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shahanikelaki M, Mohammadi M, Mohammadi A, Moradians V. Coinfection of pulmonary tuberculosis and mucormycosis in a patient with poor controlled diabetes mellitus: A case report. Radiol Case Rep 2023; 18:4202-4205. [PMID: 37753499 PMCID: PMC10518342 DOI: 10.1016/j.radcr.2023.08.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/28/2023] Open
Abstract
Coinfection of pulmonary mucormycosis and tuberculosis is a rare and challenging condition, particularly in immunocompromised patients. We present the case of a 60-year-old woman with poorly controlled diabetes mellitus who developed dysphonia, persistent cough, and expectoration. Imaging studies revealed a cavitary lesion and a mass in the left lung, along with stenosis of the left main bronchus. A bronchoscopy confirmed the presence of a bronchomediastinal fistula with pus discharge. Polymerase chain reaction testing of bronchial secretions revealed a co-infection of tuberculosis and mucormycosis. The patient was initiated on appropriate treatment for both infections, and her symptoms improved without disease progression. Concomitant pulmonary mucormycosis and tuberculosis pose significant diagnostic challenges due to overlapping clinical and radiological features. Early recognition and a multidisciplinary approach involving infectious disease specialists, pulmonologists, radiologists, and surgeons are crucial for optimal management. The prognosis of this coinfection is poor, emphasizing the importance of timely diagnosis and treatment. To improve outcomes, comprehensive screening and early detection of coinfections in high-risk patients, such as those with uncontrolled diabetes, are essential. Future advancements in diagnostic tools may facilitate prompt and accurate diagnosis. Clinicians should maintain a high index of suspicion and employ appropriate diagnostic techniques to ensure early identification and effective management of these complex infections.
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Affiliation(s)
- Mehran shahanikelaki
- Department of Internal Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohammadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Aynaz Mohammadi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran
| | - Vahan Moradians
- Department of Internal Medicine, School of Medicine, Hazrat-e Rasool General Hospital, Iran University of Medical Sciences, Tehran, Iran
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Seth A, Patil SS, Axelrod D, Singh H, Sharma A, Kenwar DB, Vaiphei K, Mandwar M, Rally S, Singh S. Outcomes after lung resection in renal transplant patients with pulmonary mucormycosis. Clin Transplant 2022; 36:e14689. [PMID: 35477936 DOI: 10.1111/ctr.14689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/01/2022]
Abstract
Pulmonary mucormycosis has been associated with high mortality (reported up to 100%) in renal transplant recipients. This was a retrospective analysis of renal transplant patients with pulmonary mucormycosis between April 2014 - March 2020, who underwent surgical resection of the affected lung along with liposomal amphotericin therapy. Patients with lower respiratory illness features underwent chest X-ray, high-resolution computed tomography of the chest, and those with suspicious findings underwent analysis of bronchioloalveolar fluid and transbronchial lung biopsy. Patients with histological or microbiological evidence of mucormycosis were started on liposomal Amphotericin B. Tacrolimus and mycophenolate mofetil were stopped at the time of diagnosis. Patients were taken up for surgical resection of the affected part of the lung. Ten patients underwent combined management, while five patients were managed medically. At last follow up, seven out of ten patients (70%) who underwent combined management and two of the five patients (40%) who were managed medically, had a mean survival of 28.86 months (sd = 15.71, median = 25) and 14.17 months (sd = 12.21, median = 18), respectively, post-diagnosis of pulmonary mucormycosis. Surgical resection combined with antifungals in the perioperative period and decreased immunosuppression may improve the outcomes in renal transplant patients with pulmonary mucormycosis. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Abhinav Seth
- Abdominal Transplant Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, Iowa City, Iowa, USA
| | - Shivakumar S Patil
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Research and Education, Nehru Building, Sector-12, Chandigarh, India
| | - David Axelrod
- Abdominal Transplant Surgery, University of Iowa Hospitals & Clinics, 200 Hawkins Dr, Iowa City, Iowa, USA
| | - Harkant Singh
