Administration Of Amphotericin Research Articles

Clinical characteristics of tracheobronchial Talaromyces marneffei infection in non-HIV-infected patients in South China

Objectives Tracheobronchial Talaromyces marneffei (T. marneffei) infections among non-HIV-infected patients are rare. To improve understanding, we analysed the clinical features, immune mechanisms, treatment, and prognosis. Methods Data on hospitalized patients with tracheobronchial T. marneffei infections from September 2013 to May 2022 were collected. The clinical and imaging features were analysed. Results Nineteen patients were enrolled, with a median age of 52 years (45–62 years). The most common symptoms were cough, expectoration, fever, weight loss, and anaemia. The total white blood cell and neutrophil counts, erythrocyte sedimentation rate, C-reactive protein, procalcitonin and globulin were increased, and the serum albumin levels were decreased. Chest CT manifestations included patchy shadows, masses, obstructive atelectasis, cavities, pleural effusion, and hilar and mediastinal lymphadenopathy. The fibreoptic bronchoscopy findings included masses, polyps or nodules with mucosal oedema, hypertrophic bulges, lumen stenosis or obstruction, and purulent secretions. T. marneffei infection was confirmed in 10 patients by positive culture, in five by both culture and metagenomic next-generation sequencing (mNGS), in two by mNGS, in one by culture and pathology and in 1 by histopathology. BALF (15/19, 78.9%) had the highest culture positive rate, followed by sputum (3/19), bronchial mucosa (1/1), lung biopsy (1/2); 36.8% of the patients were coinfected with other pathogens. For induction therapy, 7, 6, 2, and 4 patients received voriconazole, amphotericin B, voriconazole combined with amphotericin B, and fluconazole therapy, respectively, and 26.3% received treatment combined with nebulization and/or administration of amphotericin B under fibreoptic bronchoscopy. Four patients were treated for underlying diseases or coinfection, 31.6% were cured, 42.1% improved, and 26.3% died. Conclusions T. marneffei infection is common in the tracheobronchial airway tissue or secretions, and bronchoscopy has important diagnostic and treatment value. Antifungal therapy, including systemic therapy, involves triazoles and amphotericin administration, and aerosol inhalation and administration of amphotericin B under bronchoscopy are important.

Challenges of Anaesthetic Management in Endoscopic Sinus Surgery in Post COVID Rhino Orbital Cerebral Mucormycosis Patients

Introduction Mucormycosis is a potentially lethal opportunistic, angioinvasive fungal infection with rapid progression and high mortality and predisposed by diabetes mellitus, corticosteroid other immunosuppressive drugs, haematological malignancies, haematological stem cell transplantation, solid organ transplantation and iron overdose. The aim of our study is to consider the challenge in providing anaesthesia in endoscopic sinus surgery for rhino orbital cerebral mucormycosis in post COVID patient. Materials and Methods A total of 20 patients after being COVID negative, posted for endoscopic debridement of paranasal sinuses and also of orbital contents were analysed with respect to outcome after surgery considering the comorbidities of the patients and toxic effect of antifungal drug. Patients’ comorbidities were optimised through preoperative evaluation prior to surgery. Adequate monitoring of haemodynamic status during intraoperative period and optimum anaesthetic management was provided in endoscopic sinus surgery. The patients were managed in recovery room in post operative period and their outcome was reviewed. Results Our patients posed 3 challenges: a) difficult airway in view of palatal perforation b) long standing diabetes mellitus with associated metabolic complications c) administration of amphotericin B could interact with anaesthetic agents and produced adverse outcome. After surgery mortality was experienced in 10% of cases. Conclusion Awareness of warning symptoms and signs, a high index of suspicion, early diagnosis and initiation of full dose of liposomal Amphotericin B and meticulous surgical management may help to optimise the outcome of ROCM in the setting of COVID 19 infection.

