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Query: UMLS:C0019158 (hepatitis)
 30,205 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The oral azole drugs--ketoconazole, fluconazole, and itraconazole--represent a major advance in systemic antifungal therapy. Among the three, fluconazole has the most attractive pharmacologic profile, including the capacity to produce high concentrations of active drug in cerebrospinal fluid and urine. Ketoconazole, the first oral azole to be introduced, is less well tolerated than either fluconazole or itraconazole and is associated with more clinically important toxic effects, including hepatitis and inhibition of steroid hormone synthesis. However, ketoconazole is less expensive than fluconazole and itraconazole--an especially important consideration for patients receiving long-term therapy. All three drugs are effective alternatives to amphotericin B and flucytosine as therapy for selected systemic mycoses. Ketoconazole and itraconazole are effective in patients with the chronic, indolent forms of the endemic mycoses, including blastomycosis, coccidioidomycosis, and histoplasmosis; itraconazole is also effective in patients with sporotrichosis. Fluconazole is useful in the common forms of fungal meningitis--namely, coccidioidal and cryptococcal meningitis. In addition, fluconazole is effective for selected patients with serious candida syndromes such as candidemia, and itraconazole is the most effective of the azoles for the treatment of aspergillosis.
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PMID:Oral azole drugs as systemic antifungal therapy. 819 Jan 49

In a retrospective analysis, 18 instances of invasive fungal infections were observed in 512 (3.5%) renal transplant recipients. These included candidiasis (8), aspergillosis (5), cryptococcosis (3) and zygomycosis (2). All patients with candidiasis had Candida isolated from blood and one or more additional sites. One of them had superadded fungaemia with Torulopsis glabrata. Pulmonary disease in four and subcutaneous infection in one were encountered in the five patients with aspergillosis. Central nervous system involvement in two and cutaneous lesion in one were the findings in patients with cryptococcosis. Zygomycosis involved the lung in one and the allograft itself in the other. Prolonged fever not responding to antibacterial drugs was the most common clinical presentation. Fungal infections occurred during the first 4 months in 10 (55.5%) and 12 to 108 months in eight (44.5%) patients. Infections with cytomegalovirus and hepatitis viruses were concommitantly present in 12 (66.7%) and eight (44.5%) patients respectively. Fourteen episodes of fungal infections (77.8%) occurred in live unrelated kidney recipients who formed only 48% of our total transplant population. Nine patients were treated with systemic and/or local amphotericin B and six with amBisome. Fluconazole was administered alone in three and in combination with amphotericin B in two. Fourteen patients died but mortality was only directly attributable to fungal infection in 11. We conclude that invasive fungal infections continue to be an important cause of morbidity and mortality in renal transplant recipients. A high index of suspicion. prompt diagnosis and early institution of specific antifungal therapy are needed.
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PMID:Invasive fungal infections in renal transplant recipients. 888 96

Invasive fungal infections, especially those caused by Candida albicans, and recurrence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection after transplantation are common complications in orthotopic liver transplant (OLT) recipients. Candida species account for >50% of all invasive fungal infections, which occur in 10%--15% of OLT recipients. The epidemiology and pathogenesis of invasive fungal infections are unique to each type of organism. Fluconazole is effective and safe in the prevention of Candida infection after OLT. Preventive measures against Aspergillus or Cryptococcus remain ill defined. Both HBV and HCV recur almost universally after OLT in infected individuals. The natural course of HBV and HCV, leading to end-stage liver damage, is accelerated. In OLT patients, administration of immunoglobulin with high titers against HBV, alone and/or in combination with lamivudine, immediately after transplantation reduces the recurrence of HBV. The combination of interferon and ribavirin is mildly effective in OLT patients who have evidence of recurrent hepatitis, and additional alternatives are being evaluated.
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PMID:Prevention of fungal and hepatitis virus infections in liver transplantation. 1138 22