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Wadhera R, Vashist A. Rare Presentation of Nasal Mucormycosis. Indian J Otolaryngol Head Neck Surg 2022; 74:3367-3369. [PMID: 36452833 PMCID: PMC9701954 DOI: 10.1007/s12070-020-02001-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 07/22/2020] [Indexed: 11/25/2022] Open
Abstract
Nasal mucormycosis is a rare opportunistic infection of the nasal cavity and paranasal sinuses caused by saprophytic fungi which can rapidly lead to death. It usually affects individuals with poorly controlled diabetes mellitus (especially those with ketoacidosis), solid malignancies, iron overload, extensive burns, in patients undergoing treatment with glucocorticosteroid agents and in patients with neutropenia related to haematologic malignancies. Presentation of nasal mucormycosis is always very extensive, but in some patients, it can present in chronic indolent form also. Here, we present a case of 65-year old male with a history of exposed nasal bone after nasal trauma 8 months back. His diabetes was in control with oral hypoglycaemics. Debridement and local flap closure was done. Culture showed the growth of Lichtheimia corymbifera and in HPE, the fungus was seen branching at right angles. So, we conclude that the possibility of nasal mucormycosis should always be borne in mind so that early and effective treatment can be initiated on time to decrease the morbidity and mortality.
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Affiliation(s)
- Raman Wadhera
- Pt. B.D Sharma PGIMS Rohtak, 3/7J Medical Campus, Rohtak, Haryana India
| | - Aarushi Vashist
- Pt. B.D Sharma PGIMS Rohtak, 3/7J Medical Campus, Rohtak, Haryana India
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Patel J, Pennington Z, Hersh AM, Hung B, Scuibba DM, Lo SFL. Mucormycosis of the Spine: A Case Report and Review of the Literature. Cureus 2022; 14:e23623. [PMID: 35494962 PMCID: PMC9049762 DOI: 10.7759/cureus.23623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2022] [Indexed: 12/03/2022] Open
Abstract
Mucormycosis is an extremely rare, invasive infection commonly isolated to patients with known immunosuppressed status. In the present case, a 36-year-old woman, with a history of T-cell acute lymphoblastic leukemia in remission, presented with T4 osteomyelitis and an associated epidural collection. Biopsy was consistent with mucormycosis, and the patient was recommended for surgical debridement. After declining debridement, the patient was successfully managed on a multiagent antifungal regimen consisting of intravenous amphotericin B, micafungin, and oral posaconazole. The patient was alive without clear evidence of disease at eight months, representing one of the first cases of spinal mucormycosis infection successfully treated with medical management alone. We additionally review the previous descriptions of spinal mucormycosis infections to identify those interventions most associated with successful clearance or containment of these infections.
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Invasive Mucormycosis in Children With Malignancies: Report From the Infection Working Group of the Hellenic Society of Pediatric Hematology-Oncology. J Pediatr Hematol Oncol 2021; 43:176-179. [PMID: 32890077 DOI: 10.1097/mph.0000000000001931] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 08/10/2020] [Indexed: 12/18/2022]
Abstract
Mucormycosis is an invasive, life-threatening fungal infection that mainly affects immunocompromised hosts. We collected data of pediatric mucormycosis cases from all 7 Greek Hematology-Oncology Departments for the years 2008-2017. Six cases of invasive mucormycosis diagnosed during treatment for malignancies were included in the study. In 4 children (66%) mucormycosis occurred within the first 20 days after diagnosis of the underlying disease. Two cases were classified as proven mucormycosis and 4 as probable. The most frequently recorded species was Rhizopus arrhizus (2 patients), followed by Mucor spp (1), and Lichtheimia spp (1). All patients received liposomal amphotericin B. Combined antifungal treatment was used in 5 cases. Surgical excision was performed in 4 cases (66%). Two patients died at 6 and 12 months after the diagnosis, respectively, 1 (17%) because of mucormycosis. Our data suggest that mucormycosis may occur early after the initiation of intensive chemotherapy in children with malignancies.
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Ojeda-Diezbarroso K, Aguilar-Rascón J, Jiménez-Juárez RN, Moreno-Espinosa S, Reséndiz-Sánchez J, Romero-Zamora JL. Successful posaconazole salvage therapy for rhinocerebral mucormycosis in a child with leukemia. Review of the literature. Rev Iberoam Micol 2019; 36:160-164. [PMID: 31563327 DOI: 10.1016/j.riam.2018.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/20/2018] [Accepted: 07/30/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Mucormycosis is a fungal infection caused by species of the Mucorales order. These microorganisms are angioinvasive, with rapid disease progression and potentially lethal in its rhinocerebral form. CASE REPORT We present the case of a 12-year-old female with trisomy 21, acute lymphoblastic leukemia and diabetes, with fever and neutropenia who developed rhinocerebral mucormicosis. After treatment with amphotericin B lipid complex and extensive surgery, disease progressed and posaconazole was added as salvage treatment with full remission of the infection. Four years after diagnosis the patient continues without relapse of mucormycosis or leukemia. CONCLUSIONS This case highlights the use of posaconazole as either monotherapy or combined therapy. Although it is still debated, it can be considered an option for salvage treatment in children with non-responding mucormycosis, despite lack of standard dosage in pediatric patients.
