Course Of Oral Fluconazole Research Articles

Fungal liver abscesses in an immunocompetent patient post cholecystectomy – a case report

Candida albicans is known to colonise the biliary tract but rarely causes invasive candidiasis post gastrointestinal or hepatobiliary surgery in the absence of host immunosuppression. This case study reports a 33-year-old immunocompetent female with a past surgical history of sleeve gastrectomy, omega loop (mini) gastric bypass and gastric ulcer repair. Two weeks post laparoscopic cholecystectomy and intraoperative cholangiogram (IOC) the patient presented with right upper quadrant abdominal pain, rigors, nausea, vomiting, fevers (39.5 degrees) and tachycardia. Liver function tests were mildly deranged, the white cell count was 10×109/L and the C-reactive protein was elevated at 327 mg/L. Computed tomography (CT) revealed multiple right lobe liver abscesses and mild splenomegaly. The patient underwent ultrasound guided drainage and Candida albicans was subsequently grown from the aspirate sample. After a 4-week course of oral fluconazole, a repeat CT abdomen and pelvis showed good resolution with 3-4 remaining small liver collections. An abdominal ultrasound 8-weeks post initial presentation showed complete resolution and subsequent gastroscope, echocardiogram and ophthalmological examination were unremarkable. Although liver abscesses caused by Candida albicans rarely occur in immunocompetent patients, it should be included in the differential diagnosis in such patients presenting with suspicious features post laparoscopic cholecystectomy and IOC.

Traumatic bilateral stylohyoid bone fracture in an Appaloosa

Summary An Appaloosa gelding presented for a traumatic puncture wound of the head ventral to the base of his left ear, bilateral epistaxis and upper respiratory compromise. The horse did not exhibit dysphagia or cranial nerve deficits. The horse suffered bilateral oblique fractures of both stylohyoid bones due to the traumatic incident, diagnosed upon endoscopy of the guttural pouches. Treatment consisted of anti-inflammatory medication, broad-spectrum antibiotics, guttural pouch lavage and dietary management with soft feeds. At a one-month follow-up examination, endoscopic evaluation revealed a union at both stylohyoid bone fracture sites. Guttural pouch mycosis was diagnosed in the left guttural pouch on the lateral wall at the entrance of the lateral compartment. The guttural pouch mycosis was treated with a nystatin and gentamicin flush, followed by a course of oral fluconazole. At the 3-month re-evaluation, the guttural pouch mycosis had completely responded to treatment.

Esophageal Involvement as a First Clinical Presentation in a Patient with Newly Diagnosed Pemphigus Vulgaris and a Review of Literature

Purpose: Sir William Osler once famously said that the mouth is the window to the body. Fittingly enough, many systemic diseases have oropharyngeal manifestations, and pemphigus vulgaris is no exception. However, esophageal involvement in pemphigus is a rare manifestation, and to date, this has only been described in small case series and case reports. However, it is an important clinical presentation that physicians have to be aware of, as timely intervention and appropriate therapy can alter clinical outcome in such patients. Here, we report a 57-year-old woman of Malay descent, who presented with odynophagia and few oral lesions with no cutane-ous or pharyngeal involvement, and was found to have newly-diagnosed pemphigus vulgaris after undergoing a diagnostic esophagogastroduodenoscopy (OGD). She was initially treated for presumed oropharyngeal candidiasis, and failed to improve with a one-week course of oral fluconazole. Diagnostic OGD showed the presence of characteristic bullous blisters in the esophagus, commonly seen in pemphigus vulgaris. She then underwent a biopsy of her lip ulcers, which confirmed the diagnosis. The patient was started on a course of oral prednisolone with marked improvement of her symptoms. To date, she remains well. By highlighting this unusual presentation, we hope to draw attention to the rarer presentations of pemphigus so that these manifestations can be recognized early and uneccessary investigations, treatment and costs can be avoided.

