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Mehta R, Nagarkar NM, Jindal A, Rao KN, Nidhin SB, Arora RD, Sharma A, Wankhede A, Satpute S, Chakravarty S, Agrawal NK, Pranita, Kannauje P, Behera A, Thangaraju P. Multidisciplinary Management of COVID-Associated Mucormycosis Syndemic in India. Indian J Surg 2021; 84:934-942. [PMID: 34642558 PMCID: PMC8493768 DOI: 10.1007/s12262-021-03134-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/25/2021] [Indexed: 11/30/2022] Open
Abstract
The study aimed to determine clinical presentation, contributing factors, medical and surgical management, and outcome of patients with coronavirus disease 2019 (COVID-19)-associated mucormycosis (CAM). A cross-sectional, single-center study was conducted on patients receiving multidisciplinary treatment for mucormycosis following the second wave of COVID-19 pandemic from April to June 2021 in India. Clinicoepidemiological factors were analyzed, 30-day overall survival and disease-specific survival were determined, and t-test was used to determine the statistical significance. A total of 215 patients were included in the study, the cases were stratified into sino-nasal 95 (44.2%), sino-naso-orbital 32 (14.9%), sino-naso-palatal 55 (25.6%), sino-naso-cerebral 12 (5.6%), sino-naso-orbito-cerebral 16 (7.4%), and sino-naso-orbito-palato-cerebral 5 (2.3%) based on their presentation. A multidisciplinary team treated patients by surgical wound debridement and medical therapy with broad-spectrum antibiotics and amphotericin B. Across all disease stages, cumulative 30-day disease-specific survival is 94% (p < 0.001, intergroup comparison, Breslow (generalized Wilcoxon) CI 95%) and overall 30-day survival is 87.9% (p < 0.001, intergroup comparison, Breslow (generalized Wilcoxon) CI 95%) (censored). Early identification, triaging, and proper multidisciplinary team management with systemic antifungals, surgical debridement, and control of comorbidities lead to desirable outcomes in COVID-associated mucormycosis. The patients with intracranial involvement have a higher chance of mortality compared to the other group.
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Affiliation(s)
- Rupa Mehta
- Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Nitin M Nagarkar
- Director and CEO, All India Institute of Medical Sciences, Raipur, India
| | - Atul Jindal
- DM Pediatric Critical care, All India Institute of Medical Sciences, Raipur, India
| | - Karthik Nagaraja Rao
- MCh Head Neck Surgery and Oncology, Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur, India
| | - S B Nidhin
- Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Ripu Daman Arora
- Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Anil Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, Raipur, India
| | - Archana Wankhede
- Department of Microbiology, All India Institute of Medical Sciences, Raipur, India
| | - Satish Satpute
- Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - Sharmistha Chakravarty
- Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India
| | - N K Agrawal
- Department of Anaesthesiology, All India Institute of Medical Sciences, Raipur, India
| | - Pranita
- Department of General Medicine, All India Institute of Medical Sciences, Raipur, India
| | - Pankaj Kannauje
- Department of General Medicine, All India Institute of Medical Sciences, Raipur, India
| | - Ajoy Behera
- Department of Pulmonology, All India Institute of Medical Sciences, Raipur, India
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Rudramurthy SM, Hoenigl M, Meis JF, Cornely OA, Muthu V, Gangneux JP, Perfect J, Chakrabarti A. ECMM/ISHAM recommendations for clinical management of COVID-19 associated mucormycosis in low- and middle-income countries. Mycoses 2021; 64:1028-1037. [PMID: 34133816 PMCID: PMC8447004 DOI: 10.1111/myc.13335] [Citation(s) in RCA: 110] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/11/2021] [Indexed: 12/11/2022]
Abstract
Reports are increasing on the emergence of COVID-19-associated mucormycosis (CAM) globally, driven particularly by low- and middle-income countries. The recent unprecedented surge of CAM in India has drawn worldwide attention. More than 28,252 mucormycosis cases are counted and India is the first country where mucormycosis has been declared a notifiable disease. However, misconception of management, diagnosing and treating this infection continue to occur. Thus, European Confederation of Medical Mycology (ECMM) and the International Society for Human and Animal Mycology (ISHAM) felt the need to address clinical management of CAM in low- and middle-income countries. This article provides a comprehensive document to help clinicians in managing this infection. Uncontrolled diabetes mellitus and inappropriate (high dose or not indicated) corticosteroid use are the major predisposing factors for this surge. High counts of Mucorales spores in both the indoor and outdoor environments, and the immunosuppressive impact of COVID-19 patients as well as immunotherapy are possible additional factors. Furthermore, a hyperglycaemic state leads to an increased expression of glucose regulated protein (GRP- 78) in endothelial cells that may help the entry of Mucorales into tissues. Rhino-orbital mucormycosis is the most common presentation followed by pulmonary mucormycosis. Recommendations are focused on the early suspicion of the disease and confirmation of diagnosis. Regarding management, glycaemic control, elimination of corticosteroid therapy, extensive surgical debridement and antifungal therapy are the standards for proper care. Due to limited availability of amphotericin B formulations during the present epidemic, alternative antifungal therapies are also discussed.
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Affiliation(s)
- Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Martin Hoenigl
- Division of Infectious Diseases, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of Infectious Diseases and Global Public Health, University of California San Diego, San Diego, California, USA
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Center of Expertise in Mycology, Radboud University Medical Center/Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Oliver A Cornely
- Department of Internal Medicine, Excellence Center for Medical Mycology (ECMM), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Chair Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Faculty of Medicine, University of Cologne, Cologne, Germany
- German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jean Pierre Gangneux
- CHU Rennes, Inserm, EHESP, Irset (Institut de recherché en santé, environnement et travail) - UMR_S 1085, Université de Rennes, Rennes, France
| | - John Perfect
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Silva JT, Ruiz-Camps I, Aguado JM. [Invasive fungal infection over the last 30 years]. Rev Iberoam Micol 2021; 38:47-51. [PMID: 34294520 DOI: 10.1016/j.riam.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/03/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022] Open
Abstract
Clinical mycology is in continuous development. The appearance of new clinical guidelines has made it possible to improve the approach to opportunistic fungal infections, especially in immunosuppressed patients (oncohematological and/or transplant recipients). At the same time, the development of new diagnostic tools and new antifungals with a greater spectrum of action and fewer side effects have led to faster diagnoses and treatments that are more effective. Along with these advances, there has been a change in the epidemiology of invasive fungal infection (IFI), with the appearance of new patients (e.g., COPD, liver cirrhosis, post-influenza) and new microorganisms (Candida auris, Lomentospora prolificans, mucorales), and resistant fungi (isolates of Aspergillus resistant to azoles) which the clinician must take into account when choosing the treatment of a patient with an IFI. In this paper we will briefly review the advances in recent decades and the emerging problems.
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Affiliation(s)
- José Tiago Silva
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre. Instituto de Investigación Hospital 12 de Octubre (i+12). Universidad Complutense de Madrid
| | - Isabel Ruiz-Camps
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d'Hebron, Barcelona
| | - José María Aguado
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre. Instituto de Investigación Hospital 12 de Octubre (i+12). Universidad Complutense de Madrid.
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Rothe K, Braitsch K, Okrojek R, Heim M, Rasch S, Verbeek M, Schmid RM, Busch DH, Lahmer T. Clinical and microbiological features and outcomes of mucormycosis in critically ill patients. Int J Infect Dis 2021; 109:142-147. [PMID: 34229089 DOI: 10.1016/j.ijid.2021.06.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 06/18/2021] [Accepted: 06/30/2021] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Mucormycosis is a rare invasive fungal infection with high mortality in patients with severe underlying predisposing factors causing immunosuppression. The exact incidence of mucormycosis and the optimal therapeutic approach is difficult to determine, especially in severe cases, due to the rarity of the disease. The new second-generation triazole isavuconazole provides an alternative treatment option which may represent a potential benefit in severe cases. MATERIALS AND METHODS A retrospective case series was conducted of patients with a positive laboratory culture for Mucorales and consistent clinical findings who required intensive care treatment. Patient characteristics including demographics, comorbidities, microbiological analysis, specific antifungal therapy and clinical outcome were analysed. RESULTS Fifteen critically ill patients with Mucorales detected between 2016 and 2019 were included in this study; the crude mortality rate was 100%. At the time of diagnosis of mucormycosis, 80% of subjects had relevant medical immunosuppression and 53.3% of subjects had neutropenia. Manifestation of mucormycosis was pulmonary in 53.3% of subjects, rhino-orbital in 20% of subjects and disseminated in 26.7% of subjects. Notably, 40% of all patients had received antifungal prophylaxis prior to mucormycosis, mainly with posaconazole due to underlying haematological malignancy, thus possibly representing break-through infections. Antifungal therapy for invasive mucormycosis was administered in 80% of subjects for a median duration of 16 days. CONCLUSION In this retrospective cohort analysis of intensive care patients, the prognosis of mucormycosis was extremely poor. An aggressive strategy for diagnosis and treatment is essential for intensive care patients with mucormycosis. There is a need for further research to determine if combination therapy in higher dosages or prompt surgery is beneficial in severe critically ill patients.
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Affiliation(s)
- Kathrin Rothe
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Munich, Germany
| | - Krischan Braitsch
- Department of Internal Medicine III, Technical University of Munich, School of Medicine, Munich, Germany
| | - Rainer Okrojek
- Department of Internal Medicine I, Technical University of Munich, School of Medicine, Munich, Germany
| | - Markus Heim
- Department of Anaesthesiology and Intensive Care Medicine, Technical University of Munich, School of Medicine, Munich, Germany
| | - Sebastian Rasch
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich, Germany
| | - Mareike Verbeek
- Department of Internal Medicine III, Technical University of Munich, School of Medicine, Munich, Germany
| | - Roland M Schmid
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich, Germany
| | - Dirk H Busch
- Institute for Medical Microbiology, Immunology and Hygiene, Technical University of Munich, School of Medicine, Munich, Germany; German Centre for Infection Research, Partner Site Munich, Munich, Germany
| | - Tobias Lahmer
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, Munich, Germany.
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Sung AH, Martin S, Phan B, Benigno M, Stephens J, Chambers R, Aram JA. Patient Characteristics and Risk Factors in Invasive Mold Infections: Comparison from a Systematic Review and Database Analysis. CLINICOECONOMICS AND OUTCOMES RESEARCH 2021; 13:593-602. [PMID: 34211287 PMCID: PMC8241810 DOI: 10.2147/ceor.s308744] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 05/28/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Diagnosis and treatment of invasive mold infections (IMI) can be challenging and IMI is a significant source of morbidity and mortality. Invasive aspergillosis (IA) and invasive mucormycosis (IM) are two of the most common mold infections. A better understanding of patient comorbidities and risk factors that predispose IMI may help clinicians to refine the difficult diagnostic and treatment process. Methods A systematic literature review (SLR) was conducted (January 2008–October 2019) for studies reporting comorbidities/risk factors of patients with IA or IM (Phase I), followed by an analysis on the Optum® US EHR database of prominent risk factor cohorts based on SLR findings and expert opinion (Phase II). From the four identified patient cohorts: 1) patients undergoing solid organ transplant (SOT) and patients with 2) hematologic cancers, 3) diabetes, or 4) lung disease, rates of IA, IM, or concurrent IA and IM; patient comorbidities; and Charlson Comorbidity Index (CCI) scores were reported. Results The SLR included 88 studies, and 46 were used to select comorbidities/risk factors cohorts in IA and IM patients. The most important comorbidities/risk factors in IA and IM patients were diabetes, lung disease, hematological malignances, and SOT. In the Optum database (N=101,340,454 patients), IA rates were highest in lung transplant (10.81%) patients and IM rates were highest in intestine transplant (0.83%) patients, lung transplant (0.43%), and hematopoietic stem cell transplant (0.49%). CCI scores were elevated in all mold infection groups compared to the total Optum cohort. Conclusion The current study describes patient comorbidity and risk factors associated with IA and IM. These data can be used to refine clinical decision-making regarding when to suspect mold infections. Future research should focus on identifying whether patients respond differently to various antifungal treatments to determine if strategic recommendations should be made for certain patient groups.
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Martín Gómez MT, Salavert Lletí M. [Mucormycosis: Current and future management perspective]. Rev Iberoam Micol 2021; 38:91-100. [PMID: 34144835 DOI: 10.1016/j.riam.2021.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/20/2021] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
Infections caused by mucorales, with an increasing incidence after candidiasis and aspergillosis, are characterized by the fast angioinvasion of blood vessels and invasion of neighboring organs or structures. Mucorales most commonly cause rhinocerebral, pulmonary, cutaneous, digestive or disseminated infections, and their spread is favored by certain underlying diseases (diabetes, kidney failure) and risk factors (neutropenia, immunosuppression, iron overload). These infections have a high mortality rate, over 40% in many series, and the key to their cure depends on both an early diagnosis and an antifungal treatment, associated in most cases with extensive surgical debridement and other adjunctive therapies. Currently, there are international guidelines, not only local ones, for the management of mucormycosis, in which it is considered by consensus and with a strong recommendation that first-line treatment with high-dose liposomal amphotericin B is the best choice. The combined antifungal treatment of polyene agents with triazoles or candins remains in open debate.
