151
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Ha TS, Park CM, Yang JH, Cho YH, Chung CR, Jeon K, Suh GY. Disseminated Gastrointestinal Mucormycosis in Immunocompromised Disease. Korean J Crit Care Med 2015. [DOI: 10.4266/kjccm.2015.30.4.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Berdai MA, Labib S, Harandou M. [Rhinocerebral mucormycosis complicating ketoacidosis diabetes]. Presse Med 2015; 45:145-6. [PMID: 26632090 DOI: 10.1016/j.lpm.2015.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Mohamed Adnane Berdai
- Centre hospitalier universitaire Hassan II, service de réanimation mère et enfant, route Sidi Hrazem, 30070 Fès, Maroc.
| | - Smael Labib
- Centre hospitalier universitaire Hassan II, service de réanimation mère et enfant, route Sidi Hrazem, 30070 Fès, Maroc
| | - Mustapha Harandou
- Centre hospitalier universitaire Hassan II, service de réanimation mère et enfant, route Sidi Hrazem, 30070 Fès, Maroc
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Plowes Hernández O, Prado Calleros HM, Soberón Marmissolle Daguerre GS, Sadek González A. Rhino-Orbito-Cerebral Mucormycosis. Management Strategies to Avoid or Limit Intracraneal Affection and Improve Survival. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015. [DOI: 10.1016/j.otoeng.2015.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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154
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Hamid ME, Joseph MRP, Al-Qahtani AS. Chronic rhinofacial basidiobolomycosis caused by Basidiobolus ranarum: Report of a case from Aseer Region, Kingdom of Saudi Arabia. J Mycol Med 2015; 25:306-9. [PMID: 26482354 DOI: 10.1016/j.mycmed.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/22/2015] [Accepted: 09/11/2015] [Indexed: 10/22/2022]
Abstract
We present a case of fungal sinusitis caused by Basidiobolus ranarum in a 22-year-old male patient with chronic rhinosinusitis in Aseer region, Kingdom of Saudi Arabia. The patient was admitted with nasal obstruction accompanied by itching, sneezing, rhinorrhea, epistaxis and recurrent headache. Axial computed tomography (CT) scan of the paranasal sinuses showed a clear left facial swelling chronic inflammation and granulomata. Basidiobolus ranarum fungus was isolated on Sabouraud dextrose agar from a biopsy specimen. The organism was characterized by flat, yellowish-grey, glabrous, becoming radially folded fungus that under the microscope showed broad vegetative hyaline hyphae that bear zygospores with protuberances. The patient made good recovery and was discharged home with no recurrences after receiving oral itraconazole and removal of the polyps surgically.
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Affiliation(s)
- M E Hamid
- College of Medicine, King Khalid University, Abha, Aseer 61314, Saudi Arabia.
| | - M R P Joseph
- College of Medicine, King Khalid University, Abha, Aseer 61314, Saudi Arabia
| | - A S Al-Qahtani
- College of Medicine, King Khalid University, Abha, Aseer 61314, Saudi Arabia
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155
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Dioverti MV, Cawcutt KA, Abidi M, Sohail MR, Walker RC, Osmon DR. Gastrointestinal mucormycosis in immunocompromised hosts. Mycoses 2015; 58:714-8. [PMID: 26456920 DOI: 10.1111/myc.12419] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Revised: 08/31/2015] [Accepted: 09/09/2015] [Indexed: 12/13/2022]
Abstract
Invasive mucormycosis is a rare fungal infection in immunocompromised hosts, but it carries a high mortality rate. Primary gastrointestinal disease is the least frequent form of presentation. Early diagnosis and treatment are critical in the management; however, symptoms are typically non-specific in gastrointestinal disease, leading to delayed therapy. To describe the clinical presentation, diagnosis, treatment and outcomes of gastrointestinal mucormycosis in immunocompromised hosts, we reviewed all cases of primary gastrointestinal mucormycosis in immunocompromised hosts reported in English literature as well as in our Institution from January 1st 1991 to December 31st 2013 for a total of 31 patients. About 52% of patients underwent solid organ transplant (SOT), while the rest had an underlying haematologic malignancy. Abdominal pain was the most common presenting symptom, followed by gastrointestinal bleeding and fever. Gastric disease was more common in SOT, whereas those with haematologic malignancy presented with intestinal disease (P = 0.002). Although gastrointestinal mucormycosis remains an uncommon condition in immunocompromised hosts, it carries significant morbidity and mortality, particularly in cases with intestinal involvement. A high index of suspicion is of utmost importance to institute early and appropriate therapy and improve outcomes.
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Affiliation(s)
| | - Kelly A Cawcutt
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Maheen Abidi
- Division of Infectious Diseases, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Rizwan Sohail
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Randall C Walker
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Douglas R Osmon
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
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156
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Blumentrath CG, Grobusch MP, Matsiégui PB, Pahlke F, Zoleko-Manego R, Nzenze-Aféne S, Mabicka B, Sanguinetti M, Kremsner PG, Schaumburg F. Classification of Rhinoentomophthoromycosis into Atypical, Early, Intermediate, and Late Disease: A Proposal. PLoS Negl Trop Dis 2015; 9:e0003984. [PMID: 26426120 PMCID: PMC4591341 DOI: 10.1371/journal.pntd.0003984] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Rhinoentomophthoromycosis, or rhino-facial conidiobolomycosis, is a rare, grossly disfiguring disease due to an infection with entomophthoralean fungi. We report a case of rhinoentomophthoromycosis from Gabon and suggest a staging system, which provides information on the prognosis and duration of antifungal therapy. METHODS We present a case of rhinoentomophthoromycosis including the histopathology, mycology, and course of disease. For the suggested staging system, all cases on confirmed rhinoentomophthoromycosis published in the literature without language restriction were eligible. Exclusion criteria were missing data on (i) duration of disease before correct diagnosis, (ii) outcome, and (iii) confirmation of entomophthoralean fungus infection by histopathology and/or mycology. We classified cases into atypical (orbital cellulitis, severe pain, fever, dissemination), early, intermediate, and late disease based on the duration of symptoms before diagnosis. The outcome was evaluated for each stage of disease. FINDINGS The literature search of the Medpilot database was conducted on January 13, 2014, (updated on January 18, 2015). The search yielded 8,333 results including 198 cases from 117 papers; of these, 145 met our inclusion criteria and were included in the final analysis. Median duration of treatment was 4, 3, 4, and 5 months in atypical, early, intermediate, and late disease, respectively. Cure rates were clearly associated with stage of disease and were 57%, 100%, 82%, and 43% in atypical, early, intermediate, and late disease, respectively. CONCLUSION We suggest a clinical staging system that underlines the benefit of early case detection and may guide the duration of antifungal treatment. The scientific value of this classification is its capacity to structure and harmonize the clinical and research approach towards rhinoentomophthoromycosis.
