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Ribeiro de Assis MCF, Lavareze L, de Lima-Souza RA, Cruz AJR, Chone CT, Egal ESA, Altemani A, Mariano FV. Necrotic palatal collapse in a 72-year-old woman with uncontrolled diabetes. J Am Dent Assoc 2024:S0002-8177(24)00024-2. [PMID: 38416091 DOI: 10.1016/j.adaj.2023.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 02/29/2024]
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Sato N, Yokoi H, Ichioka M, Ishii A, Matsubara T, Yanagita M. Invasive aspergillosis in the patient with focal segmental glomerulosclerosis initiating hemodialysis: a case report and mini-review. RENAL REPLACEMENT THERAPY 2022. [DOI: 10.1186/s41100-022-00455-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Abstract
Background
Invasive aspergillosis (IA) is a severe form of fungal infection caused by the genus Aspergillus in immunocompromised hosts and has a high mortality rate. End-stage kidney disease (ESKD) is one of the risk factors for developing fungal infection; however, the detailed clinical and treatment course of ESKD patients with IA has been scarcely reported, especially for the patient initiating hemodialysis (HD). Here, we experienced a patient under immunosuppressive therapy for focal segmental glomerulosclerosis (FSGS) who suffered from IA involving lung and brain and resulted in initiating HD.
Case presentation
A 66-year-old male patient with a history of suspected non-tuberculosis mycobacterial lung disease was initially admitted to the hospital with minimal change disease and subsequently diagnosed as FSGS with worsening urinary protein levels. The combined treatment including immunosuppressive treatments of cyclosporin and glucocorticoids and low-density lipoprotein apheresis was initiated, and then, he experienced the symptoms of dry cough, somnolence, and disorientation, which were subsequently diagnosed as IA involving lung and brain. The patient required renal replacement therapy, and maintenance HD was continued. Despite the intensive treatment with multiple antifungals of liposomal amphotericin B, voriconazole, micafungin, and amphotericin B, the pneumonia of the patient did not improve, and he subsequently passed away.
Conclusions
We report the case of the IA under immunosuppressive treatment, who was subsequently initiated maintenance HD. The detailed clinical course of medications used to treat the patient is presented with the literature review of IA in ESKD and HD patients and those with past acid-fast bacterial infections. The careful determination of the intensity of immunosuppression and monitoring of the patient’s symptoms and early definitive diagnosis is crucial in treating IA in immunocompromised hosts with ESKD or in HD under immunosuppressive treatment, as the mortality for these patients is suspected to be high despite the intensive treatment.
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Townsend L, Martin-Loeches I. Invasive Aspergillosis in the Intensive Care Unit. Diagnostics (Basel) 2022; 12:2712. [PMID: 36359555 PMCID: PMC9689891 DOI: 10.3390/diagnostics12112712] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 08/28/2023] Open
Abstract
Invasive pulmonary aspergillosis (IPA) is a serious condition resulting in significant mortality and morbidity among patients in intensive care units (ICUs). There is a growing number of at-risk patients for this condition with the increasing use of immunosuppressive therapies. The diagnosis of IPA can be difficult in ICUs, and relies on integration of clinical, radiological, and microbiological features. In this review, we discuss patient populations at risk for IPA, as well as the diagnostic criteria employed. We review the fungal biomarkers used, as well as the challenges in distinguishing colonization with Aspergillus from invasive disease. We also address the growing concern of multidrug-resistant Aspergillosis and review the new and novel therapeutics which are in development to combat this.
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Affiliation(s)
- Liam Townsend
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, D08 NHY1 Dublin, Ireland
| | - Ignacio Martin-Loeches
- Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James’s Hospital, D08 NHY1 Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity College Dublin, D02 PN91 Dublin, Ireland
- Hospital Clinic, Institut D’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Ciberes, 08036 Barcelona, Spain
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Xie J, Tian S, Liu J, Cao R, Yue P, Cai X, Shang Q, Yang M, Han L, Zhang DK. Dual role of the nasal microbiota in neurological diseases—An unignorable risk factor or a potential therapy carrier. Pharmacol Res 2022; 179:106189. [DOI: 10.1016/j.phrs.2022.106189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/06/2022] [Accepted: 03/17/2022] [Indexed: 12/11/2022]
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Bougioukas L, Campbell B, Crooker K, Freed JA, Wilcock J, Singh D, Hale AJ. Invasive Aspergillus flavus sinusitis in an immunocompetent patient using intranasal cocaine. IDCases 2021; 26:e01327. [PMID: 34804802 PMCID: PMC8585617 DOI: 10.1016/j.idcr.2021.e01327] [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: 10/27/2021] [Revised: 11/01/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022] Open
Abstract
Invasive fungal sinusitis is a rare and potentially fatal infection that tends to occur in immunocompromised hosts. Presented is the case of a 33-year-old immunocompetent male with several months of recurrent facial and nasal pain refractory to several antibacterial courses before a diagnosis of invasive Aspergillus sinusitis was made. The patient’s symptoms and infection were successfully treated with a combination of surgical debridement and voriconazole. The authors review the epidemiology, risk factors, diagnosis, and treatment of invasive fungal sinusitis due to Aspergillus.