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Affiliation(s)
- María Teresa Martín Gómez
- Sección de Micología, Servicio de Microbiología, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Miguel Salavert Lletí
- Unidad de Enfermedades Infecciosas (Área Clínica Médica), Hospital Universitario y Politécnico La Fe, Valencia, España.
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Pałka Ł, Gaur V. The importance of mucormycosis infections on
example of Rhino Orbital Cerebral Mucormycosis. POSTEP HIG MED DOSW 2021. [DOI: 10.5604/01.3001.0014.8123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Mucormycosis is an angioinvasive fungal infection, characterized by high morbidity and mortality
and is strongly dependent on the patient’s general health condition, initial site of infection,
and the time from diagnosis to treatment commencement. It has been reported that the
occurrence of mucormycosis has increased rapidly, also among immunocompetent patients.
Moreover, the rise in number is expected to continue. Among all clinical manifestations of
mucormycosis, the rhino-orbital-cerebral type (ROCM) is the most common. The aim of this
article is to increase the awareness of mucoral infections, especially ROCM, and to describe its
first symptoms, as proper treatment requires immediate surgical and medical intervention.
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Affiliation(s)
| | - Vivek Gaur
- Jaipur Dental College, Maharaj Vinayek Global University, Jaipur, India
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Pérez-Arques C, Navarro-Mendoza MI, Murcia L, Lax C, Sanchis M, Capilla J, Navarro E, Garre V, Nicolás FE. A Mucoralean White Collar-1 Photoreceptor Controls Virulence by Regulating an Intricate Gene Network during Host Interactions. Microorganisms 2021; 9:459. [PMID: 33672193 PMCID: PMC7927057 DOI: 10.3390/microorganisms9020459] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 02/08/2021] [Accepted: 02/18/2021] [Indexed: 01/02/2023] Open
Abstract
Mucolares are an ancient group of fungi encompassing the causal agents for the lethal infection mucormycosis. The high lethality rates, the emerging character of this disease, and the broad antifungal resistance of its causal agents are mucormycosis features that are alarming clinicians and researchers. Thus, the research field around mucormycosis is currently focused on finding specific weaknesses and targets in Mucorales for developing new treatments. In this work, we tested the role of the white-collar genes family in the virulence potential of Mucor lusitanicus. Study of the three genes of this family, mcwc-1a, mcwc-1b, and mcwc-1c, resulted in a marked functional specialization, as only mcwc-1a was essential to maintain the virulence potential of M. lusitanicus. The traditional role of wc-1 genes regulating light-dependent responses is a thoroughly studied field, whereas their role in virulence remains uncharacterized. In this work, we investigated the mechanism involving mcwc-1a in virulence from an integrated transcriptomic and functional approach during the host-pathogen interaction. Our results revealed mcwc-1a as a master regulator controlling an extensive gene network. Further dissection of this gene network clustering its components by type of regulation and functional criteria disclosed a multifunctional mechanism depending on diverse pathways. In the absence of phagocytic cells, mcwc-1a controlled pathways related to cell motility and the cytoskeleton that could be associated with the essential tropism during tissue invasion. After phagocytosis, several oxidative response pathways dependent on mcwc-1a were activated during the germination of M. lusitanicus spores inside phagocytic cells, which is the first stage of the infection. The third relevant group of genes involved in virulence and regulated by mcwc-1a belonged to the "unknown function," indicating that new and hidden pathways are involved in virulence. The unknown function category is especially pertinent in the study of mucormycosis, as it is highly enriched in specific fungal genes that represent the most promising targets for developing new antifungal compounds. These results unveil a complex multifunctional mechanism used by wc-1 genes to regulate the pathogenic potential in Mucorales that could also apply to other fungal pathogens.
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Affiliation(s)
- Carlos Pérez-Arques
- Departmento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain; (C.P.-A.); (M.I.N.-M.); (L.M.); (C.L.); (E.N.)
| | - María Isabel Navarro-Mendoza
- Departmento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain; (C.P.-A.); (M.I.N.-M.); (L.M.); (C.L.); (E.N.)
| | - Laura Murcia
- Departmento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain; (C.P.-A.); (M.I.N.-M.); (L.M.); (C.L.); (E.N.)
| | - Carlos Lax
- Departmento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain; (C.P.-A.); (M.I.N.-M.); (L.M.); (C.L.); (E.N.)
| | - Marta Sanchis
- Unidad de Microbiología, Universitat Rovira i Virgili, IISPV, 43003 Tarragona, Spain; (M.S.); (J.C.)
| | - Javier Capilla
- Unidad de Microbiología, Universitat Rovira i Virgili, IISPV, 43003 Tarragona, Spain; (M.S.); (J.C.)
| | - Eusebio Navarro
- Departmento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain; (C.P.-A.); (M.I.N.-M.); (L.M.); (C.L.); (E.N.)
| | - Victoriano Garre
- Departmento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain; (C.P.-A.); (M.I.N.-M.); (L.M.); (C.L.); (E.N.)
| | - Francisco Esteban Nicolás
- Departmento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, 30100 Murcia, Spain; (C.P.-A.); (M.I.N.-M.); (L.M.); (C.L.); (E.N.)
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Liang Y, Chen X, Wang J, Guo C, Liu F, Yang J. Oral posaconazole and bronchoscopy as a treatment for pulmonary mucormycosis in pediatric acute lymphoblastic leukemia patient: A case report. Medicine (Baltimore) 2021; 100:e24630. [PMID: 33578579 PMCID: PMC7886464 DOI: 10.1097/md.0000000000024630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/15/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Mucormycosis is a rare fungal infection that typically occurs in immunosuppressed patients following chemotherapy or hematopoietic stem cell transplantation. PATIENT CONCERNS An 11-year-old child with newly developed acute lymphoblastic leukemia suffered from the paroxysmal left chest pain, fever, and hemoptysis. DIAGNOSES We made a histopathologic diagnosis aided by bronchoscopy techniques, which indicated invasive fungal hyphae that are characteristic of mucormycosis. INTERVENTIONS The patient was treated with oral posaconazole and repeated bronchoscopy interventions for 4 months. OUTCOMES The patient's clinical signs and symptoms and signs were no longer present. The prior lung lesions were also no longer observable using radiologic methods, and a 3-month follow-up with the patient showed no signs of mucormycosis recurrence. Finally, the patient was cured, when the cancer chemotherapy was stopped. Close follow-up for another 2 years showed no evidence of recurrence. LESSONS Mucormycosis diagnosis is difficult as clinical and imaging findings vary. This case demonstrates that posaconazole monotherapy combined with bronchoscopy interventions may be a safe and effective treatment option for pediatric pulmonary mucormycosis.
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Kato H, Foster CM, Karri K. Incidence, predisposing conditions and outcomes of cutaneous mucormycosis: A national database study. Mycoses 2021; 64:569-572. [PMID: 33480122 DOI: 10.1111/myc.13245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 12/18/2020] [Accepted: 01/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The body of evidence on cutaneous mucormycosis is largely derived from case reports or single-centre databases. OBJECTIVES Our study aimed to describe incidence, predisposing factors and inpatient outcomes of cutaneous mucormycosis in the United States. METHODS We conducted a population-based retrospective study using the National Inpatient Sample 2016-17 data. Fifty-six discharges had a diagnosis of cutaneous mucormycosis on the International Classification of Diseases, tenth revision. Descriptive analysis was performed for the demographics, predisposing factors, length of stay (LOS), cost and inpatient mortality. The NIS represents 20% of all discharges in the United States, which allowed us to estimate the national incidence of cutaneous mucormycosis. RESULTS An estimated total of 280 admissions occurred between 2016 and 2017, indicating 3.9 cases per million admissions across the United States. The estimated incidence rate was 0.43 cases per million people per year. Median age was 49.5 (19-59) years, 44.6% were female, and 54.9% were Caucasian. We identified haematologic malignancies (48.2%) and solid organ transplantations (10.7%), often accompanied by skin/soft tissue or post-procedural infections, were the most common predisposing conditions. Median LOS was 15 (6-31) days, median total charges were 187,030 (65,962-446,265) USD, and in-hospital mortality rate was 16.1%. CONCLUSIONS In current clinical practice, physicians may encounter cutaneous mucormycosis most commonly in severely immunocompromised hosts with haematologic malignancies or transplantations, accompanied by skin/soft tissue or post-procedural infections. A high index of suspicion and prompt tissue sampling in at-risk groups is important to improve the outcomes.
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Affiliation(s)
- Hirotaka Kato
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
| | - Corey M Foster
- Department of Internal Medicine, King's Daughter's Health, Madison, IN, USA
| | - Kishore Karri
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
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Muthu V, Agarwal R, Dhooria S, Sehgal IS, Prasad KT, Aggarwal AN, Chakrabarti A. Has the mortality from pulmonary mucormycosis changed over time? A systematic review and meta-analysis. Clin Microbiol Infect 2021; 27:538-549. [PMID: 33418022 DOI: 10.1016/j.cmi.2020.12.035] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/25/2020] [Accepted: 12/31/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES Pulmonary mucormycosis (PM) is increasingly being reported in immunocompromised patients and has a high mortality. Our aim was to assess the mortality of PM and its trend over time. We also evaluated the role of combined medical-surgical therapy in PM. METHODS We performed a systematic review of Pubmed, Embase, and Cochrane central databases. Studies were eligible if they described at least five confirmed cases of PM and reported mortality. We also assessed the effect of combined medical-surgical therapy versus medical treatment alone on PM mortality. We used a random-effects model to estimate the pooled mortality of PM and compared it across three time periods. The factors influencing mortality were assessed using meta-regression. We evaluated the risk difference (RD) of death in the following: subjects undergoing combined medical-surgical therapy versus medical therapy alone, subjects with isolated PM versus disseminated disease, and PM in diabetes mellitus (DM) versus non-DM as a risk factor. RESULTS We included 79 studies (1544 subjects). The pooled mortality of PM was 57.1% (95% confidence interval [CI] 51.7-62.6%). Mortality improved significantly over time (72.1% versus 58.3% versus 49.8% for studies before 2000, 2000-2009, and 2010-2020, respectively, p 0.00001). This improved survival was confirmed in meta-regression after adjusting for the study design, the country's income level, and the sample size. Combined medical-surgical therapy was associated with a significantly lower RD (95%CI) of death: -0.32 (-0.49 to -0.16). The disseminated disease had a higher risk of death than isolated PM, but DM was not associated with a higher risk of death than other risk factors. CONCLUSIONS While PM is still associated with high mortality, we noted improved survival over time. Combined medical-surgical therapy improved survival compared to medical treatment alone.
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Affiliation(s)
- Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Inderpaul Singh Sehgal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kuruswamy Thurai Prasad
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ashutosh N Aggarwal
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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62
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Bonifaz A, Tirado-Sánchez A, Paredes-Farrera F, Moreno-Moreno J, Araiza J, González GM. Oral involvement in mucormycosis. A retrospective study of 55 cases. Enferm Infecc Microbiol Clin 2020; 39:S0213-005X(20)30293-7. [PMID: 33158598 DOI: 10.1016/j.eimc.2020.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/07/2020] [Accepted: 09/13/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Mucormycosis with oral involvement (OIM) is a rare opportunistic and lethal mycosis, which has increased in the last decade and is generally associated with uncontrolled diabetes and neutropenia. METHODS A retrospective study of cases with OIM was carried out in a tertiary-care center. Mycological and histological examinations were performed, and the isolated organisms were identified by morphology and molecular biology. RESULTS Fifty-five OIM patients were included, with a median age of 38 years (61.8% males). The most frequent associated disease was type-2 diabetes mellitus (61%), followed by neutropenia due to acute lymphocytic leukemia (27%). The main presentation was palatal and mandibular ulcers (92.7%) and, to a lesser extent, gingival and lingual necrosis. The diagnosis was established by mycological and histopathological studies. The most frequent fungi isolated was Rhizopus arrhizus (67.2%). CONCLUSION OIM is a rapidly progressing disease, therefore, an early diagnosis and the proper control of predisposing factors is necessary, and consequently, contributing to improve the outcome of mucormycosis.