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Affiliation(s)
- Christian G. Blumentrath
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen and Deutsches Zentrum für Infektionsforschung, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital Lambaréné, Lambaréné, Gabon
- Centre de Recherche Médicale de la Ngounié, Fougamou, Gabon
| | - Martin P. Grobusch
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen and Deutsches Zentrum für Infektionsforschung, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital Lambaréné, Lambaréné, Gabon
- Center of Tropical Medicine and Travel Medicine, Department of Infectious Diseases, Division of Internal Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Rella Zoleko-Manego
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen and Deutsches Zentrum für Infektionsforschung, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital Lambaréné, Lambaréné, Gabon
- Centre de Recherche Médicale de la Ngounié, Fougamou, Gabon
| | - Solange Nzenze-Aféne
- Département de Parasitologie, Mycologie et Médicine Tropicale, Université des Sciences de la Santé, Libreville, Gabon
| | - Barthélemy Mabicka
- Département d'Anatomie Pathologique et d`Histologie et Embryologie, Université des Sciences de la Santé, Libreville, Gabon
| | | | - Peter G. Kremsner
- Institut für Tropenmedizin, Eberhard Karls Universität Tübingen and Deutsches Zentrum für Infektionsforschung, Tübingen, Germany
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital Lambaréné, Lambaréné, Gabon
| | - Frieder Schaumburg
- Centre de Recherches Médicales de Lambaréné (CERMEL), Albert Schweitzer Hospital Lambaréné, Lambaréné, Gabon
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
- * E-mail:
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Abstract
Neuro-ophthalmological emergencies constitute vision or life-threatening conditions if diagnosis and treatment are not promptly undertaken. Even with immediate therapy, these clinical entities carry a high rate of morbidity. They may present with diplopia, visual loss, and/or anisocoria. Arteritic anterior ischemic optic neuropathy is an ominous condition, which can cause permanent and severe vision loss, stroke, or aortic dissection, requiring immediate steroid therapy. Pituitary apoplexy may go unnoticed if only computed axial tomography is performed. Diseases affecting the cavernous sinus and orbital apex region, such as cavernous sinus thrombosis or mucormycosis, can give rise to simultaneous vision loss and diplopia and, if not treated, may extend to the brain parenchyma causing permanent neurological sequela. An isolated third nerve palsy may be the harbinger of a cerebral aneurysm, carrying a significant risk of mortality. Horner syndrome can be the initial presentation of a carotid dissection, an important cause of stroke in the young adult. The neurohospitalist should be familiar with the workup and management of neuro-ophthalmological emergencies.
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Affiliation(s)
- João Lemos
- Michigan State University, East Lansing, MI, USA
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158
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Vallabhaneni S, Mody RK. Gastrointestinal Mucormycosis in Neonates: a Review. CURRENT FUNGAL INFECTION REPORTS 2015. [DOI: 10.1007/s12281-015-0239-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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159
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Reddy SS, Rakesh N, Chauhan P, Sharma S. Rhinocerebral Mucormycosis Among Diabetic Patients: An Emerging Trend. Mycopathologia 2015; 180:389-96. [PMID: 26349570 DOI: 10.1007/s11046-015-9934-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/27/2015] [Indexed: 02/04/2023]
Abstract
Mucormycosis is an acute necrotic fungal infection with a fulminant course. Earlier considered a rare entity, mucormycosis is being reported with increasing frequency in recent years, possibly due to the increase in immunocompromised population especially diabetic patients. We report three cases of rhinocerebral mucormycosis among poorly controlled diabetic patients. This article emphasizes the need for further awareness of this disease, early diagnosis, and treatment to counter this opportunistic infection.
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Affiliation(s)
- Sujatha S Reddy
- Department of Oral Medicine, Diagnosis and Radiology, M.S. Ramaiah Dental College and Hospital, Msrit Post, New Bel Road, Bangalore, 560054, Karnataka, India.
| | - N Rakesh
- Department of Oral Medicine, Diagnosis and Radiology, M.S. Ramaiah Dental College and Hospital, Msrit Post, New Bel Road, Bangalore, 560054, Karnataka, India
| | - Pallavi Chauhan
- Department of Oral Medicine, Diagnosis and Radiology, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, Uttar Pradesh, 201302, India
| | - Shivani Sharma
- Department of Oral Medicine, Diagnosis and Radiology, M.S. Ramaiah Dental College and Hospital, Msrit Post, New Bel Road, Bangalore, 560054, Karnataka, India
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160
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Blyth CC, Gilroy NM, Guy SD, Chambers ST, Cheong EY, Gottlieb T, McGuinness SL, Thursky KA. Consensus guidelines for the treatment of invasive mould infections in haematological malignancy and haemopoietic stem cell transplantation, 2014. Intern Med J 2015; 44:1333-49. [PMID: 25482744 DOI: 10.1111/imj.12598] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mould species represent the pathogens most commonly associated with invasive fungal disease in patients with haematological malignancies and patients of haemopoietic stem cell transplants. Invasive mould infections in these patient populations, particularly in the setting of neutropenia, are associated with high morbidity and mortality, and significantly increase the complexity of management. While Aspergillus species remain the most prevalent cause of invasive mould infections, Scedosporium and Fusarium species and the Mucormycetes continue to place a significant burden on the immunocompromised host. Evidence also suggests that infections caused by rare and emerging pathogens are increasing within the setting of broad-spectrum antifungal prophylaxis and improved survival times placing immunosuppressed patients at risk for longer. These guidelines present evidence-based recommendations for the antifungal management of common, rare and emerging mould infections in both adult and paediatric populations. Where relevant, the role of surgery, adjunctive therapy and immunotherapy is also discussed.
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Affiliation(s)
- C C Blyth
- School of Paediatrics and Child Health, The University of Western Australia, Perth, Western Australia; Department of General Paediatrics, Princess Margaret Hospital for Children, Subiaco, Western Australia; PathWest Laboratory Medicine WA, Subiaco, Western Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia
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161
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Gupta M, Narang T, Kaur RJ, Manhas A, Saikia UN, Dogra S. A prospective case series evaluating efficacy and safety of combination of itraconazole and potassium iodide in rhinofacial conidiobolomycosis. Int J Dermatol 2015; 55:208-14. [PMID: 26234812 DOI: 10.1111/ijd.12966] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 01/03/2015] [Accepted: 01/05/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Rhinofacial conidiobolomycosis (RFC) is an uncommon subcutaneous fungal infection producing painless swelling with grotesque deformity of the face. Although there are case reports and small case series; there are very few prospective studies evaluating treatment outcome and long-term follow-up. OBJECTIVE To evaluate the safety and efficacy of combination of itraconazole (200 mg twice daily) and saturated solution of potassium iodide (SSKI) in patients with RFC. METHODS Ten patients of RFC were studied over a period of 5 years. Diagnosis was confirmed by clinical, histopathological, and microbiological evaluation. Conidiobolus was cultured in four cases and in the rest of the cases, the histopathology was suggestive of RFC. They were treated with itraconazole (200 mg twice daily) and SSKI and followed up for a minimum of 1 year after stopping treatment. RESULTS The mean age was 38.7 years and the mean duration of symptoms was 22.4 months. Males were predominantly involved (9 : 1). Seven patients responded to the combination treatment, five had complete resolution and two had good improvement (50-75%); however, in two patients the response was minimal (<25% regression of the swelling) and one patient did not show any improvement after 6 months of treatment. CONCLUSION Combination of itraconazole and SSKI is an effective treatment modality for RFC with relatively faster onset of action, low relapse rates, and minimal adverse effects. It can be considered as first-line treatment in patients with RFC.
