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 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A randomized double-blind trial was conducted to assess the local effectiveness and safety of a troche form of clotrimazole in the treatment of oropharyngeal candidiasis in cancer patients. One half of the patients received one 10-mg troche and the other half received one 50-mg troche, five times a day for two weeks. Clinical cures were observed in 50 episodes, resulting in a cure rate of 96%. The median duration of oropharyngeal candidiasis after the start of therapy was three days in those treated with the 50-mg troche and four days in those who had received the 10-mg troche. Side effects were minimal, and only one patient experienced nausea and abdominal pain. Both the 10-mg and 50-mg troches appear to be efficacious and safe, but the 50-mg dose may be preferable because it is somewhat more effective without additional toxicity.
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PMID:Oropharyngeal candidiasis treated with a troche form of clotrimazole. 37 58

In the past few years a new syndrome of invasive Candida infection, the so-called hepatosplenic or chronic systemic candidiasis (CSC), has been recognized with increasing frequency in neutropenic patients. From January 1985 to December 1990, ten of 305 acute leukemia (AL) patients treated at our institution were diagnosed as having CSC. In contrast, during the same period this type of Candida infection was not observed in any patient with hematological diseases other than AL treated in our center, including 277 patients who underwent bone marrow transplantation. All patients with CSC had fever and hepatomegaly, and five complained of abdominal pain. Seven patients had neutrophilic leukocytosis and six an increased serum alkaline phosphatase activity. Abdominal computed tomography and ultrasound study showed typical lesions in eight and seven patients, respectively. In four patients a laparoscopy-guided needle liver biopsy displayed yellowish nodules on the liver surface, and the histologic study revealed large granulomas with yeasts and pseudohyphae. All patients were given amphotericin B (mean: 4.6 g, range: 1-12.5 g) and 5-fluorocytosine, and five received fluconazole. No patient died as a direct consequence of CSC and in six the infection resolved. Finally, once controlled, the infectious complication did not preclude subsequent intensive antileukemic therapy, including bone marrow transplantation.
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PMID:Chronic systemic candidiasis in acute leukemia. 162 59

The focus of this study on coital allergy is on discussing the basis for and clinical implications of the immunological reactions that mediate allergic reactions to semen. Allergic reactions to antigens in seminal plasma occur in the case of acute systemic hypersensitivity (ACH), localized postcoital allergic seminal vulvovaginitis, and/or hypersensitivity to exogenous allergens in semen. In the few cases (30 cases at present), ACH may manifest itself in generalized urticaria, orbital and vulval edema, vulval and generalized pruritus, bronchospasm, lower abdominal pain, hypotension, and loss of consciousness. There may be a family history of atopy. Symptoms may appear over months or years before reaching a severe level. The usual case is the appearance after the 1st coital act or after a change in coital, genital, or reproductive occasions. It is not specific to a particular male partner. It may be self-limiting. Condom usage or abstinence may lead to abatement. Localized vulvovaginitis may occur simultaneously with ACH or exist alone. The symptoms are local pruritus, burning, swelling, erythema, and urticaria in varying degrees for up to a week and occur during or after coitus. Douching or vulval irrigations may ameliorate symptoms. Misdiagnosis as genital herpes or infective vulvovaginitis may occur in mild cases. Exogenous allergens derived from drugs, food, and other sources presenting in the semen may contribute to hypersensitivity. This is different from reactions to intrinsic components of seminal plasma. Vaginal exposure to chemical products such as soaps or to airborne particles such as pollen may produce allergic responses. Another possibility is that genital candidiasis may produce local Ige antibodies, and PGE2 induced suppression of cell-mediated immunity. The immunological mechanisms are described as type I hypersensitivity reactions with the antigen reacting with reaginic antibodies of the Ige class which are bound to mast cell or circulating basophils. The antigens and the immune reactions are specified. In the clinical diagnosis, the rare acute systemic form is obvious, but the atypical, recurrent, and intractable forms of vulvovaginitis require investigation with skin tests. Treatment may involve artificial insemination for those seeking pregnancy, immunotherapy, or antihistamines, rather than use of a condom or abstinence.
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PMID:Allergy to coitus. 168

Hepatosplenic candidiasis has increased in frequency among immunocompromised hosts. Risk factors include hematologic malignancy, intensive chemotherapy, prolonged neutropenia, and treatment with broad-spectrum antibiotics. Patients most commonly present with abdominal pain, persistent fevers despite antibiotic therapy, and an elevated alkaline phosphatase level that is out of proportion to other hepatic enzyme levels. Gastrointestinal mucosal damage secondary to intensive chemotherapy may allow colonization with Candida species and subsequent seeding of the portal vein. Treatment has consisted of prolonged courses of amphotericin B, with mortality rates approaching 50%. We report a case of hepatosplenic candidiasis in a patient with acute myelogenous leukemia who had clinical and radiographic improvement during fluconazole therapy. Fluconazole may be an efficacious and less toxic alternative to amphotericin B.
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PMID:Fluconazole in the treatment of hepatosplenic candidiasis. 173 74

Three children with acute leukemia presented with prolonged fever and neutropenia after cytostatic therapy, which was followed by abdominal pain, hepatomegaly, and hepatic dysfunction with raised serum alkaline phosphatase. Abdominal CT scan and ultrasound demonstrated multiple small lesions compatible with the hepatosplenic candidiasis syndrome. Liver biopsies showed microabscesses with a granulomatous appearance, but evidence of yeasts and pseudohyphae was present in 1 case only. Cultures were negative. Treatment with amphotericin B and 5-fluorocytosine was successful in two children. At autopsy, one child had signs of active infection. We reviewed the literature on 27 children with hepatosplenic candidiasis. Abdominal symptomatology and prolonged fever, despite antibiotic therapy, in a patient with previous or present neutropenia after cytotoxic exposure, should lead to a careful evaluation, including noninvasive imaging studies, open liver biopsy, and prompt aggressive antifungal treatment, the response to which requires close follow-up.
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PMID:Hepatosplenic candidiasis in children with cancer. Three cases in leukemic children and a literature review. 220 7