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Affiliation(s)
- Alexandro Bonifaz
- Dermatology Service, & Mycology Department, Hospital General de México, "Dr. Eduardo Liceaga", Mexico.
| | - Andrés Tirado-Sánchez
- Dermatology Service, & Mycology Department, Hospital General de México, "Dr. Eduardo Liceaga", Mexico
| | | | | | - Javier Araiza
- Dermatology Service, & Mycology Department, Hospital General de México, "Dr. Eduardo Liceaga", Mexico
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63
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Skiada A, Pavleas I, Drogari-Apiranthitou M. Epidemiology and Diagnosis of Mucormycosis: An Update. J Fungi (Basel) 2020; 6:jof6040265. [PMID: 33147877 PMCID: PMC7711598 DOI: 10.3390/jof6040265] [Citation(s) in RCA: 268] [Impact Index Per Article: 67.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 10/30/2020] [Accepted: 11/01/2020] [Indexed: 12/17/2022] Open
Abstract
Mucormycosis is an angioinvasive fungal infection, due to fungi of the order Mucorales. Its incidence cannot be measured exactly, since there are few population-based studies, but multiple studies have shown that it is increasing. The prevalence of mucormycosis in India is about 80 times the prevalence in developed countries, being approximately 0.14 cases per 1000 population. Diabetes mellitus is the main underlying disease globally, especially in low and middle-income countries. In developed countries the most common underlying diseases are hematological malignancies and transplantation. Τhe epidemiology of mucormycosis is evolving as new immunomodulating agents are used in the treatment of cancer and autoimmune diseases, and as the modern diagnostic tools lead to the identification of previously uncommon genera/species such as Apophysomyces or Saksenaea complex. In addition, new risk factors are reported from Asia, including post-pulmonary tuberculosis and chronic kidney disease. New emerging species include Rhizopus homothallicus, Thamnostylum lucknowense, Mucor irregularis and Saksenaea erythrospora. Diagnosis of mucormycosis remains challenging. Clinical approach to diagnosis has a low sensitivity and specificity, it helps however in raising suspicion and prompting the initiation of laboratory testing. Histopathology, direct examination and culture remain essential tools, although the molecular methods are improving. The internal transcribed spacer (ITS) region is the most widely sequenced DNA region for fungi and it is recommended as a first-line method for species identification of Mucorales. New molecular platforms are being investigated and new fungal genetic targets are being explored. Molecular-based methods have gained acceptance for confirmation of the infection when applied on tissues. Methods on the detection of Mucorales DNA in blood have shown promising results for earlier and rapid diagnosis and could be used as screening tests in high-risk patients, but have to be validated in clinical studies. More, much needed, rapid methods that do not require invasive procedures, such as serology-based point-of-care, or metabolomics-based breath tests, are being developed and hopefully will be evaluated in the near future.
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Affiliation(s)
- Anna Skiada
- First Department of Medicine, Laiko Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece
- Correspondence: ; Tel.: +30-2107-462-607
| | | | - Maria Drogari-Apiranthitou
- Fourth Department of Internal Medicine, General University Hospital “Attikon”, National and Kapodistrian University of Athens, 12462 Athens, Greece;
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Álvarez-Uría A, Guinea JV, Escribano P, Gómez-Castellá J, Valerio M, Galar A, Vena A, Bouza E, Muñoz P. Invasive Scedosporium and Lomentosora infections in the era of antifungal prophylaxis: A 20-year experience from a single centre in Spain. Mycoses 2020; 63:1195-1202. [PMID: 32749009 DOI: 10.1111/myc.13154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Non-Aspergillus mould infections such as those caused by Scedosporium apiospermum or Lomentospora prolificans are an emerging threat. Few studies have monitored their long-term incidence. OBJECTIVES To analyse the epidemiology, risk factors, clinical features and incidence of patients with proven and probable infections. PATIENTS/METHODS Patients admitted to Gregorio Marañón Hospital between 1998 and 2017 and from whom Scedosporium/Lomentospora was isolated were studied. Subjects were classified as having a probable/proven invasive fungal infection or colonization. Molecular identification and antifungal susceptibility testing of isolates causing infection were performed, as well as a description of the patients and incidence of infection. RESULTS One or more Scedosporium/Lomentospora isolates were identified in 67 patients. Sixteen (23.9%) patients had developed infection: 11 scedosporiosis and 5 lomentosporiosis. Stable incidence was observed throughout the study period. Most patients were immunosuppressed and the most common underlying diseases were haematologic malignancy (25%), solid organ transplantation (25%) and chronic corticoid therapy (25%). Breakthrough infection occurred in four patients, 2/11 (18.2%) cases of scedosporiosis and 2/5 (40%) of lomentosporiosis. Overall mortality was 54.5% (6/11) and 80% (4/5) in subjects with scedosporiosis and lomentosporiosis, respectively. High MICs of amphotericin B and remarkable inter-species susceptibility variability to triazoles was observed for most isolates. CONCLUSIONS In contrast to previous studies, the incidence of scedosporiosis and lomentosporiosis has not increased at our hospital over the years. The tendency to cause disseminated infection and a reduced susceptibility to most antifungal agents leads to high mortality.
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Affiliation(s)
- Ana Álvarez-Uría
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
| | - Jesus Vicente Guinea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias- CIBERES (CB06/06/0058), Madrid, Spain
| | - Pilar Escribano
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
| | - Javier Gómez-Castellá
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
| | - Maricela Valerio
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
| | - Alicia Galar
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
| | - Antonio Vena
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
| | - Emilio Bouza
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias- CIBERES (CB06/06/0058), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
- CIBER Enfermedades Respiratorias- CIBERES (CB06/06/0058), Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Azanza JR, Grau S, Vázquez L, Rebollo P, Peral C, López-Ibáñez de Aldecoa A, López-Gómez V. The cost-effectiveness of isavuconazole compared to voriconazole, the standard of care in the treatment of patients with invasive mould diseases, prior to differential pathogen diagnosis in Spain. Mycoses 2020; 64:66-77. [PMID: 32989796 PMCID: PMC7894146 DOI: 10.1111/myc.13189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 12/29/2022]
Abstract
Background Invasive mould diseases are associated with high morbidity, mortality and economic impact. Its treatment is often started prior to differential pathogen diagnosis. Isavuconazole is approved for treatment of invasive aspergillosis (IA) and invasive mucormycosis (IM) when amphotericin‐B is not indicated. Objectives To estimate the cost‐effectiveness of isavuconazole vs voriconazole for the treatment of adult patients with possible IA prior to differential pathogen diagnosis, in Spain. Methods A decision tree analysis was performed using the Spanish Healthcare System perspective. Among all patients with possible IA, it was considered that 7.81% actually had IM. Costs for laboratory analysis, management of adverse events, hospitalisation and drugs per patient, deaths and long‐term effects in life years (LYs) and quality‐adjusted LYs (QALYs) were considered. Efficacy data were obtained from clinical trials and utilities from the literature. Deterministic and probabilistic sensitivity analyses (PSA) were conducted. Results In patients with possible IA and when compared to voricanozole, isavuconazole showed an incremental cost of 4758.53€, besides an incremental effectiveness of +0.49 LYs and +0.41 QALYs per patient. The Incremental Cost Effectiveness Ratio was 9622.52€ per LY gained and 11,734.79€ per QALY gained. The higher cost of isavuconazole was due to drug acquisition. Main parameters influencing results were mortality, treatment duration and hospitalisation days. The PSA results showed that isavuconazole has a probability of being cost‐effective of 67.34%, being dominant in 24.00% of cases. Conclusions Isavuconazole is a cost‐effective treatment compared to voriconazole for patients with possible IA for a willingness to pay threshold of 25,000€ per additional QALY.
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Affiliation(s)
- José Ramón Azanza
- Clinical Pharmacology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Santiago Grau
- Pharmacy Department, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lourdes Vázquez
- Hematology Department, Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | | | - Carmen Peral
- Pharmacoeconomics Department, Pfizer, Madrid, Spain
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Host Immune Defense upon Fungal Infections with Mucorales: Pathogen-Immune Cell Interactions as Drivers of Inflammatory Responses. J Fungi (Basel) 2020; 6:jof6030173. [PMID: 32957440 PMCID: PMC7557740 DOI: 10.3390/jof6030173] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
During the last few decades, mucormycosis has emerged as one of the most common fungal infections, following candidiasis and aspergillosis. The fungal order responsible for causing mucormycosis is the Mucorales. The main hallmarks of this infection include the invasion of blood vessels, infarction, thrombosis, and tissue necrosis, which are exhibited at the latest stages of the infection. Therefore, the diagnosis is often delayed, and the rapid progression of the infection severely endangers the life of people suffering from diabetes mellitus, hematological malignancies, or organ transplantation. Given the fact that mortality rates for mucormycosis range from 40 to 80%, early diagnosis and novel therapeutic strategies are urgently needed to battle the infection. However, compared to other fungal infections, little is known about the host immune response against Mucorales and the influence of inflammatory processes on the resolution of the infection. Hence, in this review, we summarized our current understanding of the interplay among pro-inflammatory cytokines, chemokines, and the host-immune cells in response to mucoralean fungi, as well as their potential use for immunotherapies.
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67
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Salmanton-García J, Seidel D, Koehler P, Mellinghoff SC, Herbrecht R, Klimko N, Ráčil Z, Falces-Romero I, Ingram P, Benítez-Peñuela MÁ, Rodríguez JY, Desoubeaux G, Barać A, García-Vidal C, Hoenigl M, Mehta SR, Cheng MP, Klyasova G, Heinz WJ, Iqbal N, Krause R, Ostermann H, Penack O, Schalk E, Sheppard DC, Willinger B, Wisplinghoff H, Vehreschild JJ, Cornely OA, Vehreschild MJGT. Matched-paired analysis of patients treated for invasive mucormycosis: standard treatment versus posaconazole new formulations (MoveOn). J Antimicrob Chemother 2020; 74:3315-3327. [PMID: 31393591 DOI: 10.1093/jac/dkz344] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/04/2019] [Accepted: 07/09/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND First-line antifungal treatment for invasive mucormycosis (IM) consists of liposomal amphotericin B. Salvage treatment options are limited and often based on posaconazole oral suspension. With the approval of posaconazole new formulations, patients could benefit from improved pharmacokinetics, safety and tolerability. OBJECTIVES Our aim was to assess the effectiveness of posaconazole new formulations for IM treatment. METHODS We performed a case-matched analysis with proven or probable IM patients from the FungiScope® Registry. First-line posaconazole new formulations (1st-POSnew) and first-line amphotericin B plus posaconazole new formulations (1st-AMB+POSnew) cases were matched with first-line amphotericin B-based (1st-AMB) treatment controls. Salvage posaconazole new formulations (SAL-POSnew) cases were matched with salvage posaconazole oral suspension (SAL-POSsusp) controls. Each case was matched with up to three controls (based on severity, haematological/oncological malignancy, surgery and/or renal dysfunction). RESULTS Five patients receiving 1st-POSnew, 18 receiving 1st-AMB+POSnew and 22 receiving SAL-POSnew were identified. By day 42, a favourable response was reported for 80.0% (n = 4/5) of patients receiving 1st-POSnew, for 27.8% (n = 5/18) receiving 1st-AMB+POSnew and for 50.0% (n = 11/22) receiving SAL-POSnew. Day 42 all-cause mortality of patients receiving posaconazole new formulations was lower compared with controls [20.0% (n = 1/5) in 1st-POSnew versus 53.3% (n = 8/15) in 1st-AMB; 33.3% (n = 6/18) in 1st-AMB+POSnew versus 52.0% (n = 26/50) in 1st-AMB; and 0.0% (n = 0/22) in SAL-POSnew versus 4.4% (n = 2/45) in SAL-POSsusp]. CONCLUSIONS Posaconazole new formulations were effective in terms of treatment response and associated mortality of IM. While posaconazole new formulations may be an alternative for treatment of IM, the limited sample size of our study calls for a cautious interpretation of these observations.
