Treatment of cryptococcosis with liposomal amphotericin B (AmBisome) in 23 patients with AIDS

Coker, Richard; Viviani, Maria Anna; Gazzard, B. G.; Pont, Bert Du; Pohle, H. D.; Murphy, SM; Atouguia, Jorge; Champalimaud, J L; Harris, J. R. W.

doi:10.1097/00002030-199306000-00011

Cited by 117 publications

(41 citation statements)

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“…One year after beginning sulfonamide therapy, the patient remains symptom-free. 4 and visceral leishmaniasis. 5,6 Of note, many of these patients had failed prior therapy with either azoles or Fungizone.…”

Section: Resultsmentioning

confidence: 99%

Failure of amphotericin B colloidal dispersion in the treatment of paracoccidioidomycosis.

Dietze

Fowler²,

Steiner³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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Abstract. Although amphotericin B desoxycholate is considered the most effective treatment for disseminated Paracoccidioides brasiliensis infections, little is known about the efficacy of lipid-based formulations of amphotericin B in this infection. In this study, we treated four adults with the juvenile form of paracoccidioidomycosis with 3 mg/ kg/day of amphotericin B colloidal dispersion for at least 28 days. Although all of the patients initially responded by clinical observation, all four patients relapsed within six months. The use of amphotericin B colloidal dispersion for the initial induction of paracoccidioidomycosis failed to cure this infection. Possible reasons for failure include dose, duration, or reduced efficacy of this lipid preparation. For many fungal infections, lipid-based preparations have been shown to have a therapeutic-toxic advantage, but our experience with Paracoccidioides infections suggests that more careful studies will need to be performed before they can be recommended for use in this mycosis.

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Section: Resultsmentioning

confidence: 99%

Failure of amphotericin B colloidal dispersion in the treatment of paracoccidioidomycosis.

Dietze

Fowler²,

Steiner³

et al. 1999

The American Journal of Tropical Medicine and Hygiene

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“…C. neoformans also remains the third most common invasive fungal infection among organ transplant recipients, accounting for 8% of fungal diseases in solid-organ transplant recipients from March 2001 through March 2006 (13,15,16). The development of drug resistance or the inability of the host's immune system to participate in eradicating the pathogen necessitates the development of new therapeutic strategies that consider the immune status of the host population commonly impacted by cryptococcal disease (17)(18)(19).…”

mentioning

confidence: 99%

STAT1 Signaling within Macrophages Is Required for Antifungal Activity against Cryptococcus neoformans

et al. 2015

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Cryptococcus neoformans, the predominant etiological agent of cryptococcosis, is an opportunistic fungal pathogen that primarily affects AIDS patients and patients undergoing immunosuppressive therapy. In immunocompromised individuals, C. neoformans can lead to life-threatening meningoencephalitis. Studies using a virulent strain of C. neoformans engineered to produce gamma interferon (IFN-␥), denoted H99␥, demonstrated that protection against pulmonary C. neoformans infection is associated with the generation of a T helper 1 (Th1)-type immune response and signal transducer and activator of transcription 1 (STAT1)-mediated classical (M1) macrophage activation. However, the critical mechanism by which M1 macrophages mediate their anti-C. neoformans activity remains unknown. The current studies demonstrate that infection with C. neoformans strain H99␥ in mice with macrophage-specific STAT1 ablation resulted in severely increased inflammation of the pulmonary tissue, a dysregulated Th1/Th2-type immune response, increased fungal burden, deficient M1 macrophage activation, and loss of protection. STAT1-deficient macrophages produced significantly less nitric oxide (NO) than STAT1-sufficient macrophages, correlating with an inability to control intracellular cryptococcal proliferation, even in the presence of reactive oxygen species (ROS). Furthermore, macrophages from inducible nitric oxide synthase knockout mice, which had intact ROS production, were deficient in anticryptococcal activity. These data indicate that STAT1 activation within macrophages is required for M1 macrophage activation and anti-C. neoformans activity via the production of NO.

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“…After the continuous intrathecal administration of liposomal amphotericin B, the cerebrospinal fluid pressure was 252.50±45.36 mm H 2 O, the white blood cell count was 20±8.94x10 6 cells/l and total cerebrospinal fluid protein was 450±65.49 mg/l. These results suggest that administration of amphotericin B liposomes caused cerebrospinal fluid levels and increased intracranial hypertension to gradually return to normal, and the white blood cell levels and the total cerebrospinal fluid protein were decreased.…”

Section: Case Reportmentioning

confidence: 99%

“…Because of its toxicity, AmB therapy has been reduced in dose and duration by successfully using it in combination with flucytosine (6). Formulations of AMB and lipids have been developed to aid its delivery, reduce toxicity, and enable higher doses to be tolerated (1).…”

Section: Introductionmentioning

confidence: 99%

Continuous intrathecal administration of liposomal amphotericin B for treatment of refractory Cryptococcus neoformans encephalitis: A case report

Xie

Luo

et al. 2017

Experimental and Therapeutic Medicine

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Abstract. The aim of the present study was to investigate the treatment of refractory Cryptococcus neoformans encephalitis with continuous administration of liposomal amphotericin B (AmB). Liposomal AmB was administered to a 28-year-old male by intravenous injection, with daily increasing dosages up to 150 mg per day and combined use of fluconazole (0.4 g per day) and oral flucytosine tablets (1.5 g per day). Following 5 months of treatment, C. neoformans could still be detected in the ink stain of cerebrospinal fluid, but the patient could not tolerate a further increase in the dosage of liposomal AmB. Instead, continuous intrathecal administration of AmB through tube drainage on the lumbar cistern was used. A total dosage of 28 mg liposomal AmB was administered to the patient over the course of 1 month. The effect of AmB administered by intravenous injection was not as great as expected and the patient's tolerance was not good. However, the patient recovered following treatment by continuous intrathecal administration of AmB through tube drainage on the lumbar cistern for 1 month. This case suggests that continuous intrathecal administration of liposomal AmB should be considered for clinical treatment of refractory cryptococcal encephalitis.

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Treatment of cryptococcosis with liposomal amphotericin B (AmBisome) in 23 patients with AIDS

Cited by 117 publications

References 0 publications

Failure of amphotericin B colloidal dispersion in the treatment of paracoccidioidomycosis.

Failure of amphotericin B colloidal dispersion in the treatment of paracoccidioidomycosis.

STAT1 Signaling within Macrophages Is Required for Antifungal Activity against Cryptococcus neoformans

Continuous intrathecal administration of liposomal amphotericin B for treatment of refractory Cryptococcus neoformans encephalitis: A case report

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