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Affiliation(s)
- Lauren Bougioukas
- Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Brendan Campbell
- University of Vermont Medical Center, Burlington, VT, United States
| | - Kyle Crooker
- University of Vermont Medical Center, Burlington, VT, United States
| | - Jason A. Freed
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Jonathan Wilcock
- University of Vermont Medical Center, Burlington, VT, United States
| | - Devika Singh
- Larner College of Medicine, University of Vermont, Burlington, VT, United States
- University of Vermont Medical Center, Burlington, VT, United States
| | - Andrew J. Hale
- Larner College of Medicine, University of Vermont, Burlington, VT, United States
- University of Vermont Medical Center, Burlington, VT, United States
- Correspondence to: University of Vermont Medical Center, Infectious Disease Unit, 111 Colchester Avenue, Mailstop 115 SM2, Burlington, VT 05401, United States.
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A rare infective cause of stroke in an immunocompetent child. Brain Dev 2021; 43:152-156. [PMID: 32855000 DOI: 10.1016/j.braindev.2020.07.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/23/2020] [Accepted: 07/26/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Infections are a common cause of childhood stroke with variable presentation. The current case describes a rare infective cause of venous and arterial stroke in an immunocompetent girl with management implications. CASE DESCRIPTION A 12 year old girl, presented with history of fever for 10 days, painful swelling of right eye for 7 days and altered sensorium for 2 days. On examination, she had right eye orbital cellulitis and fullness of right paranasal area. On nervous system examination, she was delirious, had right eye ophthalmoparesis, left upper motor neuron facial palsy and signs of meningeal inflammation. Her contrast enhanced CT head and subsequent MRI brain with arteriography and venography revealed right cavernous sinus and distal internal carotid artery thrombosis. She was started on intravenous ceftriaxone and vancomycin and subcutaneous heparin. In view of persistent symptoms, endoscopic debridement of right nasal cavity was done, which showed growth of aspergillus flavus. Subsequently, she was started on intravenous voriconazole. Within a week, she was afebrile, her inflammatory and neurological signs started improving. She was discharged after 3 weeks of intravenous voriconazole which was continued for 3 more weeks orally. Her procoagulant and immunodeficiency work up were normal. At 4 months follow up, she showed both clinical and radiological resolution. CONCLUSIONS Despite high mortality described in sino-orbital aspergillosis, early and appropriate treatment led to optimal outcome. In deep seated infections, isolation of etiological organism should be attempted, particularly when patient doesn't respond to conventional antimicrobial therapy.
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Huang G, Ye X, Yang X, Wang C, Zhang L, Ji G, Zhang K, Wang H, Zheng A, Li W, Wang J, Han X, Wei Z, Meng M, Ni Y. Invasive pulmonary aspergillosis secondary to microwave ablation: a multicenter retrospective study. Int J Hyperthermia 2018; 35:71-78. [PMID: 29874934 DOI: 10.1080/02656736.2018.1476738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE Invasive pulmonary aspergillosis (IPA) is a life-threatening complication of microwave ablation (MWA) during the treatment of primary or metastatic lung tumors. The purpose of this study was to investigate the clinical, radiological and demographic characteristics and treatment responses of patients with IPA after MWA. MATERIALS AND METHODS From January 2011 to January 2016, all patients who were treated by MWA of their lung tumors from six health institutions were enrolled in this study. Patients with IPA secondary to MWA were identified and retrospectively evaluated for predisposing factors, clinical treatment, and outcome. RESULTS The incidence of IPA secondary to lung MWA was 1.44% (23/1596). Of the 23 patients who developed IPA, six died as a consequence, resulting in a high mortality rate of 26.1%. Using computed tomography (CT), pulmonary cavitation was the most common finding and occurred in 87.0% (20/23) of the patients. Sudden massive hemoptysis was responsible for one-third of the deaths (2/6). Most patients (22/23) received voriconazole as an initial treatment, and six patients with huge cavities underwent intracavitary lavage. Finally, 17 patients (73.9%) achieved treatment success. CONCLUSIONS Lung MWA may be an additional host risk factor for IPA, particularly in elderly patients with underlying diseases and in patients who have recently undergone chemotherapy. Early and accurate diagnosis of IPA after MWA is critical for patient prognosis. Voriconazole should be given as the first-line treatment as early as possible. Bronchial artery embolization or intracavitary lavage may be required in some patients.
