1
|
Gupta N, Malla S, Tirlangi PK, Magazine R, Uk C, Ravindra P, Bhat R, Varma M, Mukhopadhyay C. Reversed halo sign: Do not forget Melioidosis. J Travel Med 2024; 31:taae036. [PMID: 38438163 DOI: 10.1093/jtm/taae036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 02/16/2024] [Accepted: 02/28/2024] [Indexed: 03/06/2024]
Abstract
In uncontrolled diabetics from South Asia, it is commonplace to diagnose pulmonary mucormycosis in the presence of a reversed halo sign (RHS) on imaging. However, travel medicine practitioners should be aware that RHS in South Asians with similar risk factors can also be seen in pulmonary melioidosis.
Collapse
Affiliation(s)
- Nitin Gupta
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Sundeep Malla
- Department of Radiodiagnosis, Amrita Institute of Medical Sciences, Faridabad 121002, India
| | - Praveen Kumar Tirlangi
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Rahul Magazine
- Department of Respiratory Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Chandrashekar Uk
- Department of Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Prithvishree Ravindra
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Rachana Bhat
- Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Muralidhar Varma
- Department of Infectious Diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
| |
Collapse
|
2
|
Souza LVS, Souza AS, Zanetti G, Marchiori E. Pulmonary mucormycosis in a patient with uncontrolled diabetes. Rev Soc Bras Med Trop 2024; 57:e009172024. [PMID: 38896656 PMCID: PMC11178377 DOI: 10.1590/0037-8682-0168-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Affiliation(s)
| | - Arthur Soares Souza
- Ultra X, São José do Rio Preto,SP, Brasil
- Faculdade de Medicina de São José do Rio Preto, SP, Brasil
| | - Gláucia Zanetti
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Edson Marchiori
- Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
3
|
Zhang Y, Wei E, Niu J, Yan K, Zhang M, Yuan W, Fang X, Jia P. Clinical features of pediatric mucormycosis: role of metagenomic next generation sequencing in diagnosis. Front Cell Infect Microbiol 2024; 14:1368165. [PMID: 38915923 PMCID: PMC11194326 DOI: 10.3389/fcimb.2024.1368165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/30/2024] [Indexed: 06/26/2024] Open
Abstract
Background Mucormycosis is an uncommon invasive fungal infection that has a high mortality rate in patients with severe underlying diseases, which leads to immunosuppression. Due to its rarity, determining the incidence and optimal treatment methods for mucormycosis in children is challenging. Metagenomic next-generation sequencing (mNGS) is a rapid, precise and sensitive method for pathogen detection, which helps in the early diagnosis and intervention of mucormycosis in children. In order to increase pediatricians' understanding of this disease, we conducted a study on the clinical features of mucormycosis in children and assessed the role of mNGS in its diagnosis. Methods We retrospectively summarized the clinical data of 14 children with mucormycosis treated at the First Affiliated Hospital of Zhengzhou University from January 2020 to September 2023. Results Of the 14 cases, 11 case of mucormycosis were classified as probable, and 3 cases were proven as mucormycosis. Most children (85.71%) had high-risk factors for mucormycosis. All 14 children had lung involvement, with 5 cases of extrapulmonary dissemination. Among the 14 cases, 4 cases underwent histopathological examination of mediastinum, lung tissue or kidney tissue, in which fungal pathogens were identified in 3 patients. Fungal hyphae was identified in 3 cases of mucormycosis, but only 1 case yielded a positive culture result. All patients underwent mNGS testing with samples from blood (8/14), bronchoalveolar lavage fluid (6/14), and tissue (1/14). mNGS detected fungi in all cases: 7 cases had Rhizomucor pusillus, 4 cases had Rhizopus oryzae, 3 cases had Rhizopus microsporus, 1 case had Lichtheimia ramosa, and 1 case had Rhizomucor miehei. Coinfections were found with Aspergillus in 3 cases, bacteria in 3 cases, and viruses in 5 cases. Conclusion Children with mucormycosis commonly exhibit non-specific symptoms like fever and cough during the initial stages. Early diagnosis based on clinical symptoms and imaging is crucial in children suspected of having mucormycosis. mNGS, as a supplementary diagnostic method, offers greater sensitivity and shorter detection time compared to traditional mucormycosis culture or histopathological testing. Additionally, mNGS enables simultaneous detection of bacteria and viruses, facilitating timely and appropriate administration of antibiotics and thereby enhancing patient outcomes.