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Affiliation(s)
- Manish Gupta
- Department of ENT, Gian Sagar Medical College & Hospital, Banur District, Patiala, Punjab, India
| | - Tarun Narang
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Rupinder Jeet Kaur
- Department of Pathology, Gian Sagar Medical College & Hospital, Banur District, Patiala, Punjab, India
| | - Ashwani Manhas
- Department of Microbiology, Gian Sagar Medical College & Hospital, Banur District, Patiala, Punjab, India
| | - Uma Nahar Saikia
- Department of Histopathology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
| | - Sunil Dogra
- Department of Dermatology, Venereology and Leprology, Post Graduate Institute of Medical Education & Research, Chandigarh, India
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162
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Miceli MH, Kauffman CA. Treatment Options for Mucormycosis. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2015. [DOI: 10.1007/s40506-015-0050-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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163
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Raveenthiran V, Mangayarkarasi V, Kousalya M, Viswanathan P, Dhanalakshmi M, Anandi V. Subcutaneous entomophthoromycosis mimicking soft-tissue sarcoma in children. J Pediatr Surg 2015; 50:1150-5. [PMID: 25783300 DOI: 10.1016/j.jpedsurg.2014.11.031] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/23/2014] [Accepted: 11/13/2014] [Indexed: 11/24/2022]
Abstract
AIM Subcutaneous entomophthoromycosis (EM) is an uncommon fungal infection of childhood. This article is intended to draw the attention of pediatric surgeons to the fact that EM can mimic soft-tissue tumor. METHODS It is a retrospective review of 16 children treated for subcutaneous EM between 2000 and 2013. RESULTS The median age of patients was 3.5 years. The typical lesion was a discoid subcutaneous mass that can be easily lifted from deeper tissues (the doughnut lifting sign). Lesions were mostly distributed in the lower half of body. All the patients were immunocompetent. Correct clinical diagnosis was made only in 4 cases while others were mistaken for a tumor. All the 8 children who underwent wide excision of the pseudotumor had local recurrence. Supersaturated solution of potassium iodide was curative in 11 cases while addition of itraconazole was needed in one case. One child died of multi-drug resistant infection. The mean treatment duration was 4.7 months (range 2-8 months). CONCLUSION Subcutaneous EM can mimic soft-tissue tumor. High index of suspicion is essential to avoid misdiagnosis and inappropriate treatment. A newly described "doughnut-lifting sign' may be helpful in clinical diagnosis. Emergence of multi-drug resistant infection is a source of concern.
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Affiliation(s)
- Venkatachalam Raveenthiran
- Department of Pediatric Surgery, Sri Ramasamy Memorial (SRM) Medical College, Kattankulathur, Chennai, India; Hindu Mission Hospital, Tambaram, Chennai, India.
| | | | - Murugesan Kousalya
- Department of Microbiology, SRM Medical College, Kattankulathur, Chennai, India
| | | | | | - Viswanathan Anandi
- Department of Microbiology, Rajah Muthiah Medical College, Chidambaram, India
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Rhino-orbito-cerebral mucormycosis. Management strategies to avoid or limit intracraneal affection and improve survival. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2015; 66:348-52. [PMID: 26048708 DOI: 10.1016/j.otorri.2015.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/19/2015] [Accepted: 01/25/2015] [Indexed: 12/26/2022]
Abstract
Mucormycosis is a rare opportunistic infection. The aim of the study was to review the cases presented in our department with rhino-orbital mucormycosis and to describe the clinical protocol, diagnosis and therapy used in these patients. We conducted a retrospective, longitudinal, descriptive study, in which we evaluated the records of patients with rhino-orbital mucormycosis in the period from January to October 2013. We found 5 cases. Pterigomaxillary fossa disease was found in 100% of our patients. Medical and surgical treatment performed early by extensive endoscopic debridement (including debridement and resection of pterygomaxillary fossa) and orbital exenteration in patients presenting with orbitary apex syndrome in conjunction with the ophthalmology department of our hospital, with excellent results in the survival of our patients (all patients survived).
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165
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Thawani R, Singh S, Sharma S, Sharma N. Infective gangrene in extremity trauma-are we targeting the right organisms? Indian J Surg 2015; 77:10-2. [PMID: 25972628 DOI: 10.1007/s12262-014-1033-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 01/05/2014] [Indexed: 11/28/2022] Open
Abstract
Mucormycosis is a rare and fatal infection that is known to occur in immunocompromised and diabetic patients. The infection is caused by a fungus of the class Zygomycetes. It has been associated with open fractures in patients at risk. We report a case of cutaneous mucormycosis leading to gangrene after a closed fracture. We recommend considering mucormycosis as a differential for wound infections not responding to antibiotics, even in closed injuries. Tissue from surgical debridement should be sent for histopathological and microbiological examination to diagnose the condition early. Early recognition, surgical management, and parenteral antifungal therapy are the mainstay of management of this illness.
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Affiliation(s)
- Rajat Thawani
- University College of Medical Sciences, Delhi, India
| | - Seema Singh
- Department of Surgery, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, 110095 India
| | - Sonal Sharma
- Department of Pathology, University College of Medical Sciences and GTB Hospital, Delhi, India
| | - Naveen Sharma
- Department of Surgery, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, 110095 India
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166
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Angali RK, Jeshtadi A, Namala VA, Gannepalli A. Fatal rhino-orbito-cerebral mucormycosis in a healthy individual. J Oral Maxillofac Pathol 2015; 18:460-3. [PMID: 25949007 PMCID: PMC4409197 DOI: 10.4103/0973-029x.151355] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/02/2015] [Indexed: 11/24/2022] Open
Abstract
Rhino-orbital-cerebral zygomycosis is a potentially lethal, opportunistic, fungal infection with protean manifestations, rapid progression, unpredictable course and high mortality. It is associated with angioinvasion and infarction, usually observed in diabetic ketoacidosis, immuno-compromised states and rarely reported in an apparently normal host. We present a case of an18-year-old patient with a chronic, painful, non healing ulcer with necrotic margins over the right side of the face which extended to both orbits involving eyes within a period of 1.5 month. Later he developed severe headache, decreased vision, inability to speak, seizures and status epilepticus with fatal outcome. Awareness of its occurrence in normal patients with prompt diagnosis and appropriate management may improve the outcome and decrease mortality.
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Affiliation(s)
- Rama Krishna Angali
- Department of Oral Pathology and Microbiology, Panineeya Institute of Dental Sciences and Research Center, Kamala Nagar, Dilsukhnagar, Hyderabad, India
| | - Anunayi Jeshtadi
- Department of Pathology, Osmania Medical College, Koti, Hyderabad, Andhra Pradesh, India
| | - Vivek Anand Namala
- Department of Pathology, Osmania Medical College, Koti, Hyderabad, Andhra Pradesh, India
| | - Ashalata Gannepalli
- Department of Oral Pathology and Microbiology, Panineeya Institute of Dental Sciences and Research Center, Kamala Nagar, Dilsukhnagar, Hyderabad, India
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167
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Hadgaonkar S, Shah K, Bhojraj S, Nene A, Shyam A. Isolated Mucormycotic Spondylodiscitis of Lumbar Spine-A Rare Case Report. J Orthop Case Rep 2015; 5:55-7. [PMID: 27299046 PMCID: PMC4722592 DOI: 10.13107/jocr.2250-0685.275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Mucormycosis is life threatening infection rarely affecting musculoskeletal system and spinal involvement is extremely rare with only two cases reported in English literature. CASE REPORT We present this rare case of spondylodiscitis with lumbar vertebral osteomyelitis due to mucormycosis in a patient with chronic kidney disease on haemodialysis diagnosed by CT guided biopsy and highlight its clinico -radiological presentation and management principles. CONCLUSION Thus, as the incidence of Mucorales infection increase due to increase in patients with predisposing factors, the unusual sites of affection increase. Treating clinician should have a high vigilance in patients with predisposing factors. Although there is dramatic improvement in the treatment modalities of mucormycosis, still the mortality is high. Early diagnosis is important to prevent dissemination and timely intervention in order to reduce morbidity and mortality. A well equipped multidisciplinary approach for clinico-radiological assessment and management is necessary.
