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Zhao Y, Tian W, Yang J, Li X, Lu H, Yu N, Zhang P, Liu C, Chen P, Lei G, Liu Y. Fungal Endophthalmitis in a Case of Rhino-Orbito-Cerebral Mucormycosis: Successfully Treated With Amphotericin B Colloidal Dispersion. Front Microbiol 2022; 13:910419. [PMID: 35783387 PMCID: PMC9240434 DOI: 10.3389/fmicb.2022.910419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/19/2022] [Indexed: 11/15/2022] Open
Abstract
Background Rhino-orbito-cerebral mucormycosis (ROCM) is an acute, fulminant, opportunistic fungal infection that usually occurs in diabetes or immunocompromised patients. Amphotericin B combined with surgical debridement remains the standard treatment, although it is controversial due to its lager nephrotoxicity. Thus far, no studies have reported the treatment for ROCM-associated fungal endophthalmitis because the exact pathogenesis and transmission routes in ROCM remain unclear. Here, we reported a case of ROCM complicated with fungal endophthalmitis treated favorably with amphotericin B colloidal dispersion (ABCD) in combination with other antifungals and surgical debridement. Case Presentation A 34-year-old woman with diabetes was admitted to our hospital owing to right-sided headache for 8 days, blindness with swelling in the right eye for 5 days, and blindness in the left eye for 1 day. MRI showed that the patient had sphenoid sinus, sinuses, frontal lobe lesions, and proptosis of the right eye. Metagenomic sequencing revealed that the patient had Rhizopus oryzae infection. During hospitalization, the patient received intravenous ABCD, oral posaconazole, and topical amphotericin B and underwent surgical debridement. After 67 days of treatment, the patient’s condition was significantly improved, and limb muscle strength showed grade V. Rhizopus oryzae showed negative results, and conjunctival swelling decreased. Additionally, no nephrotoxicity occurred during treatment. After discharge, the patient’s treatment was transitioned to oral posaconazole and she was free of complaints during the 30-day follow-up without any additional treatment for ROCM. Conclusion Treatment with ABCD combined with other antifungal drugs and surgical debridement for ROCM complicated with fungal endophthalmitis showed remarkable efficacy and good safety. Hence, this regimen is a promising treatment strategy for this fatal disease.
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Affiliation(s)
- Yinlong Zhao
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wenbin Tian
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiankai Yang
- Department of Neurosurgery, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xueqing Li
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Huaihai Lu
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ning Yu
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pei Zhang
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Chao Liu
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Pengfei Chen
- Department of Ophthalmology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Guang Lei
- Department of Otolaryngology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya Liu
- Department of Anesthesiology and Intensive Care, The Second Hospital of Hebei Medical University, Shijiazhuang, China
- *Correspondence: Ya Liu,
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Gibson JF, Bojarczuk A, Evans RJ, Kamuyango AA, Hotham R, Lagendijk AK, Hogan BM, Ingham PW, Renshaw SA, Johnston SA. Blood vessel occlusion by Cryptococcus neoformans is a mechanism for haemorrhagic dissemination of infection. PLoS Pathog 2022; 18:e1010389. [PMID: 35446924 PMCID: PMC9022829 DOI: 10.1371/journal.ppat.1010389] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/21/2022] [Indexed: 11/18/2022] Open
Abstract
Meningitis caused by infectious pathogens is associated with vessel damage and infarct formation, however the physiological cause is often unknown. Cryptococcus neoformans is a human fungal pathogen and causative agent of cryptococcal meningitis, where vascular events are observed in up to 30% of patients, predominantly in severe infection. Therefore, we aimed to investigate how infection may lead to vessel damage and associated pathogen dissemination using a zebrafish model that permitted noninvasive in vivo imaging. We find that cryptococcal cells become trapped within the vasculature (dependent on their size) and proliferate there resulting in vasodilation. Localised cryptococcal growth, originating from a small number of cryptococcal cells in the vasculature was associated with sites of dissemination and simultaneously with loss of blood vessel integrity. Using a cell-cell junction tension reporter we identified dissemination from intact blood vessels and where vessel rupture occurred. Finally, we manipulated blood vessel tension via cell junctions and found increased tension resulted in increased dissemination. Our data suggest that global vascular vasodilation occurs following infection, resulting in increased vessel tension which subsequently increases dissemination events, representing a positive feedback loop. Thus, we identify a mechanism for blood vessel damage during cryptococcal infection that may represent a cause of vascular damage and cortical infarction during cryptococcal meningitis. Meningitis is a life threatening form of infection in the brain that is difficult to treat. How infection spreads from the blood to cause meningitis is not well understood. Here we have shown how infection with the fungus Cryptococcus neoformans can be spread from the blood by blocking and bursting blood vessels. Using zebrafish larvae, we were able to follow the same infections over a period of days to understand how this infection behaves in blood vessels. We found that fungal cells become stuck within blood vessels depending on their size. These cells grow within blood vessels, resulting in the blood vessels becoming wider. We measured increased tension in blood vessels suggesting that, with the bloackage and widening of vessels, there was increased local blood pressure. We found that vessel blockage was associated with their rupture and spreading of fungus into the surround tissue. Finally, by increasing the tension in vessels we could increase the number of blood bursting events supporting our conclusion that blood vessel blockage leads to the spread of the infection outside of blood vessels.
