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Subedi RC, Adhikari A, Gurung S, Jha P, Acharya S, Shiwakoti TK, Bhatta B, Kharbuja N, Lamichhane B, Paudel R, Jha SK. Rhino-orbital-cerebral mucormycosis with Klebsiella and MRSA co-infection in a diabetic patient: a case report. Ann Med Surg (Lond) 2024; 86:5590-5594. [PMID: 39239010 PMCID: PMC11374222 DOI: 10.1097/ms9.0000000000002416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/23/2024] [Indexed: 09/07/2024] Open
Abstract
Introduction and importance Rhino-orbital-cerebral mucormycosis is an opportunistic infection caused by fungus species Rhizopus and Mucor. Early recognition and aggressive management is crucial for favorable outcomes. A delay in diagnosis and treatment is fatal. Case presentation A 32-year-old female presented with high-grade fever, right-sided facial deviation associated with facial swelling, and inability to move her left eye for 10 days. Biopsy from the left nasal cavity showed fibrinoid material, edema, and sheets of neutrophilic infiltrate while KOH preparation of nasal scrapping showed aseptate hyphae with obtuse-angled branching. Amphotericin B, oral posaconazole, and antibiotics were started with exploration and debridement of the affected tissue. The patient recovered well and was discharged. Discussion Immunocompromised people are primarily affected by mucormycosis, a serious fungal illness. Inhaling fungal spores, especially those of the Rhizopus and Mucor species, is the usual cause. Rhinocerebral mucormycosis (ROCM), the most common type, increased during COVID-19 pandemic, frequently as a result of hyperglycemia brought on by steroids. Angioinvasion and tissue necrosis are pathogenesis-related processes that are made worse by diabetes and the overuse of glucocorticoids. Histopathology, culture, and imaging are used in the diagnosis. Surgery and antifungal drugs like Amphotericin B are used in treatment. Early intervention and interdisciplinary care, including hyperbaric oxygen therapy, are critical for survival. Results deteriorate with postponed therapy, underscoring the urgency of prompt action. Conclusion Mucormycosis should be kept in mind while formulating differential diagnosis of infective pathology in immunocompromised patients. Early diagnosis and treatment are important in improving patient prognosis in rhino-orbital-cerebral mucormycosis.
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Affiliation(s)
| | - Ayush Adhikari
- Department of Anesthesia and Critical Care, Tribhuvan University Teaching Hospital
| | - Shekhar Gurung
- Department of Emergency Medicine, Chattarapati Free Health Clinic Community Hospital
| | - Pinky Jha
- Nepalese Army Institute of Health Sciences
| | - Subi Acharya
- Department of Pediatrics, Patan Academy of Health Sciences, Lalitpur
| | - Tibbin Kumar Shiwakoti
- Department of General Practice and Emergency Medicine, Karnali Academy of Health Sciences, Karnali
| | - Bhuwan Bhatta
- Department of Internal Medicine, Kantipur Hospital, Kathmandu
| | | | | | - Raju Paudel
- Department of Neurology, Grande International Hospital
| | - Saroj Kumar Jha
- Department of Internal Medicine, Gajendra Narayan Singh Hospital, Rajbiraj, Nepal
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Management of Invasive Infections in Diabetes Mellitus: A Comprehensive Review. BIOLOGICS 2023. [DOI: 10.3390/biologics3010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
Patients with diabetes often have more invasive infections, which may lead to an increase in morbidity. The hyperglycaemic environment promotes immune dysfunction (such as the deterioration of neutrophil activity, antioxidant system suppression, and compromised innate immunity), micro- and microangiopathies, and neuropathy. A greater number of medical interventions leads to a higher frequency of infections in diabetic patients. Diabetic individuals are susceptible to certain conditions, such as rhino-cerebral mucormycosis or aspergillosis infection. Infections may either be the primary symptom of diabetes mellitus or act as triggers in the intrinsic effects of the disease, such as diabetic ketoacidosis and hypoglycaemia, in addition to increasing morbidity. A thorough diagnosis of the severity and origin of the infection is necessary for effective treatment, which often entails surgery and extensive antibiotic use. Examining the significant issue of infection in individuals with diabetes is crucial. Comprehensive research should examine why infections are more common amongst diabetics and what the preventive treatment strategies could be.
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Li DM, Lun LD. Rhino-Orbital-Cerebral Mycosis and Extranodal Natural Killer or/and T-Cell Lymphoma, Nasal Type. Front Med (Lausanne) 2022; 9:851208. [PMID: 35783622 PMCID: PMC9248758 DOI: 10.3389/fmed.2022.851208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 05/06/2022] [Indexed: 12/02/2022] Open
Abstract
Background Extranodal natural killer/T-cell lymphoma, nasal type is a syndrome of middle face destruction with an association to Epstein-Barr virus. Fungi have been recovered from the diseased tissue now and then but were often seen as a lymphoma-associated secondary infection. However, there are ENKTL-NT cases with the recoveries of fungi and complete recovery with antifungal therapy, which are quite similar to rhino-orbital-cerebral mycosis (ROCM) that often confuses the physicians. Methods We searched Medline for English-language manuscripts limited to “human” and “case reports,” “letters,” “reviews,” and “clinical conferences” from 1966 to 2022. We used MeSH terms “lymphoma, extranodal nk-t-cell” [MeSH Terms] or “lethal midline granuloma” [MeSH Terms], in combination with MeSH terms “microbiology” [subheading] or “microbiology” [all fields] or “fungi” [all fields] or “fungi” [MeSH Terms] for ENKTL-NT with infections. We used MeSH terms “Mycoses” in combination with “Nose” [Mesh] OR “Orbital Diseases” [Mesh] for rhino-orbital-cerebral fungal infections. Results We appraised 149 included articles and extracted references related to ENKTL-NT and/or ROCM. Themes and subcategories were subsequently derived. Our findings revealed that ROCM and ENKTL-NT are characterized by progressive and destructive ulcers in the midline face or rhino-orbital structures. ROCM is mainly caused by fungi in the order of Mucorales, and ENKTL-NT is usually associated with Epstein-Barr virus and sometimes fungi. Radiologically, both are characterized by non-specific features of sinusitis, soft tissue infection, and necrosis. Pathologically, ROCM and ENKTL-NT share the same characteristics of inflammation, necrosis, and granuloma. ROCM is characterized by the detection of fungi in tissue, while ENKTL-NT is typically positive for NK/T-cell markers and cytotoxic granule-associated proteins, proliferation, and vascular damage of angioinvasion, which could be incited by Mucor irregularis and Rhizopus arrhizus in patients and mice. Conclusion ENKTL-NT and ROCM share many similarities in clinical presentations, radiology, and histopathology, and might have the same etiology. This may explain why the two diseases are tangled together in the reported cases, and suggests the role that the fungi may play in the development of these ENKTL-NT/ROCM diseases. The reason why ENKTL-NT and ROCM are sometimes confused is that the main pathogens of ROCM, Mucor irregularis and Rhizopus arrhizus, are the fungal causative agents of ENKTL-NT.