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Affiliation(s)
- Karla Ojeda-Diezbarroso
- Pediatric Infectious Diseases Department, Hospital Infantil de México Federico Gómez, Mexico; Otorhinolaryngology Department, Hospital Infantil de México Federico Gómez, Mexico
| | - Juan Aguilar-Rascón
- Otorhinolaryngology Department, Hospital Infantil de México Federico Gómez, Mexico
| | - Rodolfo Norberto Jiménez-Juárez
- Pediatric Infectious Diseases Department, Hospital Infantil de México Federico Gómez, Mexico; Department of Pediatrics, Infectious Diseases Hospital, National Medical Center La Raza, Mexican Institute of Social Security, Mexico City, Mexico.
| | | | - Jesús Reséndiz-Sánchez
- Pediatric Infectious Diseases Department, Hospital Infantil de México Federico Gómez, Mexico
| | - José Luis Romero-Zamora
- Pediatric Infectious Diseases Department, Hospital Infantil de México Federico Gómez, Mexico
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Chikley A, Ben-Ami R, Kontoyiannis DP. Mucormycosis of the Central Nervous System. J Fungi (Basel) 2019; 5:jof5030059. [PMID: 31288475 PMCID: PMC6787740 DOI: 10.3390/jof5030059] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 12/17/2022] Open
Abstract
Mucormycosis involves the central nervous system by direct extension from infected paranasal sinuses or hematogenous dissemination from the lungs. Incidence rates of this rare disease seem to be rising, with a shift from the rhino-orbital-cerebral syndrome typical of patients with diabetes mellitus and ketoacidosis, to disseminated disease in patients with hematological malignancies. We present our current understanding of the pathobiology, clinical features, and diagnostic and treatment strategies of cerebral mucormycosis. Despite advances in imaging and the availability of novel drugs, cerebral mucormycosis continues to be associated with high rates of death and disability. Emerging molecular diagnostics, advances in experimental systems and the establishment of large patient registries are key components of ongoing efforts to provide a timely diagnosis and effective treatment to patients with cerebral mucormycosis.
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Affiliation(s)
- Amanda Chikley
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel
| | - Ronen Ben-Ami
- Infectious Diseases Unit, Tel Aviv Sourasky Medical Center, Tel Aviv 64239, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 64239, Israel.
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, The University of Texas, M.D. Anderson Cancer Center, Houston 77030, TexasTX 77030, USA.
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Abstract
Rhino-orbital-cerebral mucormycosis (ROCM) is a rare fulminant opportunistic fungal infection that despite relevant treatment has high mortality. We present a case of a 3-year-old girl with acute lymphoblastic leukemia and ROCM, who was treated successfully with excessive surgery, systemic antifungal treatment with amphotericin B (AmB), posaconazole, and terbinafine as well as hyperbaric oxygen. Surgery included, beside extracranial and intracranial removal of infected areas, endoscopic sinus and skull base surgery with local AmB installation and in addition placement of an Ommaya reservoir for 114 intrathecal administrations of AmB. In addition, we review the literature of ROCM in pediatric patients with hematological diseases.
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Schwartze VU, Jacobsen ID. Mucormycoses caused by Lichtheimia species. Mycoses 2014; 57 Suppl 3:73-8. [PMID: 25186921 DOI: 10.1111/myc.12239] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/22/2014] [Accepted: 02/25/2014] [Indexed: 11/26/2022]
Abstract
Mucormycoses are life-threatening infections with fungi from the order Mucorales (Mucoromycotina). Although mucormycoses are uncommon compared to other fungal infections, e.g. aspergillosis and candidiasis, the number of cases is increasing especially in immunocompromised patients. Lichtheimia (formerly Absidia) species represent the second to third most common cause of mucormycoses in Europe. This mini review presents current knowledge about taxonomy and clinical relevance of Lichtheimia species. In addition, clinical presentation and risk factors will be discussed. Proper animal infection models are essential for the understanding of the pathogenesis and the identification of virulence factors of fungal pathogens. To date, several animal models have been used to study Lichtheimia infection. A brief overview of the different models and the main conclusions from the infection experiments is summarised in this review.
