BACKGROUND: Amphotericin B is used in pediatrics for severe fungal infections despite its known nephrotoxic side effects. Tubular injury and renal vasoconstriction range from 15-58% with exact risk factors that predispose children to developing these complications still undefined. OBJECTIVES: To determine the risk factors for nephrotoxicity with deoxycholate Amphotericin B treatment among children 6 months-18 years old at the Philippine Children‘s Medical Center from 2006-2017 METHODS: This is a retrospective case-control study of 150 patients. Cases had decrease in eGFR by at least 25% and/or developed hypokalemia after at least one dose of Amphotericin. Those who did not develop nephrotoxicity were considered controls. Risk factors evaluated were age, sex, nutritional status, underlying medical condition, cumulative dose, concomitant use of nephrotoxic drugs used, treatment with diuretics and intravenous hydration. Results were analyzed using univariate and multivariate regression models. RESULTS: Using logistic regression, underlying malignancy had the highest odds ratio of 33.1 and nutritional status of z score=0 showed the lowest at 0.158. Duration of treatment >14 days had 1.75 times chance of developing nephrotoxicity while total cumulative dose >7.1 mg/kg had 1.5 times more chance of developing nephrotoxicity. Subjects given diuretics had 5.5 times more odds, while those not given concomitant nephrotoxic medications were 5.33% less likely to develop renal toxicity. CONCLUSION: Risk factors for nephrotoxicity were malignancy as an underlying medical condition, duration of amphotericin treatment of >14 days, cumulative dose >7.1 mg/kg and diuretic use. Normal nutritional status and no other concomitant nephrotoxic medication use had lesser odds of developing nephrotoxicity. RECOMMENDATIONS Clinicians should consider these risk factors, institute measures to monitor occurrence of nephrotoxicity and the need for alternative fungal therapy in these children. With identification of the population at risk, prospective research on determining the specific onset of renal effects and possible intervention is recommended.
Amphotericin B

No abstract available.
Amphotericin B* ; Hemoptysis*

BACKGROUND: Although standardized broth dilution methods for antifungal susceptibility testing are available, easier testing procedures are desirable. We evaluated the E-test (AB disk, Sweden) as a possible alternative instead of NCCLS (National Committee for Clinical Laboratory Standards) broth macrodilution method. METHODS: Fifty-two bloodstream isolates of Candida spp. (including 11 C. albicans, 13 C. tropicalis, 18 C. parapsilosis, 1 C. glabrata, 4 C. krusei, 2 C. pelliculosa, 2 C. lipolytica, and 1 C. guilliermondii) were tested. Amphotericin B and fluconazole MICs for each isolate were determined by both NCCLS broth macrodilution method and E-test. The results of E-test for Candida spp. were compared with those of NCCLS macrodilution method. For selecting plating media for E-test, we compared E-test results in two different media (RPMI and Casiton medium) using five ATCC Candida strains. RESULTS: As E-test media, we selected RPMI medium for amphotericin B and Casitone medium for fluconazole because of higher agreement with NCCLS method. The E-test and NCCLS method of 52 Candida spp. yielded a very narrow range of MICs (0.064-2.0 microgram/mL) for amphotericin B and a broad range of MICs (0.5-64 microgram/mL) for fluconazole. The agreements of E-test within one doubling dilutions of the macrodilution reference were 90.4% (24h and 48h) for amphotericin B, and 90.4% (24h) and 96.2% (48h) for fluconazole. CONCLUSION: The E-test is a valuable alternative to the NCCLS macrodilution method for amphotericin B and fluconazole susceptibility testing of Candida species.
Amphotericin B ; Candida* ; Fluconazole

Mucormycosis is a fungal disease in which normal saphrophytic molds produce an acute and often rapidly fatal infection. Patients with orbital mucormycosis commonly present with abrupt visual loss, orbital pain and facial hypoaethesia. In our case, mucormycosis was confirmed by histopathological examination and it was mainly treated with daily intravenous amphotericin B for 42 days. As medical treatment was successful, no orbital exenteration has been necessitated.
Amphotericin B ; Fungi ; Humans ; Mucormycosis* ; Orbit*

Mucormycosis is a fungal disease in which normal saphrophytic molds produce an acute and often rapidly fatal infection. Patients with orbital mucormycosis commonly present with abrupt visual loss, orbital pain and facial hypoaethesia. In our case, mucormycosis was confirmed by histopathological examination and it was mainly treated with daily intravenous amphotericin B for 42 days. As medical treatment was successful, no orbital exenteration has been necessitated.
Amphotericin B ; Fungi ; Humans ; Mucormycosis* ; Orbit*

