Oral Fluconazole Therapy Research Articles

Dual Organism Periprosthetic Joint Infection Following Total Knee Arthroplasty: A Case Report and One Year Follow-Up

Abstract Periprosthetic joint infections (PJI) of the knee are mostly due to a single organism, very rarely, it is due to dual organisms, and even rarer are dual Gram-negative bacilli and fungal infections. Most fungal infections are caused by Candida albicans; however, very few case reports are available for nonalbicans Candida in immunocompetent patients. We report an unusual case of nonalbicans Candida infection with Gram-negative bacilli in the knee joint with no predisposing risk factors. A 59-year-old man reported following mild pain, swelling, and restricted knee movements in a case of a primary total knee arthroplasty. The patient had minimal symptoms but had gross lysis around implants on imaging. His inflammatory markers were significantly high and knee aspiration was turbid, with raised polymorphs without any conclusive staining result. The culture reports revealed a fungal and Gram-negative organism infection. The patient was managed by debridement, prosthesis removal and antibiotic-loaded cement spacer insertion, and culture-specific antibiotics, followed by revision TKA and oral fluconazole therapy. The patient had a good clinical performance at 3 months and 1-year follow-up visits, with a painless range of motion of 10°–90° and there was no evidence of recurrence of infection. Dual Gram-negative and fungal prosthetic joint infection is a rare but serious complication. In the presence of mild clinical symptoms, but extensive lysis around the implant, fungal pathology should be considered irrespective of the immune status of the patient.

An unusual case of reactivated latent pulmonary cryptococcal infection in a patient after short\u2010term steroid and azathioprine therapy: a case report

BackgroundCryptococcus is one of the major fungal pathogens infecting the lungs. Pulmonary cryptococcal infection is generally considered a community-acquired condition caused by inhalation of dust contaminated with fungal cells from the environment. Here, we report a case developing pulmonary cryptococcosis 3 months after hospital admission, which has rarely been reported before.Case presentationA 73-year-old female patient who was previously immunocompetent experienced persistent dry cough for 2 weeks, 3 months after admission. Chest computed tomography (CT) showed a new solitary pulmonary nodule developed in the upper lobe of the left lung. Staining and culture of expectorated sputum smears were negative for bacteria, acid-fast bacilli, or fungus. The patient then underwent biopsy of the lesion. Histopathology findings and a positive serum cryptococcal antigen titer (1:8) indicated pulmonary cryptococcosis. Daily intravenous 400 mg fluconazole was administered initially followed by oral fluconazole therapy. Follow-up chest CT after 3 months of antifungal therapy showed complete disappearance of the pulmonary nodule. Respiratory symptoms of the patient also resolved. A complete investigation excluded the possibility of a patient-to-patient transmission or primarily acquiring the infection from the hospital environment. Based on the patient’s history of exposure to pigeons before admission and recent steroid and azathioprine use after admission for the treatment of myasthenic crisis, reactivation of a latent pulmonary cryptococcal infection acquired before admission, in this case, is impressed.ConclusionsAlthough rarely reported, pulmonary cryptococcal infection should be included in the differential diagnosis of hospitalized patients with respiratory symptoms, especially in those with predisposing risk factors. Chest image studies and further surgical biopsy are needed for confirmation.

EP13 A case of candida albicans septic sacroiliitis complicating severe COVID-19 infection