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Affiliation(s)
- Shailesh Hadgaonkar
- Sancheti Institute For Orthopaedics And Rehabilitation, Pune, Maharashtra. India
| | - Kunal Shah
- Sancheti Institute For Orthopaedics And Rehabilitation, Pune, Maharashtra. India
| | | | - Abhay Nene
- Wockhardt Hospital, Mumbai, Maharashtra. India
| | - Ashok Shyam
- Sancheti Institute For Orthopaedics And Rehabilitation, Pune, Maharashtra. India
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168
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Kursun E, Turunc T, Demiroglu YZ, Alışkan HE, Arslan AH. Evaluation of 28 cases of mucormycosis. Mycoses 2015; 58:82-7. [PMID: 25590855 DOI: 10.1111/myc.12278] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/20/2014] [Accepted: 11/09/2014] [Indexed: 12/20/2022]
Abstract
Mucormycosis is a rare but invasive fungal disease with high mortality. The present study aimed to retrospectively investigate the demographic characteristics, as well as the clinical, radiological and laboratory features and the results of treatment, in the patients followed in our hospital because of mucormycosis. The present study retrospectively evaluated 28 cases, which were followed in our hospital because of mucormycosis between January 2002 and July 2013. The clinical form was rhinocerebral in 27 cases (rhinoorbital in 12, nasal in 8 and rhinoorbitocerebral in 7) and disseminated in one case. With regard to predisposing factors, diabetes mellitus (n = 20), haematological malignancy (n = 6) and chronic renal insufficiency (n = 5) were the leading concomitant diseases. Seventeen (61%) of 28 cases showed atypical clinical picture. With regard to the therapeutic outcomes; it was found that 14 (50%) cases died and six cases recovered with sequel. Today, when particularly the prevalence of immunosuppressive diseases and conditions are gradually increasing, the incidence of mucormycosis is also increased. Considering that the majority of our cases had atypical clinical involvement and complications, being familiar with the characteristics of this disease could be life-saving together with early diagnosis and treatment.
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Affiliation(s)
- Ebru Kursun
- Department of Infectious Diseases and Clinical Microbiology, Başkent University Medical Faculty, Adana, Turkey
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169
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Cutaneous, Subcutaneous and Systemic Mycology. VETERINARY MYCOLOGY 2015. [PMCID: PMC7122059 DOI: 10.1007/978-81-322-2280-4_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The first description of dermatophytosis was recorded by Celsus, a Roman encyclopaedist who described a suppurative infection of scalp (‘porrigo’ or ‘kerion of Celsus’) in De Re Medicina (30 A.D.). Throughout the middle ages, several descriptions of dermatophytosis were produced where it is described as ‘tinea’. The keratin-destroying moths which made circular holes in the woollen garments are known as Tinea. Due to similarity in the structure of circular lesion of dermatophytosis on the smooth skin with the circular hole made by moth, Cassius Felix introduced the term ‘tinea’ to describe the lesions. In 1806, Alibert used the term ‘favus’ to describe the honey-like exudate in some scalp infections. However, the fungal aetiology of tinea was first detected by Robert Remak, a Polish physician who first observed the presence of hyphae in the crusts of favus. This detection is also a landmark in medical history because this is the first description of a microbe causing a human disease. He himself did not publish his work, but he permitted the reference of his observations in a dissertation by Xavier Hube in 1837. Remak gave all the credits of his discovery to his mentor Schoenlein who first published the fungal etiological report of favus in 1839. He observed the infectious nature of the favus by autoinoculation into his own hands and also successfully isolated the fungus later (1945) and named Achorion schoenleinii (Trichophyton schoenleinii) in honour of his mentor. In 1844, Gruby described the etiologic agent of tinea endothrix, later became known as Trichophyton tonsurans. The genus Trichophyton was created and described by Malmsten (1845) with its representative species T. tonsurans. Charles Robin identified T. mentagrophytes in 1847 and T. equinum was identified by Matruchot and Dassonville in 1898. Raymond Jacques Adrien Sabouraud (France) first compiled the description of Trichophyton in his book (Les Teignes) in 1910 which was based on his observation in artificial culture. The sexual state of dermatophyte was described by Nannizzi (1927). Emmons (1934) first reported the classification of dermatophytes based on vegetative structures and conidia. Gentles (1958) established the successful treatment of tinea capitis with griseofulvin.
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170
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Forrester JD, Chandra V, Shelton AA, Weiser TG. Gastrointestinal mucormycosis requiring surgery in adults with hematologic malignant tumors: literature review. Surg Infect (Larchmt) 2014; 16:194-202. [PMID: 25405775 DOI: 10.1089/sur.2013.232] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Gastrointestinal mucormycosis is associated with high mortality rates. Appropriate and early antifungal therapy and prompt surgical intervention are essential. METHOD Case report and literature review. RESULTS Nineteen case reports were reviewed describing adults with hematologic malignant tumors who developed intestinal mucormycosis and underwent surgery. The overall survival rate was 50%. CONCLUSION Intestinal mucormycosis is an infection associated with a high mortality rate although adults with underlying hematologic malignant have improved outcomes compared with other groups.
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171
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Mendoza L, Vilela R, Voelz K, Ibrahim AS, Voigt K, Lee SC. Human Fungal Pathogens of Mucorales and Entomophthorales. Cold Spring Harb Perspect Med 2014; 5:cshperspect.a019562. [PMID: 25377138 DOI: 10.1101/cshperspect.a019562] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In recent years, we have seen an increase in the number of immunocompromised cohorts as a result of infections and/or medical conditions, which has resulted in an increased incidence of fungal infections. Although rare, the incidence of infections caused by fungi belonging to basal fungal lineages is also continuously increasing. Basal fungal lineages diverged at an early point during the evolution of the fungal lineage, in which, in a simplified four-phylum fungal kingdom, Zygomycota and Chytridiomycota belong to the basal fungi, distinguishing them from Ascomycota and Basidiomycota. Currently there are no known human infections caused by fungi in Chytridiomycota; only Zygomycotan fungi are known to infect humans. Hence, infections caused by zygomycetes have been called zygomycosis, and the term "zygomycosis" is often used as a synonym for "mucormycosis." In the four-phylum fungal kingdom system, Zygomycota is classified mainly based on morphology, including the ability to form coenocytic (aseptated) hyphae and zygospores (sexual spores). In the Zygomycota, there are 10 known orders, two of which, the Mucorales and Entomophthorales, contain species that can infect humans, and the infection has historically been known as zygomycosis. However, recent multilocus sequence typing analyses (the fungal tree of life [AFTOL] project) revealed that the Zygomycota forms not a monophyletic clade but instead a polyphyletic clade, whereas Ascomycota and Basidiomycota are monophyletic. Thus, the term "zygomycosis" needed to be further specified, resulting in the terms "mucormycosis" and "entomophthoramycosis." This review covers these two different types of fungal infections.