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Affiliation(s)
- Guanghui Huang
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Jinan, Shandong Province , China
| | - Xin Ye
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Jinan, Shandong Province , China
| | - Xia Yang
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Jinan, Shandong Province , China
| | - Chuntang Wang
- b Department of Oncology , Second People Hospital of Dezhou , Dezhou, Shandong Province , China
| | - Licheng Zhang
- c Department of Oncology , 88 Hospital of Chinese People's Liberation Army , Taian, Shandong Province , China
| | - Guangdong Ji
- d Department of Oncology , Taishan Hospital of Shangdong Province , Taian, Shandong Province , China
| | - Kaixian Zhang
- e Department of Oncology , Teng Zhou Central People's Hospital Affiliated to Jining Medical College , Tengzhou, Shandong Province , China
| | - Huili Wang
- f Department of Oncology , Affiliated Hospital of Jining Medical University , Jining, Shandong Province , China
| | - Aimin Zheng
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Jinan, Shandong Province , China
| | - Wenhong Li
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Jinan, Shandong Province , China
| | - Jiao Wang
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Jinan, Shandong Province , China
| | - Xiaoying Han
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Jinan, Shandong Province , China
| | - Zhigang Wei
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Jinan, Shandong Province , China
| | - Min Meng
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Jinan, Shandong Province , China
| | - Yang Ni
- a Department of Oncology , Shandong Provincial Hospital Affiliated to Shandong University , Jinan, Shandong Province , China
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Mert D, Iskender G, Duygu F, Merdin A, Dal Mehmet S, Dogan M, Tekgündüz E, Ertek M, Altuntaş F. Invasive Aspergillosis with Disseminated Skin Involvement in a Patient with Acute Myeloid Leukemia: A Rare Case. Hematol Rep 2017. [PMID: 28626542 PMCID: PMC5472346 DOI: 10.4081/hr.2017.6997] [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] [Indexed: 11/23/2022] Open
Abstract
Invasive pulmonary aspergillosis is most commonly seen in immunocompromised patients. Besides, skin lesions may also develop due to invasive aspergillosis in those patients. A 49-year-old male patient was diagnosed with acute myeloid leukemia. The patient developed bullous and zosteriform lesions on the skin after the 21st day of hospitalization. The skin biopsy showed hyphae. Disseminated skin aspergillosis was diagnosed to the patient. Voricanazole treatment was initiated. The patient was discharged once the lesions started to disappear.
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Affiliation(s)
- Duygu Mert
- Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Gülşen Iskender
- Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Fazilet Duygu
- Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Alparslan Merdin
- Hematology Clinic and Bone Marrow Transplantation Unit, Ankara, Turkey
| | | | - Mehmet Dogan
- Department of Pathology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Emre Tekgündüz
- Hematology Clinic and Bone Marrow Transplantation Unit, Ankara, Turkey
| | - Mustafa Ertek
- Infectious Diseases and Clinical Microbiology, Ankara, Turkey
| | - Fevzi Altuntaş
- Hematology Clinic and Bone Marrow Transplantation Unit, Ankara, Turkey
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Abstract
The nasal cavity and paranasal sinuses occupy the top of the upper respiratory tract and form pneumatic spaces connected with the atmosphere. They are located immediately beneath the base of the cranium, where crucial vital structures are harbored. From this region, very much exposed to airborne agents, arise some of the more complex and rare benign and malignant lesions seen in humans, whose difficulties in interpretation make this remarkable territory one of the most challenging in the practice of surgical pathology. Contents of this chapter cover inflammations and infections, polyps and pseudotumors, fungal and midfacial destructive granulomatous lesions, as well as benign, borderline, and malignant neoplasms. Among the neoplasms, emphasis is made on those entities characteristic or even unique for the sinonasal region, such as Schneiderian papillomas, glomangiopericytoma, intestinal- and non-intestinal-type adenocarcinomas, olfactory neuroblastoma, nasal-type NK-/T-cell lymphoma, and teratocarcinosarcoma. Moreover, recently recognized entities involving this territory, i.e., HPV-related non-keratinizing carcinoma, NUT carcinoma, and SMARCB1-deficient basaloid carcinoma, are also discussed in the light of their specific molecular findings. Furthermore, the text is accompanied by numerous classical and recent references, several tables, and 100 illustrations.
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Affiliation(s)
- Antonio Cardesa
- University of Barcelona, Anatomic Pathology Hospital Clínic University of Barcelona, Barcelona, Spain
| | - Pieter J. Slootweg
- Radboud Univ Nijmegen Medical Center, Pathology Radboud Univ Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Nina Gale
- University of Ljubljana,, Institute of Pathology, Faculty of Medic University of Ljubljana,, Ljublijana, Slovenia
| | - Alessandro Franchi
- University of Florence, Dept of Surg & Translational Medicine University of Florence, Florence, Italy
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Balsitis M, Elgoweini M, Martin SJ, Shankland GS, Paxton J, Bal AM. Primary invasive aspergillosis with disseminated intravascular coagulation as a presenting feature of non-Hodgkin's lymphoma. Med Mycol Case Rep 2015. [PMID: 26199867 PMCID: PMC4506975 DOI: 10.1016/j.mmcr.2015.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Invasive aspergillosis (IA) is a life-threatening infection. IA is usually seen in severely immunocompromised patients. However, IA as a presenting feature of non-Hodgkin's lymphoma is rare. The patient we describe had no signs or symptoms of lymphoma prior to hospital admission. A. fumigatus was isolated from respiratory tract specimens on the day of admission and fungal elements were detected on autopsy. Isolation of Aspergillus in patients with severe sepsis should trigger a search haematological malignancy.
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Affiliation(s)
- Margaret Balsitis
- Department of Pathology, University Hospital Crosshouse, Kilmarnock KA2 0BE, United Kingdom
| | - Maha Elgoweini
- Department of Pathology, University Hospital Crosshouse, Kilmarnock KA2 0BE, United Kingdom
| | - Sarah J Martin
- Infection Unit, University Hospital Crosshouse, Kilmarnock KA2 0BE, United Kingdom
| | - Gillian S. Shankland
- Clinical Mycology Reference Laboratory, Southern General Hospital, Glasgow G51 4TF, United Kingdom
| | - Jane Paxton
- Department of Pathology, University Hospital Crosshouse, Kilmarnock KA2 0BE, United Kingdom
| | - Abhijit M Bal
- Department of Microbiology University Hospital Crosshouse, Kilmarnock KA2 0BE, United Kingdom
- Corresponding author. Fax: +44 1563 825000.