Cryptococcal Meningitis with Inadequate Response to Antifungal Therapy or Drug-Induced Side Effects That Make It Difficult to Continue Treatment: Management to Avoid Treatment Difficulties and Intracerebroventricular Antifungal Administration for Refractory Cases

The treatment of cryptococcal encephalomyelitis is often complicated by an inadequate response to antifungal therapy and the reduction or withdrawal of antifungal agents due to adverse effects. To achieve a favorable prognosis, patients should be treated with appropriate drugs according to the latest guidelines. In addition to systemic antifungal drug administration in refractory cases, intracerebroventricular administration of amphotericin B may be considered.

Black Fungi in Arabian Horses: Scanning Electron Microscopy Study of Cutaneous Equine Mucormycosis Caused by Mucor indicus for the First Time in Eastern Province, Saudi Arabia

Four Arabian mares and two Arabian stallions had been admitted to a University Veterinary Medicine Teaching Hospital because of a mass in its right nasal cavity. Horses numbered from 1 to 6. All infections in horses occur in the area of the nostrils. Horse 1 was an Arabian mare of 5-year-old 390kg and had a mass (3.5x3.5 cm in diameter) in its right nasal cavity. Horse 2 was an Arabian mare of 7-year-old 370.0kg and had a mass (4.0x5.5 cm in diameter) in its right nasal cavity. Horse 3 was an Arabian mare of 6.3-year-old 379kg and has a mass (9.0x4.0 cm in diameter) in its right nasal cavity. Horse 4 was an Arabian mare of 5.8-year-old 395.3kg and had a mass (5.0x5.5 cm in diameter) in its right nasal cavity. Horse 5 was an Arabian stallion of 8.2-year-old 421kg and had a mass (4.0x5.5 cm in diameter) in its right nasal cavity. Horse 6 was an Arabian stallion of 7-year-old 471kg and had a mass (4.0x5.5 cm in diameter) in its right nasal cavity. Endoscopic examination of upper respiratory tract revealed a mass that blocked most of the right nasal passage. The mass covered by a bulky pile of ulcerated granulation tissue exuding thick serosanguinous fluid. A specimen of mucor indicus was isolated from a polypes sample and its identity confirmed through LSU rRNA sequence analysis. Microbiological examination showed abundant fungal growth and the strain corresponded to mucor indicus. On histological examination, the dermis and subcutaneous tissue showed the presence of mucor indicus. Mucor indicus confirmed by scanning electron microscopy and light microscopy. Clinical recovery occurred 3 weeks after administration of amphotericin B (40.0 mg/kg body weight/day). The current study concluded that mucor indicus was verified in eastern province of Saudi Arabia for the first time.

Characteristics of Mucormycosis in Hematological Patients and a Death Prediction Model.

Mucormycosis is an angioinvasive fungal infection, associated with high mortality. The aim of our study was to explore the high-risk factors and predict the death of hematological disease complicated with mucormycosis. We retrospectively analyzed clinical data of 31 patients with hematological disease complicated with mucormycosis, adopted random forest to establish the death prediction model, and validated the model in another 15 patients. The median age of the 31 cases was 46 (28–51) years, male to female ratio 1.38:1, and 90-day mortality rate 54.8%. The most common underlying disease was acute myeloid leukemia (58.1%). The main clinical symptoms were fever (100%), cough (87.1%), sputum (80.6%), chest pain (61.3%), and hemoptysis (19.4%). Reversed halo sign (83.9%) was the most common computed tomography sign. A total of 48.4% of patients also had aspergillus or bacterial infections. Discriminative models were constructed by random forest with 17 non-survivors and 14 survivors. Procalcitonin, the duration of intravenous administration of amphotericin B or amphotericin B liposomes, and neutropenia at death or 90 days of survival were the leading risk factors for poor prognosis, with area under the curve of 0.975 (95% CI 0.934–1). We chose 0.6775 as death prediction threshold (with 82.3% sensitivity and 100% specificity) and validated the model successfully in another 15 patients. Chest pain and reversed halo sign are specific clinical and image signs of hematological disease complicated with mucormycosis. Neutropenia, elevated procalcitonin, and insufficient use time of amphotericin B or amphotericin B liposomes are risk factors for death.