Collapse
|
4
|
Lin L, Zhang H. Treatment of pediatric invasive mucor lung abscess using local fenestration and drainage surgery: A case report. Asian J Surg 2024; 47:2831-2832. [PMID: 38378415 DOI: 10.1016/j.asjsur.2024.02.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/02/2024] [Indexed: 02/22/2024] Open
Affiliation(s)
- Liangkang Lin
- Department of Pediatrics, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518033, China
| | - Haiyang Zhang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
| |
Collapse
|
5
|
Li L, Zhen X, Wang W. Clinical Characteristics and Prognoses of Mucormycosis in Four Children. Infect Drug Resist 2024; 17:1971-1978. [PMID: 38779351 PMCID: PMC11110804 DOI: 10.2147/idr.s462725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
Background Mucormycosis is a fatal invasive fungal infection that commonly affects immunocompromised children. The aim of our study was to investigate the clinical manifestations, treatments, and prognosis of pediatric patients with mucormycosis. Methods We conducted a retrospective search in Shenzhen Children's Hospital from July 2013 to July 2023 for all patients with mucormycosis. The clinical manifestation, pathogen detection, radiology, treatments, and prognosis were analyzed. Results Four cases were identified. Underlying conditions included acute myeloid leukemia with myeloid sarcoma (n = 1), thalassemia (post-allogeneic hematopoietic stem cell transplantation; n = 1), systemic lupus erythematosus (n = 1), and bilateral nephroblastoma (post-bilateral nephrectomy; n = 1). Two patients were disseminated mucormycosis, one case was pulmonary mucormycosis, and one case was cerebral mucormycosis. Fever, cough, and dyspnea were the main clinical symptoms of pulmonary mucormycosis, headache was the main clinical symptom of cerebral mucormycosis. Lung CT findings included consolidation, multiple nodules, halo sign, air crescent sign, and pleural effusion. The contrast-enhanced CT showed pulmonary artery and pulmonary vein occlusions in two patients and pseudoaneurysm in two patients. Amphotericin B formulations were administered as first-line therapy in all cases; in three cases, Triazole was administered in combination with amphotericin B. Conclusion Mucormycosis is a life-threatening disease involving multiple systems. Aorta pseudoaneurysm is a rare and fatal complication, enhanced CT can assist in diagnosis. Early diagnosis and appropriate therapeutic strategies are needed.
Collapse
Affiliation(s)
- Li Li
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| | - Xiaoli Zhen
- Department of Radiology, Shenzhen Children’s Hospital, Shenzhen, People’s Republic of China
| | - Wenjian Wang
- Department of Respiratory Diseases, Shenzhen Children’s Hospital, Shenzhen, Guangdong, People’s Republic of China
| |
Collapse
|
6
|
Sedhai YR, Ahmed MA, Waheed I, Warren HL, Singh K. Pulmonary mucormycosis in a young diabetic. Am J Med Sci 2024:S0002-9629(24)01148-0. [PMID: 38575070 DOI: 10.1016/j.amjms.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/05/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024]
Affiliation(s)
- Yub Raj Sedhai
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, United States.
| | - Muhammad Altaf Ahmed
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, United States
| | - Irfan Waheed
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, United States
| | - Harry Lee Warren
- Division of Cardiothoracic and Vascular Surgery, University of Kentucky College of Medicine, Bowling Green, KY, United States
| | - Karan Singh
- Division of Pulmonary Disease, and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, United States.