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Affiliation(s)
- Leonel Mendoza
- Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan 48424-1031 Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, Michigan 48424-1031
| | - Raquel Vilela
- Biomedical Laboratory Diagnostics, Michigan State University, East Lansing, Michigan 48424-1031 Faculty of Pharmacy, Federal University of Minas Gerais (UFMG), Minas Gerais, CEP33400000 Belo Horizonte, Brazil Belo Horizonte Brazil; Superior Institute of Medicine (ISMD), Minas Gerais, CEP33400000 Belo Horizonte, Brazil
| | - Kerstin Voelz
- Institute of Microbiology and Infection & School of Biosciences, University of Birmingham, Birmingham B15 2TT, United Kingdom The National Institute of Health Research Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom B15 2WB
| | - Ashraf S Ibrahim
- Division of Infectious Diseases, Harbor-University of California Los Angeles Medical Center, St. John's Cardiovascular Research Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California 90502 David Geffen School of Medicine at UCLA, Los Angeles, California 90095
| | - Kerstin Voigt
- Jena Microbial Resource Collection, Leibniz Institute for Natural Product Research and Infection Biology and University of Jena, Faculty of Biology and Pharmacy, Institute of Microbiology, Neugasse 25, 07743 Jena, Germany
| | - Soo Chan Lee
- Department of Molecular Genetics and Microbiology, Duke University Medical Center, Durham, North Carolina 27710
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172
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Abstract
Few among the millions of fungal species fulfill four basic conditions necessary to infect humans: high temperature tolerance, ability to invade the human host, lysis and absorption of human tissue, and resistance to the human immune system. In previously healthy individuals, invasive fungal disease is rare because animals' sophisticated immune systems evolved in constant response to fungal challenges. In contrast, fungal diseases occur frequently in immunocompromised patients. Paradoxically, successes of modern medicine have put increasing numbers of patients at risk for invasive fungal infections. Uncontrolled HIV infection additionally makes millions vulnerable to lethal fungal diseases. A concerted scientific and social effort is needed to meet these challenges.
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Affiliation(s)
- Julia R Köhler
- Division of Infectious Diseases, Children's Hospital, Harvard Medical School, Boston, Massachusetts 02115
| | - Arturo Casadevall
- Departments of Microbiology and Immunology and Medicine, Division of Infectious Diseases, Albert Einstein College of Medicine, New York, New York 10461
| | - John Perfect
- Division of Infectious Diseases, Duke Medical Center, Durham, North Carolina 27710
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173
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El-Shabrawi MHF, Arnaout H, Madkour L, Kamal NM. Entomophthoromycosis: a challenging emerging disease. Mycoses 2014; 57 Suppl 3:132-7. [PMID: 25319641 DOI: 10.1111/myc.12248] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 02/27/2014] [Accepted: 03/04/2014] [Indexed: 11/29/2022]
Abstract
Entomophthoromycosis is a rare fungal infection that may affect immunocompetent hosts; predominantly in tropical and subtropical regions. Recently, the importance of this emerging mycosis has increased and the scope of its manifestations has been expanded. These manifestations; however, may masquerade as other clinical entities. Prompt diagnosis of this infection requires a high index of suspicion. Although histopathological examination and cultures are the gold standard diagnostic tools; molecular diagnosis is now available and started to play an important role. The cornerstone treatment is prolonged anti-fungal therapy along with surgical debridement. More awareness of this mycosis is warranted for definitive diagnosis and implementation of early proper therapeutic strategies.
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174
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Pozo Laderas JC, Pontes Moreno A, Pozo Salido C, Robles Arista JC, Linares Sicilia MJ. [Disseminated mucormycosis in immunocompetent patients: A disease that also exists]. Rev Iberoam Micol 2014; 32:63-70. [PMID: 25543322 DOI: 10.1016/j.riam.2014.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 01/01/2014] [Accepted: 01/21/2014] [Indexed: 11/28/2022] Open
Abstract
Mucormycosis is usually an acute angioinvasive infections, which leads to non-suppurative necrosis and significant tissue damage. It represents 1.6% of all the invasive fungal infections and predominates in immunosuppressed patients with risk factors. Incidence has been significantly increased even in immunocompetent patients. Due to finding a case of disseminated mucormycosis caused by Rhizomucor pusillus in a young immunocompetent patient, a systematic review was carried out of reported cases in PubMed of mucormycosis in immunocompetent adults according to the main anatomic locations, and especially in disseminated cases. A review of the main risk factors and pathogenicity, clinical manifestations, techniques of early diagnosis, current treatment options, and prognosis is presented. Taxonomy and classification of the genus Mucor has also been reviewed.
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Affiliation(s)
- Juan Carlos Pozo Laderas
- Servicio de Medicina Intensiva, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Córdoba, España; Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Córdoba, España.
| | | | - Carmen Pozo Salido
- Servicio Urología, Hospital Universitario Fundación Alcorcón, Madrid, España
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175
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Miguita e Souza J, Sproesser Junior AJ, Felippu Neto A, Fuks FB, Oliveira CACD. Rhino facial zygomycosis: case report. ACTA ACUST UNITED AC 2014; 12:347-50. [PMID: 25167339 PMCID: PMC4872948 DOI: 10.1590/s1679-45082014rc2579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 12/11/2013] [Indexed: 11/21/2022]
Abstract
Zygomycosis is an invasive disease that affects both immunocompetent and immunocompromised, depending on the type of strain. This disease diagnosis is clinical and histopathological, and its treatment is based on antifungal therapy and surgical cleaning. This paper reports a case of a boy with invasive zygomycosis rinofacial who final treatment was successful after underwent antifungal and surgical therapies.
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176
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Nagakawa H, Igari H, Konishi K, Kashizaki F, Aoyama M, Watanabe A, Tatsumi K, Kamei K. [An autopsy case of tension pneumothorax due to the rupture of intrapulmonary cavity by mucormycosis during treatment with a ventilator]. Med Mycol J 2014; 54:285-9. [PMID: 23995418 DOI: 10.3314/mmj.54.285] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 50-year-old man with chronic renal failure (hemodialysis treatment) and interstitial pneumonia (IP) was referred to our hospital for exacerbation of IP. We immediately administered a mechanical ventilation, broad spectrum antibiotics, steroid pulse therapy, and endoxan pulse therapy in the intensive care unit, but alveolar opacities became worse. Subsequently, an intrapulmonary cavity appeared in the left middle lung field on the chest X-ray and we also administered amphotericin B. However he died of tension pneumothorax on the tenth day of hospitalization. In an autopsy the rupture of the intrapulmonary cavity of the left S3 region was detected and we diagnosed as invasive pulmonary mucormycosis by Grocott stain of the cavitary lesion. We report a rare case that complicated by fatal tension pneumothorax during treatment with a ventilator in invasive pulmonary mucormycosis and review the literature.
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177
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178
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Lee SH, Son YG, Sohn SS, Ryu SW. Successful treatment of invasive gastric mucormycosis in a patient with alcoholic liver cirrhosis: A case report. Exp Ther Med 2014; 8:401-404. [PMID: 25009590 PMCID: PMC4079431 DOI: 10.3892/etm.2014.1753] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 04/10/2014] [Indexed: 12/28/2022] Open
Abstract
Gastrointestinal (GI) mucormycosis is a rare and life-threatening invasive fungal infection. GI mucormycosis occur in all parts of the alimentary tract, with the stomach being the most common site. Diabetes mellitus and other types of conditions associated with immunodeficiency, including hematologic malignancies, solid organ transplantation and glucocorticoid therapy, are risk factors for GI mucormycosis. There are few studies reporting cases of gastric mucormycosis in patients with liver cirrhosis, and even fewer reporting the successful treatment of invasive gastric mucormycosis in a patient with liver cirrhosis. This study presents a case of invasive gastric mucormycosis in a patient with liver cirrhosis, which was treated successfully by prompt diagnosis, metabolic support, surgical debridement of involved tissues and antifungal therapy.
