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Infectious Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
Susanna J. Dunachie, Hanif Esmail, Ruth Corrigan, Maria Dudareva
Amphotericin B is used for severe fungal infections where other agents are not effective and is also used to treat leishmaniasis. The liposomal formulation is mostly used due to lower side effects, but it is expensive.
Infiltrative Optic Neuropathies
Published in Vivek Lal, A Clinical Approach to Neuro-Ophthalmic Disorders, 2023
Aniruddha Agarwal, Sabia Handa, Vishali Gupta
Cryptococcal infection is characterized by a rapid onset of a few hours to a few days due to rapid and direct invasion of the optic nerve. Commonly, patients are already being treated with amphotericin B and/or fluconazole for cryptococcal meningitis and an increase of the dose can be effective in helping to control the optic nerve involvement. Amphotericin B may be given intravitreally and/or intravenously. This condition carries high systemic and visual morbidity and the prognosis is usually guarded.107,108
Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Amphotericin B, an antifungal agent, is used primarily to treat systemic mycotic infections. No controlled studies of amphotericin B during pregnancy are published. Review of 18 case reports suggested no evidence of teratogenicity of amphotericin B (Briggs et al., 2021).
Association between fluid infusions and the recovery from acute kidney injury in patients administered liposomal amphotericin B: a nationwide observational study
Published in Renal Failure, 2022
Masato Tashiro, Yoko Obata, Takahiro Takazono, Yuki Ota, Tomotaro Wakamura, Yui Shiozawa, Ai Tsuyuki, Taiga Miyazaki, Tomoya Nishino, Koichi Izumikawa
Invasive fungal infections frequently occur in immunocompromised and critically ill patients and are associated with high rates of morbidity and mortality [1–5]. Amphotericin B is a broad-spectrum antifungal drug that covers clinically relevant yeasts and molds that cause mycoses, such as aspergillosis, candidiasis, cryptococcosis, and mucormycosis [6]. However, the use of amphotericin B has been limited because of its high incidence of toxicities, including nephrotoxicity, liver disorders, and hypokalemia [6]. Liposomal amphotericin B (L-AMB), which encapsulates amphotericin B in a liposomal membrane, was developed to reduce the toxicity of amphotericin B while maintaining its antifungal activity [6]. However, this specific liposomal formulation causes reduced tissue distribution in the kidneys and drug-associated nephrotoxicity, including excessive renal vasoconstriction and renal tubular damage. [7–9]. Despite the reduced nephrotoxicity, physicians are reluctant to prescribe L-AMB, especially to patients with renal failure, because of the risk of acute kidney injury (AKI) [10,11].
Postpartum Endogenous Endophthalmitis in a Young Immunocompetent Female by a Rare Fungus Candida ciferrii
Published in Ocular Immunology and Inflammation, 2022
Pooja Bansal, Meenakshi Thakar, Ravinesh Kumar, Poonam Loomba
This case posed multiple challenges, such as indolent course of the disease leading to delayed diagnosis of EE, prolonged treatment with steroids, neonatal safety of systemic antifungal agents and risk of developing RD due to delay in appropriate treatment as well as a complication o vitrectomy. Systemic antifungal therapy during lactation is challenging because of lack of data on efficacy and safety in neonates. Amphotericin B and fluconazole are found to be safe in pregnancy and lactation. Fluconazole has high oral bioavailability, rapid tissue penetration and a good safety profile in neonates.13,14 PPV in FEE has a diagnostic as well as therapeutic role. It is recommended in sight-threatening FEE with dense vitritis, if there is a diagnostic dilemma or not responsive to systemic therapy. Retinal detachment (RD) is a potential complication of FEE (26%) compared to endogenous bacterial infections (2%), during the course of management. Proposed mechanism is contraction of vitreous membranes in the peripheral retina or at the sclerotomy sites leading to retinal breaks. It is postulated that early vitrectomy (within a week of presentation) in FEE might reduce the incidence of RD.15,16
An Iris Tumor Secondary to Talaromyces Marneffei Infection in a Patient with AIDS and Syphilis
Published in Ocular Immunology and Inflammation, 2022
Tingkun Shi, Lingjie Wu, Jinnan Cai, Haoyu Chen
Talaromyces marneffei is a fungus which was previously called Penicillium Marneffei. It is prevalent in southern China, eastern India, and Southeast Asia. It usually affects immunocompromised patients. Talaromycosis may involve the skin, lung, mouth, liver, and the whole body. The skin biopsy result of our case is consistent with the reported talaromycosis lesion in literature.9 There was a case report of vitritis and retinal abscess secondary to Penicillium marneffei in an HIV positive patient. The patient responded to intravenous and intravitreal amphotericin.10 Another article reported bilateral granulomatous anterior uveitis in a HIV-patient with disseminated Talaromycosis marneffei infection, but the lesions were small and multiple. The patient responded to intravenous and intracameral amphotericin B injection.11 Our case was a unilateral single big iris mass, which is different from the previous reports. Although amphotericin was recommended in literature as the first-line therapy, it is not available in our hospital. We used oral voriconazole and topical fluconazole without intraocular or intravenous injection. The iris and skin lesions subsided completely after anti-fungal therapy.