Candida albicans prosthetic arthritis treated with fluconazole alone.

Conventional treatment of Candida prosthetic joint infection usually includes surgery followed by a long period of antifungal medication. We report a case of Candida albicans prosthetic arthritis successfully treated with fluconazole alone.     

Locally invasive pulmonary aspergillosis in a healthy man successfully treated with oral fluconazole.

A 74-year-old healthy man with locally invasive form of pulmonary aspergillosis (PA) is reported. Chest X-ray film showed a segmental infiltration of right upper lobe (RUL) without cavitation, and the transbronchial lung biopsy specimen contained numerous hyphae of aspergillus species. Complication of bronchial asthma, or bronchiectasis were absent, and hyphae of aspergillus were present at only one segment of RUL. After 5 months of therapy with oral fluconazole, the PA had dramatically improved. Fluconazole was found to be effective for the locally invasive form of PA in a healthy man.     

Candida albicans fungemia with pulmonary localization treated with fluconazole. A case report

We report a case of Candida albicans fungemia complicated by a pulmonary localization in a non-immunocompromised patient. Complete recovery was obtained after a long course of high-dose fluconazole in spite of in vitro resistance of the Candida to fluconazole. The usefulness of fluconazole therapy, the best dosage regimen and the in vitro and in vivo correlations are discussed.     

Candida albicans purulent pericarditis treated successfully without surgical drainage.

Cures of Candida pericarditis reported in the literature uniformly involved surgical drainage of the pericardial space. We report a patient with purulent pericarditis caused by Candida albicans who was treated successfully with antifungal chemotherapy combined with a single pericardiocentesis that did not completely evacuate the pericardial space. This case indicates that thoracotomy with surgical drainage of the pericardium is not mandatory for successful therapy of Candida pericarditis.     

A premature infant with skin injury successfully treated with bilayered cellular matrix

The immature skin of premature infants is functionally less effective than the skin of full-term infants and therefore more vulnerable to injury. This article discusses the use of a biologic wound healing agent--bilayered cellular matrix--to heal a denuded hip wound in a premature infant. The treatment involved a compassionate use, single application of an investigational biologic wound healing agent to a 2.0-cm x 1.5-cm hip wound in a 23-week gestational age premature infant. A sterile, nonadherent dressing containing 3% bismuth tribromophenate in a special petrolatum blend on a fine mesh gauze also was applied over the biologic dressing and changed as needed. Wound closure was evaluated by photographs taken before and after the application of the bilayered cellular matrix. Wound measurements were reduced to 1.0 cm x 0.5 cm by day 4 post application of the bilayered cellular matrix, and clean granulation tissue was present. The wound was healed 10 days later. No signs or symptoms of infection were evident during the follow-up period and no adverse events were recorded. Comparative studies are warranted to fully evaluate the utility of bilayered cellular matrix in this clinical setting.     

Candida albicans arthritis in an infant

Candida albicans arthritis, preceded by peritonitis and septicaemia arose in an infant following cardiac surgery. Details of the case are described. Diagnosis and management of this condition are discussed.     

Candida tropicalis arthritis in a patient with acute myeloid leukemia successfully treated with fluconazole: Case report and review of the literature

Summary The case of a 77-year-old woman with acute myeloid leukemia who developedCandida tropicalis septic arthritis of the knee after remission-inducing chemotherapy is reported. A literature review ofC. tropicalis non-prosthetic arthritis is included. The isolate was susceptible to fluconazole (MIC 0.25 mg/l). She was treated with fluconazole (400 mg orally) and frequent relieving synovial aspirations. After 1 month of antifungal therapy the synovial fluid became culture negative. Fluconazole concentration in the synovial fluid and serum were 20 mg/l and 19.4 mg/l, respectively. The patient was treated for a total of 7 months and made a full recovery. This is the first report of the successful use of fluconazole in the treatment of septic arthritis due toC. tropicalis.     

Rhinofacial entomophthoromycosis due to Conidiobolus coronatus. A report of a case treated successfully with fluconazole]

A case of rhinofacial entomophthoromycosis caused by Conidiobolus coronatus is reported in a 30-years-old male from S?o Paulo, Brazil. The patient was successfully treated with oral fluconazole in a prolonged regimen. The diagnosis was confirmed by histopathological and mycological data.     

Entomophthoramycosis by Conidiobolus coronatus. Report of a case successfully treated with the combination of itraconazole and fluconazole

Rhinoentomophthoramycosis caused by Conidiobolus coronatus in a 61-year old woman was unsuccessfully treated during 8 years with all the antifungals available in the Brazilian market, including potassium iodide for 1 month, sulfamethoxazole plus trimethoprim for 2 months, amphotericin B, total dose of 1130 mg, cetoconazole, 400 mg/day for 6 months, fluconazole, 200 mg/day, for at least 2 months and, itraconazole, 400 mg/day for 2 months, followed by 200 mg/day for 4 more months. Complete clinical and mycological cure was achieved using itraconazol 400 mg/day in association with fluconazol 200 mg/day during 24 months. After cure she was submitted to plastic surgery to repair her facial deformation. Today she remains clinically and mycologically cured after 59/60 months (5 years!) without any specific antifungal. We thus suggest the use of the combination of itraconazole and fluconazole as an additional option for the treatment of this mycosis.     