| |
Collapse
|
7
|
Peghin M, Graziano E, Grossi PA. Skin and soft tissue infections in solid organ transplants. Curr Opin Infect Dis 2024; 37:112-120. [PMID: 38050739 DOI: 10.1097/qco.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
PURPOSE OF REVIEW Skin and soft tissue infections (SSTI) in solid organ transplant (SOT) recipients may be a great challenge for clinicians caring for SOT due to the involvement of both common and opportunistic pathogens associated with a blunted immune response. The purpose of this review is to outline current literature and describe open issues on the management of SSTI in this special population. RECENT FINDINGS Clinical presentation in SOT recipients can manifest as isolated skin lesions after primary inoculation or be the sign of a disseminated infection. Tissue samples for microscopy and histopathology are crucial to making an accurate diagnosis given the nonspecific and heterogeneous appearance of skin lesions. Multidisciplinary teams are required for a comprehensive diagnosis and management. SUMMARY SSTI are frequent contributors to morbidity and mortality in SOT. Specific research focused on the clinical presentation, risk factors and management in this special population is needed.
Collapse
Affiliation(s)
- Maddalena Peghin
- Infectious and Tropical Diseases Unit, Department of Medicine and Surgery, University of Insubria, ASST-Sette Laghi, Varese, Italy
| | | | | |
Collapse
|
8
|
Lax C, Nicolás FE, Navarro E, Garre V. Molecular mechanisms that govern infection and antifungal resistance in Mucorales. Microbiol Mol Biol Rev 2024; 88:e0018822. [PMID: 38445820 PMCID: PMC10966947 DOI: 10.1128/mmbr.00188-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
SUMMARYThe World Health Organization has established a fungal priority pathogens list that includes species critical or highly important to human health. Among them is the order Mucorales, a fungal group comprising at least 39 species responsible for the life-threatening infection known as mucormycosis. Despite the continuous rise in cases and the poor prognosis due to innate resistance to most antifungal drugs used in the clinic, Mucorales has received limited attention, partly because of the difficulties in performing genetic manipulations. The COVID-19 pandemic has further escalated cases, with some patients experiencing the COVID-19-associated mucormycosis, highlighting the urgent need to increase knowledge about these fungi. This review addresses significant challenges in treating the disease, including delayed and poor diagnosis, the lack of accurate global incidence estimation, and the limited treatment options. Furthermore, it focuses on the most recent discoveries regarding the mechanisms and genes involved in the development of the disease, antifungal resistance, and the host defense response. Substantial advancements have been made in identifying key fungal genes responsible for invasion and tissue damage, host receptors exploited by the fungus to invade tissues, and mechanisms of antifungal resistance. This knowledge is expected to pave the way for the development of new antifungals to combat mucormycosis. In addition, we anticipate significant progress in characterizing Mucorales biology, particularly the mechanisms involved in pathogenesis and antifungal resistance, with the possibilities offered by CRISPR-Cas9 technology for genetic manipulation of the previously intractable Mucorales species.
Collapse
Affiliation(s)
- Carlos Lax
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Francisco E. Nicolás
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Eusebio Navarro
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| | - Victoriano Garre
- Departamento de Genética y Microbiología, Facultad de Biología, Universidad de Murcia, Murcia, Spain
| |
Collapse
|
9
|
Thornton CR. The potential for rapid antigen testing for mucormycosis in the context of COVID-19. Expert Rev Mol Diagn 2024; 24:161-167. [PMID: 37405409 DOI: 10.1080/14737159.2023.2233906] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 07/04/2023] [Indexed: 07/06/2023]
Abstract
INTRODUCTION Mucormycosis is a highly aggressive angio-invasive disease of humans caused by Mucorales fungi. Prior to the COVID-19 pandemic, mucormycosis was a rare mycosis typically seen in immunocompromised patients with hematological malignancies or in transplant recipients. During the second wave of the pandemic, there was a dramatic increase in the disease, especially in India where a unique set of circumstances led to large numbers of life-threatening and disfiguring rhino-orbital-cerebral mucormycosis (ROCM) infections. AREAS COVERED The review examines mucormycosis as a super-infection of COVID-19 patients, and the risk factors for COVID-19-associated mucormycosis (CAM) that drove the ROCM epidemic in India. The limitations of current diagnostic procedures are identified, and the measures needed to improve the speed and accuracy of detection discussed. EXPERT OPINION Despite increased awareness, global healthcare systems remain unprepared for further outbreaks of ROCM. Current diagnosis of the disease is slow and inaccurate, negatively impacting on patient survival. This is most evident in low- to middle-income countries which lack suitably equipped diagnostic facilities for rapid identification of the infecting pathogens. Rapid antigen testing using point-of-care lateral-flow assays could potentially have aided in the quick and accurate diagnosis of the disease, allowing earlier intervention with surgery and Mucorales-active antifungal drugs.