Lattice dystrophy complicated by Cryptococcus curvatus infection

AbstractPurpose To present a novel case of Cryptococcus curvatus (CC) keratitis in a patient with Lattice dystrophy (LD).Methods A 57 year old lady with a family history of LD had a right re‐graft for suspected recurrent lattice dystrophy. Her initial penetrating keratoplasty (PK) was in 2004 after which she kept good vision. 5 years later she developed a small ulcer caused by presumable Candida which healed completely following topical miconazole and short course of oral fluconazole. In 6 months she developed gutter, increasing astigmatism, recurrent erosions without inflammation and progressive peripheral opacities leading to a 2nd PK.Results Histology of the 2nd PK revealed amyloid deposits in both host and graft elements confirming recurrent LD. In addition the graft contained numerous yeasts within epithelium and stroma along scars from previous PK. The capsulated fungi were seen on PAS, grocott and mucicarmine stains. No inflammatory response was associated with the fungi. Microbiology confirmed these as (CC). On review of findings from initial infection, it seemed that Cryptococcus instead of Candida was indeed the causative agent of her previous ulcer. Interestingly, she had no history of local trauma prior to her first corneal ulceration and there was never evidence of infection elsewhere. Unfortunately, 2 years after the 2nd PK the graft developed new opacities that lead to a 3rd PK which revealed recurrent (CC) keratitis again without any inflammatory response. The left eye also had a corneal graft in 2009 given her underlying LD and mercifully has never been infected.Conclusion To our knowledge Cryptococcus curvatus keratitis was never described in English literature.In fact, it seems that this is the first description of ocular infection by this species.

Fungal Osteomyelitis of Calcaneus due to Candida albicans: A Case Report

Osteomyelitis can be a challenging entity to treat. Because of the emergence of risk factors, including broad-spectrum antibiotics, intravenous drug abuse, immunocompromised hosts, and other factors, opportunistic pathogens have increased in prevalence in bone infections. A review of the published data revealed few reported cases of fungal osteomyelitis localized to the foot. In the present report, we describe a rare case of fungal osteomyelitis localized to the calcaneus in an elderly female patient who was successfully treated with surgical debridement and a 6-week course of oral fluconazole.

Cutaneous Protothecosis following a Tape-Stripping Injury

Prototheca species are ubiquitous achlorophyllic algae that can, in rare instances, manifest as cutaneous infection in humans at sites of traumatic inoculation into the skin. We report a 77-year-old man who developed cutaneous protothecosis at the site of an iatrogenic tape-stripping type injury. The diagnosis was confirmed by histologic examination and tissue culture. The patient responded completely to a 17-week course of oral fluconazole. Cutaneous protothecosis can present clinically as nonspecific indolent inflammatory plaques that require skin biopsy for definitive diagnosis.

Oesophageal Candidiasis in Elderly Patients

This article reviews risk factors, prevention and management of oesophageal candidiasis (OC) in the elderly. Putative risk factors for OC in the elderly include old age itself, malignant disease, antibacterial and corticosteroid use, chronic obstructive pulmonary disease, acid suppression treatment, oesophageal dysmotility and other local factors, diabetes mellitus and HIV/AIDS. We have found evidence for a risk association between OC in the elderly and malignant disease (both haematological and non-haematological), antibacterial therapy and corticosteroid (including inhaled corticosteroids) use. We also found evidence of an association between OC in the elderly and oesophageal dysmotility or HIV/AIDS, but little direct evidence of an association between diabetes or old age per se. The literature on OC in the elderly is not large. The published series evaluating OC in this age group are small in size, often do not contain controls and mostly contain only limited information about the age of the patients. Prevention of OC is mainly the avoidance of exposure to the risk factors wherever possible. Specific measures such as highly active antiretroviral therapy in AIDS, prophylactic fluconazole when receiving chemotherapy for malignancy, using spacing devices, mouth rinsing soon after inhalation of corticosteroids and avoiding the use of cortiocosteroids just before bedtime are useful. OC is often responsive to a 2- to 3-week course of oral fluconazole, but resistance may be encountered in AIDS or in the presence of uncorrected anatomical factors in the oesophagus. Itraconazole solution, voriconazole or caspofungin may be used in refractory cases. Use of amphotericin B is restricted because of its narrow therapeutic index.

Candida Osteo-Chondromyelitis Complicating Thoraco-Abdominal Esophageal Surgery

Candida albicans osteo-costochondromyelitis is a rare condition. Such pathology after esophagectomy has not been reported. Report of four cases and review of pertinent English-language literature. Four patients underwent esophageal surgery via a left thoraco-abdominal approach between June, 1999 and March, 2000. After complicated post-operative courses, Candida osteomyelitis of the costochondral margin presented initially as a cutaneous sinus. All patients responded well to surgical debridement followed by a three-month course of oral fluconazole.

Tinea capitis due to Trichophyton rubrum in a 3‐month‐old infant

Tinea capitis as a result of Trichophyton rubrum has very rarely been reported in infants. A 3-month-old girl with tinea capitis as a result of T. rubrum is reported. Our patient was treated with a 3-week course of oral fluconazole, which resulted in clearance of the scalp lesion. To our knowledge this case is the first in the literature in which fluconazole was used to treat T. rubrum tinea capitis in children.