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Affiliation(s)
- Josie F. Gibson
- Department of Infection, Immunity and Cardiovascular disease, Bateson Centre and Florey Institute, University of Sheffield, United Kingdom
- Institute of Molecular and Cell Biology, Agency of Science, Technology and Research (A-Star), Singapore
| | - Aleksandra Bojarczuk
- Department of Infection, Immunity and Cardiovascular disease, Bateson Centre and Florey Institute, University of Sheffield, United Kingdom
- Faculty of Physical Education, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Robert J. Evans
- Department of Infection, Immunity and Cardiovascular disease, Bateson Centre and Florey Institute, University of Sheffield, United Kingdom
| | - Alfred Alinafe Kamuyango
- Department of Infection, Immunity and Cardiovascular disease, Bateson Centre and Florey Institute, University of Sheffield, United Kingdom
| | - Richard Hotham
- Department of Infection, Immunity and Cardiovascular disease, Bateson Centre and Florey Institute, University of Sheffield, United Kingdom
| | - Anne K. Lagendijk
- Division of Genomics of Development and Disease, Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - Benjamin M. Hogan
- Division of Genomics of Development and Disease, Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - Philip W. Ingham
- Institute of Molecular and Cell Biology, Agency of Science, Technology and Research (A-Star), Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Stephen A. Renshaw
- Department of Infection, Immunity and Cardiovascular disease, Bateson Centre and Florey Institute, University of Sheffield, United Kingdom
| | - Simon A. Johnston
- Department of Infection, Immunity and Cardiovascular disease, Bateson Centre and Florey Institute, University of Sheffield, United Kingdom
- * E-mail:
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Guo X, Fang J, Wu Y. Risk factors of intracranial infection in patients after intracranial aneurysm surgery: Implication for treatment strategies. Medicine (Baltimore) 2021; 100:e27946. [PMID: 35049198 PMCID: PMC9191603 DOI: 10.1097/md.0000000000027946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022] Open
Abstract
Postoperative intracranial infection after intracranial aneurysm is relatively common in clinical setting; it is necessary to analyze the clinical risk factors of postoperative intracranial infection, to provide reliable evidence to the management of aneurysm.Patients with intracranial aneurysm admitted from January 1, 2016, to November 30, 2020, are included. We collected the patient's personal and treatment data, and analyzed the risk factors of intracranial infection by multivariate logistic regression analysis. We compared the cerebrospinal fluid (CSF) indicators and serological indicators and analyzed their correlation with intracranial infection by spearman analysis.A total of 236 patients with intracranial aneurysm were included; the incidence of postoperative intracranial infection was 12.71%. There were significant differences in the diabetes, intraoperative aneurysm rupture, intraoperative CSF leakage, duration of surgery, and estimated blood loss between infection and non-infection group. Logistic regression indicated that diabetes [odds ratio (OR) 2.053, 95% confidence interval (95% CI) 1.092∼3.385], intraoperative aneurysm rupture (OR 2.239, 95% CI 1.173∼4.312), intraoperative CSF leakage (OR 2.168, 95% CI 1.033∼3.451), duration of surgery ≥360 minutes (OR 1.926, 95% CI 1.108∼2.655), and estimated blood loss ≥125 mL (OR 2.459, 95% CI 1.854∼3.447) were the independent risk factors of postoperative intracranial infection in patients with aneurysm surgery (all P < .05). Klebsiella pneumoniae, Escherichia coli, and Staphylococcus epidermidis were the top 3 commonly seen pathogens. Spearman analyses indicated that PCT, CRP, LA, LDH were all correlated with intracranial infection (all P < .05).There are multiple factors for the postoperative intracranial infection in patients with aneurysm. Coping strategies should be formulated targeted on those risks to improve the prognosis of patients.
