Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0019158 (hepatitis)
 30,205 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In an open study 58 patients with chronic dermatophytosis mainly caused by Trichophyton rubrum and five patients with Tinea capitis were treated with ketoconazole. The indications were ineffectiveness of or side effects to griseofulvin. Response to treatment varied from 1 week in scalp infections to 11 weeks in toe-nail lesions. Dermatophytosis of hands and feet were cured in 25%, marked improvement observed in further 30%. Toe- and finger-nail infections were cured in 20% and 43%, respectively, and marked improvement seen in further 36% and 14%, respectively. All scalp infections were cured without relapse. Recurrence of infections before 6 months after treatment was seen in 55-60% of hand and foot lesions and 33-38% of finger and toe-nail infections. In a double-blind study 20 patients with onychomycosis caused by T. rubrum the efficacy of ketoconazole was compared to that of griseofulvin. Cure rates in the griseofulvin group were 25% for finger-nails and zero for toe-nails, while 50% and 57% experienced marked improvement. In the ketoconazole group, 25% of finger-nail infections were cured and 75% markedly improved, while the corresponding figures for toe-nails were 11% and 89%, respectively. Adverse reactions to ketoconazole were seen in 29 (46%) of the patients in the open study and in 2 (20%) in the double-blind study and comprised mainly minor complaints. Side effects caused discontinuation in 12 patients, in two of whom due to toxic hepatitis.
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PMID:Oral ketoconazole as an alternative to griseofulvin in recalcitrant dermatophyte infections and onychomycosis. 240 17

We have treated 48 cases of onychomycosis (of which 37 were caused by dermatophytes, 10 by yeasts and one by Scopulariopsis brevicaulis) with 200 mg ketoconazole daily. We obtained recovery in 65 p. 100 of the cases of onyxis caused by dermatophytes and in 80 p. 100 of the cases of onychomycosis due to Candida. The one patient presenting an infection with Scopulariopsis brevicaulis recovered in 13 months. The average duration necessary to obtain complete recovery was 6 1/2 months for onychomycosis of the hands due to dermatophytes and 12 1/2 months for those of the feet. Perionyxis due to Candida needed 2 months of treatment with this drug, however 6 months of treatment were necessary to obtain recovery for onycholysis due to Candida. Biological tests remained normal and the side-effects were minimal and essentially gastrointestinal in our study. Ketoconazole is an effective treatment for onychomycosis: it is active against the different mycotic agents infecting nails and well tolerated by the patient. Several minor effects such as itching, nausea, headache and more serious reactions such as erythrodermia and hepatitis have been reported. Regular control and biological tests are therefore necessary. Patients with other diseases should avoid the use of ketoconazole for treatment of onychomycosis.
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PMID:[Ketoconazole and onychomycosis]. 608 41

Ketoconazole, a new broad-spectrum oral antifungal agent, has proved most useful in the treatment of superficial and systemic fungal infections. Chronic conditions like mucocutaneous candidiasis can be treated with but few side effects. An increasing number of cases have, however, been noted of severe toxic hepatitis, following ketoconazole treatment. A new case (a 61-yr-old woman treated for onychomycosis) is reported here.
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PMID:Toxic hepatitis following ketoconazole treatment. 632 Mar 58

To evaluate the incidence, severity, and course of ketoconazole-associated hepatic injury, 211 patients with onychomycosis were randomized by a ratio of 2:1 to receive either ketoconazole (137 patients) or griseofulvin (74 patients). All of them were seronegative for hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) and had no biochemical abnormality before therapy. The two groups were comparable in age, sex, and pretherapy liver biochemical tests. Liver biochemical tests were followed up biweekly for 3 months, and then at monthly intervals during the remaining course of therapy. No biochemical abnormality or hepatic injury was found in patients during griseofulvin treatment. Of the patients treated with ketoconazole, 24 (17.5%; 95% confidence interval [CI], 11.1% to 23.9%) showed asymptomatic transaminase elevation. Ketoconazole was discontinued immediately after overt hepatitis developed in another 4 patients (2.9%; 95% CI, 0.1% to 5.7%) who did not succumb to hepatic decompensation. The abnormal biochemical changes in patients with overt hepatitis returned to normal after discontinuing ketoconazole. Elderly patients were more prone to develop overt hepatitis. In patients with asymptomatic liver injury, the abnormal biochemical changes gradually returned to normal despite continuing ketoconazole therapy. The results of this cohort study suggest that ketoconazole-induced overt hepatitis is more common than previously believed and that transient subclinical injury is much more common than overt hepatitis. Therapy with ketoconazole may be continued with caution in the absence of symptoms and/or hyperbilirubinemia, but should be discontinued if overt hepatitis occurs.
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PMID:Hepatic injury during ketoconazole therapy in patients with onychomycosis: a controlled cohort study. 930 18

