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• W2119319504 abstract "Sir, Little is known about liposomal amphotericin B penetration into cerebrospinal fluid (CSF). We describe a case of Candida albicans shunt infection and report pharmacokinetic information about liposomal amphotericin B. A 79-year-old man with haemorrhagic intraventricular stroke required an external ventricular shunt. Three days after the surgical procedure, the patient developed fever (38°C), lethargy and neck stiffness. Analysis of ventricular CSF revealed 105 white cells/mm 3 (90% of the white cells were neutrophils), a glucose level of 23 mg/dL (glucose level in the blood: 106 mg/dL) and protein of 119 mg/dL. Microscopic examination of the Gram staining showed yeast and no other microorganisms. Cultures were positive for C. albicans in three separate samples. The blood culture was sterile. The patient had been treated with fluconazole 400 mg intravenously (iv) daily, oxacillin 12 g iv daily, rifampicin 600 mg iv daily, but meningitis persisted. Twenty days after the stroke, the patient was admitted to our Infectious Diseases unit. The external shunt was removed and replaced immediately, and therapy with AmBisome (3 mg/kg/day) and flucytosine (150 mg/kg/day) was started. In addition, on days 7–9 of the new treatment, intraventricular amphotericin B deoxycholate was injected into the shunt at a dose of 4 mg daily (the shunt was closed for 4 h). Despite this therapy, the patient had a torpid clinical course; his fluids and clinical condition improved but without complete resolution. CSF culture was positive until the 7th day of therapy and after this was negative. Following 23 days of this drug regimen, serial CSF and serum samples were taken to check amphotericin B levels. Some samples were also taken during intraventricular infusion. All samples were stored at –80°C until assay. After 30 days, the patient died as a result of a second haemorrhagic stroke. Amphotericin B concentrations in the patient’s CSF and serum samples were analysed by HPLC," @default.
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• W2119319504 date "2003-11-12" @default.
• W2119319504 modified "2023-09-27" @default.
• W2119319504 title "AmBisome administration for Candida albicans shunt infections" @default.
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• W2119319504 doi "https://doi.org/10.1093/jac/dkg475" @default.
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