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Cunningham CA, Grys TE, Downey FX, Saling CF, Orenstein R, Blair JE. Deep Sternal Wound Infection Caused by Rhizopus Species After Coronary Artery Bypass Graft. Open Forum Infect Dis 2024; 11:ofae302. [PMID: 38872847 PMCID: PMC11170494 DOI: 10.1093/ofid/ofae302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/24/2024] [Indexed: 06/15/2024] Open
Abstract
Deep sternal wound infection is a rare complication of cardiac surgery that is typically caused by skin resident flora, such as species of Staphylococcus and Streptococcus. Infections caused by fungi are less common and are generally caused by Candida species. Regardless of etiology, these infections are associated with significant morbidity and mortality. We present a case of postoperative mediastinitis that occurred following a 5-vessel coronary artery bypass graft and was caused by a filamentous fungus of the Rhizopus genus. The patient was treated with serial debridement, liposomal amphotericin B, and isavuconazonium and was discharged from the hospital in stable condition. Fungal mediastinitis is a rare entity, and clinicians must maintain a high level of suspicion to make the diagnosis. A fungal cause of postoperative mediastinitis should be considered in patients with negative bacterial cultures, uncontrolled diabetes, or current immunosuppression or those who present weeks after surgery with a subacute onset of symptoms.
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Affiliation(s)
- Cody A Cunningham
- Department of Internal Medicine, Mayo Clinic School of Graduate Medical Education, Scottsdale, Arizona, USA
| | - Thomas E Grys
- Department of Pathology and Laboratory Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Francis X Downey
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | - Robert Orenstein
- Division of Infectious Disease, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Janis E Blair
- Division of Infectious Disease, Mayo Clinic Arizona, Phoenix, Arizona, USA
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2
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Invasive fungal infections in neonates: a review. Pediatr Res 2022; 91:404-412. [PMID: 34880444 DOI: 10.1038/s41390-021-01842-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/16/2021] [Accepted: 10/28/2021] [Indexed: 12/15/2022]
Abstract
Invasive fungal infections remain the leading causes of morbidity and mortality in neonates, especially preterm and very low birth weight infants. Most invasive fungal infections are due to Candida or Aspergillus species, and other fungi are increasingly reported and described. Appropriate identification and treatment are required to augment activity and reduce the toxicity of antifungal drugs. Successful use of antifungals in the vulnerable neonatal population is important for both prevention and treatment of infection. Strategies for prevention, including prophylactic antifungal therapy as well as reducing exposure to modifiable risk factors, like limiting antibiotic exposure, discontinuation of central catheters, and hand hygiene are key techniques to prevent and decrease rates of invasive fungal infections. In conclusion, this is a review of the most common causes, prevention strategies, prophylaxis, and treatment of invasive fungal infections in neonates.
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Bernatchez SF, Schommer K. Infection prevention practices and the use of medical tapes. Am J Infect Control 2021; 49:1177-1182. [PMID: 33766550 DOI: 10.1016/j.ajic.2021.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/12/2021] [Accepted: 03/13/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Medical tapes are ubiquitous in healthcare and there are currently no guidelines for their storage and use. Tapes cannot be cleaned or disinfected; yet, several clinicians may use a given roll for any number of patients. Reports of tape contamination associated with clinical infection have been published. PURPOSE We reviewed the literature reporting microbiological studies, case reports of infections, and nosocomial outbreaks associated with the use of medical tapes and other adhesive devices to assess the prevalence of this problem. METHODS We conducted a literature search for cross-contamination due to medical tape use in 6 databases in June 2020 using indexing terms for surgical tape, adhesive agent, adhesives or the keyword for tape. We compiled available evidence on tape contamination as a cause for healthcare-associated infections (HAIs). MAIN FINDINGS Forty-two publications reported relevant microbiological studies, case reports of infections, and/or nosocomial outbreaks. Results demonstrated that tape rolls handled with questionable practices can harbor pathogens. Some studies showed the association between contaminated tape and HAIs, which in some cases even led to death. CONCLUSIONS The time has come to establish national guidelines to help reduce the risk of cross-contamination from medical tapes. We offer suggested elements for these guidelines. The COVID-19 pandemic brings greater scrutiny to eliminate any avoidable cause of infection transmission.
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Hoyos Á, Mejía MA, Herrera V, Soto A, Rico C. Necrotizing cellulitis due to Rhizopus arrhizus in an extremely premature infant. IDCases 2020; 20:e00754. [PMID: 32368491 PMCID: PMC7186520 DOI: 10.1016/j.idcr.2020.e00754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 03/22/2020] [Accepted: 03/22/2020] [Indexed: 11/18/2022] Open
Abstract
We report an extremely premature infant with necrotizing cellulitis. After minor trauma to the left arm when removing an adhesive sensor, patient developed rapidly progressive cellulitis, which evolved into a necrotic ulcer. Microbiological studies (mass spectroscopy and molecular assay) identified Rhizopus arrhizus as the responsible fungus.