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Affiliation(s)
- Dong Ming Li
- Division of Dermatology and Mycological Lab, Peking University Third Hospital, Beijing, China
- *Correspondence: Dong Ming Li, ,
| | - Li De Lun
- Division of Nephrology and Rheumatism, Air Force General Hospital PLA, Beijing, China
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Shah S, Budania P, Shah A, Parmar U. Unique way of chest wall reconstruction using Integra Dermal Regeneration Template (IDRT) in a patient with post traumatic mucormycosis: A case report. Int J Surg Case Rep 2022; 95:107229. [PMID: 35617736 PMCID: PMC9133762 DOI: 10.1016/j.ijscr.2022.107229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/17/2022] [Accepted: 05/17/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Necrotizing soft tissue infections (NSTI) are caused by toxin-producing bacteria and fungi that results in rapid progression of disease with significant local tissue destruction. CASE PRESENTATION We present a case report of a 57-year-old male patient in line with the SCARE 2020 criteria. He was admitted to the emergency department with a small abrasion on the right antero-lateral chest wall, and a diffuse necrotic patch of skin and soft tissues with purulent discharge. CLINICAL DISCUSSION Clinical examination, routine blood investigations, CT scan chest, and chest x-ray were performed. Patient underwent debridement six times, followed by negative pressure wound therapy (NPWT). After negative culture report, Integra Meshed Dermal Regeneration Template (IMDRT), measuring 4 × 5 in. was applied and NPWT continued. The outer layer of IDRT was removed on Day 19. Split thickness skin grafting (STSG) was performed once neodermis formation was confirmed. NPWT was continued post skin grafting for a week. IDRT was successfully taken up over the raw area with exposed lung. Patient was discharged 10 days after STSG. The patient's condition improved remarkably and he was able to breathe normally. There was no puckering or tethering effect on the grafted area and not much fibrosis. He showed speedy recovery with healed donor site and 100% uptake of grafted tissue. CONCLUSION IDRT along with NPWT is an effective and useful technique for spontaneous regeneration of the dermis and basement membrane to promote wound healing in traumatic patients with NSTIs. LEVEL OF EVIDENCE Level V. STUDY TYPE Therapeutic.
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Affiliation(s)
- Sanjay Shah
- Consultant Trauma Surgeon and Head, Emergency Department, Apollo Hospitals International Ltd, Gandhinagar, Gujarat, India.
| | - Pushpa Budania
- Dept of General Surgery, Apollo Hospitals Int Ltd, Gandhinagar, Gujarat, India
| | - Akshay Shah
- Dept of General Surgery, Apollo Hospitals Int Ltd, Gandhinagar, Gujarat, India
| | - Uvaish Parmar
- Dept of General Surgery, Apollo Hospitals Int Ltd, Gandhinagar, Gujarat, India
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Archana A, Sinha A, Kokkayil P, Pradhan S, Jha S, Sarfraz A, Pati BK, Thakuria B. Subcutaneous entomophthoramycosis in a child presenting as panniculitis: a case report from Bihar, India. IJID REGIONS 2022; 3:168-170. [PMID: 35755460 PMCID: PMC9216389 DOI: 10.1016/j.ijregi.2022.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022]
Abstract
The article reports a rare case of subcutaneous entomophthoramycosis. The patient was misdiagnosed with non-infective panniculitis, which led to extensive involvement. Subsequently, the patient was diagnosed correctly using standard techniques which included KOH wet mount, culture and isolation. Lactophenol cotton blue mount was performed for identification of the organism as Basidiobolus spp. The patient was cured after treatment with itraconazole and potassium iodide.
A 5-year-boy from Bihar, India was admitted to a tertiary care hospital with painful swelling over both lower limbs and buttocks, which had been increasing progressively for the past 1 year. The condition was initially undiagnosed and was later misdiagnosed as non-infective panniculitis, delaying treatment. Subsequently, the patient was diagnosed with subcutaneous entomophthoramycosis caused by Basidiobolus spp. A preliminary diagnosis was made by considering the history, clinical features, radiological findings and histopathological examination of the biopsied tissue. The confirmatory diagnosis was made using conventional techniques on aspirated pus, which included KOH wet mount and fungal culture on Sabouraud dextrose agar tubes incubated at 28°C and 37°C, respectively. Lactophenol cotton blue mount and slide culture were performed for identification of the fungal isolate. The patient responded well to oral itraconazole and oral potassium iodide. Delayed diagnosis and extensive involvement in a rare case of subcutaneous entomophthoramycosis causing panniculitis emphasizes the importance of correct diagnosis and appropriate, effective treatment.
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Affiliation(s)
- Archana Archana
- Department of Microbiology, All India Institute of Medical Sciences, Patna, Phulwarisarif, Bihar, India
| | - Asmita Sinha
- Department of Dermatology, All India Institute of Medical Sciences, Patna, Phulwarisarif, Bihar, India
| | - Prathyusha Kokkayil
- Department of Microbiology, All India Institute of Medical Sciences, Patna, Phulwarisarif, Bihar, India
- Corresponding author. Address: Department of Microbiology, All India Institute of Medical Sciences, Patna, Phulwarisarif, Bihar 801507, India. Tel.: +91 8593992711.
| | - Swetalina Pradhan
- Department of Dermatology, All India Institute of Medical Sciences, Patna, Phulwarisarif, Bihar, India
| | - Sweta Jha
- Department of Microbiology, All India Institute of Medical Sciences, Patna, Phulwarisarif, Bihar, India
| | - Asim Sarfraz
- Department of Microbiology, All India Institute of Medical Sciences, Patna, Phulwarisarif, Bihar, India
| | - Binod K. Pati
- Department of Microbiology, All India Institute of Medical Sciences, Patna, Phulwarisarif, Bihar, India
| | - Bhaskar Thakuria
- Department of Microbiology, All India Institute of Medical Sciences, Patna, Phulwarisarif, Bihar, India
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Ghosh D, Dey S, Chakraborty H, Mukherjee S, Halder A, Sarkar A, Chakraborty P, Ghosh R, Sarkar J. Mucormycosis: A new threat to Coronavirus disease 2019 with special emphasis on India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022; 15:101013. [PMID: 35342843 PMCID: PMC8934183 DOI: 10.1016/j.cegh.2022.101013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 12/10/2021] [Accepted: 03/10/2022] [Indexed: 01/03/2023] Open
Abstract
The main reason for the growth of mucormycosis in people with Coronavirus disease-2019 (COVID-19) is mainly produced by Rhizopus spp. The infective mechanisms and issues recognized in Rhizopus spp. are the cell wall, germination proteins, and enzymes assisted to iron sequestration, CotH protein, and positive regulation of the GRP78 cell receptor. Mucormycosis is mainly caused by the Rhizopus spp. such as R. oryzae, R. microsporus, R. arrhizus, R. homothallicus, etc. that are gifted to numerous host defense mechanisms and attribute to the endothelium via specific receptors, GRP78 simplifying their endocytosis and angio-invasion. Factors such as hyperglycemia, elevated iron concentrations, and ketoacidosis have been shown to contribute to the pathogenesis in the tentative situation. The analytical data of 'black fungus disease' or 'mucormycosis', specify India reported for about 42.3% of published cases, followed by the USA about 16.9%, Iraq, Bangladesh, Iran, Paraguay, and 1 case each from Brazil, Mexico, Italy, UK, China, France, Uruguay, Turkey, and Austria. The COVID-19 infection is maybe a predisposing factor for mucormycosis and is related to a high mortality rate. Early recognition and restriction of hyperglycemia, liposomal amphotericin B, and surgical debridement are the bases in the successful managing of mucormycosis.
