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Pulle MV, Bishnoi S, Asaf BB, Puri HV, Deshwal V, Kumar A. COVID associated pulmonary mucormycosis: Outcomes of surgical therapy. Asian Cardiovasc Thorac Ann 2023; 31:133-141. [PMID: 36426415 DOI: 10.1177/02184923221140258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aims at reporting the surgical outcomes of COVID associated pulmonary mucormycosis with special emphasis on surgical mortality. METHODS This prospective observational study was conducted in a dedicated thoracic surgical unit in Gurugram, India over 18 months. An analysis of demography, peri-operative variables were carried out. Various parameters were analysed to assess the factors affecting mortality. RESULTS Total of 44 patients with diagnosis of CAPM were managed during the study period. All were started on anti-fungal therapy. However, 33 patients (75%) were operated whereas rest 11 (25%) were not considered suitable for surgery. In the surgical cohort (n = 33), there were 20 males (60.6%) and 13 females (39.4%), with a mean age of 54.8 years (range, 33-72 years). The mean duration of the symptoms was 1.1 weeks. Non-anatomical wedge resection of lobe(s) was performed in 5 patients (15.1%), lobectomy/bi-lobectomy was required in 26 patients (78.9%) and left pneumonectomy in 2 patients (6%). There were 5 peri-operative deaths (15.1%), all due to fungal sepsis. ECOG scale > 2 (P ≤ 0.001), higher Charlson Comorbidity Index score > 2 (P = 0.04) and pneumonectomy (P = 0.02) were the predictors of mortality. On comparison with NCPM, there was no difference in the incidence of post-operative complications (P = 0.50) and the post-operative mortality (P = 0.69). CONCLUSION Aggressive surgical resection with clear margins should be offered in CAPM, whenever feasible. Surgery for CAPM was not associated with higher post-operative complications including mortality compared to Non-COVID Pulmonary Mucormycosis.
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Affiliation(s)
- Mohan Venkatesh Pulle
- Department of Thoracic Surgery, Institute of Chest Surgery, Medanta - The Medicity, Gurugram, India
| | - Sukhram Bishnoi
- Department of Thoracic Surgery, Institute of Chest Surgery, Medanta - The Medicity, Gurugram, India
| | - Belal Bin Asaf
- Department of Thoracic Surgery, Institute of Chest Surgery, Medanta - The Medicity, Gurugram, India
| | - Harsh Vardhan Puri
- Department of Thoracic Surgery, Institute of Chest Surgery, Medanta - The Medicity, Gurugram, India
| | - Vikas Deshwal
- Division of Infectious Diseases, Medanta - The Medicity, Gurugram, India
| | - Arvind Kumar
- Department of Thoracic Surgery, Institute of Chest Surgery, Medanta - The Medicity, Gurugram, India
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Pulle MV, Puri HV, Asaf BB, Bishnoi S, Sharma S, Kumar A. Outcomes of early anti-fungal therapy with aggressive surgical resection in pulmonary mucormycosis. Lung India 2021; 38:314-320. [PMID: 34259168 PMCID: PMC8272436 DOI: 10.4103/lungindia.lungindia_758_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives The standard management protocols are lacking in the management of pulmonary mucormycosis (PM). The present study aims at reporting our clinical experience and proposing an algorithm for the management of PM. Materials and Methods This is a retrospective analysis of a prospectively maintained database at a dedicated thoracic surgical unit in New Delhi, India, over 7 years. An analysis of demographic characteristics and perioperative variables including complications was carried out. Various parameters were analyzed to assess the factors affecting mortality after surgical intervention. Results Out of total 19 patients, 15 were males (78.9%) and 4 females (21.1%), with a mean age of 43.8 years (range, 19-72 years). Chronic kidney disease (status postrenal transplant on immunosuppressant therapy) was the most common predisposing factor in 11 patients (57.8%). All patients were initially started on antifungal therapy, and after 7-8 days, the response was assessed by computed tomography scan of the chest, and based on that, 15 patients (78.9%) were operated (surgical group) and the rest 4 (21.1%) were not (nonsurgical group). In the surgical group, lobectomy was required in 12 (80%) and pneumonectomy in 3 patients (20%). Postoperative complications occurred in 5 patients (33.3%). There were 3 perioperative deaths (within 90 days of surgery) (20%). Poor Eastern Cooperative Oncology Group performance status (>2) and longer duration of symptoms (>2 weeks) were independent predictors of mortality after surgery. The survivors in the surgical group are doing well. However, all four patients in the nonsurgical group died due to disease progression. Conclusion After few days of initiation of antifungal therapy, aggressive surgical resection must be performed (wherever feasible) to improve survival outcome in patients with PM.