Грибковый эндофтальмит

The question of the pathogenesis and development of fungal endophthalmitis is an urgent research topic Purpose. Evaluation of the clinical effectiveness of treatment of patients with fungal endophthalmitis over the past 5 years using the developed surgical technology. Material and methods. In the period 2016-2021, 5 patients with fungal endophthalmitis were treated. With the fungal etiology of endophthalmitis, one patient was after a penetrating wound, 4-after corneal microtraumas with the development of keratouveitis (all after using contact lenses). Surgical treatment included taking intraocular material for examination, performing vitrectomy in the maximum possible volume, tamponade of the vitreal cavity with perfluorodecalin (for 5-14 days) and intravitreal administration of amphotericin B in 10 mcg in 0.1 ml. Results. As a result of treatment of fungal endophthalmitis, it was possible to preserve the eye as an organ in 3 patients (60%), to preserve visual functions in 1 patient (20%). Conclusion. Fungal endophthalmitis is a severe pathology of the visual organ. The prognosis for the preservation of visual functions is unfavorable, the preservation of the eye is doubtful. Key words: fungal endophthalmitis, vitrectomy, perfluorodecalin, amphotericin B.

Histoplasmosis: diagnostic and therapeutic aspect

Histoplasmosis has been reported since 1932 in various regions in Indonesia. This disease is caused by thermally dimorphic fungus Histoplasma capsulatum var. capsulatum which is experiencing an increasing incidence worldwide. Human infection occurs when spores in soil contaminated with bird and bat droppings are inhaled and change to form yeast in the lungs. The majority of these forms of infection are mild and can heal on their own, but if large numbers of spores/ inoculum are inhaled, or the host is immunosuppressed, serious lung disease and even dissemination may occur with a high mortality rate. The diagnosis can be made by combining clinical symptoms with laboratory test results. Conventional laboratory methods such as direct examination or histopathology and culture are the gold standards for histoplasmosis diagnosis. The weakness of culture is the nature of H. capsulatum as a slow grower fungus that takes 4-6 weeks to grow. In addition, laboratory tests can be carried out with antibody detection or antigen detection. Antigen detection is more benefi cial for hosts with immunosuppression or acute form, while antibody detection is more important in the chronic form of the diseases. Molecular-based assays have high specifi city but are not yet available commercially and are more widely used for culture identifi cation to confi rm the species of H. capsulatum. Histoplasmosis therapy usually begins with the administration of amphotericin B for around two weeks, followed by maintenance with itraconazole for 6 - 9 months duration. A careful history of possible exposure and the appropriate laboratory diagnostic approach is essential to provide appropriate therapy.

Topical Administration of Amphotericin B as an Effective Adjuvant Treatment for a Deep Fungal Infection of Diabetic Foot Injury.

Topical Administration of Amphotericin B as an Effective Adjuvant Treatment for a Deep Fungal Infection of Diabetic Foot Injury.

A Plumieridine-Rich Fraction From Allamanda polyantha Inhibits Chitinolytic Activity and Exhibits Antifungal Properties Against Cryptococcus neoformans.