Twenty patients suffering from dermatomycosis have been treated with fluconazole at the dose of 50 mg/daily for 20 days. These patients (10 M + 10 F) were aged 36 years on average (range 17-65 years). And were suffering from the following: Tinea pedis (3 cases), Tinea cruris (1 case), Tinea corporis (9 cases), Tinea versicolor (3 cases), Candidiasis (5 cases). One patient was suffering from Tinea on two different body sites. 19 patients finished the treatment and reported a complete clinical and mycological healing either at the end of the therapy on at follow-up visits. One patient, who was already suffering from gastritis, had to interrupt the therapy early due to abdominal pain. General safety was excellent.
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PMID:[Fluconazole in the treatment of dermatomycoses. Clinical experience]. 236 98

In patients with acute leukaemia, Candida infection may affect exclusively the liver and the spleen. Two such cases were revealed by persistent fever despite correction of bone marrow aplasia, abdominal pain, anicteric cholestasis and hypodense areas at computerized tomography suggesting hepatosplenic abscesses. Surgical liver biopsy confirmed the fungal infection and showed images of granuloma, mycelial filaments and yeasts; cultures were usually negative. The severity of these infections requires an early treatment, but amphotericin B is not very effective. Our two patients were cured after treatment with fluoconazole completed, in one of them by splenectomy.
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PMID:[Hepato-splenic candidiasis in patients treated for leukemia]. 253 56

Four immune-compromised children who were receiving antineoplastic chemotherapy (three for leukemia), presented with recurrent episodes of fever and left upper abdominal pain. Blood cultures grew enteric gram-negative organisms in three children. Multiple blood cultures were negative for fungus although three patients had mucocutaneous and urinary candidiasis. All remained febrile and symptomatic despite treatment with broad spectrum antibiotics and antifungal chemotherapy. Computed tomography (CT) scans in all patients showed 2- to 10-mm focal defects in the spleen. The larger defects could be seen by ultrasonography but not on the live-spleen nuclear scan. A splenectomy was performed 2 to 4 weeks after the onset of symptoms in each child, and the cut surface of the spleens showed multiple small abscesses. All operative cultures were negative. A histological examination confirmed Candida infection in two patients and Aspergillus in one. Necrotizing granulomas strongly suggestive of fungus were seen in the fourth child. The patients defervesced and appeared well within three days. Antifungal therapy was continued. One child remains in remission from acute lymphocytic leukemia; one continues on chemotherapy; and one has recurrent widespread tumor. The patient with Aspergillus died following a bone marrow transplantation 6 months after the splenectomy. He had disseminated aspergillosis. An immune-compromised patient with persistent unexplained fever should have a CT scan of the abdomen. The presence of multiple splenic lesions strongly suggests fungal disease. If antifungal therapy does not result in complete resolution of fever and the splenic lesions, a splenectomy is indicated.
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PMID:Splenic microabscesses in the immune-compromised patient. 275 88

The effect of various contraceptive methods on Chlamydia trachomatis (CT) infection was examined in a group of 158 women, with a mean age of 26.9 years, patients of a family planning clinic. Their symptoms were mild abdominal pain or vaginal discharge. Antibodies to CT were examined by an indirect immunoperoxidase assay, with a commercial kit. From each patient a vaginal smear was collected for bacteriologic and mycologic study. In group I, consisting of 30 married women with a mean age of 31 years, 5 (16.7%) IUD users had a positive test for CT antibodies. In group II, comprising 57 women, with a mean age of 23.3 years, 22 (38.6%) oral contraceptive (OC) users, of whom 94.7% were unmarried, had positive tests for CT antibodies. The difference between these two groups was statistically significant (p less than 0.05). In group III, comprising 71 women with a mean age of 28.1 years, 62% unmarried and using other contraceptive methods, 15 (21.1%) had a positive test for CT antibodies. The incidence of CT infection was not different in the 3 groups under study, when the factors of age and marital status were taken into consideration (p greater than 0.30). Bacterial vaginal infection was found in 43.3% of the IUD users, compared with only 14% of the OC users (p less than 0.01). In contrast, in the OC users, candidiasis was predominant, the difference from the other groups being statistically significant (p less than 0.001). The women with positive antibodies also more frequently had colonies of bacterial and mycological vaginal infection.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The link between contraceptive methods and Chlamydia trachomatis infection. 323 83

Focal hepatosplenic candidiasis has been recognized with increasing frequency in recent years. We reviewed the cases of eight patients seen between 1982 and 1985, and information on 60 patients whose cases have been reported in the world literature. The characteristics of focal hepatosplenic candidiasis include persistent fever in a neutropenic patient whose leukocyte count is returning to normal, often coupled with abdominal pain; an elevated alkaline phosphatase level; and less commonly, rebound leukocytosis. The characteristic "bull's eye" lesions seen with hepatic ultrasound examination or computed tomography generally are not detectable until neutrophil recovery has occurred. Diagnosis can be established only by biopsy evidence of yeasts or pseudohyphae in the granulomatous lesions. Cultures are frequently negative, however, especially in patients who have been pretreated with antifungal agents. We review the evolving nature of hepatosplenic candidiasis, focusing on diagnosis and treatment.
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PMID:Hepatic candidiasis in cancer patients: the evolving picture of the syndrome. 327 68


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