Case report - IntroductionBacterial and fungal infections are recognised complications of viral pneumonia, particularly in patients who are critically ill. We describe a case of fungal sacroiliitis complicating severe COVID-19 pneumonia following a prolonged intensive care unit (ICU) admission.Candida albicans sacroilitis is a rarely reported infection with few case reports in the literature. Candida osteoarticular infections can present as septic arthritis, with knee involvement in 75% of cases, or osteomyelitis. The latter presentation differs based on age - vertebral involvement (51%) is more common in adults while children are more likely to present with infection in the long bones, ribs, or sternum.Case report - Case descriptionA 48-year-old Afro-Caribbean gentleman with a history of hypertension and obesity was admitted to the ICU with clinical, laboratory and radiographic features of COVID-19 infection despite persistently negative swabs. Whilst in ICU he required mechanical ventilation. His stay was further complicated by multiple infections, pulmonary emboli, and the presence of a cavitating lesion in the left lung. Cultures from bronchoalveolar lavage and a central venous catheter line grew Serratia Mascense, candida glabrata and pseudomonas were isolated from his urine. He was treated with multiple antibiotics including meropenem, tazocin, ceftazidime and avibactam.After 61 days in the ICU he was transferred to the ward. He developed severe pain in his right hip which was worse on movement. This was followed by urinary incontinence and sensory deficit in the right L2/L3 dermatome. He underwent magnetic resonance imaging (MRI) of his spine and sacroiliac joints which showed right sided sacroiliitis and oedema around the iliopsoas muscle. He was started on vancomycin, later changed to ceftazidime avibactam and metronidazole. An echocardiogram did not show any vegetations. He underwent a biopsy of his sacroiliac joints which confirmed the presence of leucocytes, extended cultures yielded candida albicans in one out of two biopsy specimens.Considering ongoing pyrexia, pain and inflammatory markers, intravenous fluconazole was added to his antibiotic regimen which resulted in a marked improvement in mobility. After four weeks, ceftazidime, metronidazole and avibactam were stopped, and fluconazole was administered as oral tablets. 6 days later he became febrile and IV fluconazole was restarted.A repeat chest CT showed resolution of the cavity but ongoing changes suggestive of organising pneumonia. A repeat MRI of the sacroiliac joints revealed minor improvement. Intravenous Fluconazole was continued for a total of 8 weeks and was changed to tablets for complete a total of 12 weeks.Case report - DiscussionThis is a severe case of COVID-19 infection who despite 9 negative PCR tests, on day 53, had positive IgG for SARS-CoV-2 infection, confirming our clinical suspicion. Particularly in the ICU setting, individuals are approximately ten times more likely to have secondary bacterial/fungal infections with more frequent detection of multidrug-resistant Gram- negative pathogens.This case highlights several difficulties. Urine cultures had confirmed candida albicans, likely to be related to catheter related urinary tract infections, and a possible source for our patient but also a resistant pseudomonas aeruginosa species. Furthermore, cultures were positive for Serratia Mascense, candida glabrata. He had also already been treated with prolonged, broad spectrum antimicrobial treatment. Considering this, establishing the aetiology of the septic sacroiliitis was challenging. The rarity of candida sacroiliitis and presence of the organism in just one specimen made this more difficult. This led to the decision of a repeat sacroiliac biopsy to supply sufficient samples for further microbial analyses such as 16S, 18S and mycobacteria culture, all of which were negative.He became febrile after the discontinuation of antimicrobials and a switch to oral fluconazole therapy. He was extensively re-investigated and despite resolution of the lung cavity, there were changes which could have been consistent with an organising pneumonia. At this point he was neutropenic, mildly eosinophilic, and therefore a drug reaction was also considered.Repeat MRI revealed resolving muscle inflammation and minimal change at the bone site, with erosions and possible reactive bone marrow oedema. Following discussion with microbiology the decision was made to persist with intravenous Fluconazole. He continued to improve, and his inflammatory markers normalised after 8 weeks of treatment. Prednisolone was started for COVID-19 related pneumonitis. Long-term antifungal treatment is advisable, and we aim to complete 12 weeks of treatment. Case report - Key learning points Patients with SARS-CoV-2 infection, particularly those requiring ICU admission were at risk of developing superinfections with multidrug-resistant Gram-negative bacteria or fungal infections.Candida albicans sacroiliitis is rare therefore early aspiration/biopsy is essential for the management.Longer treatment is needed in osteoarticular candida infections, even up to 6 or 12 months, therefor long-term close monitoring of this patients is essential.The utility and timing of reimaging patients following such infections is still unclearClose multidisciplinary and interdisciplinary team collaboration is essential in the management of this complex patients