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Affiliation(s)
- Deganta Ghosh
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Sagardeep Dey
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Himanko Chakraborty
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Sneha Mukherjee
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Ankita Halder
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Akash Sarkar
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084
| | - Pallab Chakraborty
- Department of Botany, Acharya Prafulla Chandra College, New Barrakpur, Kolkata, West Bengal, India, 700131
| | - Rajdeep Ghosh
- GSL Medical College and General Hospital, Rajahmundry, Andhra Pradesh, India, 533296
| | - Joy Sarkar
- Department of Botany, Dinabandhu Andrews College, Garia, Kolkata, West Bengal, India, 700084,Corresponding author
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Pandey M, Xess I, Singh G, Kumar R, Mahapatra M, Jyotsna VP, Agarwal R, Ghosh A, Iram A, Mani P. Conventional PCR as a reliable method for diagnosing invasive mucormycosis in resource-limited settings. J Med Microbiol 2021; 70. [PMID: 34038342 DOI: 10.1099/jmm.0.001370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction. Invasive mucormycosis (IM) is a life-threatening infection caused by fungi belonging to the order Mucorales. Histopathology, culture and radiology are the mainstay of diagnosis but lack sensitivity, leading to a delay in timely diagnosis and intervention. Recently, PCR-based approaches have been shown to be a promising method in diagnosing IM.Hypothesis/Gap Statement. Molecular-based approaches may be a valuable adjunct to standard conventional methods for diagnosing IM, especially among culture negatives and patients on antifungal therapy.Aim. In the present study we aimed to evaluate the clinical utility of panfungal and Mucorales-specific PCR for diagnosing IM from various clinical specimens.Methodology. This was a prospective study in which 239 clinically suspected cases of IM attending our tertiary care hospital from August 2015 to March 2018 were enrolled. All the cases were defined as 'proven', 'probable' or 'possible' based on EORTC/MSGERC guidelines. In addition to conventional diagnostics (KOH-calcofluor stain and culture), panfungal and Mucorales-specific PCR assays were also performed. The amplified products were sequenced for species identification. In vitro antifungal susceptibility was performed on all the culture-positive isolates.Results. Among 239 clinically suspected cases of IM, only 140 cases were diagnosed by the demonstration of aseptate ribbon-like hyphae on direct microscopy. Culture was positive in 35.7 % (54/140) of direct microscopy-positive samples. Among the proven cases (n=11), the sensitivity for both Mucorales-specific nested PCR and panfungal PCR was 100 %, but specificity was 91.9 and 73.7% respectively. In probable cases (n=129), the sensitivity of both the PCRs was 98.5 % and specificity for panfungal PCR was 73.7 and 91.9 % for Mucorales-specific PCR.Conclusion. Pan fungal PCR in combination with Mucorales-specific PCR, followed by sequencing, may play a significant role in IM diagnosis especially among those negative for both direct microscopy and culture.
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Affiliation(s)
- Mragnayani Pandey
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Gagandeep Singh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Kumar
- Department of Otorhinolaryngology, All India Institute of Medical Sciences, New Delhi, India
| | - Manoranjan Mahapatra
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
| | - Viveka P Jyotsna
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Reshu Agarwal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arnab Ghosh
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Azka Iram
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Mani
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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8
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Prakash H, Ghosh AK, Rudramurthy SM, Singh P, Xess I, Savio J, Pamidimukkala U, Jillwin J, Varma S, Das A, Panda NK, Singh S, Bal A, Chakrabarti A. A prospective multicenter study on mucormycosis in India: Epidemiology, diagnosis, and treatment. Med Mycol 2019; 57:395-402. [PMID: 30085158 DOI: 10.1093/mmy/myy060] [Citation(s) in RCA: 185] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/21/2018] [Accepted: 07/12/2018] [Indexed: 09/13/2023] Open
Abstract
Mucormycosis due to Mucorales is reported at large numbers in uncontrolled diabetics across India, but systematic multicenter epidemiological study has not been published yet. The present prospective study was conducted at four major tertiary care centers of India (two in north and two in south India) during 2013-2015 to compare the epidemiology, treatment strategies and outcome of mucormycosis between the two regions. Molecular techniques were employed to confirm the identity of the isolates or to identify the agent in biopsy samples. A total of 388 proven/probable mucormycosis cases were reported during the study period with overall mortality at 46.7%. Uncontrolled diabetes (n = 172, 56.8%) and trauma (n = 31, 10.2%) were the common risk factors. Overall, Rhizopus arrhizus (n = 124, 51.9%) was the predominant agent identified, followed by Rhizopus microsporus (n = 30, 12.6%), Apophysomyces variabilis (n = 22, 9.2%) and Rhizopus homothallicus (n = 6, 2.5%). On multivariate analysis, the mortality was significantly associated with gastrointestinal (OR: 18.70, P = .005) and pulmonary infections (OR: 3.03, P = .015). While comparing the two regions, majority (82.7%) cases were recorded from north India; uncontrolled diabetes (n = 157, P = .0001) and post-tubercular mucormycosis (n = 21, P = .006) were significantly associated with north Indian cases. No significant difference was noted among the species of Mucorales identified and treatment strategies between the two regions. The mortality rate was significantly higher in north Indian patients (50.5%) compared to 32.1% in south India (P = .016). The study highlights higher number of mucormycosis cases in uncontrolled diabetics of north India and emergence of R. microsporus and R. homothallicus across India causing the disease.
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Affiliation(s)
- Hariprasath Prakash
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anup Kumar Ghosh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Pankaj Singh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Immaculata Xess
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Jayanthi Savio
- Department of Microbiology, St. John's Medical College, Bengaluru, Karnataka, India
| | - Umabala Pamidimukkala
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Joseph Jillwin
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Varma
- Department of Internal medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashim Das
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naresh K Panda
- Department of Otolaryngology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Surjit Singh
- Department of Paediatric Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Molecular Identification of Causative Agents in 25 Cases with Mucormycosis in Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019. [DOI: 10.5812/archcid.69100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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10
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Horn CB, Wesp BM, Fiore NB, Rasane RK, Torres M, Turnbull IR, Ilahi ON, Punch LJ, Bochicchio GV. Fungal Infections Increase the Mortality Rate Three-Fold in Necrotizing Soft-Tissue Infections. Surg Infect (Larchmt) 2017; 18:793-798. [PMID: 28850295 DOI: 10.1089/sur.2017.164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Necrotizing soft-tissue infections (NSTIs) result in significant morbidity and mortality rates, with as many as 76% of patients dying during their index admission. Published data suggest NSTIs rarely involve fungal infections in immunocompetent patients. However, because of the recent recognition of fungal infections in our population, we hypothesized that such infections frequently complicate NSTIs and are associated with higher morbidity and mortality rates. METHODS A prospectively maintained Acute and Critical Care Surgery (ACCS) database spanning 2008-2015 and including more than 7,000 patients was queried for patients with NSTIs. Microbiologic data, demographics, and clinical outcomes were abstracted. Risk factors and outcomes associated with NSTI with positive intra-operative fungal cultures were determined. Frequencies were compared by χ2 and continuous variables by the Student t-test using SPSS. Because the study included only archived data, no patient permission was needed. RESULTS A total of 230 patients were found to have NSTIs; 197 had intra-operative cultures, and 21 (10.7%) of these were positive for fungi. Fungal infection was more common in women, patients with higher body mass index (BMI), and patients who had had prior abdominal procedures. There were no significant differences in demographics, co-morbidities, or site of infection. The majority of patients (85.7%) had mixed bacterial and fungal infections; in the remaining patients, fungi were the only species isolated. Most fungal cultures were collected within 48 h of hospital admission, suggesting that the infections were not hospital acquired. Patients with positive fungal cultures required two more surgical interventions and had a three-fold greater mortality rate than patients without fungal infections. CONCLUSIONS This is the largest series to date describing the impact of fungal infection in NSTIs. Our data demonstrate a three-fold increase in the mortality rate and the need for two additional operations. Consideration should be given to starting patients on empiric anti-fungal therapy in certain circumstances.