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Affiliation(s)
| | | | - Belal Bin Asaf
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Sukhram Bishnoi
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
| | - Shikha Sharma
- Department of Anaesthesia, Pain, and Perioperative Medicine, Sir Ganga Ram Hospital, New Delhi, India
| | - Arvind Kumar
- Centre for Chest Surgery, Sir Ganga Ram Hospital, New Delhi, India
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Claustre J, Larcher R, Jouve T, Truche AS, Nseir S, Cadiet J, Zerbib Y, Lautrette A, Constantin JM, Charles PE, Daubin C, Coudroy R, Dellamonica J, Argaud L, Phelouzat P, Contou D, Pocquet J, Voiriot G, Navellou JC, Lavagne P, Durand M, Cornet M, Schwebel C, Terzi N. Mucormycosis in intensive care unit: surgery is a major prognostic factor in patients with hematological malignancy. Ann Intensive Care 2020; 10:74. [PMID: 32514787 PMCID: PMC7280386 DOI: 10.1186/s13613-020-00673-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 05/04/2020] [Indexed: 12/30/2022] Open
Abstract
Background Mucormycosis is an invasive fungal infection, with an increasing incidence especially in patients with hematological malignancies. Its prognosis is poor because of its high invasive power and its intrinsic low susceptibility to antifungal agents. We aimed to describe the epidemiology of mucormycosis in intensive care units (ICU) and evaluate the outcomes. We performed a retrospective multi-center study in 16 French ICUs between 2008 and 2017. We compared the patients who survived in ICU and the patients who did not to identify factors associated with ICU survival. Then, we focused on the subgroup of patients with hematological malignancies. Results Mucormycosis was diagnosed in 74 patients during the study period. Among them, 60 patients (81%) were immunocompromised: 41 had hematological malignancies, 9 were solid organ transplant recipients, 31 received long-term steroids, 11 had diabetes, 24 had malnutrition. Only 21 patients survived to ICU stay (28.4%) with a median survival of 22 days (Q1–Q3 = 9–106) and a survival rate at day 28 and day 90, respectively, of 35.1% and 26.4%. Survivors were significantly younger (p = 0.001), with less frequently hematological malignancies (p = 0.02), and less malnutrition (p = 0.05). Median survival in patients with hematological malignancies (n = 41) was 15 days (Q1–Q3 = 5–23.5 days). In this subgroup, curative surgery was a major factor associated with survival in multivariate analysis (odds ratio = 0.71, [0.45–0.97], p < 0.001). Conclusion Overall prognosis of mucormycosis in ICU remains poor, especially in patients with hematological malignancies. In this subgroup of patients, a therapeutic strategy including curative surgery was the main factor associated with survival.