Cryptococcosis is a fungal infection caused mainly by the pathogenic yeasts Cryptococcus neoformans and Cryptococcus gattii. The infection initiates with the inhalation of propagules that are then deposited in the lungs. If not properly treated, cryptococci cells can disseminate and reach the central nervous system. The current recommended treatment for cryptococcosis employs a three-stage regimen, with the administration of amphotericin B, flucytosine and fluconazole. Although effective, these drugs are often unavailable worldwide, can lead to resistance development, and may display toxic effects on the patients. Thus, new drugs for cryptococcosis treatment are needed. Recently, an iridoid named plumieridine was found in Allamanda polyantha seed extract; it exhibited antifungal activity against C. neoformans with a MIC of 250 μg/mL. To address the mode of action of plumieridine, several in silico and in vitro experiments were performed. Through a ligand-based a virtual screening approach, chitinases were identified as potential targets. Confirmatory in vitro assays showed that C. neoformans cell-free supernatant incubated with plumieridine displayed reduced chitinase activity, while chitinolytic activity was not inhibited in the insoluble cell fraction. Additionally, confocal microscopy revealed changes in the distribution of chitooligomers in the cryptococcal cell wall, from a polarized to a diffuse cell pattern state. Remarkably, further assays have shown that plumieridine can also inhibit the chitinolytic activity from the supernatant and cell-free extracts of bacteria, insect and mouse-derived macrophage cells (J774.A1). Together, our results suggest that plumieridine can be a broad-spectrum chitinase inhibitor.

Comparison of Two Treatment Modalities and PCR to Assess Treatment Effectiveness in Macrorhabdosis.

Macrorhabdosis is a debilitating disease condition that affects budgerigars (Melopsittacus undulatus), cockatiels (Nymphicus hollandicus), and many other bird species worldwide. Macrorhabdus ornithogaster is a pathogen which leads to nonspecific clinical signs, and to date, diagnosis as well as therapy are still challenging. In this study, medical histories of 32 budgerigars and 7 cockatiels with macrorhabdosis diagnosed clinically and by polymerase chain reaction (PCR) within a period of 24 months (from January 2016 to January 2018) were retrospectively analyzed. Macrorhabdus ornithogaster was diagnosed through fecal samples collected over several days and analyzed by microscopic examination or PCR. The effectiveness of 2 different amphotericin B treatment regimens were investigated by PCR. In 23 cases, treatment was performed with amphotericin B via drinking water at 0.1 mg/mL for 28 days. For the remaining 16 birds, an alternative treatment regimen of amphotericin B at 100 mg/kg PO q12h for 10 days was combined with administration of amphotericin B via drinking water at 0.1 mg/mL for 28 days. Fecal samples of all treated flocks were reexamined by PCR 10-14 days post-amphotericin B treatment. More than half (56.4%) of the treated birds tested negative for M ornithogaster irrespective of the treatment regimen. In addition to clinical improvement and microscopic examination of droppings, PCR was used for the first time to evaluate treatment response in birds diagnosed with M ornithogaster. Administration of amphotericin B via drinking water proved to be effective in more than 50% of cases, indicating a less stressful alternative to the oral administration of amphotericin B twice daily.

PEDOMETRIA APLICADA A ESTUDO COMPARATIVO ENTRE MORFINA E TRAMADOL EM BOVINOS

Resumo A analgesia com opioides é limitada ou indefinida em ruminantes. Neste trabalho, objetivou-se a realização de um estudo comparativo entre dois analgésicos opioides: a morfina e o tramadol, com base nas avaliações clínica e pedométrica de animais submetidos a artrite e sinovite experimental transitórias, desenvolvidas na articulação interfalângica distal, após administração intra-articular de anfotericina B. Utilizou-se seis animais, em dois tratamentos distintos, com morfina, na dose de 0,5 mg/kg e 20 dias depois com tramadol, na dose de 1,8 mg/kg, ambos via intramuscular. Os animais foram avaliados em intervalos de três horas, num total de 27 horas, observando-se parâmetros fisiológicos, deambulação e atividade pedométrica. Claudicação e alterações pedométricas foram observadas para ambos os fármacos. Por meio das variáveis da atividade pedométrica, observou-se um padrão de inquietação compatível com nocicepção podal, não havendo a interferência dos fármacos sobre a claudicação. Concluiu-se que a morfina e o tramadol, nas doses testadas, foram incapazes de interferir na atenuação do grau de claudicação no momento de máxima estimulação dolorosa, frente ao modelo experimental de dor ortopédica.

