PURPOSE: To investigate the clinical efficacy of intracameral amphotericin injection and to evaluate risk factors affecting primary treatment success in fungal infection invading the anterior segment of the eye. METHODS: Twenty-six eyes of 26 patients diagnosed with fungal infection in the anterior segment were studied. The initial treatment regimen was a topical 0.15% amphotericin application and itraconazole oral administration after culture. Amphotericin (5 ug/0.1 ml, 0.1 cc) was repeatedly injected intracamerally when the infection intensified. Penetrating keratoplasty was conducted for eyes unresponsive to intracameral amphotericin injection. The relative risk ratios of ulcer size, infiltration depth, culture positivity, and hypopyon were compared in each treatment group to evaluate the treatment response. RESULTS: Of patients with fungal infection, 30.7% were cured with intracameral amphotericin injection, while 30.7% needed penetrating keratoplasty. Intracameral amphotericin injection was needed in the presence of large corneal ulcers (>14 mm2), hypopyon, positive fungal culture, use of steroid eye drops, and deep infiltration at initial examination. Large ulcer size (>14 mm2) was the main risk factor for needing penetrating keratoplasty. Of the eyes Candida infection, 66.5% needed evisceration. CONCLUSIONS: Large ulcer size and the isolation of Candida were poor prognostic factors related to the efficacy of intracameral amphotericin injection.
Administration, Oral ; Amphotericin B* ; Candida ; Humans ; Itraconazole ; Keratoplasty, Penetrating ; Odds Ratio ; Ophthalmic Solutions ; Risk Factors* ; Ulcer

PURPOSE: The efficacy of continuous bladder irrigation with amphotericin B versus oral administration of fluconazole(Diflucan ) was compared in the treatment of patients with candiduria. . MATERIALS AND METHODS: A prospective and comparative study of candiduriawas done on 28 patients(Amphotericin B: 13, Fluconazole: 15). Continuous bladder irrigation with 50mg amphotericin B/iota sterile water infused during 24 hours for 2 days was compared to oral administration of 50-100mg/day fluconazole for a range of 7-14 days. Urine culture were obtained 3days, 7 days after continuous bladder irrigation with amphotericin B and 7 days, 14 days after oral administration of fluconazole. RESULTS: The organism was eradicated in 10 patients(76.9%) who received continuous irrigation of amphotericin B and 11 patients(73.3%) who received oral fluconazole therapy. So, There was no statistically significant difference between continuous bladder irrigation with Amphotericin B group and oral medication of fluconazole group(p>0.05). CONCLUSIONS: There was no difference in the cure rate of candiduria between continuous bladder irrigation with Amphotericin B group and oral medication of fluconazole group. So, patient's condition(Foley catheterization, possibility of ambulation and oral feeding) and convinience will be the important deciding factors to select adequate treatment method of candiduria.
Administration, Oral* ; Amphotericin B* ; Catheterization ; Catheters ; Fluconazole* ; Humans ; Prospective Studies ; Urinary Bladder* ; Walking ; Water

Mucormycosis is an invasive fungal infection, caused by members of the order Mucorales, that usually occurs in immunocompromised individuals. It manifests itself in a variety of ways and rarely may be confined to the cutaneous tissues. We report a case of primary cutaneous mucormycosis associated with longstanding diabetes mellitus and liver cirrhosis. A 53-year-old woman was presented because of cutaneous discoloration and bullae on the both lower extremities. Cutaneous lesions consisted of necrotic blackish discoloration with bullae and ill-defined margins with extending nature. A biopsy specimen from the cutaneous lesion revealed large, broad, nonseptate hyphae branched at right angles. Our patient was successfully treated with intravenous administration of amphotericin B and surgical debridement of necrotic tissue.
Administration, Intravenous ; Amphotericin B ; Biopsy ; Debridement ; Diabetes Mellitus ; Female ; Humans ; Hyphae ; Liver Cirrhosis ; Lower Extremity ; Middle Aged ; Mucorales ; Mucormycosis*