Efficacy of daily oral terbinafine versus pulse fluconazole therapy in the treatment of tinea corporis, tinea cruris, and tinea faciei: A comparative study

Introduction: Both terbinafine and fluconazole are effective systemic drugs for dermatophytosis. They can be used intermittently as pulse doses or as daily doses for the treatment of the same. Aim: The aim of this study was to assess the efficacy and safety of 1 week twice a day therapy of terbinafine and to compare it with that of a daily 2-week course of terbinafine and weekly pulse fluconazole therapy. The adverse effects and relapse rates after the completion of therapy were assessed. Materials and Methods: A study was conducted with 90 patients divided into three Groups A, B, and C. Patients were assessed at 2 and 4 weeks of starting treatment and 6 weeks following the completion of treatment. Adverse effects if any were noted. Clinical scores were calculated, and skin scraping for potassium hydroxide (KOH) examination was done. Clinical improvement was assessed. A mycological cure is defined as a negative KOH examination. Results: There was a significant decrease in clinical scores before treatment and at 2 and 4 weeks of visits. The highest clinical cure rates were attained in Group A (80%), followed by Group B (73.33%) and Group C (63.3%). Mycological cure rate at 4 weeks was highest in Group A (93.3%), followed by Group B (86.7%) and Group C (83.3%). This difference in clinical and mycological cure rates in the three groups was not found to be statistically significant. Of the patients who had responded to treatment at 4 weeks, the clinical and mycological cure was maintained in 96.4% individuals in Group A, 96.1% in Group B, and 88% in Group C at 6 weeks. Thus, the highest number of recurrences was seen in Group C, followed by Group B and Group A. All the three treatment regimens were well tolerated. Side effects were seen in 17 patients. They were mild and predominantly gastrointestinal. Conclusion: All three drugs in different regimens were found to be equally efficacious in the treatment of dermatophytic infections in our center.

Uso do flucozanol associado à excisão cirúrgica no tratamento da pitiose cutânea equina

Cutaneous pythiosis is an important disease affecting horses raised in regions with a hot climate and water stagnation, occurring throughout all regions of Brazil. The disease progresses rapidly, and treatment for chronic lesions is challenging. The purpose of this study was to evaluate the efficacy of fluconazole after surgical excision and electrocauterization of cutaneous lesions in horses naturally infected with Pythium insidiosum. We treated 10 horses with cutaneous pythiosis, whose diagnoses were confirmed by histopathological and immunohistochemical examinations. After surgical debridement of lesion, animals received fluconazole orally for 21 days, in combination with topical treatment for the wounds. After 7 days of therapy, there was decreased serosanguineous secretion and no kunkers in the wounds in all horses. All lesions healed completely after therapy, and there were no recurrences 10 months after discharge. When associated with surgical excision, oral fluconazole therapy was an effective treatment in clinical cases of equine cutaneous pythiosis.

Pleural fluid secondary to pulmonary cryptococcal infection: a case report and review of the literature

BackgroundPulmonary Cryptococcosis (PC) is diagnosed with increasing incidence in recent years, but it does not commonly involve the pleural space. Here, we report a HIV-negative case with advanced stage IIIB non-small cell lung cancer (NSCLC) treated with radiation therapy presented with dyspnea, a new PET-positive lung mass and bilateral pleural effusion suspecting progressive cancer. However, the patient has been diagnosed as pulmonary cryptococcal infection and successfully treated with oral fluconazole therapy.Case presentationA 77-year-old male with advanced stage non-small cell lung cancer treated with combined chemo-radiation therapy who presented with progressive dyspnea, a new PET-positive left lower lobe lung mass and bilateral pleural effusions. Initial diagnostic thoracentesis and bronchoscopy yielded no cancer, but instead found yeast forms consistent with cryptococcal organisms in the transbronchial biopsies of the left lower lobe lung mass. Subsequent to this, the previously collected pleural fluid culture showed growth of Cryptococcus neoformans. The same sample of pleural effusion was tested and was found to be positive for crytococcal antigen (CrAg) by a lateral flow assay (LFA). The patient has been treated with oral fluconazole therapy resulting in gradual resolution of the nodular infiltrates.ConclusionPC should be considered in immunosuppressed cancer patients. Additionally, concomitant pleural involvement in pulmonary cryptococcal infections may occur. The incidence of false positive 18FDG-PET scans in granulomatous infections and the use of CrAg testing in pleural fluid to aid in diagnosis are reviewed.