Histoplasmose pulmonar grave em um gato doméstico: tratamento com Anfotericina B e Itraconazol

Background: Histoplasmosis is a systemic mycosis whose etiologic agent is the fungus Histoplasma capsulatum. This fungal infection, which is the second most frequent systemic mycotic fungal disease in felines in the United States, has rarely been found in cats in Brazil. This paper reports on a case of acute pulmonary histoplasmosis in a domestic cat treated with oral itraconazole associated with amphotericin B administered subcutaneously. This treatment resulted in clinical remission of the patient’s symptoms, as evidenced by radiographic follow-ups.Case: A domestic cat suffering from acute dyspnea was taken to a veterinary clinic. The animal was subjected to emergency oxygen therapy, and kept at rest through sedation with midazolam. A physical examination revealed normally colored mucosa, 8% dehydration, bristly fur, body condition score 2/9, tachypnea with respiratory rate of 100 breaths per minute and expiratory dyspnea. The radiographic examination showed marked opacification of all the pulmonary fields, with a mixed pattern (interstitial and alveolar) of heterogeneous appearance and diffuse distribution, which are changes consistent with an inflammatory infectious process (pneumonia). A cytological analysis of the pleural fluid revealed round to oval-shaped intracytoplasmic structures, varying in size from 2 to 4 μm, inside foamy macrophages, consistent with Histoplasma capsulatum. Based on the diagnosis of pulmonary histoplasmosis, and in view of the patient’s acute respiratory distress, it was decided to treat the cat using itraconazole associated with amphotericin B. Itraconazole was administered orally at a dose of 100 mg/cat every 24 h, while amphotericin B was administered subcutaneously at a dose of 0.5 mg/kg, combined with 100 mL of sodium chloride 0.9% and 100 mL of 5% glycated serum, with monitoring of serum concentrations of symmetric dimethylarginine (SDMA). Amphotericin B was administered every 48 h up to the 7th dose, followed by three times a week up to the 11th dose, and then twice a week up to the 16th dose. The animal was released from the veterinary hospital 10 days after its admission, showing a considerably improved respiratory condition and a respiratory rate of 40 breaths per minute. Continuation of the antifungal treatment with itraconazole was prescribed, maintaining the same dose and frequency of administration until a new recommendation would be made, as well as frequent return visits for the administration of amphotericin B and reassessment of the animal. The administration of amphotericin B was discontinued when the animal’s respiratory condition stabilized; hence, the feline received a total of 16 doses of the drug. The animal showed remission of clinical respiratory symptoms, confirmed by follow-up chest X-rays, which revealed significantly less radiodense pulmonary parenchyma in response to treatment with itraconazole and amphotericin B. Five months after beginning its treatment, the cat is being treated orally with itraconazole (100 mg/cat, every 24 h), without recrudescence of the clinical symptoms.Discussion: To date, six cases of feline histoplasmosis have been reported in Brazil, only one of which had pulmonary involvement and was treated successfully. The use of oral itraconazole associated with subcutaneous amphotericin B has proved to be effective for the treatment of acute pulmonary histoplasmosis in domestic cats. Note that a rapid diagnosis of pulmonary disease is essential in order to immediately implement a combined drug therapy linked with monitoring to ensure the protocol is safe for the patient

Tissues and Plasma Drug Concentrations Following Intraperitoneal Administration of Amphotericin B Prepared in Acetate/Acetic Acid Buffer Solution

The aim of this work is to study the effect of the physicochemical environment on in vivo distribution of amphotericin B, which was prepared in acetic acid/acetate buffer pH 5.4 at a concentration of 10-4 M. Rats were injected intraperitoneally with this antifungal solution at the doses of 1, 2 or 5 mg/kg body weight. At predefined time, amphotericin B from tissues and plasma was extracted and analysed using the second derivative spectrophotometry methodology. The level of amphotericin B in tissues and plasma depended on the administered dose and decreased over a period of time. The highest concentrations were found in the spleen, followed by the liver, but were lower in kidneys and plasma. Amphotericin B was accumulated in the intraperitoneal cavity (the peritoneal adipose tissue) in large quantities proportional to the dose administered intraperitoneally. This formulation has the advantage of being easy to prepare and inexpensive, it seems very promising for the treatment of fungal infections of spleen and peritoneal cavity.

