Intrabronchial instillation of amphotericin B lipid complex: a case report
| Autor: | V. Tarrazona, P. Morales, E. SanMartín, M. Santos, G. Galán, E. Monte |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
Adult
Male medicine.medical_specialty Antifungal Agents Cystic Fibrosis medicine.medical_treatment Perforation (oil well) Bronchi Candida glabrata Postoperative Complications Amphotericin B medicine Lung transplantation Aspergillosis Humans Scedosporium Voriconazole Transplantation biology Scedosporium prolificans business.industry Aspergillus fumigatus Candidiasis biology.organism_classification medicine.disease Surgery Stenosis Instillation Drug Mycetoma business medicine.drug Follow-Up Studies Lung Transplantation |
| Zdroj: | Transplantation proceedings. 41(6) |
| ISSN: | 1873-2623 |
| Popis: | Objective. We sought to present our results of topical intrabronchial installation of amphotericin B lipid complex (AmpB lipid). Patient and Methods. A deposit of fungal material was observed in a bilateral lung transplant recipient who experienced stenosis of the left anastomosis and have been fitted with a double endobronchial prosthesis. The deposit was adherent to the prosthetic material, causing marked local laceration, risk of perforation, and exacerbation of the bronchial stenosis. Upon cultivation of a bronchial aspirate (BAS), we isolated Aspergillus fumigatus, Scedosporium prolificans, and Candida glabrata. Systemic antifungal treatment was begun with oral voriconazole (200 mg every 12 hours) and inhaled AmpB lipid (25 mg once daily). The fungal deposit on the prosthetic material was treated by topical instillation of a solution of 25 mg AmpB lipid before and after each therapeutic fibrobronchoscopy (FB), which was performed weekly at 5 consecutive examinations. Tolerance was excellent. Results. The improvement obtained after the procedure made it possible to withdraw one of the displaced prostheses. Subsequent cultivation for the fungi found in the BAS was persistently negative over a follow-up of 2 years. Conclusion. Topical intrabronchial instillation of AmpB lipid has proven effective and well tolerated for the treatment of localized fungal colonies. This use could be extended by protocol to FB in the early postoperative period after lung transplantation for antifungal prophylaxis. |
| Databáze: | OpenAIRE |
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