Presentation
The presented case shows one of the multiple issues concerning migration between neighboring countries. [ncbi.nlm.nih.gov]
Entire Body System
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Congestive Heart Failure
Evidence supporting the association between itraconazole and the onset of congestive heart failure (CHF) is limited and is based on cases reported after drug market release. [ncbi.nlm.nih.gov]
At least three of our seven subjects developed either congestive heart failure or hypertension while receiving 400 mg itraconazole, daily. [erj.ersjournals.com]
Congestive Heart Failure, Cardiac Effects and Drug Interactions: Itraconazole should not be administered for the treatment of onychomycosis in patients with evidence of ventricular dysfunction such as congestive heart failure (CHF) or a history of CHF [rxwiki.com]
Itraconazole has been associated with reports of congestive heart failure. [drugs.com]
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Fatigue
Common toxicities included fatigue, nausea, anorexia, rash, and a syndrome of hypokalemia, hypertension, and edema. [ncbi.nlm.nih.gov]
Symptoms of heart failure include fatigue, edema (fluid retention), shortness of breath, nausea, abdominal pain, and inability to sleep unless sitting upright. [medicinenet.com]
Monitor for signs and symptoms of hearing loss, pancreatitis, hepatic dysfunction (jaundice, fatigue, nausea, vomiting, dark urine, pale stools), heart failure, muscle disorder, and pulmonary or peripheral edema. • Monitor potassium level. [medical-dictionary.thefreedictionary.com]
Common toxicities included fatigue, nausea, anorexia, rash, and a syndrome of hypokalemia, hypertension, and edema. Conclusion. [doi.org]
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Intravenous Administration
On day 17 of itraconazole treatment, she developed hypotension and hypoxemia shock after intravenous administration of itraconazole 200 mg, which was eventually reversed by steroid treatment. [ncbi.nlm.nih.gov]
The rapid intravenous administration, insufficient dilution and drug vehicle have been associated with the dysrhythmias caused by imidazole antifungals. [jmedicalcasereports.com]
Itraconazole mean total plasma clearance following intravenous administration is 278 mL/min. Itraconazole clearance decreases at higher doses due to saturable hepatic metabolism. Absorption Itraconazole is rapidly absorbed after oral administration. [drugs.com]
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Hypoxemia
To report a rare but severe adverse effect of intravenous itraconazole, anaphylactic shock with hypotension and hypoxemia, in a female patient with acute lymphoblastic leukemia (ALL). [ncbi.nlm.nih.gov]
Respiratoric
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Aspiration
Following intake of the drug products, gastric and duodenal fluids were aspirated and analyzed for itraconazole concentration, total content and solubilizing capacity. [ncbi.nlm.nih.gov]
Gastrointestinal
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Overeating
Switching to itraconazole resulted in worsening of the rash and skin sloughing over 25% of his body. He was given an oral-graded challenge of voriconazole which he tolerated without incident. [ncbi.nlm.nih.gov]
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Nausea
Common toxicities included fatigue, nausea, anorexia, rash, and a syndrome of hypokalemia, hypertension, and edema. [ncbi.nlm.nih.gov]
Nausea / vomiting, diarrhea, headache, stomach upset, or dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. [webmd.com]
10% Systemic fungal infections Nausea (11%) 1-10% (Systemic fungal infections) Rash (9%) Vomiting (5%) Edema (4%) Headache (4%) Abnormal liver function test results (3%) Diarrhea (3%) Fever (3%) Fatigue (3%) Hypertension (3%) Pruritus (3%) Abdominal pain [reference.medscape.com]
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Abdominal Pain
10% Systemic fungal infections Nausea (11%) 1-10% (Systemic fungal infections) Rash (9%) Vomiting (5%) Edema (4%) Headache (4%) Abnormal liver function test results (3%) Diarrhea (3%) Fever (3%) Fatigue (3%) Hypertension (3%) Pruritus (3%) Abdominal pain [reference.medscape.com]
Table 3: Clinical Trials of Systemic Fungal Infections: Adverse Events Occurring with an Incidence of Greater than or Equal to 1% Body System/Adverse Event Incidence (%) (N 602) Gastrointestinal Nausea 11 Vomiting 5 Diarrhea 3 Abdominal Pain 2 Anorexia [rxlist.com]