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Affiliation(s)
- Volker U Schwartze
- Institute of Microbiology, Department of Microbiology and Molecular Biology, University of Jena, Jena, Germany; Leibniz Institute for Natural Product Research and Infection Biology, Department of Molecular and Applied Microbiology, Hans Knöll Institute, Jena, Germany
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Kourbeti IS, Mylonakis E. Fungal central nervous system infections: prevalence and diagnosis. Expert Rev Anti Infect Ther 2014; 12:265-73. [PMID: 24392732 DOI: 10.1586/14787210.2014.874282] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Fungal infections of the central nervous system (CNS) are rare but they pose a significant challenge. Their prevalence spans a wide array of hosts including immunosuppressed and immunocompetent individuals, patients undergoing neurosurgical procedures and those carrying implantable CNS devices. Cryptococcus neoformans and Aspergillus spp. remain the most common pathogens. Magnetic resonance imaging can help localize the lesions, but diagnosis is challenging since invasive procedures may be needed for the retrieval of tissue, especially in cases of fungal abscesses. Antigen and antibody tests are available and approved for use in the cerebrospinal fluid (CSF). PCR-based techniques are promising but they are not validated for use in the CSF. This review provides an overview on the differential diagnosis of the fungal CNS disease based on the host and the clinical syndrome and suggests the optimal use of diagnostic techniques. It also summarizes the emergence of Cryptococcus gatti and an unanticipated outbreak caused by Exserohilum rostratum.
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Affiliation(s)
- Irene S Kourbeti
- Infectious Disease Division, Alpert Medical School and Brown University, Rhode Island Hospital, RI, USA
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Rhinocerebral zygomycosis with pansinusitis in a 14-year-old girl with type 1 diabetes: a case report and review of the literature. Ital J Pediatr 2013; 39:77. [PMID: 24325793 PMCID: PMC4029383 DOI: 10.1186/1824-7288-39-77] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 12/07/2013] [Indexed: 12/26/2022] Open
Abstract
Background Zygomycosis is a rare life-threatening fungal infection affecting mostly patients with predisposing conditions such as diabetes mellitus, immunodeficiency, haemochromatosis or major trauma. Methods We describe a case of rhinocerebral zygomycosis in a girl with type 1 diabetes and review previous published cases and treatment options. Results A 14-year-old girl with type 1 diabetes mellitus occurred with dental pain, facial swelling, ecchymosis and left eye decreased visual acuity, unresponsive to antibiotic therapy. The coltures of the sinusal mucosa were positive for fungal species belonging to the Zygomycetes. She performed antifungal therapy with posaconazole (POS) with a very slow improvement and a poor glycemic control, leading to blindness of the left eye. Conclusion Our report adds further awareness on rhinocerebral zygomycosis and emphasizes on urgent diagnosis and timely management of this potentially fatal fungal infection through an adequate treatment.
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Galgóczy L, Tóth L, Virágh M, Papp T, Vágvölgyi CS. In vitro interactions of amantadine hydrochloride, R-(-)-deprenyl hydrochloride and valproic acid sodium salt with antifungal agents against filamentous fungal species causing central nervous system infection. ACTA BIOLOGICA HUNGARICA 2012; 63:490-500. [PMID: 23134606 DOI: 10.1556/abiol.63.2012.4.8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The mortality rates of fungal infections that affect the central nervous system are high in consequence of the absence of effective antifungal drugs with good penetration across the blood-brain barrier and the blood-cerebrospinal fluid barrier. In the present work in vitro antifungal activities of three good penetrating non-antifungal drugs (amantadine hydrochloride, R-(-)-deprenyl hydrochloride, valproic acid sodium salt) and their combinations with three antifungal agents (amphotericin B, itraconazole, terbinafine) were tested with broth microdilution method against eight fungal isolates belonging to Zygomycetes (Lichtheimia corymbifera, Rhizomucor miehei, Rhizopus microsporus var. rhizopodiformis, Saksenaeavasiformis) and Aspergillus genus (A. flavus, A. fumigatus, A. nidulans, A. terreus). These are known to be possible agents of central nervous fungal infections (CNFI). When used alone, the investigated nonantifungal drugs exerted slight antifungal effects. In their combinations with antifungal agents they acted antagonistically, additively and synergistically against zygomyceteous isolates. Primarily antagonistic interactions were revealed between the investigated drugs in case of Aspergilli, but additive and synergistic interactions were also observed. The additive and synergistic combinations allowed the usage of reduced concentrations of antifungal agents to inhibit the fungal growth in our study. These combinations would be a basis of an effective, less toxic therapy for treatment of CNFI.