A 11-year-old girl with chronic mucocutaneous candidiasis(CMCC) has been observee since the age of 4 years. At first(November, 1978) there was a good response to treatment with amphotericin B intravenously of total 300 mg, but not to with oral administration of nystatin and local clotrirnazole cream. Since that time, she bas been admitted on different occasions for further evaluation and therapy because of recurrences. During the most recent hospitalization in October, 1985, she was suffered from herpes zoster in addition to CMCC. We treatecl her with analgesics and intravenous globulin for herpes zoster, and concomitantly with ketoconazole(200 mg/day) and 5-fluarocytosine for 20 days. At the end of this period, she was free of any clinical evidences of CMCC and herpes zoster.
Administration, Oral ; Amphotericin B ; Analgesics ; Candidiasis, Chronic Mucocutaneous* ; Child ; Female ; Herpes Zoster ; Hospitalization ; Humans ; Ketoconazole ; Nystatin ; Recurrence

Amphotericin B ; administration & dosage ; adverse effects ; Child ; Child, Preschool ; Drug Therapy, Combination ; Female ; Humans ; Male ; Meningitis, Cryptococcal ; diagnosis ; drug therapy

Two young males from Central Province were referred to Port Moresby General Hospital with chronic headaches. In each case the initial impression of tuberculous meningitis needed revision in the light of strongly positive cryptococcal serology. Cryptococcal meningitis occurs with sufficient frequency in Papua New Guinea that it should be considered in cases of raised intracranial pressure, ataxia, cranial neuropathy and visual disturbances. Delay in treatment may be disastrous. In contrast to the developed world where fungal meningitides show a predilection for the immunosuppressed, the experience to date in Papua New Guinea is that the majority of cases in both adults and children occur in ostensibly immunocompetent individuals. The epidemiology, clinical course and current treatment of this potentially curable disease are discussed.
Amphotericin B - administration & ; dosage ; Child ; Drug Therapy, Combination - administration & ; dosage ; Flucytosine - administration & ; dosage ; Follow-Up Studies ; Meningitis, Cryptococcal - drug therapy ; Papua New Guinea

<b>OBJECTIVEb>Chronic pulmonary aspergillosis is different from acute pulmonary aspergillosis in clinical picture, radiogram, diagnostic procedures and prognosis. Four patients with chronic pulmonary aspergillosis had been misdiagnosed as having pneumonia or pulmonary tuberculosis for a long time before admission to the hospital. The purpose of this report was to summarize the clinical manifestations and laboratory findings for correct diagnosis of chronic pulmonary aspergillosis.

<b>METHODSb>Four patients with chronic pulmonary aspergillosis seen between October 2002 and October 2004 were retrospectively studied. Their clinical manifestations, chest radiographic feature, immune status, diagnostic procedure, therapy and prognosis were reviewed.

<b>RESULTSb>The chief complaints of these patients were chronic cough and fever for 3 to 12 months. Chest wall abscess developed in the late course in case 1 and 4. Fine moist rales were heard and hepatosplenomegaly was found in case 1 and 2. No abnormal sign was found in case 3 and 4. Chest radiographic feature: lobar consolidation with adjacent pleural thickening was present in all cases. In early phase, solitary or multiple small nodules were found in 2 cases. Case 1-3 had normal IgG, IgM, IgA, IgE, T Cell subsets and NBT test. Case 4 had chronic granulomatous disease. Etiologic evidences: culture was positive for Aspergillus (A.) fulmigatus in sputum and in chest wall abscess in case 1 and 4; for A. niger in sputum and spore existing in lung tissue in case 2; for A. fulmigatus in sputum and hypha existing in lung tissue in case 3. All patients were treated with combination of amphotericin B and itraconazole. Their symptoms were controlled 10-30 d after treatment. In case 1 the disease relapsed 6 months later and the patient died at last due to giving up treatment by his parents. Case 2 was free of symptom for 12 months and his chest radiographic lesion disappeared completely 6 months later. Treatment of case 4 was given up. Case 3 continued to receive treatment and observation.

<b>CONCLUSIONb>Chronic pulmonary aspergillosis should be considered in children with long period fever and cough and lobar consolidation associated with adjacent pleural thickening or with nodular infiltration. The diagnosis of chronic pulmonary aspergillosis depended on identification of aspergillus from sputum or lung tissue. Combined amphotericin B and itraconazole might control the disease.