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Affiliation(s)
| | - Brendan M Wesp
- Department of Surgery, Washington University , St Louis, Missouri
| | - Nicholas B Fiore
- Department of Surgery, Washington University , St Louis, Missouri
| | - Rohit K Rasane
- Department of Surgery, Washington University , St Louis, Missouri
| | - Marlon Torres
- Department of Surgery, Washington University , St Louis, Missouri
| | | | - Obeid N Ilahi
- Department of Surgery, Washington University , St Louis, Missouri
| | - Laurie J Punch
- Department of Surgery, Washington University , St Louis, Missouri
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Abstract
Basidiobolomycosis is an uncommon cutaneous zygomycete infection typically seen in immunocompetent individuals. Diagnosis can be made by biopsy and fungal culture of the lesion. Treatment with Potassium iodide and co-trimoxazole is simple and effective. Early and accurate diagnosis of basidiobolomycosis is essential to avoid dissemination and mortality. We present a case with basidiobolomycosis resembling Fournier's gangrene.
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Affiliation(s)
- Roshni Julia Rajan
- Department of Pediatrics, Christian Medical College, Vellore 632004, India
| | - Promila Mohanraj
- Department of Microbiology, Christian Medical College, Vellore 632004, India
| | - Winsley Rose
- Department of Pediatrics, Christian Medical College, Vellore 632004, India
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12
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Patel AK, Patel KK, Patel K, Gohel S, Chakrabarti A. Mucormycosis at a tertiary care centre in Gujarat, India. Mycoses 2017; 60:407-411. [PMID: 28276102 DOI: 10.1111/myc.12610] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/08/2017] [Accepted: 02/07/2017] [Indexed: 11/28/2022]
Abstract
The prevalence of mucormycosis is reportedly high in India, although the studies are mainly from north and south India only. We analysed the mucormycosis cases at tertiary care centres of West India. We retrieved the clinical details of all the patients with probable and proven mucormycosis diagnosed at Sterling Hospital and ID clinic at Ahmedabad, Gujarat over the period from 1 January 2013 through 30 April 2015. The data were analysed to determine demography, risk factors, underlying diseases, site of infection and outcome of these patients. A total of 27 patients with the median age of 50 (16-65) years were diagnosed with mucormycosis during the period. Rhino-orbital-cerebral mucormycosis was the most common (51.9%) presentation. Majority (55.6%) of the patients had uncontrolled diabetes with or without ketoacidosis; 25.9% patients had no underlying disease and most of them (85.7%) had cutaneous mucormycosis. In this group, the mortality was 25.9% and an equal percentage of patients were lost to follow up; 14 (51.9%) patients could complete 6 weeks of amphotericin B therapy. All patients who completed antifungal therapy survived except one. Like other parts of India, uncontrolled diabetes was the predominant risk factor for mucormycosis in our group. Patients completing 6 weeks of amphotericin B treatment were likely to survive.
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Affiliation(s)
- Atul K Patel
- Infectious Diseases Clinic, "VEDANTA" Institute of Medical Sciences, Ahmedabad, India
| | - Ketan K Patel
- Infectious Diseases Clinic, "VEDANTA" Institute of Medical Sciences, Ahmedabad, India
| | - Kamlesh Patel
- Department of Microbiology, Sterling Hospital, Ahmedabad, India
| | - Swati Gohel
- Infectious Diseases Clinic, "VEDANTA" Institute of Medical Sciences, Ahmedabad, India
| | - Arunaloke Chakrabarti
- Department of Medical Mycology, Postgraduate Institute of Medical Education & Research, Chandigarh, India
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14
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Abstract
Neuro-ophthalmological emergencies constitute vision or life-threatening conditions if diagnosis and treatment are not promptly undertaken. Even with immediate therapy, these clinical entities carry a high rate of morbidity. They may present with diplopia, visual loss, and/or anisocoria. Arteritic anterior ischemic optic neuropathy is an ominous condition, which can cause permanent and severe vision loss, stroke, or aortic dissection, requiring immediate steroid therapy. Pituitary apoplexy may go unnoticed if only computed axial tomography is performed. Diseases affecting the cavernous sinus and orbital apex region, such as cavernous sinus thrombosis or mucormycosis, can give rise to simultaneous vision loss and diplopia and, if not treated, may extend to the brain parenchyma causing permanent neurological sequela. An isolated third nerve palsy may be the harbinger of a cerebral aneurysm, carrying a significant risk of mortality. Horner syndrome can be the initial presentation of a carotid dissection, an important cause of stroke in the young adult. The neurohospitalist should be familiar with the workup and management of neuro-ophthalmological emergencies.
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Affiliation(s)
- João Lemos
- Michigan State University, East Lansing, MI, USA
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15
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Reddy SS, Rakesh N, Chauhan P, Sharma S. Rhinocerebral Mucormycosis Among Diabetic Patients: An Emerging Trend. Mycopathologia 2015; 180:389-96. [PMID: 26349570 DOI: 10.1007/s11046-015-9934-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/27/2015] [Indexed: 02/04/2023]
Abstract
Mucormycosis is an acute necrotic fungal infection with a fulminant course. Earlier considered a rare entity, mucormycosis is being reported with increasing frequency in recent years, possibly due to the increase in immunocompromised population especially diabetic patients. We report three cases of rhinocerebral mucormycosis among poorly controlled diabetic patients. This article emphasizes the need for further awareness of this disease, early diagnosis, and treatment to counter this opportunistic infection.
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Affiliation(s)
- Sujatha S Reddy
- Department of Oral Medicine, Diagnosis and Radiology, M.S. Ramaiah Dental College and Hospital, Msrit Post, New Bel Road, Bangalore, 560054, Karnataka, India.
| | - N Rakesh
- Department of Oral Medicine, Diagnosis and Radiology, M.S. Ramaiah Dental College and Hospital, Msrit Post, New Bel Road, Bangalore, 560054, Karnataka, India
| | - Pallavi Chauhan
- Department of Oral Medicine, Diagnosis and Radiology, Shree Bankey Bihari Dental College and Research Centre, Ghaziabad, Uttar Pradesh, 201302, India
| | - Shivani Sharma
- Department of Oral Medicine, Diagnosis and Radiology, M.S. Ramaiah Dental College and Hospital, Msrit Post, New Bel Road, Bangalore, 560054, Karnataka, India
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16
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Bala K, Chander J, Handa U, Punia RS, Attri AK. A prospective study of mucormycosis in north India: experience from a tertiary care hospital. Med Mycol 2015; 53:248-57. [PMID: 25587084 DOI: 10.1093/mmy/myu086] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Order Mucorales and class of Mucormycetes. We conducted a prospective study of 38 patients who were diagnosed as having mucormycosis in a tertiary care hospital during January 2010 to June 2011. The cases were analyzed regarding the site of involvement, underlying disease and species of fungi isolated, antifungal susceptibility pattern of the isolates, and outcome of therapy. The mean age of the patients was 40.43 years, with 72% male. Rhino-orbital mucormycosis (61.5%) was the most common presentation followed by cutaneous manifestations (31%), gastrointestinal symptoms (5%), and pulmonary (2.5%). Diabetes mellitus (56%) was the significant risk factor in rhino-orbito-cerebral presentation (OR = 7.55, P = 0.001). Among 23 culture isolates, Rhizopus arrhizus (37.5%) was the most common, followed by Apophysomyces variabilis (29.2%), Lichtheimia ramosa (16.7%), Rhizopus microsporus (4.2%), Rhizomucor pusillus (4.2%), and Apophysomyces elegans (4.2%). Rhizopus arrhizus was most commonly isolated from rhino-orbito-cerebral mucormycosis and Apophysomyces species were generally obtained from cutaneous mucormycosis. In vitro antifungal susceptibility showed that 16 isolates were sensitive to amphotericin B (MIC less than 1 μg/ml), while in contrast, all isolates were found to be resistant to voriconazole (MIC- 0.25 to >8), fluconazole (MIC > 32), flucytosine (MIC > 32). Treatment regimens included antifungal therapy, reversal of underlying predisposing risk factors, and surgical debridement. Combination of surgery and medical treatment with amphotericin B was significantly better (OR = 0.2, P < 0.04) than amphotericin B alone (61.5% vs. 10.3% patient survival). The awareness of fungal diseases amongst clinicians is required to decrease the fatal outcome of disease.
