1/32. Systemic mycoses during prophylactical use of liposomal amphotericin b (Ambisome) after liver transplantation.We investigated the prophylactical administration of liposomal amphotericin b (Ambisome) in the early phase after liver transplantation (LTx). Fifty-eight patients received Ambisome prophylactically after LTx. Ambisome (1 mg kg-1 day-1) was given intravenously for 7 days after LTx. Immunosuppressive prophylaxis was cyclosporin A (CsA) based in 11 patients. Forty-seven patients had a tacrolimus-based immunosuppressive regimen. CsA and tacrolimus dosages were adjusted to trough levels of 150-250 ng ml-1 (EMIT) and 5-15 ng ml-1 (MEIA II) respectively. Three patients died from sepsis due to aspergillus fumigatus infection. Reasons for a fatal outcome were foudroyant Aspergillus pneumonia in a patient transplanted for fulminant hepatic failure on post-operative day (pod) 8; Aspergillus sepsis with severe endocardidtis in a patient with two retransplantations for graft non/dysfunction on pod 24; and disseminated aspergillosis due to aspergillus fumigatus in a patient retransplanted for primary non-function (pod 19). All three patients underwent haemofiltration for renal failure. One patient with candida albicans sepsis (pod 4) recovered under increased dosage of Ambisome (3 mg kg-1 per day). Ambisome (1 mg kg-1 per day) seems to be beneficial against systemic Candida infections. However, the onset of systemic Aspergillus infections could not be prevented. Obviously, higher Ambisome doses appear to be necessary against Aspergillus. We recommend the use of Ambisome (3 mg kg-1 per day) for patients with risk factors such as graft dys-/non-function, retransplantation, haemofiltration and complicated acute liver failure to prevent invasive aspergillosis.- - - - - - - - - - ranking = 1keywords = fumigatus (Clic here for more details about this article) |
2/32. Invasive fungal sinusitis in the acquired immunodeficiency syndrome.Invasive fungal sinusitis can present as either an indolent or fulminant process that primarily affects immunocompromised individuals. In this article, the clinical characteristics of four cases of invasive fungal sinusitis in patients with AIDS are analyzed and 22 additional previously reported cases in the literature are reviewed. In addition to hiv infection, other variables common to these cases include facial pain or headache out of proportion to clinical or radiographic findings, cd4 lymphocyte count less than 50 cells/mm(3), absolute neutrophil count less than 1,000 cells/mm(3), subtle radiographic evidence suggesting invasion and an indolent clinical course of the invasive infection. The most common pathogen detected was aspergillus fumigatus. Maintaining a high index of suspicion, critically assessing these clinical findings, and prudently reviewing CT scans may facilitate early diagnosis and prompt intervention in these patients.- - - - - - - - - - ranking = 0.5keywords = fumigatus (Clic here for more details about this article) |
3/32. Fungal endophthalmitis after a single intravenous administration of presumably contaminated dextrose infusion fluid.PURPOSE: To report fungal endophthalmitis in nonimmunocompromised patients, each of whom received a single intravenous administration of presumably contaminated dextrose infusion fluid for minor ailments in rural settings. methods: This noncomparative case series included 12 nonimmunocompromised patients (12 eyes) with culture-positive fungal endophthalmitis. All eyes underwent initial vitreous tap with injection of intravitreal antibiotics. Eleven eyes required pars plana vitrectomy and oral fluconazole or itraconazole for 4 to 6 weeks. One patient with panophthalmitis was treated with intravenous amphotericin b. To support the hypothesis that contaminated intravenous fluid was the possible risk factor, samples from 72 sealed bottles of 5% dextrose were subjected to fungal culture. RESULTS: patients presented 1 to 11 weeks (mean, 4.6 weeks) after the intravenous infusion. All eyes had a positive smear and cultures for fungi. Aspergillus specimen was isolated in nine eyes, Candida in two eyes, and mucor in one eye. Final visual acuity was 20/80 or better in 8 (66.6%) eyes. Eleven of the 72 samples from dextrose bottles were culture-positive for fungi: six for aspergillus fumigatus, three for aspergillus niger, and two for candida albicans. CONCLUSION: A presumed contaminated intravenous infusion administered in a rural setting was found as a new risk factor for development of endogenous fungal endophthalmitis. These patients were successfully treated with pars plana vitrectomy and oral fluconazole and itraconazole therapy.- - - - - - - - - - ranking = 0.5keywords = fumigatus (Clic here for more details about this article) |