Confusion between Two Amphotericin B Formulations Leading to a Paediatric Rehospitalisation.

A heavily immunosuppressed, 43-kg, 9-year-old patient was recovering from a bone marrow transplant. Primary prophylaxis against invasive fungal infections was liposomal amphotericin B (AmBisome®, 2.3 mg/kg [100 mg] two times per week). Once home, following a first amphotericin B infusion, he presented with strong diarrhoea and vomiting; this was repeated after the second infusion. The clinical situation worsened rapidly and the patient was rehospitalised. On admission, he presented with acute renal failure. During the 2-week hospitalisation, renal function recovered progressively. A few days after returning home, a new administration of amphotericin B was again followed by diarrhoea and vomiting, together with shivering and fever. The child was again rapidly rehospitalised. Investigation revealed that the community pharmacist, relying on drug software, had selected an inappropriate substitute drug: the patient had been administered amphotericin B deoxycholate (Fungizone®) and not liposomal amphotericin B. Depending on the indication, intravenous AmBisome® is usually administered at a dose between 3 and 5 mg/kg bodyweight; this dose can be increased to up to 10 mg/kg/day. Intravenous Fungizone®, however, should be administered using an initial dose of 0.25 mg/kg bodyweight, up to a recommended 1-mg/kg/day dose. The child had thus received 100 mg of Fungizone®, or ten times the recommended dose.

Prevention of amphotericin B nephrotoxicity through use of phytotherapeutic medication.

Objective To evaluate the effect of diosmin and hesperidin flavonoids in the prevention of amphotericin B nephrotoxicity, through an experimental model on rats. Method Adult, male Wistar rats were distributed into the following groups: saline; diosmin hesperidin (animals that received 50 mg/kg of diosmin hesperidin, drinking water, for ten days); amphotericin B (animals that received 15 mg/kg/day of amphotericin B through intraperitoneal treatment for five days); amphotericin B+diosmin hesperidin. Renal function, fractional excretion of sodium; potassium and magnesium and oxidative metabolites were evaluated. Results Treatment with amphotericin B reduced renal function, as shown by the clearance of creatinine, increased tubular function markers and fractional excretion of sodium, potassium, magnesium and oxidative metabolites. Pre-treatment with diosmin hesperidin ameliorated clearance of creatinine and reduced tubular and oxidative injury. Conclusion Administration of amphotericin B resulted in reduction of renal function with tubular injury, and diosmin hesperidin showing an antioxidant protective effect on the kidneys.

Evaluation of intravenous regional perfusion with amphotericin B and dimethylsulfoxide to treat horses for pythiosis of a limb.

BackgroundTreatment for horses with pythiosis of a limb is challenging. This study aims to evaluate the effects of administering amphotericin B in a 10 % solution of dimethylsulfoxide by intravenous regional limb perfusion (IRLP) to treat horses for cutaneous pythiosis of a limb.ResultsAll 15 of the horses treated had complete resolutions of their lesion between 6 to 9 weeks after a single IRLP treatment. No complications were observed at the site of venipuncture for IRLP. Before initiation of treatment, there was anemia and marked leucocytosis which resolved following treatment. Serum biochemistry showed no significant changes.ConclusionsIRLP administration of amphotericin B in a 10 % DMSO solution was easily performed, relatively inexpensive and an effective treatment for treating horses for pythiosis of a limb and resolved the infection with no complications.