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Affiliation(s)
- Kiran Bala
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India.
| | - Jagdish Chander
- Department of Microbiology, Government Medical College Hospital, Chandigarh, India
| | - Uma Handa
- Department of Pathology, Government Medical College Hospital, Chandigarh, India
| | - Rajpal Singh Punia
- Department of Pathology, Government Medical College Hospital, Chandigarh, India
| | - Ashok Kumar Attri
- Department of General Surgery, Government Medical College Hospital, Chandigarh, India
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Narayanan Ml S, Narayanan CD, Kindo AJ, Arora A, Haridas PA. Fatal fungal infection: the living dead. J Surg Case Rep 2014; 2014:rju104. [PMID: 25352577 PMCID: PMC4210749 DOI: 10.1093/jscr/rju104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Necrotizing fasciitis is an uncommon infection mainly caused by Streptococcus pyogenes, which is also known as flesh-eating bacteria. It is often caused by bacteria, but can also be caused and complicated by fungus. We report a case of bacterial necrotizing fasciitis that was complicated by a fatal fungal infection, a rare clinical presentation affecting the upper limbs, head and neck, in a young diabetic female patient. It was an unsuspected case of fungal infection with mucormycosis, which proved to be fatal due to a delay in diagnosis and treatment.
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Affiliation(s)
| | | | | | - Apurva Arora
- Department of General Surgery, SRMC, Chennai, India
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18
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Wang S, Li R, Yu J. Apoptotic-like phenotype triggered by hydrogen peroxide and amphotericin B in the fungusRhizopus arrhizus. Mycoses 2014; 57 Suppl 3:25-30. [PMID: 25267143 DOI: 10.1111/myc.12240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 02/05/2014] [Accepted: 02/10/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Sibu Wang
- Department of Dermatology; Peking University First Hospital; Beijing China
| | - Ruoyu Li
- Department of Dermatology; Peking University First Hospital; Beijing China
| | - Jin Yu
- Department of Dermatology; Peking University First Hospital; Beijing China
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19
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Chowdhary A, Kathuria S, Singh PK, Sharma B, Dolatabadi S, Hagen F, Meis JF. Molecular characterization andin vitroantifungal susceptibility of 80 clinical isolates of mucormycetes in Delhi, India. Mycoses 2014; 57 Suppl 3:97-107. [DOI: 10.1111/myc.12234] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 04/28/2014] [Accepted: 04/28/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Anuradha Chowdhary
- Department of Medical Mycology; Vallabhbhai Patel Chest Institute; University of Delhi; Delhi India
| | - Shallu Kathuria
- Department of Medical Mycology; Vallabhbhai Patel Chest Institute; University of Delhi; Delhi India
| | - Pradeep Kumar Singh
- Department of Medical Mycology; Vallabhbhai Patel Chest Institute; University of Delhi; Delhi India
| | - Brijesh Sharma
- Department of Medicine; Post Graduate Institute of Medical Education and Research; Dr. Ram Manohar Lohia Hospital; Delhi India
| | - Somayeh Dolatabadi
- CBS-KNAW Fungal Biodiversity Center; Utrecht the Netherlands
- Institute for Biodiversity and Ecosystem Dynamics; University of Amsterdam; Amsterdam The Netherlands
| | - Ferry Hagen
- Department of Medical Microbiology and Infectious Diseases; Canisius-Wilhelmina Hospital; Nijmegen the Netherlands
| | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases; Canisius-Wilhelmina Hospital; Nijmegen the Netherlands
- Department of Medical Microbiology; Radboud University Medical Centre; Nijmegen the Netherlands
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20
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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: 120] [Impact Index Per Article: 12.0] [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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21
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22
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Hallur V, Singh G, Rudramurthy SM, Kapoor R, Chakrabarti A. Demodex mite infestation of unknown significance in a patient with rhinocerebral mucormycosis due to Apophysomyces elegans species complex. J Med Microbiol 2013; 62:926-928. [DOI: 10.1099/jmm.0.054338-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Demodex mites have been reported in the past as a cause of facial rash in immunosuppressed patients. Here, we report an interesting case of possible demodicosis associated with rhinocerebral mucormycosis. The association of mites with a fungus was detected on direct microscopic examination of the scrapings of a nasal ulcer. The mite and the fungus were identified as Demodex folliculorum and Apophysomyces elegans species complex, respectively.
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Affiliation(s)
- Vinaykumar Hallur
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Gagandeep Singh
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Shivaprakash M. Rudramurthy
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Rakesh Kapoor
- Department of Radiotherapy, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Arunaloke Chakrabarti
- Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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23
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Gayathri Devi H, Mohan Rao K, Prathima K, Moideen R. Pulmonary mucormycosis presenting with vocal cord paralysis. Respir Med Case Rep 2013; 9:15-7. [PMID: 26029622 PMCID: PMC3949554 DOI: 10.1016/j.rmcr.2013.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/10/2013] [Accepted: 03/12/2013] [Indexed: 11/18/2022] Open
Abstract
Pulmonary mucormycosis is a relatively uncommon infection. It can present in various forms. Very few cases of pulmonary mucormycosis presenting as vocal cord paralysis have been described in the literature. We report a case of pulmonary mucormycosis presenting as vocal cord paralysis in an uncontrolled diabetic patient.
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Affiliation(s)
- H.J. Gayathri Devi
- Department of Chest Diseases, MS Ramaiah Medical College, Bangalore – 560 054, India
- Corresponding author. Tel.: +91 9916195235 (Mobile).
| | - K.N. Mohan Rao
- Department of Chest Diseases, MS Ramaiah Medical College, Bangalore – 560 054, India
| | - K.M. Prathima
- Department of Pathology, MS Ramaiah Memorial Hospital, Bangalore – 560 054, India
| | - Riyaz Moideen
- Department of Chest Diseases, MS Ramaiah Medical College, Bangalore – 560 054, India
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24
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Ananthaneni AR, Undavalli SB, Velagapudi RP, Guduru VS. Mucormycosis: an atrocious mate of patients with diabetes. BMJ Case Rep 2013; 2013:bcr-2013-009600. [PMID: 23645655 DOI: 10.1136/bcr-2013-009600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Mucormycosis also called zygomycosis is a rare infection caused by saprophytic aerobic fungus that belongs to a group of fungi called Mucoromycotina in the order Mucorales. Earlier these fungi were called Zygomycota but this scientific name has recently been changed. Mucormycosis can result in an acute, rapidly advancing and occasionally fatal disease caused by different fungi typically found in the soil and in association with decaying organic matter such as leaves, compost piles or rotten wood. These fungal infections are relatively infrequent; however, they occur in individuals who are debilitated in some major way and occasionally in groups of people with multiple penetrating injuries that are contaminated with soil and water from the environment. Mucormycosis is not contagious and does not spread from person to person.