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Affiliation(s)
- Jon Salmanton-García
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Danila Seidel
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Philipp Koehler
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
| | - Sibylle C Mellinghoff
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Cologne, Germany
| | - Raoul Herbrecht
- Department of Oncology and Hematology, Hôpitaux Universitaires de Strasbourg and Université de Strasbourg, Inserm, UMR-S1113/IRFAC, Strasbourg, France
| | - Nikolai Klimko
- Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, Saint Petersburg, Russia
| | - Zdeněk Ráčil
- Department of Internal Medicine-Hematology and Oncology, Masaryk University, Brno, Czech Republic.,University Hospital Brno, Brno, Czech Republic
| | - Iker Falces-Romero
- Clinical Microbiology and Parasitology Department, University Hospital La Paz, Madrid, Spain
| | - Paul Ingram
- Department of Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia.,School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia
| | - Miguel-Ángel Benítez-Peñuela
- Center of Microbiological Research of Cesar (CIMCE), Rosario Pumarejo de López Hospital, Laura Daniela Clinic, Médicos Clinic LTDA, Valledupar, Colombia
| | - José Yesid Rodríguez
- Center of Microbiological Research of Cesar (CIMCE), Rosario Pumarejo de López Hospital, Laura Daniela Clinic, Médicos Clinic LTDA, Valledupar, Colombia
| | - Guillaume Desoubeaux
- Parasitology, Mycology and Tropical Medicine Service, University Hospital of Tours, Tours, France.,Inserm U1100, Tours University, Tours, France
| | - Aleksandra Barać
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Serbia
| | - Carolina García-Vidal
- Service of Infectious Diseases, Clínic Hospital, University of Barcelona, Institute of Biomedical Research August Pi i Sunyer, Barcelona, Spain
| | - Martin Hoenigl
- Division of Infectious Diseases, University of California San Diego, San Diego, CA, USA.,Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sanjay R Mehta
- Division of Infectious Diseases, University of California San Diego, San Diego, CA, USA.,Department of Medicine, San Diego Veterans Affairs Medical Center San Diego, CA, USA
| | - Matthew P Cheng
- Division of Infectious Diseases, Departments of Medicine, Microbiology and Immunology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Galina Klyasova
- Department of Clinical Microbiology, Mycology and Antibiotic Therapy, National Research Center for Hematology, Moscow, Russia
| | - Werner J Heinz
- Department of Internal Medicine II, Julius Maximilians University, Würzburg, Germany
| | - Nousheen Iqbal
- Section of Pulmonology and Critical Care, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Robert Krause
- Section of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Helmut Ostermann
- Department of Internal Medicine III, University of Munich, Munich, Germany
| | - Olaf Penack
- Department for Hematology, Oncology and Tumorimmunology, Charité University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany
| | - Enrico Schalk
- Department of Haematology and Oncology, Medical Centre, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Donald C Sheppard
- Division of Infectious Diseases, Departments of Medicine, Microbiology and Immunology, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Hilmar Wisplinghoff
- University of Cologne, Institute for Medical Microbiology, Immunology and Hygiene, Cologne, Germany.,Wisplinghoff Laboratories, Cologne, Germany.,Institute for Virology and Clinical Microbiology, Witten/Herdecke University, Witten, Germany
| | - J Janne Vehreschild
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,German Centre for Infection Research (DZIF), partner site Bonn - Cologne, Cologne, Germany.,Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany
| | - Oliver A Cornely
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany.,German Centre for Infection Research (DZIF), partner site Bonn - Cologne, Cologne, Germany.,Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany.,Clinical Trials Centre Cologne (ZKS Köln), University of Cologne, Cologne, Germany.,Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Maria J G T Vehreschild
- University of Cologne, Faculty of Medicine and University Hospital of Cologne, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), European Diamond Excellence Center for Medical Mycology (ECMM), Cologne, Germany.,German Centre for Infection Research (DZIF), partner site Bonn - Cologne, Cologne, Germany.,Center for Integrated Oncology CIO Köln/Bonn, Medical Faculty, University of Cologne, Cologne, Germany.,Department of Internal Medicine, Infectious Diseases, Goethe University, Frankfurt, Frankfurt am Main, Germany
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Elzein F, Albarrag A, Kalam K, Arafah M, Al-Baadani A, Eltayeb N, Aloteibi F, Alrashed A, Abdullah RA, Alasiri S. Mucormycosis: An 8-year experience of a tertiary care centre in Saudi Arabia. J Infect Public Health 2020; 13:1774-1779. [PMID: 32891591 DOI: 10.1016/j.jiph.2020.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 02/08/2023] Open
Abstract
Mucormycosis is a rare fungal infection with an extremely high morbidity and mortality. Data on the burden of the disease in the Arab world is lacking. The aim of this study is to highlight the incidence and outcome of this infection in a tertiary care center in the Kingdom of Saudi Arabia (KSA). In this retrospective study we included all mucormycosis cases admitted to our center between January 2013 and December 2019. A total of 18 proven patients with a median age of 43.5 years (range 13-72 years, 72% males) were identified. The most common presentation was cutaneous and rhino-orbito-cerebral, followed by gastrointestinal mucormycosis. Apophysomyces variabilisRhizopus oryzae) were the main fungal isolates on molecular testing. Trauma was the chief underlying etiology (41.0%) with motor vehicle accident (MVCs) being the predominant type (43.0%). For this reason, most of our patients were young with cutaneous disease and had a better prognosis. All patients received liposomal amphotericin B alone or in combination with other antifungal agents. Repeated aggressive debridement and reversal of the underlying factor was attempted in all patients. This underscores the lower mortality (27.8%) seen in this group. The diagnosis of Mucorales infection is challenging. A high index of suspicion with prompt treatment is required to improve the high mortality of this aggressive disease. Further studies are needed to understand the epidemiology and outcome of this disease in Saudi Arabia.
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Affiliation(s)
- Fatehi Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.
| | - Ahmed Albarrag
- Department of Pathology, College of Medicine, King Saud University, Saudi Arabia
| | - Kiran Kalam
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Maria Arafah
- Department of Pathology, College of Medicine, King Saud University, Saudi Arabia
| | - Abeer Al-Baadani
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Nazik Eltayeb
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | | | - Abdulrahman Alrashed
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Rashid Al Abdullah
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
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69
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Evaluation of MucorGenius® mucorales PCR assay for the diagnosis of pulmonary mucormycosis. J Infect 2020; 81:311-317. [DOI: 10.1016/j.jinf.2020.05.051] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
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Abstract
BACKGROUND Mucormycosis is a rare but emerging life-threatening fungal disease with limited treatment options. Isavuconazole is a new triazole that has shown efficacy in adults for primary and salvage treatment of mucormycosis. However, data in children are scarce. METHODS The demographic and clinical data of pediatric patients with proven mucormycosis who were treated with isavuconazole in 2015 to 2019 at 2 centers were collected. RESULTS Four children of median age 10.5 years (range 7-14) met the study criteria. Three had underlying hematologic malignancies, and 1 had sustained major trauma. Isavuconazole was used as salvage therapy in all: in 3 patients for refractory disease, and in 1 after intolerance to another antifungal drug. Isavuconazole was administered alone or combined with other antifungal agents. Following treatment and surgical intervention, complete clinical, radiologic and mycologic responses were documented in all patients. A literature review identified 8 children with mucormycosis who were successfully treated with isavuconazole, as salvage therapy in the majority. CONCLUSION Our limited experience supports the use of isavuconazole as salvage therapy in pediatric mucormycosis.
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Pagano L, Dragonetti G, De Carolis E, Veltri G, Del Principe MI, Busca A. Developments in identifying and managing mucormycosis in hematologic cancer patients. Expert Rev Hematol 2020; 13:895-905. [PMID: 32664759 DOI: 10.1080/17474086.2020.1796624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Mucormycoses represent a rare but very aggressive class of mold infections occurring in patients with hematological malignancies (HMs). In the past, patients at high risk of invasive mucomycosis (IM) were those affected by acute myeloid leukemia but over the last ten years the prophylaxis with a very effective mold-active drug, such as posaconazole, has completely modified the epidemiology. In fact, IM is now observed more frequently in patients with lymphoproliferative disorders who do not receive antifungal prophylaxis. AREAS COVERED The attention was focused on the epidemiology, diagnosis, prophylaxis and treatment of IM in HMs. Authors excluded pediatric patients considering the different epidemiology and differences in treatment given the limitation of the use of azoles in the pediatric field. A systematic literature review was performed using PubMed database listings between February 2014 and February 2020 using the following MeSH terms: leukemia, hematological malignancies, stem cell transplantation, mucormycosis, molds, prophilaxis, treatment. EXPERT OPINION The epidemiology of mucormycosis in HMs is changing in the last years. The availability of drugs more effective than in the past against this infection has reduced the mortality; however, a timely diagnosis remains a relevant problem potentially influencing the outcome of hematologic patients with IM.
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Affiliation(s)
- Livio Pagano
- Hematology Section, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy.,Hematology Section, Università Cattolica Del Sacro Cuore , Rome, Italy
| | - Giulia Dragonetti
- Hematology Section, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy
| | - Elena De Carolis
- Microbiology Section, Fondazione Policlinico Universitario Agostino Gemelli- IRCCS , Rome, Italy
| | - Giuseppe Veltri
- Radiology Section, Università Cattolica Del Sacro Cuore , Rome, Italy
| | - Maria Ilaria Del Principe
- Ematologia, Dipartimento Di Biomedicina E Prevenzione, Università Degli Studi Di Roma "Tor Vergata" , Roma, Italy
| | - Alessandro Busca
- Stem Cell Transplant Center, AOU Citta' Della Salute E Della Scienza , Turin, Italy
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72
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Tribble DR, Ganesan A, Rodriguez CJ. Combat trauma-related invasive fungal wound infections. CURRENT FUNGAL INFECTION REPORTS 2020; 14:186-196. [PMID: 32665807 DOI: 10.1007/s12281-020-00385-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Purpose of review This review highlights research from the past five years on combat trauma-related invasive fungal wound infections (IFIs) with a focus on risk stratification to aid patient management, microbiology, and diagnostics. Recent Findings A revised classification scheme stratifies wounds into three risk groups: IFI, High Suspicion of IFI, and Low Suspicion of IFI. This stratification is based on persistence of wound necrosis and laboratory fungal evidence, presence of signs/symptoms of deep soft-tissue infections, and the need for antifungals. Use of this classification could allow for prioritization of antifungal therapy. Further, IFIs delay wound healing, particularly when caused by fungi of the order Mucorales. Lastly, molecular sequencing offers promising and complimentary results to the gold standard histopathology. Summary Optimal management of combat-related IFIs depends on early tissue-based diagnosis with aggressive surgical debridement and concomitant dual antifungal therapy. Further research on clinical decision support tools and rapid diagnostics are needed.
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Affiliation(s)
- David R Tribble
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814
| | - Anuradha Ganesan
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.,Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Bethesda MD 20817.,Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889
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Pan J, Tsui C, Li M, Xiao K, de Hoog GS, Verweij PE, Cao Y, Lu H, Jiang Y. First Case of Rhinocerebral Mucormycosis Caused by Lichtheimia ornata, with a Review of Lichtheimia Infections. Mycopathologia 2020; 185:555-567. [PMID: 32388712 DOI: 10.1007/s11046-020-00451-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 04/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lichtheimia species are emerging opportunistic fungal pathogens in the Mucorales, causing serious skin and respiratory infections in immunocompromised patients. Established agents are Lichtheimia corymbifera and L. ramosa, while L. ornata is a novel agent. Available data on a species-specific analysis of Lichtheimia infections are limited. METHODS The first case of a fatal rhino-orbital-cerebral infection in a hematopoietic stem cell transplantation recipient caused by L. ornata is reported; the agent was identified by sequencing the ITS ribosomal region. We reviewed the literature on mucormycosis due to Lichtheimia species between 2009 and 2018, with an analysis of risk factors and epidemiological and clinical data. RESULTS In addition to our Lichtheimia ornata case, 44 cases of human Lichtheimia were analyzed. Lichtheimia predominated in Europe (68.2%), followed by Asia (16%), and Africa (9%). The most common underlying condition was hematological malignancy (36.3%), followed by trauma/major surgery (27.3%), while diabetes mellitus was rare (11.4%). Site of infection was mostly skin and soft tissues (45.5%) and lung (25%), while relatively few cases were disseminated (13.6%) or rhinocerebral (11.4%). Mortality (36.4%) was mainly due to disseminated and rhinocerebral infections. CONCLUSION In contrast to Rhizopus, the most common agent of mucormycosis recorded in patients with diabetes mellitus, Lichtheimia infections were primarily associated with hematological malignancies and major skin barrier damage. Given the fact that classical rhinocerebral mucormycosis remains difficult to treat, independent of causative species, timely application of amphotericin B accessory to debridement may be required for patient survival.
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Affiliation(s)
- Junling Pan
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China
| | - Clement Tsui
- Department of Pathology, Sidra Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.,Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Mengxing Li
- Department of Hematology, The Affiliated Hospital, Guizhou Medical University, Guiyang, China
| | - Kun Xiao
- Department of Radiology, Guiyang Third People's Hospital, Guiyang, China
| | - G Sybren de Hoog
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands.,Center of Expertise in Mycology of Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands.,Center of Expertise in Mycology of Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Yu Cao
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China
| | - Hongguang Lu
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China
| | - Yanping Jiang
- Department of Dermatology, The Affiliated Hospital, Guizhou Medical University, Beijing Road 4, Yunyan District, Guiyang, China. .,Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands. .,Center of Expertise in Mycology of Radboud University Medical Center, Canisius Wilhelmina Hospital, Nijmegen, Netherlands.
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74
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Prohaska S, Henn P, Wenz S, Frauenfeld L, Rosenberger P, Haeberle HA. A case report of fatal disseminated fungal sepsis in a patient with ARDS and extracorporeal membrane oxygenation. BMC Anesthesiol 2020; 20:107. [PMID: 32381041 PMCID: PMC7203726 DOI: 10.1186/s12871-020-01031-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 05/03/2020] [Indexed: 02/07/2023] Open
Abstract
Background With the following report we want to present an unusual case of a patient suffering from acute respiratory distress syndrome with early discovery of bacterial pathogens in bronchoalveolar liquid samples that developed a fatal undiscovered disseminated fungal infection. Case presentation A 67-year-old man was admitted to our university hospital with dyspnea. Progressive respiratory failure developed leading to admission to the intensive care unit, intubation and prone positioning was necessary. To ensure adequate oxygenation and lung protective ventilation veno-venous extracorporeal membrane oxygenation was established. Despite maximal therapy and adequate antiinfective therapy of all discovered pathogens the condition of the patient declined further and he deceased. Postmortem autopsy revealed Mucor and Aspergillus mycelium in multiple organs such as lung, heart and pancreas as the underlying cause of his deterioration and death. Conclusion Routine screening re-evaluation of every infection is essential for adequate initiation and discontinuation of every antiinfective therapy. In cases with unexplained deterioration and unsuccessful sampling the possibility for diagnostic biopsies should be considered.
