scholarly journals Our experience in endoscopic management of mucormycosis: a case series and review of literature

2017 ◽  
Vol 3 (2) ◽  
pp. 465
Author(s):  
Inderdeep Singh ◽  
Vikas Gupta ◽  
Salil Kumar Gupta ◽  
Sunil Goyal ◽  
Manoj Kumar ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Case Series ◽  
Favourable Outcome ◽  
Surgical Debridement ◽  
Liposomal Amphotericin B ◽  
Nasal Endoscopy ◽  
Endoscopic Management ◽  
High Dose ◽  
Immunocompromised Status

Sinonasal mucormycosis is uncommon entity and it rarely infects a healthy host. When it does occur; it becomes very difficult to treat because of the speed of progress of disease and can have fatal outcomes. The mainstays of therapy are treatment of immunocompromised status, systemic high dose Amphotericin B, and surgical debridement of necrosed or nonviable tissue. The following six cases, managed at our centre from July 2016 to October 2016, outline nuances in the diagnosis of invasive sinonasal mucormycosis and highlight the importance of timely surgical debridement and importance of endoscopic approach in complete clearance of disease in order to facilitate medical management to work. All cases included in this study were found to be immunocompromised and had unilateral severe diminution of vision due to periorbital extension of disease. Diagnostic nasal endoscopy revealed black-brown crust and tenacious pus filling up nasal cavity, erosion of turbinates and nasal septal perforation. One patient showed erosion of hard palate and eschar formation. CECT/MRI of PNS showed evidence of bony erosion and orbital involvement. Biopsy taken during nasal endoscopy confirmed the presence of mucormycosis. All patients were started on Liposomal Amphotericin B and broad spectrum antibiotics in renal corrected dosages and taken up for urgent endonasal endoscopic debridement. All paranasal sinuses were cleared and orbital decompression was done. Postoperatively all patients were continued on Liposomal Amphotericin B in renal corrected dosages for two-three weeks and being followed up monthly. One patient could not survive due to several co morbidities and severe immunocompromised status. Only one patient showed recurrence of disease on one month postoperative follow up. Five patients showed improvement in visual acuity. Sinonasal mucormycosis if inappropriately diagnosed and treated can be a fatal condition. Energetic diagnostic workup, combined with equally energetic management, surgical and management leads to favourable outcome.<p> </p>

Favourable outcome in a child with acute lymphoblastic leukaemia and pulmonary mucormycosis managed with combination antifungal therapy of liposomal amphotericin B and caspofungin

2021 ◽  
Vol 14 (10) ◽  
pp. e245329
Author(s):  
Sanjeev Khera ◽  
Vikram Singh ◽  
Somali Pattanayak
Keyword(s):  
Acute Lymphoblastic Leukaemia ◽  
Amphotericin B ◽  
Antifungal Therapy ◽  
Lymphoblastic Leukaemia ◽  
Liposomal Amphotericin ◽  
Favourable Outcome ◽  
Surgical Debridement ◽  
Liposomal Amphotericin B ◽  
High Dose ◽  
Pulmonary Mucormycosis

Pulmonary mucormycosis (PM) accounts for more than half the cases of mucormycosis in paediatric haematological malignancies, with mortality reaching as high as 90%. Surgical debridement of lesion along with liposomal amphotericin B (L-AMB) constitutes the mainstay of management of mucormycosis and offers best chances of survival. There are no reliable data available in the literature justifying the use of combination antifungal therapy (CAfT). We describe a child with acute lymphoblastic leukaemia (ALL) who developed multiple localised PM during induction chemotherapy. He was managed with CAfT with L-AMB and caspofungin in view of progressive PM on high-dose L-AMB monotherapy. There was complete resolution of PM after 6 months of CAfT at the end of intensive chemotherapy of ALL. There were no significant side effects of CAfT. CAfT may be of value in cases of mucormycosis refractory to high doses of L-AMB, where surgical debridement is not feasible.

