Acute Disseminated Coccidioidomycosis: Two Cases Treated with Amphotericin B

Abstract

Amphotericin B* has been shown to have marked fungistatic action in vitro against a number of nonpathogenic and pathogenic fungi, including Candida albicans, Cryptococcus neoformans, Histoplasma capsulatum, Blastomyces dermatiditis, and Coccidioides immitis. 1-3 Some fungi, such as nocardia and aspergillus, are relatively more resistant to the antibiotic. In vivo, amphotericin has been protective in experimental animals infected with C. albicans, C. neoformans, H. capsulatum, and C. immitis. 2,4-6 In patients with disseminated fungus diseases, amphotericin has been effective in the therapy of histoplasmosis and blastomycosis, 7,8 and patients with cryptococcal meningitis have usually responded to treatment. 8-11 However, the number of patients with the disseminated form of coccidioidomycosis so far treated with amphotericin is relatively small, and the results of therapy have been inconclusive. Aside from difficulties in evaluation due to the variable course of the disease, an apparent lack of response may have been due in some instances to inadequate dosage of amphotericin.