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Liss B, Vehreschild JJ, Bangard C, Maintz D, Frank K, Grönke S, Michels G, Hamprecht A, Wisplinghoff H, Markiefka B, Hekmat K, Vehreschild MJGT, Cornely OA. Our 2015 approach to invasive pulmonary aspergillosis. Mycoses 2015; 58:375-82. [DOI: 10.1111/myc.12319] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 03/09/2015] [Accepted: 03/09/2015] [Indexed: 12/13/2022]
Affiliation(s)
- B. Liss
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- Center for Integrated Oncology CIO KölnBonn; University of Cologne; Cologne Germany
| | - J. J. Vehreschild
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- Center for Integrated Oncology CIO KölnBonn; University of Cologne; Cologne Germany
- German Centre for Infection Research (DZIF); partner site Bonn-Cologne; Cologne Germany
| | - C. Bangard
- Department of Radiology; University Hospital of Cologne; Cologne Germany
| | - D. Maintz
- Department of Radiology; University Hospital of Cologne; Cologne Germany
| | - K. Frank
- Department III of Internal Medicine; Heart Centre of the University of Cologne; Cologne Germany
| | - S. Grönke
- Department III of Internal Medicine; Heart Centre of the University of Cologne; Cologne Germany
| | - G. Michels
- Department III of Internal Medicine; Heart Centre of the University of Cologne; Cologne Germany
| | - A. Hamprecht
- Institute for Medical Microbiology; Immunology and Hygiene; University Hospital of Cologne; Cologne Germany
| | - H. Wisplinghoff
- Institute for Medical Microbiology; Immunology and Hygiene; University Hospital of Cologne; Cologne Germany
| | - B. Markiefka
- Institute of Pathology; University Hospital of Cologne; Cologne Germany
| | - K. Hekmat
- Department of Cardiothoracic Surgery; University Hospital of Cologne; Cologne Germany
| | - M. J. G. T. Vehreschild
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- Center for Integrated Oncology CIO KölnBonn; University of Cologne; Cologne Germany
- German Centre for Infection Research (DZIF); partner site Bonn-Cologne; Cologne Germany
| | - O. A. Cornely
- Department I of Internal Medicine; University Hospital of Cologne; Cologne Germany
- Center for Integrated Oncology CIO KölnBonn; University of Cologne; Cologne Germany
- German Centre for Infection Research (DZIF); partner site Bonn-Cologne; Cologne Germany
- Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD); University of Cologne; Cologne Germany
- Clinical Trials Centre Cologne; ZKS Köln; University of Cologne; Cologne Germany
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12
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Yang CC, Hsu PC, Cheng CW, Lee MH. Coexistence of fatal disseminated invasive aspergillosis and pyoderma gangrenosum: a case report. Med Princ Pract 2011; 20:380-3. [PMID: 21577002 DOI: 10.1159/000324802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 10/18/2010] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To report an unusual case of disseminated aspergillosis involving the lymph nodes, lungs, and skin in a patient with pyoderma gangrenosum (PG) and myelodysplastic syndrome (MDS). CASE PRESENTATION AND INTERVENTION A 46-year-old man presented with productive cough of 2 weeks' duration. Besides, several painless, fixed lymph nodes were palpated at his left neck. He had PG and MDS diagnosed in June 2004 with regular use of oral dapsone and prednisolone. His skin lesions healed with scar formation and no purulent discharge. A computed tomography scan of the head, neck and chest showed bilateral lung consolidation and abscesses at the left neck, right upper lung and right pleura. The neck abscess culture grew Aspergillus species. Dark reddish macules developed over the right arm, chest and abdominal wall, and the left lower limb 2 weeks after initiation of amphotericin B. The histology of the right arm skin biopsy showed invasive aspergillosis. Caspofungin was started then for suspicion of poor response to amphotericin B. He expired despite 35 days of antifungal therapy. CONCLUSION This report highlights the rarity of coexistence of disseminated aspergillosis and PG, and should alert physicians to the possibility of invasive fungal infection superimposed on a chronic skin lesion.
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Affiliation(s)
- Chien-Chang Yang
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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13
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Thirumala R, Ramaswamy M, Chawla S. Diagnosis and management of infectious complications in critically ill patients with cancer. Crit Care Clin 2010; 26:59-91. [PMID: 19944276 DOI: 10.1016/j.ccc.2009.09.007] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cancer and its treatments lead to profound suppression of innate and acquired immune function. In this population, bacterial infections are common and may rapidly lead to overwhelming sepsis and death. Furthermore, infections caused by viral and fungal pathogens should be considered in patients who have specific immune defects. As cancer therapies have become more aggressive the risk for infection has increased and many patients require intensive care support. Despite improvements in long-term survival, infections remain a common complication of cancer therapy and accounts for the majority of chemotherapy-associated deaths. By understanding the host defense impairments and likely pathogens clinicians will be better able to guide diagnosis and management of this unique population.
