• 한국임상약학회지
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• 제22권4호
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• pp.340-346
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• 2012

Background: Amphotericin B is a mainstay in the treatment of many systemic fungal infections due to its wide antifungal spectrum and low incidence of resistance. However, the use of amphotericin B is limited by its nephrotoxicity. Objectives: The objective of this study was to evaluate the incidence and risk factors of renal adverse drug reactions (ADRs) of conventional amphotericin B (Fungizone$^{(R)}$). In addition, we compared the changes of serum creatinine (SCr) between patients who remained conventional amphotericin B and patients who were switched to liposomal amphotericin B after occurrence of renal adverse reactions. Methods: Adult hospitalized patients who reported renal adverse reactions caused by conventional amphotericin B from January 2011 to July 2012 at pharmacovigilance center in Yonsei University Healthcare System included in this study. ADRs scored as 'doubtful' in Naranjo probability ADR scale were excluded. We retrospectively analyzed patients' basic clinical characteristics, concurrent diseases or nephrotoxic drugs in order to find variables that can correlate with occurrence of renal ADRs. Changes in SCr were compared between conventional amphotericin B group and liposomal amphotericin B group. Results: A total of 231 ADRs after administration of conventional amphotericin B in 75 patients were reported to pharmacovigilance center and assessed their severities as 'possible', 'probable', or 'definite'. Renal adverse reaction was the most common ADR with incidence rate of 42% (96 of 231 ADRs). Mean change in SCr from baseline was 0.26 mg/dL (change % 37.8) and statistically significant (p=0.000). Simple correlations analysis revealed that the number of concurrent diseases and number of nephrotoxic drugs were positively correlated with changes in SCr, but these results were not statistically significant. Among 43 patients who remained amphotericin B after occurrence of renal ADRs, 27 patients was administered conventional amphotericin B and 16 patients changed to liposomal amphotericin B. Mean change in SCr in amphotericin B group was 0.23 mg/dL (32.75%), whereas mean change in SCr in liposomal amphotericin B group were -0.28 mg/dL (19.38%) and difference between two groups was statistically significant (p=0.003). The numbers of patient with SCr elevation more than 30% were 9 (33.3%) in amphotericin B group and 2 (12.5%) in liposomal amphotericin B group (Odd Ratio=3.50, 95% Confidence Interval 0.65-18.85; p=0.130). Conclusion: An analysis of ADRs due to amphotericin B administration revealed significant mean changes in SCr from baseline. Switching to liposomal amphotericin B showed significant decrease in SCr compared with conventional amphotericin B.

• Clinical and Experimental Pediatrics
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• 제53권2호
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• pp.239-243
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• 2010

저자들은 고식적인 항진균제에 반응하지 않는 극소 저체중 출생아에서 발생한 지속적인 전신 칸디다증에서 이들 고식적인 항진균제에 고용량의 caspofungin을 병용 투여하여 국내에서 처음으로 특별한 약물 부작용 없이 치유한 1례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.

• Parasites, Hosts and Diseases
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• 제57권3호
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• pp.291-294
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• 2019

Primary amebic encephalitis (PAM) is a devastating central nervous system infection caused by Naegleria fowleri, a free-living amoeba, which can survive in soil and warm fresh water. Here, a 43-year-old healthy male was exposed to warm freshwater 5 days before the symptom onset. He rapidly developed severe cerebral edema before the diagnosis of PAM and was treated with intravenous conventional amphotericin B while died of terminal cerebral hernia finally. Comparing the patients with PAM who has similar clinical symptoms to those with other common types of meningoencephalitis, this infection is probably curable if treated early and aggressively. PAM should be considered in the differential diagnosis of purulent meningoencephalitis, especially in patients with recent freshwater-related activities during the hot season.