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Affiliation(s)
- Seung Hyoung Lee
- Department of Surgery, Dong San Medical Center, Keimyung University School of Medicine, Daegu 700-712, Republic of Korea
| | - Young Gil Son
- Department of Surgery, Dong San Medical Center, Keimyung University School of Medicine, Daegu 700-712, Republic of Korea
| | - Soo Sang Sohn
- Department of Surgery, Dong San Medical Center, Keimyung University School of Medicine, Daegu 700-712, Republic of Korea
| | - Seung Wan Ryu
- Department of Surgery, Dong San Medical Center, Keimyung University School of Medicine, Daegu 700-712, Republic of Korea
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179
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Cazorla A, Grenouillet F, Piton G, Faure É, Delabrousse É, Mathieu P, Viennet G, Kantelip B, Millon L, Valmary-Degano S. Une forme gastro-intestinale de basidiobolomycose d’évolution fatale. Ann Pathol 2014; 34:228-32. [PMID: 24950873 DOI: 10.1016/j.annpat.2014.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 08/16/2013] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
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180
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Gupta V, Rajagopalan N, Patil M, Shivaprasad C. Aspergillus and mucormycosis presenting with normal chest X-ray in an immunocompromised host. BMJ Case Rep 2014; 2014:bcr-2014-204022. [PMID: 24717585 DOI: 10.1136/bcr-2014-204022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Invasive aspergillus and mucormycosis infection are not uncommon in immunocompromised individuals. Endobronchial fungal infections have been reported in the literature, especially in patient's with diabetes complicated by diabetic ketoacidosis, but end bronchial coinfection with aspergillus and mucormycosis without pulmonary involvement has not been described in the literature. We report the case of a woman with diabetes who presented with gastrointestinal symptoms, ketoacidosis and respiratory distress, with an apparently normal chest X-ray. Investigations revealed a cavitatory lesion in the left lower lobe of the lungs on CT scan. Bronchoscopy revealed intense mucosal oedema and whitish plaques at the lower end of the trachea and right main stem bronchus with a normal left bronchial tree. Microbiological and pathological results confirmed aspergillus and mucormycosis. Despite aggressive medical management, the patient deteriorated and died of respiratory failure. Strong suspicion of invasive fungal infections in immunocompromised patients with respiratory failure and minimal chest infiltrates, early fibreoptic bronchoscopy and early aggressive treatment is crucial for the patient's survival.
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Affiliation(s)
- Vipin Gupta
- Department of Pulmonology and Critical Care, Mazumdar Shaw Medical Center, Narayana Health, Bangalore, Karnataka, India
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181
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Abstract
Zygomycosis is an acute or chronic infection caused by several fungal agents belonging to the phylum Zygomycota. These are saprophytic fungi and are found ubiquitously in the environment. These are emerging highly opportunistic pathogenic organisms. Basidiobolus ranarum (B. haptosporus, B. meristoporus) is a fungus belonging to the order Entomophthorales under the family Zygomycota. Basidiobolomycosis is a predominantly subcutaneous infection involving the trunk and limbs in immunocompetent hosts. We hereby report a case of Basidiobolomycosis from the Department of Microbiology, Siddhartha Medical College, Vijayawada in a 6 month old child who presented to us with a painless swelling over her left knee following an insect bite.
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Affiliation(s)
- Usha Rani Anaparthy
- Department of Microbiology, Siddhartha Medical College, Vijayawada, Andhra Pradesh, India
| | - G Deepika
- Department of Microbiology, Siddhartha Medical College, Vijayawada, Andhra Pradesh, India
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182
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Muszewska A, Pawłowska J, Krzyściak P. Biology, systematics, and clinical manifestations of Zygomycota infections. Eur J Clin Microbiol Infect Dis 2014; 33:1273-87. [PMID: 24615580 PMCID: PMC4077243 DOI: 10.1007/s10096-014-2076-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 01/31/2014] [Indexed: 01/13/2023]
Abstract
Fungi cause opportunistic, nosocomial, and community-acquired infections. Among fungal infections (mycoses) zygomycoses are exceptionally severe, with a mortality rate exceeding 50%. Immunocompromised hosts, transplant recipients, and diabetic patients with uncontrolled keto-acidosis and high iron serum levels are at risk. Zygomycota are capable of infecting hosts immune to other filamentous fungi. The infection often follows a progressive pattern, with angioinvasion and metastases. Moreover, current antifungal therapy frequently has an unfavorable outcome. Zygomycota are resistant to some of the routinely used antifungals, among them azoles (except posaconazole) and echinocandins. The typical treatment consists of surgical debridement of the infected tissues accompanied by amphotericin B administration. The latter has strong nephrotoxic side effects, which make it unsuitable for prophylaxis. Delayed administration of amphotericin and excision of mycelium-containing tissues worsens survival prognoses. More than 30 species of Zygomycota are involved in human infections, among them Mucorales is the most abundant. Prognosis and treatment suggestions differ for each species, which makes fast and reliable diagnosis essential. Serum sample PCR-based identification often gives false-negative results; culture-based identification is time-consuming and not always feasible. With the dawn of Zygomycota sequencing projects significant advancement is expected, as in the case of treatment of Ascomycota infections.
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Affiliation(s)
- A Muszewska
- Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Pawiskiego 5a, 02-106, Warsaw, Poland,
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183
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Matsumoto K, Yamamoto W, Ohgusa E, Tanaka M, Maruta A, Ishigatsubo Y, Kanamori H. Disseminated Cunninghamella bertholletiae infection with septic pulmonary embolism after allogeneic bone marrow transplantation. Transpl Infect Dis 2014; 16:304-6. [PMID: 24593246 DOI: 10.1111/tid.12190] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/30/2013] [Accepted: 09/22/2013] [Indexed: 12/25/2022]
Abstract
Mucormycosis in immunocompromised patients is often reported. We report a patient who developed non-thrombotic pulmonary embolism due to Cunninghamella bertholletiae after allogeneic stem cell transplantation.
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Affiliation(s)
- K Matsumoto
- Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan
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184
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Katragkou A, Walsh TJ, Roilides E. Why is mucormycosis more difficult to cure than more common mycoses? Clin Microbiol Infect 2014; 20 Suppl 6:74-81. [PMID: 24279587 DOI: 10.1111/1469-0691.12466] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although considered to be a rare infection, mucormycosis (zygomycosis) has emerged as the second most common invasive mould infection. Despite the advent of newer antifungal agents, mortality rate of mucormycosis remains exceedingly high. Successful management of mucormycosis requires early diagnosis, reversal of underlying predisposing risk factors, surgical debridement and prompt administration of active antifungal agents. However, mucormycosis is not always amenable to cure. There are challenging obstacles that lead to difficulties in management of amphotericin B. These include unique host-based risk factors for mucormycosis, the fungus' resistance to innate host defences and distinctive features of its immunopathogenesis, such as extensive angioinvasion, increased virulence and use of chelators by the fungus as siderophores. In addition to these obstacles, the difficulties in early diagnosis, including nonspecific clinical manifestations, lack of serological methods, as well limitations of culture and molecular methods, lead to delay in initiation of antifungal therapy. Finally, the variability of susceptibility to amphotericin B and resistance to most other conventional antifungal agents leads to major limitations in successful treatment of this devastating infection.