4/32. Unusual presentations of isolated sphenoid fungal sinusitis.Isolated sphenoid fungal sinusitis is a rare and often difficult to diagnose condition as the presenting symptoms are often vague and non-specific. In this series each case has a different clinical presentation with a different causative fungus. Although isolated fungal sphenoid sinusitis is usually seen in immunocompromised individuals, two of the three cases presented were immunocompetent. The fungi were pseudallescheria boydii, aspergillus fumigatus and schizophyllum commune. In order to illustrate the great diversity of clinical signs, each case is individually presented. The characteristic radiological signs and the clinical management of each case are also presented. The danger signs of associated pathology are discussed with particular reference to an associated squamous carcinoma in one case. Surgical options and chemotherapy are discussed. Isolated sphenoid fungal sinusitis is a rare condition that if undiagnosed may result in considerable morbidity and even mortality of patients.- - - - - - - - - - ranking = 0.5keywords = fumigatus (Clic here for more details about this article) |
5/32. Fungal surveillance of an open haematology ward.Air sampling and surveillance cultures for fungi were performed in a Scottish general haematology ward over a five-month period in 1997. The mean total fungal count from the air sampling appeared to be correlated with the number of patients colonized by Aspergillus. The most commonly isolated species were Aspergillus versicolor, A. fumigatus and A. niger. Rooms with portable air filtration units had significantly lower total fungal counts than the others. Swabs were taken from 70 patients (mean age 62 years); 114 of the 563 cultures (20.2%) were positive. The most commonly isolated species were A. fumigatus, candida albicans, C. glabrata and C. parapsilosis. Samples taken from the tongue and perineum showed colonization more often than those taken from the nostrils. Almost half the patients (48.6%) were colonized on, or within seven days of, admission; 11.4% became colonized whilst on the unit. One patient developed fatal aspergillosis. We conclude that colonization or high air-borne spore concentrations are not necessarily predictive of fungal infection but may prompt early treatment or more aggressive prophylaxis of potentially fatal invasive infections.- - - - - - - - - - ranking = 1keywords = fumigatus (Clic here for more details about this article) |
6/32. Complications of valvular surgery--5 cases report with special reference to the conduction system--.Five interesting autopsy cases of post-valvular replacement death are reported and discussed with special reference to disturbances of the conduction system. The most important acute changes are hemorrhages; the significance of a venous hemorrhage is emphasized. Chronic changes are collagenization of conduction system. One case of mycotic valvulitis, probably due to aspergillus, and one case of dissecting aneurysm probably related to previous valve replacement surgery are included.- - - - - - - - - - ranking = 0.76045354629362keywords = aspergillus (Clic here for more details about this article) |
7/32. Cerebral aspergillosis caused by neosartorya hiratsukae, brazil.We report the first case of infection by neosartorya hiratsukae, an ascomycete in which the conidial state resembles aspergillus fumigatus. The fungus caused a brain infection in a Brazilian woman, who died despite itraconazole treatment. Diagnosis was established by direct microscopic examination, computed tomographic scan, and magnetic resonance imaging of the brain, and repeated cultures from the lesions. The in vitro antifungal susceptibility of the isolate is provided.- - - - - - - - - - ranking = 0.5keywords = fumigatus (Clic here for more details about this article) |