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Affiliation(s)
- Raghukumar Thirumala
- Critical Care Medicine Service, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, C1179, New York, NY 10021, USA
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14
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Abenza-Abildua M, Fuentes-Gimeno B, Morales-Bastos C, Aguilar-Amat M, Martinez-Sanchez P, Diez-Tejedor E. Stroke due to septic embolism resulting from Aspergillus aortitis in an immunocompetent patient. J Neurol Sci 2009; 284:209-10. [DOI: 10.1016/j.jns.2009.04.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 04/16/2009] [Accepted: 04/21/2009] [Indexed: 11/28/2022]
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15
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Parize P, Chandesris MO, Lanternier F, Poirée S, Viard JP, Bienvenu B, Mimoun M, Méchai F, Mamzer MF, Herman P, Bougnoux ME, Lecuit M, Lortholary O. Antifungal therapy of Aspergillus invasive otitis externa: efficacy of voriconazole and review. Antimicrob Agents Chemother 2009; 53:1048-53. [PMID: 19104029 PMCID: PMC2650565 DOI: 10.1128/aac.01220-08] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Revised: 10/11/2008] [Accepted: 11/20/2008] [Indexed: 11/20/2022] Open
Abstract
Invasive otitis externa (IOE) due to Aspergillus is a rare, potentially life-threatening, invasive fungal infection affecting immunocompromised patients. The invasive process may lead to skull base osteomyelitis with progressive cranial nerve palsies and can result in irreversible hearing and neurological impairment. We report two cases of Aspergillus IOE treated with voriconazole alone and a literature review of antifungal therapy of Aspergillus IOE. Twenty-five patients, including the two described in the present report, were analyzed. Eighteen patients were treated with amphotericin B, and nine of them received itraconazole as an additional agent. Three patients received initial therapy with itraconazole, and one patient was treated with both voriconazole and caspofungin therapy. The two patients in the present report received voriconazole therapy alone with good clinical and biological tolerance despite prolonged treatment. The last patient did not receive antifungal therapy, as the diagnosis was made postmortem. Eighteen patients underwent an initial extensive surgical debridement. The majority of the patients had a favorable outcome, 17 patients experienced a complete recovery, and 6 showed a partial improvement. Both of the patients reported on here had favorable outcomes, and no aggressive surgical debridement was required. Although voriconazole has been shown to be effective for the treatment of invasive aspergillosis, its precise role in the management of Aspergillus IOE had not been documented. These observations demonstrate that voriconazole could be an effective and well-tolerated therapeutic option for the management of Aspergillus IOE.
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Affiliation(s)
- Perrine Parize
- Université Paris Descartes, Hôpital Necker-Enfants Malades, Paris, France
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Abstract
Die Gesichtsmitte (der Bezirk zwischen Oberlippe und Stirn) entwickelt sich zwischen der 4. und 8. Schwangerschaftswoche. [ 220] Der Stirnfortsatz bildet sich währen der 4. postovulatorischen Woche, aus ihm gehen die oberen und mittleren Anteile des Gesichts hervor. Die Oberkiefer- und Nasenwülste entwickeln sich unterhalb des Stirnfortsatzes. Am Ende der 4. Woche bilden zwei oberflächliche Verdickungen der Nasenwülste die Riechplakoden, die ektodermaler Herkunft sind und aus denen der Epithelbelag der Nasenhöhle und Nasennebenhöhlen hervorgeht. Die Plakoden stülpen sich ein und bilden die Riechgruben, aus denen die vorderen Choanen (Nasenlöcher) und weniger oberflächlich die primitiven hinteren Choanen entstehen. Die medialen Nasen- und Stirnfortsätze bilden das Nasenseptum, die Stirnknochen, Nasenknochen, die Siebbeinzellen- Komplexe und die oberen Schneidezähne. Die lateralen Nasen- und Oberkieferfortsätze vereinigen sich zur Bildung des Philtrum und der Columella. Das knorpelige Nasenskelet bildet sich während der 7. und 8. postovulatorischen Woche tief unterhalb der Nasen- und Stirnbeinknochen aus dem Chondrocranium. Die Nasennebenhöhlen entwickeln sich in der 6. Fetalwoche aus den lateralen Nasenwänden, und ihr Wachstum setzt sich nach der Geburt während des gesamten Kindes- und Jugendalters fort.