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Affiliation(s)
- Álvaro Hoyos
- Department of Pediatrics, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Carrera 72A No. 78B-50, Medellín, Colombia
- Corresponding author at: Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Carrera 72A No. 78B-50, Medellín, Colombia.
| | - María Adelaida Mejía
- Department of Dermatology, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Carrera 72A No. 78B-50, Medellín, Colombia
| | - Verónica Herrera
- Pathology Laboratory, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana Clínica Vida Fundación, Carrera 72A No. 78B-50, Medellín, Colombia
| | - Andrés Soto
- Dinamica Microbiology Laboratory, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Carrera 72A No. 78B-50, Medellín, Colombia
| | - Clara Rico
- Department of Pediatrics, Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Carrera 72A No. 78B-50, Medellín, Colombia
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Outbreaks of Mucorales and the Species Involved. Mycopathologia 2019; 185:765-781. [PMID: 31734800 DOI: 10.1007/s11046-019-00403-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/22/2019] [Indexed: 01/27/2023]
Abstract
The order Mucorales is an ancient group of fungi classified in the subphylum Mucoromycotina. Mucorales are mainly fast-growing saprotrophs that belong to the first colonizers of diverse organic materials and represent a permanent part of the human environment. Several species are able to cause human infections (mucormycoses) predominantly in patients with impaired immune system, diabetes, or deep trauma. In this review, we compiled 32 reports on community- and hospital-acquired outbreaks caused by Mucorales. The most common source of mucoralean outbreaks was contaminated medical devices that are responsible for 40.7% of the outbreaks followed by contaminated air (31.3%), traumatic inoculation of soil or foreign bodies (9.4%), and the contact (6.2%) or the ingestion (6.2%) of contaminated plant material. The most prevalent species were Rhizopus arrhizus and R. microsporus causing 57% of the outbreaks. The genus Rhizomucor was dominating in outbreaks related to contaminated air while outbreaks of Lichtheimia species and Mucor circinelloides were transmitted by direct contact. Outbreaks with the involvement of several species are reported. Subtyping of strains revealed clonality in two outbreaks and no close relation in two other outbreaks. Based on the existing data, outbreaks of Mucorales can be caused by heterogeneous sources consisting of different strains or different species. Person-to-person transmission cannot be excluded because Mucorales can sporulate on wounds. For a better understanding and prevention of outbreaks, we need to increase our knowledge on the physiology, ecology, and population structure of outbreak causing species and more subtyping data.
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A Guide to Investigating Suspected Outbreaks of Mucormycosis in Healthcare. J Fungi (Basel) 2019; 5:jof5030069. [PMID: 31344775 PMCID: PMC6787571 DOI: 10.3390/jof5030069] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/04/2019] [Accepted: 07/17/2019] [Indexed: 12/11/2022] Open
Abstract
This report serves as a guide for investigating mucormycosis infections in healthcare. We describe lessons learned from previous outbreaks and offer methods and tools that can aid in these investigations. We also offer suggestions for conducting environmental assessments, implementing infection control measures, and initiating surveillance to ensure that interventions were effective. While not all investigations of mucormycosis infections will identify a single source, all can potentially lead to improvements in infection control.
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Kaur H, Ghosh A, Rudramurthy SM, Chakrabarti A. Gastrointestinal mucormycosis in apparently immunocompetent hosts—A review. Mycoses 2018; 61:898-908. [DOI: 10.1111/myc.12798] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/09/2018] [Accepted: 05/25/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Harsimran Kaur
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
| | - Anup Ghosh
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
| | - Shivaprakash M. Rudramurthy
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
| | - Arunaloke Chakrabarti
- Department of Medical MicrobiologyPostgraduate Institute of Medical Education and Research PGIMER Chandigarh India
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Singla K, Samra T, Bhatia N. Primary Cutaneous Mucormycosis in a Trauma Patient with Morel-Lavallée Lesion. Indian J Crit Care Med 2018; 22:375-377. [PMID: 29910552 PMCID: PMC5971651 DOI: 10.4103/ijccm.ijccm_343_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Mucormycosis is an aggressive fungal infection caused by zygomycetes from the order of Mucorales. Immunocompromised patients or patients with comorbidities are susceptible to this infection. There are many forms of mucormycosis such as rhino-orbito-cerebral, cutaneous, gastrointestinal, and pulmonary. Cutaneous mucormycosis is rare in trauma patients with no comorbidities. Morel-Lavallée lesions are rare degloving injuries in trauma patients. We report a case of cutaneous mucormycosis in a trauma patient with the Morel-Lavallée lesions.
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Affiliation(s)
- Karan Singla
- Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanvir Samra
- Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Bhatia
- Department of Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Shelly D, Mishra S, Gupta D, Bharadwaj R. Invasive cutaneous mucormycosis in a preterm neonate presenting as a vesicobullous lesion. INDIAN J PATHOL MICR 2018; 61:103-105. [DOI: 10.4103/ijpm.ijpm_796_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Yacoub A, Soni KK, Mojica L, Mai J, Morano J, Cruse CW, Sandin RL, Nanjappa S, Bohra C, Gajanan G, Greene JN. Primary Gangrenous Cutaneous Mold Infections in a Patient With Cancer and Neutropenia. Cancer Control 2017; 23:265-71. [PMID: 27556666 DOI: 10.1177/107327481602300309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Opportunistic fungal infections caused by Aspergillus and Candida followed by infections with Fusarium, Rhizopus, Mucor, and Alternaria species are an important cause of morbidity and mortality in patients with hematological malignancies. Cutaneous mucormycosis infections are rare, and the incidence, outcomes, and factors associated with survival in the setting of hematological malignancies are not clear. METHODS A literature search was conducted for all cases of primary cutaneous mold infections in patients with hematological malignancy, of which 50 cases were found. Our case of a patient with a hematological malignancy who sustained a cat bite that in turn caused a primary cutaneous mold infection is also included. RESULTS In the 51 cases identified, 66.7% were neutropenic upon presentation, and 54.9% were male with an average age of 32 years. Aspergillus species (33.3%) was the most cited followed by Rhizopus species (19.6%). Overall mortality rate was 29.4% and was observed more frequently in patients with neutropenia (60.0%) and without surgical intervention (73.3%). Survival rate was higher (35.3%) for cases utilizing both antifungal and surgical intervention. The antifungal agent with the highest survival rate was amphotericin B and its formulations (58.8%). CONCLUSIONS Neutropenia within hematological malignancies demonstrate a risk for developing severe cutaneous fungal infections, of which primary cutaneous mucormycosis can carry significant mortality. Combination antifungal therapy and surgical debridement appears to be associated with higher survival outcomes and warrants further investigation.