8/32. Brainstem auditory evoked response in adolescents with acoustic mycotic neuroma due to environmental exposure to toxic molds.Indoor air contamination with toxic opportunistic molds is an emerging health risk worldwide. Some of the opportunistic molds include: stachybotrys chartarum, Aspergillus species (A. fumigatus, A. flavus, A. niger, A. versicolor etc.), Cadosporium, alternaria, penicillium, trichoderma, fusarium graminearum etc. These molds flourish in homes that are moist and damp. Reports of floods are now evident in many parts of the world. With these global changes in climatic conditions that favor the opportunistic mode of living among these molds, some health authorities are beginning to feel concerned about the diversity and the extent to which opportunistic molds can cause adverse health effects in humans. mycotoxicosis is the collective name for all the diseases caused by toxic molds. Frequently, we have cases of acoustic neuroma due to mycotoxicity in our Center. Mycotic neuroma probably has not been reported before and the application of brainstem auditory evoked response (BAER) techniques in acoustic mycotic neuroma have not been reported either. The aim of this study, therefore, was to report cases and measurements of acoustic mycotic neuroma in adolescents using the brainstem auditory evoked response. The patients' case history, clinical neurological and neurobehavioral questionnaires were assessed. Then, the BAERs were recorded between Cz and Ai, with a second channel, Cz-Ac. The case histories and the questionnaires were analyzed in conjunction with the outcome of the objective brainstem auditory evoked response measurements. The prevalent subjective findings in the patients were headaches, memory loss, hearing loss, lack of concentration, fatigue, sleep disturbance, facial swelling, rashes, nosebleeds, diarrhea, abdominal pains and respiratory difficulties. Objective BAER showed overall abnormalities in all the patients. Although the waveform abnormalities varied, 1-3 interpeak latencies were abnormal in all the patients. overall results showed the presence of acoustic mycotic neuroma and confirmed the sensitivity and usefulness of BAER in screening acoustic mycotic neuroma and sensorineural auditory dysfunction.- - - - - - - - - - ranking = 0.5keywords = fumigatus (Clic here for more details about this article) |
9/32. Voriconazole in the treatment of invasive mold infections in transplant recipients.mortality due to invasive mold infections in solid organ transplant recipients is very high despite therapy with amphotericin b, including lipid formulations. Voriconazole is a triazole with a good activity against molds, including Aspergillus spp. and scedosporium spp. Experience with voriconazole is limited, but preliminary results in patients with these infections are promising. Reported here is the experience with voriconazole administered on a compassionate-use basis to five patients with invasive mold infections: four solid organ recipients and one patient with an autoimmune disorder. Four patients had invasive aspergillus fumigatus infection (3 lung infections, 1 abdominal infection) and one had invasive ocular scedosporium apiospermum infection. The MIC of voriconazole was < or =1 microg/ml for all isolates (NCCLS performance standards for microdilution assay, proposed standard M38-P). Voriconazole was administered as primary therapy in a patient with scedosporium infection and, in patients with Aspergillus infections, after persistence of positive culture despite a cumulative dose of 3 g of a lipid formulation of amphotericin b. Voriconazole was administered for a median time of 80 days (range, 60-90 days). No visual disturbances were observed, but one patient presented a moderate increase in liver enzymes. An increase in the levels of immunosuppressive drugs (tacrolimus or cyclosporine) was detected in all patients during coadministration with voriconazole. A clinical response was observed in all patients (complete response, n=3; partial response, n=2), and a microbiological response was observed in all but one patient. Furthermore, a good relationship between the MIC of voriconazole and outcome was observed. Voriconazole is an effective and safe therapy for treatment of invasive mold infections in solid organ recipients. To avoid toxicity with this drug, however, the dosing of immunosuppressive drugs must be reduced.- - - - - - - - - - ranking = 0.5keywords = fumigatus (Clic here for more details about this article) |
10/32. Fungal sinusitis the important role of the histopathology in the clinical management.Four cases of fungal sinusitis are reported. These include one case of aspergillus sinusitis alone, one case of combined aspergillus and paecilomyces sinusitis, and two cases of mucormycotic (zygomycotic) sinusitis. Although fungal sinusitis appears to be rare, it can pose difficulty in clinical diagnosis and we have demonstrated how the pathologist can help to alert the otolaryngologists of possible fungal sinusitis. Since the histopathological examination is important, a specimen for biopsy is mandatory.- - - - - - - - - - ranking = 1.5209070925872keywords = aspergillus (Clic here for more details about this article) |
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