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Affiliation(s)
- Antonio Cardesa
- Department of Pathological Anatomy, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spanien
| | - Pierre Rudolph
- Pathologisches Institut, Mühlenstr. 31, 45759 Recklinghausen, Deutschland
| | - Thomas Mentzel
- Dermatopathologische Gemeinschaftspraxis, Siemensstr. 6/1, 88048 Friedrichshafen, Deutschland
| | - Pieter J. Slootweg
- Department of Pathology HP 437, University Medical Center St. Radbound, P.O. Box 9101, 6500 Nijmegen, Niederlande
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17
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Is Family Screening Necessary in Brucellosis? Infection 2008; 36:575-7. [DOI: 10.1007/s15010-008-7022-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2007] [Accepted: 04/10/2008] [Indexed: 10/21/2022]
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Abstract
The incidence of invasive fungal infections has increased dramatically over the past two decades, mostly due to an increase in the number of immunocompromised patients.1–4 Patients who undergo chemotherapy for a variety of diseases, patients with organ transplants, and patients with the acquired immune deficiency syndrome have contributed most to the increase in fungal infections.5 The actual incidence of invasive fungal infections in transplant patients ranges from 15% to 25% in bone marrow transplant recipients to 5% to 42% in solid organ transplant recipients.6,7 The most frequently encountered are Aspergillus species, followed by Cryptococcus and Candida species. Fungal infections are also associated with a higher mortality than either bacterial or viral infections in these patient populations. This is because of the limited number of available therapies, dose-limiting toxicities of the antifungal drugs, fewer symptoms due to lack of inflammatory response, and the lack of sensitive tests to aid in the diagnosis of invasive fungal infections.1 A study of patients with fungal infections admitted to a university-affiliated hospital indicated that community-acquired infections are becoming a serious problem; 67% of the 140 patients had community-acquired fungal pneumonia.8
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20
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Chao TK, Liu CM, Huang WH. Significance of blood-tinged post-nasal drip in paranasal sinus disease. The Journal of Laryngology & Otology 2007; 122:814-7. [PMID: 17888198 DOI: 10.1017/s0022215107000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Blood-tinged post-nasal drip is a rare manifestation of paranasal sinus disease. Although the presence of such a symptom would intuitively prompt suspicion of malignancy, no previously published study has addressed this issue. METHODS One hundred and ninety-three patients with paranasal sinus lesions, who had undergone endoscopic sinus surgery for treatment or biopsy, were prospectively recruited. Their clinical information was collected and analysed. RESULTS In patients without blood-tinged post-nasal drip, 177/181 (97.8 per cent) had chronic paranasal sinusitis and fungal sinusitis. However, in patients who presented with this symptom, six of 12 (50 per cent) were diagnosed with other conditions. The difference was statistically significant (Fisher's exact test, two tails, p < 0.001). In patients with blood-tinged post-nasal drip, diagnoses other than chronic paranasal sinusitis and fungal sinusitis were found more frequently in older males. CONCLUSION The chance of diagnoses other than the usual sinusitis increased significantly in patients with paranasal sinus diseases who presented with blood-tinged post-nasal drip, especially in older males.
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Affiliation(s)
- T-K Chao
- Department of Otolaryngology, Far Eastern Memorial Hospital, Pan-Chiao, Taipei, Taiwan.
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21
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Marinovic T, Skrlin J, Vilendecic M, Rotim K, Grahovac G. Multiple Aspergillus brain abscesses in immuno-competent patient with severe cranio-facial trauma. Acta Neurochir (Wien) 2007; 149:629-32; discussion 632. [PMID: 17460817 DOI: 10.1007/s00701-007-1148-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Accepted: 03/15/2007] [Indexed: 10/23/2022]
Abstract
Aspergillosis of the central nervous system (CNS) is a rare, but well described disease in immuno-competent patients. We present a 65-year-old patient who developed neuro-aspergillosis 10 months after severe cranio-facial trauma (Le Fort III). He was treated successfully with surgery including stereotactic drainage and, with Amphotericin B, Liposomal Amphotericin B, and Itraconazol.
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Affiliation(s)
- T Marinovic
- Department of Neurosurgery, University Hospital Dubrava, Zagreb, Croatia
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22
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Pachón J, Cisneros JM, Collado-Romacho AR, Lomas-Cabezas JM, Lozano de León-Naranjo F, Parra-Ruiz J, Rivero-Román A. Tratamiento de las infecciones fúngicas invasoras. Enferm Infecc Microbiol Clin 2006; 24:254-63. [PMID: 16725086 DOI: 10.1016/s0213-005x(06)73772-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Invasive fungal infections have increased progressively in the last decades, producing elevated morbidity and mortality. In recent years, there have been numerous advances in the treatment of these diseases, with the introduction of new drugs in clinical practice and the information derived from several types of studies. This has improved the prognosis of some invasive fungal infections and increased the therapeutic options in various clinical situations. This new knowledge must be assessed to determine its application in clinical practice, taking into account available scientific evidence and clinical experience. With this aim, the Andalusian Society of Infectious Diseases has developed this consensus document containing recommendations for the treatment of the invasive fungal infections.
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Affiliation(s)
- Jerónimo Pachón
- Sociedad Andaluza de Enfermedades Infecciosas, Hospitales Universitarios Virgen del Rocio, Avda. Manuel Siurot s/n, 41013 Seville, Spain. jeronimo.pachon.sspa@ juntadeandalucia.es
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23
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Affiliation(s)
- Antonio Cardesa
- grid.5841.80000000419370247Department of Pathological Anatomy, Hospital Clinic, University of Barcelona, Villarroel 170, 08036 Barcelona, Spain
| | - Pieter J. Slootweg
- grid.10417.330000000404449382Department of Pathology, University Medical Center St. Radboud, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Scott H, Griffin D. Ovarian cancer complicated by invasive pulmonary aspergillus. Gynecol Oncol 2005; 100:216-7. [PMID: 16169576 DOI: 10.1016/j.ygyno.2005.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2005] [Revised: 08/22/2005] [Accepted: 08/23/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND Invasive aspergillus is a rarely reported infection in patients with solid tumors. CASE A 59-year-old woman developed invasive pulmonary aspergillus after surgical debulking of an advanced ovarian adenocarcinoma and initiation of adjuvant combination chemotherapy. CONCLUSION Invasive pulmonary aspergillus is rarely diagnosed in patients with solid tumors such as ovarian cancer. Risk factors for development of the disease can include neutropenia, immunosuppression and chronic steroid use. Successful treatment of the infection relies upon prompt diagnosis and utilization of effective antifungal medications for a prolonged period of time.