• Asian Pacific Journal of Cancer Prevention
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• 제15권24호
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• pp.10933-10935
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• 2015

Background: Many scientists have reported Candida species to be of great concern because of the high frequency that they colonize and infect human hosts, particularly cancer patients. Moreover, in the last decades Candida species have developed resistance to many antifungal agents. Based on this, we aimed to identify and determine the prevalence of Candida spp from blood culture bottles among cancer patients and their antifungal resistance pattern. Materials and Methods: From the blood culture bottles isolation and identification of the Candida spp were performed by conventional microbiological techniques. The in vitro antibiotic resistance pattern of the isolates was determined by CLSI guidelines. Genomic DNA was isolated and amplified. Each gene was separated by agar gel electrophoresis. Results: Identification of Candida spp was based on the presence of yeast cells in direct examination, culture and DNA extraction. Of the 68 blood samples collected during the study period (April 2013 to October 2013), five (7.35%) were positive for the presence of Candida spp, 2 (40%) of which were identified as Candida albicans and 3 (60%) were Candida non-albicans. Conclusions: High resistance to amphotricin B was observed among all the Candida non-albicans isolates. Regular investigations into antifungal resistance will help us to get an updated knowledge about their antibiotic resistance pattern which may help the physician in selecting the antibiotics for empirical therapy.

• Tuberculosis and Respiratory Diseases
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• 제44권5호
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• pp.1083-1093
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• 1997

연구배경 : 폐효모균증은 중추 신경계 효모균증에 비해 비교적 나타나나 근래에 폐질환에 대한 진단의 기저 질환의 증가등으로 인해 발생 빈도가 점차 증가하고 있다. 또 이 질환의 아급성으로 나타나는 비 특이적인 증상들로 인해 국내에 많은 폐질환과 오인하여 치료하기가 쉽다. 이에 저자들은 국내에 폐효모균증과 본원에서 경험한 예를 대상으로 국내에서의 폐효모균증의 임상 양상을 알아보고자 한다. 방 법 : 1985년부터 1996년까지 한양대학교 의과대화 부속병원에서 경험한 5예와 1984년부터 1996년까지 국내 문헌에 발표된 9예의 폐효모균증 환자를 대상으로 후향적으로 의무 기록과 보고 문헌을 조사하였다. 결 과 : 50대 이상의 고령에서 주로 발생하며 남녀비는 3.6 : 1로 남자에서 호발하였다. 변역 상태를 저하시키는 기자 질환이 6예에서 있었으나 나머지 8예는 기저 질환이 없어 정상인에게서도 폐효모균증이 발생할 수 있음을 보여주고 있다. 임상증상은 증상이 없거나 비 특이적인 호흡기 증상들이 아급성으로 나타나고 있었으며 이로 인해 정확한 진단이 이루어지기 전에 폐결핵으로 오인 치료된 예가 많았다. 흉부 방사선 검사상 고립성 폐경화와 광범한 폐침윤이 흔한 소견이었으며 비교적 드물다는 늑막 삼출, 폐문부 림프절 비대, 공동 형성등도 관찰 되었다. 특별한 호발부위는 없었다. 진단 방법으로는 주로 폐생검을 통한 조직학적 방법이 이용되었고 그 중 경피적 세침 흡인 생검술이 가장 많이 사용되었다. cryptococcus neoformans에 대한 객담 도말 검사, 배양검사와 혈청에서 검사한 latex agglutination test논 낮은 양성률을 보여주었다. 치료는 여러 항 진균제 (fluconazole, amphotericin B, flucytosine, ketonazole), 수술 또는 이들을 병합한 방법등으로 다양하게 사용되었다. 1990년 이후에는 경구 투여가 가능한 flucon-azole 또는 ketoconazole 등을 이용한 치료가 증가하고 있는 양상이다. 치료후 대개 4개월이내에 흉부 방사선상 병변의 흔적만 남든지 거의 소설되는 양상을 보였다. 재발한 예는 없었다. 결 론 : 폐효모균증은 국내 폐렴의 드문 원인이나 1985년이 후 꾸준히 보고되고 있다. 호발 연령은 50대 이후이나 젊고 기저 질환이 없는 예에서도 발생하여 정상인에서도 이 질환의 가능성에 대해 고려해야 하며 아급성의 비 특이적인 증상을 호소하며 일반 항생제에 잘 반응하지 않아 폐결핵과의 감별진단이 중요하다. 객담 및 혈청 검사로는 진단률이 낮아 폐조직 생검 등의 조직학적 확진이 필요하며 아직 치료 방법이 확립되어 있지 않지만 근래 간편하게 경구로 복용할 수 있고 효과적인 약제가 선호되고 있다.