Collapse
|
10
|
Zhou Y, Hu Y, Liu S, Yao H. Clinical diagnosis and treatment of invasive pulmonary mucormycosis: A case report and technical precautions. Asian J Surg 2023; 46:5939-5941. [PMID: 37690896 DOI: 10.1016/j.asjsur.2023.08.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/30/2023] [Indexed: 09/12/2023] Open
Affiliation(s)
- Yue Zhou
- Zunyi Medical University, China; Department of Respiratory Medicine, Guizhou Provincial People's Hospital, Guizhou Province, China
| | - Yunxiang Hu
- Dalian Medical University, China; Department of Orthopedics, Central Hospital of Dalian University of Technology, Dalian City, Liaoning Province, China
| | - Sanmao Liu
- Dalian Medical University, China; Department of Orthopedics, Central Hospital of Dalian University of Technology, Dalian City, Liaoning Province, China
| | - Hongmei Yao
- Department of Respiratory Medicine, Guizhou Provincial People's Hospital, Guizhou Province, China.
| |
Collapse
|
11
|
Hoellinger B, Magnus L, Ruch Y, Ohana M, Hansmann Y, Letscher-Bru V, Lejay A, Chakfé N, Danion F. Case Report and Literature Review of Prosthetic Cardiovascular Mucormycosis. Emerg Infect Dis 2023; 29:2388-2390. [PMID: 37877713 PMCID: PMC10617327 DOI: 10.3201/eid2911.230837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
We report a rare case of aorto-bi-iliac prosthetic allograft mucormycosis in a 57-year-old immunocompetent patient in France. Outcome was favorable after surgery and dual antifungal therapy with liposomal amphotericin B and isavuconazole. In a literature review, we identified 12 other cases of prosthetic vascular or heart valve mucormycosis; mortality rate was 38%.
Collapse
|
12
|
Gulia K, Singhal S, Jain P, Chaudhry D, Ahuja A, Singh PK. Stridor in a Patient with Uncontrolled Diabetes: An Uncommon Adversary, Successfully Managed with Bronchoscopy. Tuberc Respir Dis (Seoul) 2023; 86:319-321. [PMID: 37455258 PMCID: PMC10555519 DOI: 10.4046/trd.2023.0074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 07/18/2023] Open
Affiliation(s)
- Kuldeep Gulia
- Pulmonary and Critical Care Medicine Department, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Suresh Singhal
- Department of Anaesthesiology, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Promil Jain
- Pathology Department, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Dhruva Chaudhry
- Pulmonary and Critical Care Medicine Department, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Aman Ahuja
- Pulmonary and Critical Care Medicine Department, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| | - Pawan Kumar Singh
- Pulmonary and Critical Care Medicine Department, Pandit Bhagwat Dayal Sharma Postgraduate Institute of Medical Sciences, Rohtak, India
| |
Collapse
|
13
|
Lynch JP, Kontoyiannis DP. Special Issue "Diagnosis and Treatment of Invasive Pulmonary Fungal Infections". J Fungi (Basel) 2023; 9:744. [PMID: 37504732 PMCID: PMC10381693 DOI: 10.3390/jof9070744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023] Open
Abstract
The Guest Editors Dr [...].
Collapse
Affiliation(s)
- Joseph P Lynch
- Division of Pulmonary, Critical Care, Interventional Pulmonology, Sleep, and Clinical Immunology, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| |
Collapse
|