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Affiliation(s)
- Abraham Yacoub
- Department of Infectious Diseases and Tropical Medicine, Moffitt Cancer Center, Tampa, FL 33612, USA.
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Tsoulas C, Tragiannidis A, Groll AH. Medical and Adjunctive Treatment of Mucormycosis in Children: Scientific Rationale and Analysis of Cases Reported in the Literature. CURRENT FUNGAL INFECTION REPORTS 2013. [DOI: 10.1007/s12281-013-0166-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Arnander MW, Lane JC, Ball S, Eckersley R. A Photo Essay of Complications of Fabric Thumb Immobilization. J Emerg Nurs 2013; 39:e33-5. [DOI: 10.1016/j.jen.2013.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 01/03/2013] [Accepted: 01/03/2013] [Indexed: 11/17/2022]
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Heydari AA, Fata A, Mojtabavi M. Chronic cutaneus mucormycosis in an immunocompetent female. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:254-5. [PMID: 23984008 PMCID: PMC3745757 DOI: 10.5812/ircmj.1953] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 07/14/2012] [Accepted: 01/08/2013] [Indexed: 11/25/2022]
Abstract
Introduction Cutaneous infection is an uncommon presentation of mucormycosis, usually seen after trauma, at the site of surgical drains or after occlusive dressings. The involved area is erythematous and painful, with varying degree of central necrosis. We report the case of chronic coetaneous infection of one year duration and without apparent necrosis in an immunocompetant patient. Case presentation A 32-year-old immunocompetent woman presented with a large unilateral firm infiltrative plaque resembling cancer lesions, disfiguring the eyelids, nose and lips. The punch biopsy and then surgical debridement was done and the diagnosis of cutaneous mucormycosis was confirmed on histologic examinations with granulomatous reaction and characteristic broad, nonseptate, pale-staining hyphae. Conclusions Mucomycosis should be in differncial diagnosis of any chronic infiltrative lesions even without visible necrosis and normal immune status of the patient.
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Affiliation(s)
- Ali Akbar Heydari
- Imam Reza Hospital. Mashad University of Medical Sciences, Mashad, IR Iran
- Corresponding author: Ali Akbar Heydari, Imam Reza Hospital, Mashad University of Medical Sciences, Mashad, IR Iran. Tel/ Fax: +98-5118412351, E-mail:
| | - Abdolhamid Fata
- Imam Reza Hospital. Mashad University of Medical Sciences, Mashad, IR Iran
| | - Maryam Mojtabavi
- Imam Reza Hospital. Mashad University of Medical Sciences, Mashad, IR Iran
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Rammaert B, Lanternier F, Zahar JR, Dannaoui E, Bougnoux ME, Lecuit M, Lortholary O. Healthcare-associated mucormycosis. Clin Infect Dis 2012; 54 Suppl 1:S44-54. [PMID: 22247444 DOI: 10.1093/cid/cir867] [Citation(s) in RCA: 184] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Mucormycosis is a severe emerging invasive fungal infection that occurs as a consequence of environmental exposure. We exhaustively reviewed all the cases of mucormycosis (European Organisation for Research and Treatment of Cancer/Mycoses Study Group 2008 criteria) attributed to healthcare procedures that occurred between 1970 and 2008. A total of 169 cases were studied (29% children, 61% male). Major underlying diseases were solid organ transplantation (24%), diabetes mellitus (22%), and severe prematurity (21%). Skin was the most common localization (57%), followed by gastrointestinal tract (15%). Culture results were available in 75% (92% positive), and results of histological examination were positive in 95%. Rhizopus was the most frequent genus (43%). Infection portal of entry included surgery and presence of medical devices such as catheters or adhesive tape. Outbreaks and clusters were related to adhesive bandages (19 cases), wooden tongue depressors (n = 5), ostomy bags (n = 2), water circuitry damage (n = 2), and adjacent building construction (n = 5). Thorough investigations are mandatory to identify healthcare-associated mucormycosis, notably in neonatology, hematological, and transplantation units.
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Affiliation(s)
- Blandine Rammaert
- Sorbonne Paris Cité, Service des Maladies Infectieuses et Tropicales, Hôpital Necker-Enfants Malades, APHP, Université Paris-Descartes, Centre d'Infectiologie Necker-Pasteur, 149 rue de Sèvres, Paris Cedex 15, France
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Gupta R, Parelkar SV, Oak S, Sanghvi B, Prakash A. Neonatal lingual and gastrointestinal mucormycosis in a case of low anorectal malformation-a rare presentation. J Pediatr Surg 2011; 46:745-748. [PMID: 21496547 DOI: 10.1016/j.jpedsurg.2010.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Revised: 12/22/2010] [Accepted: 12/22/2010] [Indexed: 10/18/2022]
Abstract
We report a 1.7 kg male infant with a low anorectal malformation treated at an outside facility and referred to us on postoperative day 11. At presentation, his upper abdomen was distended, and he had perianal mucoid discharge. The tongue had a blackish discoloration. An erect abdominal radiograph showed a few fluid-filled bowel loops in the upper abdomen with a gasless lower abdomen and pelvis, suggestive of upper small bowel obstruction. There were no specific radiological features of necrotizing enterocolitis. He underwent laparotomy and bowel resection for perforated jejunum. Histopathology of the tissue specimen was suggestive of mucormycosis. Postoperatively, he received intravenous amphotericin B (liposomal) and was started on liquid enteral nutrition after 2 weeks. However, the anterior two thirds of his tongue gradually sloughed off. He is awaiting reconstruction of the tongue. The purpose of this report is to emphasize that physicians should have a high index of suspicion for oral and gastrointestinal tract mucormycosis in neonates with metabolic disturbances who present with a discolored oral mucosa and an abdominal mass with intestinal obstruction. Early diagnosis and an aggressive approach of combined medical and surgical treatment may improve the outcome of patients with this potentially lethal invasive disease.
