A total of 526 surveys originating from 72% of the Colombian political divisions were received during the 5-year period. Most patients (76.6%) were males and 74.9% were 21-50 years old. The most prevalent risk factor was HIV infection (83.5%) with cryptococcosis defining AIDS in 23% of the cases. In the general population the estimated mean annual incidence rate for cryptococcosis was 2.4 x 106 inhabitants while in AIDS patients this rate rose to 3.3 x 103. In 474 surveys stating clinical features, most frequent complaints were headache 84.5%, fever 63.4%, nausea and vomiting 57.5%, mental alterations 46.3%, meningeal signs 33.0%, cough 26.4% and visual alterations 24.5%. Neurocryptococcosis was recorded in 81.8% of the cases. Laboratory diagnosis was based on direct examination, culture and latex in 29.3% cases. From 413 Cryptococcus isolates analyzed, 95.6% were identified as C. neoformans var. grubii, 1% C. neoformans var. neoformans, and 3.4% C. gattii. Treatment was reported for 71.6% of the cases with amphotericin B alone or in combination with fluconazole prescribed in 28%. Conclusions: Surveys done through passive surveillance continue to be sentinel markers for HIV infection and represent a systematic approach to the study of opportunistic problems regularly afflicting AIDS patients since cryptococcosis requires no compulsory notification in Colombia.

Introducción. Desde 1997 se viene realizando un programa nacional de vigilancia sobre la criptococosis en Colombia. Se presentan los resultados correspondientes a los pacientes diagnosticados entre el 2006 y el 2010. Objetivo. Analizar los datos obtenidos durante este periodo. Materiales y métodos. Análisis retrospectivo de las encuestas. Resultados. Durante los cinco años mencionados se recibieron 526 encuestas representativas del 72 % de la división política colombiana. La mayoría de pacientes (76,6 %) eran hombres y 74,9 % estaban entre los 21 y los 50 años. El factor de riesgo prevalente fue la infección por VIH (83,5 %), y la criptococosis definió el sida en 23 % de los casos. La incidencia anual promedio en la población general fue de 2,4 por un millón de habitantes mientras que, en pacientes con sida, aumentó a 3,3 por 1.000. En 474 encuestas se informaron manifestaciones clínicas; las más frecuentes fueron: cefalea (84,5 %), fiebre (63,4 %), náuseas y vómito (57,5 %), alteraciones mentales (46,3 %), signos meníngeos (33 %), tos (26,4 %) y alteraciones visuales (24,5 %). La neurocriptococosis se reportó en 81,8 % de los casos. El diagnóstico se hizo por examen directo, cultivo y antigenemia en 29,3 % de los casos. De 413 aislamientos recuperados, 95,6 % fueron C. neoformans var. grubii, 1 % C. neoformans var. neoformans, y 3,4 % C. gattii. En 71,6 % de los casos para el tratamiento se administró anfotericina B y en 28 % se combinó con fluconazol. Conclusiones. La vigilancia pasiva continúa siendo un marcador centinela para la infección por VIH, y constituye una aproximación sistemática al estudio de infecciones oportunistas en pacientes con sida, debido a que la criptococosis no es de notificación obligatoria en Colombia.

Adolescent , Adult , Aged , Child , Female , Humans , Male , Middle Aged , Young Adult , Cryptococcosis/epidemiology , AIDS-Related Opportunistic Infections/epidemiology , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Antigens, Fungal/blood , Colombia/epidemiology , Cryptococcosis/diagnosis , Cryptococcosis/drug therapy , Cryptococcosis/microbiology , Cryptococcus gattii/immunology , Cryptococcus gattii/isolation & purification , Cryptococcus neoformans/immunology , Cryptococcus neoformans/isolation & purification , Drug Resistance, Multiple, Fungal , Fluconazole/administration & dosage , Fluconazole/therapeutic use , Health Surveys , Incidence , Population Surveillance , Retrospective Studies , Symptom Assessment
Int. j. morphol ; 30(2): 559-566, jun. 2012. ilus
Article in English | LILACS | ID: lil-651830


The aim of our study was to compare the nephrotoxic effects of liposomal amphotericin B (Ambisome) and amphotericin B lipid complex (Abelcet) on rat kidneys at short (14 days) and long term (28 days) treatment applications. Thirty-six male Wistar rats were included and divided into six groups (n=6). Groups 1 and 4 are composed as control groups by administrating intraperitoneal (ip) 0, 9 molar Serum physiologic for a period of 14 and 28 days respectively. Group 2 and 3 are treated with 5 mg/kg Ambisome and 5 mg/kg Abelcet for 14 days respectively, group 5 and 6 are treated with same agents for 28 days respectively. Then, the rats were transcardially perfused, samples were taken from cortex and medulla regions of kidneys. The micrographs of group 1 and 4 were seen as normal. For short term treatment, some morphological changes were seen in proximal tubule cells in group 3 whereas in group 2 the graphs were observed as normal. However, after long term drug using in group 5 and 6 there were vacuolization, increased lysosomal structures and deep basal folding's into tubular cells lumen. These experiments establish that renal damage were seen in short and long term use of Abelcet and long term use of Ambisome.

El objetivo de nuestro estudio fue comparar los efectos nefrotóxicos de la anfotericina B liposomal (AmBisome) y anfotericina B en complejo lipídico (Abelcet) sobre riñones de ratas, en el tratamiento de aplicación a corto (14 días) y largo plazo (28 días). Fueron incluidas en el estudio 36 ratas Wistar machos, divididas en seis grupos (n = 6). Los Grupos 1 y 4 fueron grupos de control mediante la administración intraperitoneal (ip) de 0, 9 molar de suero fisiológico durante un periodo de 14 y 28 días respectivamente. Los Grupos 2 y 3 fueron tratados con 5 mg/kg de ambisome y 5 mg/kg abelcet durante 14 días respectivamente, y finalmente los grupos Grupos 5 y 6 tratados con los mismos agentes durante 28 días, respectivamente. Luego, las ratas fueron perfundidas vía transcardíaca, y se tomaron muestras de la corteza y la médula renal. Las micrografías de los grupos 1 y 4 se observaron normal. En el tratamiento a corto plazo, algunos cambios morfológicos se observaron en las células del túbulo proximal en el grupo 3, mientras que en el grupo 2 los gráficos se observaron normales. Sin embargo, después de utilizar la droga a largo plazo en los grupos 5 y 6 hubo vacuolización, aumento de las estructuras lisosomales y un profundo plegamiento basal de las células del lumen tubular. Estos experimentos establecen que el daño renal se produce en el uso a corto y largo plazo de Abelcet, y largo plazo de Ambisome.

Animals , Rats , Amphotericin B/toxicity , Liposomes/toxicity , Kidney/ultrastructure , Amphotericin B/administration & dosage , Liposomes/administration & dosage , Rats, Wistar , Kidney , Time Factors