Long-term amphotericin B therapy for disseminated histoplasmosis in patients with acquired immunodeficiency syndromes (AIDS)

Article Abstract:

Histoplasmosis is a widespread infection caused by the fungus Histoplasma capsulatum, and may occur as a mild, self-healing infection or develop into a severe fatal disease. The severe form of histoplasmosis is associated with fever, anemia (the reduction in red blood cells), enlargement of the spleen and liver, leukopenia (an abnormal decrease in white blood cells), involvement of the lungs, deterioration of the adrenal gland, and ulcers of the gastrointestinal tract. The antifungal agent amphotericin B given intravenously or directly into the circulation is used to treat histoplasmosis. The effectiveness and toxic effects of amphotericin B were evaluated in 22 patients with acquired immunodeficiency syndrome (AIDS) and disseminated histoplasmosis. Sixteen patients completed the study, five patients died, and one patient was switched to a different treatment regimen. Out of 16 patients, only one patient died from a relapse of histoplasmosis, two died from other causes, and the remaining 13 remained free of relapse. The average follow-up period was 14 months, and there were no differences in the outcome of patients treated weekly or biweekly with amphotericin B. Sixty-three percent of patients developed complications related to injection into a blood vessel. The results show that amphotericin B is effective and well-tolerated in patients with AIDS and disseminated histoplasmosis. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Histoplasmosis, AIDS patients, AIDS (Disease)

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Cardiopulmonary toxicity after liposomal amphotericin B infusion

Article Abstract:

Amphotericin B is an antifungal drug used to treat severe fungal infections of the blood and internal organs. While it is generally the only effective agent for these life-threatening infections, amphotericin B has severe toxic side effects. Efforts are underway to develop a form of amphotericin that will be delivered in liposomes, or fat globules, in the hope that these globules will deliver the drug directly to the pathogenic fungus, and result in less toxicity to the patient. A 22-year-old woman with lymphoma was found to have fungal abscesses in her liver, which did not respond to a large dose of conventionally delivered amphotericin. An experimental form of liposomal amphotericin was given to the patient. Immediately following infusion of the drug, she became short of breath and was found to have a diminished blood oxygen level, evidence of pulmonary edema (fluid in the lungs), and heart failure. On subsequent days, the liposomal amphotericin was given over a longer period of time, and measures of her heart and lung functions were assessed before and after the drug infusions. Despite a lack of symptoms with the slower infusions, tests revealed that heart and lung functions deteriorated around the times of amphotericin administration. Thus, while liposomal delivery does offer promise, it still carries risks of toxicity, specifically to the heart and the lungs. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration, Mycoses

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Alopecia associated with fluconazole therapy

Article Abstract:

Patients taking fluconazole for fungal infections may experience temporary hair loss as a side effect while taking the medication. Researchers reviewed the medical information of 33 patients taking fluconazole who had experienced some hair loss. The daily dose of fluconazole ranged from 100 milligrams (mg) weekly to 800 mg daily with most patients (88%) taking at least 400 mg of fluconazole every day for an average of 7.1 months. All 33 patients had experienced some scalp hair loss while 10 patients had additional hair loss either from the chest, underarms, legs, pubic area, or face. Three patients had so much scalp hair loss that they needed a wig. Patients noticed hair loss an average of 3.2 months after starting to take the drug. Hair began growing again after discontinuing therapy and was back to normal an average of 6 months later.

Causes of, Baldness, Alopecia, Antifungal agents, Fluconazole

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