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Affiliation(s)
- Johanna Claustre
- Service de Pneumologie, CH Annecy Genevois, 1 Avenue de l'hôpital, 74370, Epagny Metz-Tessy, France.
| | - Romaric Larcher
- Médecine Intensive Réanimation, CHU Montpellier, Montpellier, France
| | - Thomas Jouve
- Université Grenoble Alpes, Grenoble, France.,Service Hospitalo-universitaire de Néphrologie, CHU Grenoble Alpes, Grenoble, France
| | - Anne-Sophie Truche
- Université Grenoble Alpes, Grenoble, France.,Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Saad Nseir
- Réanimation Médicale, CHU Lille, Lille, France
| | - Julien Cadiet
- Service de médecine intensive Réanimation, CHU Nantes, Nantes, France
| | | | | | | | | | | | - Remi Coudroy
- Réanimation médicale, CHU Poitiers, Poitiers, France
| | - Jean Dellamonica
- Médecine Intensive Réanimation, CHU Nice, Université Côte d'Azur, Nice, France
| | | | | | - Damien Contou
- Réanimation polyvalente, CH Argenteuil, Argenteuil, France
| | | | | | | | - Pierre Lavagne
- Réanimation Polyvalente Chirurgicale, CHU Grenoble Alpes, Grenoble, France
| | - Michel Durand
- Réanimation Cardio-vasculaire et Thoracique, CHU Grenoble Alpes, Grenoble, France
| | - Muriel Cornet
- Université Grenoble Alpes, Grenoble, France.,Laboratoire de Mycologie-Parasitologie, CHU Grenoble Alpes, Grenoble, France
| | - Carole Schwebel
- Université Grenoble Alpes, Grenoble, France.,Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France
| | - Nicolas Terzi
- Université Grenoble Alpes, Grenoble, France.,Médecine Intensive Réanimation, CHU Grenoble Alpes, Grenoble, France
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Jin F, Li Q, Bai C, Wang H, Li S, Song Y, Zeng Y, Zhou R, Li W, Hu C, Zhang J, Zhou H, Zhang H. Chinese Expert Recommendation for Diagnosis and Treatment of Massive Hemoptysis. Respiration 2019; 99:83-92. [PMID: 31509823 DOI: 10.1159/000502156] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 07/16/2019] [Indexed: 11/19/2022] Open
Abstract
Massive hemoptysis is one of emergency and critical diseases of the respiratory system. The definition of massive hemoptysis has always been different in the literature, which often depends on the quantitative estimation of the amount of hemoptysis, such as the amount of hemoptysis being in the range of 300-600 mL within 24 h, or hemoptysis more than 3 times within 1 week. Each amount of hemoptysis that is greater than 100 mL can be considered as massive hemoptysis, but the amount of hemoptysis is difficult to accurately estimate. Therefore, massive hemoptysis can be defined as any life-threatening hemoptysis and any hemoptysis that may cause airway obstruction and asphyxia. Massive hemoptysis accounts for approximately 5% of all hemoptysis cases and usually indicates the presence of a potentially severe respiratory or systemic disease. The mortality rate of massive hemoptysis is about 6.5-38%. The cause of death is generally shock caused by airway obstruction or excessive bleeding, and asphyxia is the main cause of death. At present, due to insufficient understanding of massive hemoptysis, there are limited technical means in the etiological diagnosis and untimely or improper treatment, resulting in high mortality of massive hemoptysis. Therefore, the diagnosis and treatment of massive hemoptysis needs to be standardized.