We report a case of primary cutaneous mucormycosis, one of five clinical forms of mucormycosis, in a 68-year-old immunocompetent woman, which developed after trauma. We treated her successfully with amphotericin B for 23 days.
Aged ; Amphotericin B ; Female ; Humans ; Mucormycosis*

Objective: To determine the in-vitro activity of voriconazole and compare it with amphotericin B, fluconazole, itraconazole, ketoconazole, and caspofungin against local yeast and mold clinical isolates Candida albicans, Candida sp., Aspergillus terreus, Aspergillus niger, and Fusarium cylindrocarpone. Methods: Review of the Institute of Ophthalmology microbiology records were done and was the basis for the local isolates included in the study. Mean inhibitory concentration (MIC) was determined using YeastOne Sensititre Microtitre Colorimery method (TREK Diagnostic Systems, England). Two-way ANOVA, Duncan, and Pearson chi-squared tests were used to analyze the data. Results: All isolates tested were sensitive to voriconazole. Eighty percent (80%) of the isolates were sensitive to amphotericin B and 25% showed resistance to itraconazole. Yeast pathogens were all sensitive to amphotericin B and voriconazole. More than 50% of the yeast pathogens were resistant to ketoconazole. Molds or filamentous fungi showed higher susceptibility to voriconazole than amphotericin B and the other antifungals. Conclusion Voriconazole exhibited good in-vitro activity against the isolates tested. It has the same efficacy on yeast pathogens (Candida albicans and Candida sp.) when compared with amphotericin B. It has superior efficacy on filamentous fungi (Aspergillus and Fusarium). There is a role for voriconazole in the treatment of ocular infections, especially in the setting of poor antifungal drug availability.
Voriconazole ; Amphotericin B ; Candida ; Fusarium ; Aspergillus

We describe New World cutaneous leishmaniasis (Leishmania amazonensis), a disease not endemic in the Philippines, in a 45-year-old man with ulcerating lesions on his hand and leg ater returning from South America. The patient responded to treatment with liposomal amphotericin B. This imported case of leishmaniasis highlights the importance of obtaining a detailed travel history in patients with chronic, non-healing skin lesions which should lead to earlier recognition and treatment.

BACKGROUND: A spectrophotometric approach to minimum inhibitory concentration (MIC) determination for filamentous fungi may provide an objective and rapid MIC reading, and quantify the hyphal growth of molds. In this study, we evaluated two spectrophotometric broth microdilution methods (SBM) to determine amphotericin B and itraconazole MICs for Aspergillus species isolated from clinical specimens. METHODS: A total of 80 clinical isolates (20 A. fumigatus, 20 A. flavus, 18 A. niger, 20 A. terreus, and 2 A. nidulans) were tested for amphotericin B and itraconazole susceptibility by the broth microdilution method. The MIC endpoint was calculated by the spectrophotometer with microplate reader (SBM-Spec method) or colorimetric XTT (tetrazolium dye) method (SBM-XTT method). The results of the SBM method were compared with those of NCCLS M38-A broth microdilution method. RESULTS: The MICs of amphotericin B by the NCCLS M38-A method ranged from 0.125 to 8 g/mL, and those of itraconazole ranged from 0.25 to 2micrograms/mL. The agreement of SBM-Spec and SBM-XTT methods within one dilution of the NCCLS M38 reference were 98.8% and 96.3% for the ampho-tericin B, and 98.8% and 100% for itraconazole, respectively. The agreements between SBM-Spec and SBM-XTT methods were 97.5% for amphotericin B and 98.8% for itraconazole. CONCLUSIONS: In antifungal susceptibility testing of Aspergillus species, the SBM method includ-ing SBM-Spec and SBM-XTT methods showed high levels of agreements with the NCCLS M38-A method. The SBM methods can be useful in the clinical laboratory.
Amphotericin B ; Aspergillus* ; Fungi ; Itraconazole ; Microbial Sensitivity Tests ; Niger

Kodamaea (Pichia) ohmeri is a rare fungal pathogen that has recently been identified as an etiological agent of fungemia in immunocompromised patients. We report a case of K. ohmeri fungemia after colonoscopic stent insertion in a 73-year-old female who was successfully treated with a 2-week course of amphotericin B without stent removal. This is the first case report of K. ohmeri fungemia that developed after colonoscopic stent insertion.
Amphotericin B ; Colonoscopy ; Female ; Fungemia ; Humans ; Immunocompromised Host ; Stents