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Affiliation(s)
- L Galgóczy
- Department of Microbiology, Faculty of Science and Informatics, University of Szeged, Szeged, Hungary.
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Woo PC, Leung SY, Ngan AH, Lau SK, Yuen KY. A significant number of reported Absidia corymbifera (Lichtheimia corymbifera) infections are caused by Lichtheimia ramosa (syn. Lichtheimia hongkongensis): an emerging cause of mucormycosis. Emerg Microbes Infect 2012; 1:e15. [PMID: 26038425 PMCID: PMC3630919 DOI: 10.1038/emi.2012.11] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2012] [Revised: 04/12/2012] [Accepted: 04/25/2012] [Indexed: 11/24/2022]
Abstract
Recently, we and others reported the discovery of Lichtheimia ramosa (syn. Lichtheimia hongkongensis). We also hypothesized that a proportion of ‘Absidia corymbifera (Lichtheimia corymbifera)' reported in the literature could be L. ramosa. In this study, we characterized 13 strains that had been reported as ‘A. corymbifera (L. corymbifera)' in the literature over an 11-year period. Microscopic examination of agar block smear preparations of all 13 strains showed abundant circinate side branches and pleomorphic giant cells with finger-like projections of L. ramosa. ITS1–5.8S–ITS2 rRNA gene cluster (internal transcribed spacer (ITS)) and partial elongation factor-1alpha (EF1α) gene sequencing showed that all 13 strains were clustered with L. ramosa; partial β-actin gene sequencing showed that most of the 13 strains were clustered with L. ramosa; and partial 28S rRNA gene sequencing showed that all 13 strains were clustered with L. ramosa, but one strain of L. corymbifera (HKU25) was also clustered with other strains of L. ramosa. A significant number of reported A. corymbifera (L. corymbifera) infections are L. ramosa infections which are of global distribution. In clinical microbiology laboratories, L. ramosa should be suspected if an Absidia-like mold that possesses abundant circinate side branches on the sporangiophores and pleomorphic giant cells with finger-like projections is observed. ITS and partial EF1α gene sequencing are more reliable than partial β-actin and 28S rRNA gene sequencing for identification of the Lichtheimia species.
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Affiliation(s)
- Patrick Cy Woo
- Department of Microbiology, The University of Hong Kong , Hong Kong, China ; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong , Hong Kong, China ; Research Centre of Infection and Immunology, The University of Hong Kong , Hong Kong, China ; Carol Yu Centre for Infection, The University of Hong Kong , Hong Kong, China
| | - Shui-Yee Leung
- Department of Microbiology, The University of Hong Kong , Hong Kong, China
| | - Antonio Hy Ngan
- Department of Microbiology, The University of Hong Kong , Hong Kong, China
| | - Susanna Kp Lau
- Department of Microbiology, The University of Hong Kong , Hong Kong, China ; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong , Hong Kong, China ; Research Centre of Infection and Immunology, The University of Hong Kong , Hong Kong, China ; Carol Yu Centre for Infection, The University of Hong Kong , Hong Kong, China
| | - Kwok-Yung Yuen
- Department of Microbiology, The University of Hong Kong , Hong Kong, China ; State Key Laboratory of Emerging Infectious Diseases, The University of Hong Kong , Hong Kong, China ; Research Centre of Infection and Immunology, The University of Hong Kong , Hong Kong, China ; Carol Yu Centre for Infection, The University of Hong Kong , Hong Kong, China
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Honeybul S, Morrison DA. Skull vault destruction after rhinocerebral mucormycosis. World Neurosurg 2012; 78:553.e1-4. [PMID: 22609027 DOI: 10.1016/j.wneu.2011.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 10/25/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Mucormycosis is a relatively rare form of fungal infection that can be rapidly progressive. Clinical presentation depends on the anatomic area of involvement; however, the commonest form is that of rhinocerebral. CASE DESCRIPTION This is the first case of extensive and progressive destruction of the skull vault despite antifungal therapy. The patient required aggressive surgical resection to arrest the disease progression and complex reconstruction using a custom made titanium cranioplasty. CONCLUSIONS This report highlights the need for early aggressive resection for cases of mucormycosis infection where there is bony involvement.
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Affiliation(s)
- Stephen Honeybul
- Department of Neurosurgery, Sir Charles Gairdner Hospital, Nedlands and Royal Perth Hospital, Perth, Western Australia, Australia.
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Schofield C, Stern A, Jevtic A. Disseminated zygomycosis due toMycocladus corymbiferawith cutaneous and cerebral involvement. Australas J Dermatol 2011; 54:e8-11. [DOI: 10.1111/j.1440-0960.2011.00752.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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