title: Pseudallescheria boydii brain abscess: association with near-drowning and efficacy of high-dose, prolonged miconazole therapy in patients with multiple abscesses.
abstract: Brain abscess caused by Pseudallescheria boydii is a highly lethal infection, usually seen in immunosuppressed patients. Five patients with P. boydii brain abscesses are described. Four of these patients acquired their infection after near-drowning; 1 patient developed an abscess after penetrating head trauma. Two patients survived their infections, which included involvement of other body sites (lung, eye, bone) as well as multiple undrained brain abscesses, after prolonged courses of high-dose parenteral miconazole (80-90 mg/kg/d). Progressive increases in miconazole dosage during the treatment periods were required to produce serum levels above the minimum inhibitory concentrations of the fungal isolates.
authors.affiliation: Department of Medical Microbiology, Creighton University School of Medicine, Omaha, Nebraska 68178.
authors.forename: D L
authors.initials: DL
authors.lastname: Dworzack
authors.forename: R B
authors.initials: RB
authors.lastname: Clark
authors.forename: W J
authors.initials: WJ
authors.lastname: Borkowski
authors.forename: D L
authors.initials: DL
authors.lastname: Smith
authors.forename: M
authors.initials: M
authors.lastname: Dykstra
authors.forename: M P
authors.initials: MP
authors.lastname: Pugsley
authors.forename: E A
authors.initials: EA
authors.lastname: Horowitz
authors.forename: T L
authors.initials: TL
authors.lastname: Connolly
authors.forename: D L
authors.initials: DL
authors.lastname: McKinney
authors.forename: M K
authors.initials: MK
authors.lastname: Hostetler
mesh_terms: D000328:Adult; D001922:Brain Abscess / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D002675:Child, Preschool; D004332:Drowning; D005260:Female; D006801:Humans; D008297:Male; D008825:Miconazole / Q000627:therapeutic use*; D008875:Middle Aged; D008271:Mycetoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000209:etiology*; D009915:Orbit / Q000293:injuries; D012151:Resuscitation; D014057:Tomography, X-Ray Computed; D014950:Wounds, Penetrating / Q000150:complications
chemical_list: D008825:Miconazole