The safety of oral fluconazole therapy in pregnancy.

[See related article at [www.cmaj.ca/lookup/doi/10.1503/cmaj.180963][2]][2] KEY POINTS Vulvovaginal candidiasis affects up to 75% of women during their lifetime and disproportionately affects pregnant women. It has not been associated with adverse pregnancy outcomes, and treatment of symptomatic

A novel form of intracranial coccidioidomycosis is present in dogs and exhibits characteristic clinical and magnetic resonance imaging findings

The neurological examination findings, clinical pathology (including Coccidioides immitis IgG/IgM serology) and magnetic resonance imaging (MRI) findings in 13 dogs with a novel form of intracranial coccidioidomycosis are described in a retrospective case series, with long-term clinical resolution documented in 11/13 dogs (84.6% of cases) with oral fluconazole therapy. The medical records of the Veterinary Neurological Center in Phoenix, Arizona from the years 2000 to 2017 were utilized to search for dogs with appropriate inclusion criteria. Magnetic resonance imaging findings were highly consistent across all cases and characteristically demonstrated bilaterally symmetric T2 hyperintensity throughout the frontal lobes, caudate nuclei, and rostral internal capsule, ±faint, wispy contrast enhancement on T1-postcontrast images. These findings were in stark contrast to previously reported MRI findings in dogs with intracranial coccidioidomycosis, which were typically characterized by a focal, strongly contrast enhancing granuloma and extensive vasogenic edema, typically unilateral. Schnauzer breeds represented eight of 13 (61.5%) cases, possibly suggesting a breed predilection. Three cases underwent repeat MRI after resolution of neurological signs and documentation of a decreased Coccidioides titer in response to fluconazole therapy. All demonstrated complete resolution of previously identified lesions, but with marked, severe atrophy of the caudate nuclei and frontal lobes bilaterally. Findings from this study document a variant appearance for intracranial coccidioidomycosis that, to the author's knowledge, has not been previously described in dogs. Authors propose that, although this variant demonstrates extensive pathological changes within the forebrain, the clinical outcome and response to treatment is favorable in a majority of cases.

Miliary tuberculosis with co-existing pulmonary cryptococcosis in non-HIV patient without underlying diseases: a case report

BackgroundTuberculosis and cryptococcosis co-infection usually occurs in immunosuppressed patients with impaired cell-mediated immunity. However, there are few reports about such co-infection in non-HIV patients without underlying diseases. Here, we report a case of miliary tuberculosis with co-existing pulmonary cryptococcosis in non-HIV patient without underlying diseases.Case presentationAn 84-year-old Asian female presented to our hospital with complaints of a 1-week history of abdominal pain and appetite loss. Chest computed tomography (CT) showed diffuse micronodules in random patterns in both lung fields. Liver, skin and bone marrow biopsies showed epithelioid cell granuloma. Polymerase chain reaction of gastric aspirate was positive for Mycobacterium tuberculosis. According to these findings, miliary tuberculosis was suspected and antimycobacterial therapy was initiated. After a 6-month treatment course, chest radiograph showed new multiple nodules in the right middle lung field. Chest CT showed that a right S6 small nodule was increased and new multiple nodules appeared in the right lower lobe. Flexible fiberoptic bronchoscopy was subsequently perfomed. Cytology of the bronchial lavage showed a small number of Periodic acid-Schiff-positive bodies, suggesting Cryptococcus species. Moreover, serum cryptococcal antigen testing was positive. According to these findings, pulmonary cryptococcosis was diagnosed, although the culture was negative. Oral fluconazole therapy was subsequently initiated. After a 6-month treatment course, chest radiograph showed gradual improvement.ConclusionAlthough tuberculosis and cryptococcosis co-infection is relatively rare in immunocompromised hosts, such as those with acquired immunodeficiency syndrome, clinicians should be aware that these infections can co-exist even in non-HIV patients without underlying diseases.