High-dose Weekly Liposomal Amphotericin B Antifungal Prophylaxis in Patients Undergoing Liver Transplantation

2015 ◽  
Vol 99 (4) ◽  
pp. 848-854 ◽  
Author(s):  
Maddalena Giannella ◽  
Giorgio Ercolani ◽  
Francesco Cristini ◽  
Mariacristina Morelli ◽  
Michele Bartoletti ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Antifungal Prophylaxis ◽  
Liposomal Amphotericin B ◽  
High Dose

scholarly journals Liposomal Amphotericin B, and Not Amphotericin B Deoxycholate, Improves Survival of Diabetic Mice Infected with Rhizopus oryzae

2003 ◽  
Vol 47 (10) ◽  
pp. 3343-3344 ◽  
Author(s):  
Ashraf S. Ibrahim ◽  
Valentina Avanessian ◽  
Brad Spellberg ◽  
John E. Edwards
Keyword(s):  
Overall Survival ◽  
Body Weight ◽  
Amphotericin B ◽  
Murine Model ◽  
Liposomal Amphotericin ◽  
Rhizopus Oryzae ◽  
Liposomal Amphotericin B ◽  
High Dose ◽  
Diabetic Mice ◽  
Amphotericin B Deoxycholate

ABSTRACT The efficacies of liposomal amphotericin B (LAmB) and amphotericin B deoxycholate (AmB) were compared in a diabetic murine model of hematogenously disseminated Rhizopus oryzae infection. At 7.5 mg/kg of body weight twice a day (b.i.d.), LAmB significantly improved overall survival compared to the rates of survival in both untreated control mice (P = 0.001) and mice treated with 0.5 mg of AmB per kg b.i.d. (P = 0.047). These data indicate that high-dose LAmB is more effective than AmB in treating murine disseminated zygomycosis.

Successful treatment of disseminated fusariosis with high dose liposomal amphotericin-B in a patient with acute lymphoblastic leukemia

2005 ◽  
Vol 85 (2) ◽  
pp. 136-138 ◽  
Author(s):  
Laura Cudillo ◽  
Andrea Tendas ◽  
Alessandra Picardi ◽  
Teresa Dentamaro ◽  
Maria Ilaria Del Principe ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Amphotericin B ◽  
Successful Treatment ◽  
Liposomal Amphotericin ◽  
Lymphoblastic Leukemia ◽  
Liposomal Amphotericin B ◽  
High Dose

High-Dose Liposomal Amphotericin B in the Therapy of Systemic Candidiasis in Neonates

2003 ◽  
Vol 22 (10) ◽  
pp. 603-607 ◽  
Author(s):  
A. Juster-Reicher ◽  
O. Flidel-Rimon ◽  
M. Amitay ◽  
S. Even-Tov ◽  
E. Shinwell ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
High Dose ◽  
Systemic Candidiasis

scholarly journals Population Pharmacokinetics of Conventional and Intermittent Dosing of Liposomal Amphotericin B in Adults: a First Critical Step for Rational Design of Innovative Regimens

2012 ◽  
Vol 56 (10) ◽  
pp. 5303-5308 ◽  
Author(s):  
William W. Hope ◽  
Joanne Goodwin ◽  
Timothy W. Felton ◽  
Michael Ellis ◽  
David A. Stevens
Keyword(s):  
Monte Carlo ◽  
Optimal Design ◽  
Monte Carlo Simulations ◽  
Amphotericin B ◽  
Liposomal Amphotericin ◽  
Liposomal Amphotericin B ◽  
High Dose ◽  
Pharmacokinetic Data ◽  
Informative Sampling ◽  
Sampling Times

ABSTRACTThere is increased interest in intermittent regimen of liposomal amphotericin B, which may facilitate use in ambulatory settings. Little is known, however, about the most appropriate dosage and schedule of administration. Plasma pharmacokinetic data were acquired from 30 patients receiving liposomal amphotericin B for empirical treatment of suspected invasive fungal infection. Two cohorts were studied. The first cohort received 3 mg of liposomal amphotericin B/kg of body weight/day; the second cohort received 10 mg of liposomal amphotericin B/kg at time zero, followed by 5 mg/kg at 48 and 120 h. The levels of liposomal amphotericin B were measured by high-pressure liquid chromatography (HPLC). The pharmacokinetics were estimated by using a population methodology. Monte Carlo simulations were performed. D-optimal design was used to identify maximally informative sampling times for both conventional and intermittent regimens for future studies. A three-compartment pharmacokinetic model best described the data. The pharmacokinetics for both conventional and intermittent dosing were linear. The estimates for the mean (standard deviation) for clearance and the volume of the central compartment were 1.60 (0.85) liter/h and 20.61 (15.27) liters, respectively. Monte Carlo simulations demonstrated considerable variability in drug exposure. Bayesian estimates for clearance and volume increased in a linear manner with weight, but only the former was statistically significant (P= 0.039). D-optimal design provided maximally informative sampling times for future pharmacokinetic studies. The pharmacokinetics of a conventional and an intermittently administered high-dose regimen liposomal amphotericin B are linear. Further pharmacokinetic-pharmacodynamic preclinical and clinical studies are required to identify safe and effective intermittent regimens.

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