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Affiliation(s)
- A Katragkou
- Infectious Diseases Unit, 3rd Department of Pediatrics, Faculty of Medicine, Aristotle University School of Health Sciences, Hippokration Hospital, Thessaloniki, Greece; Transplantation-Oncology Infectious Diseases Program, Weill Cornell Medical Center, New York, NY, USA
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185
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Pana ZD, Vikelouda K, Roilides E. Rare Fungal Infections in Children: An Updated Review of the Literature. CURRENT FUNGAL INFECTION REPORTS 2014. [DOI: 10.1007/s12281-014-0175-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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186
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Twizeyimana E, Chauty A, Pihet M, Ardant MF, Adeye A, Zidane M, de Gentile L, Saint-André JP, Chabasse D. [Rhinofacial conidiobolomycosis associated with cervical, thoracic and brachial localizations: one clinical case in Nigeria]. J Mycol Med 2014; 24:48-55. [PMID: 24440611 DOI: 10.1016/j.mycmed.2013.12.001] [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: 10/11/2013] [Revised: 12/02/2013] [Accepted: 12/05/2013] [Indexed: 01/19/2023]
Abstract
We report here the clinical case of a Nigerian adult patient who received medical care during October 2010, at the Center for Diagnosis and Treatment of Buruli ulcer in Pobè (Benin). He presented a massive facial tumor associated with several subcutaneous (cervical, thoracic and upper limbs) nodules, evolving since several years. Tissue samples collected at Pobè medical center were addressed to the mycology and histology laboratories of Angers University Hospital (France), according to the medical exchange agreement between the two institutions about the diagnosis and treatment of Buruli ulcer disease. Histological examination showed a Splendore-Hoeppli phenomenon, consisting of a granulomatous reaction made of eosinophilic polynuclear cells surrounding rare, large and irregular, non-septate hyphae. A filamentous fungus was isolated by cultivation of the clinical samples, which was identified as Conidiobolus coronatus. The patient was treated orally with daily doses of ketoconazole (400 mg per day). After 4 months of treatment, a marked regression of the facial lesion was obtained. A first constructive facial surgery was achieved, but the patient did not attend the second step. This case report allows us to remind the mycological diagnosis of this exotic mycosis, but also to emphasize the main difficulties encountered in medical management in the developing countries.
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Affiliation(s)
- E Twizeyimana
- Laboratoire de parasitologie-mycologie, institut de biologie en santé, centre hospitalier universitaire, 4, rue Larrey, 49933 Angers cedex 9, France
| | - A Chauty
- Centre de diagnostic et de traitement de l'ulcère de Buruli, Pobè, Bénin
| | - M Pihet
- Laboratoire de parasitologie-mycologie, institut de biologie en santé, centre hospitalier universitaire, 4, rue Larrey, 49933 Angers cedex 9, France.
| | - M-F Ardant
- Centre de diagnostic et de traitement de l'ulcère de Buruli, Pobè, Bénin
| | - A Adeye
- Centre de diagnostic et de traitement de l'ulcère de Buruli, Pobè, Bénin
| | - M Zidane
- Laboratoire d'anatomie pathologique, institut de biologie en santé, centre hospitalier universitaire, 4, rue Larrey, 49933 Angers cedex 9, France
| | - L de Gentile
- Laboratoire de parasitologie-mycologie, institut de biologie en santé, centre hospitalier universitaire, 4, rue Larrey, 49933 Angers cedex 9, France
| | - J-P Saint-André
- Laboratoire d'anatomie pathologique, institut de biologie en santé, centre hospitalier universitaire, 4, rue Larrey, 49933 Angers cedex 9, France
| | - D Chabasse
- Laboratoire de parasitologie-mycologie, institut de biologie en santé, centre hospitalier universitaire, 4, rue Larrey, 49933 Angers cedex 9, France
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187
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Gastrointestinal Mucormycosis in Patients With Hematologic Malignancy. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2014. [DOI: 10.1097/ipc.0b013e3182948eb0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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188
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Bulent Ertugrul M, Arikan-Akdagli S. Mucormycosis. Emerg Infect Dis 2014. [DOI: 10.1016/b978-0-12-416975-3.00023-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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189
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Abstract
Rhino-orbital-cerebral mycosis (ROCM) is a life-threatening fungal disease associated mostly with Mucoralean fungi. The infection presents as headache, vision loss, proptosis, ptosis, painful ophthalmoplegia, and peripheral face palsy, with a high mortality (>80% for infections that spread to the brain) and severe morbidity, such as eyeball exenteration and vision loss. In our hospital, a 61-year-old woman with diabetes was diagnosed with rhino-orbital-cerebral infection caused by Alternaria infectoria. Cavernous sinus thromboses (CST) were seen in surgery, pathology, and MRI. She did not respond to potent antifungal therapy until the adding of anti-thrombosis drugs. By analyzing our case, together with the ones that have been published, we realized that fungal thrombosis in the cavernous sinus is the main pathophysiological problem in ROCM that typically shows mass enhancement within the cavernous sinus in radiographic images, thrombosis with characteristics of ischemia and infarction in pathology. Anticoagulation/antithrombus therapy might be helpful in the management of ROCM if potent antifungal treatment does not have effect.
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Affiliation(s)
- D.M. Li
- Department of Dermatology and Mycological Laboratory, Peking University Third Hospital, Beijing, China
- Centraalbureau voor Schimmelcultures, Utrecht, The Netherlands
| | - P.P. Shang
- Department of Dermatology and Mycological Laboratory, Peking University Third Hospital, Beijing, China
| | - L. Zhu
- Department Otorhinolaryngology, Peking University Third Hospital, Beijing, China
| | - G.S. De Hoog
- Centraalbureau voor Schimmelcultures, Utrecht, The Netherlands
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190
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191
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Ye B, Yu D, Zhang X, Shao K, Chen D, Wu D, Zhang Y, Zhou Y, Shen Y, Yu Q. Disseminated Rhizopus microsporus infection following allogeneic hematopoietic stem cell transplantation in a child with severe aplastic anemia. Transpl Infect Dis 2013; 15:E216-23. [PMID: 24119033 DOI: 10.1111/tid.12144] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 05/31/2013] [Accepted: 07/05/2013] [Indexed: 11/30/2022]
Abstract
Disseminated Rhizopus microsporus infections are uncommon in children and are resistant to echinocandin and azole antifungal agents. We describe a child with severe aplastic anemia who developed disseminated R. microsporus infection following allogeneic hematopoietic stem cell transplantation. R. microsporus was identified microscopically in the hepatic drain culture and was confirmed on the basis of 18S rRNA and 28S rRNA sequence analyses. The patient was treated successfully with hepatic drainage and amphotericin B deoxycholate.
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Affiliation(s)
- B Ye
- Department of Hematology, The First Affiliated Hospital, Zhejiang University of Traditional Chinese Medicine, Hangzhou, China
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192
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193
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Indolent mucormycosis of the paranasal sinus in immunocompetent patients: are antifungal drugs needed? The Journal of Laryngology & Otology 2013; 127:872-5. [PMID: 23941886 DOI: 10.1017/s0022215113001795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To report the clinical characteristics and treatment outcomes of indolent paranasal mucormycosis in immunocompetent individuals. MATERIALS AND METHODS A retrospective review of four immunocompetent patients with indolent mucormycosis of the paranasal sinus managed by endoscopic sinus surgery only was performed. One year of regular follow up comprised angled endoscopy and repeated paranasal sinus computed tomography three months after surgery. RESULTS Clinical symptoms were non-specific. Pre-operative paranasal sinus computed tomography showed opacification of the unilateral maxillary sinus with focal calcification but without bony destruction or extension to the orbit or cranium. All patients underwent endoscopic sinus surgery without administration of antifungal agents. There was no recurrence on regular clinical and radiological follow up. CONCLUSION For indolent paranasal mucormycosis in immunocompetent patients, endoscopic sinus surgery can be the treatment of choice, and the administration of antifungal drugs may not be necessary.