Concurrent Disseminated Cryptococcus neoformans and Abdominal Tuberculosis in a Renal Transplant Recipient – Paradoxical Reaction or IRIS?

A 36 year old-man diagnosed with ESRD on hemodialysis, presented with fever, moderate abdominal pain with frequent non-bloody loose stools, headache, blurring of vision and molloscum-contagiousum like skin lesions. HIV test was negative and CT brain was normal. Blood culture grew Cryptococcus neoformans with high titer antigenemia. Amphotericin B and fluconazole were started and the patient was discharged on oral fluconazole therapy. Four weeks later, he was readmitted with persistent high spikes of temperature, profuse sweating and severe frontal headache. CT brain revealed a faint hypodense lesion at right frontal lobe with ill-defined margin and lumbar puncture was deferred. Pan-sensitive mycobacterium tuberculosis was grown from stool sample. Blood cryptococcalantigenemia was reported again and he was started on a new IV amphotericin intensive cycle and high dose fluconazole. Quadruple anti-tuberculosis treatment was initiated. The patient made a full clinical recovery including total resolution of skin lesions; laboratory and radiological recovery.

Concurrent Disseminated Cryptococcus neoformans and Abdominal Tuberculosis in a Renal Transplant Recipient – Paradoxical Reaction or IRIS?

A 36 year old-man diagnosed with ESRD on hemodialysis, presented with fever, moderate abdominal pain with frequent non-bloody loose stools, headache, blurring of vision and molloscum-contagiousum like skin lesions. HIV test was negative and CT brain was normal. Blood culture grew Cryptococcus neoformans with high titer antigenemia. Amphotericin B and fluconazole were started and the patient was discharged on oral fluconazole therapy. Four weeks later, he was readmitted with persistent high spikes of temperature, profuse sweating and severe frontal headache. CT brain revealed a faint hypodense lesion at right frontal lobe with ill-defined margin and lumbar puncture was deferred. Pan-sensitive mycobacterium tuberculosis was grown from stool sample. Blood cryptococcalantigenemia was reported again and he was started on a new IV amphotericin intensive cycle and high dose fluconazole. Quadruple anti-tuberculosis treatment was initiated. The patient made a full clinical recovery including total resolution of skin lesions; laboratory and radiological recovery.

Treatment of mycotic tracheitis in a horse with fluconazole and systemic iodine

SummaryFungal infections of the equine trachea have been rarely reported. This case report describes the successful treatment of a mare with fungal infection of the trachea that had severe diffuse granulomatous thickening, erosions and haemorrhage of the proximal half of the trachea. The horse was treated with oral fluconazole and systemic iodine therapy. Serial endoscopic examinations confirmed rapid resolution of the condition.

Chronic vulvovaginal candidiasis in patients using a levonorgestrel-containing intrauterine device.

Chronic vulvovaginal candidiasis is usually responsive to therapy with oral antifungals. We present a case series of 13 patients with this condition who were also using a levonorgestrel intrauterine system (LNG-IUS). All cases responded to ongoing oral fluconazole therapy while the LNG-IUS was in situ. The LNG-IUS was removed in six patients and of these, two experienced clinical improvement with lower fluconazole dosage requirements and three experienced complete resolution of symptoms. One remains on fluconazole 100 mg daily.

Quality of life in patients with chronic vulvovaginal candidiasis: A before and after study on the impact of oral fluconazole therapy.