- Department of Cardiothoracic and Vascular Surgery, Advanced Cardiac Center, Postgraduate Institute of Medical Research and Education, Sector-12, Chandigarh, India
| | - Ashish Sharma
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Research and Education, Nehru Building, Sector-12, Chandigarh, India
| | - Deepesh Benjamin Kenwar
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Research and Education, Nehru Building, Sector-12, Chandigarh, India
| | - Kim Vaiphei
- Department of Pathology, Postgraduate Institute of Medical Research and Education, Research Block A, Sector-12, Chandigarh, India
| | - Milind Mandwar
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Research and Education, Nehru Building, Sector-12, Chandigarh, India
| | - Sahil Rally
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Research and Education, Nehru Building, Sector-12, Chandigarh, India
| | - Sarbpreet Singh
- Department of Renal Transplant Surgery, Postgraduate Institute of Medical Research and Education, Nehru Building, Sector-12, Chandigarh, India
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Georgakopoulou VE, Gkoufa A, Aravantinou A, Garmpis N, Mantzouranis K, Chlapoutakis S, Sklapani P, Garmpi A, Trakas N, Damaskos C. Hemoptysis in Renal Transplant Recipients. Acta Med Litu 2021; 28:220-229. [PMID: 35637936 PMCID: PMC9133616 DOI: 10.15388/amed.2021.28.2.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Hemoptysis is the expectoration of blood from respiratory system. Clinical entities associated with hemoptysis in renal transplant recipients differ from those causing hemoptysis in common population. This review summarizes all reported clinical conditions related to hemoptysis in renal transplant patients, their causes, diagnostic approach and management. Methods and Materials: Primary literature was researched through MEDLINE/PubMed database and Google Scholar without restrictions. Relevant and current literatures related to hemoptysis in renal transplant recipients were used. Results: Overall 23 articles were included, since they report clinical conditions associated with hemoptysis in renal transplant recipients. Opportunistic lung infections, pulmonary hemorrhage associated with drugs and malignancies are usual causes of hemoptysis in these patients, sometimes with a fatal outcome. Conclusions: Hemoptysis is an important manifestation in renal transplant patients, caused frequently by rare clinical entities, different from those in common population.
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Priya P, Ganesan V, Rajendran T, Geni VG. Mucormycosis in a Tertiary Care Center in South India: A 4-Year Experience. Indian J Crit Care Med 2020; 24:168-171. [PMID: 32435094 PMCID: PMC7225759 DOI: 10.5005/jp-journals-10071-23387] [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] [Indexed: 01/15/2023] Open
Abstract
Background Mucormycosis is an emerging fungal infection in both developed and developing countries with different target population. Unusual isolates and unusual clinical presentations have been reported from India in recent times. Objectives The present study was done to know the epidemiology, risk factors, diagnostic modalities, and treatment outcome of mucormycosis patients in our hospital. Materials and methods The study was carried out over a period of 4 years from October 2015 to October 2019. This is a retrospective observational chart review of patients diagnosed with proven and probable mucormycosis. Information on demography, clinical features, risk factors, laboratory and radiological findings, treatment (including medical and surgical treatment), and outcome was extracted from the records. Primary outcome at 42 days was determined. Results Thirty-eight patients were diagnosed with mucormycosis based on microbiological and/or histopathological examination (HPE) of the clinical samples. Most commonly affected age-group was between 41 years and 60 years. More number of cases were reported during the months of post rainy season (September to December). A large number of patients (77%) presented with uncontrolled diabetes mellitus. Rhino-orbito-cerebral mucormycosis was the most common presentation followed by cutaneous infection. Antifungal treatment was started in around 80% of the cases. Twenty patients were managed by combined medical and surgical intervention. Eight patients died while the outcome of nine was unknown, as they left the hospital against medical advice and could not be followed up. Conclusion Mucormycosis, an insidious killer, should be an important differential diagnosis in progressive soft tissue infections and deep organ infection. How to cite this article Priya P, Ganesan V, Rajendran T, Geni VG. Mucormycosis in a Tertiary Care Center in South India: A 4-Year Experience. Indian J Crit Care Med 2020;24(3):168–171.