We describe a previously healthy woman who developed liver cirrhosis as a sequela of acute hepatic injury that was induced by ketoconazole administration to treat onychomycosis. The initial presentation of the disease was of a typical acute hepatitis, characterized by nausea, anorexia, fatigue, and jaundice that developed during the administration of ketoconazole. Many other causes of hepatitis were absent in the patient. Even though the hepatic injury was gradually resolved for several months after cessation of the drug, the liver function was not completely restored. Six months after the onset of illness, a follow-up abdominal computed tomography and peritoneoscopic liver biopsy were performed. They revealed a marked reduction in the liver volume and a definite cirrhotic change, which persisted for more than 5 years. The case suggests that the administration of ketoconazole can cause liver cirrhosis through acute hepatic injury within a short time under certain circumstances.
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PMID:Liver cirrhosis developed after ketoconazole-induced acute hepatic injury. 1467 75

Because of impaired host defenses and a favorable environment at specific anatomic sites, there is an increased prevalence of seborrheic dermatitis, mucosal and cutaneous candidiasis, tinea pedis, and onychomycosis in the geriatric population compared with other age groups. Both KOH and fungal culture are timely, convenient, and cost-effective methods of diagnosis. Sensitivity of these tests depends on proper technique for specimen collection and experience. KOH 20% with DMSO and DTM are highly recommended. Treatment should be tailored to the diagnosis and the individual patient. This includes the targeted spectrum of coverage (dermatophyte or yeast); topical versus systemic therapy; review of the patient's medication list for potential drug interactions; and likelihood of compliance. Checking baseline laboratories and routine monitoring of complete blood count and liver function tests in healthy patients, without a history of liver disease or active hepatitis, and without potential drug interactions, seems unwarranted for rare adverse events. Successful management requires adequate patient education, correction of underlying predisposing factors, and prophylactic measures against recurrence.
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PMID:Cutaneous fungal infections in the elderly. 1501 8

We report a 53-year old Mexican female who developed liver dysfunction following a seven-day course of treatment with terbinafine for onychomycosis. She presented with jaundice and abdominal pain. Her serum bilirubin levels showed a peak value of 23.2 mg/dL seven weeks after discontinuing the medication. Infectious causes (hepatitis viruses A, B and C) were excluded. Imaging studies of the abdomen did not reveal any abnormalities. Serum iron and ceruloplasmin levels were normal. Autoantibodies were negative. A liver biopsy revealed necrosis and mononuclear infiltration of the parenchyma, mainly along the sinusoids and surrounding the portal spaces and biliary ducts. Eosinophil infiltration of the portal spaces was also noted. Treatment with ursodeoxycholic acid and ademethionine was started. Her liver tests normalized in the sixth months after stopping terbinafine.
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PMID:Terbinafine hepatotoxicity. A case report and review of literature. 1509 7

Trichophytic onychomycosis of the feet represents an important and serious medical problem. Until recent years, there was not cure for this unpleasant pathology. It is only at the beginning of the 50s, especially at the onset of the antimycotic systemic therapy that a cure is available offering high rate of clinical and mycological therapy. The purpose of this report is to better inform on the undesirable side-effects of antimycotic agents which are currently so largely disseminated. The case of a young patient is presented who was enjoying good health and who after 6 weeks of starting therapy with terbinafine on a doses of 1 pill of 250 mg a day, to treat a trichophytic onychomycosis in both feet, developed severe symptoms of toxic colostatic hepatitis duly corroborated after pertinent testing. Patient had a full recovery after a few months of having interrupted her therapy, apparently without any sequel. The literature in this regard has been revised and a close monitoring of the hepatic function is recommended prior and during treatment with this drug. The need to continue research to find an ideal antimycotic still not found is also recommended.
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PMID:[Colestasic toxic hepatitis caused by terbinafine: case report]. 1561 6