Amphotericin B ; administration & dosage ; Child ; Child, Preschool ; Chronic Disease ; Drug Therapy, Combination ; Female ; Humans ; Infant ; Itraconazole ; administration & dosage ; Male ; Pulmonary Aspergillosis ; diagnosis ; drug therapy

Adult ; Amphotericin B ; administration & dosage ; therapeutic use ; Antifungal Agents ; administration & dosage ; therapeutic use ; Fluconazole ; administration & dosage ; therapeutic use ; Glucocorticoids ; adverse effects ; Hepatitis B, Chronic ; complications ; Humans ; Male ; Pulmonary Aspergillosis ; complications ; diagnosis ; drug therapy ; Tomography, X-Ray Computed

Though topical administration of antifungal agents for fungal keratitis is effective, it results various toxic effect on cornea depending on the kinds of agents. So, the authors applied several kinds of antifungal agents on the cornea of rabbit and made a comparative study for corneal epithelial damage of which is related to each agents and instillation time using scanning electron microscope. Forty eyes from twenty rabbits were instilled with 0.15% amphotericin B, 5% natamycin, 1% clotrimazole, 0.2% fluconazole and BSS(as a control) in single drop in each eight eyes and then each two corneas resected and examined after 30 minutes, 1 hours, 3 hours and 6 hours. All antifungals showed toxic effects on the corneal epithelium. Significant loss, elongation or swelling in microvilli, especially at the cell periphery, were noted. The top layer of epithelial cells showed moth-eaten appearance or punched-out lesions, and localized destruction. The surface cells were shrunken with wrinkling of plasma membrane and bulging of nucleous. Part of surface cells lost intercellular attachment leaving retraction fibrils. Rarely first and second layer cells of the epithelium were destructed, exposing third layer cells. Dark cells and premature desquamating cells increased significantly with the lapse of time. In general, 5% natamycin and 1% clotrimazole showed relatively severe epithelial toxicity, on the other hand, 0.15% amphotericin B and 0.2% fluconazole shoed mild epithelial toxicity. Localized damages in the epithelial cells were developed in the early stage, and an extent and the depth of the damage in the cells increased in the course of time after instillation.
Administration, Topical ; Amphotericin B ; Antifungal Agents* ; Cell Membrane ; Clotrimazole ; Cornea ; Epithelial Cells ; Epithelium ; Epithelium, Corneal* ; Fluconazole ; Hand ; Keratitis ; Microscopy, Electron, Scanning ; Microvilli ; Natamycin ; Rabbits*

Chromoblastomycosis is a chronic fungal infection of the skin and subcutaneous tissues caused by pigmented or dematiaceous fungi that are implanted into the dermis from the external environment. The vast majority of infections are caused by Fonsecaea pedrosoi and Cladosporium carrionii. Several drugs, such as itraconazole, amphotericin B, terbinafine, have been tried with variable success and various therapeutic techniques, including radiotherapy, cryosurgery, electrodesiccation and surgical excision, can be applied as a further treatment. So far, there are five cases filed as chromoblastomycosis in Korea. Four of them are reported from the southern part of the Korea. Intralesional injection or occlusive dressing of Amphotericin B, and oral administration of intraconazole have been used for the treatment in reported cases. Now, we report firstly a case of chromoblastomycosis treated with terbinafine. A 54-year-old Korean teacher had 10 x 5.5 cm sized dark purple colored plaque with crusts 4 years earlier as a linear plaque after an injury by the thorns of wooden chair. A skin biopsy revealed pseudoepitheliomatous hyperplasia and dermal infiltration of mixed inflammatory cells and Touton type multinucleated giant cells with numerous sclerotic cells. Several clusters of sclerotic bodies were observed also within the giant cells. On the fungus culture, the colony showed slowly growing dark-brown colored heaped appearance in 4 weeks. Isolated fungus was identified as Fonsecaea pedrosoi. Because of partial response to 10 months' itraconazole treatment, the treatment regimen was changed to terbinafine 500 mg/d with marked improvement after 4 months.
Administration, Oral ; Amphotericin B ; Biopsy ; Chromoblastomycosis* ; Cladosporium ; Cryosurgery ; Dermis ; Fungi ; Giant Cells ; Humans ; Hyperplasia ; Injections, Intralesional ; Itraconazole ; Korea ; Middle Aged ; Occlusive Dressings ; Radiotherapy ; Skin ; Subcutaneous Tissue