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Affiliation(s)
- Poorna Priya
- Department of Pathology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - Vithiya Ganesan
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - T Rajendran
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
| | - V G Geni
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
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Alqhamdi S, Idress B, Alharbi A, Aljurais N. Case report: Disseminated pulmonary mucormycosis involving spleen in diabetic patient with aggressive surgical approach. Int J Surg Case Rep 2018; 54:42-46. [PMID: 30522077 PMCID: PMC6280629 DOI: 10.1016/j.ijscr.2018.11.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 11/15/2018] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Mucormycosis is a life threatening fungal infection that occurs in immunocompromised patients. PRESENTATION OF CASE A 36-year-old Saudi male with known case of Insulin-Dependent Diabetes Mellitus (IDDM), who was presented with productive cough and diarrhea. Computed tomography (CT) revealed a disseminated fungal invasion of the lungs and spleen with invading the fundus of the stomach. An aggressive surgical approach and amphotericin B treatment resolved his condition. DISCUSSION Disseminated Mucormycosis in one organ can spread hematogenously to other organs and can cause severe morbidity and mortality in high risk individuals. The diagnosis of mucormycosis is usually delayed, Antifungal therapy alone is insufficient for mucormycosis, and surgical debridement for all infected tissue is often required. CONCLUSION Mucormycosis is a life threating infection, and usually the diagnosis late because of non-specific clinical, radiological feature and need biopsy for confirmation of the organism. The cornerstone for the management and increase the survival rate remain on rapid diagnosis, treatment of the underlying predisposing condition, and urgent surgical debridement.
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Affiliation(s)
- Saleh Alqhamdi
- Department of General Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Bandar Idress
- Department of General Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Ashwag Alharbi
- Department of General Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Nawaf Aljurais
- Department of General Surgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Kim YI, Kang HC, Lee HS, Choi JS, Seo KH, Kim YH, Na J. Invasive Pulmonary Mucormycosis With Concomitant Lung Cancer Presented With Massive Hemoptysis by Huge Pseudoaneurysm of Pulmonary Artery. Ann Thorac Surg 2014; 98:1832-5. [DOI: 10.1016/j.athoracsur.2013.12.051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 10/13/2013] [Accepted: 12/02/2013] [Indexed: 10/24/2022]
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Chakrabarti A, Singh R. Mucormycosis in India: unique features. Mycoses 2014; 57 Suppl 3:85-90. [PMID: 25187095 DOI: 10.1111/myc.12243] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 04/21/2014] [Accepted: 04/22/2014] [Indexed: 01/03/2023]
Abstract
Mucormycosis remains a devastating invasive fungal infection, with high mortality rates even after active management. The disease is being reported at an alarming frequency over the past decades from India. Indian mucormycosis has certain unique features. Rhino-orbito-cerebral presentation associated with uncontrolled diabetes is the predominant characteristic. Isolated renal mucormycosis has emerged as a new clinical entity. Apophysomyces elegans and Rhizopus homothallicus are emerging species in this region and uncommon agents such as Mucor irregularis and Thamnostylum lucknowense are also being reported. This review focuses on these distinct features of mucormycosis observed in India.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Cadelis G. [Hemoptysis complicating bronchopulmonary mucormycosis in a diabetic patient]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:83-88. [PMID: 23434001 DOI: 10.1016/j.pneumo.2012.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Revised: 12/13/2012] [Accepted: 12/15/2012] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Mucormycosis are the fungal infections caused by emerging ubiquitous filamentous fungi classified as zygometes and order as mucorales. They occur mainly in immunosuppressed patients and diabetics. The onset of hemoptysis, in this context, may rapidly become life-threatening. OBSERVATION We report the case of a man of 83 years, Caribbean with a history of non-insulindependent diabetes and HTLV1 seropositive. At admission he presented with fever, cough and cachexia. Chest X-ray revealed a snapshot of excavation within alveolar consolidation. Endoscopy showed a mucopurulent plug obstructing lingula. The histological appearance of bronchial biopsies was in favor of mucormycosis. A combined treatment with liposomal amphotericin B and posaconasole was implemented, but the occurrence of abundant hemoptysis led us to make a left upper lobectomy. Finally, the outcome was favorable and the patient was discharged after hospitalization of 56 days. CONCLUSION A medicosurgical treatment during mucormycosis complicating bronchopulmonary hemoptysis not controlled by medical treatment alone seems to offer an effective therapeutic strategy.
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Affiliation(s)
- G Cadelis
- Service de Pneumologie, CHU de Pointe-à-Pitre, route de Chauvel, 97159 Pointe-à-Pitre cedex, Guadeloupe.