法尼醇在促氟康唑耐药白念珠菌凋亡中的作用机制

目的:初步探讨法尼醇促进氟康唑耐药白念珠菌凋亡的可能机制。方法:采用药物浓度梯度法构建氟康唑耐药的白念珠菌株,经鉴定后设为氟康唑耐药组;氟康唑敏感的白念珠菌株作为对照组。在2组中加入终浓度为200μmol/L的法尼醇,孵育24 h后采用四甲基偶氮唑盐(methylthiazolyl tetrazolium,MTT法)比色法检测加入法尼醇后氟康唑耐药与敏感白念珠菌的增殖情况。应用流式细胞仪、激光共聚焦显微镜等,检测并比较2组菌株的胱天蛋白酶3(caspase 3)的活化程度、菌株内还原型谷胱甘肽的含量及细胞内活性氧类(reactive oxygen species,ROS)含量,进而比较不同组菌株在细胞凋亡、细胞内氧化还原及氧化应激水平上的差异。结果:与对照组比较,加入法尼醇后,氟康唑耐药的白念珠菌株增殖下降,其差异具有统计学意义(P=0.0057)。氟康唑耐药组白念珠菌内的还原型谷胱甘肽的含量下降,细胞内ROS含量及胱天蛋白酶3活性上升,且差异均具有统计学意义(分别P=0.011、P=0.023、P=0.036)。结论:法尼醇通过减少耐药菌株细胞内还原型谷胱甘肽的含量,增加胞内ROS含量,增强胱天蛋白酶3活性,使耐药白念珠菌抗氧化能力下降并促使真菌发生细胞凋亡。     

Candida albicans tricuspid valve endocarditis in an intravenous drug addict: successful treatment with fluconazole

An addicted, intravenous drug user was treated for Candida albicans tricuspid valve endocarditis with high dose fluconazole for 8 months, without relapse after 30 months.     

汉防己甲素对氟康唑抗白念珠菌生物膜增效活性的初步研究

目的探讨汉防己甲素（tetrandrine,TET）对氟康唑（fluconazole,FLC）抗白念珠菌生物膜是否有增效活性。方法构建白念珠菌生物膜,参照微量稀释法,测定FLC单独及其联合TET对生物膜不同时期的最小抑菌浓度（minimum in-hibitory concentration,MIC）;生物膜重新悬浮后,测定FLC单独及其联合TET对不同浓度菌液的MIC。结果 FLC单独及其联合TET对白念珠菌生物膜最初期（0h）的MIC50值范围分别为0.25～64μg/mL和0.125～16μg/mL（P=0.002）;早期（4h）的MIC50值范围分别为8～256μg/mL和1～64μg/mL（P=0.000）;中期（24h）、成熟期（48h）的MIC50值均〉1024μg/mL。生物膜重新悬浮后,FLC单独及其联合TET对低浓度菌液（终浓度为1×103 CFU/mL）的MIC值范围分别为0.25～64μg/mL和0.125～16μg/mL（P=0.003）,高浓度菌液（终浓度为1×106 CFU/mL）的MIC值均〉64μg/mL。结论汉防己甲素在体外对氟康唑抗白念珠菌生物膜最初期（0h）、早期（4h）有增效活性,对中期（24h）、成熟期（48h）无增效活性;汉防己甲素对氟康唑抗白念珠菌生物膜重新悬浮后的低浓度菌液（终浓度为1×103 CFU/mL）有增效活性,高浓度菌液（终浓度为1×106 CFU/mL）无增效活性。     

Candida meningitis in an infant after abdominal surgery successfully treated with intrathecal and intravenous amphotericin B: A case report

Rationale:Studies on Candida infections in the central nervous system, especially in infants and young children that did or did not have postoperative surgery, are rarely reported. Thus far, intrathecal (i.t.) amphotericin B (AmB) is not routinely recommended as a therapy for Candida meningitis. We report the first case of Candida meningitis in an infant who underwent abdominal surgery and was successfully treated with i.t. and intravenous (i.v.) AmB in the mainland of China.Patient concerns:Candida meningitis was confirmed by culture and immunoserological tests in a 1-day-old girl after surgery. She was treated with fluconazole for 1 month, but the patient''s symptoms showed no improvement.Diagnoses:After surgery, the infant started having recurrent attacks of fever, and laboratory tests of the cerebrospinal fluid (CSF) revealed antigens of Candida tropicalis. CSF tests revealed a high total protein level and a low glucose level. She was diagnosed with a secondary Candida meningitis.Interventions:After azole therapy failure, intrathecal and intravenous AmB therapy were used as rescue therapies.Outcomes:After nearly 2 months of AmB treatment, all repeat CSF cultures were negative, the infant was deemed stable and was discharged home, and she continued taking voriconazole orally as an outpatient.Lessons:The combination of i.t. and i.v. administration of AmB can provide a safe and effective alternative to managing this rare but severe disease.