1/2. serum itraconazole and hydroxyitraconazole concentrations and interaction with digoxin in a case of chronic hypertrophic pachymenigitis caused by aspergillus flavus.A patient treated with itraconazole (ITCZ) under the diagnosis of aspergillus flavus-induced chronic hypertrophic pachymeningitis is presented. The reason for the successful cure of this patient was investigated by the pharmacokinetic analysis of serum levels of ITCZ. Concurrently administered digoxin was also investigated for its drug-drug interaction. The patient (a 75-year-old male) developed ophthalmopathy, and was diagnosed as having A. flavus hypertrophic pachymeningitis by pachymeninx biopsy. After admission, he was treated with FLCZ, AMPH, 5-FC and MCZ. The infection tended to subside with the AMPH administration. Since renal insufficiency was induced by AMPH and the other antifungal drugs were ineffective, daily administration of 200 mg of ITCZ was initiated, and the inflammatory signs and symptoms gradually subsided. The symptoms did not recur during the 36 months of itraconazole treatment after discharge, and it was concluded that ITCZ was effective for A. flavus hypertrophic pachymeningitis. Pharmacokinetic parameters of ITCZ and OH-ITCZ as follows: ITCZ: Cmax 93.2 ng/ml, T1/2 beta 11 hours, AUC0-24 999 ng.h/ml, OH-ITCZ: Cmax 159.4 ng/ml, T1/2 beta 16. 2 hours, AUC0-24 of 1391 ng.h/ml. Both ITCZ and OH-ITCZ reached steady states seven days after administration began. The ITCZ and OH-ITCZ levels in serum collected 36 months after the initiation of administration were 452.9 ng/ml and 1233.6 ng/ml, respectively. Cmax and AUC0-24 of ITCZ and OH-ITCZ on the second day were markedly lower than those in healthy adults reported by Oguchi et al., and hypoalbuminemia observed at administration on that day was considered the most probable cause. It was assumed that the most plausible reason for a successful cure even at a low dose of ITCZ was the increase of distribution to tissue by the increase of the unbound form. digoxin was concurrently given to this patient at 0. 125 mg/day, but the blood digoxin level was not elevated. Consideration of the blood level of albumin is believed to be important for evaluating the blood concentration of ITCZ.- - - - - - - - - - ranking = 1keywords = meninx (Clic here for more details about this article) |
2/2. meningitis caused by rhodotorula rubra in an hiv-infected patient.meningitis caused by rhodotorula spp. in hiv-infected patients has not been reported previously. We present a brief review of the literature regarding medically important species of rhodotorula and a case of meningitis caused by rhodotorula rubra in an hiv-infected patient. The diagnosis was confirmed by the isolation of the fungus from the CSF. The course of rhodotorula-induced meningitis was characterized by gradual development over several months, severe headache and high body temperature. No signs of damage to the meninx or inflammatory changes were observed. Therapy with 5-fluorocytosine for 15 days was successful in eliminating the yeast from the CSF. Eight months later the meningitis relapsed with R. rubra being recovered from the CSF. Suppressive therapy with itraconazole (400 mg daily during 3 months) followed by maintenance therapy (200 mg daily) eradicated the infection.- - - - - - - - - - ranking = 1keywords = meninx (Clic here for more details about this article) |