Chronic vulvovaginal candidiasis (CVVC) is a disorder characterised by the signs and symptoms of vulvovaginal inflammation and causally associated with the presence of Candida spp. in the vagina. This study aimed to establish the impact of treatment with fluconazole in CVVC on patients' quality of life (QoL). This was a before and after study conducted in vulval dermatology clinics in Sydney, Australia. Patients were assessed at baseline by the dermatology life quality index (DLQI) and visual analogue scale (VAS) grading of erythema at baseline and at 12 weeks after an oral fluconazole regime. The primary outcome measures were a change in their DLQI score and VAS grading. The secondary outcome measures were its tolerability and adverse events. A total of 82 of 91 patients (90%) completed the study. The mean drop in their DLQI score was 11.6 [95% CI (10.1, 13.0)] (P < 0.001). The post-treatment VAS scores were significantly lower than the pretreatment scores (P < 0.001). Adverse effects requiring cessation of fluconazole occurred in 4% of patients. Fluconazole treatment at a dose of 50-100 mg daily achieved a significant observable and improvement in the QoL of 96% of patients with CVVC within 12 weeks of treatment. Adverse effects were minimal.

Efficacy and safety of a single oral 150 mg dose of fluconazole for the treatment of vulvovaginal candidiasis in Japan

Vulvovaginal candidiasis is the second most common cause of vaginal infections following bacterial vaginosis. For the treatment of vulvovaginal candidiasis, antifungal agents are used either as topical (vaginal tablets and cream) or oral formulations. A single oral 150 mg dose of fluconazole has been recommended as the standard therapy for uncomplicated, acute vulvovaginal candidiasis in global guidelines; however, in Japan oral fluconazole therapy has not been approved. We conducted a phase 3 study to evaluate the efficacy and safety of a single oral 150 mg dose of fluconazole in Japanese subjects with vulvovaginal candidiasis for regulatory submission. A total of 157 subjects received a single oral 150 mg dose of fluconazole. Candida species (104 strains) were identified by fungal culture from 102 subjects at baseline, including Candida albicans (100 strains). The efficacy rate for the therapeutic outcome (assessed based on a comprehensive evaluation of the clinical and mycological efficacy in each subject) was 74.7% (74/99) on Day 28 in the modified Intent-To-Treat (m-ITT) population. Concerning the clinical and mycological efficacy on Day 28 in the m-ITT population, the cure, cure or improvement, and eradication rates were 81.6%, 95.9%, and 85.9%, respectively. The most common treatment-related adverse events were diarrhea and nausea (1.9% for each). No clinically significant safety issues were reported. A single oral 150 mg dose of fluconazole demonstrated excellent therapeutic efficacy and was well tolerated in Japanese subjects with vulvovaginal candidiasis. NCT01806623.

Oral candidiasis - Perleche Mimicking Malignancy

Candida species inhabit the mucosal surfaces of healthy individuals. Major forms of oral candidiasis are pseudomembranous and atrophic form, but chronic hyperplastic candidiasis (CHC) is rarely seen. We encountered a case of whitish plaque with nodule and ulceration. When an intraoral nodule is observed, the possibility of CHC should be taken into consideration. Biopsy of the lesion failed to show any signs of malignancy, and patient responded well to oral fluconazole therapy only.&#x0D; CBMJ 2014 January: Vol. 03 No. 01 P: 53-55