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Affiliation(s)
- Rahul Gupta
- Department of Pediatric Surgery, King Edward Memorial Hospital, Mumbai, India.
| | - Sandesh V Parelkar
- Department of Pediatric Surgery, King Edward Memorial Hospital, Mumbai, India
| | - Sanjay Oak
- Department of Pediatric Surgery, King Edward Memorial Hospital, Mumbai, India
| | - Beejal Sanghvi
- Department of Pediatric Surgery, King Edward Memorial Hospital, Mumbai, India
| | - Advait Prakash
- Department of Pediatric Surgery, King Edward Memorial Hospital, Mumbai, India
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17
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Adalja A, Kaka AS. Necrotic arm lesions in an intravenous drug user. Intern Emerg Med 2010; 5:439-40. [PMID: 20390464 DOI: 10.1007/s11739-010-0375-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 02/10/2010] [Indexed: 11/30/2022]
Affiliation(s)
- Amesh Adalja
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh Medical Center, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
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Dehority W, Willert J, Pong A. Zygomycetes infections in pediatric hematology oncology patients: a case series and review of the literature. J Pediatr Hematol Oncol 2009; 31:911-9. [PMID: 19855304 DOI: 10.1097/mph.0b013e3181bbc516] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Fungi from the Zygomycetes class are increasingly recognized causes of infection in immunosuppressed children, but no comprehensive literature review and few case series have been published on the topic. A case series of 6 pediatric oncology patients with Zygomycetes infections cared for at our institution was constructed, and a concurrent search of the English language literature for Zygomycetes infections in children with oncologic disorders was undertaken. Our case series described 6 patients (5 male) between the ages of 2.5 and 19.5 years. One patient was diagnosed with rhinocerebral disease, 2 with rhinosinusitis, 2 with pulmonary involvement, and 1 with a gastrointestinal presentation. Five patients survived. Our literature review identified 82 cases from 61 studies. The mean subject age was 10.8 years (1.4 to 21.0 y). About 92.7% of all patients suffered from some form of leukemia, with 70.7% suffering from acute lymphoblastic leukemia. Overall, 58.5% of reported patients survived, with individuals with disseminated disease showing the worst prognosis (68.2% mortality) and those with cutaneous disease the best (14.3% mortality). Survival is increasingly reported in the literature, perhaps as a result of improved diagnostic capabilities, increased physician awareness and increased reliance on adjunctive surgical therapy.
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Affiliation(s)
- Walter Dehority
- Department of Pediatrics, The University of New Mexico Health Sciences Center, Albuquerque, NM 87131-0001, USA.
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Sankar J, Arun S, Sankar MJ, Seth R, Thavraj V, Kabra SK, Vasantha M. 'Primary cutaneous mucormycosis during induction chemotherapy in a child with acute lymphoblastic leukemia'. Indian J Pediatr 2009; 76:1161-3. [PMID: 20072858 DOI: 10.1007/s12098-009-0280-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2008] [Accepted: 10/15/2008] [Indexed: 10/20/2022]
Abstract
We report a child with acute lymphoblastic leukemia who developed primary cutaneous mucormycosis at the site of lumbar puncture during induction chemotherapy. Though high mortality rates are reported with invasive mucormycosis, prompt biopsy, early identification and antifungal therapy using a combination regime of amphotericin-B and rifampicin along with extensive surgical debridement led to complete cure of the lesions in the index case.
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Affiliation(s)
- Jhuma Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
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Roilides E, Zaoutis TE, Katragkou A, Benjamin DK, Walsh TJ. Zygomycosis in neonates: an uncommon but life-threatening infection. Am J Perinatol 2009; 26:565-73. [PMID: 19391079 PMCID: PMC6999698 DOI: 10.1055/s-0029-1220775] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We systematically reviewed all published cases of zygomycosis, an increasingly important infection with high mortality, in neonates. We searched PubMed and individual references for English publications of single cases or case series of neonatal (0 to 1 month) zygomycosis. Cases were included if they fulfilled prespecified criteria. Fifty-nine cases were published through July 2007. Most of the infants (77%) were premature. The most common sites of zygomycosis were gastrointestinal (54%) and cutaneous (36%) diseases. This pattern differs from sinopulmonary and rhinocerebral patterns of older children. Fifty-six percent of cases were diagnosed by histology only and 44% by histology and culture. RHIZOPUS spp. were isolated from 18/25 (72%) cases. Thirty-seven percent of patients received no antifungal therapy. Thirty-two (54%) neonates underwent surgery with (39%) or without (15%) antifungal agents. Overall mortality was 64%. A higher fraction of neonates treated with amphotericin B and surgery survived than those who received no therapy (70% versus 5%). Zygomycosis is a life-threatening infection in neonates with a distinct pattern of gastrointestinal and cutaneous involvement and high mortality. Combination of amphotericin B and surgery was common management strategy in survivors.