In vitro interactions between amphotericin B and hydrocortisone: potential implications for intrathecal therapy.

Fungal meningitis remains a severe and often lethal infection requiring aggressive antifungal therapy and in refractory cases the use of intrathecal amphotericin B (AmB). Administration of amphotericin B by this method may result in clinically apparent adverse reactions such as paresthesias, radiculitis, or myelopathy. Coadministration of hydrocortisone is therefore often given in an attempt to avoid these effects; however, the potential consequences of this approach on fungal growth or on drug synergy/antagonism had not previously been assessed. We used the checkerboard titration broth microdilution method to analyze interactions by fractional inhibitory concentration indices (FICIs). The combination of amphotericin B and hydrocortisone resulted in synergy or indifference against all isolates (Candida, Cryptococcus, and Coccidioides) during in vitro testing at low concentrations. Antagonism was observed using higher hydrocortisone concentrations (those not observed in vivo) suggesting possible steric hindrance or binding to AmB may occur at doses unlikely to be present during clinical care. Concurrent hydrocortisone and AmB administration should not be avoided due to in vitro antagonism concerns.

Mucormycose rhinosinusienne révélée par une ulcération nécrotique vélopalatine

Mucormycosis is a deep mycosis which has been spreading out in recent years. It is still poorly understood and poorly described in sub-Saharan Africa. The authors report a case of sinonasal localization, of fatal evolution and late diagnosis in a young child. It is about a 13-year-old child suffering from chronic rhinosinus syndrome for two years. He was observed in stomatology for a necrotic velar ulceration that have occurred for three months. The clinical, radiological and histological explorations were in favor of a sinonasal mucormycosis. The administration of amphotericin B and the surgical treatment did not slow down the fatal evolution. Mucormycosis should not be dealt with any diagnostic error and no therapeutic improvisation. It has to be thought about when dealing with a rhinosinusal syndrome with cleft ulceration.

Antifungal agent utilization evaluation in hospitalized neutropenic cancer patients at a large teaching hospital.

To evaluate pattern of using of three antifungal drugs: fluconazole, amphotericin B and voriconazole, at the hematology–oncology and bone marrow transplant wards of one large teaching hospital. In a prospective cross-sectional study, we evaluated the appropriateness of using antifungal drugs in patients, using Infectious Disease Society of America (IDSA) and National Comprehensive Cancer Network (NCCN) guidelines. All the data were recorded daily by a pharmacist in a form designed by a clinical pharmacist and infectious diseases specialist, for antifungals usage, administration, and monitoring. During the study, 116 patients were enrolled. Indications of prescribing amphotericin B, fluconazole, and voriconazole were appropriate according to guidelines in 83.4%, 80.6%, and 76.9% respectively. The duration of treatments were appropriate according to guidelines in 75%, 64.5%, and 71.1% respectively. The dose of voriconazole was appropriate according to guidelines in 46.2% of patients. None of the patients received salt loading before administration of amphotericin B. The most considerable problems with the mentioned antifungals were about the indications and duration of treatment. In addition, prehydration for amphotericin B and dosage of voriconazole were not completely compatible with the mentioned guidelines. A suitable combination of controlling the use of antifungals and educational programs could be essential for improving the general process of using antifungal drugs at our hospital.

Late-Onset Prosthetic Valve Fungal Endocarditis due to Candida albicans: A Case Report and Review of Literature from India

Late-Onset Prosthetic Valve Fungal Endocarditis due to Candida albicans: A Case Report and Review of Literature from India The incidence of prosthetic valve endocarditis (PVE) is 1-4%. Fungal endocarditis (FE) is an uncommon complication of valve replacement surgery. The incidence of PVE is highest within the first 12 months following surgery. We report here a fatal case of late-onset fungal endocarditis after 15 years of mitral valve replacement for which administration of amphotericin B is crucial for survival of patients.