Reply to Torres and Suarez

To the Editor—We appreciate Drs Torres and Suarez's interest in our article, “High-Dose Oral Fluconazole Therapy Effective for Cutaneous Leishmaniasis Due to Leishmania (Vianna) braziliensis” [1]. They refer to evidence of Leishmania amazonensis isolated from human as well as domestic and wild reservoir hosts from the state of Ceara and suggest it is an important etiologic agent of cutaneous leishmaniasis in the region. Concerning human hosts, their statement is based on 2 publications [2, 3] that showed a single isolate of L. amazonensis from only 1 human case of cutaneous leishmaniasis. Both articles deal with the same parasite grown from a human skin biopsy sample in 1984. Because that event was so rare, the question as to whether it was an imported case remains. In respect to domestic and wild reservoirs of L. amazonensis in the state of Ceara, there is no proof of isolates of L. amazonensis from any reservoir or from sandflies. The data available for isolates from humans [4–7], from domestic and wild reservoir hosts [4, 6], and from sandflies [4, 6, 8, 9] support our statement: Leishmania (Viannia) braziliensisis is the only known agent of cutaneous leishmaniasis in the state of Ceara. In a large study of 272 human isolates from 39 different municipalities, all were characterized as L. braziliensis [5]. In another report [6], the author studied 354 isolates from humans, rodents, dogs, and sandflies; all were characterized as L. braziliensis. Furthermore, because the patients in our study were from several different endemic areas, the hypothesis that the response of our patients was due to aspecific clinical syndrome caused by L. braziliensis from a specific endemic area is not true. The lymphadenopathy described in L. braziliensis infection [5] has been documented in other regions of Brazil, and its detection depends on the moment patients seek medical attention and on a comprehensive physical examination because this lymphadenopathy is an early manifestation of infection and, as a rule, the lymphadenopathy is painless and abates as the ulcer progresses. There is evidence that 1 strain of L. braziliensis from 1 region may be genetically different from another strain from other regions [10], and it is possible that these strains may respond differently to therapy. Hence, it is critically important that fluconazole be tested in other areas where L. braziliensis and other species of Leishmania are endemic, keeping in mind that optimal weight-based dosing is very likely to be an important determinant of therapeutic success [1].

Pulmonary Cryptococcosis Mimicking Primary Lung Cancer with Multiple Lung Metastases

Cryptococcosis is an invasive fungal infection, which is more common in immunocompromised patients. However, pulmonary cryptococcosis can occur in immunocompetent patients and should be considered on a differential diagnosis for nodular or mass-like lesions in chest radiograph. Recently, we experienced a patient with pulmonary cryptococcosis, successfully treated with oral fluconazole therapy. A 74-year-old female patient was referred for an evaluation of abnormal images, a large consolidative mass with multiple nodular consolidations and small nodules that mimics primary lung cancer with multiple lung to lung metastases. Computed tomography-guided lung biopsy confirmed the diagnosis of pulmonary cryptococcosis. The follow-up image taken after 4 months with oral fluconazole treatment showed marked improvement.

High-Dose Oral Fluconazole Therapy Effective for Cutaneous Leishmaniasis Due to Leishmania (Vianna) braziliensis

We report for the first time the successful use of fluconazole to treat cutaneous leishmaniasis due to Leishmania braziliensis. We used escalating doses from 5 to 8 mg/kg per day. At a dose of 5 mg/kg per day, 75% patients were cured, and at 8 mg/kg per day, the cure rate was 100%. Fluconazole was well tolerated.

Colletotrichum truncatum: an Unusual Pathogen Causing Mycotic Keratitis and Endophthalmitis

In recent years, the well-known plant pathogens of the Colletotrichum genus were increasingly reported to cause ophthalmic infections in humans. Among 66 species in the Colletotrichum genus, only a few are known to be pathogenic for humans. We report here five cases of ophthalmic infections due to Colletotrichum truncatum, a species never reported earlier to cause human infection. The isolates were identified by morphological characteristics and the sequencing of internal spacer regions of ribosomal DNA. The progress of lesions in those patients was slow compared to that of lesions caused by Aspergillus or Fusarium infections. The surgical management included total penetrating keratoplasty in patients with keratitis and pars plana vitrectomy in endophthalmitis. Two patients were treated additionally with intravitreal amphotericin B deoxycholate, one patient with oral itraconazole, and another patient with oral and topical fluconazole therapy. The present series therefore highlights the expanding spectrum of agents causing eye infections and the inclusion of C. truncatum as a human pathogen.