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Affiliation(s)
- Heather Scott
- Wake Forest University School of Medicine, Department of Obstetrics and Gynecology, Winston Salem, NC 27157, USA
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Brodsky JW, Seidenfeld SM, Brooks B, Shabat S. Aspergillus osteomyelitis and lymphangitis in immunocompromised patient after toenail clipping. Foot Ankle Int 2005; 26:576-8. [PMID: 16045852 DOI: 10.1177/107110070502600715] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- James W Brodsky
- Baylor University Medical Center, UTSWMS, Dallas, TX 75246, USA
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Mekan SF, Saeed O, Khan JA. Invasive aspergillosis with polyarthritis. Fallbericht. Invasive Aspergillose mit Polyarthritis. Mycoses 2004; 47:518-20. [PMID: 15601460 DOI: 10.1111/j.1439-0507.2004.01031.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a case of septic arthritis of multiple joints in an 18-year-old male caused by Aspergillus fumigatus. His initial presentation was of low-grade fever followed by involvement of both knee and ankle joints. Later, there was also involvement of metacarpophalangeal joints. Diagnosis was based on biopsy and culture of the skin and joint lesions. The symptoms resolved readily under administration of itraconazole. We recommend that clinicians should be alerted of potential fungal etiology in cases of fever and chronic arthritis, which is unresponsive to conventional medical therapy.
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Affiliation(s)
- S F Mekan
- Department of Biological and Biomedical Sciences, The Aga Khan University Hospital, Karachi, Pakistan.
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Sridhar H, Jayshree RS, Bapsy PP, Appaji L, Navin Kumar M, Shafiulla M, VijayKumar BR. Invasive aspergillosis in cancer. Mycoses 2002; 45:358-63. [PMID: 12421281 DOI: 10.1046/j.1439-0507.2002.00803.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ten confirmed cases of invasive aspergillosis (IA) in cancer patients were analysed retrospectively. Eight were pulmonary, one was sinonasal and one was cutaneous. The majority of patients had haematological malignancies (7), the remaining three were cases of solid tumours. Fever was present in all 10 cases. Cough and lung signs were present in all eight cases of invasive pulmonary aspergillosis. Haemoptysis was encountered in three of nine cases of pulmonary and sinonasal aspergillosis. Mortality was low (2%). While corticosteroids, antibiotics and anticancer chemotherapy/radiotherapy were factors predisposing the patients to IA, neutropenia was perhaps responsible for their mortality. Seven of the patients had other associated pathogens isolated in culture in addition to Aspergillus spp. Aspergillus fumigatus was the predominant species, followed by A. flavus, A. glaucus, A. nidulans and A. niger. Direct microscopic examination (in six of seven cases) and culture (six of seven cases) correlated well with radiographic and clinical findings in cases with lung involvement. Serology for anti-Aspergillus antibodies performed by gel diffusion precipitin test was positive in one case of sinonasal aspergillosis, wherein only one precipitin band was observed. Correlation of clinical symptoms, consistent radiographic findings and microbiological work-up (the latter including a triad of direct microscopy, culture and serology) are required to arrive at a diagnosis of IA, especially where histology cannot form the mainstay of diagnosis.
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Affiliation(s)
- H Sridhar
- Department of Microbiology, Kidwai Memorial Institute of Oncology, Hosur Road, Bangalore 560 029, India
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Chow L, Brown NE, Kunimoto D. An unusual case of pulmonary invasive aspergillosis and aspergilloma cured with voriconazole in a patient with cystic fibrosis. Clin Infect Dis 2002; 35:e106-10. [PMID: 12384856 DOI: 10.1086/343743] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2002] [Revised: 06/05/2002] [Indexed: 11/03/2022] Open
Abstract
The development of pulmonary aspergilloma and invasive aspergillosis is a rare complication of cystic fibrosis. We describe a 29-year-old patient with cystic fibrosis who had invasive pulmonary aspergillosis that was not cured by amphotericin B, liposomal amphotericin B, or itraconazole. This patient was subsequently successfully treated and cured with the novel antifungal agent voriconazole.
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Affiliation(s)
- Laura Chow
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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29
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Koss T, Bagheri B, Zeana C, Romagnoli MF, Grossman ME. Amphotericin B-resistant Aspergillus flavus infection successfully treated with caspofungin, a novel antifungal agent. J Am Acad Dermatol 2002; 46:945-7. [PMID: 12063497 DOI: 10.1067/mjd.2002.120627] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Invasive aspergillosis is uncommon in immunocompetent hosts but is the second most common opportunistic fungal infection in immunocompromised patients. There has been a dramatic increase in the incidence of life-threatening aspergillosis during the past 2 decades, and the morbidity and mortality of these infections despite antifungal therapy remain unacceptably high. We describe a patient with amphotericin B-resistant Aspergillus flavus successfully treated with caspofungin, an agent belonging to a new class of antifungal drugs. Caspofungin shows great promise in the treatment of invasive aspergillosis.