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Affiliation(s)
- Anu Radha Ananthaneni
- Department of Oral Pathology, St Joseph Dental College, Eluru, Andhra Pradesh, India.
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25
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Disseminated Zygomycosis Caused by Cunninghamella bertholletiae in Patient with Hematological Malignancy and Review of Published Case Reports. Mycopathologia 2012; 175:99-106. [DOI: 10.1007/s11046-012-9595-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 10/22/2012] [Indexed: 01/23/2023]
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26
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Vehreschild JJ, Birtel A, Vehreschild MJGT, Liss B, Farowski F, Kochanek M, Sieniawski M, Steinbach A, Wahlers K, Fätkenheuer G, Cornely OA. Mucormycosis treated with posaconazole: review of 96 case reports. Crit Rev Microbiol 2012; 39:310-24. [PMID: 22917084 DOI: 10.3109/1040841x.2012.711741] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Mucormycosis is an emerging invasive fungal infection, primarily affecting immunocompromised patients. The disease is difficult to diagnose and mortality reaches 40% even if treated adequately. Depending on site of infection and risk factors, surgical debridement in combination with systemically active antifungal drugs are the mainstay treatment strategies. Lipid-based amphotericin B is the treatment of choice for first-line therapy while posaconazole may be a promising alternative. We performed a PubMed search on reports of patients with mucormycosis treated with posaconazole. From 2003 to 2011, 96 cases have been published. Diagnosis was based on histology alone in 2 (2.1%) and microbiological evidence in 67 (69.8%), while no data on the diagnostic approach was reported in 27 (28.1%) patients. The most frequent pathogens were Rhizopus spp. (31.2%), followed by Mucor spp. (14.6%). The site of infection was predominantly rhino-orbital (38.5%, of which 43% also had central nervous system [CNS] involvement), followed by disseminated disease (22.1%). A complete response was achieved in 62 (64.6%), partial response in 7 (7.3%) patients, and stable disease in 1 (1%). Overall mortality was 24% (lacking data for three patients). In published case reports on posaconazole treatment for mucormycosis, the drug was frequently and successfully used in combination or as second line therapy.
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Affiliation(s)
- Joerg J Vehreschild
- 1st Department of Internal Medicine, University of Cologne, Cologne, Germany.
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Gamaletsou MN, Sipsas NV, Roilides E, Walsh TJ. Rhino-Orbital-Cerebral Mucormycosis. Curr Infect Dis Rep 2012; 14:423-34. [DOI: 10.1007/s11908-012-0272-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Nawange SR, Singh SM, Naidu J, Jain S, Nagpal T, Behrani DS, Mellado E, Tudela JLR. Zygomycosis caused by Rhizopus microsporus and Rhizopus oryzae in Madhya Pradesh (M.P.) Central India: a report of two cases. Mycopathologia 2012; 174:171-6. [PMID: 22437261 DOI: 10.1007/s11046-012-9532-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Accepted: 02/18/2012] [Indexed: 11/30/2022]
Abstract
Zygomycosis encompasses infections due to two distinct orders of fungi, Mucorales and Entomophthorales. With rare exception, Entomophthorales are restricted to tropical areas. By contrast, mucorales are ubiquitous opportunistic fungi, which play a crucial part in the natural decay process. In human pathology, they may be opportunistic agents and be responsible for rare infection called (Mucormycosis) zygomycosis. We report two cases of zygomycosis from Madhya Pradesh, Central India, one caused by Rhizopus oryzae in a diabetic patient and another caused by Rhizopus microsporus in an apparently healthy patient. The cases were diagnosed by direct microscopy, histopathological examination and culture. Both the patients were successfully treated with liposomal amphotericin B. Rhizopus microsporus is, for the first time reported from Madhya Pradesh, India, causing rhino-maxillary orbital zygomycosis.
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Affiliation(s)
- Shesh R Nawange
- Department of Biological Sciences, Rani Durgavati University, Jabalpur, Madhya Pradesh, India.
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29
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Kaushik R. Primary cutaneous zygomycosis in India. Indian J Surg 2012; 74:468-75. [PMID: 24293901 DOI: 10.1007/s12262-012-0429-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Accepted: 03/02/2012] [Indexed: 01/19/2023] Open
Abstract
Cutaneous zygomycosis remains underdiagnosed despite being frequently encountered. Delay in the diagnosis contributes to delay in treatment, and a resultant high morbidity and mortality. A retrospective analysis of the reported cases of cutaneous zygomycosis from India was made using various search engines and cross-referencing from available manuscripts. A total of 42 publications from India on the topic were identified, since the first reported case of primary cutaneous zygomycosis by Veliath et al. (1976). There are 130 described cases of cutaneous zygomycosis with an overall mortality of 35 %. The commonest zygomycete identified was Apophysomyces elegans, and the commonest predisposing factor was breach of the skin. Surprisingly, diabetes was reported only in 36 cases (27.69 %). It is important to be aware of this unusual but fatal infection in order to manage it properly and have a good outcome.
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Affiliation(s)
- Robin Kaushik
- Department of Surgery, Government Medical College and Hospital, Sector 32, Chandigarh, India ; House No 132, Sector 6, Panchkula, 134 109 Haryana India
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Evidence implicating Thamnostylum lucknowense as an etiological agent of rhino-orbital mucormycosis. J Clin Microbiol 2012; 50:1491-4. [PMID: 22301030 DOI: 10.1128/jcm.06611-11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
In this report, we present a case of rhino-orbital mucormycosis in a 57-year-old female with poorly controlled diabetes mellitus. The only mold cultured at 25°C, 37°C, and 40°C from a specimen of the nasal crust was identified phenotypically and independently using nuclear ribosomal DNA sequence data as Thamnostylum lucknowense. To our knowledge, this report presents the first data implicating this mucoraceous fungus as a mycotic agent of human infection.
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31
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Caira M, Trecarichi EM, Mancinelli M, Leone G, Pagano L. Uncommon mold infections in hematological patients: epidemiology, diagnosis and treatment. Expert Rev Anti Infect Ther 2012; 9:881-92. [PMID: 21810058 DOI: 10.1586/eri.11.66] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Invasive fungal diseases continue to be an important cause of morbidity and mortality in immunosuppressed patients. This is of particular interest, since the progress we made in the treatment of underlying malignancies has led to an increase of the number of persons 'at high risk'. During the last few years, several changes in clinical practice in hematology (new immunosuppressants, hematopoietic stem cell transplants) have influenced the epidemiology of invasive fungal diseases; in particular, cases due to some uncommon etiologic agents are being increasingly reported, making it even more urgent to reconsider differential diagnoses in high-risk patients. A better understanding of epidemiology, risk factors and prognosis appears to be crucial to analyze prevention and diagnostic strategies, as well as to guarantee an early and adequate treatment.