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Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis 2012; 54 Suppl 1:S23-34. [PMID: 22247442 DOI: 10.1093/cid/cir866] [Citation(s) in RCA: 794] [Impact Index Per Article: 66.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Mucorales order of the class of Zygomycetes. Mucormycosis has emerged as the third most common invasive mycosis in order of importance after candidiasis and aspergillosis in patients with hematological and allogeneic stem cell transplantation. Mucormycosis also remains a threat in patients with diabetes mellitus in the Western world. Furthermore, this disease is increasingly recognized in recently developed countries, such as India, mainly in patients with uncontrolled diabetes or trauma. Epidemiological data on this type of mycosis are scant. Therefore, our ability to determine the burden of disease is limited. Based on anatomic localization, mucormycosis can be classified as one of 6 forms: (1) rhinocerebral, (2) pulmonary, (3) cutaneous, (4) gastrointestinal, (5) disseminated, and (6) uncommon presentations. The underlying conditions can influence clinical presentation and outcome. This review describes the emerging epidemiology and the clinical manifestations of mucormycosis.
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Affiliation(s)
- George Petrikkos
- National and Kapodistrian University of Athens, Attikon Hospital, Haidari, Athens, Greece.
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Challa S, Uppin SG, Uppin MS, Paul RT, Prayaga AK, Rao MT. Pulmonary zygomycosis: A clinicopathological study. Lung India 2011; 28:25-9. [PMID: 21654982 PMCID: PMC3099506 DOI: 10.4103/0970-2113.76297] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Zygomycosis is an emerging infection worldwide. Pulmonary zygomycosis (PZ) is uncommon with only few reported series from India. MATERIALS AND METHODS All cases of PZ diagnosed on histopathology between 1995 and 2008 were included. Clinical and imageological findings were noted in all cases. Routine hematoxylin and eosin-stained sections were studied to assess the pathology; Gomori's methenamine silver (GMS), periodic acid Schiff were done for delineating fungal morphology. Culture reports were collected wherever available. Treatment and outcome details were noted. RESULTS Seven patients were diagnosed with PZ during the study period, which included six males and one female patient. Six of these had diabetes mellitus (DM) and one patient was on chemotherapy for the treatment of Hodgkin's lymphoma. Fever and cough were the most common presenting features. Consolidation with or without cavitation was seen in six patients and lung abscess with fungal ball in one patient. All six patients with DM had upper lobe involvement and four had multiple lesions. Histological sections revealed necrotizing inflammation, hemorrhagic infarcts and angioinvasion. Culture was available in two patients, which grew Rhizopus oryzae. Five patients succumbed to disease and remaining two were lost to follow-up. CONCLUSION Diabetes mellitus is the most common predisposing factor for PZ and carries high mortality.
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Affiliation(s)
- Sundaram Challa
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Andhra Pradesh, India
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Abstract
Fungal pulmonary infections are becoming more prevalent as a consequence of the rising prevalence of immunocompromised patients. Besides ubiquitous opportunistic fungi such as Aspergillus spp and geographically delimited mycoses, fungi that were previously thought to be of uncertain pathogenicity, such as hyaline and dematiaceous molds, are increasingly being diagnosed as the causes of invasive disease in profoundly immunosuppressed hosts. Overall progress in the clinical management of fungal pulmonary infections has been slow compared with other areas of infectious diseases. However, recent encouraging advances in fungal diagnostics and therapeutics have resulted in improved clinical outcomes, particularly in vulnerable patient populations such as solid organ or allogeneic hematopoietic stem cell transplant recipients. This article provides an overview of endemic mycoses and other emerging fungal pulmonary infections. Recent developments in terms of the diagnosis and clinical management of these infections are also discussed.
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Affiliation(s)
- Li Yang Hsu
- Department of Medicine, National University Health System, Singapore 119074, Singapore.