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Affiliation(s)
- Emmanuel Roilides
- 3rd Department of Pediatrics, Aristotle University, Thessaloniki, Greece.
| | - Theoklis E. Zaoutis
- Department of Pediatrics and the Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, and Division of Infectious Diseases, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Aspasia Katragkou
- 3rd Department of Pediatrics, Aristotle University, Thessaloniki, Greece
| | - Daniel K. Benjamin
- Department of Pediatrics, Duke Clinical Research Institute, Duke University, Durham, North Carolina
| | - Thomas J. Walsh
- Pediatric Oncology Branch, National Cancer Institute, Bethesda, Maryland
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Abstract
Zygomycosis, often referred to as ''mucormycosis'' or ''phycomycosis,'' is a rapidly progressive fungal infection which usually occurs in immunocompromised individuals, and is characterized by soft tissue destruction and invasion of blood vessels. The rare and easily misdiagnosed primary cutaneous form may present as a superficial erosion with a painless, gradual onset and slow progression of symptoms or a gangrenous, necrotic ulceration due to rapid tissue and vascular invasion. With the latter form, the mortality rate among affected individuals is high even after aggressive surgical debridement and amphotericin B administration, emphasizing the importance of early recognition and proper diagnosis. We present two instances of gangrenous cutaneous zygomycosis in immunocompromised children and review the literature with regard to etiology, diagnosis and treatment, highlighting the pediatric population.
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LeMaile-Williams M, Burwell LA, Salisbury D, Noble-Wang J, Arduino M, Lott T, Brandt ME, Iiames S, Srinivasan A, Fridkin SK. Outbreak of Cutaneous Rhizopus arrhizus Infection Associated with Karaya Ostomy Bags. Clin Infect Dis 2006; 43:e83-8. [PMID: 17029127 DOI: 10.1086/508277] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 06/27/2006] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND We investigated an outbreak involving 2 patients hospitalized at hospital A with cutaneous Rhizopus arrhizus (oryzae) infections of surgically created stomas. METHODS A cohort study involving all patients having ileostomy or colostomy surgery during the outbreak period (January-April 2005) was performed. Environmental samples, including samples obtained from nonsterile karaya (a plant-derived adhesive) ostomy bags and from select hospital areas, were collected. A point prevalence survey was conducted at 5 unrelated hospitals to assess stoma care practices and mold contamination of karaya ostomy bags outside of hospital A. Zygomycete isolates were identified by standard methods. RESULTS Infections occurred 7 and 10 days after operations for the 2 patients; 1 patient died. In a 21-patient cohort, receiving the equivalent of > or =0.5 mg/kg per day of prednisone during the week prior to the index date was associated with infection (infection rate, 33% for patients receiving > or =0.5 mg/kg per day of prednisone vs. 0% for patients receiving <0.5 mg/kg per day of prednisone; P=.07). The time to first ostomy bag change was longer for patients with infection (median duration, 8.5 days; range, 7-10 days) than for the 19 patients without infection (median duration, 1.5 days; range, 1-17 days; P=.08). At unrelated hospitals, the median time to first ostomy bag change was 2 days (range, 1-6 days) for 18 patients after ostomy. R. arrhizus was recovered from 10 of 18 karaya ostomy bags from hospital A and from karaya ostomy bags donated from 3 of 5 other hospitals, but it was not recovered from the hospital A environment. CONCLUSIONS The initial karaya ostomy bag was likely to be the source of Rhizopus infection, and prolonged exposure before the first ostomy bag change might have precipitated infection in these susceptible individuals. Karaya might contain opportunistic molds that can pose an infectious risk among susceptible persons.
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Affiliation(s)
- Mysheika LeMaile-Williams
- Epidemic Intelligence Service, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, 30333 USA
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26
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Gari-Toussaint M, Poirée M, Mouroux J, Novelas S, Butori C, Gantier JC. Infection pulmonaire à Cunninghamella bertholletiae chez une jeune patiente leucémique. J Mycol Med 2006. [DOI: 10.1016/j.mycmed.2006.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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27
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28
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Stevens DL, Bisno AL, Chambers HF, Everett ED, Dellinger P, Goldstein EJC, Gorbach SL, Hirschmann JV, Kaplan EL, Montoya JG, Wade JC. Practice guidelines for the diagnosis and management of skin and soft-tissue infections. Clin Infect Dis 2005; 41:1373-406. [PMID: 16231249 DOI: 10.1086/497143] [Citation(s) in RCA: 926] [Impact Index Per Article: 48.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Accepted: 07/14/2005] [Indexed: 01/11/2023] Open
Affiliation(s)
- Dennis L Stevens
- Infectious Diseases Section, Veterans Affairs Medical Center, Boise, Idaho 83702, USA.
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29
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Katta R, Bogle MA, Levy ML. Primary cutaneous opportunistic mold infections in a pediatric population. J Am Acad Dermatol 2005; 53:213-9. [PMID: 16021112 DOI: 10.1016/j.jaad.2005.03.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to describe the features of cutaneous opportunistic mold infections in a general pediatric population. METHODS Computerized pathology records from Texas Children's Hospital in Houston during the years 1991 to 2000 were used to identify any biopsy specimens of skin diagnosed as having fungus or mold. The corresponding medical records were reviewed to identify cases of cutaneous opportunistic mold infections. Cases were limited to those with histologic confirmation of hyphae within the dermis or extending to the dermis. RESULTS A total of 11 cases in neonates and 22 cases in children and adolescents were identified. Prematurity and low birth weight were the major risk factors in the neonatal population. The nonneonatal cases mainly occurred in those with malignancies or undergoing transplantation. Mortality in neonates was 64%, but decreased to 18% in the nonneonatal population. CONCLUSION Our overview of cutaneous infection by opportunistic molds in a pediatric population highlights the risk factors, causative organisms, and outcome of this group of infections. Even in the presence of severe compromise of the immune system, children with primary cutaneous mold infections had a favorable outcome with appropriate diagnosis and therapy.