Tell your doctor right away if you develop symptoms of liver disease, such as: nausea / vomiting that doesn't stop, loss of appetite, stomach / abdominal pain, yellowing eyes / skin, dark urine. [webmd.com]
Skin
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Eczema
Itraconazole is sometimes used for inflammatory skin diseases such as atopic eczema, seborrhoeic dermatitis or psoriasis, if a fungus or yeast is thought to be contributing to the condition. [dermnetnz.org]
[…] and tapeworms); some contraceptive pills (birth control pills), such as dienogest, ulipristal; reboxetine, venlafaxine (used to treat depression and anxiety); cinacalcet, to treat an over active parathyroid; alitretinoin (oral formulation), to treat eczema [news-medical.net]
Neurologic
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Headache
10% Systemic fungal infections Nausea (11%) 1-10% (Systemic fungal infections) Rash (9%) Vomiting (5%) Edema (4%) Headache (4%) Abnormal liver function test results (3%) Diarrhea (3%) Fever (3%) Fatigue (3%) Hypertension (3%) Pruritus (3%) Abdominal pain [reference.medscape.com]
1 Malaise 1 Myalgia 1 Vasculitis 1 Vertigo 1 The following adverse events occurred with an incidence of greater than or equal to 1% (N 112): headache: 10%; rhinitis: 9%; upper respiratory tract infection: 8%; sinusitis, injury: 7%; diarrhea, dyspepsia [rxlist.com]
Nausea / vomiting, diarrhea, headache, stomach upset, or dizziness may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly. [webmd.com]
Workup
Other Pathologies
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Brain Edema
Over the next few days, while our patient was stabilized and his renal function improved he developed anisocoria due to a new ischemic stroke on the opposite side, complicated with brain edema. [jmedicalcasereports.com]
Other ECG Findings
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Ischemic Changes
An electrocardiogram (ECG) showed atrial fibrillation (AF) with rapid ventricular response; his echocardiogram ejection fraction of 60% with no wall hypokinesia and computed tomography (CT) results confirmed ischemic changes in the area of distribution [jmedicalcasereports.com]
Treatment
CONCLUSIONS: For patients with mild or moderate onychomycosis, we recommended a pure medication treatment or combination treatment with medication and laser. [ncbi.nlm.nih.gov]
Prognosis
[…] report highlights the importance of a high degree of clinical suspicion in order to diagnose and treat allergic bronchopulmonary aspergillosis in patients with a long-standing history of severe asthma as early as possible as this has a major impact on prognosis [ncbi.nlm.nih.gov]
Tumor expression and circulating levels of angiogenic factors have been correlated with aggressive tumor growth, predilection for metastasis, and prognosis in a wide array of solid tumors, including lung cancer ( 2–4 ). [doi.org]
Etiology
This is the second report of this fungus as an etiologic agent of eumycetoma in humans. [ncbi.nlm.nih.gov]
Epidemiology
Local epidemiology is vital in guiding prophylaxis strategy. [ncbi.nlm.nih.gov]
European Journal of Epidemiology 9, 455 –6. 5. Powderly, W. G., Robinson, K. & Keath, E. J. ( 1993 ). Molecular epidemiology of recurrent oral candidiasis in human immunodeficiency virus-positive patients: evidence for two patterns of recurrence. [jac.oxfordjournals.org]
Penicillium marneffei infection and recent advances in the epidemiology and molecular biology aspects. Clin Microbiol Rev 2006 ;19: 95 - 110 2. Supparatpinyo K, Khamwan C, Baosoung V, Nelson KE, Sirisanthana T. [nejm.org]
Gastrointestinal basidiobolomycosis in Arizona: clinical and epidemiological characteristics and review of the literature. Clin Infect Dis. 2001; 32:1448-55. 106. Pasha TM, Leighton JA, Smilack JD et al. [drugs.com]
Prevention
All triazole antifungals except itraconazole capsule were effective in preventing IFIs. Posaconazole was more efficacious in reducing IFIs and all-cause deaths than were fluconazole and itraconazole. [ncbi.nlm.nih.gov]
(via conazole antifungal agent ) (via triazole antifungal agent ) antifungal drug Any antifungal agent used to prevent or treat fungal infections in humans or animals. [ebi.ac.uk]
Ketoconazole has been used to prevent relapse, but available information suggests that up to 50 percent of AIDS patients relapse even with ketoconazole treatment. A more effective therapy to prevent recurrence is needed. [clinicaltrials.gov]