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Li JY, Yong TY, Jurisevic CA, Russ GR, Grove DI, Coates PTH, Disney AP. Successful Treatment of Pulmonary Mucormycosis in a Renal Transplant Recipient with Limited Pulmonary Reserve by Combined Medical and Surgical Therapy. Heart Lung Circ 2009; 18:226-8. [DOI: 10.1016/j.hlc.2007.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2007] [Accepted: 12/22/2007] [Indexed: 10/22/2022]
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Skin mucormycosis presenting as an erythema-nodosum-like rash in a renal transplant recipient: a case report. J Med Case Rep 2008; 2:112. [PMID: 18423044 PMCID: PMC2365968 DOI: 10.1186/1752-1947-2-112] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Accepted: 04/19/2008] [Indexed: 11/30/2022] Open
Abstract
Introduction Cutaneous mucormycosis is a rare entity related to kidney transplantation. It usually presents with ecthyma-like lesions and black necrotic cellulitis. We report an unusual case of primary cutaneous mucormycosis presenting as erythema-nodosum-like lesions in a woman who had received a renal transplant. Case presentation A 49-year-old woman with diabetes received a living-unrelated kidney transplant. Her clinical course was uneventful for the first six months after transplantation. She then developed multiple, painful, erythema-nodosum-like lesions on her right leg and thigh following an episode of minor trauma. Mucormycosis was diagnosed by skin biopsy. Microscopic examination also showed panniculitis. The patient was treated successfully with amphotericin B and surgical resection. To our knowledge, this is the first description of primary cutaneous mucormycosis with erythema-nodosum-like lesions and panniculitis after renal transplantation. Conclusion Cutaneous mucormycosis should be considered in the differential diagnosis when a kidney transplant recipient develops erythema-nodosum-like lesions with panniculitis.
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Kebapci N, Efe B, Alataş F, Açikalin M, Kiraz N. Pulmonary multinodular mucormycosis in type 1 diabetic patient with diabetic ketoacidosis. J Endocrinol Invest 2007; 30:247-52. [PMID: 17505160 DOI: 10.1007/bf03347433] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We report a case of pulmonary multinodular mucormycosis in a Type 1 diabetic patient with diabetic ketoacidosis. He had a history of 20-pack-year tobacco use. The initial chest roentgenogram and thorax tomography (after the treatment of diabetic ketoacidosis) revealed multiple nodular lesions with cavitation in the upper lobes of pulmonary parenchyma. Resection of three nodular lesion demonstrated cheesy necrotic mass in the cavitating lesions. The diagnosis of pulmonary multinodular mucormycosis was made depending on the histopathologic examination yielding nonseptated right angle branching-shaped hyphae typical of mucormycosis. The patient was started on liposomal amphotericin B and discharged at the sixth week of therapy with a scheduled therapy of amphotericin B. When he came back after 33 months, he was metabolically unregulated under the insulin therapy. He confessed that he had been smoking heroin besides tobacco for the last 5 years. A new thorax computerized tomography showed that pulmonary nodules were slightly regressed but not resolved.
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Affiliation(s)
- N Kebapci
- Department of Endocrinology and Metabolism, Eskişehir Osmangazi University Medical Faculty, Eskişehir, Turkey.
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Almyroudis NG, Sutton DA, Linden P, Rinaldi MG, Fung J, Kusne S. Zygomycosis in solid organ transplant recipients in a tertiary transplant center and review of the literature. Am J Transplant 2006; 6:2365-74. [PMID: 16925570 DOI: 10.1111/j.1600-6143.2006.01496.x] [Citation(s) in RCA: 190] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Zygomycetes are ubiquitous fungi that can cause invasive disease associated with high mortality. We report 10 solid organ transplant recipients with zygomycosis (incidence 2 per 1000) and reviewed 106 cases in the English-language literature. These included renal (n = 73), heart (n = 16), lung (n = 4), heart/lung (n = 2), liver (n = 19) and kidney/pancreas (n = 2) transplant recipients. All patients were receiving immunosuppression and the vast majority steroids. The clinical presentation included rhino-sino-orbital (n = 20), rhinocerebral (n = 16), pulmonary (n = 28), gastrointestinal (n = 13), cutaneous (n = 18), renal (n = 6) and disseminated disease (n = 15). Most frequently isolated genera were Rhizopus (73%) followed by Mucor (13%). The overall mortality was 49%. While rhino-sino-orbital disease had the best prognosis, rhinocerebral disease had high mortality (93%) comparable to disseminated disease. A favorable outcome was associated with limited, surgically accessible disease and early surgical intervention along with amphotericin B administration.