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Affiliation(s)
- Faguang Jin
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, China,
| | - Qiang Li
- Department of Respiratory and Critical Care Medicine, Dongfang Hospital, Tongji University, Shanghai, China
| | - Chong Bai
- Department of Respiratory Medicine, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Hongwu Wang
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China
| | - Shiyue Li
- Guangzhou Institute of Respiratory Health, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China
| | - Yiming Zeng
- Department of Respiratory Pulmonary and Critical Care Medicine, The Second Hospital of Fujian Medical University, Quanzhou, China
| | - Rui Zhou
- Department of Respiratory Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wangping Li
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, China
| | - Chengping Hu
- Department of Respiration, Central South University Xiangya Hospital, Changsha, China
| | - Jie Zhang
- Department of Respiration, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hongmei Zhou
- Department of Respiration, Affiliated Zhongshan Hospital of Guangdong Medical University, Guangzhou, China
| | - Haitao Zhang
- Department of Respiratory and Critical Care Medicine, Tangdu Hospital, Air Force Medical University, Xi'an, China
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Hirano T, Yamada M, Sato K, Murakami K, Tamai T, Mitsuhashi Y, Tamada T, Sugiura H, Sato N, Saito R, Tominaga J, Watanabe A, Ichinose M. Invasive pulmonary mucormycosis: rare presentation with pulmonary eosinophilia. BMC Pulm Med 2017; 17:76. [PMID: 28454572 PMCID: PMC5410085 DOI: 10.1186/s12890-017-0419-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 04/25/2017] [Indexed: 10/30/2022] Open
Abstract
BACKGROUND Fungi can cause a variety of infectious diseases, including invasive mycosis and non-invasive mycosis, as well as allergic diseases. The different forms of mycosis usually have been described as mutually exclusive, independent entities, with few descriptions of overlapping cases. Here, we describe the first reported case of a patient with the complication of pulmonary eosinophilia in the course of invasive mucormycosis. CASE PRESENTATION A 74-year-old Japanese man with asthma-COPD overlap underwent emergency surgery for a ruptured abdominal aortic aneurysm. The surgery was successful, but fever and worsening dyspnea appeared and continued from postoperative day (POD) 10. A complete blood count showed leukocytosis with neutrophilia and eosinophilia, and the chest X-ray showed consolidation of the left upper lung at POD 15. We suspected nosocomial pneumonia together with an exacerbation of the asthma-COPD overlap, and both antibiotics and bronchodilator therapy were initiated. However, the symptoms, eosinophilia and imaging findings deteriorated. We then performed a bronchoscopy, and bronchoalveolar lavage (BAL) fluid analysis revealed an increased percentage of eosinophils (82% of whole cells) as well as filamentous fungi. We first suspected that this was a case of allergic bronchopulmonary mycosis (ABPM) caused by Aspergillus infection and began corticosteroid therapy with an intravenous administration of voriconazole at POD 27. However, the fungal culture examination of the BAL fluid revealed mucormycetes, which were later identified as Cunninghamella bertholletiae by PCR and DNA sequencing. We then switched the antifungal agent to liposomal amphotericin B for the treatment of the pulmonary mucormycosis at POD 29. Despite replacing voriconazole with liposomal amphotericin B, the patient developed septic shock and died at POD 39. The autopsy revealed that filamentous fungi had invaded the lung, heart, thyroid glands, kidneys, and spleen, suggesting that disseminated mucormycosis had occurred. CONCLUSIONS We describe the first reported case of pulmonary mucormycosis with pulmonary eosinophilia caused by Cunninghamella bertholletiae, which resulted in disseminated mucormycosis. Although it is a rather rare case, two important conclusions can be drawn: i) mycosis can simultaneously cause both invasive infection and a host allergic reaction, and ii) Cunninghamella bertholletiae rarely infects immunocompetent patients.
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Affiliation(s)
- Taizou Hirano
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Mitsuhiro Yamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan.
| | - Kei Sato
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Koji Murakami
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Tokiwa Tamai
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Yoshiya Mitsuhashi
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Tsutomu Tamada
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Hisatoshi Sugiura
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Naomi Sato
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Ryoko Saito
- Department of Anatomic Pathology, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Junya Tominaga
- Department of Diagnostic Radiology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
| | - Akira Watanabe
- Research Division for Development of Anti-Infective Agents, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Masakazu Ichinose
- Department of Respiratory Medicine, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan
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Abstract
A 78-year-old diabetic man presented with consolidation in the middle and lower lobe of the right lung. An endobronchial mucoid mass was found to be obstructing the right middle lobe and right lower lobe bronchi. The patient was treated with intravenous amphotericin B followed by a right pneumonectomy. Histopathology of the resected specimen demonstrated broad nonseptate hyphae branching at right angles, characteristic of mucormycosis.