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Affiliation(s)
- Stefanie Prohaska
- Department of Anesthesiology and Intensive Care Medicine, Intensivstation 39, Tübingen University Hospital, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Philipp Henn
- Department of Anesthesiology and Intensive Care Medicine, Intensivstation 39, Tübingen University Hospital, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Svetlana Wenz
- Department of Pathology, Tübingen University Hospital, Eberhard-Karls-University, Tübingen, Germany
| | - Leonie Frauenfeld
- Department of Pathology, Tübingen University Hospital, Eberhard-Karls-University, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, Intensivstation 39, Tübingen University Hospital, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Helene A Haeberle
- Department of Anesthesiology and Intensive Care Medicine, Intensivstation 39, Tübingen University Hospital, Eberhard-Karls-University, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
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Mtibaa L, Halwani C, Tbini M, Boufares S, Souid H, Ben Sassi R, Gharsallah H, Ben Mhamed R, Akkari K, Jemli B. Successful treatment of rhino-facial mucormycosis in a diabetic patient. Med Mycol Case Rep 2020; 27:64-67. [PMID: 32123659 PMCID: PMC7036620 DOI: 10.1016/j.mmcr.2020.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/24/2019] [Accepted: 01/13/2020] [Indexed: 12/22/2022] Open
Abstract
Mucormycosis is a rapidly progressing and lethal infection caused by fungi of the order mucorales. The disease occurs mostly in patients with uncontrolled diabetes or other predisposing systemic conditions. We report a case of rhinofacial mucormycosis in a 39-year-old diabetic patient. The diagnosis was established by clinical examination, imaging, and confirmed by mycological examination. Rhizopus arrhizus was isolated. He was successfully treated with amphotericin B, surgical resection, diabetes control and hyperbaric oxygen therapy.
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Affiliation(s)
- Latifa Mtibaa
- Laboratory of Parasitology-Mycology, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Chiraz Halwani
- Department of ENT, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Makram Tbini
- Department of ENT, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Siwar Boufares
- Laboratory of Parasitology-Mycology, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Hana Souid
- Laboratory of Parasitology-Mycology, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Raja Ben Sassi
- Department of Hyperbaric Oxygenotherapy, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Hedi Gharsallah
- Department of Hyperbaric Oxygenotherapy, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Rania Ben Mhamed
- Department of ENT, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Khemaies Akkari
- Department of ENT, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
| | - Boutheina Jemli
- Laboratory of Parasitology-Mycology, Military Hospital of Tunis, 1008, Monfleury, Tunis, Tunisia
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76
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Guinea J, Escribano P, Vena A, Muñoz P, Martínez-Jiménez MDC, Padilla B, Bouza E. Correction: Increasing incidence of mucormycosis in a large Spanish hospital from 2007 to 2015: Epidemiology and microbiological characterization of the isolates. PLoS One 2020; 15:e0229347. [PMID: 32049980 PMCID: PMC7015364 DOI: 10.1371/journal.pone.0229347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0179136.].
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77
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Mercier T, Reynders M, Beuselinck K, Guldentops E, Maertens J, Lagrou K. Serial Detection of Circulating Mucorales DNA in Invasive Mucormycosis: A Retrospective Multicenter Evaluation. J Fungi (Basel) 2019; 5:jof5040113. [PMID: 31816976 PMCID: PMC6958450 DOI: 10.3390/jof5040113] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 12/02/2019] [Accepted: 12/02/2019] [Indexed: 12/13/2022] Open
Abstract
Invasive mucormycosis is a fungal infection with high mortality. Early diagnosis and initiation of appropriate treatment is essential to improve survival. However, current diagnostic tools suffer from low sensitivity, leading to delayed or missed diagnoses. Recently, several PCR assays for the detection of Mucorales DNA have been developed. We retrospectively assessed the diagnostic and kinetic properties of a commercial Mucorales PCR assay (MucorGenius®, PathoNostics) on serial blood samples from patients with culture-positive invasive mucormycosis and found an overall sensitivity of 75%. Importantly, a positive test preceded a positive culture result by up to 81 days (median eight days, inter-quartile range 1.75–16.25). After initiation of appropriate therapy, the average levels of circulating DNA decreased after one week and stabilized after two weeks. In conclusion, detection of circulating Mucorales DNA appears to be a good, fast diagnostic test that often precedes the final diagnosis by several days to weeks. This test could be especially useful in cases in which sampling for culture or histopathology is not feasible.
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Affiliation(s)
- Toine Mercier
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
- Correspondence:
| | - Marijke Reynders
- Department of Laboratory Medicine, Medical Microbiology, AZ St Jan Bruges, 8000 Bruges, Belgium
| | - Kurt Beuselinck
- Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Ellen Guldentops
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Johan Maertens
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
- Department of Hematology, University Hospitals Leuven, 3000 Leuven, Belgium
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, Katholieke Universiteit Leuven, 3000 Leuven, Belgium
- Department of Laboratory Medicine and National Reference Centre for Mycosis, University Hospitals Leuven, 3000 Leuven, Belgium
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78
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Cornely OA, Alastruey-Izquierdo A, Arenz D, Chen SCA, Dannaoui E, Hochhegger B, Hoenigl M, Jensen HE, Lagrou K, Lewis RE, Mellinghoff SC, Mer M, Pana ZD, Seidel D, Sheppard DC, Wahba R, Akova M, Alanio A, Al-Hatmi AMS, Arikan-Akdagli S, Badali H, Ben-Ami R, Bonifaz A, Bretagne S, Castagnola E, Chayakulkeeree M, Colombo AL, Corzo-León DE, Drgona L, Groll AH, Guinea J, Heussel CP, Ibrahim AS, Kanj SS, Klimko N, Lackner M, Lamoth F, Lanternier F, Lass-Floerl C, Lee DG, Lehrnbecher T, Lmimouni BE, Mares M, Maschmeyer G, Meis JF, Meletiadis J, Morrissey CO, Nucci M, Oladele R, Pagano L, Pasqualotto A, Patel A, Racil Z, Richardson M, Roilides E, Ruhnke M, Seyedmousavi S, Sidharthan N, Singh N, Sinko J, Skiada A, Slavin M, Soman R, Spellberg B, Steinbach W, Tan BH, Ullmann AJ, Vehreschild JJ, Vehreschild MJGT, Walsh TJ, White PL, Wiederhold NP, Zaoutis T, Chakrabarti A. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. THE LANCET. INFECTIOUS DISEASES 2019; 19:e405-e421. [PMID: 31699664 PMCID: PMC8559573 DOI: 10.1016/s1473-3099(19)30312-3] [Citation(s) in RCA: 839] [Impact Index Per Article: 167.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 04/10/2019] [Accepted: 06/05/2019] [Indexed: 12/20/2022]
Abstract
Mucormycosis is a difficult to diagnose rare disease with high morbidity and mortality. Diagnosis is often delayed, and disease tends to progress rapidly. Urgent surgical and medical intervention is lifesaving. Guidance on the complex multidisciplinary management has potential to improve prognosis, but approaches differ between health-care settings. From January, 2018, authors from 33 countries in all United Nations regions analysed the published evidence on mucormycosis management and provided consensus recommendations addressing differences between the regions of the world as part of the "One World One Guideline" initiative of the European Confederation of Medical Mycology (ECMM). Diagnostic management does not differ greatly between world regions. Upon suspicion of mucormycosis appropriate imaging is strongly recommended to document extent of disease and is followed by strongly recommended surgical intervention. First-line treatment with high-dose liposomal amphotericin B is strongly recommended, while intravenous isavuconazole and intravenous or delayed release tablet posaconazole are recommended with moderate strength. Both triazoles are strongly recommended salvage treatments. Amphotericin B deoxycholate is recommended against, because of substantial toxicity, but may be the only option in resource limited settings. Management of mucormycosis depends on recognising disease patterns and on early diagnosis. Limited availability of contemporary treatments burdens patients in low and middle income settings. Areas of uncertainty were identified and future research directions specified.
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Affiliation(s)
- Oliver A Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany; Clinical Trials Center Cologne, University Hospital of Cologne, Cologne, Germany.
| | - Ana Alastruey-Izquierdo
- Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
| | - Dorothee Arenz
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Sharon C A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, New South Wales Health Pathology, and the Department of Infectious Diseases, Westmead Hospital, School of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Eric Dannaoui
- Université Paris-Descartes, Faculté de Médecine, APHP, Hôpital Européen Georges Pompidou, Unité de Parasitologie-Mycologie, Service de Microbiologie, Paris, France
| | - Bruno Hochhegger
- Radiology, Hospital São Lucas da Pontificia Universidade Catolica do Rio Grande do Sul (PUCRS), Escola de Medicina, Porto Alegre, Brazil; Radiology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Martin Hoenigl
- Section of Infectious Diseases and Tropical Medicine and Division of Pulmonology, Medical University of Graz, Graz, Austria; Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, San Diego, USA
| | - Henrik E Jensen
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven and Clinical Department of Laboratory Medicine and National Reference Center for Mycosis, University Hospitals Leuven, Leuven, Belgium
| | - Russell E Lewis
- Infectious Diseases Clinic, Sant'Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Sibylle C Mellinghoff
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Mervyn Mer
- Divisions of Critical Care and Pulmonology, Department of Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences University of the Witwatersrand, Johannesburg, South Africa
| | - Zoi D Pana
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece
| | - Danila Seidel
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Donald C Sheppard
- Division of Infectious Diseases, Department of Medicine, Microbiology and Immunology, McGill University, Montreal, Quebec, Canada
| | - Roger Wahba
- Department of General, Visceral and Cancer Surgery, University Hospital of Cologne, Cologne, Germany
| | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Alexandre Alanio
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Department of Mycology, CNRS UMR2000, Parasitology-Mycology Laboratory, Lariboisière, Saint-Louis, Fernand Widal Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Abdullah M S Al-Hatmi
- Westerdijk Fungal Biodiversity Institute, Utrecht, The Netherlands; Centre of Expertise in Mycology RadboudUMC/Canisius Wilhelmina Hospital, Nijmegen, The Netherlands; Ministry of Health, Directorate General of Health Services, Ibri, Oman
| | - Sevtap Arikan-Akdagli
- Department of Medical Microbiology, Hacettepe University School of Medicine, Sıhhiye Ankara, Turkey
| | - Hamid Badali
- Department of Medical Mycology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ronen Ben-Ami
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Infectious Diseases Unit, Tel Aviv Medical Center, Tel- Aviv, Israel
| | - Alexandro Bonifaz
- Dermatology Service & Mycology Department, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - Stéphane Bretagne
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Department of Mycology, CNRS UMR2000, Parasitology-Mycology Laboratory, Lariboisière, Saint-Louis, Fernand Widal Hospitals, Assistance Publique-Hôpitaux de Paris (AP-HP), Université de Paris, Paris, France
| | - Elio Castagnola
- Infectious Diseases Unit, Istituto Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Methee Chayakulkeeree
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Arnaldo L Colombo
- Special Mycology Laboratory, Division of Infectious Diseases, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Dora E Corzo-León
- Department of Epidemiology and Infectious Diseases, Hospital General Dr Manuel Gea González, Mexico City, Mexico; Medical Mycology and Fungal Immunology/Wellcome Trust Strategic Award Program, Aberdeen Fungal Group, University of Aberdeen, King's College, Aberdeen, UK
| | - Lubos Drgona
- Oncohematology Clinic, Faculty of Medicine, Comenius University and National Cancer Institute, Bratislava, Slovakia
| | - Andreas H Groll
- InfectiousDisease Research Program, Department of Paediatric Hematology/Oncology and Center for Bone Marrow Transplantation, University Children's Hospital Münster, Münster, Germany
| | - Jesus Guinea
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación v Sanitaria Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Claus-Peter Heussel
- Diagnostic and Interventional Radiology, Thoracic Clinic, University Hospital Heidelberg, Heidelberg, Germany
| | - Ashraf S Ibrahim
- Division of Infectious Diseases, Los Angeles Biomedical Research Institute at Harbor-University of California at Los Angeles (UCLA) Medical Center, Torrance, CA, USA
| | - Souha S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nikolay Klimko
- Department of Clinical Mycology, Allergology and Immunology, North Western State Medical University, St Petersburg, Russia
| | - Michaela Lackner
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University Innsbruck, Innsbruck, Austria
| | - Frederic Lamoth
- Infectious Diseases Service, Department of Medicine and Institute of Microbiology, Lausanne University Hospital, Lausanne, Switzerland; Institute of Microbiology, Department of Laboratories, Lausanne University Hospital, Lausanne, Switzerland
| | - Fanny Lanternier
- Institut Pasteur, National Reference Center for Invasive Mycoses and Antifungals, Department of Mycology, Paris Descartes University, Necker-Enfants Malades University Hospital, Department of Infectious Diseases and Tropical Medicine, Centre d'Infectiologie Necker-Pasteur, Institut Imagine, AP-HP, Paris, France
| | - Cornelia Lass-Floerl
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University Innsbruck, Innsbruck, Austria
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, Korea
| | - Thomas Lehrnbecher
- Division of Paediatric Haematology and Oncology, Hospital for Children and Adolescents, Johann Wolfgang Goethe-University, Frankfurt, Germany
| | - Badre E Lmimouni
- School of Medicine and Pharmacy, University Mohammed the fifth, Hay Riad, Rabat, Morocco
| | - Mihai Mares
- Laboratory of Antimicrobial Chemotherapy, Ion Ionescu de la Brad University, Iaşi, Romania
| | - Georg Maschmeyer
