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

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

No abstract available.
Amphotericin B* ; Hemoptysis*

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: Because of recently increasing reports of resistance of Candida (C.) species to antifungal agents, it is necessary to perform antifungal susceptibility testing. ATB FUNGUS 2 (bioMerieux, France) is an easy-to-perform in-vitro antifungal susceptibility test. OBJECTIVE: The purpose of the study was to investigate the minimal inhibitory concentration (MIC) of antifungal agents against Candida species isolated from skin lesion using ATB FUNGUS 2. METHODS: Eighty two clinical isolates of Candida species (including 56 C. albicans, 14 C. parapsilosis, 7 C. guilliermondii, 5 C. glabrata) were testeding ATB FUNGUS 2. MICs against itraconazole (ICZ), fluconazole (FCZ), flucytosine (FC) and amphotericin B (AMP) were read after 24 hours incubation. RESULTS: MIC of ICZ was <0.125microgram/ml on 73 (89.0%) clinical isolates of Candida species except > or =2.0microgram/ml on four strains (3 C. albicans, 1 C. glabrata) and 0.25~0.5microgram/ml on five strains (1 C. parapsilosis, 3 C. guilliermondii, 1 C. glabrata). MIC of FCZ was <8microgram/ml on 78 (95.1%) Candida species except >128microgram/ml on 3 C. albicans and 16microgram/ml on 1 C. parapsilosis. MIC of FC was <0.5microgram/ml on 76 (92.7%) Candida species except >64microgram/ml on 6 C. albicans. MIC of AMP was all (100.0%) <0.5microgram/ml. CONCLUSION: ATB FUNGUS 2 represented a simple and valuable method for antifungal susceptibility testing of Candida species.
Amphotericin B ; Antifungal Agents ; Candida* ; Fluconazole ; Flucytosine ; Fungi* ; Itraconazole ; Skin

Pulmonary Aspergillomas usually arise from proliferation of Aspergillus in preexisting parenchymal cavities.202 college students (99 men, 103 women) aged 18% 26 years. Fasting blood samples were. The most common symptom in this disorder is hemoptysis, which may be minimal in amount or it may be massive & life threatening. The optimum therapy for pulmonary aspergilloma is controversial. The major options available include surgical resection of the lesion, a number of medical therapies, or simple observation of the patient for a time. Surgery is the most effective treatment but it is limited to some patient because most patients haute underlying pulmonary disease. Thus the various form of medical therapy was available with successful result. The authors present a case of percutaneous intracavitary amphoterician B injection for the treatment of pulmonary aspergilloma & its successful effect for the repetitive hemoptysis.
Amphotericin B* ; Aspergillus ; Fasting ; Hemoptysis* ; Humans ; Lung Diseases ; Male