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Affiliation(s)
- Yoon Joo Hong
- Department of Thoracic and Cardiovascular Surgery Ewha Woman's University Dongdaemun Hospital Seoul, Korea
| | - Doo Yun Lee
- Department of Thoracic and Cardiovascular Surgery Ewha Woman's University Dongdaemun Hospital Seoul, Korea
| | - Young Sik Park
- Department of Thoracic and Cardiovascular Surgery Ewha Woman's University Dongdaemun Hospital Seoul, Korea
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Long B, Koyfman A. Mucormycosis: what emergency physicians need to know? Am J Emerg Med 2015; 33:1823-5. [PMID: 26452511 DOI: 10.1016/j.ajem.2015.08.037] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/19/2015] [Accepted: 08/24/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Mucormycosis is a rare presentation for patients in the emergency department (ED), primarily affecting immunocompromised patients. Multiple forms of infection are present, and with poor prognosis, ED diagnosis and treatment of this deadly condition are necessary. OBJECTIVE OF REVIEW The aim of this review is to provide an overview of the presentations and forms of mucormycosis, diagnosis, and treatment of this deadly disease. DISCUSSION This review provides background on the fungi causing mucormycosis, which are prevalent in nature. The article discusses the risk factors for infection with mucormycosis, as normal hosts are able to clear the disease, but immunocompromised and diabetic patients are at risk for organism inoculation and spread. The fungi are angioinvasive and cause necrosis. This article describes the various forms of the disease: rhino-orbital-cerebral, pulmonary, central nervous system, gastrointestinal, renal, disseminated, and cutaneous. Finally, this review evaluates diagnosis, treatment, and prognosis. CONCLUSION Emergency department diagnosis and treatment are necessary in patients with infection with mucormycosis. Physicians should be suspicious of this disease in immunocompromised and diabetic patients. Treatment requires antifungal agents such as amphotericin B and surgical debridement. Prognosis is poor.
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Affiliation(s)
- Brit Long
- Department of Emergency Medicine, San Antonio Military Medical Center, Houston, TX 78234.
| | - Alex Koyfman
- Department of Emergency Medicine, The University of Texas Southwestern Medical Center, Dallas, TX 75390.
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Misra P, Roy P, Dutta V, Saha TK. Fatal massive hemoptysis: An autopsy study. Med J Armed Forces India 2015; 71:S234-6. [PMID: 26265843 DOI: 10.1016/j.mjafi.2014.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Accepted: 04/30/2014] [Indexed: 10/24/2022] Open
Affiliation(s)
- Pratibha Misra
- Assistant Professor, Dept of Biochemistry, Armed Forces Medical College, Pune-411040, India
| | - Partha Roy
- Associate Professor, Dept of Microbiology, Armed Forces Medical College, Pune-411040, India
| | - Vibha Dutta
- Consultant (Pathology), Army Hospital (R&R), Delhi Cantt-10, India
| | - T K Saha
- Brig (Med), Head Quarter 16 Corps, C/o 56 APO, India
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Karnak D, Avery RK, Gildea TR, Sahoo D, Mehta AC. Endobronchial Fungal Disease: An Under-Recognized Entity. Respiration 2006; 74:88-104. [PMID: 16864987 DOI: 10.1159/000094708] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2006] [Accepted: 04/13/2006] [Indexed: 01/15/2023] Open
Abstract
Most fungi enter the human body via inhalation; however, endobronchial fungal infection (EBFI) seems to be a rare manifestation compared to pulmonary or systemic disease. This presentation seems to be related to environmental factors as well as to the host status. With the increasing popularity of flexible bronchoscopy, it is being recognized with a higher frequency. Bronchoscopic findings in EBFI vary from mild mucosal inflammation to central airway obstruction. We searched English literature related to the topic and found 228 total cases of EBFI: Aspergillus species (121), Coccidioides immitis (38), Zygomycetes (31), Candida species (14) Cryptococcus neoformans (13), and Histoplasma capsulatum (11). We have also included a single case of endobronchial Pseudallescheria boydii infection in a lung transplant recipient that has not been reported previously. Most patients were immunocompromised, exhibited systemic manifestations of the primary infection, and responded to appropriate therapy. EBFI should be included in the differential diagnosis of any form of airway lesions in immunocompromised patients, especially among residents from the endemic areas.
