Treatment of pulmonary blastomycosis with high-dose liposomal amphotericin B in a patient receiving extracorporeal membrane oxygenation

Servais, R; Ammar, Mahmoud; Gurnani, Payal

doi:10.1136/bcr-2019-229612

Cited by 6 publications

(7 citation statements)

References 14 publications

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“…Liposomes functionalized with groups, such as mannose, have been found to increase alveolar cell uptake, whereas attaching them with specific antibodies increases tissue targeting and local drug release in the lungs [ 151 , 152 ]. In several studies, liposomes have been shown to deliver drugs like amphotericin B and paclitaxel in pulmonary diseases [ 153 , 154 ]. The liposomal formulation of N -acetylcysteine has shown improved prophylactic efficacy against lipopolysaccharide-induced lung injuries in animal models displaying ARDS pathology [ 155 ].…”

Section: Nanotechnology-based Drug Delivery Systems In Ardsmentioning

confidence: 99%

Nanotherapeutics in the treatment of acute respiratory distress syndrome

et al. 2021

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Acute respiratory distress syndrome (ARDS) is a form of oxygenation failure primarily characterized by rapid inflammation resulting from a direct pulmonary or indirect systemic insult. ARDS has been a major cause of death in the recent COVID-19 outbreak wherein asymptomatic respiratory tract infection progresses to ARDS from pneumonia have emphasized the need for a reliable therapy for the disease. The disease has a high mortality rate of approximately 30–50%. Despite the high mortality rate, a dearth of effective pharmacotherapy exists that demands extensive research in this area. The complex ARDS pathophysiology which remains to be understood completely and the multifactorial etiology of the disease has led to the poor diagnosis, impeded drug-delivery to the deeper pulmonary tissues, and delayed treatment of the ARDS patients. Besides, critically ill patients are unable to tolerate the off-target side effects. The vast domain of nanobiotechnology presents several drug delivery systems offering numerous benefits such as targeted delivery, prolonged drug release, and uniform drug-distribution. The present review presents a brief insight into the ARDS pathophysiology and summarizes conventional pharmacotherapies available to date. Furthermore, the review provides an updated report of major developments in the nanomedicinal approaches for the treatment of ARDS. We also discuss different nano-formulations studied extensively in the ARDS preclinical models along with underlining the advantages as well as challenges that need to be addressed in the future.

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Section: Nanotechnology-based Drug Delivery Systems In Ardsmentioning

confidence: 99%

Nanotherapeutics in the treatment of acute respiratory distress syndrome

et al. 2021

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“…An increasing number of institutions have reported experience in using extracorporeal membrane oxygenation (ECMO) for severe blastomycosis-associated ARDS. 58,60,61,[108][109][110][111][112][113][114] Good outcomes have been reported in many cases 58,61,115 ; however, the fact that most published experience is from individual case reports or small case series warrants interpreting these results with caution because of the potential for reporting bias. One case report suggested that liposomal amphotericin B became sequestered in and occluded the ECMO circuit, 116 but other published reports have not noted this complication.…”

Section: Difficult-to-treat Complications Of Blastomycosismentioning

confidence: 99%

“…One case report suggested that liposomal amphotericin B became sequestered in and occluded the ECMO circuit, 116 but other published reports have not noted this complication. 60,108,[110][111][112][113][114] In another case report, a patient with blastomycosis-associated ARDS requiring ECMO deteriorated despite standard dosing of liposomal amphotericin B (5 mg/kg daily), but seemed to respond to a higher dose (7.5 mg/kg daily was needed for clinical response). 113 In light of these concerns, we recommend treating blastomycosis-associated ARDS in patients receiving ECMO with liposomal amphotericin B dosed at 7.5 mg/kg daily.…”

Section: Difficult-to-treat Complications Of Blastomycosismentioning

confidence: 99%

“…60,108,[110][111][112][113][114] In another case report, a patient with blastomycosis-associated ARDS requiring ECMO deteriorated despite standard dosing of liposomal amphotericin B (5 mg/kg daily), but seemed to respond to a higher dose (7.5 mg/kg daily was needed for clinical response). 113 In light of these concerns, we recommend treating blastomycosis-associated ARDS in patients receiving ECMO with liposomal amphotericin B dosed at 7.5 mg/kg daily. 113 If problems with circuit occlusion occur and cannot be overcome with circuit changes, amphotericin B deoxycholate (1 mg/kg daily) would be appropriate for most patients.…”

Section: Difficult-to-treat Complications Of Blastomycosismentioning

confidence: 99%

“…113 In light of these concerns, we recommend treating blastomycosis-associated ARDS in patients receiving ECMO with liposomal amphotericin B dosed at 7.5 mg/kg daily. 113 If problems with circuit occlusion occur and cannot be overcome with circuit changes, amphotericin B deoxycholate (1 mg/kg daily) would be appropriate for most patients.…”

Section: Difficult-to-treat Complications Of Blastomycosismentioning

confidence: 99%

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Blastomycosis

Schwartz

Kauffman

2020

Semin Respir Crit Care Med

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Blastomycosis is a serious fungal disease of humans and other mammals caused by environmentally acquired infection with geographically restricted, thermally dimorphic fungi belonging to the genus Blastomyces. The genetic and geographic diversity of these pathogens is greater than previously appreciated. In addition to Blastomyces dermatitidis and the cryptic species Blastomyces gilchristii, which cause blastomycosis in mid-western and various eastern areas of North America, atypical blastomycosis is occasionally caused by Blastomyces helicus in western parts of North America and Blastomyces percursus in Africa. Blastomycosis is acquired by inhalation of the conidia that are produced in the mold phase; in the lungs, temperature-dependent transformation occurs to the yeast phase. In this form, the organism is phagocytized by macrophages and can spread hematogenously to various organs causing disseminated infection. Pulmonary disease is most common and varies from mild, self-limited infection to severe, potentially fatal adult respiratory distress syndrome. Disseminated infection is manifested primarily by skin lesions, but many other organs can be involved. Diagnosis is established by growth of the organism in culture; however, a tentative diagnosis can be made quickly by histopathological identification of the classic yeast form in tissues or by finding Blastomyces antigen in urine or serum. Blastomycosis is treated initially with amphotericin B when the disease is severe, involves the central nervous system, or the host is immunosuppressed. Itraconazole is recommended for primary therapy in mild-to-moderate infection and for step-down therapy after initial amphotericin B treatment. Voriconazole and posaconazole can be used for patients in whom itraconazole is not tolerated.

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