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Affiliation(s)
- Tamara Koss
- Department of Dermatology, Columbia-Presbyterian Medical Center, New York, New York, USA
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Sohail MA, Al Khabori M, Hyder J, Verma A. Acute fulminant fungal sinusitis: clinical presentation, radiological findings and treatment. Acta Trop 2001; 80:177-85. [PMID: 11600098 DOI: 10.1016/s0001-706x(01)00174-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Acute fulminant fungal sinusitis is characterized by acute symptoms and rapid progress with a mortality rate of 60-80%. A large number of survivors have permanent neurological, visual and cosmetic disabilities. This clearly underscores the need of early recognition of this disease in at risk population in order to start urgent treatment. The at-risk population of diabetics, AIDS and other immunosuppressed is likely to increase, as will the incidence of acute fulminant fungal sinusitis. In the present study we have reviewed nine cases of acute fulminant fungal sinusitis to determine clinical presentation, related radiological picture and optimum treatment. Most common presenting features were fever, headache, facial swelling and proptosis. Many patients presented with blindness, facial paralysis and meningitis. Predisposing causes were uncontrolled diabetes with ketoacidosis in four out of six cases, post renal transplant immunosuppression and leukemia. All patients were treated with amphotericin B or liposomal amphotericin B (AmBisome). Diagnosis was confirmed by biopsy and culture of sinus mucosa, soft tissues of cheek, or orbit. Mucor (Zygomycetes) was identified on culture or histopathology in all cases. Surgical debridement was performed in seven cases. Six out of nine patients survived but morbidity was high: only two patients survived without any permanent disability.
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Affiliation(s)
- M A Sohail
- ENT Department, Al Nahdha Hospital, P.O. Box 937, Postal Code 112, Sultanate of Oman, Oman
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31
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Gordon SM, Avery RK. Aspergillosis in lung transplantation: incidence, risk factors, and prophylactic strategies. Transpl Infect Dis 2001; 3:161-7. [PMID: 11493398 DOI: 10.1034/j.1399-3062.2001.003003161.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Invasive aspergillosis remains a significant cause of morbidity and mortality in transplantation, especially lung and allogeneic bone marrow transplant recipients. The epidemiology, classic and newly recognized risk factors, and incidence of aspergillosis are reviewed. Risk factors include environmental exposures, airway colonization, profound immunosuppression, neutropenia, prior cytomegalovirus infection, and renal dysfunction. Clinical and radiographic presentations of invasive aspergillosis are discussed, including some unusual manifestations in lung transplant recipients. Early and accurate diagnosis of aspergillosis remains a challenge, and diagnostic strategies are reviewed, with an emphasis on the chest computerized tomography scan and on transbronchial or open lung biopsy. Recent advances include prophylactic and pre-emptive antifungal strategies, newer therapeutic agents, and improved risk stratification.
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Affiliation(s)
- S M Gordon
- Department of Infectious Disease, Infection Control, and Transplant Center, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Abstract
Infection frequently complicates the course of cancer treatment and often adversely affects the outcome. Patients have a greater tendency for acquiring infections caused by opportunistic microorganisms. Agents with low virulence potential may lead to invasive and often life-threatening infections because of altered host immune function. The immune dysfunction may be caused by the underlying malignancy, by antineoplastic chemotherapy, or by invasive procedures during supportive care.
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Affiliation(s)
- A Safdar
- Department of Medicine, Division of Infectious Diseases, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
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Ruiz A, Lonjedo E, Agramunt M, Martínez-Rodrigo JJ, Palmero J. Tratamiento percutáneo con anfotericina B en un caso de aspergilosis pulmonar invasiva. RADIOLOGIA 2001. [DOI: 10.1016/s0033-8338(01)77007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Torres AM, Agrawal S, Peters S, Khurana K, Feiglin D, Schroeder E, Izquierdo R. Invasive aspergillosis diagnosed by fine-needle aspiration of the thyroid gland. Thyroid 1999; 9:1119-22. [PMID: 10595462 DOI: 10.1089/thy.1999.9.1119] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Invasive aspergillosis has been increasingly recognized as causing significant morbidity and mortality in immunocompromised patients but has never been diagnosed by fine-needle thyroid aspiration. A 24-year-old female with systemic lupus erythematosus presented with cough, shortness of breath, and fever of unknown origin unresponsive to broad-spectrum antibiotics. History and physical examination failed to indicate a source of infection. An 111In white blood cell scan showed thyroid localization. Physical examination revealed a multinodular goiter with a left dominant nodule. Fine-needle aspiration biopsy of a thyroid nodule revealed branching hyphae suggestive of Aspergillus sp. Despite immediate and aggressive treatment with amphotericin B and fluconazole, the patient died of overwhelming infection.
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Affiliation(s)
- A M Torres
- Department of Medicine, Endocrinology, Diabetes and Metabolism, SUNY Health Science Center at Syracuse, New York 13210, USA
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