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Lersy F, Royer-Leblond J, Lhermitte B, Chammas A, Schneider F, Hansmann Y, Lefebvre N, Denis J, Sabou M, Lafitte F, Cotton F, Boncoeur-Martel MP, Tourdias T, Pruvo JP, Cottier JP, Herbrecht R, Kremer S. Cerebral mucormycosis: neuroimaging findings and histopathological correlation. J Neurol 2021; 269:1386-1395. [PMID: 34240320 DOI: 10.1007/s00415-021-10701-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/04/2021] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Mucormycosis are infections caused by molds of the order Mucorales. These opportunistic infections are rare, difficult to diagnose, and have a poor prognosis. We aimed to describe common radiographic patterns that may help to diagnose cerebral mucormycosis and search for histopathological correlations with imaging data. METHODS We studied the radiological findings (CT and MRI) of 18 patients with cerebral mucormycosis and four patients' histopathological findings. RESULTS All patients were immunocompromised and/or diabetic. The type of lesions depended on the infection's dissemination pathway. Hematogenous dissemination lesions were most frequently abscesses (59 lesions), cortical, cortical-subcortical, or in the basal ganglia, with a halo aspect on DWI for lesions larger than 1.6 cm. Only seven lesions were enhanced after contrast injection, with different presentations depending on patients' immune status. Ischemia and hemorrhagic areas were also seen. Vascular lesions were represented by stenosis and thrombosis. Direct posterior extension lesions were bi-fronto basal hypodensities on CT and restricted diffusion without enhancement on MRI. A particular extension, perineural spread, was seen along the trigeminal nerve. Histopathological analysis found endovascular lesions with destruction of vessel walls by Mucorales, microbleeds around vessels, as well as acute and chronic inflammation. CONCLUSIONS MRI is the critical exam for cerebral mucormycosis. Weak ring enhancement and reduced halo diffusion suggest the diagnosis of fungal infections. Involvement of the frontal lobes should raise suspicion of mucormycosis (along with aspergillosis). The perineural spread can be considered a more specific extension pathway of mucormycosis.
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Affiliation(s)
- François Lersy
- Service d'imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière 67200, Strasbourg, France
| | | | - Benoit Lhermitte
- Department of Pathology, Hautepierre University Hospital, 1 avenue Molière, 67200, Strasbourg, France
| | - Agathe Chammas
- Service d'imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière 67200, Strasbourg, France
| | - Francis Schneider
- Service de Médecine-Intensive-Réanimation, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Yves Hansmann
- Service de Maladies Infectieuses, NHC, CHU de Strasbourg, Strasbourg, France
| | - Nicolas Lefebvre
- Service de Maladies Infectieuses, NHC, CHU de Strasbourg, Strasbourg, France
| | - Julie Denis
- CHU de Strasbourg, Laboratoire de Parasitologie Et de Mycologie Médicale, Plateau Technique de Microbiologie, 1 rue Koeberlé, 67000, Strasbourg, France
| | - Marcela Sabou
- CHU de Strasbourg, Laboratoire de Parasitologie Et de Mycologie Médicale, Plateau Technique de Microbiologie, 1 rue Koeberlé, 67000, Strasbourg, France.,Université de Strasbourg, Institut de Parasitologie Et de Pathologie Tropicale, DIHP-UR 7292, Fédération de Médecine Translationnelle, 3 rue Koeberlé, 67000, Strasbourg, France
| | - François Lafitte
- Radiology Department, Rothschild Foundation in Paris, Paris, France
| | - François Cotton
- Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, Lyon, France.,Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, CREATIS UMR 5220, U1206, Pierre-Bénite, F-69495, Lyon, France
| | - Marie-Paule Boncoeur-Martel
- INSERM, U1094, Neuroépidémiologie Tropicale, Limoges, France.,Univ. Limoges, U1094, Neuroépidémiologie Tropicale, Institut D'Epidémiologie Et de Neurologie Tropicale, GEIST, Limoges, France.,IRD, Unité Associée, Neuroépidémiologie Tropicale, Limoges, France.,Service de Neuroradiologie, CHU Limoges, Limoges, France
| | - Thomas Tourdias
- CHU de Bordeaux, Neuro imagerie diagnostique et thérapeutique, 33000, Bordeaux, France.,Univ. Bordeaux, INSERM U1215, Neurocentre Magendie, 33000, Bordeaux, France
| | - Jean-Pierre Pruvo
- Inserm U 1172, CHU de Lille, University of Lille, Lille, France.,Department of Neuroradiology, CHU de Lille, University of Lille, Lille, France
| | | | - Raoul Herbrecht
- Department of Hematology, Institut de Cancérologie Strasbourg.Europe (ICANS) and Université de Strasbourg, Inserm UMR-S1113/IRFAC, Strasbourg, France
| | - Stéphane Kremer
- Service d'imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 avenue Molière 67200, Strasbourg, France. .,Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France.
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