- Department of Hematology, Oncology and Palliative Care, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Centre of Expertise in Mycology Radboudumc/Canisius Wilhelmina Hospital, Nijmegen, Netherlands
| | - Joseph Meletiadis
- Clinical Microbiology Laboratory, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Medical Microbiology and Infectious Diseases, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C Orla Morrissey
- Department of Infectious Diseases, Alfred Health & Monash University, Melbourne, Australia
| | - Marcio Nucci
- Department of Internal Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rita Oladele
- Department of Medical Microbiology & Parasitology, College of Medicine, University of Lagos, Yaba, Lagos, Nigeria; Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Livio Pagano
- Department of Hematology, Fondazione Policlinico Universitario A. Gemelli -IRCCS- Universita Cattolica del Sacro Cuore, Roma, Italy
| | - Alessandro Pasqualotto
- Federal University of Health Sciences of Porto Alegre, Hospital Dom Vicente Scherer, Porto Alegre, Brazil
| | - Atul Patel
- Infectious Diseases Clinic, Vedanta Institute of Medical Sciences, Navarangpura, Ahmeddabad, India
| | - Zdenek Racil
- Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | - Malcolm Richardson
- UK NHS Mycology Reference Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Emmanuel Roilides
- Infectious Diseases Unit, 3rd Department of Paediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Thessaloniki, Greece; Hippokration General Hospital, Thessaloniki, Greece
| | - Markus Ruhnke
- Hämatologie & Internistische Onkologie, Lukas-Krankenhaus Bünde, Onkologische Ambulanz, Bünde, Germany
| | - Seyedmojtaba Seyedmousavi
- Department of Medical Mycology/Invasive Fungi Research Center (IFRC), School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran; Center of Expertise in Microbiology, Infection Biology and Antimicrobial Pharmacology, Tehran, Iran; Molecular Microbiology Section, Laboratory of Clinical Immunology and Microbiology, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Neeraj Sidharthan
- Department of Hemato Oncology, Amrita Institute of Medical Sciences, Amrita Viswa Vidyapeetham University, Kochi, India
| | - Nina Singh
- Division of Infectious Diseases, University of Pittsburgh Medical Center and VA Pittsburgh Healthcare System, Infectious Diseases Section, University of Pittsburgh, Pittsburgh, PA, USA
| | - János Sinko
- Infectious Diseases Unit, Szent Istvan and Szent Laszlo Hospital, Budapest, Hungary
| | - Anna Skiada
- Department of Infectious Diseases, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Monica Slavin
- University of Melbourne, Melbourne, VIC, Australia; The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Parkville, Melbourne, VIC, Australia
| | - Rajeev Soman
- P D Hinduja Hospital & Medical Research Centre, Department of Medicine, Veer Sarvarkar Marg, Mumbai, India
| | - Brad Spellberg
- Los Angeles County and University of Southern California (LAC+USC) Medical Center, Los Angeles, CA, USA
| | - William Steinbach
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University Medical Center, Durham, NC, USA
| | - Ban Hock Tan
- Department of Infectious Diseases, Singapore General Hospital, Singapur, Singapore
| | - Andrew J Ullmann
- Department for Internal Medicine II, University Hospital Würzburg, Würzburg, Germany
| | - Jörg J Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; Department of Internal Medicine, Hematology/Oncology, Goethe University Frankfurt, Frankfurt, Germany
| | - Maria J G T Vehreschild
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF) partner site Bonn-Cologne, Cologne, Germany; Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt, Germany
| | - Thomas J Walsh
- Departments of Medicine, Pediatrics, Microbiology & Immunology, Weill Cornell Medicine, and New York Presbyterian Hospital, New York City, NY, USA
| | - P Lewis White
- Public Health Wales Microbiology Cardiff, UHW, Heath Park, Cardiff, UK
| | - Nathan P Wiederhold
- Fungus Testing Laboratory, University of Texas Health Science Center, San Antonio, TX, USA
| | - Theoklis Zaoutis
- Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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79
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Shadrivova OV, Burygina EV, Klimko NN. Molecular Diagnostics of Mucormycosis in Hematological Patients: A Literature Review. J Fungi (Basel) 2019; 5:jof5040112. [PMID: 31795369 PMCID: PMC6958327 DOI: 10.3390/jof5040112] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/26/2019] [Accepted: 11/27/2019] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES to analyze the results of molecular methods applying for the diagnosis of mucormycosis in hematologic patients based on a literature review. DATA SOURCES A systematic search in databases PubMed, Google Scholar for August 2019. Review eligibility criteria: original articles published in English, studies of molecular methods for the diagnosis of mucormycosis in hematologic patients. RESULTS We analyzed the research data from 116 hematological patients with mucormycosis, including children (6%). Patients with localized forms of mucormycosis prevailed (72%), and lung involvement was diagnosed in 58% of these cases. For molecular verification of the causative agent of mucormycosis, blood serum was most often used, less commonly postoperative and autopsy material, biopsy specimens, formalin-fixed paraffin-embedded samples and bronchoalveolar lavage, pleural fluid and sputum. The sensitivity of molecular diagnostics of mucormycosis in a cohort of hematological patients was 88.2%. CONCLUSION The use of molecular techniques along with standard mycological methods will improve the diagnostics of mucormycosis in hematologic patients. However, prospective studies of the effectiveness of molecular methods for the diagnosis of mucormycosis of various etiologies in hematological patients, including children, using bronchoalveolar lavage (BAL) and cerebrospinal fluid (CSF) are needed.
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80
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Uchida T, Okamoto M, Fujikawa K, Yoshikawa D, Mizokami A, Mihara T, Kondo A, Ohba K, Kurohama K, Nakashima M, Sekine I, Nakamura S, Miyazaki Y, Kawakami A. Gastric mucormycosis complicated by a gastropleural fistula: A case report and review of the literature. Medicine (Baltimore) 2019; 98:e18142. [PMID: 31770250 PMCID: PMC6890297 DOI: 10.1097/md.0000000000018142] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
RATIONALE Mucormycosis is a rare opportunistic fungal infection with poor prognosis. The incidence of mucormycosis has been increasing, and it is a threat to immunocompromised hosts. We present a case of gastric mucormycosis complicated by a gastropleural fistula during immunosuppressive treatment for adult-onset Still disease (AOSD). PATIENT CONCERNS An 82-year-old woman diagnosed with AOSD who developed gastric ulcers during the administration of an immunosuppressive therapy with corticosteroids, cyclosporine, and tocilizumab complained of melena and epigastralgia. Esophagogastroduodenoscopy showed multiple ulcers covered with grayish or greenish exudates. DIAGNOSES The patient diagnosed with mucormycosis based on culture and biopsy of the ulcers, which showed nonseptate hyphae branching at wide angles. Mucor indicus was identified using polymerase chain reaction. INTERVENTIONS AND OUTCOMES Although liposomal amphotericin B was administered, gastric mucormycosis was found to be complicated by a gastropleural fistula. The patient died because of pneumonia due to cytomegalovirus infection, and autopsy revealed the presence of Mucorales around the fistula connecting the stomach and diaphragm. LESSONS Gastric mucormycosis is refractory to treatment and fatal. Surgical resection, if possible, along with antifungal drugs can result in better outcomes.
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Affiliation(s)
| | | | | | | | | | - Tomo Mihara
- Department of Infectious Disease, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya
| | - Akira Kondo
- Department of Infectious Disease, Japan Community Healthcare Organization, Isahaya General Hospital, Isahaya
| | | | - Kazuhiro Kurohama
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki
| | - Masahiro Nakashima
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki
| | - Ichiro Sekine
- Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, Nagasaki
| | - Shigeki Nakamura
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo
| | - Yoshitsugu Miyazaki
- Department of Chemotherapy and Mycoses, National Institute of Infectious Diseases, Tokyo
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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81
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Aftandilian C, Eguiguren L, Mathew R, Messner A. Mucormycosis diagnosed during induction chemotherapy in five pediatric patients with acute lymphoblastic leukemia. Pediatr Blood Cancer 2019; 66:e27834. [PMID: 31131954 DOI: 10.1002/pbc.27834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/02/2019] [Accepted: 05/14/2019] [Indexed: 01/22/2023]
Abstract
Mucormycosis in pediatric oncology patients is a rare invasive fungal infection associated with significant morbidity and mortality. We describe five patients diagnosed with mucormycosis during induction chemotherapy for acute lymphoblastic leukemia at our institution. All of the patients in our series survived, some in spite of having disseminated disease. Most of the patients' chemotherapy was modified with the aim of controlling their leukemia while minimizing immunosuppression until their fungal infection was under control. Although mucormycosis is frequently fatal, rapid diagnosis and a multidisciplinary approach can lead to excellent outcomes, even in patients undergoing intensive chemotherapy.
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Affiliation(s)
- Catherine Aftandilian
- Pediatric Hematology/Oncology, Stanford University School of Medicine, Palo Alto, California
| | - Lourdes Eguiguren
- Pediatric Infectious Disease, Stanford University School of Medicine, Palo Alto, California
| | - Roshni Mathew
- Pediatric Infectious Disease, Stanford University School of Medicine, Palo Alto, California
| | - Anna Messner
- Pediatric Otolaryngology/Head and Neck Surgery, Stanford University School of Medicine, Palo Alto, California
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82
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Hassan MIA, Cseresnyes Z, Al-Zaben N, Dahse HM, Vilela de Oliveira RJ, Walther G, Voigt K, Figge MT. The geographical region of origin determines the phagocytic vulnerability of Lichtheimia strains. Environ Microbiol 2019; 21:4563-4581. [PMID: 31330072 DOI: 10.1111/1462-2920.14752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/17/2019] [Indexed: 12/15/2022]
Abstract
Mucormycoses are life-threatening infections that affect patients suffering from immune deficiencies. We performed phagocytosis assays confronting various strains of Lichtheimia species with alveolar macrophages, which form the first line of defence of the innate immune system. To investigate 17 strains from four different continents in a comparative fashion, transmitted light and confocal fluorescence microscopy was applied in combination with automated image analysis. This interdisciplinary approach enabled the objective and quantitative processing of the big volume of image data. Applying machine-learning supported methods, a spontaneous clustering of the strains was revealed in the space of phagocytic measures. This clustering was not driven by measures of fungal morphology but rather by the geographical origin of the fungal strains. Our study illustrates the crucial contribution of machine-learning supported automated image analysis to the qualitative discovery and quantitative comparison of major factors affecting host-pathogen interactions. We found that the phagocytic vulnerability of Lichtheimia species depends on their geographical origin, where strains within each geographic region behaved similarly, but strongly differed amongst the regions. Based on this clustering, we were able to also classify clinical isolates with regard to their potential geographical origin.
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Affiliation(s)
- Mohamed I Abdelwahab Hassan
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena, Germany.,Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany.,Pests & Plant Protection Department, National Research Centre, 33rd El Buhouth St., 12622 Dokki, Giza, Egypt
| | - Zoltan Cseresnyes
- Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena, Germany
| | - Naim Al-Zaben
- Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany.,Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena, Germany
| | - Hans-Martin Dahse
- Infection Biology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena, Germany
| | - Rafael J Vilela de Oliveira
- Post-Graduate Course in the Biology of Fungi, Department of Mycology, Federal University of Pernambuco, Av. Prof. Nelson Chaves, s/n, Recife, Prince Edward Island, Brazil
| | - Grit Walther
- National Reference Center for Invasive Fungal Infections, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena, Germany
| | - Kerstin Voigt
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena, Germany.,Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany
| | - Marc Thilo Figge
- Institute of Microbiology, Faculty of Biological Sciences, Friedrich Schiller University Jena, Jena, Germany.,Applied Systems Biology, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knöll Institute, Jena, Germany
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83
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Chikley A, Ben-Ami R, Kontoyiannis DP. Mucormycosis of the Central Nervous System. J Fungi (Basel) 2019; 5:jof5030059. [PMID: 31288475 PMCID: PMC6787740 DOI: 10.3390/jof5030059] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 12/17/2022] Open
Abstract
Mucormycosis involves the central nervous system by direct extension from infected paranasal sinuses or hematogenous dissemination from the lungs. Incidence rates of this rare disease seem to be rising, with a shift from the rhino-orbital-cerebral syndrome typical of patients with diabetes mellitus and ketoacidosis, to disseminated disease in patients with hematological malignancies. We present our current understanding of the pathobiology, clinical features, and diagnostic and treatment strategies of cerebral mucormycosis. Despite advances in imaging and the availability of novel drugs, cerebral mucormycosis continues to be associated with high rates of death and disability. Emerging molecular diagnostics, advances in experimental systems and the establishment of large patient registries are key components of ongoing efforts to provide a timely diagnosis and effective treatment to patients with cerebral mucormycosis.
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Affiliation(s)
- Amanda Chikley
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
| | - Ronen Ben-Ami
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel.
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, The University of Texas, M.D. Anderson Cancer Center, Houston 77030, TexasTX 77030, USA.
