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Cunninghamella bertholletiae Infection in a Bone Marrow Transplant Patient: Amphotericin Lung Penetration, MIC Determinations, and Review of the Literature
Author(s) -
Garey Kevin W.,
Pendland Susan L.,
Huynh T.,
Bunch Tarqinus H.,
Jensen Gerard M.,
Pursell Kenneth J.
Publication year - 2001
Publication title -
pharmacotherapy: the journal of human pharmacology and drug therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.227
H-Index - 109
eISSN - 1875-9114
pISSN - 0277-0008
DOI - 10.1592/phco.21.9.855.34560
Subject(s) - amphotericin b , lung , minimum inhibitory concentration , microbiology and biotechnology , biology , medicine , antibiotics , antifungal
Infections caused by Cunninghamella bertholletiae , an opportunistic fungal organism, have an extremely high mortality rate. A fatal case of C. bertholletiae fungal pneumonia occurred in a man who had received an allogeneic bone marrow transplant. Aggressive debridement and high‐dose liposomal amphotericin B failed to eradicate the infection. Right lung tissue samples obtained during lobectomy were assayed for amphotericin B concentrations by high‐performance liquid chromatography, and minimum inhibitory concentration (MIC) determinations of amphotericin B against C. bertholletiae were determined by the macrobroth dilution method. The MIC for the isolate of C. bertholletiae was 4 μg/ml. Amphotericin B lung concentrations averaged 9.5 μg/ml (range 3.7–13.8 μg/ml), with a corresponding serum trough concentration of 0.9 μg/ml. To our knowledge, this is the first reported case of amphotericin B concentrations measured at the site of infection in a patient with a pulmonary Cunninghamella infection, together with a corresponding MIC of the organism. The patient's death, which occurred despite aggressive debridement and high amphotericin B lung concentrations, highlights the need for novel strategies to treat infections caused by invasive molds such as C. bertholletiae .