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Affiliation(s)
- N G Almyroudis
- Department of Medicine, Univeristy of Pittsburgh Medical Center, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania, USA
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Chayakulkeeree M, Ghannoum MA, Perfect JR. Zygomycosis: the re-emerging fungal infection. Eur J Clin Microbiol Infect Dis 2006; 25:215-29. [PMID: 16568297 DOI: 10.1007/s10096-006-0107-1] [Citation(s) in RCA: 221] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Invasive fungal infections are major medical complications in immunocompromised patients. The recent rise in the incidence of cancer and the increased use of newer medical treatment modalities, including organ transplantations, have resulted in growing numbers of highly immunosuppressed individuals. Although aspergillosis and candidiasis are among the most common invasive mycoses in such patients, there is evidence that the incidence of infectious diseases caused by Zygomycetes has risen significantly over the past decade. Patients with diabetes, malignancies, solid organ or bone marrow transplants, or iron overload and those receiving immunosuppressive agents, deferoxamine therapy, or broad-spectrum antimicrobial drugs are at highest risk for zygomycosis. This review details the emergence and importance of zygomycosis in current clinical practice and its manifestations and management. The etiologic species, pathogenesis and risk factors for zygomycosis are reviewed and updated. The clinical spectrum of zygomycosis is now broader, and it can be difficult to distinguish between mucormycosis and enthomophthoramycosis, both of which can manifest as disease ranging from a superficial infection to an angioinvasive infection with high mortality. Finally, the three-part treatment strategy (antifungal drugs, surgery, control of underlying diseases) is reviewed. Lipid formulations of amphotericin B are the antifungal agents of choice for treatment of zygomycosis. A novel antifungal triazole, posaconazole, has been developed and may become approved for treatment of zygomycosis. The clinical experience with adjunctive treatments like colony-stimulating factors, interferon-gamma, and hyperbaric oxygen therapy is still limited.
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Affiliation(s)
- M Chayakulkeeree
- Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, P.O. Box 3867, Durham, NC 27710, USA
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Abstract
Over half of all renal transplant recipients in the tropical countries develop a serious infection at some point in the posttransplant period and 20% to 40% of them succumb to these infections. Many of these infections are endemic to the region. A multitude of factors including unhygienic conditions, hot and humid climate, late presentation, lack of knowledge about the spectrum of organisms in these areas, scanty diagnostic techniques, and high cost of lifesaving antimicrobial agents contribute to this dismal outcome. Tuberculosis is observed in 10% to 15% of transplant recipients. Pleuropulmonary disease is most frequent, but the commonly employed tests are seldom helpful in the diagnosis. Bronchoalveolar lavage is very sensitive in early detection of this infection and allows timely institution of specific therapy. Hepatitis virus infections are generally acquired before transplant, and viral replication is accelerated under the effect of immunosuppressive therapy leading to chronic liver disease. Cytomegalovirus (CMV) disease has shown a fourfold increase after introduction of cyclosporine to the immunosuppressive regimes at our center. Coinfection with other bacteria or fungi is frequent in CMV-infected allograft recipients. Opportunistic fungal infections are seen in less than 10% of allograft recipients, but this figure is likely an underestimate. The frequently encountered fungal infections include Candida, Aspergillus, Cryptococcus, and Mucor. Fungal infections carried a high mortality of over 65% at our center. The protean manifestations of the opportunistic infections and nonavailability of sensitive diagnostic tests in most centers in the underdeveloped countries often delay the diagnosis and institution of therapy.
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Affiliation(s)
- Vivekanand Jha
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Lee E, Vershvovsky Y, Miller F, Waltzer W, Suh H, Nord EP. Combined medical surgical therapy for pulmonary mucormycosis in a diabetic renal allograft recipient. Am J Kidney Dis 2001; 38:E37. [PMID: 11728997 DOI: 10.1053/ajkd.2001.29293] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mucormycosis is a rare opportunistic infection that complicates chronic debilitating diseases and immunosuppressed solid-organ transplant recipients. We present a case of life-threatening pulmonary mucormycosis in a diabetic renal allograft recipient who survived with reasonable renal function. Early recognition of this entity and prompt use of bronchoalveolar lavage (BAL) are critical to the outcome. Antifungal therapy combined with early surgical excision of infected, necrotic tissue appears to be the preferred course of action. Judicious withholding of immunosuppressants until fungemia cleared did not jeopardize allograft function.
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Affiliation(s)
- E Lee
- Division of Nephrology, Department of Medicine, School of Medicine, State University of New York at Stony Brook, Stony Brook, NY 11794, USA
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