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Use of amphotericin B during pregnancy: case report and review
J L Dean1, J E Wolf, A C Ranzini
1Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Abstract:
Unlike the situation with many antimicrobial agents, there is limited experience with the use of amphotericin B during pregnancy. Although reports of fungal infections during pregnancy have been published, few describe fungemia with either Candida or Torulopsis species. We present a case of fungemia due to Torulopsis glabrata that occurred during pregnancy and that was treated with amphotericin B. Drug concentrations were measured in placental tissue, cord serum, and infant serum at delivery. Although the last dose of amphotericin B was administered 4 weeks before delivery, the concentrations in all three specimens were still within the MIC ranges for most strains of Candida albicans and T. glabrata as measured by broth dilution. We speculate that persistent tissue concentrations of amphotericin B most likely contributed to the sustained hypokalemia in the mother and the increased creatinine level in the infant. In the latter case, placental tissue may have served as the reservoir from which amphotericin B was slowly released into fetal circulation.
Insights
Limited data exists for amphotericin B in pregnancy. This case study found persistent drug levels in placental tissue and cord serum weeks after treatment, potentially impacting mother and infant health.
Area of Science:
- Medical Mycology
- Pharmacology
- Maternal-Fetal Medicine
Background:
- Limited clinical experience exists regarding amphotericin B use during pregnancy.
- Fungal infections, particularly fungemia, are infrequently reported in pregnant individuals.
Observation:
- A case of fungemia caused by Torulopsis glabrata during pregnancy is presented.
- Amphotericin B was administered for treatment, with drug concentrations subsequently measured in maternal placental tissue, cord serum, and infant serum.
Findings:
- Detectable concentrations of amphotericin B remained in placental tissue, cord serum, and infant serum four weeks after the last maternal dose.
- These concentrations were within the minimum inhibitory concentration (MIC) range for common fungal pathogens like Candida albicans and Torulopsis glabrata.
Implications:
- Persistent amphotericin B tissue concentrations may contribute to maternal hypokalemia and infant elevated creatinine levels.
- The placenta may act as a reservoir for amphotericin B, facilitating slow release into fetal circulation post-treatment.