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Affiliation(s)
- Rajani Katta
- Department of Dermatology, Baylor College of Medicine, Houston, TX 77030, USA
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30
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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: 1858] [Impact Index Per Article: 97.8] [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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31
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El Deeb Y, Al Soub H, Almaslamani M, Al Khuwaiter J, Taj-Aldeen SJ. Post-traumatic cutaneous mucormycosis in an immunocompetent patient. Ann Saudi Med 2005; 25:343-5. [PMID: 16212131 PMCID: PMC6148005 DOI: 10.5144/0256-4947.2005.343] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2004] [Indexed: 11/22/2022] Open
Affiliation(s)
- Y El Deeb
- Hamad Medical Corporation, Doha, Qatar
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32
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Sundararajan T, Kumar CPG, Menon T, Rekha K, Venkatadesikalu M. Cutaneous zygomycosis due to Rhizopus oryzae in a patient with acute lymphoblastic leukemia. Fallbericht. Kutane Zygomykose durch Rhizopus oryzae bei einem patienten mit akuter lymphoblstischer Leukamie. Mycoses 2004; 47:521-3. [PMID: 15601461 DOI: 10.1111/j.1439-0507.2004.01051.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report herein a case of primary cutaneous zygomycosis caused by Rhizopus oryzae in a 7-year-old girl with acute lymphoblastic leukemia (ALL) receiving intensive chemotherapy. The diagnosis was based on observation of hyphal elements in cutaneous biopsy and isolation of the fungus in culture. The patient responded to surgical intervention and treatment with amphotericin B.
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Affiliation(s)
- T Sundararajan
- Department of Microbiology, Dr ALM Postgraduate Institute of Basic Medical Sciences, University of Madras, Chennai, India.
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33
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Kaufman D, Fairchild KD. Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Clin Microbiol Rev 2004; 17:638-80, table of contents. [PMID: 15258097 PMCID: PMC452555 DOI: 10.1128/cmr.17.3.638-680.2004] [Citation(s) in RCA: 288] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Twenty percent of very-low-birth-weight (<1500 g) preterm infants experience a serious systemic infection, and despite advances in neonatal intensive care and antimicrobials, mortality is as much as threefold higher for these infants who develop sepsis than their counterparts without sepsis during their hospitalization. Outcomes may be improved by preventative strategies, earlier and accurate diagnosis, and adjunct therapies to combat infection and protect the vulnerable preterm infant during an infection. Earlier diagnosis on the basis of factors such as abnormal heart rate characteristics may offer the ability to initiate treatment prior to the onset of clinical symptoms. Molecular and adjunctive diagnostics may also aid in diagnosing invasive infection when clinical symptoms indicate infection but no organisms are isolated in culture. Due to the high morbidity and mortality, preventative and adjunctive therapies are needed. Prophylaxis has been effective in preventing early-onset group B streptococcal sepsis and late-onset Candida sepsis. Future research in prophylaxis using active and passive immunization strategies offers prevention without the risk of resistance to antimicrobials. Identification of the differences in neonatal intensive care units with low and high infection rates and implementation of infection control measures remain paramount in each neonatal intensive care unit caring for preterm infants.
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Affiliation(s)
- David Kaufman
- Department of Pediatrics, Division of Neonatology, P.O. Box 800386, University of Virginia Health System, 3768 Old Medical School, Hospital Drive, Charlottesville, VA 22908, USA.
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34
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Boyd AS, Wiser B, Sams HH, King LE. Gangrenous cutaneous mucormycosis in a child with a solid organ transplant: a case report and review of the literature. Pediatr Dermatol 2003; 20:411-5. [PMID: 14521558 DOI: 10.1046/j.1525-1470.2003.20508.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Infections by members of the Phycomycetes class of fungi typically arise in patients with substantial underlying immunosuppression. Several clinical presentations, including that of gangrenous cellulitis, have been described. In the pediatric population, critically ill premature newborns and older children with underlying hematopoietic malignancies and/or bone marrow transplantation are affected. Presentation in children with solid organ transplants is rare. Successful therapy for this condition includes aggressive debridement of infected tissue and systemic administration of amphotericin B.
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Affiliation(s)
- Alan S Boyd
- Department of Medicine (Dermatology), Vanderbilt University, Nashville, Tennessee 37232, USA.
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35
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Abstract
Zygomycosis is a rare fungal infection that may present as a necrotizing soft tissue infection in the neonate. This report illustrates the typical presentation of a premature, infant with a rapidly progressive soft tissue necrotizing infection of his upper extremity at an intravenous site. Early diagnosis with tissue biopsy confirmed the diagnosis of Zygomycosis. Successful treatment required systemic amphotercin B and aggressive debridement requiring through-the-elbow amputation for survival.