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Affiliation(s)
- Demet Karnak
- Department of Chest Diseases, Ankara University School of Medicine, Ankara, Turkey, and Department of Chest Medicine, KEM Hospital, Mumbai, India
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10
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Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, Sein M, Sein T, Chiou CC, Chu JH, Kontoyiannis DP, Walsh TJ. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005; 41:634-53. [PMID: 16080086 DOI: 10.1086/432579] [Citation(s) in RCA: 1837] [Impact Index Per Article: 96.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Accepted: 04/18/2005] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Zygomycosis is an increasingly emerging life-threatening infection. There is no single comprehensive literature review that describes the epidemiology and outcome of this disease. METHODS We reviewed reports of zygomycosis in the English-language literature since 1885 and analyzed 929 eligible cases. We included in the database only those cases for which the underlying condition, the pattern of infection, the surgical and antifungal treatments, and survival were described. RESULTS The mean age of patients was 38.8 years; 65% were male. The prevalence and overall mortality were 36% and 44%, respectively, for diabetes; 19% and 35%, respectively, for no underlying condition; and 17% and 66%, respectively, for malignancy. The most common types of infection were sinus (39%), pulmonary (24%), and cutaneous (19%). Dissemination developed in 23% of cases. Mortality varied with the site of infection: 96% of patients with disseminated disease died, 85% with gastrointestinal infection died, and 76% with pulmonary infection died. The majority of patients with malignancy (92 [60%] of 154) had pulmonary disease, whereas the majority of patients with diabetes (222 [66%] of 337) had sinus disease. Rhinocerebral disease was seen more frequently in patients with diabetes (145 [33%] of 337), compared with patients with malignancy (6 [4%] of 154). Hematogenous dissemination to skin was rare; however, 78 (44%) of 176 cutaneous infections were complicated by deep extension or dissemination. Survival was 3% (8 of 241 patients) for cases that were not treated, 61% (324 of 532) for cases treated with amphotericin B deoxycholate, 57% (51 of 90) for cases treated with surgery alone, and 70% (328 of 470) for cases treated with antifungal therapy and surgery. By multivariate analysis, infection due to Cunninghamella species and disseminated disease were independently associated with increased rates of death (odds ratios, 2.78 and 11.2, respectively). CONCLUSIONS Outcome from zygomycosis varies as a function of the underlying condition, site of infection, and use of antifungal therapy.
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Affiliation(s)
- Maureen M Roden
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, MD 20892, USA
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Chadli-Chaieb M, Bchir A, Fathallah-Mili A, Ach K, Maaroufi A, Garrouche A, Chaieb L. [Mucormycosis in the diabetic patient]. Presse Med 2005; 34:218-22. [PMID: 15798533 DOI: 10.1016/s0755-4982(05)88251-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Mucormycosis is a rare, devastating, fungal infection, which disproportionately affects non-controlled diabetic patients, notably during ketoacidosis. It can be manifested in rhinocerebral, but also pulmonary and disseminated forms. OBSERVATIONS Four consecutive diabetic patients who were admitted to the Farhat Hached Hospital, Sousse, Tunisia, between January 2001 and November 2002, are presented. Three patients exhibited ketoacidosis and one renal failure with hyperosmolarity. Infection was limited to the sinuses in two cases, to lower respiratory tract in one case, and was probably disseminated in one case. Diagnosis was confirmed by mycological and histological findings in all cases. Systemic Amphotericin B was associated with surgical debridement of the lesions in patients with rhinocerebral involvement. DISCUSSION Despite aggressive therapy, mortality was high (3 out of 4 patients). Mucormycosis remains a severe, frequently fatal disease in diabetic patients.