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Affiliation(s)
- Morena Caira
- Hematology Division, Università Cattolica S. Cuore, Rome, Italy.
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32
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Slavin MA, Chakrabarti A. Opportunistic fungal infections in the Asia-Pacific region. Med Mycol 2012; 50:18-25. [DOI: 10.3109/13693786.2011.602989] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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33
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Mendiratta V, Karmakar S, Jain A, Jabeen M. Severe cutaneous zygomycosis due to Basidiobolus ranarum in a young infant. Pediatr Dermatol 2012; 29:121-3. [PMID: 21906146 DOI: 10.1111/j.1525-1470.2011.01476.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Basidiobolomycosis classically presents as a noninflammatory, nonulcerated, nontender woody indurated mass without much contiguous spread. It is almost always seen in an immunocompetent host younger than 20. We report a case of a 9-month-old baby with a rapidly expanding malignant presentation of basidiobolomycosis with nonhealing ulcers and spread to underlying muscles, mimicking lymphoma. She responded poorly to itraconazole alone but showed dramatic improvement with a combination therapy of itraconazole and potassium iodide. The case also highlights an early acquisition of the infection at 1 month of age.
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Affiliation(s)
- Vibhu Mendiratta
- Department of Dermatology, Lady Hardinge Medical College, Delhi, India.
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Chaudhry A, Hirano SA, Hayes TJ, Torosky C. Fatal rhino-orbito-cerebral mucormycosis in a patient with liver disease. J Am Acad Dermatol 2011; 65:241-3. [PMID: 21679839 DOI: 10.1016/j.jaad.2010.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 12/29/2009] [Accepted: 01/03/2010] [Indexed: 10/18/2022]
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35
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A case of rhinoorbital mucormycosis in a leukemic patient with a literature review from Turkey. Mycopathologia 2011; 172:397-405. [PMID: 21761152 DOI: 10.1007/s11046-011-9449-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Accepted: 07/03/2011] [Indexed: 12/18/2022]
Abstract
Mucormycosis (Zygomycosis) is a rare, invasive, opportunistic fungal infection of the paranasal sinuses, caused by a fungus of the order Mucorales. We report a case of rhinoorbital mucormycosis caused by Rhizopus oryzae in an acute lymphoblastic leukemia patient and review the 79 Mucormycosis cases reported in the last decade from Turkey. In our case, the diagnosis was made with endoscopic appearance, computerized tomography of the paranasal sinuses, and culture of the surgical materials. Following aggressive surgical debridement and parenteral amphotericin B therapy, the patient recovered completely. In Turkish literature, rhinocerebral manifestations were the most common form of the mucormycosis (64 cases), followed by pulmonary form (6 cases). The most common risk factor was hematologic malignancies (32 cases) and diabetes mellitus (32 cases), similar to those reported from the rest of the world. The etiologic agents responsible for the review cases were Rhizopus sp., Mucor spp., Rhizomucor spp., Rhizopus oryzae, Mucor circinelloides, and Lichtheimia corymbifera. Although various treatment modalities were used, amphotericin B was the mainstay of therapy. Mortality rate was found to be 49.4% in review cases. It seems that strong clinical suspicion and early diagnosis, along with aggressive antifungal therapy and endoscopic sinus surgery, have great importance for better prognosis in mucormycosis.
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Sun HY, Singh N. Mucormycosis: its contemporary face and management strategies. THE LANCET. INFECTIOUS DISEASES 2011; 11:301-11. [PMID: 21453871 DOI: 10.1016/s1473-3099(10)70316-9] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Several countries have seen rising frequencies of mucormycosis among patients with haematological disorders, malignancies, or diabetes mellitus, and among transplant recipients. Growing numbers of immunocompromised hosts, widespread use of antifungal agents inactive against mucormycosis, or other unidentified factors, could be contributing to this situation. The predominant clinical manifestations of mucormycosis vary from host to host. Additionally, risk factors specific to different subgroups have been identified, such as leukaemia, allogeneic haemopoietic stem-cell transplant, voriconazole prophylaxis, diabetes, and malnutrition. We summarise the current state of knowledge of characteristics and risk factors and discuss topical developments in therapeutic methods and strategies in the management of mucormycosis.
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Affiliation(s)
- Hsin-Yun Sun
- Infectious Diseases Section, VA Pittsburgh Healthcare System, Pittsburgh, PA 15240, USA
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Chronic rhinofacial mucormycosis caused by Mucor irregularis (Rhizomucor variabilis) in India. J Clin Microbiol 2011; 49:2372-5. [PMID: 21508154 DOI: 10.1128/jcm.02326-10] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this article, we describe a chronic case of rhinofacial mucormycosis caused by Mucor irregularis, formerly known as Rhizomucor variabilis var. variabilis, a rare mycotic agent in humans. The infection caused progressive destruction of the nasal septum and soft and hard palate, leading to collapse of the nose bridge and an ulcerative gaping hole. The mucoralean mold cultured from a nasal biopsy specimen was determined by multilocus DNA sequence data to be conspecific with M. irregularis.
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Auxiliadora-Martins M, Alkmim-Teixeira G, Machado-Viana J, Nicolini E, Martins-Filho O, Bellissimo-Rodrigues F, Carlotti Jr. C, Basile-Filho A. Meningoencephalitis caused by a zygomycete fungus (Basidiobolus) associated with septic shock in an immunocompetent patient: 1-year follow-up after treatment. Braz J Med Biol Res 2010; 43:794-8. [DOI: 10.1590/s0100-879x2010007500067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2009] [Accepted: 07/05/2010] [Indexed: 11/21/2022] Open
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de Paula DAJ, de Oliveira Filho JX, da Silva MC, Colodel EM, Broetto L, Pinto PM, Schrank A, Nakazato L, Dutra V. Molecular Characterization of Ovine Zygomycosis in Central Western Brazil. J Vet Diagn Invest 2010; 22:274-7. [DOI: 10.1177/104063871002200220] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Zygomycosis is an important granulomatous disease that affects humans and animals, particularly sheep in tropical regions. Rhinofacial and nasopharyngeal zygomycosis were described in sheep in association with Conidiobolus spp. The present study characterized 5 samples of Conidiobolus isolated from 3 herds with clinical disease in Mato Grosso State, Brazil. The clinical and pathological findings were similar to nasopharyngeal zygomycosis. Based on morphological features, isolates were classified as Conidiobolus spp., and molecular phylogenetic analyses based on 18S ribosomal DNA grouped all isolates in a Conidiobolus lamprauges cluster. The current report describes the molecular characterization of ovine nasopharyngeal zygomycosis associated with C. lamprauges.
