Nitin Gupta1,2, Sourabh Srinivas1, Anagha Harikumar1, K Devaraja3, Vishnu Teja Nallapati1, Kavitha Saravu1,2. 1. Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India. 2. Manipal Center for Infectious Diseases, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India. 3. Department of Otorhinolaryngology, Kasturba Medical College and Hospital, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.
Abstract
Introduction: Liposomal amphotericin use is limited in developing countries due to its extremely high cost and availability. Therefore, the study aimed to evaluate deoxycholate amphotericin B's utility and adverse effect profile in patients with mucormycosis. Methodology: This retrospective cohort study from 2019 to 2021 included patients with proven mucormycosis who received deoxycholate amphotericin B for more than or equal to five days and had at least three creatinine values on treatment. Baseline demographic details, risk factors and treatment details of all the patients were recorded. In addition, the details of treatment-related adverse effects and outcomes were ascertained. Results: Of the 57 included patients, a history of diabetes, COVID-19 and steroid use was present in 49 (86%), 43 (75.4%) and 33 (57.9%) patients, respectively. Isolated rhino-orbital mucormycosis was the most common presentation (n=49, 86%). The median time of follow-up was 48 (30.5-90) days. A total of 8 (14%) patients died during the hospital stay. The median duration of amphotericin treatment was 21 (14-40) days. Thirty-nine patients (68.4%) developed hypokalaemia on treatment, while 27 (47.4%) patients developed hypomagnesaemia. A total of 34 (59.6%) patients developed AKI on treatment. The median day of development of AKI was 6 (4-10) days. The median baseline, highest and final creatinine values were 0.78 (0.59-0.94) mg/dl, 1.27 (0.89-2.16) mg/dl and 0.93 (0.74-1.59) mg/ dl respectively. The median percentage change from baseline to highest value and last follow-up value was 45% (0.43%-161%) and 25% (-4.8%-90.1%) respectively. The final creatinine was less than 150% of the baseline in 36 (63.2%) patients. Conclusion: Deoxycholate amphotericin is an acceptable alternative for treating mucormycosis in resource-constrained settings.
Introduction: Liposomal amphotericin use is limited in developing countries due to its extremely high cost and availability. Therefore, the study aimed to evaluate deoxycholate amphotericin B's utility and adverse effect profile in patients with mucormycosis. Methodology: This retrospective cohort study from 2019 to 2021 included patients with proven mucormycosis who received deoxycholate amphotericin B for more than or equal to five days and had at least three creatinine values on treatment. Baseline demographic details, risk factors and treatment details of all the patients were recorded. In addition, the details of treatment-related adverse effects and outcomes were ascertained. Results: Of the 57 included patients, a history of diabetes, COVID-19 and steroid use was present in 49 (86%), 43 (75.4%) and 33 (57.9%) patients, respectively. Isolated rhino-orbital mucormycosis was the most common presentation (n=49, 86%). The median time of follow-up was 48 (30.5-90) days. A total of 8 (14%) patients died during the hospital stay. The median duration of amphotericin treatment was 21 (14-40) days. Thirty-nine patients (68.4%) developed hypokalaemia on treatment, while 27 (47.4%) patients developed hypomagnesaemia. A total of 34 (59.6%) patients developed AKI on treatment. The median day of development of AKI was 6 (4-10) days. The median baseline, highest and final creatinine values were 0.78 (0.59-0.94) mg/dl, 1.27 (0.89-2.16) mg/dl and 0.93 (0.74-1.59) mg/ dl respectively. The median percentage change from baseline to highest value and last follow-up value was 45% (0.43%-161%) and 25% (-4.8%-90.1%) respectively. The final creatinine was less than 150% of the baseline in 36 (63.2%) patients. Conclusion: Deoxycholate amphotericin is an acceptable alternative for treating mucormycosis in resource-constrained settings.
Authors: Oliver A Cornely; Ana Alastruey-Izquierdo; Dorothee Arenz; Sharon C A Chen; Eric Dannaoui; Bruno Hochhegger; Martin Hoenigl; Henrik E Jensen; Katrien Lagrou; Russell E Lewis; Sibylle C Mellinghoff; Mervyn Mer; Zoi D Pana; Danila Seidel; Donald C Sheppard; Roger Wahba; Murat Akova; Alexandre Alanio; Abdullah M S Al-Hatmi; Sevtap Arikan-Akdagli; Hamid Badali; Ronen Ben-Ami; Alexandro Bonifaz; Stéphane Bretagne; Elio Castagnola; Methee Chayakulkeeree; Arnaldo L Colombo; Dora E Corzo-León; Lubos Drgona; Andreas H Groll; Jesus Guinea; Claus-Peter Heussel; Ashraf S Ibrahim; Souha S Kanj; Nikolay Klimko; Michaela Lackner; Frederic Lamoth; Fanny Lanternier; Cornelia Lass-Floerl; Dong-Gun Lee; Thomas Lehrnbecher; Badre E Lmimouni; Mihai Mares; Georg Maschmeyer; Jacques F Meis; Joseph Meletiadis; C Orla Morrissey; Marcio Nucci; Rita Oladele; Livio Pagano; Alessandro Pasqualotto; Atul Patel; Zdenek Racil; Malcolm Richardson; Emmanuel Roilides; Markus Ruhnke; Seyedmojtaba Seyedmousavi; Neeraj Sidharthan; Nina Singh; János Sinko; Anna Skiada; Monica Slavin; Rajeev Soman; Brad Spellberg; William Steinbach; Ban Hock Tan; Andrew J Ullmann; Jörg J Vehreschild; Maria J G T Vehreschild; Thomas J Walsh; P Lewis White; Nathan P Wiederhold; Theoklis Zaoutis; Arunaloke Chakrabarti Journal: Lancet Infect Dis Date: 2019-11-05 Impact factor: 25.071
Authors: J R Wingard; P Kubilis; L Lee; G Yee; M White; L Walshe; R Bowden; E Anaissie; J Hiemenz; J Lister Journal: Clin Infect Dis Date: 1999-12 Impact factor: 9.079
Authors: Martin Hoenigl; Danila Seidel; Agostinho Carvalho; Shivaprakash M Rudramurthy; Amir Arastehfar; Jean-Pierre Gangneux; Nosheen Nasir; Alexandro Bonifaz; Javier Araiza; Nikolai Klimko; Alexandra Serris; Katrien Lagrou; Jacques F Meis; Oliver A Cornely; John R Perfect; P Lewis White; Arunaloke Chakrabarti Journal: Lancet Microbe Date: 2022-01-25