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194
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Strasfeld L, Espinosa-Aguilar L, Gajewski JL, Stenzel P, Pimentel A, Mater E, Maziarz RT. Emergence of Cunninghamella as a pathogenic invasive mold infection in allogeneic transplant recipients. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2013; 13:622-8. [PMID: 23850285 DOI: 10.1016/j.clml.2013.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 05/01/2013] [Accepted: 05/02/2013] [Indexed: 12/20/2022]
Affiliation(s)
- Lynne Strasfeld
- Division of Infectious Diseases, Oregon Health and Science University, Portland, OR.
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195
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Thornton CR, Wills OE. Immunodetection of fungal and oomycete pathogens: established and emerging threats to human health, animal welfare and global food security. Crit Rev Microbiol 2013; 41:27-51. [PMID: 23734714 DOI: 10.3109/1040841x.2013.788995] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Filamentous fungi (moulds), yeast-like fungi, and oomycetes cause life-threatening infections of humans and animals and are a major constraint to global food security, constituting a significant economic burden to both agriculture and medicine. As well as causing localized or systemic infections, certain species are potent producers of allergens and toxins that exacerbate respiratory diseases or cause cancer and organ damage. We review the pathogenic and toxigenic organisms that are etiologic agents of both animal and plant diseases or that have recently emerged as serious pathogens of immunocompromised individuals. The use of hybridoma and phage display technologies and their success in generating monoclonal antibodies for the detection and control of fungal and oomycete pathogens are explored. Monoclonal antibodies hold enormous potential for the development of rapid and specific tests for the diagnosis of human mycoses, however, unlike plant pathology, their use in medical mycology remains to be fully exploited.
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196
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Aravindan A, Suranyi M, Saunders J, Yong J, Cleland B. A deadly thorn prick. Clin Kidney J 2013; 6:334-7. [PMID: 26064496 PMCID: PMC4400470 DOI: 10.1093/ckj/sfs058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Accepted: 04/22/2012] [Indexed: 11/12/2022] Open
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197
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Dusart A, Duprez T, Van Snick S, Godfraind C, Sindic C. Fatal rhinocerebral mucormycosis with intracavernous carotid aneurysm and thrombosis: a late complication of transsphenoidal surgery? Acta Neurol Belg 2013; 113:179-84. [PMID: 23135781 DOI: 10.1007/s13760-012-0151-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/15/2012] [Indexed: 12/13/2022]
Abstract
Mucormycosis is a rare opportunistic fungal infection. Rhinocerebral form of the disease mainly affects diabetic or immunocompromised patients. Mucormycosis have specific tropism for blood vessels leading to mucorthrombosis and less often to mycotic aneurysms. We report on a patient initially presenting with a severe sphenoid sinusopathy, who progressively evolved to cavernous sinus syndrome, internal carotid aneurysm followed by spontaneous thrombosis, chronic meningitis and ultimately fatal hypertensive hydrocephalus. Necropsy revealed a purulent infiltrate containing thin-walled, aseptate, right-angle branching, hyphae consistent with mucormycosis. His only relevant previous medical history was a transsphenoidal surgery for pituitary macroadenoma 21 years before. We hypothesize that post-surgical mucosal changes in the sphenoid sinus have been a favoring factor for delayed and invasive mucor infection.
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198
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Vilela VM, Marques HDC, Carvalho REDDS, Zavelinske E, Duque AGDS, Dutra BL. Cavernous sinus syndrome due to rhino-orbital-cerebral mucormycosis. Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000300016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The present report describes the case of a 43-year-old diabetic patient with facial pain, protruding eyes, nasal congestion and decreased right vision (involvement of the ipsilateral cranial nerves III, IV and V). Computed tomography showed diffuse sinusitis at right, cribriform plate erosion and presence of a hypodense collection in the frontal lobe with peripheral enhancement. Magnetic resonance imaging confirmed the presence of a cerebral abscess. Samples were collected from the lesion, confirming hyphae compatible with mucormycosis.
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Affiliation(s)
| | | | | | - Erika Zavelinske
- Hospital Universitário da Universidade Federal de Juiz de Fora, Brazil
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199
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Elguazzar S, Benouachane T, Nasri A, Malihy A, Tligui H, Bentahila A. [Iliofemoral cutaneous mucormycosis with endopelvic extension in an immunocompetent child]. Arch Pediatr 2013; 20:754-7. [PMID: 23706611 DOI: 10.1016/j.arcped.2013.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 04/11/2013] [Indexed: 10/26/2022]
Abstract
Mucormycosis is a rare opportunistic fungal infection with clinical polymorphism and is rapidly extensive and destructive. It is caused by fungi of the mucorales group in the environment and generally arises in the context of immunosuppression. Often difficult and late, diagnosis is based on mycological and histological examination. We report the case of a 10-year-old patient admitted for a pruritic erythematous scaly eruption located in the right inguinal area associated with satellite lymphadenopathy and lymphedema of the right lower limb. The histological study of the cutaneous biopsy revealed a granulomatous reaction with filaments. The mycological examination of the collection of the cutaneous lesion showed mucorales filaments and a stump of Absidia corymbifera was isolated. Abdomino-pelvic CT showed muscular extension with vascular and ureteral englobement. The diagnosis of cutaneous mucormycosis was made. Immunological investigations were normal. Treatment included itraconazole for 3months followed by IV amphotericin B for 1month, with favorable clinical and radiological progression. Mucormycosis is an uncommon fungal infection whose cutaneous localization is rare. It occurs exceptionally in immunocompetent patients and is clinically manifested by a vesicular and pustular rash progressing to ulceration. The diagnosis is confirmed by mycological and histological studies. Treatment consists of antifungal therapy associated with surgical excision of necrotic and infected tissue.
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Affiliation(s)
- S Elguazzar
- Service de pédiatrie IV, faculté de médecine et pharmacie, université Mohammed V-Souissi, hôpital d'enfants, avenue Belarbi El Alaoui, BP 6203, Rabat, Maroc.
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200
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Ananthaneni AR, Undavalli SB, Velagapudi RP, Guduru VS. Mucormycosis: an atrocious mate of patients with diabetes. BMJ Case Rep 2013; 2013:bcr-2013-009600. [PMID: 23645655 DOI: 10.1136/bcr-2013-009600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mucormycosis also called zygomycosis is a rare infection caused by saprophytic aerobic fungus that belongs to a group of fungi called Mucoromycotina in the order Mucorales. Earlier these fungi were called Zygomycota but this scientific name has recently been changed. Mucormycosis can result in an acute, rapidly advancing and occasionally fatal disease caused by different fungi typically found in the soil and in association with decaying organic matter such as leaves, compost piles or rotten wood. These fungal infections are relatively infrequent; however, they occur in individuals who are debilitated in some major way and occasionally in groups of people with multiple penetrating injuries that are contaminated with soil and water from the environment. Mucormycosis is not contagious and does not spread from person to person.
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Affiliation(s)
- Anu Radha Ananthaneni
- Department of Oral Pathology, St Joseph Dental College, Eluru, Andhra Pradesh, India.
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