Esophageal Polyps in a HIV Infected Patient with Upper GI Bleeding

To highlight esophageal polyps in the setting of upper GI bleeding in a HIV infected patient. Case Report: 40 y/o male was referred for follow up EGD two months after an episode of massive upper gastrointestinal bleed. Initial upper endoscopy (EGD) had revealed multiple esophageal polyps with ulcerations and the patient was subsequently placed on proton pump inhibitors. Follow up EGD revealed multiple small and large polyps in the esophagus with severe candidal esophagitis. A single large pedunculated polyp (7 cm in length) was seen in the upper esophagus that extended from 15 cm to 22 cm from the gums. Barium esophagogram also revealed the multiple esophageal polyps and the large pedunculated polyp was clearly seen in the proximal esophagus, measuring 2 cm in transverse diameter. Biopsies from the polyp showed candida esophagitis with granulation tissue and ulceration. No dysplasia or malignancy were noted. Viral cultures were negative. The patient was treated with a two week course of oral fluconazole. He was noncompliant with subsequent follow up. Two months later, HIV testing was found to be positive and his CD4 count was 6. He developed respiratory failure and died shortly afterwards at an outside instituition. Discussion: Esophageal polyps in the setting of HIV infection is seen rarely. Primary esophageal lymphomas and inflammatory fibroid polyps of the esophagus have been reported in HIV infected patients and they usually present with dysphagia. Esophageal polyps as a possible cause of upper GI bleeding, as illustrated in our case, is extremely rare. Conclusion: In patients with HIV infection, esophageal polyps should be considered in the setting of upper GI bleeding. [figure 1][figure 2]FigureFigure

Treatment outcomes of endogenous fungal endophthalmitis.

Endogenous fungal endophthalmitis may present in a debilitated or otherwise healthy host, may be increasing in prevalence, and is most commonly caused by Candida albicans. Recognizing the potential for complications with systemic amphotericin B use, recent investigators have developed several newer principles governing the treatment of such cases. For cases of simple choroiditis or very minimal endophthalmitis (i.e., vitritis), systemic treatment with oral fluconazole may be effective; however, if vitritis symptoms persist or progress, vitrectomy allows for better clearing of the organism. Intravitreal amphotericin B in conjunction with vitrectomy has been advocated by many. The most recent series have shown that an extended course of oral fluconazole following vitrectomy without intravitreal amphotericin B affects resolution of infection in the vast majority of patients. Final visual acuity outcomes depend most on the site of initial choroiditis. If the macula is spared and preretinal membranes can be effectively removed, visual acuity results can be exceedingly good.

Percutaneous Ureteral Biopsy with the Simpson Atherectomy Catheter

An 86-year-old woman with acute renal failure and bilateral hydronephrosis was referred for placement of bilateral percutaneous nephrostomy tubes. She had been diagnosed with urinary obstruction and chronic bacterial urinary tract infections based on the results of urine culture and renal ultrasound and on the presence of an elevated white blood cell count. Cystoscopy showed bladder inflammation but no masses. Cytologic analysis of urine obtained a t cystoscopy was negative for malignant cells. Fungal cultures were positive for Candida albicans. Bilateral nephrostomy tubes (Medi-techBoston Scientific, Watertown, Mass) were placed, and nephrostograms showed bilateral hydronephrosis, high-grade distal ureteral obstructions, and multiple small ureteral nodules 2-4 mm in dimension (Fig 1). Follow-up nephrostograms obtained 3 weeks later after a short course of intravesical amphotericin B (50 mg/L five times per day for 3 days) and a 3week course of oral fluconazole (100 mg per day for 3 days then every other day for 21 days) showed persistent obstruction and no change in the ureteral filling defects seen on the previous study. The right nephrostomy catheter was exchanged for a 10-F peel-away sheath (Medi-techBoston Scientific). Through this sheath, a 10-F over-the-wire Simpson atherectomy catheter with a 9.3-mm working diameter was advanced into the midureter in a region that contained numerous filling defects. The positioning balloon of the atherectomy catheter was inflated, and several shavings were obtained (Fig 2). The patient then underwent bilateral placement of internal double-J ureteral stents. The tissue samples were submitted to the pathology laboratory for histologic analysis. The samples were stained with hematoxylin-eosin stain, which revealed grade I1 papillary transitional cell carcinoma (Fig 3). The diagnosis was later corroborated by means of bladder biopsy performed during repeated cystoscopy; biopsy results indicated a diagnosis of grade I11 transitional cell carcinoma.