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84
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Hassan MIA, Voigt K. Pathogenicity patterns of mucormycosis: epidemiology, interaction with immune cells and virulence factors. Med Mycol 2019; 57:S245-S256. [PMID: 30816980 PMCID: PMC6394756 DOI: 10.1093/mmy/myz011] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/20/2018] [Accepted: 02/13/2019] [Indexed: 12/14/2022] Open
Abstract
Fungi of the basal lineage order Mucorales are able to cause infections in animals and humans. Mucormycosis is a well-known, life-threatening disease especially in patients with a compromised immune system. The rate of mortality and morbidity caused by mucormycosis has increased rapidly during the last decades, especially in developing countries. The systematic, phylogenetic, and epidemiological distributions of mucoralean fungi are addressed in relation to infection in immunocompromised patients. The review highlights the current achievements in (i) diagnostics and management of mucormycosis, (ii) the study of the interaction of Mucorales with cells of the innate immune system, (iii) the assessment of the virulence of Mucorales in vertebrate and invertebrate infection models, and (iv) the determination of virulence factors that are key players in the infection process, for example, high-affinity iron permease (FTR1), spore coat protein (CotH), alkaline Rhizopus protease enzyme (ARP), ADP-ribosylation factor (ARF), dihydrolipoyl dehydrogenase, calcineurin (CaN), serine and aspartate proteases (SAPs). The present mini-review attempts to increase the awareness of these difficult-to-manage fungal infections and to encourage research in the detection of ligands and receptors as potential diagnostic parameters and drug targets.
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Affiliation(s)
- Mohamed I Abdelwahab Hassan
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, Adolf-Reichwein-Strasse 23, 07745 Jena, Germany
- Department of Microbiology and Molecular Biology, Institute of Microbiology, Faculty of Biological Sciences, University of Jena, Neugasse 25, 07743 Jena, Germany
- Pests and Plant Protection Department, National Research Centre, 33rd El Buhouth Street (Postal code: 12622) Dokki, Giza, Egypt
| | - Kerstin Voigt
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology - Hans Knoell Institute, Adolf-Reichwein-Strasse 23, 07745 Jena, Germany
- Department of Microbiology and Molecular Biology, Institute of Microbiology, Faculty of Biological Sciences, University of Jena, Neugasse 25, 07743 Jena, Germany
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85
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Global Epidemiology of Mucormycosis. J Fungi (Basel) 2019; 5:jof5010026. [PMID: 30901907 PMCID: PMC6462913 DOI: 10.3390/jof5010026] [Citation(s) in RCA: 415] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/14/2019] [Accepted: 03/16/2019] [Indexed: 12/16/2022] Open
Abstract
Mucormycosis is an angio-invasive fungal infection, associated with high morbidity and mortality. A change in the epidemiology of mucormycosis has been observed in recent years with the rise in incidence, new causative agents and susceptible population. The rise has been perceived globally, but it is very high in the Asian continent. Though diabetes mellitus overshadow all other risk factors in Asia, post-tuberculosis and chronic renal failure have emerged as new risk groups. The rhino-cerebral form of mucormycosis is most commonly seen in patients with diabetes mellitus, whereas, pulmonary mucormycosis in patients with haematological malignancy and transplant recipients. In immunocompetent hosts, cutaneous mucormycosis is commonly seen following trauma. The intriguing clinical entity, isolated renal mucormycosis in immunocompetent patients is only reported from China and India. A new clinical entity, indolent mucormycosis in nasal sinuses, is recently recognized. The causative agents of mucormycosis vary across different geographic locations. Though Rhizopusarrhizus is the most common agent isolated worldwide, Apophysomycesvariabilis is predominant in Asia and Lichtheimia species in Europe. The new causative agents, Rhizopus homothallicus, Mucor irregularis, and Thamnostylum lucknowense are reported from Asia. In conclusion, with the change in epidemiology of mucormycosis country-wise studies are warranted to estimate disease burden in different risk groups, analyse the clinical disease pattern and identify the new etiological agents.
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86
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Millon L, Scherer E, Rocchi S, Bellanger AP. Molecular Strategies to Diagnose Mucormycosis. J Fungi (Basel) 2019; 5:jof5010024. [PMID: 30897709 PMCID: PMC6463105 DOI: 10.3390/jof5010024] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 03/14/2019] [Accepted: 03/18/2019] [Indexed: 12/14/2022] Open
Abstract
Molecular techniques have provided a new understanding of the epidemiology of mucormycosis and improved the diagnosis and therapeutic management of this life-threatening disease. PCR amplification and sequencing were first applied to better identify isolates that were grown from cultures of biopsies or bronchalveolar lavage samples that were collected in patients with Mucorales infection. Subsequently, molecular techniques were used to identify the fungus directly from the infected tissues or from bronchalveolar lavage, and they helped to accurately identify Mucorales fungi in tissue samples when the cultures were negative. However, these tools require invasive sampling (biospsy, bronchalveolar lavage), which is not feasible in patients in poor condition in Hematology or Intensive Care units. Very recently, PCR-based procedures to detect Mucorales DNA in non-invasive samples, such as plasma or serum, have proved successful in diagnosing mucormycosis early in all patients, whatever the clinical status, and these procedures are becoming essential to improving patient outcome.
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Affiliation(s)
- Laurence Millon
- Parasitology Mycology Department, University Hospital, 25000 Besancon, France.
- Chrono-Environnement UMR/CNRS 6249, University of Bourgogne Franche-Comté, 25000 Besançon, France.
| | - Emeline Scherer
- Parasitology Mycology Department, University Hospital, 25000 Besancon, France.
- Chrono-Environnement UMR/CNRS 6249, University of Bourgogne Franche-Comté, 25000 Besançon, France.
| | - Steffi Rocchi
- Parasitology Mycology Department, University Hospital, 25000 Besancon, France.
- Chrono-Environnement UMR/CNRS 6249, University of Bourgogne Franche-Comté, 25000 Besançon, France.
| | - Anne-Pauline Bellanger
- Parasitology Mycology Department, University Hospital, 25000 Besancon, France.
- Chrono-Environnement UMR/CNRS 6249, University of Bourgogne Franche-Comté, 25000 Besançon, France.
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87
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Klimko N, Khostelidi S, Shadrivova O, Volkova A, Popova M, Uspenskaya O, Shneyder T, Bogomolova T, Ignatyeva S, Zubarovskaya L, Afanasyev B. Contrasts between mucormycosis and aspergillosis in oncohematological patients. Med Mycol 2019; 57:S138-S144. [DOI: 10.1093/mmy/myy116] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 09/06/2018] [Accepted: 10/17/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- N Klimko
- I.Mechnikov North-Western State Medical University, 1/28 Santiago de Cuba str., St. Petersburg, Russian Federation, 194291
| | - S Khostelidi
- I.Mechnikov North-Western State Medical University, 1/28 Santiago de Cuba str., St. Petersburg, Russian Federation, 194291
| | - O Shadrivova
- I.Mechnikov North-Western State Medical University, 1/28 Santiago de Cuba str., St. Petersburg, Russian Federation, 194291
| | - A Volkova
- I.P.Pavlov First Saint Petersburg State Medical University, 6–8 L’va Tolstogo str., Saint Petersburg, Russian Federation, 197022
| | - M Popova
- I.P.Pavlov First Saint Petersburg State Medical University, 6–8 L’va Tolstogo str., Saint Petersburg, Russian Federation, 197022
| | - O Uspenskaya
- Leningrad Regional Clinical Hospital, 45 Lunacharskogo prospect, St. Petersburg, Russian Federation, 197022
| | - T Shneyder
- Leningrad Regional Clinical Hospital, 45 Lunacharskogo prospect, St. Petersburg, Russian Federation, 197022
| | - T Bogomolova
- I.Mechnikov North-Western State Medical University, 1/28 Santiago de Cuba str., St. Petersburg, Russian Federation, 194291
| | - S Ignatyeva
- I.Mechnikov North-Western State Medical University, 1/28 Santiago de Cuba str., St. Petersburg, Russian Federation, 194291
| | - L Zubarovskaya
- I.P.Pavlov First Saint Petersburg State Medical University, 6–8 L’va Tolstogo str., Saint Petersburg, Russian Federation, 197022
| | - B Afanasyev
- I.P.Pavlov First Saint Petersburg State Medical University, 6–8 L’va Tolstogo str., Saint Petersburg, Russian Federation, 197022
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88
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Manesh A, Rupali P, Sullivan MO, Mohanraj P, Rupa V, George B, Michael JS. Mucormycosis-A clinicoepidemiological review of cases over 10 years. Mycoses 2019; 62:391-398. [PMID: 30685896 DOI: 10.1111/myc.12897] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 11/17/2018] [Accepted: 01/18/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND Limited data exist for epidemiology and outcomes of various agents causing mucormycosis in various clinical settings from developing countries like India. OBJECTIVES To study the epidemiology and outcomes of various agents causing mucormycosis in different clinical settings in a tertiary care hospital from South India. PATIENTS AND METHODS We reviewed details of 184 consecutive patients with culture-proven mucormycosis with consistent clinical syndrome and supporting features from September 2005 to September 2015. RESULTS The mean age of patients was 50.42 years; 70.97% were male. Unlike developed countries, R microsporus (29/184; 15.7%) and Apophysomyces elegans (20/184; 10.8%) also evolved as important pathogens in addition to R arrhizus in our setting. Paranasal sinuses (136/184; 73.9%) followed by musculoskeletal system (28/184; 15.2%) were the common areas of involvement. Apophysomyces elegans typically produced skin and musculoskeletal disease in immune-competent individuals with trauma (12/20; 60%) and caused significantly lower mortality (P = 0.03). R microsporus was more common in patients with haematological conditions (25% vs 15.7%) and was less frequently a cause for sinusitis than R arrhizus (27.58% vs 10.9%). The overall mortality was 30.97%. Combination therapy with surgery and antifungals offered the best chance for cure. CONCLUSIONS Agents causing mucormycosis may have unique clinical and epidemiological characteristics.
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Affiliation(s)
- Abi Manesh
- Christian Medical College, Vellore, Tamil Nadu, India
| | | | | | | | - Vedantam Rupa
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Biju George
- Christian Medical College, Vellore, Tamil Nadu, India
| | - Joy S Michael
- Christian Medical College, Vellore, Tamil Nadu, India
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89
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Viñuela L, Domínguez-Gil M, de Frutos M, López-Urrutia L, Ramos C, Eiros JM. [Uncommon mycoses]. Rev Iberoam Micol 2019; 36:41-43. [PMID: 30686746 DOI: 10.1016/j.riam.2018.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 06/06/2018] [Accepted: 07/30/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Fungal infections should be suspected in severe wounds that have been contaminated with organic material or soil, even when the patient is immunocompetent. The aim of this article is to contribute to a better understanding and knowledge of the antifungal sensitivity and epidemiology of some rare pathogens that may trigger severe infections. CASE REPORT Four different moulds were isolated from the wounds of an immunocompetent woman who was involved in a road accident: Lichtheimia corymbifera, Scedosporium boydii, Fusarium solani and Purpureocillium lilacinum. Some of them were isolated from different sites. A profile of in vitro resistance was performed with an Epsilometer (Etest™) using five antifungal agents: voriconazole, posaconazole, itraconazole, anidulafungin an amphotericin B. The results obtained were consistent with those from other cases reported in the literature. CONCLUSIONS Early aggressive surgery, antifungal therapy and, above all, frequent debridement of necrotic tissue, are the tools against filamentous fungi infections. Antifungal sensitivity of any mould involved in an infection has to be determined, in order to a better understanding of these rare pathogens whose incidence is increasing.
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Affiliation(s)
- Lourdes Viñuela
- Servicio de Microbiología y Parasitología, Hospital Universitario Río Hortega, Valladolid, España.
| | - Marta Domínguez-Gil
- Servicio de Microbiología y Parasitología, Hospital Universitario Río Hortega, Valladolid, España
| | - Mónica de Frutos
- Servicio de Microbiología y Parasitología, Hospital Universitario Río Hortega, Valladolid, España
| | - Luis López-Urrutia
- Servicio de Microbiología y Parasitología, Hospital Universitario Río Hortega, Valladolid, España
| | - Carmen Ramos
- Servicio de Microbiología y Parasitología, Hospital Universitario Río Hortega, Valladolid, España
| | - José María Eiros
- Servicio de Microbiología y Parasitología, Hospital Universitario Río Hortega, Valladolid, España
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90
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Jeong W, Keighley C, Wolfe R, Lee WL, Slavin MA, Chen SCA, Kong DCM. Contemporary management and clinical outcomes of mucormycosis: A systematic review and meta-analysis of case reports. Int J Antimicrob Agents 2019; 53:589-597. [PMID: 30639526 DOI: 10.1016/j.ijantimicag.2019.01.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 12/20/2018] [Accepted: 01/06/2019] [Indexed: 11/27/2022]
Abstract
With the advent of newer antifungals, optimum treatment of mucormycosis remains to be fully elucidated. This study systematically evaluated the contemporary management and outcomes of mucormycosis. Mucormycosis cases in patients aged ≥18 years published between January 2000 and January 2017 were identified through Ovid MEDLINE and Embase. Of the 3619 articles identified, 600 (851 individual patient cases) were included in the review. Of the 851 patient cases, antifungal treatment details were available for 785. Intravenous (i.v.) amphotericin B formulations remained the most commonly prescribed first-line antifungals (760/785; 96.8%): 88.2% (670/760) were initiated as monotherapy and 11.8% (90/760) as combination antifungal therapy. Posaconazole oral suspension monotherapy was prescribed as an initial antifungal in 11 cases. It was also administered as maintenance or salvage therapy in 39 and 25 cases, respectively. Itraconazole capsule monotherapy (n = 10) was prescribed primarily for cutaneous disease in patients not receiving any immunosuppressive therapy. All-cause 90-day mortality was 41.0% (349/851). Initial treatment with combination antifungals did not reduce 90-day mortality compared with i.v. conventional amphotericin B or i.v. liposomal amphotericin B monotherapy [35/90 (38.9%) vs. 146/369 (39.6%) vs. 91/258 (35.3%), respectively; P = 0.541]. Concomitant surgical and antifungal therapy was associated with significantly lower 90-day mortality compared with treatment with antifungals alone (OR = 0.23, 95% CI 0.13-0.41; P < 0.001). The findings suggest that first-line antifungals with good efficacy remain an urgent unmet need. Whilst surgery is fundamental to improving survival, the clinical utility of combination antifungal therapy or posaconazole monotherapy requires further investigation.
