Isolated renal mucormycosis in two patients with AIDS

Mucormycosis in Human Immunodeficiency Virus-Infected Individuals: A Systematic Review of Case Reports

Mucormycosis in human immunodeficiency virus (HIV) infection is uncommon; notably, many cases have additional predisposing factors. Whether mucormycosis differs in HIV-affected individuals with and without additional risk factors (e.g., neutropenia, diabetes mellitus, and transplantation) remains unclear. In this systematic review, we identified 94 cases of HIV and mucormycosis classifiable into three groups: (1) HIV with additional risk factors (n = 50), (2) intravenous drug users (IVDU, n = 24), and (3) no other risk factor (n = 19) for mucormycosis. The most common presentation in IVDU was renal (41.7%) and cerebral mucormycosis (39.2%), whereas rhino-orbital mucormycosis (ROM, 4.2%) was uncommon. In the other two groups, ROM was the most common presentation. Rhizopus was the most frequently isolated Mucorales; however, in IVDU, Lichtheimia was the most common. The overall mortality was 53% and not significantly different in the three groups. Mucormycosis in HIV-infected individuals is rare without additional risk factors or IVDU.

The burden of mucormycosis in HIV-infected patients: A systematic review

OBJECTIVES

Mucormycosis is an invasive fungal infection afflicting immunocompromised patients, causing a significant degree of morbidity and mortality. The purpose of the study was to provide a comprehensive analysis describing the epidemiology and outcome of mucormycosis in the scenario of HIV infection.

METHODS

We systematically searched PubMed for reports about mucormycosis associated with HIV. Eligible studies describe the predisposing factor, clinical form, treatment, and survival outcome.

RESULTS

We included 61 articles from 212 reviewed abstracts, corresponding to 67 cases. Patients were mostly men (68.2%) with a median CD4(+) count of 47 [IQR 17-100] cells/mm(3). Intravenous drug use (50%), neutropenia (29.7%) and corticosteroid use (25%) were the predominant associated factors. The main clinical forms were disseminated (20.9%), renal (19.4%), and rhino-cerebral (17.9%). Rhizopus (45.5%) and Lichtheimia spp (30.3%) were the main fungal isolates. Treatment consisted of antifungal therapy and surgery in 38.8%. Overall mortality rate was 52.2%, and varied with the site of infection: 92.9% for disseminated disease, 62.5% for cerebral disease, 60% for pulmonary infection, and 36.4% for cutaneous infection. Survival was worse for those who did not initiate antifungals (p = .04), who were antiretroviral naïve (p = .01), who were admitted to ICU (p = .003) or had disseminated disease (p = .007).

CONCLUSIONS

Mucormycosis is a life-threatening infection in HIV patients and clinician should be aware of this co-infection in the differential diagnosis of HIV opportunistic infections.

Mucormycosis in an HIV-infected renal transplant patient: A case report and review of the literature

Patient: Female, 15

Final Diagnosis: Mucormycosis

Symptoms: Lower extremity swelling • respiratory failure • short of breath

Medication: —

Clinical Procedure: —

Specialty: Infectious Diseases

Imagerie des formes viscérales graves de la mucormycose chez 5 patients immunodéprimés

OBJECTIVES

Show the contribution of imaging to the diagnosis and follow-up of serious mucormycosis in immunodepressed patients.

MATERIALS AND METHODS

Retrospective analysis of the 5-year radiological data in serious forms of mucormycosis occurring in patients with bone marrow allografts who are in refractory chronic graft-versus-host disease after bone marrow transplantation from 2002 to 2005. The positive diagnosis was bacteriologically and pathologically positive in all cases.

RESULTS

This study involved three patients with isolated pulmonary involvement and two cases of disseminated mucormycosis. Areas of pulmonary condensations were found in all cases, one of whom had a low-attenuation zone and parenchymal nodules. The kidney, liver, and spleen lesions were clearly limited, hypoechogenic, hypodense, and homogenous with no peripheral contrast material uptake. There was thyroid involvement in the form of hypoechogenic nodules. Rapid growth of the lesions was observed on follow-up CT (n=3) and despite surgical treatment (n=2) and intensive medical management, all cases ended in death.

CONCLUSION

Mucormycosis is an integral part of the differential diagnosis of infectious syndromes in immunodepressed patients during the period after bone marrow transplantation. Imaging can assist in the diagnosis but pathological confirmation remains indispensable.

Primary renal zygomycosis due to Rhizopus oryzae

Primary renal zygomycosis is a rare fungal infection, and only 45 cases have been reported in the literature. The major etiologic agents of the disease were Mucor spp., Rhizomucor spp., Rhizopus spp. and Absidia spp. Here we report a case of primary renal zygomycosis due to Rhizopus oryzae infection. The patient had systemic lupus erythematosus and was treated with corticosteroids. He had frequent micturition, urodynia and passed amorphous and membranous-looking masses through the urethra several times prior to admission. Histopathological examination of the mass showed numerous broad and nonseptate hyphae. Rhizopus oryzae was isolated from the mass. We also reviewed the clinical features of primary renal zygomycosis in the literature.

Radiologic evaluation of patients with renal infections

Although renal imaging is not indicated routinely in cases of uncomplicated renal infection, CT is a highly sensitive modality to diagnose and guide the management of patients with acute renal infection. CT is particularly useful in identifying complications of renal infection. Intravenous urography and US are limited to screening for urinary obstruction, renal calculi, and underlying anomalies. CT is also of value in establishing the diagnosis in equivocal cases, in evaluating high-risk patients, and in determining the nature and extent of disease. CT urography is increasingly performed as a comprehensive urinary tract imaging study. MRI may be performed when patients have contraindications to iodinated contrast material. Cortical scintigraphy is the preferred imaging study for the evaluation of children with acute pyelonephritis, although power Doppler US can be considered as a possible alternative. Recent limited studies using gadolinium-enhanced MRI have been shown to be valuable in the depiction of changes of acute pyelonephritis.

Vaginal mucormycosis: a case report

Although Zygomycetes cause life-threatening, opportunistic infections in immunocompromised hosts, the first case of vaginitis caused by Mucor species in a healthy woman is reported. Mucor vaginitis, which caused mild symptoms only, was refractory to conventional azole therapy and resistant to flucytosine. Cure was achieved with topical amphotericin B.

Renal mucormycosis in the HIV patient

Mucormycosis is an increasingly recognized opportunistic infection. It usually affects patients with debilitating conditions such as cancer, diabetes mellitus, renal failure, and extensive burns. Mucor infection has also been described in human immunodeficiency virus (HIV) patients. The most common clinical presentations are the cerebral, cutaneous, and renal forms. We describe a unique case of bilateral renal mucormycosis presenting with renal failure in an HIV-infected patient. In the immunosuppressed host, a history of intravenous (IV) drug abuse associated with symptoms of pyelonephritis should alert the clinician to the possibility of mucor infection. Blood and urine culture are often negative. The diagnosis is made histologically in most cases. The treatment of HIV patients with mucormycosis and renal failure includes hemodialysis, nephrectomy, and intravenous amphotericin in addition to antiretroviral therapy. Bilateral renal involvement with Mucor carries a poor prognosis.