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MESH Headings
- Amputation, Surgical
- Antifungal Agents/therapeutic use
- Arm
- Debridement
- Fasciitis, Necrotizing/diagnosis
- Fasciitis, Necrotizing/microbiology
- Fasciitis, Necrotizing/therapy
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/microbiology
- Infant, Premature, Diseases/therapy
- Male
- Soft Tissue Infections/diagnosis
- Soft Tissue Infections/microbiology
- Soft Tissue Infections/therapy
- Zygomycosis/diagnosis
- Zygomycosis/therapy
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Affiliation(s)
- Erika Scheffler
- Department of Surgery, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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36
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Abstract
Several aspects of emerging pediatric cutaneous infections are of importance to the clinician. New manifestations of parvovirus infection should be recognized promptly, especially because transmission to susceptible populations might lead to serious complications. In the immunocompromised pediatric population, the outcome of cutaneous mold infections can be improved with prompt recognition and initiation of treatment. The incidence of community-acquired MRSA infections in pediatrics is becoming more than a regional concern, and this coincides with the issue of limited antibiotic susceptibility for MRSA as well as other infections. New antibiotics such as linezolid are emerging as potential treatments for drug-resistant pathogens. An older group of antibiotics, the fluoroquinolones, appear to be well tolerated in children and should not be withheld from this population when the benefits of treatment out-weigh the risks.
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Affiliation(s)
- Denise Metry
- Department of Dermatology, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin Street, CC 620.16 6560, Houston, TX 77030-2399, USA.
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37
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Oh D, Notrica D. Primary cutaneous mucormycosis in infants and neonates: case report and review of the literature. J Pediatr Surg 2002; 37:1607-11. [PMID: 12407548 DOI: 10.1053/jpsu.2002.36193] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A case of angioinvasive cutaneous mucormycosis in a premature infant, eventually requiring extracorporeal membrane oxygenation therapy, is described. The fungal infection began at the site of a brachial artery catheter that had been covered with an adhesive dressing in the left antecubital fossa. The infection progressed rapidly over a 5-day period, and a left arm amputation was required. Fungal hyphae were present at the margins of resection. The patient eventually had disseminated mucormycosis and died. A second case of cutaneous mucormycosis in another premature infant also is presented. This infant had the infection at an intravenous catheter site. Rapid initiation of surgical debridement of the wound and amphotericin B therapy resulted in patient survival. Eighteen reported cases of cutaneous mucormycosis in neonates were found and are reviewed. Prematurity, low birth weight, broad-spectrum antibiotics, corticosteroid therapy, and local trauma to the skin site were common risk factors. Only 7 of the 18 patients survived. Therapy consisted of local debridement and intravenous amphotericin B. High index of suspicion, early diagnosis, and rapid institution of therapy can improve survival rate. The key to prevention appears to be appropriate skin care.
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Affiliation(s)
- Daniel Oh
- University of Arizona College of Medicine, Phoenix Integrated Surgical Residency, Phoenix, AZ, USA
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38
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Dammin TC. Case 9-2002: orbital mucormycosis. N Engl J Med 2002; 347:855-6; author reply 855-6. [PMID: 12226163 DOI: 10.1056/nejm200209123471118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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39
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40
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Johnson RA. The immune compromised host in the twenty-first century: management of mucocutaneous infections. SEMINARS IN CUTANEOUS MEDICINE AND SURGERY 2000; 19:19-61. [PMID: 10834604 DOI: 10.1053/sd.2000.7371] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Infectious diseases encountered in dermatology have changed tremendously during the past few decades with the emergence of the immunocompromised host. This change is a result of the human immunodeficiency virus epidemic, use of immunomodulating drugs, bone marrow transplantation, increasing prevalence of diabetes mellitus, and an aging population. New pathogens have been discovered and new disorders have occurred. In the compromised host, infection can be more aggressive and widespread locally, be caused by opportunistic pathogens, and be disseminated hematogenously from or to the skin. The prevalence of nonmelanoma skin cancer has increased, and squamous cell carcinomas can be more aggressive with more rapid local growth as well as frequency of metastasis.
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Affiliation(s)
- R A Johnson
- Department of Dermatology, Beth Israel-Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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41
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Abstract
A peptic ulcer in a child looks the same as it does in an adult, and many of the aetiologies of peptic ulcer disease in children are similar to those in adults. However, there are many differences between children and adults, especially in the areas of clinical presentation, the prevalences of different types of ulcer disease, and the prevalence of complications of ulcer disease. Therefore the approach to diagnosis and management in children is often at variance with that in adults. One important example is the approach to suspected Helicobacter pylori (H. pylori) disease in children, in which consensus groups have advised a considerably different approach in children. While the chapter deals with the full range of peptic ulcer disease in children, the focus is on those aspects in which there are differences between adults and children.
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Affiliation(s)
- R Dohil
- University of California at San Diego, USA
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42
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Affiliation(s)
- R Dohil
- Division of Gastroenterology, British Columbia Children's Hospital, Vancouver, Canada
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43
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Cherney CL, Chutuape A, Fikrig MK. Fatal invasive gastric mucormycosis occurring with emphysematous gastritis: case report and literature review. Am J Gastroenterol 1999; 94:252-6. [PMID: 9934766 DOI: 10.1111/j.1572-0241.1999.00809.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Emphysematous gastritis is an often lethal, rare clinical entity referring to air bubbles in the wall of the stomach produced by gas-forming bacteria. Invasive gastrointestinal mucormycosis is an unusual clinical presentation of this invasive fungal disease. We report the first case of invasive gastric mucormycosis occurring with emphysematous gastritis, and review the literature regarding both of these clinical entities.