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Affiliation(s)
- M Chadli-Chaieb
- Service d'endocrinologie et des maladies metaboliques, Centre hospitalo-universitaire Farhat Hached de Sousse, 4000 Sousse, Tunisia.
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12
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Wolf O, Gil Z, Leider-Trejo L, Khafif A, Biderman P, Fliss DM. Tracheal mucormycosis presented as an intraluminal soft tissue mass. Head Neck 2004; 26:541-3. [PMID: 15162356 DOI: 10.1002/hed.20055] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mucormycosis is a potentially lethal disease caused by an opportunistic fungal infection. It occurs mostly in diabetic or immunosuppressed patients and usually involves the lungs or paranasal sinuses. METHODS We report a rare case of a patient with diabetic ketoacidosis who presented with progressive cough and dyspnea. CT of the neck and chest showed an intraluminal soft-tissue mass extending from the first tracheal ring to the thoracic inlet, causing severe destruction of the trachea. Direct laryngoscopy and biopsy demonstrated hyphal invasion with architecture typical of invasive mucormycosis. RESULTS The patient underwent resection of the upper trachea and prolonged amphotericin B therapy and is disease free at 24 months after surgery. CONCLUSIONS In patients with diabetes presenting with progressive hoarseness, dyspnea, and endobronchial mass, a fungal infection should be considered. In case of invasive tracheal mucormycosis, prompt diagnosis and early surgical resection may help improve survival.
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Affiliation(s)
- Omer Wolf
- Department of Otolaryngology Head & Neck Surgery, Tel-Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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13
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Abstract
Zygomycosis, an uncommon but frequently fatal mycosis caused by fungi of the class Zygomycetes, develops most commonly as an opportunistic disease. Successful therapy involves a combined approach based on early diagnosis, prompt institution of medical therapy, and extensive surgical debridement of all devitalized tissue. Given the rarity of this condition, novel therapeutic strategies have been limited and only tested on an individual basis. The use of high-dose lipid formulations of amphotericin B, prompt reversal of the underlying predisposing condition, and hyperbaric oxygen are the most common strategies that have shown potential value in the treatment of zygomycosis.
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Affiliation(s)
- Corina E Gonzalez
- Division of Pediatric Hematology-Oncology, Department of Pediatrics, Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC 20007, USA.
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14
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Widmann MD, Hruska LA, Kernstine KH. Complete video-assisted resection of trilobar mucormycosis. J Laparoendosc Adv Surg Tech A 2000; 10:219-21. [PMID: 10997846 DOI: 10.1089/109264200421621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A case of trilobar pulmonary mucormycosis in a diabetic patient with severe obstructive pulmonary disease, successfully treated with systemic antifungal therapy and complete video-assisted thoracic surgery (VATS) resection, is presented. The VATS approach permitted accurate diagnosis and definitive therapy using lung-sparing techniques in a minimally invasive manner.
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Affiliation(s)
- M D Widmann
- Division of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA.
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15
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Abstract
Pulmonary mucormycosis is a recognized entity occurring in diabetics and immunocompromised patients. It has a poor prognosis unless early diagnosis is made and appropriate surgical therapy instituted along with appropriate antifungal therapy. We describe here one of few cases of tracheal involvement by mucormycosis. Extensive destruction of the trachea and bibasal pneumonia led to the patient's death.
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Affiliation(s)
- D R Andrews
- Department of Cardiothoracic Surgery, Royal Perth Hospital, Western Australia, Australia
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16
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Escobar Sacristán J, de Granda Orive J, Ramírez García J, Ortiz de Villajos E, López Perales M, Barberán López J. Mucormicosis pulmonar: presentación de un caso y revisión bibliográfica. Arch Bronconeumol 1996. [DOI: 10.1016/s0300-2896(15)30839-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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