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Affiliation(s)
- Wirawan Jeong
- Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia
| | - Caitlin Keighley
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, The University of Sydney, 170 Hawkesbury Road, Westmead, NSW 2145, Australia; Marie Bashir Institute for Biosecurity and Emerging Infections, The University of Sydney, 176 Hawkesbury Road, Westmead, NSW 2145, Australia
| | - Rory Wolfe
- Department of Epidemiology and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC 3004, Australia
| | - Wee Leng Lee
- Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia
| | - Monica A Slavin
- National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC 3050, Australia
| | - Sharon C-A Chen
- Centre for Infectious Diseases and Microbiology Laboratory Services, ICPMR, New South Wales Health Pathology, Westmead Hospital, The University of Sydney, 170 Hawkesbury Road, Westmead, NSW 2145, Australia; Marie Bashir Institute for Biosecurity and Emerging Infections, The University of Sydney, 176 Hawkesbury Road, Westmead, NSW 2145, Australia
| | - David C M Kong
- Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia; Pharmacy Department, Ballarat Health Services, 1 Drummond Street N., Ballarat Central, VIC 3350, Australia; The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC 3000, Australia.
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91
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Jeong W, Keighley C, Wolfe R, Lee W, Slavin M, Kong D, Chen SA. The epidemiology and clinical manifestations of mucormycosis: a systematic review and meta-analysis of case reports. Clin Microbiol Infect 2019; 25:26-34. [DOI: 10.1016/j.cmi.2018.07.011] [Citation(s) in RCA: 236] [Impact Index Per Article: 47.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 12/20/2022]
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92
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Skiada A, Lass-Floerl C, Klimko N, Ibrahim A, Roilides E, Petrikkos G. Challenges in the diagnosis and treatment of mucormycosis. Med Mycol 2018. [PMID: 29538730 DOI: 10.1093/mmy/myx101] [Citation(s) in RCA: 264] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The diagnosis and treatment of mucormycosis are challenging. The incidence of the disease seems to be increasing. Hematological malignancies are the most common underlying disease in countries with high income and uncontrolled diabetes in developing countries. Clinical approach to diagnosis lacks sensitivity and specificity. Radiologically, multiple (≥10) nodules and pleural effusion are reportedly associated with pulmonary mucormycosis. Another finding on computerized tomography (CT) scan, which seems to indicate the presence of mucormycosis, is the reverse halo sign. Microscopy (direct and on histopathology) and culture are the cornerstones of diagnosis. Molecular assays can be used either for detection or identification of mucormycetes, and they can be recommended as valuable add-on tools that complement conventional diagnostic procedures. Successful management of mucormycosis is based on a multimodal approach, including reversal or discontinuation of underlying predisposing factors, early administration of active antifungal agents at optimal doses, complete removal of all infected tissues, and use of various adjunctive therapies. Our armamentarium of antifungals is slightly enriched by the addition of two newer azoles (posaconazole and isavuconazole) to liposomal amphotericin B, which remains the drug of choice for the initial antifungal treatment, according to the recently published guidelines by ECIL-6, as well as those published by ECMM/ESCMID. Despite the efforts for better understanding of the pathogenesis, early diagnosis and aggressive treatment of mucormycosis, the mortality rate of the disease remains high.
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Affiliation(s)
- A Skiada
- Laiko Hospital, National and Kapodistrian University of Athens, Greece
| | - C Lass-Floerl
- Division of Hygiene and Medical Microbiology, Laboratory for Invasive Fungal Infections, Medical University of Innsbruck, Austria
| | - N Klimko
- Department of Clinical Mycology, Allergy and Immunology, North Western State Medical University, Saint Petersburg, Russia
| | - A Ibrahim
- Division of Infectious Diseases, David Geffen School of Medicine, UCLA.,Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, USA
| | - E Roilides
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration General Hospital, Thessaloniki, Greece
| | - G Petrikkos
- School of Medicine, European University of Cyprus
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93
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Pilmis B, Alanio A, Lortholary O, Lanternier F. Recent advances in the understanding and management of mucormycosis. F1000Res 2018; 7. [PMID: 30271573 PMCID: PMC6134337 DOI: 10.12688/f1000research.15081.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 12/11/2022] Open
Abstract
Mucormycoses were difficult-to-manage infections owing to limited diagnostic tools and therapeutic options. We review here advances in pathology understanding, diagnostic tools including computed tomography, and serum polymerase chain reaction and therapeutic options.
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Affiliation(s)
- Benoit Pilmis
- Paris Descartes University, Sorbonne Paris Cité, Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Imagine Institute, Paris, France.,Antimicrobial Stewardship Team, Microbiology Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Alexandre Alanio
- Université Paris Diderot, Sorbonne Paris Cité, Laboratoire de Parasitologie-Mycologie, Hôpital Saint-Louis, Groupe Hospitalier Lariboisière, Saint-Louis, Fernand Widal, AP-HP, Paris, France.,Molecular Mycology Unit, Institut Pasteur, CNRS UMR2000, Paris, France.,Centre National de Référence Mycoses invasives et Antifongiques, Institut Pasteur, Paris, France
| | - Olivier Lortholary
- Paris Descartes University, Sorbonne Paris Cité, Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Imagine Institute, Paris, France.,Molecular Mycology Unit, Institut Pasteur, CNRS UMR2000, Paris, France.,Centre National de Référence Mycoses invasives et Antifongiques, Institut Pasteur, Paris, France
| | - Fanny Lanternier
- Paris Descartes University, Sorbonne Paris Cité, Infectious Diseases Unit, Necker-Enfants Malades University Hospital, AP-HP, Imagine Institute, Paris, France.,Molecular Mycology Unit, Institut Pasteur, CNRS UMR2000, Paris, France.,Centre National de Référence Mycoses invasives et Antifongiques, Institut Pasteur, Paris, France
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94
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El Zein S, El-Cheikh J, El Zakhem A, Ibrahim D, Bazarbachi A, Kanj SS. Mucormycosis in hospitalized patients at a tertiary care center in Lebanon: a case series. Infection 2018; 46:811-821. [PMID: 30121719 DOI: 10.1007/s15010-018-1195-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 08/13/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Mucormycosis (MCM) is a rare fungal infection affecting people with impaired immunity. Data related to MCM from Lebanon are scarce. The aim of this study is to shed light on the epidemiology, incidence, and outcome of patients with MCM hospitalized at a tertiary care center in Lebanon. METHODS We conducted a retrospective chart review between Jan 1, 2008 and Jan 10, 2018. All patients with proven or probable MCM were included. RESULTS A total of 20 patients were included. Their median age was 49 years and the majority were males. Comorbidities included mainly hematologic malignancy and diabetes mellitus. Most common sites of involvement were rhino-orbital and pulmonary, respectively. The number of MCM cases/10.000 hospital admissions increased significantly between 2008 and 2017 (0.47 vs. 1.18; P < 0.05). A liposomal amphotericin B formulation alone or in combination with other antifungals was used as a first line agent in all patients. All-cause mortality was 60%; however, death was attributed to MCM in 20% of cases. CONCLUSION The incidence of MCM has significantly increased over the past 10 years at our institution, most likely due to the increasing patient population at risk. Understanding the epidemiology of MCM in our setting would help guide antifungal therapy.
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Affiliation(s)
- Saeed El Zein
- Division of Infectious Diseases, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Jean El-Cheikh
- Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aline El Zakhem
- Division of Infectious Diseases, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Dima Ibrahim
- Division of Infectious Diseases, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon
| | - Ali Bazarbachi
- Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Souha S Kanj
- Division of Infectious Diseases, American University of Beirut Medical Center, Riad El Solh, PO Box 11-0236, Beirut, 1107 2020, Lebanon.
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95
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Kaneko Y, Oinuma KI, Terachi T, Arimura Y, Niki M, Yamada K, Kakeya H, Mizutani T. Successful Treatment of Intestinal Mycosis Caused by a Simultaneous Infection with Lichtheimia ramosa and Aspergillus calidoustus. Intern Med 2018. [PMID: 29526942 PMCID: PMC6148160 DOI: 10.2169/internalmedicine.0254-17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
A 53-year-old woman was hospitalized due to septic shock after developing pneumococcal pneumonia after undergoing esophageal cancer surgery. Her transverse colon became perforated after receiving antimicrobial chemotherapy; therefore, emergency subtotal colectomy was performed. Fungi detected in both her colon tissue and a drainage sample indicated intestinal mucormycosis. Early intensive treatment with high-dose liposomal amphotericin B was successful, and she was subsequently discharged from the hospital. The fungal isolates were identified to be Lichtheimia ramosa and Aspergillus calidoustus via gene sequencing using panfungal primers as well as species-specific primers against elongation factor 1 and beta-tubulin for detecting Lichtheimia and Aspergillus, respectively.
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Affiliation(s)
- Yukihiro Kaneko
- Department of Bacteriology, Osaka City University Graduate School of Medicine, Japan
- Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, Japan
| | - Ken-Ichi Oinuma
- Department of Bacteriology, Osaka City University Graduate School of Medicine, Japan
- Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, Japan
| | - Tsuneko Terachi
- Department of Infection Control Center, Osaka Police Hospital, Japan
| | | | - Mamiko Niki
- Department of Bacteriology, Osaka City University Graduate School of Medicine, Japan
- Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, Japan
| | - Koichi Yamada
- Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, Japan
- Department of Infection Control Science, Osaka City University Graduate School of Medicine, Japan
| | - Hiroshi Kakeya
- Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, Japan
- Department of Infection Control Science, Osaka City University Graduate School of Medicine, Japan
| | - Tetsu Mizutani
- Department of Infection Control Center, Osaka Police Hospital, Japan
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96
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Pomorska A, Malecka A, Jaworski R, Radon-Proskura J, Hare RK, Nielsen HV, Andersen LO, Jensen HE, Arendrup MC, Irga-Jaworska N. Isavuconazole in a Successful Combination Treatment of Disseminated Mucormycosis in a Child with Acute Lymphoblastic Leukaemia and Generalized Haemochromatosis: A Case Report and Review of the Literature. Mycopathologia 2018; 184:81-88. [DOI: 10.1007/s11046-018-0287-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 07/02/2018] [Indexed: 01/31/2023]
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97
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Nezafati S, Kazemi A, Asgari K, Bahrami A, Naghili B, Yazdani J. Rhinocerebral mucormycosis, risk factors and the type of oral manifestations in patients referred to a University Hospital in Tabriz, Iran 2007-2017. Mycoses 2018; 61:764-769. [PMID: 29896908 DOI: 10.1111/myc.12802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 06/10/2018] [Accepted: 06/11/2018] [Indexed: 12/12/2022]
Abstract
Inadequate data are available on the global epidemiology of mucormycosis, mainly derived from the evaluation of specific population groups. Rhinocerebral mucormycosis is an invading and fatal mycosis, particularly among diabetic patients. In the present study, patients hospitalised in Imam Reza Hospital in Tabriz, from 2007 to 2017, were evaluated. The hospital information system (HIS) was used to collect the records of the patients. A total of 42 patients with a diagnosis of mucormycosis were included in the study, 40 cases (95%) of which had a diagnosis of the rhinocerebral form. Of these 40 patients, 21 (52.5%) and 19 (47.5%) were male and female, respectively. Seven cases (17.5%) of rhinocerebral mucormycosis were due to dental procedures. The most predisposing factor in the patients was diabetes with 36 (90%) cases. In our study, the role of tooth extraction in patients with uncontrolled diabetes was identified as an important factor. It may show the important role of dentists in preventing of the disease in diabetic patients.
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Affiliation(s)
- Saeed Nezafati
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Abdolhassan Kazemi
- Department of Parasitology and Medical Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kasra Asgari
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Bahrami
- Department of Endocrinology and Metabolism, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Behrooz Naghili
- Department of Tropical and Infectious Diseases, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Yazdani
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
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98
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Características clínicas y evolución de los pacientes diagnosticados de mucormicosis en un hospital de tercer nivel (2012-2016). Rev Iberoam Micol 2018; 35:162-166. [DOI: 10.1016/j.riam.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/27/2018] [Accepted: 04/27/2018] [Indexed: 11/20/2022] Open
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