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Affiliation(s)
- Daphine Ariadne Jesus de Paula
- Postgraduate Course in Veterinary Science, Department of Veterinary Science, Federal University of Mato Grosso, Brazil, and the Department of Molecular Biology and Biotechnology, Center for Biotechnology, Federal University of Rio Grande do Sul, Brazil
| | - João Xavier de Oliveira Filho
- Postgraduate Course in Veterinary Science, Department of Veterinary Science, Federal University of Mato Grosso, Brazil, and the Department of Molecular Biology and Biotechnology, Center for Biotechnology, Federal University of Rio Grande do Sul, Brazil
| | - Maria Cristina da Silva
- Postgraduate Course in Veterinary Science, Department of Veterinary Science, Federal University of Mato Grosso, Brazil, and the Department of Molecular Biology and Biotechnology, Center for Biotechnology, Federal University of Rio Grande do Sul, Brazil
| | - Edson Moleta Colodel
- Postgraduate Course in Veterinary Science, Department of Veterinary Science, Federal University of Mato Grosso, Brazil, and the Department of Molecular Biology and Biotechnology, Center for Biotechnology, Federal University of Rio Grande do Sul, Brazil
| | - Leonardo Broetto
- Postgraduate Course in Veterinary Science, Department of Veterinary Science, Federal University of Mato Grosso, Brazil, and the Department of Molecular Biology and Biotechnology, Center for Biotechnology, Federal University of Rio Grande do Sul, Brazil
| | - Paulo Marcos Pinto
- Postgraduate Course in Veterinary Science, Department of Veterinary Science, Federal University of Mato Grosso, Brazil, and the Department of Molecular Biology and Biotechnology, Center for Biotechnology, Federal University of Rio Grande do Sul, Brazil
| | - Augusto Schrank
- Postgraduate Course in Veterinary Science, Department of Veterinary Science, Federal University of Mato Grosso, Brazil, and the Department of Molecular Biology and Biotechnology, Center for Biotechnology, Federal University of Rio Grande do Sul, Brazil
| | - Luciano Nakazato
- Postgraduate Course in Veterinary Science, Department of Veterinary Science, Federal University of Mato Grosso, Brazil, and the Department of Molecular Biology and Biotechnology, Center for Biotechnology, Federal University of Rio Grande do Sul, Brazil
| | - Valéria Dutra
- Postgraduate Course in Veterinary Science, Department of Veterinary Science, Federal University of Mato Grosso, Brazil, and the Department of Molecular Biology and Biotechnology, Center for Biotechnology, Federal University of Rio Grande do Sul, Brazil
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Radhakrishnan N, Sachdeva A, Oberoi J, Yadav SP. Conidiobolomycosis in relapsed acute lymphoblastic leukemia. Pediatr Blood Cancer 2009; 53:1321-3. [PMID: 19731329 DOI: 10.1002/pbc.22259] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Invasive fungal infections in immunocompromised children suffering from hematological malignancies have been a major cause of morbidity and mortality. In recent years fungi other than aspergillus and candida are gaining importance. These emerging fungal infections have distinct epidemiological features and management issues especially in immunocompromised patients. Here we report the isolation of Conidiobolus coronatus, a rarely reported zygomycetes infection in a patient suffering from acute lymphoblastic leukemia. Conidiobolus generally causes indolent infection in the sino-respiratory tract. They are known to be angioinvasive and can disseminate. There is no consensus regarding appropriate antifungal treatment for Conidiobolus infection.
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Affiliation(s)
- Nita Radhakrishnan
- Pediatric Hematology Oncology and BMT Unit, Department of Pediatrics, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, India
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Ganesh R, Manikumar S, Vasanthi T. Rhinocerebral mucormycosis in an adolescent with type 1 diabetes mellitus: case report. ACTA ACUST UNITED AC 2009; 28:297-300. [PMID: 19021947 DOI: 10.1179/146532808x375477] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Rhinocerebral mucormycosis is a severe opportunistic infection affecting immunocompromised patients. A 14-year-old boy with rhino-orbito-cerebral mucormycosis and type 1 diabetes is described. He responded well to amphotericin B lipid complex followed by itraconazole.
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Affiliation(s)
- R Ganesh
- Kanchi Kamakoti CHILDS Trust Hospital, Nungambakkam, Chennai, India.
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Alvarez E, Sutton DA, Cano J, Fothergill AW, Stchigel A, Rinaldi MG, Guarro J. Spectrum of zygomycete species identified in clinically significant specimens in the United States. J Clin Microbiol 2009; 47:1650-6. [PMID: 19386856 PMCID: PMC2691065 DOI: 10.1128/jcm.00036-09] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2009] [Revised: 03/05/2009] [Accepted: 04/09/2009] [Indexed: 11/20/2022] Open
Abstract
Several members of the order Mucorales (subphylum Mucoromycotina) are important agents of severe human infections. The identification of these fungi by using standard mycologic methods is often difficult and time consuming. Frequently, the etiological agent in clinical cases is reported either as a Mucor sp., which is not the most frequent genus of zygomycetes, or only as a member of the Mucorales. For this reason, the actual spectrum of species of zygomycetes and their incidences in the clinical setting is not well known. The goals of this study were to compare the results of the molecular identification of an important set of clinical isolates, received in a mycological reference center from different regions of the United States, with those obtained by using the traditional morphological methods and to determine the spectrum of species involved. We tested 190 isolates morphologically identified as zygomycetes by using sequencing of the internal transcribed spacer (ITS) region of the ribosomal DNA. Molecular identification revealed that Rhizopus oryzae represented approximately half (44.7%) of these isolates. The remainder was identified as Rhizopus microsporus (22.1%), Mucor circinelloides (9.5%), Mycocladus corymbifer (formerly Absidia corymbifera) (5.3%), Rhizomucor pusillus (3.7%), Cunninghamella bertholletiae (3.2%), Mucor indicus (2.6%), Cunninghamella echinulata (1%), and Apophysomyces elegans (0.5%). The most common anatomic sites for clinically significant zygomycetes, as determined by isolates sent to the Fungus Testing Laboratory for identification and/or susceptibility testing and included in this study, were the sinuses, lungs, and various cutaneous locations, at 25.8%, 26.8%, and 28%, respectively. These sites represented approximately 80% of the isolates evaluated. A high level of correlation (92.6%) between morphological and molecular identifications was found.
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Affiliation(s)
- E Alvarez
- Mycology Unit, Medical School and Institut d'Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, C/Sant Llorenç 21, 43201 Reus, Tarragona, Spain
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Nasofacial Entomophthoromycosis. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2009. [DOI: 10.1097/ipc.0b013e31816fd5b5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Devidayal, Menon P, Vaiphei K, Singh M, Rao K, Singhi S. Pleuropulmonary zygomycosis in a diabetic child. Clin Pediatr Endocrinol 2009; 18:35-40. [PMID: 24790378 PMCID: PMC4004882 DOI: 10.1297/cpe.18.35] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2008] [Accepted: 11/18/2008] [Indexed: 11/04/2022] Open
Abstract
A 12 yr old girl with type 1 diabetes presented in ketoacidosis and consolidation of left lower lobe along with left pleural effusion. A diagnosis of mucormycosis was made on smear examination of an exudative pleural aspirate. Left lower lobe lobectomy was performed along with drainage of pleural collection with tube thoracostomy. Worsening respiratory distress postoperatively due to increase in empyema fluid necessitated a second surgery. Pleuropulmonary involvement as seen in this patient is an extremely rare occurrence possibly related to the propensity of mucor to invade blood vessels rather than extend outwardly into pleural cavity.
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Affiliation(s)
| | | | - Kim Vaiphei
- Advanced Pediatric Center & Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Kln Rao
- Department of Pediatric Surgery
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Cuenca-Estrella M, Bernal-Martinez L, Isla G, Gomez-Lopez A, Alcazar-Fuoli L, Buitrago M. Incidence of zygomycosis in transplant recipients. Clin Microbiol Infect 2009; 15 Suppl 5:37-40. [DOI: 10.1111/j.1469-0691.2009.02978.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Chakrabarti A, Chatterjee SS, Shivaprakash MR. Overview of Opportunistic Fungal Infections in India. ACTA ACUST UNITED AC 2008; 49:165-72. [DOI: 10.3314/jjmm.49.165] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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