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Affiliation(s)
- C L Cherney
- The Division of Infectious Diseases, The Hospital of St. Raphael, New Haven, Connecticut 06511, USA
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44
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45
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Holzel H, Macqueen S, MacDonald A, Alexander S, Campbell CK, Johnson EM, Warnock DW. Rhizopus microsporus in wooden tongue depressors: a major threat or minor inconvenience? J Hosp Infect 1998; 38:113-8. [PMID: 9522289 DOI: 10.1016/s0195-6701(98)90064-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The investigation and management of an apparent outbreak of Rhizopus spp. in a London paediatric referral centre between September 1995 and April 1996 is described. The organism was identified in microbiological surveillance samples from 23 patients nursed in four hospital areas. Investigations revealed the presence of the organism in spatulae from all ward areas investigated and from closed boxed containers held in the central hospital stores obtained from a new supplier. In contrast, culture of spatulae from the initial supplier failed to yield any fungal isolates. The incident was reported to the Medical Device Agency (MDA), the Central Public Health Laboratory Service (CPHLS) and the Birmingham PHLS. A statement was prepared for the weekly Communicable Disease Report and a hazard warning issued by the MDA. The spatulae were withdrawn from use and the contract with the original supplier was re-established. This incident resulted in contamination of samples only and no patient involvement. It highlights the problems which may follow use of equipment for unintended purposes and the need for good manufacturing practice guidelines to be applied to non-sterile equipment used in direct patient care.
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Affiliation(s)
- H Holzel
- Great Ormond Street Hospital for Children NHS Trust, London, UK
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46
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Affiliation(s)
- A F Robertson
- Department of Pediatrics, East Carolina University School of Medicine, Greenville, NC 27858-4354, USA.
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47
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Wirth F, Perry R, Eskenazi A, Schwalbe R, Kao G. Cutaneous mucormycosis with subsequent visceral dissemination in a child with neutropenia: a case report and review of the pediatric literature. J Am Acad Dermatol 1997; 36:336-41. [PMID: 9039214 DOI: 10.1016/s0190-9622(97)80412-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Primary cutaneous mucormycosis is a rare opportunistic fungal infection that is usually limited to the skin. We describe a primary cutaneous Rhizopus infection occurring at a site occluded by a sterile adhesive dressing in which the disease was viscerally disseminated at the time fo diagnosis. Mucormycosis should be considered in all ecthyma-like lesions in immunocompromised patients. It may be rapidly diagnosed by examination of hematoxylin-eosin and PAS-stained sections of the eschar base and a culture of a leading edge tissue aspirate. We review 21 cases of primary cutaneous mucormycosis in children and compare them with the present case.
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Affiliation(s)
- F Wirth
- Department of Dermatology, University of Maryland School of Medicine, Baltimore, USA
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48
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Mitchell SJ, Gray J, Morgan ME, Hocking MD, Durbin GM. Nosocomial infection with Rhizopus microsporus in preterm infants: association with wooden tongue depressors. Lancet 1996; 348:441-3. [PMID: 8709784 DOI: 10.1016/s0140-6736(96)05059-3] [Citation(s) in RCA: 122] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We report four cases of cutaneous infection with Rhizopus microsporus in vulnerable preterm infants in one neonatal nursery. METHODS There was no overlap in hospital stay between the first two cases and an extensive programme of environmental sampling was therefore initiated, with special attention being paid to items that had close contact with infants' skin. Samples were cultured by standard techniques, including fungal culture with Sabouraud's medium. Filamentous fungi with non-septate hyphae were presumptively identified as agents of mucormycosis and referred to the Mycology Reference Laboratory, Bristol, UK, for speciation. FINDINGS The source of infection was identified as wooden tongue depressors, which were used on the nursery to construct splints for intravenous and arterial cannulation sites. The outbreak was ended by the removal of these items from the nursery. INTERPRETATION Wooden tongue depressors can be a vehicle for transmission of mucormycosis. The combination of warm, humid conditions in neonatal incubators, particularly in association with occlusive dressings, may favour cutaneous fungal invasion and put small, sick babies at risk of infection.
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Affiliation(s)
- S J Mitchell
- Neonatal Unit, Birmingham Women's Hospital, Edgbaston, UK
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49
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Abstract
We describe a patient with zygomycosis that resembled herpes zoster infection. The diagnosis was readily made with a potassium hydroxide preparation that revealed sparsely to non-septate hyphae. The patient responded to combination antifungal therapy with amphotericin B and fluconazole. The clinical response correlated with antifungal susceptibility test results.
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Affiliation(s)
- S G Woods
- Department of Dermatology, University Hospitals of Cleveland, Case Western Reserve University, Ohio 44106
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50
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Craig NM, Lueder FL, Pensler JM, Bean BS, Petrick ML, Thompson RB, Eramo LR. Disseminated Rhizopus infection in a premature infant. Pediatr Dermatol 1994; 11:346-50. [PMID: 7899188 DOI: 10.1111/j.1525-1470.1994.tb00103.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 16-day-old premature male infant developed rapidly expanding necrotic facial plaques. Histology and cultures of tissue biopsy specimens revealed infection with Rhizopus arrhizius. The patient was treated aggressively with surgical debridement, amphotericin B, and rifampin, but had a progressive spread of the cutaneous infection and a fatal clinical course. He had gastrointestinal and pulmonary involvement on autopsy. Zygomycoses are rapidly progressive infections which generally affect immunocompromised hosts. Premature infants should be included as individuals at risk for disseminated zygomycotic disease.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Debridement
- Dermatomycoses/diagnosis
- Dermatomycoses/physiopathology
- Dermatomycoses/therapy
- Fatal Outcome
- Fungemia/diagnosis
- Fungemia/physiopathology
- Fungemia/therapy
- Humans
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnosis
- Infant, Premature, Diseases/microbiology
- Infant, Premature, Diseases/physiopathology
- Infant, Premature, Diseases/therapy
- Male
- Mucormycosis/diagnosis
- Mucormycosis/physiopathology
- Mucormycosis/therapy
- Rhizopus/isolation & purification
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Affiliation(s)
- N M Craig
- Department of Dermatology, Northwestern University Medical School, Chicago, Illinois
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